Welcome to the first instalment in what will be a six-part series of articles on Motivation. There's a big hole in medical literature when it comes to motivation in rehabilitation. This series seeks to fill in that hole a little. Where does our motivation come from, what is it, and what's its relationship to rehabilitation, return to work, to employees and the workplace and service providers?

Motivation is a word we bandy about a lot. I'm slumped in the couch after dinner. Motivation to clean dishes: zero. I've promised myself I'll jog each day before I leave for work, but the weather's been miserable. My motivation to exercise: not zero, but poor. That motivation might skyrocket, however, if my doctor tells me my health is under threat by my being overweight. When we lack motivation, it's hard to get much done. When we're bursting with it, we have fresh ideas, energy and the satisfaction of doing the things we want to be doing.

What about the motivation to get better after an injury or illness? Surely we're all motivated then. Well, it's not that simple. Return to work coordinators and others struggle with people who appear 'unmotivated' – getting results can be hard work. Why is it that some people in rehabilitation seem less motivated than others? For an injured worker, motivation is an integral part of the rehabilitation process. Without it, the stamina to follow what might be a difficult path to recovery will likely wane.

According to a rehab study conducted by M. Ekstrom and M. Helgesson in Stockholm, Sweden, “Motivation is described primarily as a will by those working with rehabilitation … a will to change.” It is a challenge for rehabilitation practitioners to be faced with a patient who seems to lack that will.

In Ekstrom and Helgesson's study, in which both rehabilitation counsellors and patients were interviewed, many counsellors said that they experience feelings of hopelessness when they meet unmotivated patients, because it's difficult to make progress.

In a 2002 paper by H. Berglind and U. Gerner entitled ‘Disability and Rehabilitation', the authors outline their view that it is too simplistic to look at someone as simply having a will to change or not, as ‘motivated' or ‘unmotivated'. “It is important,” the authors state, “to make clear what the person is motivated to achieve.”

“A client may be motivated to go back to work and at the same time unmotivated to undertake a certain rehabilitation program,” say Berglind and Gerner. “He or she may not consider the program would make it easier to return to work.”

Similarly, a patient may be motivated to do the rehabilitation required, but not to go back to work. The goal of the program – to enable the injured worker to return to work and normal life – might not be a priority in the life of the patient.

If a patient can't see the benefit of a rehabilitation program, and doesn't believe it will take them where they'd like to be, it will be hard for a patient to dig up the motivation to undertake the rehabilitation successfully.

Berglind and Gerner show that wanting to return to work is connected to a patient's view of their possibilities. Therefore, it should be a task for those working in rehabilitation to help their patients find out what their preferences and possibilities really are. A patient aware of one possible outcome compared with another, helped to understand where rehabilitation could advance them to, will be a better – that is, more motivated – patient.

“To motivate someone often means to make the person act in a way that I think is the best. But best for whom?” The client does not always think the same as the professional. “All motivational work should start where the client is.” Before convincing a patient they can do more than they think, we must first know what they think.

“Some people think they can manage almost anything, other people have a very low perception of their own ability, they don't think they can manage almost anything,” write Berglind and Gerner. A person's self-confidence seems to be closely related to their motivation.

Motivation and motivational work, their paper says, must be understood in a social context. The relationship between the return to work coordinator or rehab professional and the patient should be one based on listening and understanding. In this way the counsellor can help direct the patient's energy towards the rehabilitation outcomes they seek. Just because a patient seems unmotivated does not necessarily mean they are an unmotivated person. The person may simply not yet have located the source of motivation they need to help them recover.
 

Motivation part one: summary

• It's too simplistic to say some people are simply motivated and others not; rather people are motivated by and to different things.
• A patient needs to know their rehabilitation will lead them to their desired outcome for them to be motivated in rehabilitation, and so RTW coordinators / rehab counsellors and patients together need to discover the patient's desired outcomes.
• Self-confidence and motivation are linked.
• Motivation must be understood in a social context.