Are motivational therapy techniques only useful for people who haven't yet decided to change?
Dear Dr. Peele,
In the Project Match trial, Motivational Intervention was one of the treatments offered. My understanding is that MI was developed to target clients who are in the contemplation stage. However, all clients who entered Project Match volunteered to participate. In this case why would one want to offer MI, when these clients are strictly in the "Preparation" stage wanting some "Action"?
Very interesting question. Project MATCH was a $30 million program designed by the NIAAA to see whether different treatments would have better impact depending upon the varying characteristics of the alcoholics being treated. In Project MATCH, motivation enhancement therapy was predicted to help people with lower motivation, while 12-step and cognitive behavioral coping skills therapy were predicted to assist people with more severe alcohol dependence. This was because motivation enhancement is supposedly a technique for generating motivation for those who are in the early stages of deciding to change (called the contemplation or precontemplation stage, versus the commitment/action stage, of the Prochaska and DiClemente "stages of change" model). On the other hand, since motivational enhancement is a brief therapy (in MATCH it comprised four sessions or fewer, compared with 12 sessions for 12-step and coping skills therapy), it supposedly would not be as successful for severely dependent alcoholics.
In fact, motivational therapy was as effective for all alcoholics treated in the study! And it was the cheapest and least intensive therapy. In my book, The Truth About Addiction and Recovery, we make motivational techniques central to all change, either therapeutic or self-initiated. Even where people have decided to change or claim they are in a change process, focusing the individual's motivation combined with manipulation of and investment in one's environment is the most successful technique for change. People can flag in their motivation, or they can lose sight of or become discouraged in pursuing their goal. These are common aspects of the change process. Motivation, along with support and reward for success, remain key throughout the process.