Therapeutic Approach - Motivational Enhancement Therapy(MET) or Motivational Interview(MI)
Originally developed by William Miller and Stephen Rollnick as an approach to addiction issues, MI can be seen as much as a treatment philosophy as a particular technique or set of techniques.
Essentially cognitive in nature, it adds a component that basically states that resistance to change can be as much about an individual's environment as it is about the individual's beliefs and internal processes. Taken to another level for therapists, another way of saying this is that resistance can be a function of the therapists approach and is, therefore, at least partly the therapists responsibility to deal with. This means that the MI therapist "rolls with resistance" and does not fight or confront it or the client.
MI speaks directly to the concept of ambivalence in the face of the need or desire for change - a key issue in addiction issues as well as in many mental health or adjustment issues. MI focuses on several key areas:
- "Rolling with resistance": In this sense, a therapist can model flexibility and resilience in session.
- Cost-benefit analysis: How does the cost of a behavior compare realistically with the benefit? This type of analysis can be done as a purely mental exercise, but is often performed very effectively in session in a very literal "on paper" fashion. This may not lead to an immediate "ah-ha" moment as the costs and benefits of a behavior are compared but lead to and contribute to the next main point of MI.
- Developing discrepancy: How does our behavior conflict with our stated beliefs, values or goals?
- Role play: We can discuss the pros and cons of drinking to intoxication, for instance, in a variety of ways. You can be me and I can argue from your perspective. This gives each of us an opportunity to appreciate authentically the position of the other without guile.
The "without guile" piece is very important here. In any one of these approaches we are hopefully cutting through the potential for our own and one another's rationalizations or tendencies to be dishonest with ourselves. For my part, cutting through a rationalization might be the need to understand a situation from your perspective, while realizing that it might not be appropriate to force my "favorite technique" on you. For your part, cutting through rationalization might be a reality check that brings both the cost and benefit of a behavior into sharper relief, exposing its impact on ourselves and those close to us.
Cutting through ambivalence is moving toward decisiveness and through our lives with a sense of our own power and efficacy. Honesty and, in as much as we can, seeing the reality of our lives for what it really is, are key to this.
MI is essentially client centered, but directive in its advice-giving feedback. It broadens that moment of decision, as Victor Frankel put it, between the desire to act and the act itself. In this it expands our ability to extend our freedom beyond simple reactivity - which is no freedom at all.
