You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
Most psychoanalytic formulations about motivation for treatment are conceptually loose and beset with internal contradictions. That library of dusty ideas usually beclouds efforts to understand what actually transpires in the consulting room. Even a crude classification system can improve the state of affairs, if it makes operational distinctions between various procedures intended to facilitate the patient's motivation to learn and to change.
Clinical explicitness affords opportunity to test and select which strategy best meets the demands of the concrete therapeutic task.
As a modest beginning, I suggest a tripartite division which applies to most treatment approaches. First, there are motivational schema which are what academic psychologists would call negative or aversive reinforcement theories or, in a lighter vein, “stick” theories. Then there are positive reinforcement or reward approaches (the “carrot” principle). Finally come those relatively newer conceptualizations of the learning process in terms of intrinsic motivation or optimal excitation, which I am tempted to label “umbrella” theories. Having proposed a classification system, however, it becomes necessary to translate it into clinical terms.
Negative motivation (stick) theories such as the classic position of Freud, rest on the premise that the most effective spur to learning is the internal cudgel of the patient's own discomfort. All human beings, according to this view, strive toward a tensionless state of