Addiction Treatment: Understanding and Integrating Motivational Enhancement Therapy
Guest Post by Jonathan Liss, Ph.D.
Of course you have heard about Motivational Interviewing, and maybe Motivational Enhancement Therapy. However, if you are not involved with MI or MET regularly, the following summary would be good way to refresh your memory, and provide a springboard for including MI more regularly in your work. Thanks Dr. Liss for this article!
Motivational Enhancement Therapy (MET) is a brief therapy, derived from Motivational Interviewing, designed to produce rapid, internally driven change for individuals in early stages of contemplation about the role of substance use in their life. Though non-directive, this brief (approximately four sessions) therapy aims to harness an individual’s own resources in articulating goals, ideally leading to actionable behavior changes.
MET includes central elements found to promote change that include personalized objective feedback about substance use, respect for choice and agency to create change, individual responsibility for making changes and options about how to change. As always, clinicians and counselors aim for accurate and attuned empathy for the experience of the client – appreciating the benefits, rewards and function of substance use for a particular client as well as potential concerns and consequences.
Supporting the Client’s Self-Efficacy
The aim of Motivational Enhancement Therapy is to support a client’s self-efficacy, leveraging awareness of changes made in the past, in any domain, as example of being able to experiment with making changes now in relation to substance use. Importantly, the client is asked to articulate and develop specific change goals, while the “importance” of making changes along with the “confidence” to make changes is assessed. Gauging importance and confidence helps fine-tune the clinician’s motivational interventions, managing the relative value of making changes along with a client’s belief in their ability to follow through and achieve those changes.
Structuring MET for Success
Though technically a relatively structured four session protocol taking place over a certain number of weeks and utilizing an objectively structured personal feedback report, components of MET can easily be adapted and integrated into individual psychotherapies, brief consultations, family therapy as well as group therapies (see Group Therapy for Substance Use Disorders by Sobell & Sobell, 2011)
Assessment
Typically, extensive assessment information is gathered prior to a first meeting and this information is then presented in a personal feedback session. Feedback is presented in a non-judgmental and neutral manner, with either explicit or implicit permission from the client to review the information. Personalized feedback might offer comparisons to national and regional norms relating to use of a particular substance along with a collection of personalized consequences and specific health risks.
Feedback
Offering feedback can heighten the discrepancy between the client’s understanding of their substance use in relationship to other people along with potential social, legal and health consequences. This information may be followed by exploring specific change goals and impressing upon the client the importance of continuing to collect ongoing data about their use of substances through tracking both frequency and quantity of use.
Identifying and Understanding Triggers
Follow up meetings include having the client work through a detailed functional analysis by identifying triggers or antecedents, both internal and external, to substance use, along with subsequent benefits, consequences and outcomes. As this information is reviewed, a deep understanding of how the substance use functions highlights targets for change and skills training. Functional analysis can also be used to increase adaptive and healthful behaviors, analyzing what triggers a healthy behavior and ways to enhance those triggers. Arguably, as a client becomes more aware of triggers, their willingness to make changes needs also to be assessed. The costs of some changes may be too high for some.
Change
Through an empathic, collaborative and respectful stance, the clinician helps foster movement in any way for the client. A spirit of experimentation with change, with small steps, can begin to highlight and demonstrate a client’s natural confidence and ability to create valued change.
Manuals for Motivational Enhancement therapy can be found through the Alcohol and Drug Institute Library at the University of Washington.
Jonathan Liss, PhD (jonathanlissphd@gmail.com) is a clinical psychologist specializing in addictions. He has a private practice in New York City and also leads addiction groups as part of the Day Treatment Program at Columbia University Medical Center where he is an Instructor of Clinical Psychology.
