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Addiction Treatment: Motivational Enhancement Therapy

Why is it used?

Motivational Enhancement Therapy (MET) is a therapeutic technique used to engage a patient through the process of identifying and changing unwanted thoughts, feelings, actions or reactions. Engaging a patient in this way can be particularly useful when dealing with drug or alcohol addiction because they are freely able to decide what they want to discuss and how they want to solve their issue. This technique is particularly beneficial because the constructs, goals and parameters of change are completely up to the patient.

Identifying the issue and setting goals

Motivational Enhancement Therapy is based on the transtheoretical model of behavior created by James Prochaska and Carlo DiClemente’s in 1983. This model is made up of five stages:

  • Stage 1 (Pre-contemplation): During this stage, the patient admits whether there is a problem to deal with or not.
  • Stage 2 (Contemplation): The patient identifies the problem or issue.
  • Stage 3 (Determination): The patient decides to change harmful behavior and a plan of action is drawn out on paper.
  • Stage 4 (Action): The patient begins steps towards “acting” differently.
  • Stage 5 (Maintenance): Sustainable action is put towards change.

If all prior stages fail, there will be a relapse stage. In this circumstance, the cycle of stages will repeat themselves.

Through MET, the patient sets a plan of action focused on one or two issues, keeping the process simple and autonomous. It is important to encourage the addict to keep his or her goals simple and easily attainable so the addict doesn’t feel overwhelmed. The therapist can help the patient set goals but, ultimately, the patient determines how these goals need to be met.

In the lives of hardcore drug users or drinkers, the experience of goal setting is typically limited to finding more drugs and alcohol. For addicts to change their way of life, they have to want that change. If the addict or alcoholic doesn’t have the desire to get sober and stay that way, no amount of goal setting is going to make a difference. MET helps a patient start indentifying aspects of his or her life that could be enriched by sobriety. This is one of the reasons why MET is so successful for an addictive personality – because it provides a sense of autonomy for the addict or alcoholic when planning life changes and seeing them through.

Motivational principles used in MET

Journaling is a reoccurring tool used in Enhancement Motivational Therapy. Writing and journaling can help patients identify any concerns about their lives, such as fears they may have and issues that might prevent them from reaching their goals. The therapist does not attempt to guide the patient in telling them what they need to change or how they need to do it.

Therapists should also use the five motivational principles outlined in the treatment guide “Motivational Enhancement Therapy with Drug Abusers” by William R. Miller, Ph.D. which underly the MET approach:

  1. Express Empathy: The therapist should have a sincerely empathetic approach in understanding the patient’s situation.
  2. Develop Discrepancy: The therapist and patient will figure out where the patient is now and where the patient wants to be in the future.
  3. Avoid Argumentation: The therapist avoids arguing with the patient.
  4. Roll with Resistance: The patient calls the shots regarding scheduling plans and setting goals.
  5. Support Self-Efficacy: The therapist will believe in the patient and work with the patient until goals are met.

Through MET, the only way the therapist is directive is when informing the patient about particulars the patient has verbalized, such as life changes he or she would like to make. The therapist’s role is to empathize and understand where patients are coming from, as well as teach them to question and process thoughts and emotions. After the patient has processed feelings and emotions, he or she can identify particular problems, solutions to those problems and how to take action to change.

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