Motivational Interviewing, Motivational Enhancement Therapy (MET), and MET plus CBT
for Mixed Substance Abuse/Dependence
Status: Strong Research Support
Motivational interviewing (MI) is a brief person-centered clinical method for strengthening clients' motivation for and commitment to change. First described by Miller (1983), it was originally designed for working with people with substance use disorders, but has since been more widely applied in health care, corrections, mental health and social work. It is particularly indicated for clients who are reluctant, ambivalent or defensive about change. Strongly rooted in the work of Carl Rogers, MI is nevertheless strategically goal-directed to facilitate an identified change. The overall spirit or style of MI is collaborative and empathic, and the course of MI is normally 1-4 sessions. Rather than working from a deficit model in which the therapist provides what the client is missing (e.g., skills, insight, knowledge), MI seeks to evoke the client's own motivations, strengths and resources. Drawing on the psycholinguistics of change, particular attention is paid in MI to specific aspects of client speech that predict subsequent change. The therapist elicits and explores the client's own reasons for change within an atmosphere of acceptance to minimize resistance and defensiveness.
MI therapists use a variety of strategies to evoke and strengthen clients' "change talk." There are specific guidelines for deciding what questions to ask, and what content to reflect and summarize. Studies have demonstrated that therapists adhering to MI-consistent skills are able to significantly increase client change talk, which in turn predicts behavior change outcomes. Therapists learning MI typically begin by developing a strong foundation of client-centered counseling skills (reflective listening, open questions, affirmation, summaries), then learn to identify, evoke, and strengthen client change talk using these skills strategically.
Motivational Enhancement Therapy (MET) combines the clinical style of MI with individual assessment feedback that may be particularly helpful for less-ready clients, where the initial task is to develop ambivalence about change. It was originally developed as a manual-guided intervention (Miller et al, 1992) for the multisite Project MATCH, a randomized clinical trial in which the 4-session MET yielded long-term reductions in alcohol consumption and problems comparable to those from 12-session cognitive-behavioral or twelve-step facilitation therapies (Project MATCH Research Group, 1997). MI and MET can be combined with other approaches such as cognitive-behavioral treatment (CBT), as tested in the multisite COMBINE study (Anton et al., 2006; Miller, 2004).
- Anton, R. F., O'Malley, S. S., Ciraulo, D. A., Cisler, R. A., Couper, D., Donovan, D. M., Gastfriend, D. R., Hosking, J. D., Johnson, B. A., LoCastro, J. S., Longabaugh, R., Mason, B. J., Mattson, M. E., Miller, W. R., Pettinati, H. M., Randall, C. L., Swift, R., Weiss, R. D., Williams, L. D., & Zweben, A. for the COMBINE Study Research Group (2006). Combined pharmacotherapies and behavioral interventions for alcohol dependence. The COMBINE study: A randomized controlled trial. Journal of the American Medical Association, 295, 2003-2017.
- Hettema, J., Steele, J., & Miller, W. R.. (2005). Motivational interviewing. Annual Review of Clinical Psychology, 1, 91-111.
- Miller, W. R. (1983). Motivational interviewing with problem drinkers. Behavioural Psychotherapy, 11, 147-172.
- Miller, W. R., & Rose, G. S. (2009). Toward a theory of motivational interviewing. American Psychologist, 64, 527-537.
- Project MATCH Research Group (1997). Matching alcoholism treatments to client heterogeneity: Project MATCH posttreatment drinking outcomes. Journal of Studies on Alcohol, 58, 7-29.
- Rollnick, S., Miller, W. R., & Butler, C. (2008). Motivational interviewing in health care: Helping patients change behavior. New York: Guilford Press.
- Rosengren, D. B. (2009). Building motivational interviewing skills. New York: Guilford Press.
- Miller, W. R., Zweben, A., DiClemente, C. C., & Rychtarik, R. G. (1992). Motivational Enhancement Therapy manual: A clinical research guide for therapists treating individuals with alcohol abuse and dependence. (Volume 2, Project MATCH Monograph Series) Rockville, MD: National Institute on Alcohol Abuse and Alcoholism.
- Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change (2nd ed.). New York: Guilford Press.
- Miller, W. R. (Ed.) (2004). Combined Behavioral Intervention manual: A clinical research guide for therapists treating people with alcohol abuse and dependence. COMBINE Monograph Series, (Vol.1). Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism. DHHS No. 04-5288.
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