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Motivational Enhancement Therapy

Motivational Enhancement Therapy

Change can be an intimidating prospect, particularly for people dealing with an addiction. Even when we are unhappy with our current situation the idea of stepping into the unknown may be a challenge. It can often feel more comfortable to remain in our present state, no matter how unpleasant it may be.

What is Motivational Enhancement Therapy?

Motivational Enhancement Therapy (MET) is a form of addiction treatment that aims to combat this reluctance to change, uncovering and sparking an individual’s internal motivations that can drive them to make the necessary changes to their behaviour. [1]

Many people would like to recover from their addiction but lack the motivation to do so. More rigorous therapy programmes such as CBT may feel too overwhelming at this stage and will not be effective if the individual does not feel internally driven and focused on recovery.

A short-term programme consisting of up to five sessions, MET is often conducted prior to the detoxification stage as it is primarily used as an initial method of treatment that can help motivate individuals to begin the recovery process.

MET is a non-judgemental and empowering form of therapy that encourages self-exploration, challenging negative self-beliefs and helping individuals find a reason to recover from addiction.

How can Motivational Enhancement Therapy treat addiction?

MET is designed to help individuals take the necessary steps to receive further treatment for their addiction, and is not intended to be used as a sole method to treat the addiction itself. It does not examine the causes of the addiction or provide long-term support – instead, it helps to uncover the internal motivations of the individual which can, in turn, drive positive behavioural changes.

The majority of studies that examine the effectiveness of MET have focused on alcohol addiction and cannabis dependency, and this form of treatment has been found to be effective when applied to these substances. [2]

MET may be combined with other forms of treatment such as cognitive behavioural therapy or the 12 Steps Programme, both of which have been proven to be highly effective methods in the treatment of various substance and behavioural addictions.

1. Understanding motivation

Not everyone will require MET for addiction recovery, as they have the ability to identify and connect to their own internal motivations without the help of a treatment programme.

The Stages of Change model, also known as the Transtheoretical Model, was developed in the 1970s in an effort to understand how certain individuals are able to make the necessary changes without relying on external factors.

It is believed that these people move through six stages as they identify their own motivations and take steps towards their long-term goal. [3]

Below are the six stages of change as understood within the Series of Change model:

2. Precontemplation

During this stage, the idea of behavioural change is more intimidating and unappealing than the reality of the situation. The individual has no desire or plans to make changes in the near future and maybe unaware that their behaviour is self-destructive.

3. Contemplation

The individual has now become aware of the fact that their behaviour is problematic in some form, and maybe considering a change in the near future. They are able to identify areas in which the idea of change could be appealing but have not yet taken steps to do so.

4. Preparation

A decision has now been made and the individual is actively planning to make the necessary behaviour changes. They may be taking small, manageable steps towards their goal (eg. researching treatment programmes) and understand that these changes will have a positive effect on their life.

5. Action

The individual has taken actionable steps towards their long-term goal and plans to continue moving forward. They may have started the detoxification process or completed the initial stages of therapy treatment, and their motivation levels will likely be high during this time.

6. Maintenance

The behaviour changes have been in place for some time, generally over a six-month duration. During this stage, the individual will focus on sustaining this behaviour and preventing relapse.

7. Termination

Addiction is a long-term recovery process, and it is not expected that most individuals will reach a stage in which they will no longer need to consider their addiction and where the chance of relapse is impossible.

For this reason, the maintenance stage is often considered as the final step within this model.

What to expect from Motivational Enhancement Therapy

MET often consists of four or five sessions, during which the patient will individually meet with a therapist to discuss the benefits of behaviour change and work to identify and draw out their internal motivations.

During the initial session, an assessment will be conducted to understand the patient’s history and individual needs. The therapist will also explain the reasons and methods behind MET with the patient invited to ask any questions they may have surrounding the process.

The following two sessions will generally focus on feedback from the assessment, while the final sessions will revolve around the benefits of behaviour change and the steps that the patient could take when faced with difficult or triggering situations. This should help to gain an understanding of what motivates the patient and which future treatments would be most effective. [1]

What are the principles of Motivational Enhancement Therapy?

The therapist will be guided by the following five key principles during the treatment process:

1. Showing empathy

A successful patient-therapist relationship is built on a foundation of understanding, trust and empathy. This allows the patient to feel supported and in turn, will be more comfortable with the idea of expressing their feelings to the therapist, who will listen to their statements and reflect them back to the patient to show that they are listening.

2. Refrain from conflict

MET is practiced in a gentle, non-judgmental way with any conflict or argument avoided as much as possible. This prevents the patient from feeling attacked and reverting to self-defensiveness while allowing them to come to their own conclusions about their behaviour.

3. Defuse resistance

When the patient expresses resistance to the idea of behaviour change, a MET therapist will not attempt to challenge them. Instead, they will often appear to agree with what the patient is saying. This helps to further build the patient-therapist relationship and decreases the risk that the patient will become defensive and refuse to engage further in treatment.

4. Boost confidence

Many people dealing with a substance abuse disorder may also struggle with feelings of low self-esteem, particularly if they have attempted treatment in the past and eventually relapsed. The therapist must work to foster feelings of self-belief within the patient and guide them toward the realisation that they have the ability to successfully complete treatment.

5. Examine discrepancy

Often, individuals dealing with any form of addiction will struggle to see how their current behaviour is impacting their current state of being and their future desires. This discrepancy can be examined throughout the treatment programme, allowing the patient to come to their own realisations about any potential behaviour changes.

What are the benefits of Motivational Enhancement Therapy?

MET is a less intimidating form of addiction treatment, particularly for individuals who are resistant to change and may struggle to keep up with more intensive methods such as cognitive behavioural therapy.

This method focuses on the motivations behind behavioural change and overcoming resistance, which many other forms of therapy do not address.

It can also help to increase confidence in people who are unsure of their ability to complete a treatment programme, or for those that have attempted recovery in the past. The short-term aspect of MET allows for a much greater success rate of completion, which can give many individuals the boost that they need to enter into a more intensive treatment programme.

What are the downsides of Motivational Enhancement Therapy?

While MET has been proven to increase motivation in individuals dealing with an alcohol or cannabis dependency, it is not a one-size-fits-all method of treatment.

As a short-term treatment option, this form of therapy is best suited to individuals with a mild to moderate substance addiction, and may not be effective in cases of severe physical and psychological dependency that require long-term treatment.

MET may also be less effective when applied to individuals with a co-occurring mental health disorder that may limit their ability to think clearly and make plans for the future.

Another potential downside of MET is the fact that the individual will require further treatment once the sessions have ended, as it has not been proven to be an effective method of recovery when used individually.

While MET appears to be a promising treatment for individuals dealing with alcohol and cannabis disorders, additional studies are needed to determine the effectiveness of this method when used to treat other substance abuse disorders and behavioural addictions.

References

[1] https://pubs.niaaa.nih.gov/publications/projectmatch/match02.pdf

[2] https://pubmed.ncbi.nlm.nih.gov/25040898/

[3] https://sphweb.bumc.bu.edu/otlt/mph-modules/sb/behavioralchangetheories/behavioralchangetheories6.html

 

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