This document provides an overview of motivation and motivational enhancement therapy (MET). It defines motivation and discusses theories of motivation including need and drive reduction theory, instinct theory, social urges theory, and goal orientation theory. It also summarizes Maslow's hierarchy of needs and characteristics of self-actualized people. The document then discusses motivational treatment approaches like brief motivational intervention, motivational interviewing, and motivational enhancement therapy. It provides details on the stages and processes of MET, including the EARS principles and three phases of building and strengthening motivation for change.

1. MOTIVATION
and
MOTIVATIONAL ENHANCEMENT
THERAPY (MET)
By
Dr.SURESH A
PG - 2
Psychiatry
KIMS , TELANGA

2. OUT LINE
• INTRODUCTION
• DEFINITIONS
• ACTIVATING FORCES OF MOTIVATION
• THEORIES OF MOTIVATION
• MOTIVATIONAL INTERVIEWING
• MOTIVATIONAL ENHANCEMENT THERAPY

3. MOTIVATION
• Something which prompts, compels and
energizes an individual to act or behave in a
particular fashion at a particular time for
attaining some specific goal or purpose.

4. DEFINITIONS

5. The force that propels an organism to seek a
goal or satisfy a need ; striving, incentive,
purpose.
-Campbell's psychiatric dictionary

6. Activating forces of motivation :-
NEEDS
DRIVES
MOTIVES
NEEDS:- These are general wants or desires.
Biological needs : Most fundamental needs to survival &
existence. Ex: water , oxygen , food and sleep.
Socio-psychological needs : Associated with socio-cultural
environment. Ex: freedom , security , love and affection.

7. • DRIVES : a need gives rise to a drive.
• An aroused reaction tendency or a state of
heightened tension that sets up activities in an
individual and sustains them for increasing his
general activity level.
• Primary drives : hunger , thirst , sex
• Secondary drives : anxiety , aggression , dependence.

8. • MOTIVES : an inner state of mind , generated
through basic needs or drives , which compel
an individual to respond till the attainment of
goal.
• EX : hunger motives , thirst , sex motives ,
maternal motive , achievement motive..

9. THEORIES OF MOTIVATION
• Need and drive reduction (push) theory
(Behaviorist view point)
• Instinctive theory
(Freud's view point)
• Social urges theory
(Adler's view point)
• Goal oriented theory
(cognitive view point)
• Self actualization (Hierarchical) theory (Maslow's view
point)

10. • Need and drive reduction (push) theory
(Behaviorist view point)
• According to watson , clark hull and skinner needs &
drives works as stimuli to evoke responses in the
form of motivation behavior.
• Aroused internal need , drive lead to
motivational behavior reduces intensity of
drive
(pushed to
engage)

11. • Instinctive theory
(Freud's view point)
• Eros (life instinct or erotic instinct) and death instinct are
the ultimate cause of the motivation in behavior.
• When life instinct stops , death instinct comes into
operation.
• Human being from birth experiences sex gratification, sex
motive.
• Social urges theory
(Adler's view point)
• Human beings are motivated primarily by social urges.
• Social urges requires margin of safety , It achieves through
domination and superiority

12. • Goal oriented theory
(cognitive view point) william james , george miller.
• Human behavior is purposeful with a certain goal in view ,
to reach it he is helped by his cognitive abilities for
development of drive or motive.
• The concept of motivation was necessary to bring the
"psychomotor gap" between ideas and actions.
• Cognitive dissonance : Imbalance between what we believe
(cognition) and what we do (conation)

13. ABRAHAM HAROLD MASLOW
ABRAHAM HAROLD MASLOW (01 APRIL 1908 – 08
JUNE 1970) WAS AN AMERICAN PSYCHOLOGIST
WHO WAS BEST KNOWN FOR CREATING MASLOW'S
HIERARCHY OF NEEDS, A THEORY OF
PSYCHOLOGICAL HEALTH PREDICATED ON
FULFILLING INNATE HUMAN NEEDS IN
PRIORITY, CULMINATING IN SELF-ACTUALIZATION.

14. MASLOW'S HIERARCHY OF NEEDS
IT IS A MOTIVATIONAL THEORY IN PSYCHOLOGY
COMPRISING A FIVE-TIER MODEL OF HUMAN NEEDS,
OFTEN DEPICTED AS HIERARCHICAL LEVELS WITHIN A
PYRAMID
MASLOW STATED THAT PEOPLE ARE MOTIVATED
TO ACHIEVE CERTAIN NEEDS AND THAT SOME NEEDS
TAKE PRECEDENCE OVER OTHERS

15. OUR MOST BASIC NEED IS FOR PHYSICAL
SURVIVAL, AND THIS WILL BE THE FIRST THING THAT
MOTIVATES OUR BEHAVIOUR. ONCE THAT LEVEL IS
FULFILLED THE NEXT LEVEL UP IS WHAT MOTIVATES
US, AND SO ON

16. BEING NEED
(GROWTH NEED)
DEFICIENCY NEEDS
MASLOW INITIALLY STATED THAT INDIVIDUALS
MUST SATISFY LOWER LEVEL DEFICIT NEEDS BEFORE
PROGRESSING ON TO MEET HIGHER LEVEL GROWTH
NEEDS.

17. HOWEVER, HE LATER CLARIFIED THAT
SATISFACTION OF A NEEDS IS NOT AN “ALL-OR-
NONE” PHENOMENON
HUMAN BEINGS ARE MOTIVATED BY A HIERARCHY
OF NEEDS

19. NEEDS ARE ORGANIZED IN A HIERARCHY IN
WHICH MORE BASIC NEEDS MUST BE MORE OR LESS
MET (RATHER THAN ALL OR NONE) PRIOR TO HIGHER
NEEDS
THE ORDER OF NEEDS IS NOT RIGID BUT INSTEAD
MAY BE FLEXIBLE BASED ON EXTERNAL
CIRCUMSTANCES OR INDIVIDUAL DIFFERENCES
MOST BEHAVIOUR IS MULTI-MOTIVATED, THAT IS,
SIMULTANEOUSLY DETERMINED BY MORE THAN ONE
BASIC NEED

20. EDUCATIONAL APPLICATIONS
BEFORE A STUDENT'S COGNITIVE NEEDS CAN BE
MET, THEY MUST FIRST FULFILL THEIR BASIC
PHYSIOLOGICAL NEEDS.
FOR EXAMPLE, A TIRED AND HUNGRY STUDENT
WILL FIND IT DIFFICULT TO FOCUS ON LEARNING.
STUDENTS NEED TO FEEL EMOTIONALLY AND
PHYSICALLY SAFE AND ACCEPTED WITHIN THE
CLASSROOM TO PROGRESS AND REACH THEIR FULL
POTENTIAL.

21. MASLOW SUGGESTS STUDENTS MUST BE
SHOWN THAT THEY ARE VALUED AND RESPECTED IN
THE CLASSROOM, AND THE TEACHER SHOULD
CREATE A SUPPORTIVE ENVIRONMENT.
STUDENTS WITH A LOW SELF-ESTEEM WILL NOT
PROGRESS ACADEMICALLY AT AN OPTIMUM RATE
UNTIL THEIR SELF-ESTEEM IS STRENGTHENED.

22. • MASLOW estimated that ONLY TWO PERCENT of people would
reach THE STATE OF SELF ACTUALIZATION.
• By Studying 18 people he considered to be SELF-ACTUALIZED
(including ABRAHAM LINCOLN and ALBERT EINSTEIN) maslow
identified 15 CHARACTERISTICS OF A SELF-ACTUALIZED
PERSON :-
1. THEY PERCEIVE REALITY EFFICIENTLY AND CAN TOLERATE
UNCERTAINTY
2. ACCEPT THEMSELVES AND OTHERS FOR WHAT THEY ARE
3. SPONTANEOUS IN THOUGHT AND ACTION

23. • 4. PROBLEM-CENTERED (NOT SELF-CENTERED)
• 5. UNUSUAL SENSE OF HUMOR
• 6. ABLE TO LOOK AT LIFE OBJECTIVELY
• 7. HIGHLY CREATIVE
• 8. RESISTANT TO ENCULTURATION, BUT NOT
PURPOSELY UNCONVENTIONAL
• 9. CONCERNED FOR THE WELFARE OF HUMANITY
• 10. CAPABLE OF DEEP APPRECIATION OF BASIC
LIFEEXPERIENCE

24. • 11. ESTABLISH DEEP SATISFYING INTERPERSONAL
RELATIONSHIPS WITH A FEW PEOPLE
• 12. PEAK EXPERIENCES
• 13. NEED FOR PRIVACY
• 14. DEMOCRATIC ATTITUDES
• 15. STRONG MORAL/ETHICAL STANDARDS

25. MOTIVATIONAL TREATMENT APPROACHES
(MTA)
• Designed to enhance patients' intrinsic
motivation
1) Brief Motivational Intervention (BMI)
2) Motivational Interviewing (MI)
3) Motivational Enhancement Therapy (MET)

26. Brief Motivational Intervention (BMI)
• vary in duration from one to four sessions (10-
60min)
• straightforward advice and information on the
negative consequences of alcohol abuse
• Minimal motivational interventions for alcohol
dependent Patients.
• Relevant for problem drinkers who are not yet
alcohol dependent
• Goal : Reduce drinking rather than abstinence

27. Motivational Interviewing
HISTORY
• “client-centered, directive method for enhancing intrinsic
motivation to change by exploring and resolving
ambivalence” (Miller & Rollnick, 2002).
• The concept of motivational interviewing evolved from
experience in the treatment of problem drinkers, and was
first described by William R. Miller in 1983 in an article
published in Behavioral Psychotherapy.
• Miller and Rollnick later elaborated on these fundamental
concepts and approaches in 1991, in a more detailed
description of clinical procedures.

28. Basis of Motivational Interviewing
(PACE Model)
• Partnership (avoid the “expert” role)
• Acceptance (respecting the person’s autonomy,
perspective, etc.)
• Compassion
• Evocation (the best ideas come from the
client/patient)

29. Core skills required (OARS)
• Open ended questions
• Affirmations
• Reflections
• Summaries

30. Open ended questions example
• Don’t ask “How much alcohol do you consume?”
What role does
alcohol play in
your life?
I consume to
get sleep in
the night..

31. Affirmations example
• Positive statements that create a sense of self confidence.
Despite all the
problems, you
have been doing
well at work
Yes doctor it’s
tough to
balance

32. • Reflections are understanding what the
client/patient is thinking and feeling and
saying it back to the person to convey
empathy and understanding.
• Summaries are basically a collection of
more than one reflection.

33. 4 Processes of Motivational
Interviewing
FocusingEngaging Evoking Planning

34. 4 Processes of Motivational
Interviewing
• Engaging is the process of establishing a
trusting and mutually respectful relationship
(Therapeutic relationship)
• Avoid assessing, labelling.
FocusingEngaging Evoking Planning

35. 4 Processes of Motivational
Interviewing
• Focusing is the ongoing process of seeking
and maintaining direction.
• Setting an agenda for change.
FocusingEngaging Evoking Planning

36. 4 Processes of Motivational
Interviewing
• Evoking is eliciting the client's own
motivations for change, while evoking hope
and confidence.
• “change talk” (ex: why do you want to make
a change? What’s your first step?)
FocusingEngaging Evoking Planning

37. 4 Processes of Motivational
Interviewing
• Planning involves the client making a
commitment to change, and together with the
counselor, developing a specific plan of action.
• The plan should be smart, specific, measurable
and achievable.
FocusingEngaging Evoking Planning

38. Motivational Interviewing and Field Instruction:
The FRAMES model
Volume 2.1 | Spring 2012 | Practice Digest | © April 2012 | fieldeducator.simmons.edu
Author(s)
Hugo Kamya, PhD
Simmons School of Social Work
Abstract:
• Motivational interviewing is defined as a “client-centered, directive
method for enhancing intrinsic motivation to change by exploring and
resolving ambivalence” (Miller & Rollnick, 2002).
• In supervision of staff, the ultimate goal is to improve an organization’s
efficiency by increasing productivity, decreasing employee stress,
vicarious trauma and burnout, and reducing clinical negligence and
malpractice.
• In supervision of interns, the major focus is on meeting the intern’s
learning needs and on developing competent practitioners.
• Motivational interviewing in supervision maximizes focus and positive
change by developing action plans and addressing ambivalence toward
change.
• Motivational interviewing uses a guide toward change called FRAMES;
the acronym stands for Feedback, Responsibility, Advice, Menu Options,
Empathy and Self-Efficacy.

39. Motivational
Enhancement Therapy
HISTORY
• Project MATCH began in 1989 in the United States
and was sponsored by the National Institute on
Alcohol Abuse and Alcoholism (NIAAA).
• The project was an 8-year, multi site investigation
that studied which types of alcoholics respond
best to which forms of treatment.

40. • Three types of treatment were investigated:
1) Cognitive Behavioral Coping Skills Therapy
2) Motivational Enhancement Therapy
3) Twelve-Step Facilitation Therapy
• The study concluded that patient-treatment
matching is not necessary in alcoholism
treatment because the three techniques are
equal in effectiveness.

41. Aim
• Motivational enhancement therapy (MET) is a
time-limited, four-session adaptation of
Motivational Interviewing and motivational
therapy.
• The goal of the therapy is not to guide the
patient through the recovery process, but to
invoke inwardly motivated change.
• It focuses on the treatment of alcohol and
other substance addictions.

42. Stages of change
• People who are not
considering change in their
problem behavior are
described as
PRECONTEMPLATORS.
The CONTEMPLATION stage
includes Individuals
beginning to consider both
that they have a problem
and the feasibility and costs
of changing that behavior.

43. Stages of change
• DETERMINATION
stage : the decision is
made to take action
and change.
• Once individuals begin
to modify the problem
behavior, they enter
the ACTION stage,
which normally
continues for 3–6
months.

44. Stages of change
• After successfully
negotiating the
action stage,
individuals move to
MAINTENANCE or
sustained change.
• If these efforts fail, a
RELAPSE occurs, and
the individual begins
another cycle.

45. • In the determination stage,
clients develop a firm resolve
to take action which is
influenced by past
experiences with change
attempts.
• Individuals who have made
unsuccessful attempts to
change their drinking
behavior in the past need
encouragement to decide to
go through the cycle again.
• Understanding the cycle of
change can help the ME
therapist to empathize with
the client and can give
direction to intervention
strategies.

46. Basic Principles of MET
(Ee-Dd-Aa-Rr-Ss)
• Express empathy
• Develop discrepancy (between what they are and
where they want to be)
• Avoid argument
• Rolling with resistance
• Support self-efficacy
• (Self-efficacy is, in essence, the belief that one can
accomplish a particular task. clients must be persuaded
that it is possible to change their own drinking and
thereby reduce related problems)

47. MET-Phases
• Phase 1 : Building motivation for change
• Phase 2 : Strengthening the commitment to
change
• Phase 3 : Follow through strategies

48. Phase 1 : How to build motivation?
• By asking open ended questions elicit self-
motivational statements.
• In general, the best opening strategy for eliciting self-
motivational statements is to ask for them:
"Tell me what concerns you about your drinking"?
"Tell me why you think you might need to make a
change.."
• Once this process is rolling, simply keep it going by
using reflective listening by asking for example,
“What else?,”.

49. • Elicited information is then responded to with
empathic reflection, affirmation, or reframing.
• The first MET session should always include feedback
to the client from the assessment. This is done in a
structured way, providing clients with a written
report of their results (Personal Feedback Report).

51. Affirmations
• Also seek opportunities to Affirm, compliment,
and reinforce the client sincerely.
“I think it’s great that you’re strong enough to
recognize the risk here
and that you want to do something before it gets
more serious.”
“You really have some good ideas for how you
might change.”

52. Reframing
• It is a strategy whereby therapists invite clients to
examine their perceptions in a new light or a
reorganized form.
• For example if the person drinks after work saying
“You may have a need to reward yourself for
successfully handling a stressful and difficult job”
implying that there are alternative ways of
rewarding oneself without going on a binge.

53. Summarizing
• It is useful to summarize periodically during a
session, particularly toward the end of a session.
• It is especially useful to repeat and summarize
the client’s self-motivational statements.
• Elements of reluctance or resistance may be
included in the summary, to prevent a negating
reaction from the client

54. Example of a short summary
“So, thus far, you’ve told me that you are
concerned you may be damaging your health by
drinking too much and that sometimes you may
not be as good a parent to your children as
you’d like because of your drinking”

55. Phase 2 : How to strengthen the
commitment?
• The strategies outlined in phase 1 are
designed to build motivation.
• A second major process in MET is to
consolidate the client’s commitment to
change, once sufficient motivation is present.
• This is by recognizing the change readiness.

56. How to recognize change readiness?
These are some changes you might observe :
• The client stops resisting and raising objections.
• The client asks fewer questions.
• The client appears more settled, resolved, unburdened, or
peaceful.
• The client makes self-motivational statements indicating a
decision to change (“I guess I need to do something about my
drinking “ “If I wanted to change my drinking, what could I do?”).
• The client begins imagining how life might be after a change.

57. Discussing a plan
• The key shift for the therapist is from focusing on
reasons for change (building motivation) to
negotiating a plan for change.
• The therapist may signal this shift by asking a
transitional question such as:
“What do you make of all this? What are you
thinking you’ll do about it? “
“Where does this leave you in terms of your
drinking? What’s your plan?”

58. • Remind the patient of his free choice by saying
“it’s up to you what you do about this” etc.
• A useful strategy is to ask the client to
anticipate the result if the client continues
drinking as before. What would be likely
consequences?
• The Change Plan Worksheet (CPW) is to be
used during Phase 2 to help in specifying the
client’s action plan.

59. Change Plan Worksheet
• The changes I want to make are:
• The most important reasons why I want to make
these changes are:
• The steps I plan to take in changing are:
• The ways other people can help me are:
• Person Possible ways to help
• I will know that my plan is working if:
• Some things that could interfere with my plan are:

60. Phase 3 : Follow through strategies
• Begin a follow through session with a review of
what has happened since your last session.
• The Phase 1 processes can be used again to renew
motivation for change.
• The Phase 2 processes can also be continued
during follow through. This may simply be a
reaffirmation of the commitment made earlier.

61. MET Sessions
• Consists of 3-4 sessions.
• The three phases are done in each session.
• If a certain phase is not completed in a session, it
can be carried over in the next session.
• Each session is concluded with a summary and
this summary is recapped in the next session.

62. Session 1
Session 2
Session 3
Session 4
1-2 weeks
6 weeks
4 weeks

63. Termination
• Formal termination should be acknowledged
and discussed at the end of the fourth session.
• Final summary should include these elements:
1. Review the most important factors and
Reconfirm these self-motivational themes.
2. Summarize the commitments and changes
that have been made thus far.

64. 3. Affirm and reinforce the client for commitments
and changes that have been made.
4. Explore additional areas for change that the
client wants to accomplish in the future.
5. Elicit self-motivational statements for the
maintenance of change.
6. Remind the client of continuing follow up
sessions, that can be helpful in maintaining
change.

65. THE “5AS”
• THE 5 MAJOR STEPS IN THIS INTERVENTION ARE:
• ASK ABOUT SUBSTANCE USE
• ADVISE -- ADVISE TO QUIT
• ASSESS COMMITMENT AND BARRIERS TO
CHANGE
• ASSIST PATIENTS COMMITTED TO CHANGE
• ARRANGE -- ARRANGE FOLLOW-UP TO
MONITOR PROGRESS

66. THE “5RS”
• RELEVANCE : WHAT IS THE PERSONAL RELEVANCE OF
QUITTING SUBSTANCE FOR THE CLIENT?
• RISKS : WHAT ARE THE POTENTIAL NEGATIVE
CONSEQUENCES OF USING SUBSTANCE FOR THE
CLIENT?
• REWARDS: WHAT ARE THE POTENTIAL BENEFITS OF
STOPPING THE SUBSTANCE FOR THE CLIENT?
• ROADBLOCKS : WHAT ARE THE BARRIERS IN QUITTING
THE SUBSTANCE AND ELEMENTS IN TREATMENT THAT
MAY HELP IN HANDLING THE BARRIERS.
• REPETITION : THE MOTIVATIONAL INTERVENTION
SHOULD BE REPEATED EVERY TIME THE UNMOTIVATED
CLIENT VISITS YOU.

67. The 5 R’s model
to increase motivation to quit

69. • Addiction. 2014 Nov;109(11):1869-77. doi: 10.1111/add.12679. Epub 2014 Aug 14.
• Efficacy of motivational enhancement
therapy on alcohol use disorders in patients
with chronic hepatitis C: a randomized
controlled trial.
• Dieperink E1, Fuller B, Isenhart C, McMaken K, Lenox R, Pocha C, Thuras P, Hauser P.
• This study concluded that Motivational
enhancement therapy (MET) appears to
increase the percentage of days abstinent in
patients with chronic hepatitis C, alcohol
use disorders and ongoing alcohol use.

71. Cognitive Behaviour
Therapy
• Assumes that the client is
motivated.
• Prescribes specific coping
strategies.
• Teaches coping behaviors
through instruction,
modeling, directed
practice, and feedback.
• Specific problem-solving
strategies are taught
Motivational
Enhancement Therapy
• Employs specific principles
and strategies for building
motivation.
• Elicits possible change
strategies from the client.
• Responsibility for change
methods is left with the
client; no training,
modeling, or practice
• Natural problem-solving
processes are elicited from
the client and significant
other

72. THANK YOU