Motivational Enhancement / Motivational Interviewing

Motivational Enhancement is an approach to assisting individuals with changing in areas of difficult behavior, utilizing the principles and strategies of the Motivational Interviewing approach, a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence as the individual progresses toward recovery.

Motivational Enhancement Therapy (MET) is an adaptation of motivational interviewing (MI) that includes one or more client feedback sessions in which normative feedback is presented and discussed in an explicitly nonconfrontational manner. Motivational interviewing is a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve their ambivalence and achieve lasting changes for a range of problematic behaviors. This intervention has been extensively tested in treatment evaluations of alcohol and other drug use/misuse. MET uses an empathic but directive approach in which the therapist provides feedback that is intended to strengthen and consolidate the client's commitment to change and promote a sense of self-efficacy. MET aims to elicit intrinsic motivation to change substance abuse by resolving client ambivalence, evoking self-motivational statements and commitment to change, and "rolling with resistance" (responding in a neutral way to the client's resistance to change rather than contradicting or correcting the client).

Motivational Interviewing (MI) is a goal-directed, client-centered counseling style for eliciting behavioral change by helping clients to explore and resolve ambivalence. The operational assumption in MI is that ambivalent attitudes or lack of resolve is the primary obstacle to behavioral change, so that the examination and resolution of ambivalence becomes its key goal. MI has been applied to a wide range of problem behaviors related to alcohol and substance abuse as well as health promotion, medical treatment adherence, and mental health issues. Although many variations in technique exist, the MI counseling style generally includes the following elements:

• Establishing rapport with the client and listening reflectively.
• Asking open-ended questions to explore the client's own motivations for change.
• Affirming the client's change-related statements and efforts.
• Eliciting recognition of the gap between current behavior and desired life goals.
• Asking permission before providing information or advice.
• Responding to resistance without direct confrontation. (Resistance is used as a feedback signal to the therapist to adjust the approach.)
• Encouraging the client's self-efficacy for change.
• Developing an action plan to which the client is willing to commit.

Adaptations of the MI counseling approach have included brief interventions for college-age youth visiting hospital emergency rooms after an alcohol-related event; brief interventions for adult patients with histories of heavy drinking presenting to primary medical care settings for routine care; and brief interventions for cocaine and heroin users presenting to urban walk-in medical clinics. Community-based substance abuse treatment clinics also have incorporated the MI counseling style into their initial intake/orientation session to improve program retention.