What Is Motivational Enhancement Therapy (MET)?

Addictions occur because of various reasons. Life stressors, genetic predispositions, and factors relating to mental and physical health can contribute to ongoing problems with addiction.

There are also different addiction treatment methods that work for different people. Some may prefer a medication-assisted (MAT) approach, while others may benefit from an assortment of therapies, such as motivational enhancement therapy, or MET.

Understanding Motivational Enhancement Therapy (MET)

What is motivational enhancement therapy? In an essence, it is a counseling approach that encourages developing an inner motivation for the client.

Some people go through the motions of life without finding any real purpose to improve. This is what motivational enhancement tries to resolve. By finding purposes and reasons to improve, clients may be able to overcome the challenges they are facing.

MET is used for mental health problems such as borderline personality disorder (BPD), eating disorders, and addiction. Compared to other types of psychotherapies, it may be more straightforward and sometimes stern. Some may prefer a gentler, step-by-step approach, but in some instances, having therapists who push people to improve may be what they need to address their struggles.

MET and Addiction Treatment

What about in the context of addiction? How is MET relevant for those who want to recover from substance use disorder? Studies have supported the effectiveness of MET. Recent research demonstrates that it may be effective to treat marijuana abuse, smoking, and alcoholism.

These studies don’t mean that MET won’t be effective for other types of substance use disorder issues. It depends on the assessment recommendations and personal preferences of each client. Below are some brief descriptions of techniques used in motivation enhancement therapy.

MET Therapies and Techniques

Motivational enhancement therapy techniques are underlined by five stages of change. Therapists systematically assess and present specific types of management for each stage. Here are various stages of change plus the types of interventions used for each with examples.

Precontemplation

At this stage, there may be no awareness of a problem or even a denial of a problem. Some techniques used in MET to move the client to the next level of change are:

• Use of visuals: The stage might depict the amount of alcohol or drugs consumed using tangible materials such as pictures or actual objects, such as sugar bags, bottles, etc.
• Open forum: Another way to move clients to the second stage of change is through an open forum where their loved ones are present. They can read letters, express themselves verbally, or become emotionally vulnerable during this time.
• Discussion and counseling: Sometimes, faulty thought processes can be the cause of resistance to change. Having an open discussion with a professional can help the client become aware of the problem.

Contemplation

At this second stage of change, the client is now considering that there is a problem and may want to change. Although they are not completely convinced, there are techniques that may move them closer to change and help build their determination to do so:

• Objective assessment: Having a health or psychological assessment while seeing objective results can help clients weigh the pros and cons of making a change. This is especially effective if the addiction becomes a matter of life and death.
• Lists of decisions: Another way to move the client to the next stage is by listing the potential consequences of receiving treatment versus remaining living as they’re living. When clients see that the results of a worsening substance addiction can be deadly, they may be motivated to change.
• Logical reasoning: Some clients prefer to set aside emotions and want logical reasons why they should make changes. They might have an open discussion with their therapist to explain logical reasons why they should seek treatment.

Determination

When the client agrees with the decision to change, it is time for them to work with their therapist to develop motivations for treating their addiction. Techniques in this stage can include motivations such as:

• Self-development: Bettering oneself is often a good catalyst for positive change. As addiction harms people over time, they might realize that it is hindering them from becoming the best versions of themselves.
• Family and loved ones: Addictions also affect the families and friends of people who are struggling with the addictions. People can be reminded of how much their addictions can hurt others.
• Faith: Those who have found faith before or during addiction treatment may also be motivated by their beliefs. Obedience to a higher power, submission, and trust are common themes to help clients move through the determination stage.
• Occupational success: Obtaining a degree, going back to work, or experiencing a fruitful business can also be good motivations to treat addiction and make positive changes.

Action

This next stage is about having specific goals. During this time, the client and therapist will list realistic and specific goals to be accomplished in a given time frame. They will also discuss the course of action needed to achieve these goals.

For example, a client may want to be alcohol-free in one month. This client may initially drink four glasses of alcohol every day.

The client and therapist may develop a specific plan to cut down the number of drinks at a regular pace until the client’s drinking has ended. It may be helpful for the client to write down these goals and plans so the client has continuous reminders of what they want to accomplish.

Maintenance

The goal of this next stage is to prevent addiction relapse. Since relapse is common after addiction rehab, clients and therapists may create preventative measures.

For example, a therapist may encourage the client to record regular activities in a habit log, write in a meditation journal to focus one’s thoughts, or use a relapse prevention guide to assist with therapy. Such continuing work and reflection can help people continue their recoveries after their formal therapy ends.

Principles of MET

In addition to outlining these motivational enhancement techniques, therapists also have a set of principles that they could use to help ensure their clients’ success.

Developing and expressing empathy

Although building motivation is the primary goal, therapists should not lose sight that clients have their unique personal struggles. Thus, the MET techniques and language that therapists use should show compassion and empathy.

Avoiding arguments

There will be instances where loved ones may be included during MET sessions. The focus could be on avoiding arguments and creating open, logical discussions to produce fruitful results.

Acknowledging the disparity between thoughts and reality

Sometimes, people perceive their thoughts to be facts, which may subject them to a form of bias. Thus, it is important for therapists to remind clients that thoughts do not always represent the realities of life. Seeking the truth is one step towards true recovery.

Accepting resistance as part of the process

Any type of change may be met with resistance–and it is understandably common. The therapist could make the client understand that change can be uncomfortable, and that being in denial or losing motivation might be parts of the process. By accepting these developments, clients may be motivated to continue their course of treatment.

MET and Other Treatments

There are studies that show MET is an effective intervention for addiction, especially when combined with other forms of treatment. One research study discussed the positive results of using cognitive behavioral therapy (CBT) along with MET to treat depressive symptoms.

Additionally, MET can be a part of a rehab treatment after clients receive medical detox for their drug or alcohol addiction. Clients might go through these steps at an inpatient addiction rehab:

• Step 1: Substance use disorder assessment and a discussion of management options
• Step 2: Medical detox
• Step 3: Motivational enhancement therapy and cognitive behavioral therapy
• Step 4: Discharge instructions and aftercare

Motivation as an Agent for Change

Building intrinsic motivation is a powerful tool to encourage someone in addiction recovery. Sometimes, MET may provide a bridge between being undecided about recovery to being motivated to produce a complete positive change.

Sources

• drugabuse.gov – Motivational Enhancement Therapy (Alcohol, Marijuana, Nicotine)
• onlinelibrary.wiley.com – Topiramate and Motivational Enhancement Therapy for Cannabis Use Among Youth: A Randomized Placebo-Controlled Pilot Study
• lib.adai.washington.edu – Motivational Enhancement Therapy (MET) (Problem Drinkers)
• theworldcounts.com – The Importance of Good Habits
• Theatlantic.com – Cognitive Biases and the Human Brain
• ncbi.nlm.nih.gov – Evaluation of Cognitive Behavioral Therapy/Motivational Enhancement Therapy (CBT/MET) in a Treatment Trial of Comorbid MDD/AUD Adolescents