IJSP-2010(3-4) - Indian Association For Social Psychiatry

III. MOTIVATIONAL ENHANCEMENT THERAPY (MET): MET
is a longer-term follow-up to an initial brief intervention strategy.
MET consists of four treatment sessions over 12 weeks
preceded by an extensive assessment. It is an empathic,
directive counseling process to help patients articulate their
motivation to change behaviour. The techniques of MET are
built on the concepts of patients' autonomy, ambivalence, and
intrinsic motivation. It combines techniques from cognitive,
client-centered, systems and social-psychological persuasion
approaches. MET is characterized by an empathic approach
in which the therapist helps to motivate the patient by asking
about the pros and cons of specific behaviours, exploring the
patient's goals and associated ambivalence about reaching
those goals and listening reflectively to the patient's responses.
Basic Principles: The principle of motivational interview has
been identified as congruent with the empowerment focus of
social work (Hohman, 1998). Miller and Rollnick (1991)
identified five basic motivational principles.
A mnemonic (DARES) was developed:
D- Develop discrepancy: The object of this process is to
elicit from the client how their behaviour differs from
their preferred lifestyle, aim and objectives.
A- Avoid arguments: This does not, however, mean that
resistance is ignored. Resistance should be looked for
and, once identified, attempts made to reduce it.
R- Roll with resistance: Resistance may take a variety of
forms- arguments, denial, excuses, blaming,
interrupting and ignoring. Miller and Rollnick (1991)
refer to this as the 'confrontation-denial trap'.
E- Express Empathy: One specific way of doing this is by
reflection, feeding back what the client says. Miller
(1983) asserts that reflection should be a passive
process but should be selective. It is a style of therapistclient
interaction most identified with the work of Carl
Rogers (1967).
S- Support self-efficacy: The client's perceived importance
of change and their confidence that they can change
are the key aspects.
Mukherjee et al
IV. COPING AND SOCIAL SKILLS TRAINING (CSST): Within
most CSST approaches, a set of basic methods target the
assumed lack of adequate coping skills that addicted
individuals have for navigating through their day-to-day lives.
This subsumes deficits in affect regulation and coping with
social interactions. Four main themes are covered in CSST:
1. Interpersonal skills for enhancing relationships: These
include strategies to increase positive social interaction
and self-confidence. At the same time, they aim
at decreasing negative social interactions and
avoidance of people, whether they are family, friends,
casual acquaintances or strangers.
2. Cognitive-emotional coping for affect regulation.
3. Coping skills for managing daily life events, stressful
events and high-risk situations related to substance
use.
4. Coping with substance-use cues.
Before the treatment starts the assessment focuses on:
1. Coping skill assessment.
2. Cue reactivity assessment.
3. Drinking triggers interview.
Treatment sessions focus on:
a. Communication-skills and social-skills training:
Communication-skills training is designed to teach
interpersonal and social skills. The various topics that address
the majority of specific high-risk situations of types of
communication skills are: Drink refusal skills, giving positive
feedback, giving criticism, receiving criticism, receiving
criticism about drinking or drug use, listening skills,
conversational skills, developing sober supports, conflictresolution
skills and nonverbal communication expressing
feelings, introduction to assertiveness, refusing requests and
receiving criticism in general (Monti & O'Leary, 1999). In the
substance abuse program developed by Azrin and colleages
(Azrin et al, 1996; Azrin et al, 1994a,b), social skills training is
implemented during the initial session when communication
guidance are reviewed.
© 2010 Indian Association for Social Psychiatry
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