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By Megan Aul, MA, LPCtherapist at Enterhealth Outpatient Center of Excellence

According to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Survey on Drug Use and Health, in 2013, there were more than 24.6 million Americans in need of treatment for addiction disorders.

One of the major hurdles that people face when trying to get treatment for addiction is that they lack the motivation to get better. Many don’t have the necessary motivation to change for three main reasons:

  1. They don’t believe their substance abuse is as serious as it really is.
  2. They don’t want to give up the positive sensations associated with drug or alcohol use.
  3. They fear the consequences of halting substance use, including withdrawal symptoms and cravings.

Realizing these fears presented a multitude of challenges for people who actually wanted to change their ways, psychologists William R. Miller and Stephen Rollnick began developing motivational interviewing 30 years ago as a way to push past these issues and give patients with low motivation the impetus they need to affect positive change.

What Is Motivational Enhancement Therapy?

Motivational enhancement therapy, also called motivational interviewing, is a psychotherapeutic approach which attempts to take a patient from a state of indecision or uncertainty to a point where they feel motivated to make positive decisions and accomplish established goals.

As the name suggests, the goal of this technique is to motivate the client to change their (negative/destructive) behavior. Motivational enhancement therapy differs from earlier motivation-based techniques in that it utilizes a non-confrontational, collaborative effort between therapist and client to spark motivation and initiate change.

Rather than taking an antagonistic approach, the therapist should engage with the client to explore his or her feelings and help the client find his own motivations. In this way, the therapist becomes a form of support that allows clients to make their own choices and arrive at their own conclusions.

Goals of the Therapist in Motivational Enhancement Therapy

Express empathy. This is a core value of person-centered therapy incorporated into motivational interviewing. The therapist needs to get an understanding of the client’s issues, struggles and barriers to improvement before the patient starts to feel a lack of judgment and criticism. That’s when free and open disclosure tends to start happening.

Point out inconsistencies. It is also the job of the therapist to try to get the client recognize the disparity between what they are doing and what their stated goals are. For instance, if the goal is to be happy and successful, using drugs and alcohol every day is not going to get them there. The therapist will be careful to use nonconfrontational interventions and will typically ask a series of questions leading the client to these types of conclusions.

Roll with resistance. Therapists who use motivational interviewing understand that at times, there will be resistance and reluctance from the client. Staying in line with the nonconfrontational stance, the therapist should not try to force or manipulate the client. The therapist must work to understand the client’s point of view and avoid their desire to correct what may be viewed as flawed ways of thinking while offering alternative ways of thinking for the client to consider.

Support the client’s self-efficacy. Many clients, dealing with addiction, recovery, and relapse have tried to maintain their sobriety with limited success. This often leads them to become less confident and hopeful for future success. The therapist should work to highlight areas of strengths and list a number of instances where the client was able to accomplish their goal.

A Session of Motivational Interviewing

A typical session of motivational interviewing will include:

Open-ended questions. Open-ended questions require the patient to increase the amount of time and detail they put into what they think and what they say. Therapists utilizing motivational interviewing employ questions like these to engage the client so they can gain a better understanding of that person’s thoughts, feelings, and beliefs. Open-ended questions also give the client the sense that they are in control of the session, further increasing honesty and building confidence.

Affirmations. Affirmations are assertions made by the therapist in support of a patient’s decision or a behavior. When done properly, these affirmations from the therapist are essential in building the client’s confidence and belief in their ability to change.

Reflections. Reflective listening is important as a component in motivational interviewing as it is in other types of therapy such as cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT). The therapist listens carefully to the client and reflects on the information, but they don’t just restate what the client says. It is a way to show the patient that the therapist understands their experience, and it’s critical for building a connection.

Summaries. To the untrained ear, summaries would seem to be the same as reflections. However, summaries differ in that they outline and recap the information the patient discussed to uncover any themes and/or common issues. Summaries can be useful because they often expose the discrepancies in the client’s narrative.

Initiate change talk. If the previous four components of the session do what they are intended, the patient should begin to initiate change talk. The client will hopefully begin to make clear statements about change and the benefits of change.

Change talk is generally divided into two categories. The first is preparatory, which includes things such as a desire for change, acknowledgement of their ability to change, reasons to change, and the need for change.

The second, and even more encouraging type of change talk, is called implementing. This includes statements of commitment to change, activation of preparedness and willingness, and taking steps to make the change.

How Enterhealth Utilizes Motivational Interviewing

Enterhealth has been using motivational interviewing techniques since it began treating people for drug and alcohol addiction more than a decade ago. Motivational interviewing is also a fantastic adjunct (or add-on) treatment for patients enrolled in SMART recovery. SMART (Self-Management and Recovery Training) is a secular, scientifically based approach that uses elements of CBT and motivational methodologies.

Motivational interviewing is a good technique for initial engagement with patients at both Enterhealth Ranch (our inpatient facility outside Dallas) and The Enterhealth Outpatient Center of Excellence (our outpatient center in the Park Cities neighborhood of Dallas). It’s also a helpful tool with patients in recovery who have become complacent with their recovery.