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The answer to the familiar diagnostic question, 'Is this person well motivated for treatment?' has much to do with how a clinician predicts the outcome of a psychotherapeutic endeavour. The kind of treatment he plans reflects (implicitly or explicitly) that prediction. When an attempt at psychoanalysis or psychotherapy fails, 'lack of motivation to change' is often offered by way of explanation. The assumption implicit in the explanation is that change for the better in psychotherapy is causally related to the person's desire to change. In recommending psychoanalysis a consultant occasionally says, 'Motivation is poor, but it will develop as the treatment goes along', with the implicit assumption that the desire to change is latent in the patient and can be promoted by certain aspects of the treatment situation.
Because such assumptions are prevalent Wallerstein & Robbins (1956) included 'motivation for change' among the variables to be studied in the Psychotherapy Research Project of the Menninger Foundation. How does a clinician ordinarily assess motivation? If the patient says in a convincing way that he wants to change, if he seems honest, if the secondary gain of the illness is not too great, and if he is willing to pay for the prescribed treatment, he is usually regarded as 'well motivated'. Therefore Wallerstein & Robbins asked clinician-researchers to estimate the 'motivation for change' of the 42 subjects of the study on the basis of their honesty, their conscious desire to change, the secondary gain of the illness, and their willingness to pay the fee. These estimates, rough and approximate as they were, were made painstakingly, and were quantified, so that 'motivation for change' was treated in subsequent studies as if it were a discrete, measurable capacity of the person that could be studied for its relevance to the planning, course, and outcome of psychotherapy. It took its place among more than 200 other variables, representing aspects of the