Years ago I asked many of the individuals whom I treated. “What accounted for your improvement in treatment?” Not infrequently, instead of attributing their improvement to the therapeutic strategies, they would often reply “You believed in me.”
Once motivation is identified as a target mechanism of change, the big question is how to increase the individuals’ motivation and effort to engage in the activities that will restore them to mental health.
Our findings noted above speak to the rationale for developing a holistic model which aligns closely with humanistic psychology, which traditionally deals with very broad features of human nature not readily observable or measurable: aspirations, values, engagement, investment, etc.
The following is a description of a consultation Dr. Beck had about an individual who has schizophrenia. Mary is a 47-year old woman who is upset about hearing voices (and hackers who will not leave her alone). She is divorced, unemployed, and somewhat hopeless. She has a good relationship with her 13-year old son.
The new emphasis is directed towards the discussion and visualization of the objectives themselves, thus the emphasis is away from removing the blocks to a positive motivation and to the increase of the motivation itself.
We hoped to discover psychosocial factors that could become targets for treatment interventions. This led us to examine the role of defeatist attitudes, which correlated with both neurocognitive impairment and functioning (Grant & Beck, 2009).
Our President Emeritus, Dr. Aaron Beck and colleagues recently published an article on their current research: What accounts for poor functioning in people with schizophrenia: a re-evaluation of the contributions of neurocognitive v. attitudinal and motivational factors.
In this integrative approach, the holistic strategies and the linear strategies to “Acting Out” behavior can complement each other.
In contrast to this compartmentalized approach, our holistic model views the individual as unique–with specific aspirations, yearnings, and needs.
When we work with individuals with schizophrenia who have been hospitalized for many years, we need to find out what their needs are. We are often able to draw on their delusions. For example, six inpatients had delusions that they were God or Jesus. To our surprise, several of the individuals responded to the question, “What is good about being God?” with the response, “You can help people.”
