Motivational enhancement therapy

Domain III · Humanistic, existential & experiential · Miller, Zweben, DiClemente · 1992

What it is

The five MI principles named by the manual, plus the stance commitments it spells out.

Format

• Four individual sessions: Session 1 at week 1, Session 2 at week 2, follow-through Sessions 3 and 4 at weeks 6 and 12; all therapy completed within 90 days.
• A significant other (SO), usually a spouse or partner, is invited to the first two sessions (up to two SO sessions).

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• using "but", which cancels the first half.
• sarcasm; use only within a solid alliance.
• advice slipping into skill training or instruction.
• hollow praise; affirmations must be true and specific.
• it must be sincere, not a tactic delivered with a wink.

Problems the guide addresses

• Resistance and arguing
• Discord or rupture in the relationship
• Stuck, ambivalent client (no readiness signs)
• Premature or over-emphatic commitment
• Client arrives intoxicated
• Missed appointments and non-adherence
• Coerced or mandated clients
• Disruptive or hostile significant other
• Client insists on moderation despite high severity or contraindications
• Client asks for coping skills or 'how to'

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.