Motivational Enhancement Therapy (MET) is a client centered, directive method used to enhance clients' intrinsic motivation to change. MET is conducted in collaboration with the client, supports clients' autonomy and self-efficacy, and avoids argumentation in therapeutic sessions. The approach de-emphasizes labeling, encourages individual responsibility and increases the client's dissonance between their ideal goals and their present behavior. Research has supported the efficacy of MET in reducing alcohol consumption among adolescent and adult substance-involved individuals.

For more on MET, check out the following sites:

The Motivational Interviewing Page - http://www.motivationalinterview.org/index.shtml

Motivational Enhancement Therapy: Description of Counseling Approach - http://www.dualdiagnosis.org/library/nida_00-4151/9.html

Motivational Interviewing - Sage Institute - http://www.sagetraining.com/motivate.html

Agenda for Motivational Interviewing: Preparing People to Change (Addictive) Behavior - http://www.sagetraining.com/agendami.html

Motivational Interviewing - http://www.ctclearinghouse.org/ac324.htm

MET Training

On November 15 & 16, 2002 and March 14 & 15, 2003 NOPIC conducted Motivational Enhancement Therapy (MET) trainings at the Radisson Hotel in New Orleans. Over 175 participants benefited from the program as Dr. Paul Toriello and fifteen assistant trainers utilized lecture, videos, small groups, demonstrations and exercises to help people learn about MET and hone their counseling skills.

The two-day trainings were followed by booster sessions, provided about 1 1/2 months later, to help clinicians who may drift from the accurate application of MET techniques. Participants who attended the 4-hour booster sessions were helped to address problems they addressed in adapting the MET approach to their specific organization, they engaged in MET skill building, and they learned about cultural competency issues through interactive exercises led by Dr. Ed Morse and Linton Carney.

Overall, participants provided very positive feedback about the MET trainings. Among those who partcipated in the November training, almost 95% reported that the training was useful or very useful to their career. Ninety-one percent reported that the training will benefit their clients. Ninety-four percent reported that they will recommend NOPIC's MET training to colleagues. Participants reported that training in reflection, the backbone of MET techniques, was particularly useful in improving substance abuse service provision.

Some participants felt the most valuable aspect of training was learning how to deal with clients who are resistant to treatment. In particular, participants reported that they thought MET approaches would be useful in working with mandated clients. Several participants felt that MET techniques would help decrease confrontation in the clinical setting.

Some participants were initially skeptical of the MET approach, but reported training in MET principles and techniques has positively impacted their work with substance involved clients. Cam Davis, BCSAC, the clinical director of Gateway Recovery Systems noted, "As a recovering alcoholic, I did not see how MET training could add anything to my personal experience. However, I found it a useful tool that complements the dogmatic approach so often used by the counselor in recovery. My staff has learned how to listen more closely to the client and guide them through the denial inherent in their disease. Both the initial group and the booster session were presented with consummate professionalism and a welcomed sense of humor."

Dr. Paul Toriello Faciliates MET Training	MET Trainees Roll-Play during a Break-Out Session

MET with Special Populations

In an effort to enhance cultural competence in the adoption of MET with substance involved adolescents, incarcerated, and post-incarcerated clients, NOPIC conducted a series of focus groups with these special populations. Several themes emerged that were incorporated into NOPIC's adaptation of a clinical guide for using MET with substance-involved individuals.

Focus groups were conducted with adolescents, many of whom reported using since they were 9 or 10 years of age. Most youth reported knowing very few people who have successfully "gotten clean." When asked what usually precipitates quitting drugs, several adolescents agreed with the statement, "something happens to you so you want to get clean." Adolescents reported quitting after finding out they or their partner is pregnant or the overdose of a close friend or relative. Several other adolescents reported they have no intentions of stopping their substance use. Adolescents reported "I'm not done having fun yet" and "I've got a lot of drugs left to do." Overall, 40% of adolescents predicted that they will be drug-free in five years. Adolescents were also asked to describe their positive and negative experiences with therapy. Several adolescents reported that therapists are effective when they "actually care," "listen to you," and "don't judge." Others had negative experiences with therapists who "don't try to relate to them." Several noted that confrontation and lecturing in therapy increases the likelihood that they will use: "If they say no, you want to do it."

Focus groups were also conducted with post-incarcerated adults most of whom were court ordered to participate in substance abuse treatment. Many reported having positive experiences with substance abuse counselors. For example, one participant said, "My counselor is the one person I can talk to. She's always there and makes me feel better." Several participants feel that counselors' empathy enhances treatment efficacy. One participant noted, "I have a counselor steeped in empathy. It helps that she understands and explains." Others however, reported their counselors "don't know them" and that they get the most help "from other clients." In general, focus group participants reported that confrontation in the therapeutic environment is counterproductive. One participant noted that confrontation "closes me. I feel I need to defend myself. I won't hear you."