What is Motivational Enhancement Therapy and How Does It Work?

The biggest roadblock to the recovery process? Many people are ambivalent about getting better. They may recognize the negative consequences of their drug abuse, but the reward is too great to deny.

Motivational enhancement therapy is useful in these instances. It motivates people to want to get better. Let’s take a look at how it works.

What Is Motivational Enhancement Therapy and How Does It Work

Motivational enhancement is behavioral therapy that helps people overcome their ambivalence to drug use and motivates them to get better. It is based on the theory of internally motivated change. People should intrinsically want to overcome drug addiction rather than feel pressured to do so.

The practice originated from motivational interviewing in the early 1980s and was formalized as a manualized treatment in the early 1990s through the U.S. National Institute on Alcohol Abuse and Alcoholism’s (NIAA) Project Match clinical trial. It addressed the need for efficient, non-confrontational interventions, focused on a readiness for change.

The Five Core Principles of MET in Addiction Treatment

While MET can take different approaches, which include:

• Express Empathy: Therapists express empathy with their clients, acknowledging their feelings and the struggle to change without judgment.

• Develop Discrepancy: Clients learn to recognize inconsistencies between their current behaviors and their overall goals and values, which builds motivation.

• Avoid Argumentation: The counselor avoids arguing with and persuading clients; rather, they see their ambivalence as normal and encourage the client toward “change talk”.

• Roll with Resistance: Resistance should be approached with curiosity and collaboratively, supporting statements that promote change rather than confronting opposition.

• Supporting self-efficacy: Affirm the client’s ability to change and empower them to succeed.

OARS Techniques: The Foundation of Motivational Interviewing

The OARS technique is a common communication strategy adapted from motivational interviewing. The letters stand for:

• O-Open-ended questions: Inviting elaboration beyond yes and no answers, encouraging clients to open up about their drug use and the reasons behind it.

• A-Affirmations: Acknowledging the client’s strengths and positive qualities to build self-efficacy and confidence

• R-Reflective listening: Paraphrase what the client is saying to demonstrate active listening and show understanding and validation, while encouraging them to dig deeper

• S-Summaries: Recap what’s been discussed in the motivational enhancement therapy session to consolidate insights, guide discussions, and transition between topics

Building Intrinsic Motivation for Lasting Recovery

The goal of motivational drug addiction treatment is to enhance intrinsic motivation and internalize the desire to get better. Here are some strategies that support the desired outcome.

• Build Autonomy, Not Pressure: Rather than pressuring people to get better, build autonomy by encouraging them to explore their options in achieving behavior change.

• Clarifying Values and Goal Setting: Encourage clients to focus on goals such as family, career, or other priorities that matter to them.

• Openly Explore Ambivalence: Explore the pros and cons of drug addiction. Then ask them which better fits how they want their life to go.

• Evoke Change Talk: Instead of giving speeches, encourage the client to discuss how they would like to change. Be specific, allowing them to explore how they would change their approach to their family, career, and other areas.

• Use Scaling Questions: These questions ask clients to rate items on a 1-10 scale, including the importance of priorities in their lives and their confidence in their ability to change. They tend to enhance motivation.

• Highlight Strengths and Successes: Empower clients by pointing out their successes, such as maintaining sobriety throughout the day or being honest in therapy.

• Turn Abstract Motivation into a Self-Chosen Plan: People are more motivated to get better when they see a clear path to sobriety that they have chosen for themselves. Therapists can encourage this therapeutic approach by asking clients about their goals and helping them achieve them. Let them know that plans can be adjusted at any time.

• Normalize Setbacks: Setbacks may occur, but the therapist should be nonjudgmental and look at failure as a learning experience.

What to Expect in MET Sessions at BlueCrest

BlueCrest offers MET sessions as part of our outpatient treatment program. Here’s what you can expect from our substance abuse treatment:

• Initial Assessment: In the early stages, we assess your needs based on the severity of the addiction, medical history, and life goals. We will determine what’s behind ambivalence to motivate change.

• Personalized Feedback: The therapist provides feedback tailored to the client’s reasons for change, goals, and progress.

• Directional Balance Exercises: Scaling questions explore the pros and cons of drug use, helping clients map out a plan for sobriety.

• Change Talk Elicitation: Clients are encouraged to discuss how they would like to change, exploring specific techniques for doing so.

• Goal Setting: The final stage involves setting realistic goals for the future. The therapist will also help you create a relapse prevention plan for the future.

Sessions typically last 20-90 minutes (with later sessions being shorter), and treatment may last 2-6 sessions.

Decisional Balance and Resolving Ambivalence About Change

Ambivalence toward change is common. Many people are torn on their addiction issues. A part of them wants to get better, and the other part wants to keep using.

MET normalizes this ambivalence. Rather than arguing about treatment adherence, it helps people sort out their feelings so they can determine what’s truly important to them.

The main strategy is decisional balance, which can be achieved by discussing the pros and cons of drug use. The therapist guides clients on their journey by pointing out where drug use interferes with their values. For example, if a client says their children are the most important thing to them, the therapist may point out how their addiction caused them to neglect their parenting duties.

They also reflect and summarize what the client says, helping them better understand the importance of behavior change.

Research Evidence Supporting MET for Substance Use Disorders

Several studies back MET’s effectiveness, including the following:

• “A 2024 review published by the Ohio Substance Use Disorder Center of Excellence found generally supportive evidence for MI and MET in treating alcohol use disorders, with six studies showing significant effects on alcohol use.”

• Research published in the Clinical Trials Network Dissemination Library reveals African American women treated with MET showed higher retention rates in the first twelve weeks as compared to those who were treated with CAU (counseling as usual).

• A 2024 review of motivational enhancement therapy and motivational interviewing published by the Ohio Substance Use Disorder Center of Excellence shows mixed results. However, it includes one body of research wherein the therapy significantly reduced heroin use among participants over a four-month period.

How MET Differs from Confrontational Addiction Treatment Approaches

MET uses a non-confrontational approach, focusing on argumentation avoidance. It differs from a confrontational approach, which:

• Acts on the assumption that the client needs to be persuaded and aims to break down denial

• Utilizes a direct, challenging, and argumentative communication style

• Escalates confrontation to develop a defensiveness cycle

• Focuses on abstinence and an admission of powerlessness

• Uses lectures and evidence to pressure clients to commit

Although some studies show both MET and confrontational addiction treatment have yielded similar positive outcomes, others reveal motivational enhancement therapy MET as the more effective counseling approach for behavioral change.

A Columbia Doctors article reveals its emphasis on self-efficacy and autonomy makes it effective for clients in the contemplation/pre-contemplation stages. Social Work Today reports that resistance cycles and defensiveness, when used in a confrontational approach, led to poorer outcomes after 12 months.

Combining MET with Cognitive Behavioral Therapy and 12-Step Programs

MET can easily be combined with cognitive behavioral approaches and 12-step programs as effective cessation strategies. Motivational enhancement gets people engaged and involved, cognitive behavioral therapy (CBT) helps them develop the coping skills they need to maintain sobriety, while a 12-step program offers community, structure, and ongoing support.

A typical sequence is as follows:

• Phase 1: MET Strategies: The goals of these initial stages are to build rapport and trust, explore ambivalence, strengthen motivation and confidence, and determine a plan to guide treatment.

• Phase 2: CBT: Clients and therapists help identify triggers that may lead to drug use, and address negative thought processes to encourage change and develop coping strategies.

• Phase 3: 12-Step Programs: Clients enter group therapy 12-step programs, where they gain support from their community, learn from others, and understand they are not alone.

Choose BlueCrest Recovery for MET Therapy and Addiction Treatment

BlueCrest Recovery provides effective recovery, offering a holistic approach. We focus on the physical and emotional aspects of addiction, supporting long-term recovery. Here’s what our service entails:

• Convenient New Jersey Location: We are based in New Jersey, a state that saw 2,816 overdose deaths in 2023. Though basedin Woodland Park, we also serve surrounding communities. Newark is just 25 minutes away, Paterson is just 15 minutes away, Jersey City is 35 minutes away, and Manhattan is just 30 minutes away from our facility, offering optimal convenience.

• Integration with New Jersey Court-Mandated Treatment Requirements: We align with these requirements, offering integrated services that uphold high state-required standards.

• Insurance Coverage: Many PPO and POS insurance plans include out-of-network benefits that may help cover treatment at BlueCrest. We recommend contacting your insurer to confirm your specific benefits.

• Connection to New Jersey Division of Mental Health and Addiction Services (DMHAS) approved treatment methods: The DMHAS approves a range of evidence-based and trauma-informed therapies, most of which are offered at our facility.

Contact us to learn more about our extensive services.