Motivational Interviewing & Motivational Enhancement Therapy

Sometimes it helps to understand why you want to do something before you can do it. When people are in active addiction, their main focus is on using the substance of their choice, and in many cases, that’s all they think about. It’s easy to stay the same and continue using. Motivational therapies help build the willingness to stay sober, and stay stopped.

To genuinely change direction, it usually takes a great deal of thought and planning. Before someone can commit to ending their use of addictive substances, it would help them to understand why they do what they do and resolve any uncertain feelings that block them from making the changes they need to.

Motivational therapies are ideal for clients who are addressing their addictions and working their way to sobriety.

Table of Contents

 Here, we will highlight some of these therapies that are designed to help substance-using clients figure out what they want as they set recovery goals.

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Behavior Therapy

Motivational Interviewing in Addiction Treatment

Motivational interviewing is a client-centered type of counseling that was developed to help resolve insecurities and feelings that are contradictory, ambivalent, or mixed, according to MotivationalInterview.net (MI.net). The aim is to help people find the motivation they need so they can feel enabled to change parts of their behavior or the whole of their behavior. The brief intervention was initially created to help clients who struggle with substance use disorders (SUD).

The motivational interview, which has been described as a short-term, practical, and an empathetic process, has two key goals. The first goal is to help clients find ways to increase their motivation; the second goal is to ensure they commit to the change.

This commitment involves creating a strategy as well so that it will be easier to make the change. Having a plan of action can also make clients feel prepared as they make changes. What makes motivational interviewing different from other therapies is that it requires that an emphatic non-confrontive approach is used. It also has stage-specific strategies.

Motivational Interviewing Usually Is Based on These Four Assumptions:

Ambivalence, or having mixed or contradictory feelings about substance use (and change) is a normal obstacle in addiction recovery

These unresolved mixed feelings can be worked though by working with one’s natural motivations and values

The relationship between the client and therapists is a partnership in which they work together and each person brings expertise to it

A counseling style that is empathetic, supportive, and directive is present and can help establish an environment in which change can occur

A therapist or motivational interviewing counselor may meet with clients anywhere from once a week to up to four times a week for a one-hour session. This meeting can take place in different settings, including clinics that specialize in aftercare or those that offer outpatient services.

Inpatient treatment centers, halfway houses, sober-living homes, and other community-based settings are also places where MI sessions are held.

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People Who Can Benefit from Motivational Interviewing Include Those Who:

  • Are not motivated, less motivated, or not ready to change
  • Have doubts about whether drug or alcohol rehab will work
  • Express anger, opposition, or other negative emotions
  • Have substance abuse problems, smoking, gambling, etc
  • Have co-occurring disorders (dual diagnosis)

MI.net writes, “[Motivational Interview] is a form of intervention [in which the purpose] is helping people to find and keep their motivation so they can change their behavior, which is preventing their healing process. MI is also used to help people lead healthier lives physically and psychologically, and it also prepares them for further therapies.”

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Some Noted Benefits of Motivational Interviewing Are:

  • Low cost. it is a short intervention that is delivered in two to four sessions.
  • Efficacy. Motivational interviewing has been shown to trigger change of high-risk behaviors in some cases.
  • Emphasis on client motivation. Clients can be helped within the first few sessions even if they do not stay for a long period.
  • Compatibility with larger health-care delivery systems. This therapy does not assume a long-term client-therapist relationship. One session may be all that’s needed to bring about behavioral change that benefits the client.

The motivational interview can be a stand-alone intervention or used with behavior therapies to give the client the best rehabilitation experience possible. It also can be used to complement recovery support groups, such as 12-step fellowship groups like Alcoholic Anonymous, cognitive therapy, and other interventions.  

Indecision can create stress. If you are on the fence about whether you should stop using drugs or alcohol, but you think you may want to quit, then motivational interviewing can help you decide what your next move.

5 Principles of Motivational Interviewing

The book Motivational Interviewing: Preparing People to Change Addictive Behavior, written by psychologists William Richard Miller and Stephen Rollnick, highlights five basic principles of motivational interviewing, and all of them can be incorporated into addiction treatment. Therapists who use MI are advised to follow these principles:

Expressing empathy shows the client acceptance and increases the chances of a rapport developing between the client and therapist.

Therapists can guide clients in recognizing and identifying discrepancies between how they live now and how they want to live in the future. Seeing these differences and becoming fully aware of them can help clients face and understand how their current behaviors are not supportive of their hopes for their future.

Therapists are encouraged to not argue or get into a confrontation with clients who are hostile or defiant or exhibit other negative behaviors. Arguments are viewed as counterproductive and do not contribute to the purpose of motivational interviewing.

Clients who exhibit resistance may be reacting in that manner because they now view the situation in a different light. Whether the response is one of defiance or a hint that a new perspective is forming, therapists are urged to “roll with resistance” to treatment. When this happens, the therapist may need to reframe negative information by introducing a new, positive view or try another approach of questioning.

Therapists should encourage their clients to see their strengths and ability to make behavioral changes. Many recovering substance users have little faith in their ability to begin again, but therapists are there to help them believe that change is possible and they can reach their goals.

Motivational interviewing is a conversation

MI is designed to make it easier for clients to express their needs to therapists. People who participate in motivational interviewing can expect their therapist to:

Ask open-ended questions. This kind of questioning allows counselors and clinicians to learn key information from clients in a neutral way. Open-ended questions require the person to go beyond single-word responses or phrases and allows for honest expression of their perspective. They also help the person share how they feel about a topic or an issue. This technique keeps communication open and helps to avoid the issue of making premature judgments or conclusions.

Engage in reflective listening. Therapists who use motivational interviewing must demonstrate to their clients that they have accurately heard and understood what has been expressed. This is often done when clinicians repeat back to clients what was understood to be said to avoid assumptions. According to SAMHSA, this listening technique “strengthens the empathic relationship between the clinician and the client and encourages further exploration of problems and feelings.” It also encourages MI clients to continue sharing what they are thinking and feeling, establishes respect, seals the alliance between the client and the clinician, and reinforces motivation.

Summarize information shared in the counseling session. According to Miller and Rollnick’s book, “Summaries reinforce what has been said, show that you have been listening carefully, and prepare the client to move on.” Summarizing the session can help therapists and clients figure out which information is important to keep for future discussions and what can be discarded. Summarizing also makes the client think about their experiences and responses shared in the session.

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Give affirming statements. When a therapist acknowledges what a client has shared during the session, it validates the client’s feelings and experiences, which also helps build up trust in the therapist-client relationship. Affirming also helps clients look inwardly to embrace their natural resources to change their behavior. Examples of affirming statements, taken from Miller and Rollnick’s book, include:

  • It must have been for you to decide to come here
  • It’s great that you want to do something about this problem
  • That must have been difficult for you
  • You're strong for having been able to live with this problem so long

Elicit Self-Motivational Statements. Therapists encourage their clients to recognize and voice their concerns and intentions with any self-motivational statements they share. Ultimately, the goal is for clients to desire change for themselves and persuade themselves that they want to and can improve. Examples of self-motivational statements include:

  • I guess this has been affecting me more than I realized
  • I feel terrible about how my drinking has hurt my family
  • I don’t know what to do, but something has to change
  • I think I could become clean and sober if I decided to
  • If I really put my mind to something, I can do it

Does Motivational Interviewing Work? Is It Effective?

Past studies have evaluated motivational interviewing for its effectiveness. According to various sources, the studies supported this approach as a useful clinical intervention. Of the 11 clinical trials involving motivational interviewing that have been conducted in the past, nine are reported to have found MI more effective than no treatment, standard treatment, extended treatment, or being on a waiting list before receiving the intervention.  Of course, everyone’s experience with MI will vary, and as with anything else, what you get out of it will depend on what effort is put into it.

Motivational Enhancement Therapy (MET)

By now, you may be asking, “Is motivational interviewing the same as motivational enhancement therapy?” or “How does motivational interviewing differ from motivational enhancement therapy?”

Motivational enhancement therapy (MET), according to the National Institute on Drug Abuse (NIDA), is a counseling approach that helps people resolve their ambivalence about stopping their drug use and going to addiction treatment. It is structured differently and involves a specific emphasis on client assessment data that is summarized and given in the form of feedback to the client. 

Motivational interviewing principles (outlined above) are used in motivational enhancement therapy to help clients create a strategy for change. MET can help clients with substance abuse disorder(s) (SUD) as well as people who have both a mental health disorder and an SUD, a condition known as dual diagnosis.

As NIDA explains, this therapy, which is typically brief, has an initial assessment battery session that is followed by two to four individual treatment sessions with a therapist. “In the first treatment session, the therapist provides feedback to the initial assessment, stimulating discussion about personal substance use and eliciting self-motivational statements,” NIDA writes.

MET is more commonly used along with other therapies. According to GoodTherapy.org, MET can serve as a form of pretreatment to help boost a person’s motivation to start a more-specific form of therapy, such as cognitive behavioral therapy (CBT) or it can be used with a different form of therapy to support the person’s motivation to change.

Does Motivational Enhancement Therapy Work?

NIDA reports that research suggests that the effects of motivational enhancement therapy depend on two factors: a) what kind of drug participants used and b) the goal of the intervention.

“This approach has been used successfully with people addicted to alcohol to both improve their engagement in treatment and reduce their problem drinking. MET has also been used successfully with marijuana-dependent adults when combined with cognitive-behavioral therapy, constituting a more comprehensive treatment approach,” NIDA writes.

It goes on to say, “The results of MET are mixed for people abusing other drugs (e.g., heroin, cocaine, nicotine) and for adolescents who tend to use multiple drugs. In general, MET seems to be more effective for engaging drug abusers in treatment than for producing changes in drug use.”

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