David Godot, Psy.D.

Motivational Enhancement Therapy

August 16, 2013 • Mental Health
Photo by Trey Ratcliff

Many times the most difficult thing about making a change is deciding to. It is the terrible ambivalence that keeps us from taking steps to improve our health, to strengthen our relationships, and to break free from patterns of behavior that damage and hold us back. Many people take the first major step of coming to therapy for addictions, or depression, or marital discord -- only to find that they are fighting an internal battle about whether or not they really want to take action. Sometimes that conflict doesn't even really show its face until you're sitting in a therapist's office being told what to do in order to get what you want. And a part of you, just... doesn't want to.

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Motivational Enhancement Therapy is like the therapy before the therapy. Before you can really dig into the work of making change in your life, you have to make that critical decision -- that this is the time. Not with part of your mind, but with all of it.

The Motivational Enhancement procedure takes about four sessions, which are spent examining the situation as it is, the changes you'd like to see, and the reasons why you'd like to see those changes. Most people are surprised at how low-pressure these sessions are. There is no point during a Motivational Enhancement session at which I will try to convince the patient of anything. My job in these sessions is just to ask the types of questions that help a person understand their own reasons for wanting to change. The final decision about how to proceed rests squarely in the hands of the patient.

The way this is done is using the techniques of motivational interviewing:

  1. Open-ended questions - This type of questioning naturally leads into the issues most pertinent not to the therapist, but to the patient.
  2. Affirmations - When we're feeling ambivalent, it's often because we're having trouble recognizing what strengths we can bring to bear on a situation. By helping you recognize the things you're already doing well, this technique provides a feeling of encouragement and stimulates problem-solving.
  3. Reflective listening - The client's own ideas and experiences are reflected back in a way that facilitates momentum toward a logical conclusion.
  4. Summaries - Periodically, the therapist provides a summary to help bring it all together and show how each of the ideas discussed connect.

So the purpose of this therapy is not to persuade the client that they should make a change -- after all, if they didn't already want a change, they wouldn't have showed up. The purpose is to help draw connections between personal experiences and strengths, so that a natural, progressive course of action will become clear.