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Most methods of psychotherapy are designed for the therapist to help the client. Motivational Enhancement Therapy (MET) seems to be one of these; but it’s actually therapy for the therapist when standard Cognitive Behavioral Therapy (CBT) just ain’t working.
Why wouldn’t CBT work? Well, for one reason, in CBT you have a therapist who believes the client is not thinking right, feeling right, or doing right; that’s why she’s having the trouble she has. If only she would do things the CBT way, everything would be much better. CBT doesn’t work when the client still wants to do things her way. Clients are often naturally resistant. That’s the problem that drives many CBT therapists mad: resistance.
Motivational Enhancement Therapy is cognitive behavioral therapy for cognitive behavioral therapists who are frustrated that cognitive behavioral therapy is not working. MET tells therapists they are doing it wrong, somewhat. MET says CBT ways are still helpful, but the therapist has to think about the client differently and present the material in a different way.
MET says the therapist should take into account the client’s position in the stages of change. A client who is in pre-contemplation phrase (MET lingo for she doesn’t know she has a problem) has to be spoken to differently than one who is ready for action. Therapists are instructed to express empathy, develop discrepancy, avoid argument, roll with resistance, and support self-efficacy. When a therapist does this, to me it looks suspiciously like he’s behaving like a Rogerian Client Centered therapist; but, you can’t say that to them. They are committed to providing therapy within the family tree of CBT.
The general idea of how to work with resistant clients using MET is to get them talking in a safe, non-judgmental space. You wait for them to express that they want to change, they’re tired of the hangovers, sick of the guilt, worried that no one is going to like them any more; then, ever so casually, you pounce. The pouncing part is distinctly not Rogerian. You pounce by subtly reinforcing change talk and ignoring resistance. This way you maneuver them into thinking that change was their idea all along. It’s a thing of beauty, and if you never heard of Carl Rogers, you might be glad that MET came along.
MET is a pretty effective type of therapy for the issue it was designed to treat: addiction. In addiction, it’s clear that the client is doing stuff that is highly self destructive. At the same time, she is highly resistant to change. That’s putting it mildly. In addiction you often have a client who is dead-set against change and is only seeing a counselor because she’s forced to. Sitting down with someone who feels that way can be pretty intimidating, let me tell you. Thank goodness I have had MET to tell me what to do. What does MET have to say? It says to me, the client will only do what she wants to do and no one can’t make her do otherwise. If I listen to Motivational Enhancement Therapy, it will enhance the motivation of the client as promised by de-enhancing my own.
Motivational Enhancement Therapy also deserves a lot of credit for helping therapists through that baffling, aggravating stage of change that it calls “contemplation phase”. This is a period, sometimes lasting years, when the client is ambivalent about recovery. He’s starting to see how his drug use, for instance, might not be all it’s cracked up to be and will often make long speeches, saying how he’s ready for change, only to return to shooting up in an instant. This is an essential part of the process, says MET. He has to try out recovery, little by little. Be patient, says MET. Lead him in a risk-reward analysis. People in contemplation phrase are not lying to you when they say they want to change, says MET; they are perfectly sincere. They just need some time to work out what it all means.
We can all use the lessons taught by Motivational Enhancement Therapy, especially when dealing with a person who promises change, but doesn’t. Express empathy, develop discrepancy, avoid argument, roll with resistance, and support self-efficacy.
Good advice for everyone.
To read the manual for how to provide MET, click here.
Keith R Wilson 