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What makes it hard to recover from a substance abuse problem? One difficulty is finding the motivation for treatment. When you are dependent on drugs or alcohol, everything seems ten times harder.

That’s where Motivational Enhancement Therapy comes in. This form of therapy is designed to combat ambivalence towards treatment. It draws on the patient’s own motivations in order to encourage them to get treatment.

What is Motivational Enhancement Therapy?

Motivational Enhancement Therapy, or MET, is a form of Motivational Interviewing (MI). MI and MET are brief intervention-based counselling techniques. They normally comprise a few short sessions. These sessions aim to make patients more motivated and get them to continue treatment.

Although MI and MET are quite similar, MET relies more on testing and feedback than MI.

Someone in recovery might try MET if they feel they are not ready for rehab yet. MET normally lasts for a few sessions, so it is not a big commitment.

MET should not replace traditional talking therapies. It is a quick, effective way to break down resistance to change. It should be a precursor to further treatment, or something that goes alongside therapies like Cognitive Behavioural Therapy (CBT).

Key concepts in Motivational Enhancement Therapy

Motivational Enhancement Therapy is aimed at those who want to change their habits, but have not built up the motivation to do so. For those people, therapies like CBT, which require a lot of time and effort, maybe too much. They need to work up to more extensive therapy.

How does MET help people find their desire to change? It does so through a very careful, gentle method that avoids judgement and contradiction. The therapist tries to tease out the patient’s motivations, then work towards the end goal of change.

Another key concept of MET is that it is heavily focused on the individual. While many other forms of therapy are held in group settings, MET tends to be on a one-to-one basis.

This allows the therapist to concentrate their energies on the individual patient. Those who struggle in group settings may prefer the one-to-one nature of MET sessions.

History of Motivational Enhancement Therapy

Motivational Enhancement Therapy is a form of Motivational Interviewing. It was created by psychologists W. R. Miller and S. Rollnick.

They pioneered this new form of counselling in the ‘80s and ‘90s. They also wrote a book called Motivational Interviewing: Preparing People for Change, in 2002.

Motivational Interviewing and Motivational Enhancement Therapy have proved very popular in recent years. In 1997, a group of psychologists and therapists formed MINT. MINT stands for the Motivational Interviewing Network of Trainers.

It teaches people about these forms of therapy. MINT has grown in size, and now features trainers from all over the world. Motivational Interviewing is now used in a range of contexts. It is a well-known and well-respected branch of counselling.

What happens in Motivational Enhancement Therapy?

Normally, someone in recovery might have up to 5 MET sessions. In this respect, MET differs from many other kinds of therapy. It is supposed to be a quick burst of counselling. It aims to help those in recovery to increase their desire for change.

In the first session, the therapist will conduct an assessment on the person in recovery. They will also ask them in detail about their history of substance abuse. Then they will go over some methods they might use to increase motivation and encourage positive thinking.

Later sessions will focus more on how to manage hard situations that put your sobriety at risk. The therapist and person in recovery will come up with a plan for these situations. They will also discuss other barriers to sobriety, such as toxic relationships.

By the end of the five sessions, the therapist will hope to have discovered some of their patient’s key motivations. They will also aim to have linked these motivations with the end goal of sobriety. Hopefully, by the end of an MET course, the patient will have a greater desire to get sober.

Motivational Enhancement Therapy as a treatment for addiction

Unlike other therapies, such as CBT, Motivational Enhancement Therapy is aimed at those with substance abuse problems. This means that it is tailored for dealing with addiction and related issues.

Most research on MET and addiction has focused on alcohol addictions. MET has been found to be helpful in some cases when used on people who have alcohol dependency issues.

It has also been successful in encouraging change on those with a cannabis dependency. For other drugs, the results have been less conclusive.

In general, MET is probably most effective at getting people with substance abuse problems to pursue more treatment. It is less effective as a treatment in itself. It should be paired with other treatments in order to have the best impact.

The Stages of Change: a model for understanding motivation

Carlo DiClemente, PhD, researched this idea of motivation. He argued that motivation is an important factor in recovery.

He came up with the idea of ‘stages of change’ in motivation. He suggested that everyone goes through these stages when trying to change their behaviour or relationship with substances.

With thanks to Medscape [1], here are the 7 stages:

  1. Precontemplation. At this stage, you have not even begun to think about change
  2. Contemplation. This is when you first start to consider a change
  3. Preparation. Having decided to change, you now get ready to go through with it
  4. Action. You follow your plan and go through with the change
  5. Upkeep. During this stage, you try to maintain the change
  6. Relapse. You return to the previous behaviour. The cycle starts again
  7. Completion. The cycle is complete

Understanding this cycle, and its role in recovery could be crucial to helping people make lasting change. Perhaps MET is best seen as a way of speeding up this cycle of change.

Without MET, people may get stuck at stage 1 or 2; with MET, hopefully, they can progress to the later stages much faster.

5 Principles of Motivational Enhancement Therapy

In MET, the therapist will use these five principles to guide them. They underpin the non-judgmental, conflict-averse approach of MET.

We’ve listed them below:

  • Reinforcing the individual’s ability to change themselves. MET is very invested in the idea that change comes from within. It is important, therefore, to emphasize that the patient has the power to change themselves. Though they may need people to unlock this power, they are ultimately responsible for making a change in their own lives
  • Avoiding conflict. Therapists will never argue with patients about, for example, the degree of their drug use. MET employs a positive, non-conflictual technique. This differs from other forms of therapy
  • Fostering empathy. It is important for the therapist to encourage the client to show empathy. Empathy can be a driving force behind positive change, especially if the person in recovery shows empathy for the people they have hurt during their period of substance abuse
  • Understanding that there is always progress to be made. Many of those who are at the beginning of the recovery process does not realise the gravity of their situation. Part of the role of the MET therapist is to gently remind the patient of how far they still have to go. This can increase motivation for change
  • Dealing with resistance to change. MET therapists approach resistance to change as natural. They help patients to overcome it, without blaming them or judging them

What are the benefits of Motivational Enhancement Therapy?

The chief benefit of MET is that it can help people overcome resistance to change. Other therapies may not focus on this particular aspect of recovery. For instance, CBT focuses more on dealing with negative thought patterns.

Through its emphasis on motivation and change, MET is very suitable for those who may not be fully ready for treatment. It can act as a good stepping stone into full drug or alcohol rehab if that is what the person in recovery needs.

It can also give someone in recovery a fuller sense of their own ability to overcome their substance abuse problem.

What are the disadvantages of Motivational Enhancement Therapy?

The main drawback of MET is that it is not for everyone. MET can be very effective for those who have mild substance abuse disorders. It is also suited to those who are clear-headed, and able to come up with a plan.

However, many people with substance abuse problems do not fit this mould. They may, for instance, have a more severe addiction. They may also have a co-occurring mental health problem. This could make it harder to plan and think logically.

Why is MET less suited for those with severe substance abuse problems? The answer is because sessions tend to only last for a short time. Those who are more dependent on substances often need longer and more intensive therapy.

Why is it useful to be able to plan and think logically for MET? Because MET involves a lot of evaluating. It also relies on testing and feedback, more than MI (Motivational Interviewing). Therefore, someone with a mental health condition such as schizophrenia or severe depression might not benefit as much from MET.

However, it is worth bearing in mind that MET goes well with other forms of therapy. Someone who might not benefit from MET in isolation could find it useful paired with CBT.

How effective is Motivational Enhancement Therapy?

Research indicates that MET is more effective for some drugs than others. For instance, it has been useful for those with alcohol dependency problems. When it works, it tends to get people to reduce their drug intake and get more treatment.

It has also been effective for those with cannabis abuse problems. One study found that the combination of CBT and MET for cannabis-dependent people had a positive impact. [2]

However, for those who use other drugs, and for teenagers, MET has met with mixed results. This suggests that MET should be recommended on a case-by-case basis. It may also be better at getting people into treatment than solving their drug abuse problems outright.

Final thoughts

In this article, we’ve seen that Motivational Enhancement Therapy can be a powerful tool for increasing motivation and getting people to seek further treatment.

It is by no means perfect and will suit some more than others. However, with the right counsellor, and the right patient, it can do a lot of good.

References

[1] https://www.medscape.com/viewarticle/472502

[2] Marijuana Treatment Project Research Group. Brief treatments for cannabis dependence: Findings from a randomized multisite trial. Journal of Consulting and Clinical Psychology 72(3):455-466, 2004.