Selected extrinsic motivation factors as determinants of engagement in psychotherapy among clients: a case of mathari national teaching and referral hospital, Nairobi, Kenya

Abstract

Psychotherapy relies on verbal communication between mental health providers and clients to achieve set goals, with client engagement being essential for successful therapeutic outcomes. In Nairobi's mental health facilities, non-engaged clients often abscond, fail to comply with therapeutic instructions, and miss sessions, indicating that extrinsic motivation may be necessary to encourage their participation. Therefore, this study examined selected extrinsic motivation factors as determinants of engagement in psychotherapy among clients. The objectives of this study were to examine how coercion, social stigma and psycho-education determine engagement in psychotherapy among clients in Mathari National Teaching and Referral Hospital, Nairobi, Kenya. This study utilized a descriptive survey study research design as this design allowed for evaluating the study variables without any manipulation. The total population for this study were 200 respondents in Mathari National Teaching and Referral Hospital and a sample size of 132 respondents was an adequate representation of the population. Proportionate sampling was used to determine the number of clients and psychologists, which provided a sample size constituting of 119 clients and 13 psychologists. An exclusion criterion was utilized to determine the appropriate clients for participation in the study and all clients with extreme emotional and cognitive deregulation were excluded from this study. Data was collected by use of a questionnaire utilizing a Likert scale, and from an interview guide to enable triangulation. To test the reliability, Cronbach's Alpha Coefficient was used and the reliability coefficient threshold of 0.86 was considered as appropriate for the instrument. The research instruments were validated through a pilot study and expert feedback from supervisors in Chuka University. Data were analyzed using descriptive statistics through the Statistical Package for the Social Sciences (SPSS) version 27 and through a thematic analysis. The results concluded that coercion and social stigma were negative determinants of engagement among clients, while psychoeducation was a positive determinant of engagement among clients in Mathari National Teaching and Referral Hospital. Therefore coercion and social stigma were overall a detriment to client engagement while psycho-education bolstered engagement among clients. The recommendations of the study were to develop individualized therapy plans that consider each client's unique needs, to minimize coercion and social stigma in relation to psychotherapy, to focus on promoting client autonomy, to adapt interactive psycho-education practices which promote participation in psychotherapy, and to empower clients to advocate for their specific psychotherapeutic needs.