Motivation in mental health : a hermeneutic qualitative exploration of client and occupational therapist narratives

• Main Author: Campbell-Breen, Tanya
• Published: University of East Anglia 2004
• Subjects: 615.8515019
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.423795

Understanding the concept of motivation in clinical mental health practice is central to the relationship between client and health care professional. This is particularly important in occupational therapy, where client engagement in purposeful activities of daily life is perceived to provide a means to improving or maintaining client functioning. However, clinical studies often conceptualise client motivation as an adherence to medication and treatment regimes. Such professional perspectives limit the non-medical aspects of people's lives and place importance on illness rather than life factors, and behaviours rather than individual interpretations. This study draws on the philosophy of hermeneutics in order to address gaps in current perspectives and approaches to the exploration of motivation in clinical mental health. The Biographic-Narrative-Interpretive Method provides a data collection and analysis method to explore individual meaning of motivation through clients' stories of life and the career stories of occupational therapists. Participants were purposefully sampled from a National Health Service Trust in England and interviewed in a three-stage procedure. The study raised five main findings. Three themes relate to the conceptualisation of 'motivation'. First, the prominence ofa key relationship in client stories. Second, the differences and difficulties in individual expression of their own motivation. Third, occupational therapists' understanding of motivation is personally rather than professional derived and that the relationship between client and occupational therapist is seen as inherently 'motivational'. A further two themes relate to methodological insights. Client participants' variations in story-telling and narrative ability highlight how meaning cannot be derived from mere observations of life events, but rather, that importance must be placed on types of narratives which include the participants' own evaluation of their lives. Finally, this study suggests that when motivation is explored from a hermeneutic perspective, the key relationship could have a chronological and ongoing temporal influence on participants' 'motivation for life'. This study proposes that motivation in mental health practice may be better understood from the analysis of client interpretations of their own life stories, rather than limiting understanding to the illness experience. Career stories from occupational therapists emphasise the dominance of a personal rather than professionally derived understanding of motivation in clinical practice. Such fmdings suggest that health professionals should be careful when justifying their assessment and understanding of motivation from an adherence and behavioural framework. While social relationships appear important in both the clients' and occupational therapists' stories, the clients focus on relationships developed from early life experiences. While the occupational therapists focus on the 'motivational' impact of the therapeutic relationship. More research is needed to explore how life and career stories provide meaning in mental health and how social relationships during life and illness experiences impact on individual mental health and professionals understanding of clinical concepts such as motivation.