How to Work with Low- and No-Motivation Clients

Sarah was a 25-year-old white American woman with purple streaks in her long brown hair, multiple nose rings and earrings, and heavy-duty black boots. She looked like a NYC downtown hipster warrior, but whatever war she had been battling, she was clearly defeated. Sitting quietly, looking at the floor, she told me that she was “seriously depressed, and super anxious”.  

Sarah had recently stopped working in the fashion company whose employ she had so eagerly sought two years ago, just after graduating from the London College of Fashion. Now she could barely get out of bed. Her live-in boyfriend, Todd, had been emotionally abusive for the past several months, telling her that his constant critiques were all her fault. When Sarah told him she was starting therapy again (she’d been in a prior therapy for one year, with no positive effect), he said she didn’t need it – she just needed to listen to him and improve herself. Todd also owed Sarah $50,000, which he’d been promising to pay back for months.   

Sarah told me she knew she needed my help, but said she didn’t know if she could change, as she had “basically zero energy and motivation”. She did not want a referral for anti-depressant medication, as she’d felt even worse when on it for two years. She said she had even lost her interest in fashion, which she’d been enthralled with her whole life.   

Every therapist is faced from time to time with clients like Sarah. They’ve often had disappointing, unproductive rounds of therapy before. They feel stuck and hopeless, and their inertia can make us feel stymied and ineffective. 

I’ve found that the usual approaches – a psychodynamic one that seeks to explore unconscious and family-of-origin issues to gain sparkling insights that free them from their internal conflicts; a cognitive-behavioural one that challenges a client’s global negative appraisal of themselves and the world around them; or a client-centered one that reflects back the client’s own words – fall short. Of course, in starting my work with Sarah, I asked about her growing-up years, and heard about her critical father and passive mother, whose behaviour towards her contributed to low self-esteem. I heard about her academic and work successes, queried her about times she’d stood up successfully to Todd, and deployed those memories to contravene her negative self-image and point out her skills and strengths – efforts that only elicited from Sarah a sad smile and sigh.   

But I have found that ultimately, the only way to mobilise low-motivation clients like Sarah is to convince them to ‘experiment with possibilities’ – to, in the words of phenomenological philosopher Martin Heidegger, enter ‘eine Lichtung’, a clearing in the dark forest of their negative beliefs about themselves and the world, try something new, and see what comes back. Change cannot happen from rearranging the discouraging thoughts and feelings of the client – they need to take new action, even one they believe is not likely to work, and see what happens. 

Based on over 33 years as a psychotherapist and theorist, I developed what I call the Creative Relational Movement approach to change, which I share with my clients. It has five principles: 

• Insight does not automatically lead to new action 
• Sustained daily motivation is not necessary for change 
• Change feels initially artificial and irrational 
• The importance of non-binding creative experiments with possibility 
• Link change efforts to daily and weekly temporal rhythms: in other words, set specific times to try the new activities 

I’m guessing the one that surprises you most is number two. Yet surprisingly, there is little research indicating that clients’ level of motivation is predictive of positive therapeutic outcomes. But think about it: haven’t we all had days when we don’t feel like going to work, taking care of the kids, exercising or, in my case, practising my drums for the past 50 years? The key to promote changes in our low-motivation clients is to have them ignore motivation altogether and, in the words of a classic Nike advertisement, ‘Just Do It’. Energy to do something comes from getting started and the positive feelings that eventually boomerang back.  

In Sarah’s case, a turning point was when I presented her with an illustrated book on the history of colours. I reasoned that although she had lost motivation for fashion, perhaps just looking at colours would stimulate her dampened enthusiasm by activating non-rational parts of her brain. She loved the book, and things started to move quickly from there: she went to a museum to enjoy some art, she found a part-time job at a gallery, and then later at a fashionable boutique. She restarted her online business of selling choice vintage clothes and, with much support from me, she kicked Todd out of her life (and eventually got the money back). 

That was four years ago. Last I saw Sarah, she was happily bopping along a Brooklyn street, and reported that she was doing quite well.   

Overcoming Hopelessness: Working with Low- and No-Motivation Clients, a Peter Fraenkel training, is available here via the PESI UK catalogue. His new book, Last Chance Couple Therapy: Bringing Relationships Back from the Brink, will be published by Norton in 2022.