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 uses the transtheoretical model of change as a basis for motivating clients to adopt healthier behavior. It is essentially a brief adaptation of motivational interviewing used specifically for substance abuse. 

Prochaska and Diclemente’s transtheoretical model for change proposes that people transition through six distinct, but not necessarily linear, stages in the process of modifying problematic behavior. It theorizes that people are not ready to make a meaningful change until they proceed to the later stages of the model, which often appears to be the reason that substance abuse treatment is unsuccessful. Motivational Enhancement Therapy attempts to help individuals successfully move through these steps in an effort to overcome ambivalence and induce readiness for quitting drugs and alcohol.  

Phases of Motivational Enhancement Therapy

Before treatment begins, clients participate in a comprehensive substance abuse assessment battery that takes several hours. Once they have completed the assessment, they are ready to embark on treatment.

Motivational Enhancement Therapy has three phases carried out over two to four sessions. 

1. Building motivation to change. In this first phase, assessment results are reviewed and the therapist provides structured feedback. The client is presented with the negative consequences of their substance abuse behavior. The phase is complete when the client expresses a genuine commitment to change. 

2. Strengthening commitment to change. The next phase focuses on developing a plan for how to implement change. The client creates this plan with guidance from the therapist. 

3. Follow through and consolidation of motivation. The final phase reviews progress and renews motivation to maintain positive changes in behavior. 

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Techniques of Motivational Enhancement Therapy

Motivational Enhancement Therapy is a client-centered therapy. Rather than being overtly directive, the therapist acts as a collaborative guide on the client’s journey toward change. A Motivational Enhancement therapist uses these five techniques to help clients self-motivate toward their goals:

Express empathy 

 This technique is used to build trust with the client. The therapist acts as a supportive listening board rather than an authority chastising past behavior. They continuously express respect and understanding toward the client. In this way, the therapist builds an environment where the individual feels accepted and has the power to make positive change. 

Develop discrepancy 

This technique raises the client’s awareness of the impact of their behavior. The therapist points out how the client’s substance abuse conflicts with their desired outcomes. This discrepancy serves to motivate them toward making a plan to alter their behavior in a way to achieve their desired goals. 

Avoid arguments 

A Motivational Enhancement Therapy therapist does not argue with their client even if they disagree. Arguments tend to lead to client resistance. Instead, the therapist uses strategies to help the client see the negative impact of drug and alcohol use. The goal is to have the client advocate for change rather than have the therapist demand it. 

Rolling 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 “they can’t stop drinking”. Instead of arguing the point, the therapist might remark that it indeed seems hard to stop and explore what makes it so difficult. Remember, one of the goals of Motivational Enhancement Therapy 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 one has in themselves to successfully perform a task. It is key to any behavior change. The Motivational Enhancement therapist consistently supports the client in their effort to curb their substance abuse. It is the therapist’s job to instill the belief that a client has the power to make positive change. 

Advantages and disadvantages of MET

Pros

• It is brief. Not many therapies provide results in four sessions or less. 

• It increases internal as opposed to external motivation, leading to more lasting effects.

• The American Psychological Association recognizes Motivational Enhancement Therapy as having “strong research support” in the treatment of alcohol abuse. As such, it is covered fully by insurance. 

• It has also been successful in treating “marijuana dependent adults” when combined with cognitive-behavioral therapy.

• While it was created specifically for alcohol abuse, it has also been found to help motivate people with treatment for other disorders. For example, it has been found to increase safe-sex behavior in the HIV population and improve participation in veterans engaging in PTSD treatment. 

Cons

• Motivational Enhancement Therapy has a mixed success rate with drugs other than alcohol and marijuana (e.g., opioids, cocaine, heroin). Although Motivational Enhancement Therapy was designed as a standalone therapy, it may be best used as a starting point for the treatment of drug abuse. Motivational Enhancement Therapy appears effective at motivating people to engage in drug treatment but may not produce lasting changes without the help of other therapies. 

Resources

• Because Motivational Enhancement Therapy is included under the umbrella of motivational interviewing, specific training for Motivational Enhancement Therapy is hard to find. It is advisable to first seek training for MI and then read the highly descriptive Motivational Enhancement Therapy manual to use the specific Motivational Enhancement Therapy approach. You can learn the basics of Motivational Enhancement Therapy in only a few days. 

• The motivational interviewing website is a wealth of information for all things MI. Here you can find information about training and resources that will get you up to speed on MET.

• Therapist Aid has several worksheets that are relevant for clients utilizing MET.

• Training for MI is readily available online. PESI offers an intensive online course presented by MI founder Stephen Rollnick. 

• If you wish to go more in-depth, various universities in the U.S. offer courses that provide certification in MI. These include the University of Maryland School of Social Work and the University of Massachusetts Medical School.

• Dawn Elise Snipes, Ph.D. has a free video online that does a good job presenting the basics of MET. 

Motivational enhancement therapy is a substance abuse treatment that uses motivational interviewing principles to promote change. It is a very brief therapy that is effective with resistant clients that may not be quite ready to loosen the grip of alcoholism on their own.