Motivational Enhancement Therapy

The aim of all psychotherapies is to improve the symptoms of individuals which hinder their personal, social and occupational life. It helps to guide the client in a manner which addresses the maladaptive thoughts and behaviours with the aid of different techniques. Motivational enhancement therapy is an intervention used with individuals to decrease their dependence on different substances by increasing awareness of the problem and the associated precipitating factors that led to that problem. It aims to identify various self-defeating thoughts while developing both intrinsic motivation and self-confidence. 

Motivational enhancement therapy is required for particularly those patients who are extremely resistant to change. This therapy is provided in collaboration with medical help as well as other therapeutic techniques like cognitive behavioural therapy for patients with substance abuse issues. This therapy is entirely based on the psychological factor motivation where individuals are gradually trained to develop an insight of their problems and progress towards recovering their addictions using intrinsic motivation. It also focuses on destructive and harmful behaviours associated with their substance abuse.

Motivational enhancement therapy functions on the following important five principles:

a). Empathy – Therapists focus on acknowledging issues presented by clients in order to increase client’s feelings of being accepted and respected. This helps in providing a supportive environment where individuals feel safe to express their thoughts in an elaborate manner without the fear of judgement.

b). Avoiding direct confrontation – Clients with substance abuse issues require patience as arguments with them can turn them more resistant to change and also make them defensive. Realisations regarding the problem and its need to change should arise from the patient’s perspective and not from the therapist.

c). Reducing discrepancy–   The therapy focuses on reducing the discrepancy between the client’s actual condition and their desired state. This is important in order to reach both short term as well as long term goals of the client.

d). Rolling with resistance – In cases where a client has held a strong rigid attitude towards change, active as well as reflective listening to what a client says plays a crucial role. Going along with their beliefs helps them feel valued and decreases the chances of defensiveness in the future.

e). Enhancing self-efficacy – It is necessary to develop confidence of client’s in their ability and potential to change. This is done by shifting attention on their strengths and reinforcing all efforts towards change.

Motivational enhancement therapy involves a series of stages:

1. Precontemplation: This is the first stage where individuals have not realised or accepted their issues with substance abuse and its need to change through recovery.
2. Contemplation: In this stage, individuals begin to develop the causes of concern with regard to their dependency and take quitting into consideration. 
3. Preparation: The person in the preparation stage begins to analyse the advantages of changing habits and makes a commitment towards the entire recovery process.
4. Action: This is one of the longest stages where plans are initiated and strategies are applied in terms of making lifestyle changes, breaking patterns of old habits and replacing them with new ones. Here, the client takes active steps towards recovery.
5. Maintenance: This is the last stage which is intended to be continued for as long as possible where the client takes efforts to guard themselves against situations that could act as a potential trigger. The client focuses on maintaining the action they took in the previous stage for establishing complete recovery.

Therefore, through the use of several principles and stages, motivational enhancement therapy attempts to make the client capable of decision making by facilitating autonomy. It also emphasises acceptance of their issues and personal responsibility for change. The main objective of the therapy is to apply motivational strategies to lead the clients to a path where the process of recovery instils hope, faith and confidence within them. 

– Urveez Kakalia & Debanjana Banerjee.