MOTIVATIONAL WORK

Swedish psychologist Revstedt offers fellow therapists and counselors a self-empowering approach to dealing with supposedly hopeless cases.

It’s a vexing problem for a therapist: how to help the most destructive, least motivated clients. Revstedt believes the answer begins with the therapist’s mindset. Typical approaches are based on a client’s overt willingness to participate in the process. But Revstedt contends that this means that the people who most need help are the least likely to get it. Worse still, he writes, the professionals who are assigned the most difficult cases often get the least support. In this book, he aims to shake up these paradoxes with a theory of “motivational work” that emphasizes the relationship between the professional and the patient. Change can be effected, he says, through personal interaction. When “latently motivated” clients seem unreceptive, Revstedt writes, it’s really an indirect appeal for help from behind a defensive barrier. Rather than be discouraged, motivational workers should accept the challenge of deciphering the client’s “contact rebus”: a “masked attempt at making contact; it is an outstretched hand wrapped in barbed wire.” He then explores the idea of contact rebuses through vivid, often heart-rending case studies, which will give readers a deeper sense of empathy for people suffering from mental illness, substance abuse and psychological trauma. The book’s comprehensiveness, however, makes it exhaustive to the point of tedium. At nearly 700 pages—300 in Chapter Four alone—it’s an unwieldy tome that presents a daunting task for time-strapped professionals. It also lacks standard features to help students grasp abstract ideas, such as explanatory text boxes and takeaway lists. That said, these editorial shortcomings may not diminish the book’s potential for combating an urgent public health problem. Overall, Revstedt’s framework promises to turn around troubled lives, and give professionals a mental foundation to support their arduous work.

An overlong but compassionate and optimistic psychological work.