Motivational Optometry

Source: Photo by Wesley Tingey on Unsplash

I don’t understand why they are doing this. Why do they continue this destructive behavior? Why won’t they stop? What can I do?

As counselors, we are often asked questions by family members that, at their heart, are requests for a vision and way to understand the actions of a loved one whose behavior is, at best, confusing or troubling and, at worst, terrifying. In these moments, families are looking for answers and guidance on how they can help.

Often, the first step in providing guidance to these families stems from an idea called “motivational optometry,” or providing families with a new set of lenses (or perspectives) to help them envision what might influence their loved one’s motivation to change.

Less effective strategies for helping a loved one change

Unfortunately, there are competing ideas in our culture that can be challenging for families to navigate as they try to understand how to help a person struggling with substances. Some of these ideas, or lenses, do not reflect the most effective strategies found in clinical studies.

Some of these not-so-helpful ideas are:

1. Recovery is not possible unless your loved one is ready to change. Their motivation to change will only come from the pain of the behavior, and “hitting bottom” is the primary way people decide to change.
2. Negative consequences are the central driver of motivation. When family members protect their loved one from experiencing these consequences they are "enabling" and prolonging their loved one’s use of substances.
3. Family members can help raise an individual from their “bottom” through caring confrontation; pain and threat remain active ingredients of change.
4. When an individual seems unmotivated, it is not due to the absence of pain, but it is due to the absence of hope. Thus, relationships that help empower individuals are important for increasing the motivation and persistence to make a change.

William White, MA, who has written extensively on the historical context surrounding substance use disorders and the recovery movement, notes that the treatment community has often embraced these ideas which are based on what influences an individual’s motivation to change substance use.

At present, a majority of the lenses and the language associated with people struggling with substances suggest that family members should rely on aversive and pain-based strategies to help their loved ones. Unfortunately, these lenses convey that there is little they can do to help. For example, telling a family member, “There is nothing you can do except to step back,” suggests that a family member has to detach in order for change to happen. This often accompanies the additional message, “You have to wait for enough negative consequences to force change; let them bottom out. While you do that, be careful of enabling,” which often leads to a complete withdrawal of support and a reduction in general kindness toward the person struggling.

Alternative perspectives

The reality is that motivation to change occurs in the context of human relationships and it is impacted by the tone and texture of a person’s relationships. We can guide someone towards change or away from it with how we engage with them and speak with them about the change process. Unfortunately, the pain-based lenses and the strategies stemming from them miss the influence family members can have by harnessing the power of positive reinforcement and communication.

Helping models such as the Community Reinforcement and Family Training (CRAFT) and Invitation to Change Approach (ITC) offer an alternative set of lenses that differ from the pain-based perspectives of motivation. These wider sets of lenses allow families to understand the behaviors they are hoping will change in the context of seeing the whole picture of their loved one. They strive to build on relationships to help empower individuals to consider change and persist in the process. Importantly, they encourage family members to consider their own values and how they want to be present for their loved ones as they try to help while allowing natural consequences to play a role. They also guide family members in the use of positive reinforcement to support and strengthen non-using behaviors and effective communication skills to offer feedback and suggestions for change.

These new perspectives or lenses extend the motivational spectrum and provide hope and allow for connection while helping families harness the full power of their relationship to invite and support change.

As counselors, let's consider our motivational optometry and the lenses we provide to families who are looking to support their loved ones. Offering broader spectrum lenses can shed light on the numerous pathways available to families to support both themselves and their loved ones during such challenging journeys.