Motivational Enhancement Therapy: Describing Counseling Approach

1. Motivational Enhancement Therapy: Description & Rationale: An Overview

1.1 Approach’s General Description

Motivational Enhancement Therapy is doing something has always been the best way of accomplishing some goals. This approach has also been undertaken in drug abuse therapy and is named MET. The therapy aims at producing a motivation for change within the mind of the patient by himself. In this way, the patient himself will devise a systematic plan which he will undertake for a positive change in his life. In this approach, most of the decisions are taken by the client himself. Yet, the decision implementation strategy is directed and planned by the professional therapist.

1.2 Approach’s Goals and Objectives

When the MET approach is applied in the case of patients of drug abuse, then the sole purpose is to cause a blockage in the path of the harmful effects that the addict faces due to the use of the drug. As it has already been mentioned that the client is the one who sets goals for himself in the course of Motivational Enhancement Therapy, so no specific goal can be enforced on him. Still, most of the time, therapists give their advice like completely abstaining from the drug or minimizing the intake. Goals related to different life activities that may affect the drug intake may be suggested as well.

1.3. Theoretical Basis of Approach/ Process of the Action

The approach of Motivational Enhancement Therapy is based on the laws of both intellectual and social psychology. What the Councilor tries to do is that he develops a thorough variation in the client’s mind. This variation is between his present behavior and the preponderant self aims. The therapist tries to generate motivation within the client’s mind, same as Bem’s self-perception theory elucidates it. A commitment for the change is produced. While undertaking the treatment, the assumption is that motivation is the quintessential thing that can trigger a desire for change.

1.4 Agent of Change

The primary agent of this change is the client himself. The Councilor is the principal assistant.

1.5 Start of Drug Addiction, and What are Causative Factors?

The problems related to the drugs are considered as the actions by the patient that is in minimum voluntary control of the patient. The abusive drugs are deemed to give motivational feelings to the abuser that override all the other motivations. The tangible goal that the Motivational Enhancement Therapy sets is to make competing motivations so strong that they override the motivations that are produced by the use of the drug.

2.Comparison With the Other Approaches

2.1 Most Same Approach of Counseling 

MET has found many similarities with the other approaches as well like it is pretty much similar to the Rogerian client-centered counseling. Still, the fundamental difference between the both is that Motivational Enhancement Therapy is more directive. MET also has similarities with reality therapy and cognitive therapy.

2.2 Most Different Approach of Counseling

 Motivational Enhancement Therapy has found many dissimilarities from those counseling approaches in which the therapist uses the confrontation method. It is also different from those approaches in which the therapist gives no advice or training to the patient.

3.FORMAT

3.1 Modes of Treatment

Mainly in the MET, only the patient is the one who comes in contact with the therapist. But still, in some cases, family members may also be present. Such Motivational Enhancement Therapy is termed as group MET. But this approach is not in much practice.

3.2 Best Treatment Setting

Both outpatient and inpatient settings are suitable for the MET. So no one setting can be considered as necessary or ideal.

3.3 Time Taken for Treatment

MET is a harsh treatment. It just takes two or four sessions of 1 hour to be completed.

3.4 Compatibility With Other Treatments methods

Motivational Enhancement Therapy is actually a way to motivate the patient, so it can act as an excellent posttreatment method to enhance the future treatment response. It has also been found very effective in the future treatment of alcohol addiction and helps to get good results in the coming treatment days.

3.5 Self Help Programs

In MET, self-help groups are formally not involved, but still, if the client wants to participate in any of such programs, then it is entirely on his will and desire. Motivational Enhancement Therapy is consistent with the approach of 12 steps.

4.Training and Characteristics of Counselor 

4.1 Educational Qualifications

Prebachelor’s level students of universities that work as supervised paraprofessional counselors can effectively take care of the this therapy process. Still, the educational qualifications are not much necessary in carrying out the MET.

4.2 Training, Skills, Experience, Credentials Required

Training for giving the MET is essential. A person who is well trained in carrying out the MET makes the therapy smoother. But to become a professional in MET, more and more practice is required.

The initial training comprises of 2 to 3 days with a person who is well experienced in the MET. Training initially focuses on the establishment of well-polished listening skills. Having good listening power is essential because, without it, other skills cannot be mastered. Once the listening skills get good, then the training proceeds to the next stage in which motivational strategies are enhanced. But one single workshop cannot make the trainee councilors professional. So proper practice and the supervision of a professional are required to enhance the skills.

4.3 Counselor’s Recovery Status

In MET, the recovery status of the Councilor is mostly irrelevant. But still, in some researches, it has been found that in the early stages of recovery, counselors over-identify and find it challenging to keep their own issues and advice aside from the process of counseling. This can cause difficulty in the process of the MET.

4.4 The Characteristics of an Ideal Counselor

The MET requires a high level of therapeutic empathy as Carl Rogers has enunciated it. Councilor that has a high level of interpersonal warmth and compatibility are highly recommended. Councilors need to get rid of their self-desires and self-perceptions, and if they cannot, they are not suitable for the MET.

4.5 Prescribed Behavior for the Counselor

 Asking good open-ended questions, excellent and reflective listening, and being supportive in your therapy are some of the behaviors that are prescribed for being a good counselor. The best strategy is producing optimism in the client and listening to his views and concerns and why he wants the change to happen. Rather than confronting it directly, the patients are asked to roll with resistance. The self-efficacy of the client is also emphasized. A perception is produced in the patient about the possibility of the change. As personal feedback, assessment findings are used most often to keep the client motivated.  

4.6 Proscribed Behaviors To Counselor

One primary that the councilors are advised to restrain from is the confrontation with the patient. Councilor should not try to prove the patient wrong and should avoid advising the patient for a change in the areas in which the patient does not feel the need for any change. So argumentation is not suitable for MET. The Councilor also tries not to give any solutions by himself like an expert. Repeated questions are also not prescribed, and in general, three direct questions are not prescribed to be asked. He should also not label the patient as an alcoholic or drinker, or drug abuser.

4.7 Recommended Supervisions

For adequate supervision with the MET, direct observation of the sessions is very much important. The councilors least observe the behaviors that are most needed to change. Supervisors should view the audio or videotape of the session again and again before the supervision. Workshops on motivational interviewing sessions are also provided to the trainees.

5 Relationship of the Client and the Counselor 

5.1 What is the Role of Counselor?

First and foremost, the Councilor is responsible for producing motivation in the patient for a positive change. Being an educator and a collaborator are also the roles of a counselor. But still, the Councilor should not deem himself as an expert advisor. A councilor temporarily becomes an educator when he analyzes the personal assessment feedback of the MET.

5.2 Who is Supposed to Talks More?

The client should be the one who should be talking the most during the session. The therapist also speaks but only during personal assessment feedback, but this Role is temporary.

5.3 How Much Directive is the Counselor?

MET is a directive and client-centered session in which the councilors use systematic strategies to achieve specific objectives. MET is considered successful only when the client does not feel directed or advised. Open-ended questions and selective reflection of the client’s material is a good way of achieving the direction rather than confrontation and sound advice. Metaphorically, a jigsaw puzzle is being solved by the counselor and the client. The Councilor helps to construct the frame, and the client is the one who is supposed to solve the puzzle. The Councilor can still provide him with any misplaced or missing piece.

5.4 The Therapeutic Alliance

The formation of a therapeutic alliance is quintessential for the MET. ,As already mentioned, the therapy is client-centered and is based on open-ended questions and reflective listening. This strategy is used until the client gets rid of all the resistance and hesitation and gets ready to discuss any change in his behavior.

6 TARGET POPULATIONS

6.1 The Client Best Suited for This Approach?

According to researches, Motivational Enhancement Therapy has been proved to be very successful in treating different alcohol-related problems. Unique makers of differential response have not yet been identified. Self-referred and court-mandated clients respond equally. According to a study, clients at the earliest stages of change show different behaviors in the MET. They mostly stay unmotivated. MET for the alcohol consumers has been studied well, but the other drugs have not been studied thoroughly. According to two studies, MET sessions with marijuana and heroin users proved too successful. The therapy other than the assessment feedback remains the same.

6.2 Clients Who are Not Suited for This Counseling Approach

Most of the time, clients want a specific direction and advice to deem MET insufficient. According to the research, the response to the alternative approaches has been the clients’ poorest until today. In the case of more and severely impaired clients, stand-alone treatment is more effective than brief counseling.

7. Assessment

Many things are included in the Motivational Enhancement Therapy. Some of them are addiction, history of the family, addiction, drug use, consequences, and many other risk factors. Different specific instruments can access these dimensions. The most desirable instruments are those that are sensitive to the preliminary stages of the impairment. To prepare the client for the assessment, a series of motivational interviews are conducted. This is a standard sequence. A structured assessment follows that may include all the dimensions that are described above. Findings from the assessment about norms are provided in the third session. This is included in personal feedback

8. Format of Session and Content

8.1 Process of Typical Session

The client’s level of motivation defines the content of a Motivational Enhancement Therapy session. Prochaska and his colleagues have described five stages of readiness:

• Precontemplation, In this stage, the client is not willing for a change.
• Contemplation, In this stage, the client has mixed feelings for the change. He thinks about the good and bad effects of the change.
• Preparation & determination, stage the client wants to change and thinks about different options.
• Action, At this stage, the decision has finally been made, and the client starts to take steps.

Councilor explores the perceived pros and cons of the contemplators. Open-ended questions and reflective paraphrase is used to produce motivation in the client. At the later stages of this therapy, the Councilor devotes all his attention to devising a change plan.

8.2 Themes and Topics of Different Sessions

The Councilor is the one who determines the theme of a given session. But still, there is a lot of content of the theme that the client provides. Some of the examples are:

• Things that he likes the most about drug use
• Things he dislikes the most about the drug usage
• Describing a day of drug use
• Reasons on why he wants to end all this
• Ideas on how he wants the change to happen

Open-ended questions and a summary of reflection are present at the start and end of the session.

8.3 Structure of The Session

Most of the sessions are planned by the Councilor, but they become more client-centered and flexible in the presentation. Motivational interviewing is a process of identifying the factors that drive the client’s behavior, which can then be modified. Motivational interviewing is used as a tool for motivating people in all the different aspects of their lives including career, family, relationships, health, wellness and happiness. Motivational interviewing is very effective for clients who wish to overcome addictions and life obstacles. Motivational interviewing is the process of identifying the motivational factors that are missing or are not effectively driving their behaviour and addressing these by developing and following a tailored action plan. Motivational interviewing is the foundation of all the work that the Alcohol Treatment centre does.

Motivational Enhancement Therapy is also used to treat co-occurring mental disorders, for example, attention deficit disorder (ADD), depression, anxiety disorders, panic disorders, etc. It may also be used to prevent other co-occurring mental disorders from developing. With the use of MET, therapist-led groups and one-on-one meetings may be arranged for clients with co-occurring mental disorders. MET trains therapists to identify and use the unique characteristics of the client to modify behavior that is causing them harm and may lead to the client developing new and healthier ways of dealing with issues, problems, and challenges in their life. This type of therapy is an essential element in any addiction treatment plan.

8.4 Different Ways to Cope with Common Clinical Problems

All types of resistance are coped by a reflective strategy instead of opposing the subject or confronting it directly. For instance, minimization or rationalization of a client can be met in various ways. The several ways might include forms of reflective listening so that all the faces of uncertainty are covered. The client’s purpose, at first, might be considered by the counselor, but after a while, redraft/reframe it. Standard program rules, i.e., attending sessions under the influence, should be implemented.

8.5 Denial, Resistance and Poor Motivation

How to Deal?

Motivational Enhancement Therapy Has the Following Characteristics:

The client is not deemed responsible for all the resistance and the poor motivation, but they are instead subjected to interpersonal influence. A councilors counseling style can affect the levels of resistance very much. In this therapy, the advice level should be kept minimum. The client is forced for a change through a confrontation in a professional manner. For decreasing the resistance behaviors, the standard strategies include variations in reflective listening. The Councilor can also give new meanings to what the client has said and can also argue properly. The Councilor can also give his voice to the resistance of the client. Finally, the client will tell the therapist why he needs to change all of his addictive behaviors. This should be expounded in clear terms.8.7

8.6 Strategies for Dealing with Crisis

Good motivations, most of the time, are the results of crisis times. One often needs rapid availability of the Motivational Enhancement Therapy councilor at that time. Counseling strategies in most cases remain the same. They might differ when quick actions are required to ensure the safety of the patient.

8.7 Response of the Counselor to the Slips and Relapses

A relapse and a slip mean that patient has started to consume alcohol or has started to use the drugs again. Motivational Enhancement Therapy experts also have to tackle this. This reuse of the drugs is also questioned by the same two methods that have been mentioned again and again in this article. Those two methods are open-ended questions and reflective listening. An expert should never be judgmental in his remarks. More heed is given to the perceptions of the client. The therapist wants to know why the client was forced to use the drugs again and what went wrong during the process. Then the previous plan is explored, and if any shortfall is observed in that plan, then a new plan is made that addresses all the shortfalls of the previous plan.

9. What Role Does the Significant Others Play in Treatment?

Significant others or the SOs have a crucial role during the treatment. They, in some cases, are used in the Motivational Enhancement Therapy sessions. They can prove to be very helpful in motivating the client and helping him devise a plan for the change. But the Councilor should maintain an eye on the SO as well. He should not allow him to become a reason for resistance and demotivation for the client. The primary function of the SO is to provide the Councilor with his observations related to the client. But his focus should not get diverted from producing the client’s motivation as it is the most necessary thing. The Councilor can use the Motivational Enhancement Therapy session in producing the motivation in the SO himself. It can also be used for producing a behavioral change in him. The reasons for the change become more critical for the client just by the involvement of an SO. The implicit goal remains the same that is producing a change in the client. This will eventually lead him to better treatment in the future. In the up coming days, immense help can be obtained from this therapy. Contact us to know more about Motivational Enhancement Therapy.

Reference:

Prochaska, J.O.; DiClemente, C.C.; and Norcross, J.C. In search of how people change: Applications to addictive behaviors. Am Psychol 47:1102-1114, 1992.

Authors:

William R. Miller, Ph.D.Regents Professor of Psychology and PsychiatryCenter on Alcoholism, substance abuse, and Addictions (CASAA) the University of New Mexico Albuquerque, NM 87131University of New Mexico Albuquerque, NM 8713