Motivational enhancement therapy (MET) is a type of psychotherapy that aims to improve a person’s motivation to change. People who enter into self-destructive behaviors such as alcohol and drug abuse are frequently uncertain or have little motivation to change those behaviors. Even though they freely acknowledge the negative impact it has on their family life, social functioning, and health.
Based on the principles of motivational psychology, MET uses techniques related to Motivational Interviewing (MI) a style of counseling. MI focuses on increasing motivation and setting goals. This approach involves an evaluation followed by 3 to 6 weekly sessions. The sessions encourage discussions about substance use and provoking talk about changing or motivational statements. The goal is to solve their uncertainty and help the person make changes to their substance use patterns.
In MET, Motivational Interviewing techniques are blended into a structured approach that involves a total evaluation of the person’s behaviors and feedback based on the results. Strategies of MET include:
- Setting goals
- Planning for change
- Encouraging internal motivation
What Was the Development of MET?
MET was a development of the Transtheoretical Model of Change (TMC), designed in 1992 to help people build commitment and achieve behavioral change. It calls on client-centered strategies from:
- Psychotherapy in Los Angeles, California
- Cognitive behavioral therapy in Los Angeles, California
- Systems theory
- The social psychology of persuasion
Important Features of MET
- A short span of duration
- The relationship with the therapist is more like a partnership than typical expert/client roles
- Motivation to change is drawn out from the client
- Directly influencing the client is avoided
- The manner is typically quiet and brings out the client’s motivations
- Readiness to change is seen as wavering concerning interpersonal interaction
The Transtheoretical Model of Change differs from most theories of psychotherapy in that its focus is on how people change instead of defining the problem. Based on research, it was proposed that individuals who change their behaviors tend to go through five stages of change, whether it is on their own or with a therapist’s help.
The Five Stages of Change
The individual doesn’t think their behavior is a problem or is not considering changing their behavior right now.
At this stage, the person is considering that their behavior might be a problem and is thinking seriously, or contemplating, changing their behavior.
This is when the person has committed to change the behavior that they believe is a problem and intends to change soon. They may have a certain plan in mind or have a target date for the change.
The person is in the process of changing their behavior. They are considered to be in the action stage for up to 6 months after the first behavior change. This assumes that they maintain the change during that period.
By stage 5, the person is working to prevent a return to the problem behavior and to preserve the new behaviors that support their new way of life.
Change is tough, and most people don’t maintain behavior change successfully on their first try. MET provides a spiral pattern of the stages of change where people can progress from contemplation to preparation to action. However, most people will backslide to an earlier stage. MET is also based on the belief that people will learn from the backslide and try something different the next time.
What is a Motivational Enhancement Therapy Session Like?
As mentioned earlier, MET is a brief therapy. Usually, it consists of an initial assessment that collects information about behaviors that are related to the problem being presented. That is followed by about 4 sessions of therapy.
In the first session, the therapist will typically provide feedback based on the initial assessment. This feedback allows the person to see how their behavior compares to the general population and it allows the person to see their behavior with a different perspective. During the session, the therapist may encourage the person to address and examine any concerns they might have had about a specific issue they’re experiencing.
Any observations that other people have made about the person’s behavior will also be included. The therapist may ask about the person’s short-term and long-term goals and evaluate any ways that their problem behavior may be interfering with those goals. When the person in therapy has expressed their concerns, the therapist may look at the available options for addressing those concerns. Treatment alternatives don’t come from the therapist. Instead, they are evoked from the individual.
How Does Treatment Alternatives Come from the Individual?
Treatment alternatives come from the individual when the therapist may ask, “What do you think can be done about this problem?” The therapist then begins to work with the individual to create a change plan. The plan will outline:
- The changes wanted
- Reasons why the change is wanted
- The steps the person will take to achieve that change
Some of this work may be carried into the second session which builds on the progress made in the first session. A close friend or relative or significant other may be included during the first few sessions. The last two sessions are meant to reinforce progress and to continue to encourage the person’s intentions.
Emphasizing Personal Choice and Control
MET is non-judgmental and non-confrontational. Diagnostic descriptions that contribute to a sense of powerlessness over the problem are avoided, while control and personal choice are highlighted. Rather than guiding a person through a process and teaching skills, the therapist in MET assumes that the person already has the resources needed for change. They then work to help the person prepare the resources to help achieve the desired outcome.
Who Can Benefit from Motivational Enhancement Therapy?
Research has generally shown the effectiveness of MET in increasing a person’s readiness to:
- stop substance abuse
- reduce the severity of the substance abuse
- lengthen the periods of abstinence
Initial evidence also indicates that MET may help strengthen the treatment of other conditions such as:
- Anxiety disorder
- Eating disorder
- Gambling disorder
MET may even be helpful for people who are at risk of developing these conditions. Further studies also suggest that MET can help inspire positive changes in health-risk behaviors among young people living with HIV.
Regardless of an individual’s level of commitment, MET can still be effective. Evidence has shown it to be especially effective when the person has a strong resistance to change or is not very motivated to change. An illustration of this is in the case of therapy for substance abuse in Los Angeles. People who abuse alcohol and drugs often find it hard to stop using because of the reinforcing effects of these behaviors.
The focus of MET on rapid change also makes it appropriate for instances where the therapist only has limited contact with the person. Because of the non-confrontational and non-judgmental style, MET is an effective treatment method for drug rehab for young adults who might be having identity issues or trying to maintain their independence.
How Does MET Work?
MET is designed to help individuals work through their hesitation about change, mostly through the use of active listening and gentle feedback. The approach is based on the assumption that people have the ability and responsibility to change, and the job of the therapist is to create conditions that enhance the person’s motivation for and commitment to change. In other words, the goal is to prepare people for change, not push them into changing right away.
At the beginning of therapy, most people are in the pre-contemplation or contemplation stage of change. At this time, the therapist will work by using nondirective counseling methods such as:
- asking open-ended questions
- listening reflectively
- affirming
- summarizing
As the client moves on to the higher stages of change, the therapist becomes more instructive by helping the person develop and carry out a plan for behavioral change. MET is based on five motivational principles that are meant to guide the therapist’s work with a client:
The therapist expresses empathy through reflective listening. They will listen to what the person is saying and then reflect on it with small changes. The changes let the person know that the therapist has heard and understood them. This builds rapport, encourages understanding, and recognizes that it’s hard to change. This is sometimes known as “engaging.”
The therapist directs attention to the discrepancy between the person’s desired state of being and their actual state of being. The discrepancy can help the person recognize the ways that their current behaviors keep them from achieving their goals. It can also motivate a behavior change. The patient and therapist work together to pinpoint target behaviors they want to change. This part is also called “focusing.”
The therapist will avoid attacking the person or their behavior. This is believed to result in resistance and defensiveness. Gentler methods are needed to raise awareness of problems, and any statements about a need for change should come from the client, not the therapist.
MET techniques work to avoid confrontation. Instead of fighting a person’s resistance, the therapist will try to diffuse it. Uncertainty is part of the process and something to be curious about. Going along with what the person is saying decreases the odds of more resistance and increases the likelihood that they will stay in therapy. During this stage, “change-talk” is drawn out and reinforced.
This is usually the planning stage of MET. A person’s motivation to change usually depends not only on the reasons for changing behavior but also on the belief that they can accomplish the tasks necessary for change. Specific plans for change and to manage pitfalls and critical situations are investigated.
One part of the therapist’s role is to help them become aware that they can successfully carry out their change plan. Commitment and setting goals can often be shared with a family member in the session. This further helps reinforce change.
Even though MET can be used alone for treatment, it is usually used in combination with other forms of therapy. It can also be used as a form of pre-treatment that can increase a person’s motivation to begin a more specific form of therapy such as cognitive behavioral therapy (CBT) in Los Angeles, California.
MET for Substance Use Disorders (SUDs)
It has been found that MET is superior to standard community treatment in reducing drug and alcohol abuse and retaining people in treatment. MET helps encourage people to become motivated to make better choices and changes to the patterns of their substance use disorder. It’s a client-centered and cooperative method.
Motivational Enhancement Therapy has been carefully researched in the area of substance abuse clients. In addition, some of the research has been specific to adolescents with SUDs. Individuals with substance abuse issues and adolescents frequently share the stereotypical characteristics of being resistant to change, difficult, and self-centered. As a result, it is assumed that an effective SUD counseling approach would also be effective for adolescents.
Westwind Recovery® can Assist with Therapy Programs
Are you struggling with substance use disorder or have a loved one who needs help? Is the stigma of addiction or mental illness keeping you from getting the help you or your loved one needs? There is help available in the Los Angeles area that can help you turn your life around. Westwind Recovery® can provide professional, comprehensive treatment for mental illness and substance use disorder. Our therapists are trained and experienced in numerous methods of therapy to treat substance use and mental health issues.
The 2021 National Survey on Drug Use and Health (NSDUH) reported that among the 20.3 million adults with SUD, 37.9% also had a mental illness, and out of the 42.1 million adults with a mental illness, 18.2% also had a co-occurring SUD. You don’t have to struggle alone. Westwind can help you find your motivation to change. Contact us today.
Dr. Deena is the Chief Clinical Officer of Westwind Recovery®, an award-winning outpatient treatment center in Los Angeles where she oversees the clinical and administrative program and treatment methods. Dr. Deena is a doctor of psychology and licensed clinical social worker since 1993. LCSW #20628. Originally from the East Coast, Dr. Deena has worked running treatment centers, worked as a therapist in psychiatric hospitals as well as school settings and currently has a thriving private practice in the LA area. Dr. Deena has appeared regularly on the Dr. Phil Show as an expert since 2003. She has also been featured on many other TV shows, podcasts and has contributed to written publications as well as podcasts.
