A qualitative interview study of patient experiences of receiving motivational enhancement therapy in a Swedish addiction specialist treatment setting

Abstract

Background Motivational enhancement therapy (MET) has shown to be efficacious as treatment of alcohol use disorder (AUD), in reducing alcohol consumption and related consequences. However, qualitative research on how patients perceive this treatment is lacking. The aim of this study was to explore how patients experience MET as a treatment for AUD. Methods Fifteen patients (8/7 female/male) participated in semi-structured interviews after receiving MET at a specialized addiction outpatient clinic in Sweden. Data were analyzed by thematic analysis. Results Five themes were identified: the therapist conveyed the MI-spirit, the therapist did not guide on how to reach the goal, participants were committed to change before starting treatment, participants were uncertain if treatment was enough to maintain change, and significant others were not wanted in sessions. Participants appreciated the supportive relationship with their therapist, but some experienced therapy as overly positive, with no room to talk about failure. Further, they experienced a low level of guidance in goal-setting. For some, this was empowering, while others requested more direction and advice. Participants perceived their motivational process to have started before treatment. MET was considered to be too brief. None of the participants brought a significant other to a session. Conclusions Therapist behaviors in line with MI spirit were emphasized as key to the development of a positive therapeutic relationship. More specific advice on goal-setting may be effective for supporting change in some patients. Longer treatment is requested among patients to support the patient’s self-efficacy for change. Significant others can support change without necessarily being present in sessions. Trial registration: The current trial was retrospectively registered at isrtcn.com (14539251).

Predictors of treatment outcome for individuals with alcohol use disorder with a goal of controlled drinking

“…The MET manual does not include any specific guidance on how to reach goals to reduce drinking or how to abstain from alcohol, which may be less favorable when aiming for a CD goal as opposed to abstinence. In a qualitative interview study from the current trial on patients’ experiences from receiving MET, the results indicated that some of the patients found the treatment to lack specific guidance on how to attain a CD goal [ 78 ]. These results taken together indicate that the MET manual may need modification to also suit both abstinent- and CD treatment goals.…”

“…However, the actual number of treatment sessions delivered was not different between groups, as an extra session was more commonly added in the MET condition, compared to in the BSCT arm. The aforementioned qualitative study on patient experiences on receiving MET as their treatment demonstrated that the treatment was perceived as too brief [ 78 ]. This may have affected the therapists’ decision to add an extra session to comparably more patients in the MET group, than what was the case in BSCT.…”