The Structure of Motivational Enhancement Therapy
MET begins with an assessment of the new client, which uses strategies developed through Motivational Interviewing (MI) in a few one-hour sessions. There are typically between one and four therapy appointments comprising MET. During sessions, the individual sets their own goals with the guidance of a therapist who draws on strategies developed in Cognitive Behavioral Therapy (CBT), systems theory, client-centered counseling, and social psychology persuasion.
- Motivation for change must come from the client, not the therapist.
- It is intentionally short.
- The therapist must avoid direct persuasion, such as offering rewards.
- The style focuses in eliciting discussion from the client.
- Readiness to change fluctuates in relation to interpersonal interaction.
- Counseling is a partnership between therapist and client.
- Precontemplation: This is the first stage during the first meeting, during which the new client does not believe that they have a problem, so they are not thinking about changing their habits or lifestyle.
- Contemplation: After some discussion with the therapist, the client may begin considering their behavior problematic and start to understand how an underlying cause may be affecting their life in a negative way. They will begin to consider making changes.
- Preparation: The client commits to changing behaviors soon. This leads to making a plan; the therapist will allow the client to work on the plan or listen as the client discusses an existing plan. If the client has trouble, the therapist can guide them on potential steps, suggesting ideas for resources to get help.
- Action: This is the process the client undergoes to change their lifestyle, including modifying their environment and shifting their behaviors. This may involve attending a rehabilitation program, moving houses, and removing intoxicating substances from the home, among others.
- Maintenance: After the action steps have been taken, the client focuses on maintaining these behavioral changes. This could involve setting up a support network to prevent relapse, avoiding places where substance abuse occurred for a certain period of time, and improving overall health through dietary changes and exercise.
- The counselor communicates with respect and empathy for the client, listening rather than telling.
- The therapist uses motivational psychology techniques to help the client understand the discrepancy between their perception of self and their actions.
- The therapist avoids argument because the client is likely to resist due to the perception of the counselor as a personal threat.
- The counselor rolls with the client’s resistance to certain aspects of the process, further avoiding confrontation.
- Using questions and interview techniques, the therapist elicits solutions to problems from the client and acknowledges that ambivalence to the process is normal.
- The counselor supports the client’s need to achieve goals on their own without interference.
When Motivational Enhancement Therapy Works
Like all forms of therapy, MET works for some individuals and does not work well for others. This form of therapy has been used to treat people struggling with substance abuse for several decades, so it is well researched and seems to work especially well for adolescents and people who are incarcerated. These two groups are most likely to undergo substance abuse counseling and rehabilitation without consenting to the process, so they need additional help to admit that they struggle with addiction and need help.
MET works for specific types of substance abuse well. People struggling with alcohol use disorder or marijuana dependency appear to benefit most from MET, especially when combined with Cognitive Behavioral Therapy, which helps the client strategize about specific behavioral changes. The process of MET appears to be less effective for people struggling with nicotine, heroin, and cocaine addiction, and among adolescents experiencing polydrug addiction and abuse.
Sessions involving MET appear to work best in the beginning of treatment; the client benefits from shifting to other, more specific treatment processes later. This involves evidence-based rehabilitation programs, most of which use CBT in group and individual treatment sessions, support groups to maintain a drug-free lifestyle after rehabilitation, and work with doctors and psychiatrists to either continue medication treatment, such as SSRIs to treat depression, or avoid medications that may accidentally trigger relapse.
Findings from Project MATCH, created by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) spanned eight years and found that MET worked best for subjects with the highest levels of anger and resistance. The group was sober on average 76.4 percent of the time compared to other groups.
MET Is Not for Everyone
Motivational Enhancement Therapy appears to be less effective for specific populations when used on its own. Two meta-analyses in a 2011 randomized trial found that highly structured MET was less effective for African Americans who struggled with substance abuse compared to white populations. Instead, ethnic minorities from many backgrounds had better outcomes when less-structured forms of Motivational Interviewing were used; white individuals seemed to respond better to the structure of MET.
Another study published in 2009, conducted by the Alliance in Motivational Enhancement Therapy and Counseling (AMETC), gathered information on MET effectiveness in various settings and found that a 2007 study reported that therapist variability on college campuses could negatively impact students seeking treatment.
It appears that MET alone does not work, although some groups may see greater benefit compared to others. Instead, Motivational Enhancement Therapy appears to work best as the initiation to a larger course of treatment, especially when the client is struggling with substance abuse.
Using Therapeutic Styles Together
One study in 2009 found that MET and CBT were more effective at eliciting and maintaining change in people undergoing substance abuse treatment than 12-Step or Alcoholics Anonymous-style support groups; however, AA and 12-Step meetings functioned well to maintain changes after CBT and MET. Combining multiple styles of therapy appears to be very effective for most people overcoming substance abuse.
Especially for adolescents, combining MET with CBT appears to create the most long-lasting behavioral change and help the clients maintain sobriety. The University of Washington’s Alcohol & Drug Abuse Institute (ADAI) found that two individual sessions of MET, followed by 3-10 weekly group sessions using CBT, function the best for long-term outcomes. In fact, for adolescents, the shorter five-session version appears more effective than the 12-session version. In a study comprising 300 adolescents with cannabis addiction disorders of some type, 27 percent of participants maintained abstinence for one year with five-session MET/CBT while only 17 percent maintained sobriety with the 12-session MET/CBT.
A study on adolescence substance abuse treatment effectiveness by the National Criminal Justice Reference Service (NCJRS) found that CBT, MET, and family therapy had the greatest effectiveness. MET, used for 1-4 sessions of 50 minutes each, plus follow-up phone interviews and/or CBT therapy lasting up to 12 weeks, was overwhelmingly effective, through multiple studies, for adolescents who had been incarcerated with substance abuse issues.
MET as part of case management appears to work well for homeless youth, whether they are also seeking help with housing, employment, and other services or not. A survey of 270 homeless adolescents between ages 14 and 20 found that:
- The MET group engaged less in alcohol and drug use over a 12-month period.
- Harm from substance abuse was reduced overall in the group.
- Less depression was reported in the MET group.
- The group had greater success finding and maintaining housing, as evidenced by fewer episodes of homelessness.
The study found that Motivational Enhancement Therapy combined with specific CBT sessions worked best for this group too. People who may feel like they have a substance abuse problem, but do not know what to do or if they should do anything at all, may benefit from working first with a counselor who specializes in MET. This person can help them create goals and find a detox and rehabilitation program that will best suit their needs and goals.