Motivational Enhancement Therapy (MET)
Motivational enhancement therapy (MET) is a form of psychotherapy (Counselling) that focuses on improving an individual’s motivation to change. Those who engage in self-destructive behaviors (Alcoholism & Drug abuse) may often be ambivalent or have little motivation to change such behaviors, despite acknowledging the negative impact of such behaviors on health, family life, or social functioning.
MET is based on the principles of motivational psychology and employs techniques associated with Motivational Interviewing, a counseling style developed by William R. Miller and Stephen Rollnick. In MET, the style and techniques of Motivational Interviewing are incorporated into a structured therapeutic approach which involves a comprehensive assessment of an individual’s behaviors, as well as systematic feedback based on the findings.
MET is a development of the Transtheoretical Model of Change (TMC) (Prochaska et al., 1992), designed to help clients build commitment and reach behavioral change. It draws on strategies from client-centered psychotherapy, cognitive therapy, systems theory, and the social psychology of persuasion.
Features of MET are:
a) It is brief in duration
b) The counseling relationship is more like e a partnership than expert/recipient roles
c) Motivation to change is elicited from the client
d) Direct persuasion is avoided
e) The style is generally quiet and eliciting
f) Readiness to change is seen as fluctuating in relation to interpersonal interaction
Transtheoretical Model of Change (TMC) is different from most theories of psychotherapy because its focus is on how people change rather than on defining the problem. Based on their research, Prochaska et al. (1992) proposed that people who change behaviors, whether on their own or with the help of a therapist, tend to go through five stages of change.
The five stages of change are:
1. Precontemplation. The client does not consider his or her behavior to be a problem and/or is not currently considering changing his or her behavior.
2. Contemplation. The client is considering that his or her behavior may be a problem and is seriously thinking of, or contemplating, changing his or her behavior.
3. Preparation. The client has made a commitment to change his/her behavior that he/she considers problematic, and is intending to make the change soon. The individual may have a specific plan in mind or may simply have a target date set for change.
4. Action. The client is currently in the process of modifying his or her. The individual is considered to be in the action stage for up to 6 months following the initial behavior change (assuming that he or she maintains the change during the period).
5. Maintenance. The client works to prevent a return to the problem behavior and to stabilize the new behaviors that supports his or her new way of living.
Change is difficult, and most people do not successfully maintain behavior change on their first attempt. TMC offers a spiral pattern of the stages of change (linear progression toward change is possible, but rare) in which people can progress from contemplation to preparation to action, but most people will lapse to an earlier stage (Prochaska, 1995). Furthermore, TMC is based on the belief that people learn from the lapse and can try something different the next time to avoid the same mistakes.
Most clients in the beginning of therapy are in precontemplation or contemplation stage of change. In these stages, the therapist works to reduce resistance by using nondirective counseling techniques such as asking open-ended questions, listening reflectively, affirming, and summarizing. As the client moves to the higher stages of change (preparation, action, and maintenance), the therapist becomes more directive and behavioral by assisting the client in developing and implementing a plan for behavioral change (Miller & Rollnick, 2002).
MET has been thoroughly researched in the field of substance abuse with some research specific to adolescent substance abuse clients. Clients with substance abuse issues and adolescents often share the stereotypical characteristics of being resistant, challenging, and narcissistic. Therefore, it is postulated that an effective substance abuse counseling approach would also be successful with adolescents.
MET is designed to help people work through their ambivalence about change, primarily through the use of active listening and gentle feedback techniques. The MET approach is founded on the assumptions that clients have the capacity and responsibility for change and that it is the therapist’s task to create conditions that enhance clients’ motivation for and commitment to change (Miller et al., 1995). In brief, the goal is to prepare people for change, not necessarily to push them into changing right away. MET seeks to support intrinsic motivation for change, which leads the client to initiate, persist in, and comply with behavior change efforts.
Miller and Rollnick (2002) listed six basic motivational principles underlying the MET approach:
(1) expression of Empathy—the therapist communicates respect for the client and listens rather than tells
(2) assisting the client in perceiving Discrepancy—the therapist uses motivational psychology principles to help the client perceive a discrepancy between where he or she is and where he or she wants to be;
(3) avoiding Argumentation because it is seen to evoke resistance, which is a client’s reaction to a threatening interpersonal interaction and resistance is a therapist’s issue;
(4) rolling with Resistance—the therapist does not meet resistance head on, but rather rolls with the momentum, with a goal of shifting client perceptions in the process;
(5) Ambivalence is viewed as normal and openly discussed—the therapist elicits solutions from the client; and
(6) support of Self-efficacy—the therapist works to enhance the client’s sense of self-efficacy, or ability to achieve goals. People only move toward change when they perceive that there is a chance of success. Other central constructs of MET are its unique strategies to increase the likelihood of behavior change, which include handling resistance, the use of a decision balance sheet, and change talk. Each of these strategies is discussed in the following section.
Although MET may be used as a stand-alone treatment, it is more often employed in conjunction with other forms of therapy. This type of therapy can also serve as a form of pre-treatment that may increase a person’s motivation to start a more specific form of therapy, such as cognitive behavioral therapy (CBT). MET might also be used along with a different form of therapy to reinforce one’s motivation to change.
A MOTIVATIONAL ENHANCEMENT THERAPY SESSION
MET is a brief therapy. It usually consists of about 4 sessions, preceded by an initial assessment that collects information on behaviors related to the presenting problem. In the first of the four MET sessions, the therapist will generally provide structured feedback based on the assessment. Feedback from the assessment allows individuals to see how their behavior compares to that of the wider population, and it can allow a person to view any concerns in a new light. During the session, the therapist will likely encourage the person in therapy to address and explore any concerns they may have about a particular issue they are experiencing, including any observations that others have made about the person in therapy’s behavior. The therapist may also ask an individual about short-term and long-term goals and evaluate any ways that a problem behavior may interfere with those goals.
Once a person in therapy has clarified any concerns, the therapist may focus on the options available for addressing those concerns. Treatment options are not prescribed; rather, they are elicited from the individual. For example, a therapist may ask, “What do you think you can do about this problem?” The therapist then works with an individual to create a change plan. This plan outlines desired changes, the reasons change is desired, and the steps the individual will take in order to achieve change. Some of this work might be carried over to the second session, which builds on the initial progress made. A significant other, such as a close relative or friend, may be included in the first few sessions. The last two sessions are intended to reinforce progress and further encourage an individual’s efforts.
MET is both nonconfrontational and non-judgmental. Diagnostic labels that convey a sense of powerlessness over the problem are avoided, while personal choice and control are emphasized. Instead of guiding an individual through a process of change and teaching specific skills, in MET, a therapist typically assumes that the individual already has the resources needed for change and works instead to help an individual mobilize these resources in order to achieve the desired outcome.
WHO CAN MOTIVATIONAL ENHANCEMENT THERAPY BENEFIT?
Research has consistently demonstrated the efficacy of MET in increasing one’s readiness to stop drug use, reducing the severity of substance use, and in lengthening periods of abstinence. Preliminary evidence also indicates that MET may be useful in enhancing the treatment of other conditions, such as anxiety, eating disorders, and problem gambling. This type of therapy may even be of help to persons who are at risk of developing these conditions. Studies further suggest that MET can help stimulate positive changes in health-risk behaviors among youth living with HIV.
MET can be used regardless of an individual’s commitment level. It has been shown to be particularly effective when an individual has a strong resistance to change or is not strongly motivated to change. An example of this is in the case of substance abuse, as individuals who abuse drugs and alcohol may often find it difficult to stop using due to the reinforcing effects of these habits. MET’s focus on rapid change also makes it suitable for cases where the therapist has only limited contact with an individual. The nonconfrontational and non-judgmental style adopted by therapists also makes MET an effective approach in the treatment of adolescents who may be experiencing identity issues and/or trying to assert their independence.