Exploring Motivational Factors Influencing Attendance in Talking Therapies: A Qualitative Study
Introduction and rationale
Counselling psychology has long realized that the client's participation and session attendance are crucial for treatment outcomes (Di Mattia & Grant, 2016). Even though talking therapies like CBT or psychodynamic therapy have been researched extensively and their effectiveness researched, therapists, especially counsellors, frequently suffer from the problem of no-show clients. Such No-shows can interfere with treatment, decrease the effectiveness of care, and may consequently affect clients' global mental health. Therefore it is important to explore the variables enabling clients' attendance and proactive participation within therapy, which is fundamental in designing therapeutic interventions that foster client involvement in the process.
Background and Rationale
The client's attendance in therapy is determined by various factors such as practical factors, MLP-therapist relationship, and motivation. Studies show that patient motivation is one of the critical factors influencing compliance with the therapy regimes and their efficacy (Magill & Hallgren, 2019). In the context of therapy, motivation could be envisaged in two-fold. Collectively, motivation in therapy could be best discussed under Self Determination Theory, where motivation is classified under intrinsic and extrinsic motivation. Intrinsic motivation relates to the aspect of doing something for the sheer joy of it. In contrast, extrinsic motivation is the aspect of doing something for the benefit of the result or the return that one gets out it it in terms of rewards or mere avoidant of punishment.
There is a vast literature on motivational interviewing (MI) as a tool to create a platform for change and increase clients' motivation to change in therapy. MI is a client-centred, directive approach to promoting the client's desire to change by exploring and acknowledging mixed feelings regarding the change (Kanat-Maymon et al., 2020). In various cases, the authors have established that MI can increase the levels of treatment compliance, as well as minimize the dropout rates. However, there is low empirical evidence concerning the interaction of various motivational dimensions and their impact on attendance in talking therapies.
In this case, the counsellor observes high levels of client nonattendance and is willing to test different types of therapies for her clients (Gopaldas, 2016). Before the introduction of new therapeutic modalities, it is essential to identify motivational factors that would ensure client attendance. These will enhance the choices of therapies that motivate the clients, increasing their compliance with therapies and attendance.
Research Question
- How to examine the modes of motivation and how they affect clients' attendance in talking therapies?
Aim
This qualitative research examines motivation in clients' attendance for talking therapies and discovers what motivators enhance or hinder their attendance. To outline these factors, the study aimed to facilitate counselling psychologists' development of interventions and selecting of the appropriate therapeutic applications, which would assist in reducing clients' no-show incidents.
Literature Review
The literature review of therapy attendance has mainly been conducted according to the organizational and individual characteristics related to service use, transportation problems, and patients' socioeconomic status (Frey et al., 2021). Although these factors are essential, the part played by psychological and motivational aspects concerning therapy attendance is relatively unknown. In most studies on motivation, several factors have been pointed out to indicate that client factors often play a significant role in determining attendance; these include the client's stage of change, the perceived utility of the service and the client's relationship with the therapist.
Examining change talk and MI's emphasis on self-generated reasons for change and addressing clients' ambivalence are several reasons MI is effective at enhancing intrinsic motivation (Steindl et al., 2018). However, there is a lack of studies pointing to a view of MI specifically to detect problems with attendance in talking therapies. Adopting a qualitative research perspective on this question enables a detailed examination of various aspects of clients' knowledge and experiences, including specific motivational factors that affect attendance.
Because clients' attendance is so central to the process of talking therapies, knowledge of motivational factors is needed to enhance attendance (Sotero et al., 2016). Therefore, this basic qualitative research aims to identify factors that will help determine reasons for clients' attendance and non-attendance to therapy sessions based on their intrinsic and extrinsic incentives. The results will be helpful in counselling psychologists practising in this area and intending to introduce new interventions or select suitable therapeutic modalities that can match clients' needs to optimize talking therapies' outcomes.
Research design
Design
The research will use an explorative qualitative research approach to examine the part played by motivation in the clients attendance to talking therapies. A qualitative approach is employed because it is particularly effective in establishing richness and detail about participants experiences and beliefs (Tenny et al., 2017). The open-ended, semi-structured interviews will provide an avenue to obtain significant qualitative data about the participants.
Participants
Recruitment of the participants will target a wide range of clients who have received talking therapies in the last six months and have been assigned a diagnosis of PTSD. The sample shall comprise the clients based on their regularity levels as a client; the regular attenders, the occasional attenders, and the non-attenders. This variation will help to achieve a clear understanding of motivational factors that define various types of attendance. The target population will be between 15 and 20 respondents to ascertain the data saturation point when no more themes are elicited.
Procedure
The subjects of the study will be selected by searching for people in therapy clinics and online communities focused on mental health. This includes flyers, emails, and social media platforms to ensure many people within the intended age bracket are informed and reached out with the intended message. Volunteers will then be requested to fill out a short eligibility quiz to participate in the survey. Face-to-face, e- or telephone interviews using an interview guide will be employed for data collection depending on participants preference/desire and feasibility. All interviews will take approximately 45-60 minutes of the respondents time. An interview guide will be designed to capture the participants perceived therapy attendance, motivational states, and barriers. All interviews will be conducted with participants' permission and recorded with participants permission on an audio device and transcribed in detail for analysis.
Analysis Approach
Thematic analysis will be employed to analyse the interview data. The researcher will first read and re-read the data in the form of transcripts to gain a general understanding. It will produce preliminary codes about motivation and attendance, which will be classified into themes (Clarke & Braun, 2017). These themes will be fine-tuned to align with the data collected Earlier established themes will be reviewed to ensure that they show the data. All the themes should be described and labelled, which will make a logical chain of the results presented in the study. The themes will, therefore, be reported in a detailed and structured manner with direct quotes from the participants, making the presentation transparent, exhaustive, and data-driven.
Ethical Considerations
Participants will receive detailed information about the study's purpose, procedures, potential risks, and benefits. Informed consent will be obtained before participation. Participant confidentiality will be maintained throughout the study (Steffen et al., 2016). Data will be anonymized, and identifiable information will be securely stored and only accessible to the research team. Participation will be entirely voluntary, and participants can withdraw from the study at any point without any consequences (Gopaldas, A. (2016; Steffen et al., 2016). Given the potentially sensitive nature of discussing personal experiences with therapy, the interviewer will be trained to handle distress and will provide information about support services if needed. The study will seek approval from the relevant institutional ethics review board before commencing. By adhering to these ethical considerations, the study aims to conduct rigorous and respectful research.
Qualitative analysis
Thematic analysis
Based on the interview transcripts, a study of the theme of friendship was carried on, and several themes were identified that depict the experience and meaning of friendship. For this reason, the themes are: Transition and Adaptation, Emotional Support and Trust, Maintaining Contact and Effort, Shared Activities and Social Bonding. The following themes focus on the aspects of friendship that participants experienced in their friendships.
Result
Theme 1: Transition and Adaptation
The life transition is crucial in forming friendships, according to both interviews. School leavers, joiners of new schools, transfer students, or entrants to university are usual situations where participants try to find new relations. For instance, one participant said, It was quite strange when he had to transfer to a new, larger school where he did not know anyone. This first unfamiliarity and feeling of loneliness are expected in such changing circumstances. Likewise, one participant narrated the first day at university whereby they referred to it as a blank canvas Another participant narrated the first day at university as an experience of absorbing the culture shock resulting from new faces as well as the task of having to start all over again. Thus, these experiences reflect the processes of searching for new friends as significant life changes require new social contacts to be built and changes in certain life circumstances.
Theme 2: Emotional Support and Trust
Another prominent theme that was revealed was related to the aspect of emotional support and trust. As in the first interview, the aspects of trust and emotional support surface in the second part of the interviews as the components of friendship. In the typical discourse, the participant comments on their social relations and mentions that after visiting friends in the pub, they would meet new people, including girls. These outings allowed them to relax, interact and foster camaraderie by participating in everyday activities. In the second case, Transcript 2, the participant is in a new friendship where trust was established quickly. There is thus that level of confidence in having met this person only once that they can share profound ideas or feelings with you. This can be an example of how trust is the cornerstone of interpersonal relationships that allow people to share personal feelings and seek comfort.
Theme 3: Maintaining Contact and Effort
The third Theme is appreciated by both the interviewees in maintaining a friendship, especially when faced with challenges such as distance or time constraints. In the first transcript, the participant talks about a friend who has relocated to university, stressing that one remains close regardless of the distance. For them, it is crucial to see each other in person. On the other hand, Transcript 2 shows that the participant is aware of the tension in moving around to talk to friends regularly, yet they express a willingness of wanting to talk to friends. The participant points out that they have a lot of trouble agreeing on details of regular communications and provide instances where the agreed level of contact fails with time. This shows that people experience time constraints when making friends as other activities bind them.
Theme 4: Shared Activities and Social Bonding
Both the participants emphasize how practical activities help in the formation and strengthening of friendships during their interviews. In the first transcript, the participant speaks about their school days, and how they lived with a best friend that included casual activities such as playing football as their way of interacting. In the same way, there is reminiscing of social bonding in Transcript 2, the participant talks of how they and their friends went to the pub often. Some of these perceptual patterns included attending dinners and business meetings where people engaged in loose and informal conversations as they drank. The above-shared activities show that having interests in common and attending public events are essential aspects of maintaining friendships as they afford chances for interaction and the formation of a pool of mutual experiences, which fosters the growth of friendships.
Flow Chart of Themes
The following diagram shows that friendship can be defined by several other themes that are related to each other.
Reflective summary
While doing this task, I realize that the following learning processes have boosted my academic and practical knowledge to a considerable level. One of the main approaches comes from reading and re-reading the material and always being proactive on the topic. To ensure that the study is practical, I intentionally reviewed literature related to counselling psychology, motivation, and the application of thematic analysis for the current research proposal and the subsequent thematic analysis.
Another significant technique was the cyclical method applied to the text production process. First, based on a set of guidelines outlined to us, I started with sections of the assignment, which made the flow of the paper from the introduction to the section on research design and then the thematic analysis logical and understandable. I found this approach helpful in ensuring I kept to the assignments objective and did not waver or lose direction. I also used visual tools, which included mind maps and diagrams such as the spider diagram in the case of the thematic analysis, as this helped in the arrangement of complicated themes and information in a manner that helped me understand and present in the best way possible.
For professional development, formative activities and feedback were invaluable. Interactions with peers and instructors provided diverse perspectives, enriching the research process. The feedback from participants on the formative assessment, particularly the need for a clearer explanation of the research design and the thoroughness of the thematic analysis, was instrumental in strengthening the subsequent changes made to the study.
Introduction and rationale
Counselling psychology has long realized that the client's participation and session attendance are crucial for treatment outcomes (Di Mattia & Grant, 2016). Even though talking therapies like CBT or psychodynamic therapy have been researched extensively and their effectiveness researched, therapists, especially counsellors, frequently suffer from the problem of no-show clients. Such No-shows can interfere with treatment, decrease the effectiveness of care, and may consequently affect clients' global mental health. Therefore it is important to explore the variables enabling clients' attendance and proactive participation within therapy, which is fundamental in designing therapeutic interventions that foster client involvement in the process.
Background and Rationale
The client's attendance in therapy is determined by various factors such as practical factors, MLP-therapist relationship, and motivation. Studies show that patient motivation is one of the critical factors influencing compliance with the therapy regimes and their efficacy (Magill & Hallgren, 2019). In the context of therapy, motivation could be envisaged in two-fold. Collectively, motivation in therapy could be best discussed under Self Determination Theory, where motivation is classified under intrinsic and extrinsic motivation. Intrinsic motivation relates to the aspect of doing something for the sheer joy of it. In contrast, extrinsic motivation is the aspect of doing something for the benefit of the result or the return that one gets out it it in terms of rewards or mere avoidant of punishment.
There is a vast literature on motivational interviewing (MI) as a tool to create a platform for change and increase clients' motivation to change in therapy. MI is a client-centred, directive approach to promoting the client's desire to change by exploring and acknowledging mixed feelings regarding the change (Kanat-Maymon et al., 2020). In various cases, the authors have established that MI can increase the levels of treatment compliance, as well as minimize the dropout rates. However, there is low empirical evidence concerning the interaction of various motivational dimensions and their impact on attendance in talking therapies.
In this case, the counsellor observes high levels of client nonattendance and is willing to test different types of therapies for her clients (Gopaldas, 2016). Before the introduction of new therapeutic modalities, it is essential to identify motivational factors that would ensure client attendance. These will enhance the choices of therapies that motivate the clients, increasing their compliance with therapies and attendance.
Research Question
- How to examine the modes of motivation and how they affect clients' attendance in talking therapies?
Aim
This qualitative research examines motivation in clients' attendance for talking therapies and discovers what motivators enhance or hinder their attendance. To outline these factors, the study aimed to facilitate counselling psychologists' development of interventions and selecting of the appropriate therapeutic applications, which would assist in reducing clients' no-show incidents.
Literature Review
The literature review of therapy attendance has mainly been conducted according to the organizational and individual characteristics related to service use, transportation problems, and patients' socioeconomic status (Frey et al., 2021). Although these factors are essential, the part played by psychological and motivational aspects concerning therapy attendance is relatively unknown. In most studies on motivation, several factors have been pointed out to indicate that client factors often play a significant role in determining attendance; these include the client's stage of change, the perceived utility of the service and the client's relationship with the therapist.
Examining change talk and MI's emphasis on self-generated reasons for change and addressing clients' ambivalence are several reasons MI is effective at enhancing intrinsic motivation (Steindl et al., 2018). However, there is a lack of studies pointing to a view of MI specifically to detect problems with attendance in talking therapies. Adopting a qualitative research perspective on this question enables a detailed examination of various aspects of clients' knowledge and experiences, including specific motivational factors that affect attendance.
Because clients' attendance is so central to the process of talking therapies, knowledge of motivational factors is needed to enhance attendance (Sotero et al., 2016). Therefore, this basic qualitative research aims to identify factors that will help determine reasons for clients' attendance and non-attendance to therapy sessions based on their intrinsic and extrinsic incentives. The results will be helpful in counselling psychologists practising in this area and intending to introduce new interventions or select suitable therapeutic modalities that can match clients' needs to optimize talking therapies' outcomes.
Research design
Design
The research will use an explorative qualitative research approach to examine the part played by motivation in the clients attendance to talking therapies. A qualitative approach is employed because it is particularly effective in establishing richness and detail about participants experiences and beliefs (Tenny et al., 2017). The open-ended, semi-structured interviews will provide an avenue to obtain significant qualitative data about the participants.
Participants
Recruitment of the participants will target a wide range of clients who have received talking therapies in the last six months and have been assigned a diagnosis of PTSD. The sample shall comprise the clients based on their regularity levels as a client; the regular attenders, the occasional attenders, and the non-attenders. This variation will help to achieve a clear understanding of motivational factors that define various types of attendance. The target population will be between 15 and 20 respondents to ascertain the data saturation point when no more themes are elicited.
Procedure
The subjects of the study will be selected by searching for people in therapy clinics and online communities focused on mental health. This includes flyers, emails, and social media platforms to ensure many people within the intended age bracket are informed and reached out with the intended message. Volunteers will then be requested to fill out a short eligibility quiz to participate in the survey. Face-to-face, e- or telephone interviews using an interview guide will be employed for data collection depending on participants preference/desire and feasibility. All interviews will take approximately 45-60 minutes of the respondents time. An interview guide will be designed to capture the participants perceived therapy attendance, motivational states, and barriers. All interviews will be conducted with participants' permission and recorded with participants permission on an audio device and transcribed in detail for analysis.
Analysis Approach
Thematic analysis will be employed to analyse the interview data. The researcher will first read and re-read the data in the form of transcripts to gain a general understanding. It will produce preliminary codes about motivation and attendance, which will be classified into themes (Clarke & Braun, 2017). These themes will be fine-tuned to align with the data collected Earlier established themes will be reviewed to ensure that they show the data. All the themes should be described and labelled, which will make a logical chain of the results presented in the study. The themes will, therefore, be reported in a detailed and structured manner with direct quotes from the participants, making the presentation transparent, exhaustive, and data-driven.
Ethical Considerations
Participants will receive detailed information about the study's purpose, procedures, potential risks, and benefits. Informed consent will be obtained before participation. Participant confidentiality will be maintained throughout the study (Steffen et al., 2016). Data will be anonymized, and identifiable information will be securely stored and only accessible to the research team. Participation will be entirely voluntary, and participants can withdraw from the study at any point without any consequences (Gopaldas, A. (2016; Steffen et al., 2016). Given the potentially sensitive nature of discussing personal experiences with therapy, the interviewer will be trained to handle distress and will provide information about support services if needed. The study will seek approval from the relevant institutional ethics review board before commencing. By adhering to these ethical considerations, the study aims to conduct rigorous and respectful research.
Qualitative analysis
Thematic analysis
Based on the interview transcripts, a study of the theme of friendship was carried on, and several themes were identified that depict the experience and meaning of friendship. For this reason, the themes are: Transition and Adaptation, Emotional Support and Trust, Maintaining Contact and Effort, Shared Activities and Social Bonding. The following themes focus on the aspects of friendship that participants experienced in their friendships.
Result
Theme 1: Transition and Adaptation
The life transition is crucial in forming friendships, according to both interviews. School leavers, joiners of new schools, transfer students, or entrants to university are usual situations where participants try to find new relations. For instance, one participant said, It was quite strange when he had to transfer to a new, larger school where he did not know anyone. This first unfamiliarity and feeling of loneliness are expected in such changing circumstances. Likewise, one participant narrated the first day at university whereby they referred to it as a blank canvas Another participant narrated the first day at university as an experience of absorbing the culture shock resulting from new faces as well as the task of having to start all over again. Thus, these experiences reflect the processes of searching for new friends as significant life changes require new social contacts to be built and changes in certain life circumstances.
Theme 2: Emotional Support and Trust
Another prominent theme that was revealed was related to the aspect of emotional support and trust. As in the first interview, the aspects of trust and emotional support surface in the second part of the interviews as the components of friendship. In the typical discourse, the participant comments on their social relations and mentions that after visiting friends in the pub, they would meet new people, including girls. These outings allowed them to relax, interact and foster camaraderie by participating in everyday activities. In the second case, Transcript 2, the participant is in a new friendship where trust was established quickly. There is thus that level of confidence in having met this person only once that they can share profound ideas or feelings with you. This can be an example of how trust is the cornerstone of interpersonal relationships that allow people to share personal feelings and seek comfort.
Theme 3: Maintaining Contact and Effort
The third Theme is appreciated by both the interviewees in maintaining a friendship, especially when faced with challenges such as distance or time constraints. In the first transcript, the participant talks about a friend who has relocated to university, stressing that one remains close regardless of the distance. For them, it is crucial to see each other in person. On the other hand, Transcript 2 shows that the participant is aware of the tension in moving around to talk to friends regularly, yet they express a willingness of wanting to talk to friends. The participant points out that they have a lot of trouble agreeing on details of regular communications and provide instances where the agreed level of contact fails with time. This shows that people experience time constraints when making friends as other activities bind them.
Theme 4: Shared Activities and Social Bonding
Both the participants emphasize how practical activities help in the formation and strengthening of friendships during their interviews. In the first transcript, the participant speaks about their school days, and how they lived with a best friend that included casual activities such as playing football as their way of interacting. In the same way, there is reminiscing of social bonding in Transcript 2, the participant talks of how they and their friends went to the pub often. Some of these perceptual patterns included attending dinners and business meetings where people engaged in loose and informal conversations as they drank. The above-shared activities show that having interests in common and attending public events are essential aspects of maintaining friendships as they afford chances for interaction and the formation of a pool of mutual experiences, which fosters the growth of friendships.
Flow Chart of Themes
The following diagram shows that friendship can be defined by several other themes that are related to each other.
Reflective summary
While doing this task, I realize that the following learning processes have boosted my academic and practical knowledge to a considerable level. One of the main approaches comes from reading and re-reading the material and always being proactive on the topic. To ensure that the study is practical, I intentionally reviewed literature related to counselling psychology, motivation, and the application of thematic analysis for the current research proposal and the subsequent thematic analysis.
Another significant technique was the cyclical method applied to the text production process. First, based on a set of guidelines outlined to us, I started with sections of the assignment, which made the flow of the paper from the introduction to the section on research design and then the thematic analysis logical and understandable. I found this approach helpful in ensuring I kept to the assignments objective and did not waver or lose direction. I also used visual tools, which included mind maps and diagrams such as the spider diagram in the case of the thematic analysis, as this helped in the arrangement of complicated themes and information in a manner that helped me understand and present in the best way possible.
For professional development, formative activities and feedback were invaluable. Interactions with peers and instructors provided diverse perspectives, enriching the research process. The feedback from participants on the formative assessment, particularly the need for a clearer explanation of the research design and the thoroughness of the thematic analysis, was instrumental in strengthening the subsequent changes made to the study.
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