What is motivational enhancement therapy?

If you or a friend or family member is experiencing challenges related to alcohol or substance use, you may have heard of motivational enhancement therapy (MET). MET is a type of therapy that’s primarily used for treating substance use disorders, though it has some other potential applications as well. Below, we’ll take a look at this therapeutic method, how it works, and its application for substance use concerns.

Motivational enhancement therapy (MET): The basics

The focus of motivational enhancement therapies is on using specific guidance from a qualified practitioner to support self-efficacy and to help motivate an individual to acknowledge their harmful behavioral patterns and work toward changing. It’s not uncommon for people with substance use disorder to feel unable to make different choices, even though they know they are negatively impacting their lives and the lives of those around them through drug abuse or alcohol abuse. With MET, a therapist who is trained in this type of treatment concentrates on enhancing the individual's awareness of and encouraging practical steps toward adjusting the unhealthy behaviors associated with substance abuse.

Power back to the individual

The central principle of MET focuses on the idea of giving power back to the individual and helping them look at their behaviors without bias so that they can embark on a journey toward meaningful transformation with the motivation to change and embrace better physical and mental health. This gives the power of change to the patient, not the therapist. MET does not have to be a stand-alone treatment and can be used in conjunction with other therapies, or as a pretreatment to get individuals prepared to engage in other therapies. In other words, if an individual isn't ready to start a new method, implementing motivational therapy or MET as a pretreatment can be helpful.

MET for addiction and self efficacy

Many people still mistakenly believe substance use disorders to simply be willpower or moral issues. However, in actuality, addiction is a disease that’s unlikely to resolve without treatment. It’s defined by the American Psychological Association (APA) as a psychological and/or physical dependence—typically on drugs or alcohol, but it’s also possible to have this type of dependence on an activity such as gambling. 

Alcohol and drug use in particular can alter the wiring of the brain and can therefore affect ways of thinking, making choices, gaining knowledge, recalling information, and managing performance. MET may be used to help the individual develop an awareness of the negative impacts of their substance use and support them in shifting their behaviors for lasting change. While it may not be applicable in every case, some individuals can experience meaningful benefits from this type of counseling. A 2021 study shows a “significant difference in self-efficacy” in individuals with alcohol use issues who underwent MET.

Motivational interviewing: A key component of the MET manual

Motivational interviewing is a technique commonly employed as part of motivational psychology or therapy It can be especially useful for those who are beginning the therapeutic process but are not yet ready or motivated to change through intrinsic motivation. It may also be helpful therapists treating individuals who are enraged or aggressive at the beginning of treatment. That said, components of the motivational interviewing approach may also be used throughout the MET process.

The goal of motivational interviewing and motivational enhancement is to stimulate the individual's motivation to achieve change through a specific type of talk treatment where the therapist is primarily the listener. It focuses on encouraging the client to express what they see as their challenges and explore why they might want to change, with the therapist then mirroring that back to them. The idea is for the individual to gain a new perspective on their situation by hearing themselves and their therapist articulate their challenges out loud, encouraging them to be more open to committing to the process of behavior change. 

The motivational enhancement therapy (MET) protocol

MET typically begins with a preliminary evaluation in which the therapist will usually ask a series of questions to help themselves and their client gain a clear perspective on the situation and current behaviors. These questions might include:

• How frequently do you consume alcohol or use substances?
• When did your consumption or overuse begin?
• What challenges have you faced due to overconsumption or use/abuse of substances?
• Do you have a family, a partner, or friends who use or consume in excess?
• What are your aspirations?
• What is most important in your daily existence?
• What changes would you make, if you could change anything in your life?

Directed treatment meetings

After an initial assessment, MET usually includes four directed treatment meetings, making it a short-term form of treatment. One of the key components of MET is that treatment is individualized to the specific needs of the person being treated. Earlier meetings in the first and second session tend to be client-centered and may focus on the individual talking through challenges and the therapist listening without judgment, and the therapist then guiding the client in setting goals. The therapist may avoid direct confrontation of issues and practice reflective listening and express empathy towards the patient. Later meetings tend to focus on strengthening self-esteem and self-care practices. In the case of substance use, the therapist may help the patient to develop a discrepancy between behaviors related to substance use and long-term goals. 

Who can benefit from motivational enhancement therapy (MET)?

As mentioned, motivational enhancement therapy is primarily associated with those experiencing substance use disorders. However, it may also be helpful in the management of some anxiety disorders, eating disorders, and gambling addiction. Another group that has shown promise with this evidence-based treatment consists of young people who are experiencing the negative impact of substance use issues, truancy issues, and conflict with parents.

It’s important to note that those who are experiencing some type of addiction may also have other mental health disorders, either pre-existing or as a result of the substance use. In cases like these, other forms of counseling may be a good project match instead of or in addition to MET.

Seeking professional help

Again, substance use issues are clinical disorders, not simply matters of willpower and it may take a variety of cessation strategies to move forward without a substance. If you’re experiencing problems with substance use or related mental health conditions, seeking the support of a qualified mental health professional is typically recommended. If you’d prefer in-person treatment, you can search for a provider in your local area. If you’d prefer to meet with a therapist from the comfort of your own home, you might consider online counseling. 

With a virtual therapy platform like BetterHelp, for instance, you can get matched with a licensed therapist affiliated with the National Institute of Mental Health who has expertise in the area in which you need support. You can then meet with them via phone or video call and even contact them via in-app messaging between sessions. Research suggests that, when following the clinical research guide, both online and in-person counseling can offer similar benefits in many cases, so you can generally pick the format that feels right for you.