Motivational Interviewing (MI) is a commonly used therapeutic modality for the treatment of drug and alcohol addiction. Motivational Interviewing is nonjudgmental and not confrontational. Rather, it empowers the patient and the therapist to form a partnership and assists the patient in overcoming his/her ambivalence about change. As is well-known, confrontational and directive therapy can lead to defensiveness and resistance, and an overall negative treatment experience.
MI is provided in an empathetic manner using reflective listening. which is the process of repeating the content of a conversation or statement to ensure that the listener has understood what has been said. Reflective listening also fosters the development of trust. The overall theme of MI is that the patient is guided in forming their own opinions and developing their own solutions to the problem. By actively prompting the patient to identify which behaviors are contrary to his/her values and goals, the patient is led on a path of self-reflection, which increases the motivation for change. This process is called fostering discrepancy, i.e. there is a discrepancy between the patient’s values and goals and his/her behavior and consequences.
Ambivalence is when a patient knows that their drug addiction or alcoholism is a problem and wishes to change, but at the same time they do not want to stop using substances or accept change. Ambivalence is not resistance or denial, but a natural part of the process of change and is expected to occur. In allowing the patient to identify his/her own problems, goals and solutions in an empathetic environment, compliance is often more easily achieved. By accepting the patient’s viewpoints, the patient is empowered to change their behaviors. Acceptance is not the same as agreement. In agreement, there is an implied “right” and “wrong” answer; whereas, acceptance relays a shared understanding of reality.
Because Motivational Interviewing is non-threatening it is well-suited to empower patients to openly disclose their feelings, behaviors and problems with the therapist. In doing so, the patient begins to accept his/her problem and becomes self-sufficient in the development and implementation of a drug addiction and alcoholism recovery plan. Certainly, when prompted, the therapist can educate the patient on the problems associated with drug and alcohol addiction as well as the solutions available.
Another type of therapy that utilizes the techniques of Motivational Interviewing is Motivational Enhancement Therapy (MET). In MET, the principles of MI have been placed in a structured format to assist the patient to progress in the stages of change. A drug addict or alcoholic ordinarily moves forwards or backwards through the following stages of change:
- Precontemplation – The patient is not relating his/her problems to drug addiction or alcoholism and does not intent to change
- Contemplation – The patient understands that his/her has a substance abuse problem, but is not ready or is fearful of implementing change
- Preparation – The patient realizes that drug addiction and alcoholism is a problem and is creating consequences, but may be unsure of their ability to change. The patient is weighing his/her options
- Action – The patient has actively begun to change his/her behavior
- Maintenance – The patient has achieved success in changing some behaviors and is working towards continued progress and maintaining the positive changes they have already made
In MET, the therapist works with the drug addict or alcoholic on a time-limited basis. It is typical that Motivational Enhancement Therapy will follow a set number of sessions, generally totaling 4 sessions. MET is a good tool to assist patients in moving from one stage of change to the next and in helping the patient see the need for other types of therapy.
Motivation Interviewing and Motivational Enhancement Therapy are unique in the sense that they do not focus as much on automatic thoughts that lead to emotions and behaviors, as does Cognitive Behavioral Therapy, but are solution-oriented and focus on core values, behaviors, and goals. MI and MET also do not focus on childhood issues, as does Schema-Based Cognitive Therapy and traditional psychotherapy. Because of this, it is commonplace for a therapist to utilize other therapeutic techniques in conjunction with MI and MET.
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