What Is Motivational Enhancement Therapy?

What Is Motivational Enhancement Therapy?

Motivational enhancement therapy (MET) is a short-term technique used in the treatment of alcohol and substance use disorders. This approach to treatment focuses on helping people to feel more motivated to change their destructive, harmful behavior.

It integrates aspects of motivational interviewing and is based on the transtheoretical model of change. For people who are ambivalent about giving up their addiction or who are not motivated to recover, MET can be a helpful way to inspire change. The MET approach can be useful for helping people understand the effects of their behavior and feel more capable of recovering from addiction.

This article discusses how motivational enhancement therapy works, what it can help with, and some of the benefits of choosing this type of treatment. It also covers some things to consider before you try MET and how to find a MET therapist.

Techniques of Motivational Enhancement Therapy

MET is brief and time-limited. It typically lasts four sessions, but in some cases may last as long as six sessions. 

The first session consists of an assessment. The next two to five sessions utilize motivational interviewing strategies to help the client gain greater awareness, build motivation, and develop a plan to change.

Motivational interviewing is a counseling approach that helps people resolve ambivalence and improve motivation to change. It focuses on helping people become more willing, confident, and ready to change. Therapists also help clients explore coping strategies and encourage commitment to making a change.

Motivational interviewing approaches to therapy focus on five key motivational principles. During treatment, MET therapists may:

• Express empathy: This strategy involves helping people develop and express empathy for others. The goal is to help them understand how their own behavior affects other people. By gaining this understanding, people may then feel more motivated to change.
• Acknowledge discrepancy: Another key aspect of motivational enhancement therapy is recognizing that there is often a discrepancy between a person's desired place to be and where they actually are. Being able to acknowledge this disparity between desire and reality can inspire people to take steps to bridge the gap.
• Avoid arguments: MET therapists do not argue with an individual about their behavior or substance use. Argumentation often triggers defensiveness and resistance to change, so gently and optimistically helping people become more aware can make the motivation to change come from within them rather than from someone else.
• Accept resistance: MET therapy recognizes that resistance is common. Instead of fighting it, therapists look for ways to defuse the struggle. The goal is to minimize resistance and allow the individual to stay in treatment and work toward building intrinsic motivation to change.
• Support self-efficacy: In order to make a change, people need to believe that they are capable of achieving their goals. Motivational enhancement therapy helps people improve self-efficacy so that they can recognize their strengths and gain a greater belief in their own capabilities.
  

What Motivational Enhancement Therapy Can Help With

Motivational enhancement therapy was developed for the treatment of addictions, but some research suggests that motivational interviewing interventions may be helpful for a variety of conditions. Some of the conditions that MET may be useful in treating include:

• Alcohol use disorder
• Bipolar disorder
• Compulsive gambling
• Eating disorders
• Generalized anxiety disorder (GAD)
• Obsessive-compulsive disorder (OCD)
• Post-traumatic stress disorder (PTSD)

One study found that MET led to short-term improvements in viral load in young people living with HIV. A 2021 study found that using MET as a complementary treatment for an evidence-based HIV prevention intervention could increase safe sex behaviors and reduce alcohol use in certain populations.

Benefits of Motivational Enhancement Therapy

According to the National Institute on Drug Abuse, MET can be beneficial because it helps people overcome their ambivalence about entering treatment and ending their substance use. Rather than directing people through a series of steps, MET is able to quickly help people develop the intrinsic motivation to work toward recovery.

Some of the key benefits of this approach include:

• It works quickly: MET is a time-limited counseling approach that takes place over four to six sessions.
• It reduces resistance and ambivalence: Since a core tenet of MET is that persuasion tactics such as confrontation, coercion, and labeling are often counterproductive, and can lead to greater resistance to change.
• It emphasizes choice: Instead of a therapist acting as an authority who directs the individual being treated, MET emphasizes that this approach is a collaborative partnership. Therapists instead help people build awareness and make choices on their own.
  

Effectiveness

According to the National Institute on Drug Abuse, MET is most effective at getting substance users to begin or participate in treatment and less effective at getting people to actually reduce their substance use.

The effectiveness of motivational enhancement therapy can depend on the nature of the individual’s addiction. Research suggests that MET is effective at helping people with alcohol problems reduce their drinking and become more engaged in treatment. 

When combined with cognitive behavior therapy, MET has also been shown to be useful for people with marijuana addiction. However, this approach may be less effective when it comes to other types of drugs including nicotine, heroin, and cocaine.

Things to Consider

While motivational enhancement therapy can be beneficial and effective for many people, that doesn't mean that it is right for everyone or every situation. As the National Institute on Drug Abuse notes, evidence suggests that the efficacy of this approach tends to be mixed when it comes to substances other than alcohol and marijuana. 

No matter what the nature of your addiction is, it is important to remember that MET is not typically used as a stand-alone treatment for addiction. It is best applied when it is utilized as an adjunctive approach alongside another treatment such as cognitive-behavioral therapy, other behavioral therapy, or a 12-step program.

How to Get Started

If motivational enhancement therapy seems like it would be helpful, there are a number of different ways to find a MET therapist. Online therapist directories are often a good place to start. Asking your doctor for a referral is also a great way to find a qualified therapist with training in this approach.

There is no specific type of psychologist who is trained to practice MET. Motivational enhancement therapy can be practiced by a type of therapist. Many therapists gain experience in this area by taking workshops or enrolling in classes that offer training in the topic. Before you begin, ask your therapist about what type of training and experience they have in the practice of MET.

Before you begin MET, ask your therapist about their background and experience in this approach. Other questions you should ask include how long treatment will last, how you can determine if you are making progress and if you can have another person present during your sessions, such as a friend, partner, or family member.