Many people find it difficult to commit to treatment, even though – at least on some level – they know they have a problem. This is a frequent issue with addicts and substance abusers (for which MET was developed), but also occurs in individuals with mental and physical health issues as well. Their reluctance is often couched in ambivalence about getting the help they need. For some, it may be that they don’t really regard their substance abuse as all that serious. Others may dislike popular addiction treatment approaches, such as 12-step programs. Unfortunately, until their ambivalence about treatment is dealt with, they’ll continue down a self-destructive path.
Motivational Enhancement Therapy was developed to address this ambivalence. It’s designed to help individuals with substance disorders tap into a genuine (although perhaps somewhat buried) desire to change their lives and discontinue their drug or alcohol use. It doesn’t involve specific steps to recovery, confrontation, or pushy or shaming tactics.
Most people don’t really want to be alcoholics, drugs addicts, or substance abusers. They likely have at least a faint recollection of their life before alcohol or drugs turned it upside down. Sadly, though, a lot of different things can get in the way of seeking treatment – or rather, having any motivation to seek treatment. These may include deeply-ingrained habits that are very hard to break, misperceptions of how treatment works, prior bad experiences with treatment, peer pressure from fellow users or addicts, and even the fear of change.
MET relies on the idea that if that deeply buried desire for change – no matter how tiny or faint – can be awakened or unearthed, then it can be nurtured and encouraged until the person is ready and willing to take steps towards recovery.
Motivational Enhancement Therapy is based on the tenets of Motivational Interviewing. MI was developed by two clinical psychologists – Stephen Rollnick and William R. Miller – who specialized in working with individuals who abused alcohol. Although MET and MI are not the same thing, it helps to understand the premise of MI to appreciate MET.
Motivational Interviewing strives to facilitate changes in behavior by eliciting self-motivational statements from the client. This person-centered approach (stemming from the work of psychologist Carl Rogers’ person-centered therapy) is very goal-directed. It encourages clients to explore the reasons for their ambivalence. Once clients exhibit – verbally or non-verbally – some desire for recovery from their problem, a plan for change can be gradually developed. The goal of MI is to resolve the ambivalence so that clients, essentially, can get out of their own way.
Motivational Interviewing typically incorporates the following elements when working with clients:
- Establish and build rapport
- Listen actively and with empathy
- Ask open-ended, rather than closed-ended questions to encourage self-exploration
- Give advice or offer information only with the client’s permission
- Support and acknowledge any efforts and statements related to making positive changes
- Help clients realize discrepancies between their goals and their current behaviors
- Nurture internal desire and ability to make positive changes
- Avoid direct confrontation when clients are resistant
- Create a plan for change that resonates with the client; in other words, one to which he or she will adhere
Premise of MET
Motivational Enhancement Therapy is based on the premise that people’s level of motivation fluctuates over time. Different things and will influence it, including people and situations. Motivation is important for changing behavior, however, because the more motivated someone is to change, the more likely he or she is to put forth the effort to do so. Low motivation correlates with little or no effort, while high motivation correlates with strong effort.
MET, as the name suggests, was originally developed to enhance clients’ motivation to make necessary changes and increase their openness to receiving help. It was set up to be a very short-term intervention with just a few treatment sessions that include the initial assessment, feedback based on the assessment, creating a treatment plan, reinforcing the client’s commitment, and reviewing the client’s progress.
The initial assessment will likely include questions similar to the following:
- How often do you drink or use?
- When did you start abusing alcohol or drugs.
- What problems have you experienced as a result of drinking or using?
- Do other family members use? Your spouse? Your friends?
- What are your goals?
- What things do you value the most in your life?
- What do you wish you could change?
You may also be given other tests to assess how well you’re doing physically as well as mentally.
Strategies used in sessions include:
- Helping clients understand that uncertainty is normal
- Discussing prior experiences with treatment
- Identifying potential obstacles
- Giving feedback that can heighten motivation
- Enlisting the support of important individuals in the client’s life
Utilizing aspects of motivational interviewing, Motivational Enhancement Therapy uses 5 key strategies to quickly boost clients’ motivation for change:
1 – The first strategy involves listening closely to what the client is saying and showing genuine empathy and understanding of what he or she is going through.
2 – The second strategy involves helping the client realize the gaps between his or her stated values and goals, and his or her current behaviors. This is often referred to as “deploying discrepancy”. For example, the client states she wants to spend more time with her family, yet goes drinking with her friends several nights a week. The therapist points out this discrepancy and how it’s an expression of the client’s ambivalence.
3 – The third strategy involves refraining from arguing with or confronting the client about the seriousness of his or her substance use or other presenting problem, as it tends put the client on the defensive. A defensive stance can quickly reduce any motivation for change, which is not the goal of MET. The therapist doesn’t try to make clients accept that they are powerless (e.g. as 12-step programs assert), and instead continues to be empathetic.
4 – The fourth strategy involves going along with – rather than against – the client’s resistance (“rolling with resistance”). In other words, the therapist remains neutral and acknowledges it rather than confronts or contradicts it.
5 – The last strategy involves expressing confidence in the client’s ability to change and supportively acknowledging the efforts to change that have already been made.
As you can see, each of these strategies stems from elements of Motivational Interviewing.
Indications for Motivational Enhancement Therapy
MET was initially developed – and most commonly used – for the treatment of individuals who abuse alcohol or drugs. However, research suggests that the effectiveness of MET varies depending on the client’s drug of choice as well as the specific treatment goals. With substance abusers, MET has been shown to be very effective with alcoholics, both in terms of decreasing their alcohol use and enhancing their commitment to the treatment process. When used in conjunction with cognitive behavioral therapy MET is an effective treatment for adults addicted to marijuana. When used with individuals who abuse drugs such as cocaine or heroin, however, MET fails to produce consistent results.
MET may be useful in the treatment of other mental health disorders besides substance use disorders, however more research needs to be done to determine how effective it is.