Because research supports the value of providing incentives in counseling for substance use problems, we’re sometimes asked about offering them in The Seven Challenges program. It’s common knowledge that potential rewards influence behavior. For example, most people will work hard for grades in school or for promotions at work. So, as my grandma would  have put it: “What’s there not to like?”

I’ve seen the effectiveness of incentives with adolescent clients mandated into drug treatment who arrive with little or no buy-in. One organization using The Seven Challenges in an intensive outpatient program devised a clever incentive system that seemed effective (without going overboard). They offered little tokens for clients at each session they attended. Then at the end of the week, the tokens were placed in a hat and a winner was drawn, with the award being some sort of valued gift, such as tickets to an event or a gift card for food. This seemed to generate excitement and involvement, buying time so counselors could develop relationships and engage clients.

In contrast, I can give an example of something “not to like” about incentives. Some organizations have used a level system that offered the incentive of promotion through their program based on the completion of Seven Challenges journals. In residential and juvenile justice settings, these promotions provide highly valued privileges. Time and again, we’ve seen clients respond to this incentive by rushing through the journals with brief, superficial answers. We imagine, too, that clients are bothered by counselors asking them questions about their work because this slows down the process. In these situations, the incentives seem to undermine the thoughtful reflection that journals are designed to elicit. That’s the reason we have explicitly advised against offering incentives for the completion of journals. Instead, we recommend acknowledgment for effort.

Let’s pause now and remind ourselves that B.F. Skinner first developed incentive theory with his experiments in the 1930s and 1940s with rats and pigeons in a Skinner Box. These animals will peck a disk or press a lever in order to get food or avoid electric shock. We know “operant conditioning” works with humans too, but we’re not rats or pigeons. We’re capable of higher-level reasoning and it’s more complicated. Let’s think this through. Here are some considerations.

First Consideration: Who Sets the Goals?

Does the client or the counselor decide about the desired behavior that earns the reward? In counseling, it has been usually (or always?) the counselor trying to motivate clients to do something that they want them to do. However, in The Seven Challenges, we pride ourselves on supporting self-determination. We don’t try to push clients toward our desired goals. We empower and aim to help them establish their own. So, we have to think carefully about incentives. Maybe we should consider encouraging clients to select their own goals that would be rewarded. Then, they may be more motivated and gain the significant satisfaction that comes from a goal that is meaningful to them.

Second Consideration: What is the Desired Behavior?

In drug counseling, incentives often revolve around the counselor-selected goal of abstinence. This may not align with the goals of our clients. So, in The Seven Challenges, we would also consider offering incentives for success in keeping drug use within limits that clients themselves have established (including possibly abstinence). Also, if we’re offering incentives, shouldn’t we reward effort in thinking through decisions? This work is as important and difficult as any other work in counseling. Offering rewards for progress in smaller increments allows for more frequent reinforcement. It also minimizes a sense of frustration, discouragement, resignation, and failure that might occur during an extended process in which clients strive for the big (all or nothing) reward.

Third Consideration: What About Internal Motivation?

When clients struggle to attain counselor-provided rewards (incentives), how does that affect their internal motivation? Are they driven to do something simply to please another person and win their approval or get a reward? Do they have an opportunity to grasp the inherent value of the goal?

Fourth Consideration: Does the Incentive Undermine the Thinking Process?

If the incentive to succeed with a behavior is motivated by the desire for a reward, will the client pause and make an effort to think about its intrinsic value? If not, in the face of adversity, they may be less likely to persevere. Also, once the extrinsic reward has been received, are clients likely to continue or discontinue the rewarded behavior? If they haven’t thought deeply about it, they may not see its value.

Here’s a true story.

When I first met this family, I learned that the parents had offered the incentive of buying an automobile for their daughter if she avoided drinking and using street drugs during her high school years. They thought she had complied, but did they really know? The girl was rewarded with a car after high school, went to college and then got problematically involved with drugs during her first semester.

Fifth Consideration: What is the Potential Negative Impact of a Large Reward?

Can the focus on the reward be such that the behavior itself becomes incidental? Large rewards might motivate people to succeed. It is also possible that large rewards might incentivize cheating, lying, and deception. Gaming the system may take priority over succeeding with the behavior. For example, people might find ways to fake drug tests, cheat on exams, and simply tell bold faced lies in order to gain the reward.

Sixth Consideration: What About Recognizing Effort and Success as it Occurs?

Personally, I think counseling is at its best when clients do well and we spontaneously feel the joy. When we share that joy and say, “Great effort,” “I can see how hard you’re working,” “It’s a pleasure to see your success,” or “Good for you for challenging yourself,” whether intended for this purpose or not, we are reinforcing success. Our clients see we recognize and acknowledge their effort and come to see that they can count on it. That becomes a real motivator.

There is much to consider. At The Seven Challenges, we don’t micromanage program implementation. We try to build clinical skills and trust the judgment of providers. We see various pitfalls but also how the thoughtful and nuanced implementation of incentives can support our clients. A spoonful of sugar helps the medicine go down.