Motivational Enhancement Therapy For Substance Abuse

Finding the Motivation to Change Your Life

What is Motivational Enhancement Therapy?

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:

  • Feedback from client about substance abuse. Do they identify they need help? What concerns them about their bad habit? Do they consider their substance abuse life threatening? What is their motivation for change currently life at this moment?
  • Further feedback on initial assessment about their substance abuse problem. Inquiry about future plans and whether their substance abuse problem conflicts with those goals. Is their concerns about their bad habits enough to motivate change within them?
  • These last two sessions are at the mid-point of their treatment. Hopefully by now the client has identified the risks of continuing their bad habits and identified their need for change to achieve their future goals. These last two sessions focus on reinforcing progress with their decisions for change, encourage reassessment about their bad habits, and focus the client on achieving their future goals with the motivation to sobriety.

Motivational Enhancement Therapy (MET) is a very effective outpatient treatment plan for those who have problems with consuming alcohol to a destructive level. This type of therapy requires few therapist to client one on one sessions and relies heavily on the client using their own resources and goals to motivate them for sobriety. The focus of this type of therapy is to get the client to identify the severity of the bad habit and change for the better to achieve future goals that cannot be met under the influence.

Principles of Motivational Enchantment Therapy

T The MET principles relies on the foundation that the client has the capability and responsibility to change their habits. The therapist’s role is to create the conditions for the client to come to that realization and enhance the client’s motivation and commitment to change focusing on potential goals and identifying the severity of their substance abuse problem. Miller and Rollnick (1991) highlighted five basic principles for a successful MET treatment plan:

Expressing Empathy

The therapist avoid the role of superiority and focuses on communicating great respect for the client and their situation of their substance abuse. Establishing the role of supportive companion and trusted consultant, ensures the client has a freedom of choice and self-direction with the therapist guiding the conversations in the client realizing, for themselves, the severity of their problem and the conflict it could have with future goals.

Motivating, complimenting, empowering, these concepts are key to this type of therapy as the therapist plays the role of listener and not telling the client how to address their problem. Gentle persuasion towards the right direction is important, however, the therapist is constantly under the assumption that the change the client must make in entirely up to them. The power of such gentle, nonaggressive persuasion has been widely recognized in clinical writings, including Bill Wilson’s own advice to alcoholics on “working with others” ( 4th Edition of Alcoholics Anonymous 1976).

Developing Discrepancy

Motivational Enhancement Therapists focus on bringing the clients attention to the discrepancy between their current lifestyle and their future goals. Focusing on the negative aspects of their bad habit like health risks, financial investment in habit, hindrance of cognitive abilities, or social decline in family and friend relationships. These consequences become a motivational catalyst for change.

Avoiding Argumentation

In many cases, the client may feel like discussing their substance abuse problem is an attack on themselves and may provoke defensiveness and opposition to the therapist’s methods. In the MET approach, argumentation is avoided at all costs and the therapist just brings the consequences of substance abuse to the client’s attention. When MET is conducted properly, the client and not the therapist voices the arguments for change (Miller and Rollnick 1991).

Roll With Resistance

MET principles do not combat resistance head on, but rather “roll with” the momentum, by shifting client perceptions of their substance abuse problem. The therapist mildly suggests new ways of thinking. This should result in the client coming up their own solutions rather than provided by the therapist.

Support Self-Efficacy

Self-efficacy is the belief that an individual can perform a specific behavior or accomplish a particular task. When applied to substance abuse, the client must be convinced that it is possible to change their bad habit regardless of their current situation. This is more commonly known as hope or optimism. Unless this thought process is instilled into the client about their problem, their motivation of change will not exist.

Motivational Enhancement Therapy (MET) is a very effective outpatient treatment plan for those who have problems with consuming alcohol to a destructive level.

Practicing Strategies

Phase One: Building Motivation for Change

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:

  • Creating open dialogue about substance abuse
  • Acknowledge or bring the client’s attention to real problems related to the substance abuse
  • Get them to express their need or willingness to change

Leading questions such as these can help the client come to these conclusions:

  • I assume, from the fact that you are here, that you have been having some concerns or difficulties related to your drinking. Tell me about those.
  • Tell me a little about your drinking. What do you like about drinking? What’s positive about drinking for you? And what’s the other side? What are your worries about drinking?
  • Tell me what you’ve noticed about your drinking. How has it changed over time? What things have you noticed that concern you, that you think could be problems, or might become problems?
  • What have other people told you about your drinking? What are other people worried about? (If a spouse or significant other is present, this can be asked directly.)
  • What makes you think that perhaps you need to make a change in your drinking?

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:

  1. It is unlikely to evoke client resistance and you are clarifying their feelings about the matter.
  2. It encourages the client to keep talking and exploring the topic, and to rationale their situation with their problem.
  3. It communicates respect, care, and builds a working therapeutic alliance of acceptance and comfortability
  4. It clarifies for the therapist exactly what the client means as feelings may be contradictory to the client. For example, the client may convey that they enjoy alcohol consumption but only at the time or in that present moment. The client may be trying to convey that only in that moment do they enjoy it and when sober regret the decision and how they feel when not under the influence.
  5. It can be used to reinforce ideas expressed by the client as a method of self-motivation. This last advantage is key as the therapist can reflect quite selectively, choosing to reinforce certain components of what the client has said and ignoring others. In this way, clients not only hear themselves saying a self-motivational statement, but also hear you saying that they said it.

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:

  • I think it’s amazing that you’re strong enough to recognize the risk here and that you want to do something before it gets more serious.
  • You’ve been through a lot, and I admire the kind of commitment.
  • You really have some good ideas for how you might change.
  • You’ve taken a big step today, and I really respect you for it.

 

Phase Two: Strengthening Commitment for Change

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:

  • The client stops resisting and raising objections.
  • The client asks fewer questions.
  • The client appears more settled, resolved, unburdened, or peaceful.
  • The client makes self-motivational statements indicating a decision to change. (“I guess I need to do something about my drinking “ “If I wanted to change my drinking, what could I do?”).
  • The client begins imagining how life might be after a change or developing future goals that involve being sober.
  • Has the client missed previous appointments or canceled prior sessions without rescheduling?

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.

 

Phase Three: Following Through Strategies

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.

  1. Reviewing progress
  2. Renewing motivation
  3. Fortifying the will of commitment

Reviewing Progress

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.

Renewing Motivation

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.

Dialogue

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.

C: Yeah.

T: Kind of a scary thought. What else worries you?

Key Concepts of MET

Key Concepts of MET

  • Motivational Enhancement Therapy (MET) can be used in conjunction with other treatment programs for more intense addictions like narcotics and alcoholism.
  • The principles for MET focus on igniting internal motivation for those who lack motivation to address their problems by methods of motivational psychology.
  • The therapist must convince the client to be optimistic and develop a sense of hope of recovery.
  • Alone, this method works well in outpatient programs with only 4 sessions for alcoholism, however, should be paired with another methods of treatment for other addictions.
  • Arguing with the client is prohibited in this type of therapy.

Strengths in MET Treatment

Strengths in Treatment

  • Encouraging the client’s motivation from within is important for full recovery. Identifying the consequences of continued bad habit that could conflict with future goals can motivate a change in behavior.
  • Instill hope or optimism about recovery, increasing rate of success.
  • Avoids being told how to recover, instead allows clients to develop a healthy rationale for recovery.

Conflicts with MET Treatment

Conflicts with Treatment

  • This method of treatment may be consider weak on its’ own, and may require an additional method to ensure full recovery.
  • This method has only 4 distinct sessions planned and the client may need more than 4 to be confident in their recovery.

References:

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.