We all know the importance of consistent home practice to generalize new strategies and promote neuroplasticity. But sometimes, no matter how hard you try to educate clients, your urgency about this just doesn’t seem to carry over.
Many variables influence someone’s motivation to work on new skills between sessions. Cognitive impairments, severity of a disorder, family involvement, access to resources, and physical or mental health can all affect at-home practice.
Speech-language pathologists can benefit from understanding how people are motivated. People can be motivated intrinsically, extrinsically or only when the feeling is right. Learning about types of motivation gave me a new perspective that changed my practice. I now see many more clients successfully carry over skills we work on in sessions to their home environment.
Although strategies vary depending on the person, here are 10 motivational strategies I find particularly effective:
- Use a planner.
I like to spend part of the session with the patient creating a rough weekly plan—we write obligations like appointments and transportation time, for example—then schedule “to-do” list items, such as homework. This exercise also helps patients think critically about what day, time and duration they have available to practice at home.
- Set realistic goals.
Using SMART goals can help your patient evaluate if they can actually complete the homework. For example: “This week, I will work on my SLP homework three times for 20 minutes each time.”
Another method is goal attainment scaling. Set up a worksheet for patients to apply this framework, from goal-setting through evaluating their own performance.
- Provide rationale.
Understanding the why can really motivate people. (Why should I do this? Why should I care?) A quick conversation might work for some clients, whereas others want to conduct their own research. I remember giving one patient an article on memory. By the next session, he returned with a binder full of articles! Additionally, connecting homework to the person’s treatment goals help explain why it’s personally relevant. Finally, I encourage patients to write their own rationale in a notebook. That way, they can reference it in the future if they need a motivation reboot.
- Build accountability.
If the intrinsic motivation approach isn’t working, external pressure motivates many people. Try creating more accountability in sessions for these types of clients. I worked with one patient who told his brother when he planned to do homework and when he completed it. The idea that someone else was waiting to hear from him got him started.
More on getting clients to practice at home:
- Measure progress.
Measuring progress accomplishes two things: It compares current and past performance and creates accountability. I sometimes use paper-based methods for patients to measure progress—to-do lists, planners, writing down SMART goals—but technology also makes tracking accomplishments easy. Many programs exist to help monitor homework, along with apps that can measure performance.
- Link new habits to old ones.
Encourage the patient to link a new habit—like homework—with an old one. For example, one patient’s routine was to clean every morning. She also found she works best in a clean environment, so she started doing homework immediately after her cleaning routine.
- Identify the optimal work environment.
Some people receive motivation from being surrounded by others who are also working. Places like a shared workspace, library or coffee shop might promote increased carryover.
Other people resist doing the same thing others do. These clients probably work better at home or in a public place, such as a park, where people don’t typically go to work.
- Reward yourself.
Ask your patient to identify a fun activity they can enjoy when finishing their homework. They can watch a TV show, take a walk, read a book or grab a cup of coffee, for example.
- Modify the homework.
Some feel stifled by rules. These clients might feel relieved when you reframe their assignments as “homework-in-progress.” Clients are more likely to try a practice activity if they aren’t rigid and you are willing to modify them. I typically have them try two or three times, and if it’s not working, we can change it.
- Use a timer.
Getting started is often the hardest part. A timer can be a great motivation checker. For example, one patient would set a timer for 10 minutes with the mindset, I will work for 10 minutes, and if I’m still not motivated, I can stop. Often when the timer ends, she would be in the groove and motivated to keep going.
Many people aren’t aware of their motivation preferences. But with treatment, it can be productive to explore motivation with patients so they can leave their sessions feeling empowered and ready to continue working!
What strategies work for you in motivating clients to practice at home? Share in the comment section below.
Emily Dubas, MS, CCC-SLP, treat patients with neurological conditions in both inpatient and outpatient rehabilitation settings at Constant Therapy and Spaulding Rehabilitation Hospital. She’s also an affiliate of ASHA Special Interest Groups 2, Neurogenic Communication Disorders, and 15, Gerontology. firstname.lastname@example.org