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Sometimes people cannot be motivated to make clinical changes for themselves but can find psychological leverage to make changes for others. An agrophobic mother may not be able to face the challenge of going outside for herself but may do so to prevent her daughter copying her avoidance behaviour. A mute child may not speak on her own behalf but may do so to help a puppet answer a question.

Appeals to altruism can unlock people to change, but as a strategy it needs careful handling, for if we only change for others this may have limited benefits. The clinical skill is to encourage the initial commitment but to widen the motivational base once progress has been made. One needs to move to the conversation - "So you found it in you to do this for your daughter to start with but how does your progress benefit you? How would you like to proceed for yourself now that you have a bit of confidence/self esteem etc."

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