M Motivational Enhancement Therapy, or commonly known as MET, is structured around the principles of igniting internal motivation for those who lack motivation to address their problems by methods of motivational psychology. This method implements procedures that motivates the client to recognize their substance abuse problem without guiding or step by step training to recovering. The client must rely on their own resources and come to terms on their own that they need help as their life is at stake.
In a traditional MET treatment plan, there are 4 planned individualized sessions:
T The early phase of MET focuses on developing clients’ motivation to making a change by reflective listening, addressing consequences with bad habits, and instilling optimism about the client’s ability to change their behavior. Some substance abusers will enter a program with the mind set of contemplating change. They may already be considering taking action and require motivation and encouragement to make the commitment. In this incident, the therapist’s task is to shift the balance in favor of change by supporting the change and complimenting the client’s decisions for that change. Eight strategies toward this end (Miller and Rollnick 1991) are outlined in this section.
Encouraging Self Motivational Statements
This strategy is based solely on the premise that we can “talk ourselves into” or “as I hear myself talk, I learn what I believe” or “if I say it, and no one has forced me to say it, then I must believe it.” This strategy relies on the therapist’s ability to instill that optimism of recovery to the point that the client verbally says with confidence that they have the means to make a commitment and go through with it.
To get to that point the therapist can ask questions or develop statements that can be considered self-motivating, these include:
Leading questions such as these can help the client come to these conclusions:
These types of leading questions helps the client’s identify the severity of their problem and lead them into a solution that encourages change, without telling them or instructing them to change.
Listening with Empathy
This strategy is key in MET as the whole goal is to have the client find the motivation from within to be sober. Listening with empathy is commonly known as active listening, reflective listening, or understanding. In this style, the therapist listens attentively to the client, and summarizes or reflects it back to the client in a conclusive manner. Acknowledgment of the client’s feeling about their substance abuse offers a number of advantages:
Affirming the Client
MET is to motivate the client to develop a drive to change their behavior. Positive re-enforcement is key in this method of therapy. Finding opportunities to encourage, compliment, and reinforce the client sincerely as it strengthens the relationship between therapist and client. Promotes the attitude of self-responsibility and empowerment in the change, and supporting client self-esteem. Some examples during treatment are:
K Knowing when to move forward with a plan of commitment is key in moving on to phase two. There are no universal signs that a client is ready to make a commitment to change, however, during sessions these responses from the client may indicate their readiness:
Discussing the Plan
At this point in the treatment the focus is on reasons for change (building motivation) to negotiating a plan for change is important. The momentum the client feels about making the decision should be capitalized on as the positive feeling of moving forward with their life in a positive direction is the motivation the therapy depends on. The objective during this phase is to help generate realistic ideas for a plan of action that generates hope for a full recovery. The overall message is, “Only you can change your drinking, and it’s up to you.”
When discussing a plan for change, worksheets and leading questions can help the client see the solution to their problem and help them develop their own plan for sobriety. Again, their solution, their motivation, their plan, is important for MET to work. The answers to their problems have to come from them to ensure their sobriety. The client may ask for advice or recommendations, this is a positive direction and advice should be given, however, with the clear implication that the decision to execute the plan is their choice depending on their will. The motivation to that plan is the therapist real goal.
Each plan should be developed based on the client’s needs and level of addiction.
O Once a strong foundation for motivation for change is achieved (Phase 1) and the client’s commitment to change has been established with a defined plan (Phase 2), MET focuses on the strategies for following through with the plan ( phase 3). Three processes are involved in following through.
Begin a session with a recap of what has happened since your last session. Discuss the commitment and plans the client made in achieving sobriety. Explore what progress the client has made toward these future goals and how these plan benefit the client’s objectives. Respond with reflection, questioning, positive re-enforcement, and re-framing the client’s perspective on their substance abuse.
The Phase 1 processes can be revisited to renew motivation for change by mentioning future goals, consequences to the client’s health if their substance abuse lifestyle is continued and reasons for change the client thinks is the most important to them. Again, using positive re-enforcement to encourage hope for a full recovery.
Rebuilding Commitment Choices
This may simply be a reaffirmation of the commitment made earlier or capitalizing on that momentum for change that was established in Phase 2. If the client has encountered significant problems or doubts about the initial plan, take the time to reevaluation, encourage their choice of freedom in the commitment plan, positive affirmation, perhaps moving toward a new plan and commitment if their motivation is stifled. Seek to reinforce the client’s sense of autonomy and self-efficacy—an ability to carry out self-chosen goals and plans.
Here is an example of a therapist- client session for motivating a changing in alcohol consumption. Notice the therapist’s role of reflective listening and leading questions so the client arrives at the solution. This dialogue is indicted with T for therapist and C for client.
THERAPIST: What else concerns you about your drinking?
CLIENT: Well, I’m not sure I’m concerned about it, but I do wonder sometimes if I’m drinking too much.
T: Too much for . . .
C: For my own good, I guess. I mean it’s not like it’s really serious, but sometimes when I wake up in the morning I feel really awful, and I can’t think straight most of the morning.
T: It messes up your thinking, your concentration.
C: Yes, and sometimes I have trouble remembering things.
T: And you wonder if that might be because you’re drinking too much.
C: Well, I know it is sometimes.
T: You’re pretty sure about that. But maybe there’s more.
C: Yeah—even when I’m not drinking, sometimes I mix things up, and I wonder about that.
T: Wonder if . . .
C: If alcohol’s pickling my brain, I guess.
T: You think that can happen to people, maybe to you.
C: Well, can’t it? I’ve heard that alcohol kills brain cells.
T: Um-hmm. I can see why that would worry you.
C: But I don’t think I’m an alcoholic or anything.
T: You don’t think you’re that bad off, but you do wonder if maybe you’re overdoing it and damaging yourself in the process.
T: Kind of a scary thought. What else worries you?
Miller, W., Zweben, A., DiClemente, C., & Rychtarik, R. (1999). MOTIVATIONAL ENHANCEMENT THERAPY MANUAL A Clinical Research Guide for Therapists Treating Individuals With Alcohol Abuse and Dependence. National Institute on Alcohol Abuse and Alcoholism Project MATCH Monograph Series, 2. Retrieved July 21, 2015, from http://pubs.niaaa.nih.gov/publications/ProjectMatch/match02.pdf
Neukrug, E. (2011). Counseling theory and practice. Australia: Brooks/Cole, Cengage Learning.