Motivation Enhancement Therapy

Motivation Enhancement Therapy: A Path to Positive Change

Motivation Enhancement Therapy (MET) is an evidence-based therapeutic approach designed to help individuals overcome ambivalence about making positive changes in their lives. It is particularly effective in addressing addictive behaviors and fostering motivation for recovery. Abraham Maslow proposed that motivation is always goal driven (Maslow, 2013). Roy Baumeister rhetorically pondered, “in light of the personal and social benefits of good self-control, it is perplexing why self-regulation fails so often despite many people’s valiant efforts and strong motivation to conquer their instincts and temptations for the sake of behaviors associated with long-term rewards that promote success in life” (Baumeister & Bauer, 2017, Kindle location: 2,097).

The goal of motivational enhancement theory is to strengthen motivation so the individual can achieve long term goals and live a better life. A key use of MET is to address lack of motivation for successful delay of immediate gratification of momentary pleasure in order to successfully obtain higher reward goals. This is especially relevant to overcoming addiction and other maladaptive behaviors that interfere with overall wellbeing.

Motivational Enhancement Therapy is a systematic intervention approach for evoking change. This theory is based on the principles of motivational psychology, and the stages of change model.

In this article, we will explore the key principles, techniques, and benefits of Motivation Enhancement Therapy.

Understanding Motivation Enhancement Therapy

Motivation Enhancement Therapy is rooted in the understanding that individuals experience of mixed feelings about changing their behavior. Whether it is overcoming substance abuse, adopting healthier lifestyle choices, or improving relationships, the process of change can be daunting. MET acknowledges the importance of intrinsic motivation and aims to amplify it by building self-efficacy and empowering individuals to make informed decisions.

MET is an integrated therapy utilizing concepts from drawn from motivational interviewing and motivational therapy. Within the MET model of therapy, there are shades of cognitive behavioral therapy and a Rogerian humanistic approach. The MET method has two components: initial assessment battery session, and two to four individual therapeutic sessions with a therapist.

William R. Miller defined motivational intervention as “an operation that increases the probability of entering, continuing, and complying with an active change strategy” (Miller, 1985). Basically, the MET utilizes a variety of techniques and styles that support motivation for the active process of change. These strategies enter around cognitive processes that strengthen intrinsic motivation and limit external pressures that may overwhelm a client’s window of toleration.

The founders designed MET to produce rapid, internally motivated change. This treatment strategy does not attempt to guide and train the client, by walking them step by step through recovery, but instead it employs motivational strategies to mobilize the client’s own change resources.

Origins of Motivation Enhancement Therapy

Motivation Enhancement Therapy can be traced back to William R. Millers’ Motivational Interview style, introduced in the early 1980’s. In 1992, Project MATCH, supported by grants under a cooperative agreement funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), conducted extensive studies on the effectiveness of Motivational Enhancement therapy for treatment of alcohol abuse, and found MET to be an effective treatment option.

Because of the brief but effective nature of Motivational Enhancement Therapy, it has been adopted by governmental agencies throughout the United States. Particularly, many probation departments use a modified version of motivational interviewing to assist clients reintegrate back into society after conviction of a criminal offense.

Comparing MET with Cognitive Behavioral Therapy

MET is an entirely different strategy from the skill and coping strategy training offered in cognitive behavioral therapy. MET theory assumes that “the key element for lasting change is a motivational shift that instigates a decision and commitment to change” (Miller, Zweben, et al., 1992). Accordingly, MET achieves this goal by assisting clients with a new decisional balance (focusing on goals that motivate change over momentary impulses to relapse), and “the strength of one’s perceived ability to manage the behavioral change” (DiClemente, 2017).

MET prioritizes the development of intrinsic motivation, understanding the external motivators are insufficient to maintain change over time. “People who develop a change strategy based on a single extrinsic motivator typically miss the importance of creating circumstances in which intrinsic rewards carry their share of the motivational load” (Grenny, et al., 2013, p. 261).

CBT assumes that motivation for recovery is already present but faulty cognitions interfere with enacting the change. Accordingly, CBT assists the clients with skills such as developing coping mechanisms, reappraising cognitions, and realigning beliefs that interfere with change.

Stages of Change Model

MET integrates Carlos C. Clemente’s theoretical model for the stages of change. DiClemente was instrumental in working with Miller to compose the Motivational Enhancement Therapy Manual published in 1992.

DiClemente’s stages of change model proposes that people change through a series of five stages:

• Precontemplation
• Contemplation
• Planning/Determination
• Action
• Maintenance

In the process of change each stage has its own challenges and necessary skills. In MET, the therapists works with the client to enhance motivation appropriate for each of these stages.

See Stages of Change for more on this topic

Active Ingredients for Change

Miller described six elements which he believed to be active ingredients of relatively brief interventions that have been shown by
research to induce change in problem drinkers, summarized by the acronym FRAMES:

• FEEDBACK of personal risk or impairment
• Emphasis on personal RESPONSIBILITY for change
• Clear ADVICE to change
• A MENU of alternative change options
• Therapist EMPATHY
• Facilitation of client SELF-EFFICACY or optimism

Five Basic Motivational Principles

MET seeks to support intrinsic motivation for change, which will lead the client to initiate, persist in, and comply with behavior change efforts. Miller and Rollnick (1991) have described five basic motivational principles underlying such an approach:

1. Express Empathy: Therapists practicing MET strive to create a non-judgmental and empathetic environment. By actively listening and showing empathy, therapists establish a rapport that fosters trust and understanding.
2. Develop Discrepancy: MET helps individuals identify the discrepancies between their current behaviors and their personal goals and values. By highlighting these discrepancies (cognitive dissonance), clients become more aware of the need for change, motivating them to take action.
3. Avoid Argumentation: Rather than engaging in confrontations, MET employs a collaborative and supportive approach. Therapists work with clients to explore the pros and cons of their behaviors, encouraging self-reflection and self-evaluation. By introducing deeper reflection into consequences of behavior, the decisional balance shifts, enhancing motivation for change.
4. Roll with Resistance: MET strategies do not fight resistance head on, but prefer the term to “roll with” the momentum. The MET therapists acts with the goal of shifting the clients perceptions, introducing new ways of thinking about problems but not imposing these ideas on the client. The MET therapist views client resistance as normal, not pathological.
5. Support Self-Efficacy: Building self-confidence and belief in one’s ability to change is crucial in MET. Therapists acknowledge individuals’ strengths and accomplishments, bolstering their self-efficacy and encouraging them to take steps towards positive change.

Techniques Used in Motivational Enhancement Therapy

Motivational Enhancement Therapy employs several evidence-based techniques to foster motivation and encourage behavioral change. Motivational counseling can be divided into two major phases: building motivation for change and strengthening commitment to change (Miller and Rollnick 1991). Building motivation for change entails tipping the client’s decisional balance in favor of change. This includes understanding the client through empathetic listening, helping the client identify self-motivational statements, and providing ample feedback and affirmation.

The first phase is centered around DiClemente’s contemplation stage of change. The therapist helps enhance the client’s motivation for change.

The Second phase of MET is to consolidate the motivation, directing it towards actual change. This includes setting goals, preparing for setbacks, and gathering resources.

To accomplish these tasks, the therapist utilizes the following techniques:

1. Assessment: Clients engage in a comprehensive assessment to understand their goals, values, and motivations. This helps therapists tailor the treatment specifically to the individual’s needs.
2. Feedback: Therapists provide feedback based on the assessment, offering insights into the client’s behavior and its consequences. This feedback is delivered in a non-confrontational manner, emphasizing empathy and understanding.
3. Goal Setting: Collaboratively, therapists and clients set realistic and achievable goals. These goals are personalized to align with the individual’s values and aspirations, ensuring a sense of ownership and commitment.
4. Exploration of Ambivalence: MET recognizes that ambivalence is a natural part of the change process. Therapists help clients explore their mixed feelings and concerns, providing a safe space to discuss and resolve them.

Benefits of Motivation Enhancement Therapy

Motivation Enhancement Therapy offers several benefits for individuals seeking positive change:

1. Greater Self-awareness: MET promotes self-reflection and deepens individuals’ understanding of their own motivations and values. This increased self-awareness is key to making meaningful and lasting changes in their lives.
2. Increased Intrinsic Motivation: By recognizing and amplifying individuals’ own motivations, MET helps cultivate internal motivation for change. This intrinsic motivation is more sustainable and enduring compared to external sources of motivation.
3. Improved Treatment Engagement: MET has proven effective in improving treatment engagement and retention rates. By addressing ambivalence, it helps individuals commit to the change process and actively participate in their own recovery.
4. Enhanced Well-being: Ultimately, MET aims to improve an individual’s overall well-being by assisting in the development of healthier and more adaptive behaviors. This not only benefits the individual but also contributes to healthier communities and relationships.

A Few Words by Psychology Fanatic

In the journey of self-improvement and change, Motivation Enhancement Therapy (MET) emerges as a beacon of hope, guiding individuals through the fog of ambivalence and resistance. This article has traversed the nuanced landscape of MET, from its empathetic approach to its strategic deployment of motivational interviewing techniques. As we conclude, it’s clear that MET’s strength lies in its ability to empower individuals, illuminating the path to change with the light of their own intrinsic motivation. By fostering a collaborative and non-confrontational environment, MET helps individuals uncover their latent desires for change, turning the key to unlock their potential. The journey of change is not a solitary one; MET stands as a testament to the power of partnership in the therapeutic process, a partnership that honors the client’s autonomy while gently nurturing the seeds of transformation.

Last Update: April 15, 2024

References:

Baumeister, Roy F. & Bauer, Isabelle M. (2017). Self-Regulatory Strength. K. D. Vohs, & R. F. Baumeister (Eds.), Handbook of Self-Regulation: Third Edition: Research, Theory, and Applications. The Guilford Press; Third edition.

DiClemente, Carlo C. (2017). Addiction and Change: How Addictions Develop and Addicted People Recover. The Guilford Press; 2nd edition.

Grenny, Joseph; Patterson, Kerry; Maxfield, David; McMillan, Ron; Switzler, Al (2013). Influencer: The New Science of Leading Change. McGraw Hill; 2nd edition.

Maslow, Abraham H. (1943/2013). A Theory of Human Motivation. Martino Fine Books

Miller, William R.; Zweben, Allen; DiClemente, Carlo C.; Rychtarik, Robert G. (1992). Project Match Monograph Series Volume 2: Motivational Enhancement Therapy Manual: A Clinical Research Guide for Therapists Treating Individuals with Alcohol Abuse and Dependence. NIAAA (National Institute on Alcohol Abuse and Alcoholism).

Miller, William R. (1985). Motivation for Treatment: A Review With Special Emphasis on Alcoholism. Psychological Bulletin, 98(1), 84-107. DOI: 10.1037/0033-2909.98.1.84

Miller, William R.; Rollnick, Stephen (1992/2012). Motivational Interviewing: Helping People Change, 3rd Edition (Applications of Motivational Interviewing Series). The Guilford Press; 3rd edition.

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