Self-Determination Theory in the Clinic: Motivating Physical and Mental Health
Self-Determination Theory in the Clinic: Motivating Physical and Mental Health
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Overview
The first part of the book provides historical background to self-determination theory, showing that it is humanistically oriented and has three decades of empirical research behind it. In the process, the authors discuss why humanistic psychology fell out of favor in academic psychology; why “self-help” and New Age books have such perennial popularity; and why it is so important for authorities to support patients’ sense of self. The remainder of the book presents many specific case examples to describe the theory’s application.
Product Details
| ISBN-13: | 9780300128666 |
|---|---|
| Publisher: | Yale University Press |
| Publication date: | 10/01/2008 |
| Sold by: | Barnes & Noble |
| Format: | eBook |
| File size: | 2 MB |
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Read an Excerpt
Self-Determination Theory in the Clinic
MOTIVATING PHYSICAL AND MENTAL HEALTHBy KENNON M. SHELDON GEOFFREY WILLIAMS THOMAS JOINER
Yale University Press
Copyright © 2003 Kennon M. Sheldon Geoffrey Williams Thomas JoinerAll right reserved.
ISBN: 978-0-300-09544-9
Chapter One
Self-Actualization, Society, and Scientific Psychology
The term self-actualization catches people's fancy. It is an alluring idea indeed that we are born with a natural tendency toward growth and goodness and that the only thing standing between our potential and us is an empathic and positive atmosphere. It's a good bet that, of all the material taught in college psychology courses, self-actualization is one of the few concepts that eventual nonpsychologists actually remember! Odds on this bet are made even better given that the psychology sections of today's large bookstores are filled with popular titles emphasizing self-actualization themes. But it's not just nonpsychologists who take to the concept; many applied clinical and counseling psychologists working in settings outside the university, such as private practice and community clinics, also emphasize concepts like personal growth and self-actualization in therapy.
Even as the general population resonates with concepts like self-actualization and buys books on related topics, and even though manyapplied psychologists emphasize the concept, scientific psychology seems, at best, to have forgotten or minimized the approach and, at worst, to have sneeringly rejected it. In a survey, Mayne, Norcross, and Sayette (1994) found that just 10 percent of clinical psychology research faculty considered themselves sympathetic to self-actualization and related views (for example, client-centered or humanistic approaches to therapy). Instead, the clinical research community in psychology tends to be much more narrowly focused, using federal grant dollars to develop and empirically validate programmatic treatments for particular disorders. In such work little thought is given to the client's self-actualization or personal growth. This is perhaps a significant omission, because although the success rates for empirically derived treatments are increasingly good, they are still lower than would be desired.
All this makes for an unsatisfactory situation that is tearing at the profession. On one hand, scientific psychologists are pointedly ignoring concepts that have extremely wide appeal, not only to general folk, but to their less research-oriented colleagues, too. Surely, given peoples' perennial interest in these themes, this group must be missing something important? On the other hand, the general public and many applied clinicians are ignoring the many new, empirically proven ideas and procedures that have emerged for treating an array of mental and physical disorders. What can be done to disseminate these new findings and procedures to the lay public and counseling professionals and, indeed, to improve the new procedures? If this situation is not resolved, we believe that it has the potential to fragment the treatment community, impede the development of better therapeutic techniques, and erode the public's interest in scientific psychology.
If only there were a science of self-actualization, and if only there were niches within empirically validated treatments where concepts like self-actualization might fit! Then there might be greater harmony between the "hard-nosed" research psychologists and the legions of applied psychologists who resonate to concepts like self-actualization; greater harmony between mechanistic theories and personalistic theories within psychology; and greater harmony between research-oriented clinicians and the needs and demands of the public whose tax dollars support much of the research that clinicians do.
Our purpose in this book is to show that this harmony is not only possible but that, in large part, it already exists and that it extends beyond the treatment of mental disorders to include traditional medical problems (among them, obesity and medication adherence). That is, a new science of self-actualization has been developed in the past thirty years, and it directly addresses the question of how best to engage the "self" of the client. This research has shown that enhancing the client's sense of personhood within the treatment setting can greatly enhance the effectiveness of any approach or procedure, medical or psychological. In a nutshell, our goal here is to present these new ideas and results and to provide guidance to physicians, clinicians and patients regarding the everyday treatment of such problems as depression, obesity, and smoking. The ideas in this book should resonate with professionals and lay readers alike, with medical and clinical professionals alike, and with research and applied psychologists alike.
We begin by briefly tracing the rise and fall of the humanistic theoretical perspective (and related perspectives) within academic psychology. This theoretical tradition, founded by Carl Rogers, Abraham Maslow, Rollo May, and many others, is most similar to the kind of thinking that is widely found in self-help books. In particular, this tradition suggests a distinctive model of the optimal provider-client relationship, one that is very different from, and potentially much more effective than, the traditional authority-supplicant role-relationship that still dominates within many helping contexts. The nature of this interpersonal model is a central topic of this book. Unfortunately, the humanistic perspective that grounds this model was largely discarded by research psychologists in the 1970s in favor of a more narrow cognitive perspective. We believe that considering why mainstream psychology rejected humanistic psychology will shed substantial light on the current divide between the "softer," growth-oriented clinicians, and the "harder," empirically oriented clinicians. Specifically, we hope to demonstrate that the divide is more a historical accident than a necessary barrier. Although the early humanists tended to marginalize themselves by rejecting empiricism, they didn't have to; as we shall see, there is no necessary conflict between humanistic theory and quantitative methodology, and indeed, they can be quite complementary (Rychlak 1977).
Following this brief historical introduction, in Chapter 2 we chart the thirty-year rise within scientific psychology of a comprehensive theory of motivation called "self-determination theory" (SDT), which carries the best of the humanistic ideas forward while finally supplying them with the research grounding that any new set of ideas requires to be taken seriously (Deci and Ryan 1985b, 2000). This theory is consistent with former notions of self-actualization as well as with the most advanced thinking of contemporary philosophers, evolutionary biologists, and dynamic systems theorists. Further, SDT is giving rigorous meaning to such concepts as "free will," "healthy values," and "true self" by focusing on individuals' quest for phenomenal ownership of their behavior as a central cause of positive adaptation and development. In particular we examine SDT's findings concerning social contexts and the enhancing or inhibiting effect that styles of authority communication can have on the development of optimal, self-regulated functioning.
After this introduction to SDT and the research that supports it, we show concretely how clinical practitioners may apply these ideas in both the psychological and medical fields to enhance the effectiveness of treatment with their clients. Specifically, we discuss SDT's concept of autonomy support. As we show in Chapter 3, autonomy support (in brief, the practice of acknowledging the client's perspective, giving the client as much choice as possible, and providing meaningful rationales when choice provision is impossible) may be the most crucial ingredient that clinicians can supply as they attempt to enact therapeutic programs with patients or clients. That is, for the purpose of maximally engaging clients' motivational and organizational resources, how a treatment program is conducted may matter at least as much as, if not more than, what the program consists of.
In Parts II and III, we discuss the concrete application of the foregoing ideas, within a variety of medical (Part II) and psychotherapeutic (Part III) domains. Here we wish to show that the approaches presented really work, as numerous high-quality studies demonstrate. We hope that by the time the reader has finished the book, he or she will not only have picked up some important tips but will understand why self-help remains a perennial topic of interest. In our view, it is primarily because the self-help authors actually convey some truths -chiefly in their implicit assumption that humans are self-organizing systems who may need little more than an acknowledgement of their autonomy and growth potential to enact tremendous changes in their lives. SDT clearly articulates what such acknowledgment consists of and how it works. In this way SDT helps to clarify how to assist the inherently active individual to improve him or herself.
The Historical Background The dark ages in psychology. The late 1950s and early 1960s formed a watershed in scientific psychology, as the field emerged from the "dark ages" of radical behaviorism. Cast under the spell of B. F. Skinner and his colleagues, most research psychologists of the 1930s, 1940s, and 1950s eschewed mentalistic theories and would not tolerate the inclusion of subjective or experiential factors within their scientific explanations. Of course, it was during this era that the dominant cultural image of research psychologists was established -namely, that they are clueless individuals in white lab coats, running rats through mazes and people through reinforcement trials while ignoring what is most important to, and about, humans.
Because of the pioneering research of Richard Tolman, Jerome Bruner, Jean Piaget, and many others, however, the behavioristic stranglehold was broken in the early 1960s. Psychologists increasingly found that many important phenomena could not be explained from within the operant behavioral worldview. Such phenomena include how rapidly children absorb the grammar of their native languages, how easily people learn new behaviors via mere observation, the fact that people persist at great length in behaviors that yield no external reward, and how creatively people solve never-before-encountered problems. Hastening the rise of mentalism was the emergence of electronic computing and its suggestion of a "rule-based software" metaphor for understanding the human mind (Baars 1986). In short, during the 1960s research psychologists finally came to agree that mental and experiential processes must be considered after all.
Two candidate successors for behavioristic psychology. Two movements stepped into the gap: cognitive psychology, which rectified the failure of behavioristic researchers to consider the signal processing that goes on within the minds of individuals, and humanistic psychology, which addressed the failure of behavioristic researchers to consider the selves and personhood of individuals. During the 1960s, these two visions of subjectivity helped overthrow the behavioristic worldview (Schultz and Schultz 1987).
Although the two perspectives agreed in their focus on the mental activity occurring within the individual, they disagreed on many other things. For example, cognitive psychology maintained a strong focus on nonconscious and nonaccessible mental processes. In this, the cognitive approach has important shared roots with Freudian psychodynamic psychology. In contrast, the humanists emphasized conscious mental processes and the power of human choice, taking strong exception to Freudian psychology's emphasis on humans as creatures driven by bestial urges and ruled by unconscious mental processes. Humanistic psychology was also in many ways the academic representative of the countercultural zeitgeist that emerged within the 1960s (Schultz and Schultz 1987); this was of course a time when many conformist assumptions and norms were cast off in favor of radical new ideologies, personal explorations, and modes of interpersonal encounter. In contrast, the cognitive perspective was not aligned with these cultural forces; in fact, cognitive scientists had little concern, at first, for understanding higher-level personality or social-cognitive processes. Yet another difference was that humanists worked mostly in applied areas of psychology, as clinicians, counselors, or social workers, whereas most cognitivists worked in academic research settings.
Yet the most important source of the rift that grew between humanistic theorists and the mainstream research community was probably their disagreement on the role of quantitative methodology in acquiring knowledge. Was it more important to conduct statistical analyses of numerical data collected from large representative samples or to conduct qualitative analyses of narrative data collected from individual lives? Humanistic writers tended to extol the narrative case-by-case approach, denouncing large sample studies, empirical quantification, and statistical-significance testing as politically loaded practices that hide and even violate the unique subjectivity of people (Jourard 1974). Human beings, it was argued, are radically different from the "objects" studied in the other natural sciences, for humans are potentially self-aware and self-transcending. From this point of view, experience is the great mystery; the human psyche can be properly explored only on its own terms, and it must thus be viewed "from the inside." In short, the humanists argued that psychology must reconstitute itself as a very different science, abandoning the pretense of objectivity inherited from the natural sciences in favor of a new, more "human" science.
Unfortunately, the products of humanistic research were often unimpressive, sometimes presenting laborious descriptive analyses of trivial personal experiences, and other times seeming to make hopelessly naive assumptions about the inherent "goodness" of human nature (Funder 1997; Smith 1982). There was also a general shying away from causal analysis, as if scientific explanation itself were taboo (Wertz 1998). Humanism began to acquire a reputation for self-indulgence and self-absorption: the human potential movement, for example, which was originally directed toward bringing about an Aquarian age of increased tolerance and self-actualization (Ferguson 1980), soon became known instead for its hedonism. That is, many people used the movement as an excuse for seeking individualistic pleasure in the absence of any restraining authority. In addition, the experiential encounter group, perhaps the most important innovation of the human potential movement, soon acquired a reputation as a place where group leaders exerted strong and sometimes dehumanizing power over participants in their quest to expose every emotion and eliminate every hang-up. Such practices were even ridiculed as the pitiful antics of hopelessly infantile individuals (Koch 1971).
Of course, most academic humanists did not fall prey to such traps and continued to promote socially responsible forms of personal fulfillment and growth. Further, they continued to write passionately and well; even today, more real insight can be gleaned from the pages of the Journal of Humanistic Psychology than can be gained from most academic psychology journals. And yet, since the 1970s the academic humanists have become increasingly marginalized within the field as a whole. Again, this seems due largely to their refusal to employ conventional empirical methods and, perhaps even more, because of their outright hostility toward those methods (Child 1973; Giorgi 1970; Wertz 1998).
(Continues...)
Excerpted from Self-Determination Theory in the Clinic by KENNON M. SHELDON GEOFFREY WILLIAMS THOMAS JOINER Copyright © 2003 by Kennon M. Sheldon Geoffrey Williams Thomas Joiner. Excerpted by permission.
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Table of Contents
Contents
Preface....................viiPart I. Self-Determination Theory: Concepts and Evidence 1. Self-Actualization, Society, and Scientific Psychology....................3
2. Self-Determination Theory and Its Supporting Research Base....................13
3. Autonomy Support and Behavioral Internalization: Promoting Ownership of Non-Enjoyable Behaviors....................28
Part II. Self-Determination Theory Applied to Medical Practice 4. Self-Determination Theory and Physical Health....................43
5. Facilitating Health Behavior Change: The Case of Tobacco Dependence....................65
6. Supporting the Internalization of Chronic Disease Management: The Case of Diabetes Mellitus....................83
Part III. Self-Determination Theory Applied to Mental Health Practice 7. Self-Determination Theory and Mental Health....................109
8. Facilitating Psychological Change: The Case of Substance Abuse Disorders....................126
9. Supporting Self-Determination in the Treatment of Anxiety and Eating Disorders....................142
10. Supporting Self-Determination in the Treatment of Mood and Personality Disorders....................165
Conclusion....................184
References....................187
Index....................199