Motivational Enhancement Therapy

        This therapy views relapse and recovery as a spectrum, and although most commonly used to treat addictions, can also be applied to any behavior that requires change, such as medication noncompliance or overeating.  Note that these stages are more cyclical than linear:  it is more the rule than the exception that the patient will move backwards as well as forwards, and relapse is part of the illness.

        Stages of Denial - Recovery:

            Precontemplation: an optimistic term for denial.  The patient is not yet ready to acknowledge a problem or being to ask for help.  "Bibliotherapy" - giving patients material to read on their own - maybe much more effective than direct confrontation at this point.
            Contemplation: the hallmark of contemplation is ambivalence; the patient is unsure whether or not there is a problem and whether or not treatment should be pursued.
            Preparation: the patient is ready to change, but not quite yet.  "I'll quit smoking in 6 months."
            Action:  the patient makes concrete behavioral changes to modify the behavior (abstains, attends meetings, seeks help).
            Maintenance: after 3-6 months of changed behavior, this is the stage generally known as "recovery" when the person needs to engage in behaviors that minimize the odds of relapse and continue to enforce the new behavior, e.g., attending meetings, helping other actively abusing patients enter recovery.  Eliciting self-motivational statements is a key method that allows the patient to direct their energies toward recovery.