Integrating MET and CBT

Counselors in the Marijuana Treatment Project (MTP) integrated motivational interviewing skills and techniques (Stephens et al. 2002) as they moved toward building skills and changing cognitions and behavior. Rather than using a traditional cognitive behavioral style of Socratic questioning and didactic teaching, the MTP MET/CBT approach used open-ended questions, gradual presentation of skills, frequent assessment of the client’s wish to hear more about a particular skill or concept, and give-and-take in the didactic portion of the sessions. Counselors frequently assessed the client’s level of motivation, renegotiating goals and repeating issues when necessary.

The CBT component of BMDC comprises six core elements and four elective skill topics (see exhibit I-2). The sequence of the sessions should be in an order that works best for the counselor and client. The six core skill topics represent the fundamental building blocks for CBT and are recommended for most clients entering treatment. To meet a particular client’s needs, a different group of skill topics may be chosen. For example, a client who has experience in similar interventions (e.g., relapse prevention) may not require a review of all the core skill topics. The counselor can select some core skills and add relevant elective materials in developing the session sequence for the client. Another client may have concerns about depression or difficulty regulating moods. The counselor can substitute the elective skill topic on depression in place of a core skill. The counselor and client determine whether and how much the treatment deviates from the established method (10 sessions including 1 assessment, 2 MET, 6 core CBT, and 1 elective).

Tips for the Counselor

• Review relevant sections of the manual before each session.

• Develop a natural style of conveying the material; avoid reading text to clients.

• Maintain a motivational style; use open-ended questions and reflections; and avoid a directive, resistance-building style.

• Encourage involvement and participation by the client.

• Allow time for role plays and feedback.

• Build self-efficacy; help the client identify and acknowledge skills already in use.

• Avoid overwhelming the client; present only one or two new skills per session.

• Remember to take a few minutes to review the between-session exercises at the start of each session.

• Attend to shifts in the client’s motivation and readiness for change.

• Explain practice exercises carefully; probe for the client’s understanding.