Motive-oriented relationship building

Domain II · Behavioural & cognitive · Caspar, Grawe · 1992 · Bern

What it is

MOTR is not a standalone therapy. It is a prescriptive principle for shaping the therapeutic relationship, and it is built into whatever method you already use (CBT, psychodynamic, general psychiatric management, DBT groups, internet guidance). The therapist uses a case formulation (Plan Analysis)…

Format

• MOTR has no fixed session protocol. The sources describe a sequence that runs alongside the host therapy. Session counts below come from the trials and are not prescriptions.
• Phase A: information gathering and first formulation (intake, session 1).

Who practises it, and how they are trained or regulated

• Version followed: the Bern Plan Analysis–based "Motive-Oriented Therapeutic Relationship" (MOTR; earlier "complementary relationship building", Grawe 1992) as described by Caspar (2019 chapter; 2018 German textbook) and operationalised in the Bern/Lausanne trials (Kramer et al., 2014; Kramer, Fisher & Zilcha-Mano, 2022). It is supplemented by Grawe's needs-based variant (Stucki & Grawe, 2007) and the current…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Questionnaires capture only consciously accessible goals.
• Not every emotion is instrumental; do not imply the patient is "using" feelings.
• A worksheet full of generic niceness. Each entry should be specific to this patient.
• Formal training is offered through the Bern postgraduate programmes and the Klaus-Grawe-Institut.
• Do not try to eliminate countertransference, because it has diagnostic value. Do not act it out either.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.