Motivational Enhancement Therapy: An Evidence-Based Approach to Making Positive Changes

Poor mental health occurs in patients for many reasons. 

Naturally, there are many ways to combat it, with treatments focusing on different aspects of behavior to regulate or encourage. 

Motivational Enhancement Therapy tackles a patient’s lack of desire to change.

Read on to learn more!

What is Motivational Enhancement Therapy (MET)?

Motivational enhancement therapy is a therapeutic method that helps patients foster a sense of motivation from within. 

It has achieved great results in people who once were considered to have little motivation.

It is a particularly effective treatment for people who struggle with motivation as a result of self-destructive behaviors or substance abuse issues.

The Rise of Motivational Enhancement Therapy

Motivational Enhancement Therapy, or MET, is a recently developed therapeutic method. 

It had its origins in the MATCH Project, which was a longitudinal study of alcoholics and the treatments that worked best for them.

The study ran for 8 years, beginning in 1989.

What Happens in Motivational Enhancement Therapy: Goals and Principles

MET encourages self-directed change.

MET therapists are skilled at inspiring their patients through motivational conversations and proactive goal-setting.

So, How Does this Look in a Clinical Setting?

Before beginning treatment, the therapist asks the patient to take some assessments to set to get a baseline for the therapist to work with. 

These assessments may take several hours but they are worth it to understand the context of the situation. 

After this, MET treatments can usually be wrapped up in just four sessions:

• Session 1: works on motivation. The therapist asks questions aimed at motivating the patient.

• Session 2: The therapist and the patient make a plan for long-term change, based partly on the results of the first session.

• The last two sessions are to follow up on progress made on the plan. The therapist will review the successes and failures of the treatment, reaffirming the patient’s motivation and commitment to the process.

 More sessions can be built in to discuss adjustments to the plan, as well as to plan against (and recover from) any relapses. 

Goals and Principles

Express Empathy 

This is important in building trust.

No real therapeutic progress as possible without trust.

There is a range of verbal and non-verbal ways to do this.

The therapist might practice active listening as well as summarizing back to the patient what was said.

Throughout the whole process, the therapist should be non-judgemental.

Acknowledge Discrepancy 

This is a powerful part of the therapy where the patient freely acknowledges the effect that self-destructive behavior (such as substance abuse) is having on them. 

The discrepancy can be defined as a kind of measure of the distance between where the patient is now and where they would like to be in the future. 

Avoid Arguments

The patient is in a vulnerable state once they have admitted discrepancy. 

They will be sensitive to any implied or actual criticism on the part of the therapist.

The therapist should be non-judgemental at all times.

Accept Resistance

If the patient appears not to want to change, it is important not to push them.

The patient will think things through in their head long before openly committing to change. 

However, the therapist can encourage the patient to reflect on their decisions.

Change is more likely to be a product of the reflective process. 

Support Self-Efficacy 

Self-efficacy in the MET setting is about understanding that you have what it takes to change.

Of course, this takes time.

The therapist should gently support this process as much as possible.

Who can Motivational Enhancement Therapy Benefit?

So far, we have discussed MET in the context of treating substance abuse because that is where it is most widely used.

But did you know that it can be applied to many types of problems?

These are some of the areas where MET works well:

Alcohol Use Disorder

MET is endorsed by the US military for those with alcohol problems because it is so effective.

For more on this, see the U.S. Department of Veteran Affairs website.[1] 

The US Medical Management Treatment Manual published by the US National Institute on Alcohol Abuse and Alcoholism also uses the MET change/plan worksheet.

Bipolar Disorder

Studies on motivational interviewing techniques indicate that MET can work well in conjunction with other therapies for bipolar disorder.[2]

Compulsive Gambling

Trials of the use of MET therapy for problem gamblers have shown excellent results, especially when used with Cognitive Behavioral Therapy.[3]

Eating Disorders

MET makes an effective pre-treatment therapy for people with eating disorders.

As eating disorders are often associated with a lack of motivation for change, MET is valuable here.[4]

Generalized Anxiety Disorder (GAD)

This is another disorder where an MET assessment prior to starting treatment has been shown to work well.[5]

Obsessive-Compulsive Disorder (OCD)

Motivational enhancement interviewing techniques aid the traditional response and exposure-type treatments used in treating patients with OCD.[6]

Post-Traumatic Stress Disorder (PTSD)

MET therapy can be used alongside Cognitive Behavior Therapy (CBT) to help people with PTSD.[7] The results were especially promising in people with both PTSD and substance abuse disorders.

Benefits of Motivational Enhancement Therapy 

As well as being a highly-effective, modern therapy that empowers the patient, MET is also practical. 

This is great for patients who need quick results due to life-threatening substance abuse disorders, and others whose conditions make them severely distressed.

It is much more convenient to attend a course of MET than spend thousands of dollars on a long-drawn-out psychoanalytical form of therapy that may take several years.

It’s Fast

MET is known for its fast results.

In just a few sessions, people can make remarkable progress.

Because of the rapid progress that MET offers, it is an economical choice.

Reduces Resistance

If a therapist challenges or tries to manipulate a patient into “making the right decision,” they are likely to be met with resistance.

The nature of MET means therapists avoid this type of resistance.

Emphasizes Choice

The therapist works with the patient rather than telling them what to do.

This builds a sense of collaboration and trust.

The Bottom Line

Motivation Enhancement Therapy is an excellent practical therapy that works fast and empowers the patient to take responsibility for their decisions.

It encourages the patient to encourage themselves, creating positive behavioral patterns through motivational strategies.

It is widely used in treating substance abuse problems, and can effectively treat many other conditions and behaviors as well! 

Thanks for reading!

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• Teletherapy is an increasingly popular way for people to get help. Find out whether it might be the right option for you.
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References:

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• [1] https://www.mentalhealth.va.gov/substance-use/treatment.asp.
• [2] Jones, S. H., Barrowclough, C., Allott, R., Day, C., Earnshaw, P., & Wilson, I. (2011). Integrated motivational interviewing and cognitive-behavioural therapy for bipolar disorder with comorbid substance use. Clinical psychology & psychotherapy, 18(5), 426–437. https://doi.org/10.1002/cpp.783.
• [3] Petry, N. M., Weinstock, J., Ledgerwood, D. M., & Morasco, B. (2008). A randomized trial of brief interventions for problem and pathological gamblers. Journal of consulting and clinical psychology, 76(2), 318–328. https://doi.org/10.1037/0022-006X.76.2.318.
• [4] Feld, R., Woodside, D. B., Kaplan, A. S., Olmsted, M. P., & Carter, J. C. (2001). Pretreatment motivational enhancement therapy for eating disorders: a pilot study. The International journal of eating disorders, 29(4), 393–400. https://doi.org/10.1002/eat.1035.
• [5] Westra, H. A., Arkowitz, H., & Dozois, D. J. (2009). Adding a motivational interviewing pretreatment to cognitive behavioral therapy for generalized anxiety disorder: a preliminary randomized controlled trial. Journal of anxiety disorders, 23(8), 1106–1117. https://doi.org/10.1016/j.janxdis.2009.07.014.
• [6] Simpson, H. B., & Zuckoff, A. (2011). Using Motivational Interviewing to Enhance Treatment Outcome in People with Obsessive-Compulsive Disorder. Cognitive and behavioral practice, 18, 28–37. https://doi.org/10.1016/j.cbpra.2009.06.009.
• [7] Coffey, S. F., Schumacher, J. A., Nosen, E., Littlefield, A. K., Henslee, A. M., Lappen, A., & Stasiewicz, P. R. (2016). Trauma-focused exposure therapy for chronic posttraumatic stress disorder in alcohol and drug dependent patients: A randomized controlled trial. Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors, 30(7), 778–790. https://doi.org/10.1037/adb0000201