Blog

The last couple of weeks we have been examining the Triad of Unconscious Motivation put forth by Lisle and Goldhammer in their book, The Pleasure Trap. We have powerful and often unconscious motivations to use our limited energy as efficiently as possible, which explains behavioral patterns and habits. In addition, we are naturally inclined to avoid pain and to seek pleasure. If we are not mindful of our thoughts and actions, these motivations can dominate our lives and, as with many of our clients, can lead to destructive behaviors and addictions.

This week I want to examine what the Triad can teach us about the helping interventions we deliver to clients to help them make difficult life changes, heal from past trauma, or improve their physical health. Just as the Triad can contribute to many of the reasons clients seek our services, it can also help us chart the path to recovery and well-being. Unfortunately, many of our systems of care ignore the power of unconscious motivations, and are set up for clients to succeed only if they find a level of insight and willpower that rarely exists in humans under high amounts of stress.

Take a moment to think about the services you deliver to clients. On a scale from 1 – 10, with 1 being not at all and 10 representing an extreme high level of motivation, how do your services rank on the following:

·         Our services are designed to help clients avoid the experience of mental, emotional, physical, and social pain.

·         Our services are designed to increase the amount of pleasure the client experiences in their day to day lives.

·         Our services are highly accessible and client friendly. Clients get what they need when they need it.

If you don’t score very high on these measures, welcome to the club! In reality, many of our systems of care and funding structures have historically done the exact opposite of what we know will elicit motivation for change and improvement in one’s life. Too often services require clients to jump through multiple hoops, experience pain through withdrawal, side effects to medications, painful medical procedures, and emotional consequences (such as having to go through assessments that bring up painful reminders of past traumas and personal failures). Rarely is pleasure even considered, as our society often thinks those in pain and poverty are lucky to receive anything that they cannot afford on their own.

It is against this tide of motivation that we try to deliver healing interventions. It isn’t a surprise that we struggle to achieve strong outcomes, as our funding often does not match the reality of human nature. Does the Triad help guide us in this difficult task?

First, we have to make our services as client-friendly as possible. This is often difficult due to assessments and other requirements that come with funding. However, many organizations are surprised to discover that they add many additional and unnecessary barriers for clients. Think about the client experience from intake to discharge. Is there any way to make this process more efficient and less painful?

Sometimes this is as simple as giving helpers flexibility to delay the intake and assessment process until a relationship is established. Other times, long established procedures are tweaked to eliminate requirements that add stress to the clients’ already stressful lives. The key in this assessment is to ask yourself the question: What can we do to make the client experience in our programs more customer friendly? When I consult with organizations, it is interesting to discover that many staff don’t know why many procedures exist and everyone assumes that it is done because of external requirements. When I ask, “Do you really need this practice?” the answer is often no, and the resulting change takes something unpleasant off the helpers’ plates and improves the clients’ experiences in the program.

A second, but related, question is how can our program eliminate pain from the client’s life? Of the three unconscious motivators, we often excel at this one. Providing housing, medication, therapy, methadone, psychosocial support, and food helps reduce both short and long term pain in the client’s lives. Where we sometimes struggle is the misguided and ineffective societal perception that our clients don’t deserve the best services and should be happy with anything they get, since it is often free or low cost.

This mindset evolves from the misunderstanding of the brain and mind that still drives policy in our country. Like most people, those that make the policies believe that if we give too much to the poor or those struggling they will get comfortable and lose motivation to change. This would be great if it was true – unfortunately, humans will reduce pain in the most efficient way possible.

Instead of putting up with all the paperwork, dehumanizing processes, and red tape, clients will naturally look for more efficient ways to relieve pain in the short term. So clients drop out of care, continue to use substances for relief, and look for both legal and illegal ways to get money to meet their basic needs. I still have not met a “welfare queen” in all my years in the field, but the concept still creeps into too many of my conversations about our work. The scary thing is that many of these conversations are with people of power and influence over funding and the systems of care. I have a fantasy that those that make policy should have to live with those impacted by these policies for at least a week. Can you imagine the change?!

The final piece of the puzzle is pleasure. As with my HIV drug adherence example last week, pleasure is too often far into the future and too ambiguous. This makes our work difficult, as those with past trauma and current high levels of stress struggle with long-term thinking and ambiguous future rewards. To add to this, many of our clients have only known lives of poverty and pain, so there is no model for the better lives we often envision for them.

Here is where the concept of cogni
tive dissonance comes to our aid. Cognitive dissonance is a conscious motivator where we either feel stress that our current situation does not match the reality we want, or that the present situation has pain and difficulty that we want to remove from our situation. Basically, cognitive dissonance helps bring the unconscious motivators of avoiding pain and increasing pleasure into the consciousness.

Change and healing happen when we help clients realize the discrepancies between their current situation and their desired reality and then, through our support and resources, assist them in creating a path out of the present pain and into a more pleasurable future. Even when we do this well, it is only the start of the change process. The client must still take this difficult journey where the pull of past ways of thinking and behaving (efficiency), short-term pleasures (drugs and sex), and escapes from pain (often again…drugs and sex) can pull the client back into past destructive thinking and action.

Take a moment this week to think about your programming and several clients. How is the Triad impacting their behaviors and success in your services? Also examine your programming and see if there are any opportunities to utilize the Triad to improve the client experience, outcomes, and staff satisfaction with the services you deliver.