Motivational Enhancement Therapy

Motivational Enhancement Therapy (MET) is a brief therapy employing motivational interviewing (MI) principles to treat substance abuse. It was created by Stephen Rollnick and William R. Miller, the creators of MI, as part of Project MATCH, a clinical trial instituted by the National Institute on Alcohol Abuse and Alcoholism. It aims to create internal motivation to curb substance abuse.

Summary

• Motivational Enhancement Therapy (MET) is a brief, evidence-based approach rooted in motivational interviewing that helps clients build internal motivation for behavior change, particularly for substance use.
• Motivational Enhancement Therapy aligns with the Transtheoretical Model of Change, meeting clients where they are and supporting progress through contemplation, preparation, action, and maintenance.
• Change is client-driven, not therapist-directed as MET emphasizes empathy, autonomy, and self-efficacy rather than confrontation.
• MET works well as an adjunct therapy, especially when clients feel ambivalent or resistant, and can be effectively adapted for teletherapy with intentional communication strategies. Download my free teletherapy practice worksheets.

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The Transtheoretical Model of Change

Motivational Enhancement Therapy uses the transtheoretical model of change, (proposed by Prochaska and DiClemente), as a basis for motivating clients to adopt healthier behavior.

The transtheoretical model of change has five stages:

• Precontemplation: An absence of self-awareness distinguishes the first stage. The individual has no motivation to change, and may not even be aware that there is a problem.
• Contemplation: In the second stage, the person acknowledges a problem, but they are unsure whether a behavior change is worth the effort. It is marked by feelings of conflict and ambivalence; it is not uncommon for individuals to be stuck in this stage for months.
• Preparation: During the preparation stage, there is recognition that the person needs to alter their behavior due to its negative consequences, and they commit to change. The person starts to gather information to develop an action plan. Individuals frequently begin to seek help from others during the preparation stage.
• Action: The action stage is when change happens. People implement their plan to achieve their goals. During this stage, individuals frequently engage in treatment and dedicate significant time and effort to modifying their behavior.
• Maintenance: The maintenance stage is the continuation of the changed behavior. Clients enter this stage after six months of exhibiting a consistent change in their behavior. People may encounter challenges, but through their success, they gain confidence in their ability to implement positive change. They aim to consolidate the revisions they have made and work to prevent relapse.

Note: Although not part of the original stages of change, some people include a sixth relapse stage as it is frequently a part of the change process.

Relapse is not a death knell. Instead, it is seen as a momentary setback and opportunity for learning that may contribute to eventual success.

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The three phases of Motivational Enhancement Therapy

Motivational Enhancement Therapy takes place in three phases held over two to four sessions:

1) Building motivation for change

In the first phase, the therapist is focused on increasing the client’s motivation to alter their behavior:

• Assessment results and history are reviewed. The therapist provides feedback and notes areas for improvement.
• The client is presented with the negative consequences of their behavior to help motivate them toward change.
• The phase is complete when the client expresses a genuine commitment to change.

2) Strengthening commitment to change

The second phase is focused on consolidating change:

• The therapist and client work collaboratively to create a plan for altering the client’s behavior. This change plan worksheet is a helpful tool.
• The therapist emphasizes that the client is in charge and the clinician is simply a guide (e.g., “it is up to you”).

3) Following through

The final stage aims to maintain behavioral change:

• The therapist reviews the client’s progress, reiterates what has been successful, and notes how they have responded to challenges.
• Motivation is renewed. If the therapist determines that motivation has waned, they may return to the objectives of phase one.
• The client reemphasizes their commitment to change. The therapist seeks to reinforce the client’s sense of autonomy and their ability to carry out their chosen plans.

Motivational Enhancement Therapy techniques

These strategies are commonly used by therapists implementing Motivational Enhancement Therapy to help clients motivate themselves towards their goals:

Consequences of action and inaction

The therapist asks the client to imagine what would happen if the client successfully changed their behavior, or if they did not.

For example, “If you stopped drinking, how would it change your life?” Or, “If you don’t stop drinking, what do you think will happen to you?”

This is a glorified pros and cons list that can be utilized in any phase of MET to increase motivation.

Express empathy

Empathy is a core principle of MET, largely borrowed from Carl Rogers’ person-centered therapy.

In MET, empathy is primarily expressed through a type of reflective listening. The therapist listens to what the client is saying, then reflects it back to them, often in a reframed form that includes acknowledgment of the client’s feelings.

In this way, the therapist exhibits respect and understanding toward the client, rather than judgment.

For example, if the client says, “I’m not sure my drinking is a problem, but I heard that alcohol kills brain cells”, the therapist may reply, “I hear you wondering if your drinking is causing harm to yourself”.

Develop discrepancy

This technique points out the differences between a client’s stated values and their current behavior.

For example, a client may say that they value being healthy but continue to have six alcoholic drinks a day.

To address this, the therapist may say, “On one hand, you say health is important to you, yet you continue to drink amounts of alcohol that you know aren’t good for you”.

Roll with resistance

It is natural for people struggling with substance abuse to be in denial and resist change. Most substance abuse therapies confront resistance, which usually leads to further defensiveness and barriers to change.

Motivational Enhancement Therapy therapists, in contrast, use resistance to further discussion and alter client perceptions.

For example, a client may say, “I can’t stop drinking”. Instead of arguing the point, the therapist might remark, “It indeed may be difficult to quit. What prevents you from stopping?”

Remember, one of the goals of MET is to have clients come up with their own solutions. This is made much more difficult if the therapist spends their time trying to convince the client they are wrong.

Support self-efficacy

Self-efficacy is the belief that you can accomplish a specific task. A client is much more likely to continue to exert the necessary effort if they have self-efficacy in their ability to maintain adaptive behavior change.

It is the job of the MET therapist to provide support and negate any maladaptive thoughts.

For example, a client may say, “I’m not sure I can keep up my sobriety. It is too hard”. The therapist might then reply: “Too hard? Haven’t you already maintained it for two months?”

Considerations for integrating Motivational Enhancement Therapy into your private practice

When attempting to integrate Motivational Enhancement Therapy into your therapy practice, please keep in mind the following considerations:

• The two resources you must have to begin to implement MET: The motivational enhancement therapy manual and the official motivational interviewing website. These are valuable tools that provide the basic information you will need to know.
• While MET has been consistently linked to lower alcohol consumption, the evidence is not as clear for its use as a standalone treatment for other mental health conditions. Theoretically, it can be used to change any type of behavior, but not enough research has been conducted on MET to offer definitive proof.
• Because of the lack of research, it is often recommended that MET be used as an adjunct to more proven therapies (e.g., cognitive behavioral therapy) to increase motivation towards engaging in those treatments. It can be administered when clients appear hesitant or lack motivation during intake.
• Therapists must have a reliable HIPAA-compliant teleconferencing platform, such as TheraPlatform, for safe and effective implementation of MET through telehealth.

Adapting Motivational Enhancement Therapy for teletherapy

Because we live in the era of telemedicine, a few simple tweaks can help adapt MET to virtual therapy:

1. Exhibiting empathy is a major principle of MET and can be difficult to express online. Therapists should make extra effort to display a warm tone, make good eye contact, and display open body language (e.g., uncrossed arms). They can also clarify and paraphrase client responses to increase feelings of understanding.
2. It can be more difficult to hear what is said when conducting teletherapy. Therapists must increase their volume and clearly enunciate.
3. Because body language is not fully seen in a virtual session, therapists must attempt to emphasize the supportive behavior that is so integral to MET. This may mean more head nodding, along with affirmative statements (e.g., “tell me more”).

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Documenting Motivational Enhancement Therapy

An essential component of MET (and indeed nearly all therapeutic work) is accurate, timely documentation.

One common structure is the SOAP format:

• S (Subjective): What the clients report — emotional state, concerns, events since last session.
• O (Objective): What the therapist observes — interaction patterns, tone, nonverbal cues.
• A (Assessment): Therapist’s clinical interpretation — what the subjective and objective data suggest in terms of attachment needs, emotional blocks, and relational dynamics.
• P (Plan): What will be done going forward — interventions, new homework, focus for next session.

Example SOAP Note for Motivational Enhancement Therapy (MET)

S — Subjective

Client reports, “I know my drinking causes problems, but it also helps me relax. I’m not sure I’m ready to give it up.” Rates importance of change as 6/10 and confidence in ability to change as 4/10 (readiness ruler).

Client acknowledges recent negative consequences, including missed workdays and increased conflict with partner, but also expresses concern about losing a primary coping strategy. Denies current withdrawal symptoms. No safety concerns reported today.

O — Objective

Engagement/Behavior: Client arrived on time, cooperative, and engaged throughout session. Affect congruent; speech clear and goal-directed.

MET Interventions Provided (Phase 1–2 focus):

• Reviewed assessment feedback and summarized patterns of substance use and related consequences.
• Explored pros and cons of change vs. no change using guided open-ended questions.
• Used reflective listening and affirmations to convey empathy and reduce defensiveness.
• Developed discrepancy between client’s stated values (health, reliability, relationships) and current substance use patterns.
• Emphasized client autonomy (“It’s your decision whether and how to change”).
• Introduced change plan worksheet; client identified one short-term goal.

Client Responses:

• Verbally acknowledged discrepancy (“I don’t like that this is affecting my relationship”).
• Generated at least two self-motivated reasons for change without clinician prompting.
• Identified one potential barrier and one personal strength supporting change.

A — Assessment

Client presents in the Contemplation stage of change, with emerging movement toward Preparation. Ambivalence remains present but motivation has increased as evidenced by spontaneous change talk and engagement in change planning.

Client demonstrates growing insight into the impact of substance use and increased self-awareness of values misalignment. Confidence remains low but shows improvement when past successes are highlighted.

Clinical Impression: MET is medically necessary to strengthen motivation, consolidate commitment to change, and support readiness for engagement in adjunctive treatment (e.g., CBT, SUD programming).

P — Plan

Frequency/Duration: MET sessions 1×/week for 2–3 additional sessions.

Next Session Focus:

• Continue strengthening commitment to change (Phase 2).
• Refine and review individualized change plan.
• Reinforce self-efficacy using past successes and current progress.
• Reassess readiness and confidence ratings.
• Determine appropriateness of transition to or integration with additional therapeutic modalities.

Modality: Telehealth via HIPAA-compliant platform.

How EHRs can help with documentation

Modern EHR/practice management platforms (such as TheraPlatform) assist greatly with documentation by providing HIPAA‑compliant, integrated systems for note entry, storage, scheduling, and billing.

They allow therapists to:

• Use and customize templates (e.g., SOAP, DAP, and others) or build their own to streamline note writing and ensure consistency.
• Link notes to treatment plans, goals, and session history so client progress is easily tracked over time.
• Utilize e-fax and secure document sharing via client portal to safely exchange information with clients or other providers while maintaining confidentiality.
• Leverage dictation and telehealth transcription, which can automatically convert sessions into therapy or assessment notes, saving time and reducing manual entry.
• Take advantage of AI features that streamline documentation by automatically populating intake form data into assessment templates and generating complete therapy and assessment notes from the information you provide, all with a single click.

Meanwhile, AI‑assisted note tools are emerging which can further help clinicians by:

• Automatically transcribing session audio (if permitted) and highlighting key moments (e.g. emotional shifts, major themes).
• Suggesting draft notes or filling in objective or assessment sections based on observed data, freeing up clinicians’ time.
• Supporting consistency and reducing missing components in notes, which helps from both clinical, legal, and insurance perspectives.

Together, structured SOAP‑type notes, good EHR platforms, and smart AI tools support better therapeutic outcomes, more efficient workflows, and stronger accountability.

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References

Miller, W., Zweben, A., DiClemente, C., and Rychtarik, R. National Institute on Alcohol Abuse and Alcoholism. Motivational Enhancement Therapy Manual. https://www.niaaa.nih.gov/sites/default/files/match02.pdf

Project MATCH (1993). Rationale and methods for a multisite clinical trial matching patients to alcoholism treatment. (1993). Alcoholism, clinical and experimental research, 17(6), 1130–1145. https://doi.org/10.1111/j.1530-0277.1993.tb05219.x

Raihan N, Cogburn M. (2023, Mar 6). Stages of change theory. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK556005

UKATT Research Team (2005). Effectiveness of treatment for alcohol problems: findings of the randomised UK alcohol treatment trial. BMJ (Clinical research ed.), 331(7516), 541. https://doi.org/10.1136/bmj.331.7516.541