Category: Treatment Therapies

Addiction doesn’t happen in a vacuum. A single person’s mental health issues can affect a whole community. And in particular, addiction can wreak havoc on family dynamics, undermining every person’s mental health. This is true for blood relatives, spouses, and chosen family members.

Many rehab programs offer family therapy to people in residential treatment. This process might focus on one person’s addiction, but it can benefit everyone who attends. This is a chance to improve your relationships, and for each person to work on their mental health.

What to Expect From a Family Therapy Session

If you go to family therapy through a rehab program, you’ll probably start by talking about addiction. You may discuss the impact of one person’s behavior, and why they started using drugs in the first place. But these conversations are only the beginning.

Family therapy is an opportunity for everyone to really hear each other, and also feel heard. Each person shares their own perspective, and talks about what’s happening in their own life. You are a part of your family, but also, your family is just one part of you. In these sessions, you can share things you might never have mentioned before. It can even feel like you’re getting to know your loved ones in a brand new way.

“Family” doesn’t have to refer to your biological relatives. ((Substance Abuse and Mental Health Services Administration. (2013). Family Therapy Can Help For People in Recovery For Mental Illness or Addiction. https://store.samhsa.gov/sites/default/files/d7/priv/sma13-4784.pdf)) According to the Substance Abuse and Mental Health Services Administration (SAMHSA), “‘Family’ means a group of two or more people with close and enduring emotional ties.” And in most programs, the patient can choose to invite chosen family to join them in therapy.

Your family will probably be able to get this treatment even if the person in treatment travels to rehab. Most programs offer both remote and in-person sessions.

The therapist will spend the first couple of meetings getting to know everyone in the room. After that, they’ll guide you through exercises designed to help your family work through interpersonal issues. ((Substance Abuse and Mental Health Services Administration. (2013). Family Therapy Can Help For People in Recovery For Mental Illness or Addiction. https://store.samhsa.gov/sites/default/files/d7/priv/sma13-4784.pdf)) For instance, the therapist might ask you to spend a week taking note of the kind things your family members say. Or, they might ask a family member to practice saying “no.”

These activities can teach you to communicate more clearly. They can also help you break out of unhealthy behavioral patterns. And when you process them in your next session, you can build on what you’ve learned.

Types of Family and Couples Therapy

There are many different types of family therapy. If you have a strong preference for one of these options, you can look for a rehab program that offers it. You may also be able to find a private family therapist in your area.

Structural Therapy

The structural method of family therapy ((Jiménez, L., Hidalgo, V., Baena, S., León, A., & Lorence, B. (2019). Effectiveness of structural–strategic family therapy in the treatment of adolescents with mental health problems and their families. International Journal of Environmental Research and Public Health, 16(7), 1255. https://doi.org/10.3390/ijerph16071255)) emphasizes achieving a well-balanced family system. This technique focuses on establishing healthy boundaries between members based on that system. For instance, a parent-child relationship has different boundaries and expectations than one between spouses.

Structural therapy begins with the therapist observing the family’s interaction patterns. ((Varghese, M., Kirpekar, V., & Loganathan, S. (2020). Family interventions: Basic principles and techniques. Indian Journal of Psychiatry, 62(Suppl 2), S192–S200. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_770_19)) Once they understand the family dynamic, they’ll suggest changes. The goal is to help everyone build sustainable relationships, and to empower your family as a whole. To achieve this, therapists may combine techniques from structural and strategic family therapy.

Strategic Therapy

During strategic therapy, ((Jiménez, L., Hidalgo, V., Baena, S., León, A., & Lorence, B. (2019). Effectiveness of structural–strategic family therapy in the treatment of adolescents with mental health problems and their families. International Journal of Environmental Research and Public Health, 16(7), 1255. https://doi.org/10.3390/ijerph16071255)) families focus on healing the symptom of a structural problem. If a family member is in rehab, you’ll likely focus on addiction as a symptom of your family’s overarching issues.

Symptoms serve a purpose—that’s why they exist in the first place. For example, a person might develop an addiction to cope with loneliness after a divorce. Even when you fix the symptom, you’re left with its underlying cause. Without expert help, families often get stuck in a cycle. Structural-strategic therapists call this a “symptom-maintaining” sequence. And it can feel like you’re bailing out a ship with a leak.

In this type of treatment, the therapist will guide your family ((Varghese, M., Kirpekar, V., & Loganathan, S. (2020). Family interventions: Basic principles and techniques. Indian Journal of Psychiatry, 62(Suppl 2), S192–S200. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_770_19)) toward a more sustainable solution. They’ll suggest practical ways you can support each other, instead of telling you what not to do. This can help you take action, and make lasting changes.

Brief strategic family therapy (BSFT) ((Szapocznik, J., Schwartz, S. J., Muir, J. A., & Brown, C. H. (2012). Brief strategic family therapy: An intervention to reduce adolescent risk behavior. Couple & Family Psychology, 1(2), 134–145. https://doi.org/10.1037/a0029002)) is a shorter version of this treatment, lasting only 12 sessions. This method is specifically designed for families with young people in treatment. The goal is to change the dynamics that encourage younger family members to act out.

Therapy With Teens

Family involvement is extremely important for teens attending rehab. Data shows that family therapy can help youth with mental health issues ((Jiménez, L., Hidalgo, V., Baena, S., León, A., & Lorence, B. (2019). Effectiveness of structural–strategic family therapy in the treatment of adolescents with mental health problems and their families. International Journal of Environmental Research and Public Health, 16(7), 1255. https://doi.org/10.3390/ijerph16071255)) work through behavioral problems. And adults who attended sessions with their teens felt more competent as parents.

Paradigm Teen & Young Adults Treatment offers family therapy for teens and their loved ones. This rehab center involves parents in every step of the recovery process. Family members can attend sessions in person, although remote therapy is also available. Teens also see their own 1:1 therapist, who debriefs parents about their child’s progress.

This rehab center also encourages relatives to connect with their peers. You can connect with other families who have similar experiences in Multi-Family Group Therapy. This lets you connect with people who play the same role as you do, in their own family. You can share mutual support, and gain new insight into your own behavior.

Couples Therapy

In couples therapy, 2 people work on their relationship as a team. It can be eye-opening to discuss your issues with a neutral 3rd party. It can also help you start conversations you’ve been delaying. You’ll learn to communicate respectfully, even when you’re talking about painful things. Therapy can help you define your needs, as individuals and as partners. And once each of you knows what you need, you can look for healthy ways to support each other.

Couples therapy isn’t just for romantic partners. It can also help roommates, best friends, siblings, and more. But no matter how your relationship is structured when you start this treatment, it might soon look very different. If you can, let go of expecting any particular outcome. Therapy isn’t about forcing yourself or your loved ones to achieve a certain goal. Instead, it’s a way of helping each of you define and then start living your best lives.

The Benefits of Family Therapy

Stronger relationships aren’t the only benefit of family therapy. This treatment can also improve the mental health of family members as individuals. And when you’re doing well, you may be able to give your loved ones more time and energy. At its best, family therapy inspires an upward spiral, in which you support each other every step of the way.

Benefits for the Person in Addiction Recovery

Family therapy isn’t only for family members; it’s also helpful for the person in rehab. Your loved ones can provide you and your care team with a fresh perspective. They might even be able to share factual information that you don’t remember, or forgot to mention. And this process isn’t about blame. Your therapist might even shut down any attempts to shame you for your addiction. Instead, family therapy is a chance for you to get to the root of the issue.

Social support is vital during addiction recovery. ((Atadokht, A., Hajloo, N., Karimi, M., & Narimani, M. (2015). The role of family expressed emotion and perceived social support in predicting addiction relapse. International Journal of High Risk Behaviors & Addiction, 4(1), e21250. https://doi.org/10.5812/ijhrba.21250)) According to research, family therapy minimizes the risk of relapse. ((Substance Abuse and Mental Health Services Administration. (2013). Family Therapy Can Help For People in Recovery For Mental Illness or Addiction. https://store.samhsa.gov/sites/default/files/d7/priv/sma13-4784.pdf)) It can also lower treatment dropout rates. There are a few factors at work here. First, family members who join you in therapy might commit to holding you accountable. Also, knowing you have their support might inspire you to stay focused on recovery.

Benefits for Family Members

If you love someone who has an addiction, you may also need to heal. Family therapy can support your recovery process, too. Treatment can help you understand your own unhealthy patterns. And once you do that, you can start to change them.

Those patterns might be directly related to your loved one’s addiction. For example, many spouses of people in recovery show signs of codependency. While this condition is born out of love, it can interfere with your mental health. If you identify this issue in yourself, you might want to consider getting 1:1 treatment.

Once your loved one enters recovery, you may feel a sense of relief. But rehab is the first step on a much longer journey. And while they continue to heal, it’s important for you to do the same.

Benefits of Ongoing Treatment—Even After Rehab

After residential treatment, it might be helpful to keep seeing a family therapist. In most cases, you’ll have to find a new provider who works outside the rehab program. And if you plan in advance, they can help ease the transition out of rehab.

There’s always an adjustment period when you enter a new phase of recovery. And moving to a new space is difficult even under the best of circumstances. If your family is living together after some apart, it’s all too easy to fall back into unhealthy patterns. Therapy can help everyone navigate this challenging time.

The Limitations of Family Therapy

Family therapy isn’t a good fit for everyone. It might be unhealthy to stay in touch with the people you knew before you started recovery. You might even choose to step away from your closest loved ones. And if someone you love goes to rehab, you might need space from them.

As hard as it can be to set these boundaries, it’s important for each of you to prioritize your own healing process. There are many valid reasons why it might be better not to engage in therapy with family members.

Trauma

If you’re healing from trauma caused by family members, you might need to set strong boundaries with them. That might even mean cutting off all contact. This is a big decision, but it doesn’t have to be a permanent one. If you’re considering this step, it’s best to talk to your therapist before taking action.

This can be a concern for people in rehab, family members, and other loved ones. No matter how much you care about someone, it’s okay to take space. Sometimes it’s even necessary. When you’re further along in your healing journey, you may be able to go back to these relationships. Or, you might find that you don’t want to.

Setting New Boundaries

When a person goes to rehab, it’s a great opportunity to step back from unhealthy relationships. If you’re entering recovery, you might stop talking to people who pressured you to take drugs. Or, you might take a break from a partnership with someone who enabled your addiction. Even people with good intentions can sometimes undermine your healing process.

Family members can set boundaries, too. That doesn’t mean you don’t care about the person in recovery. In fact, it’s often the exact opposite. You can use this time to think about your role in the person’s life, how their addiction affects your mental health. If you’re not in a good place, you can’t effectively support them either. Stepping back from the relationship can give you some much-needed perspective. And then, you can start thinking about what comes next.

Learning to Let Go

In family and couples therapy, each person starts to understand and communicate their own needs and boundaries. And ideally, you’ll all start working toward your personal goals. In time, every one of you can learn to thrive.

That being said, your goals won’t always align with those of your loved ones. You might even find that your values are incompatible. In some situations—as with parents and minors—you’ll need to meet in the middle. But sometimes, the best outcome is for you to part ways. In some cases, ending a relationship is a sign of successful family or couples therapy.

Separating can be an act of love. This is a way of giving each other the space you need to live your best lives. You’ll both be free to put energy into the relationships that fulfill you. Or, you can take some time to yourself while you focus on recovery.

Family Therapy Can Help You Move Forward

Exploring your relationships can help you understand yourself better. And that understanding is an essential part of recovery. Whether you’re in treatment, or you love someone with an addiction, family therapy can help you heal.

Browse our list of rehab centers with family therapy programs to learn more about support groups, housing options, and other types of therapy they offer.

Reviewed by Rajnandini Rathod

Equine therapy (ET), also known as equine-assisted therapy (EAT), is an increasingly popular method of addiction treatment. In this therapy, your interactions with a horse will help you achieve therapeutic goals. Specifically, you might work on social skills, sensory processing, and physical wellness. You may also gain insight into how your behavior affects those around you.

Because ET doesn’t require much conversation, you may feel more at ease working through issues that you don’t feel comfortable addressing in traditional talk therapy. While you may already have an affinity for horses, this therapy can still be beneficial even if you’ve never interacted with these animals before–many people report that horses seem like nonjudgmental creatures that make them feel safe. If this sounds appealing to you, you may choose to explore rehab programs that offer equine therapy.

What is Equine Therapy?

During equine therapy, your therapist will guide you through a series of tasks with the horse. This can include anything from riding to ground activities like grooming or walking, depending on the type of ET your treatment center offers. Session lengths vary, but you can usually expect them to last around 30-90 minutes.

One study determined the following common factors in equine-assisted therapies: ((White‐Lewis, S. (2019). Equine‐assisted therapies using horses as healers: A concept analysis. Nursing Open, 7(1), 58–67. https://doi.org/10.1002/nop2.377))

• The goal of the interaction is a positive outcome for the participant.
• Treatment occurs through the interactions between the horse and human, which are purposeful and regulated.
• A trained facilitator, such as a therapist, is present with the horse, in addition to the human receiving the therapy.

Throughout the session, your therapist will be able to learn about you through your interactions with the horse. This process can help you work through whatever comes up—sometimes it’s not at all what you expect.

Equine-assisted therapies are becoming more popular ((Marchand, W. R., Andersen, S. J., Smith, J. E., Hoopes, K. H., & Carlson, J. K. (2021). Equine-assisted activities and therapies for veterans with posttraumatic stress disorder: Current state, challenges and future directions. Chronic Stress, 5, 2470547021991556. https://doi.org/10.1177/2470547021991556)) in Europe and the U.S. since their inception in the ‘90s. But what, exactly, takes place during one of these sessions?

What are the Different Types of Equine-Assisted Therapies and Activities (EAAT)?

There are several different kinds of equine-assisted therapies and activities (EAAT) that you may encounter at rehab centers. While there are some discrepancies about the terms used for various types of equine therapy, we’ll look at some of the more popular options below.

Note that offerings vary from rehab to rehab depending on their facilities, staff, and treatment approach. You can contact the admissions team at a center you’re considering for more details about their specific program.

Equine-Assisted Psychotherapy (EAP)

One that you’ll encounter often at many different rehab centers is equine-assisted psychotherapy (EAP). Contrary to popular belief, EAP doesn’t involve riding the horse. During this experiential therapy, the therapist leads the client and horse through a series of activities on the ground. The whole process is slow and gentle, and helps encourage personal growth, responsibility, and healing.

Don Lavender, program director at Camino Recovery in Spain, has worked with horses for over 40 years, and even helped bring the treatment to the U.S. in the early 2000s. According to Don, “It’s become a really effective therapy. It’s therapeutic for the person because they get to learn connection with others.” Don also says that this connection can replace their substance use, and be an integral part of the healing process.

Therapeutic Horseback Riding (THR)

THR includes horseback riding, ((White‐Lewis, S. (2019). Equine‐assisted therapies using horses as healers: A concept analysis. Nursing Open, 7(1), 58–67. https://doi.org/10.1002/nop2.377)) and may include activities like leading the horse around or through obstacles, or simply walking or trotting, depending on the rider’s experience level. This may also include grooming and caring for the horse.

Therapeutic Carriage Driving

In therapeutic carriage driving, ((White‐Lewis, S. (2019). Equine‐assisted therapies using horses as healers: A concept analysis. Nursing Open, 7(1), 58–67. https://doi.org/10.1002/nop2.377)) clients drive the horse while riding in a carriage. This can give the person driving feelings of empowerment and responsibility, especially if other people are present in the carriage. In addition, people who may be unable to ride a horse due to physical difficulties can still experience benefits from THR through this activity.

Interactive Vaulting

Interactive vaulting sessions ((White‐Lewis, S. (2019). Equine‐assisted therapies using horses as healers: A concept analysis. Nursing Open, 7(1), 58–67. https://doi.org/10.1002/nop2.377)) can include gymnastics while riding the horse and group problem solving tasks.

What Happens During an Equine-Assisted Psychotherapy Session?

It may depend on the center, but at Soberman’s Estate, clients are eased into this type of therapy. Equine & Meditation Coach Janice Story doesn’t have the client participate in any particular activities on the first day. Instead, she simply lets the person bond with the horse. “I’ll have them just sit and pet the horse, and see what comes up for them,” she says.

Later, they might go on walks, practice leading the horse, and eventually work their way up to various trust-building and communication practices. During some of these sessions, the client has a blindfold on. Story, or another client, then leads the blindfolded client to the horse and through a series of trust-building tasks, such as picking up their feet. “It teaches clients that they can do something without really knowing how,” she says. “We give them tools and relate it to how they can take it with them when they leave, when they try to navigate their journey back into life.”

At Camino Recovery, Lavender has the client start by grooming the horse, and allows both parties to get to know each other. Eventually, they move towards “lunging.” This involves getting the horse to move around the pen with their personal energy rather than with a rope. To do this requires the client to understand, read and tend to the horse’s emotions.

These are just a few examples of what you might expect during equine-assisted psychotherapy. While it may seem intimidating, Story is confident that the experience will be a positive one. “When our clients first show up, some of them say, ‘I don’t know what this equine therapy is going to do for me,’” she says. “By the end of an hour they’re asking me when we come back.”

How EAT Can Improve Mental Health

Equine-assisted therapy can improve mental health ((White‐Lewis, S. (2019). Equine‐assisted therapies using horses as healers: A concept analysis. Nursing Open, 7(1), 58–67. https://doi.org/10.1002/nop2.377)) in several ways. Research shows that it can increase self-esteem. It can also inspire feelings of freedom, independence, and competency.

Our own beliefs about these creatures play a role in this process. According to researchers, interacting with horses creates “visual imagery of power and beauty,” which can empower recipients of this therapy. What’s more, horses have been human companions for thousands of years. ((Domesticating Horses. (n.d.). American Museum of National History ; American Museum of National History. https://www.amnh.org/exhibitions/horse/domesticating-horses)) We’re used to seeing them as pets, working animals, transportation, and entertainment. This familiarity can help clients establish trust.

Horses Provide Connection and Comfort

Equine therapy can also facilitate connection. ((Marchand, W. R., Andersen, S. J., Smith, J. E., Hoopes, K. H., & Carlson, J. K. (2021). Equine-assisted activities and therapies for veterans with posttraumatic stress disorder: Current state, challenges and future directions. Chronic Stress, 5, 2470547021991556. https://doi.org/10.1177/2470547021991556)) According to one study, “many people find that human-horse bonding results in a comforting and affectionate relationship.”

Horses are pack animals, and they need a connection with their herd. And that doesn’t just mean connecting with other animals—they can also bond with people. Experts believe horses may actually “perceive humans as herd members.” This allows them to form close bonds with ET clients during treatment.

In another study, scientists observed that equine therapy was an effective treatment for combat veterans. ((Lanning, B. A., & Krenek, N. (2013). Guest Editorial: Examining effects of equine-assisted activities to help combat veterans improve quality of life. Journal of Rehabilitation Research and Development, 50(8), vii–xiii. https://www.rehab.research.va.gov/jour/2013/508/pdf/JRRD-2013-07-0159.pdf)) “When you’re with a horse they give you kindness and compassion and love and they don’t expect anything,” one participant explained. “They don’t want to give you advice and they don’t want to make things seem less than they are. They’re just there for you.”

These relationships can be extremely grounding for people in addiction recovery. Many people report that it feels comforting to connect with such a large, powerful animal. By slowly building a rewarding bond based on mutual trust and respect, as ET clients gain the horse’s trust, they learn to trust themselves.

Sharing Your Emotions Becomes Easier

Equine-assisted therapy provides a nonjudgmental place ((Marchand, W. R., Andersen, S. J., Smith, J. E., Hoopes, K. H., & Carlson, J. K. (2021). Equine-assisted activities and therapies for veterans with posttraumatic stress disorder: Current state, challenges and future directions. Chronic Stress, 5, 2470547021991556. https://doi.org/10.1177/2470547021991556)) for people to express themselves. By interacting with a non-verbal animal, you may feel safe to share thoughts you normally wouldn’t mention to another person.

After over 30 years of working with horses, Janice Story understands the animals, and how much they can truly help her clients, very well. “The horses are really amazing at creating a safe space for our clients. When clients first come in, oftentimes they haven’t felt any emotions for a long time. Horses will bring that up for them.”

EAT Can Boost Your Confidence

Equine-assisted activities can improve your self-esteem. ((Marchand, W. R., Andersen, S. J., Smith, J. E., Hoopes, K. H., & Carlson, J. K. (2021). Equine-assisted activities and therapies for veterans with posttraumatic stress disorder: Current state, challenges and future directions. Chronic Stress, 5, 2470547021991556. https://doi.org/10.1177/2470547021991556)) Horses are large animals, and some people may find this intimidating, especially if they haven’t interacted with them before. But when they overcome these challenges successfully, they feel empowered, which boosts their sense of self-confidence.

Because horses are pack animals, they naturally look for a leader. If the person doesn’t become the leader, the horse will. Therefore, the person must establish themself as the leader, and work on becoming assertive and confident in order to gain the horse’s respect. This process can teach you valuable leadership skills.

Building Self-Awareness

Horses have evolved to be on the lookout for predators. Because of this, they’re highly attuned to their environment. And in equine therapy, that awareness includes empathy.

Horses easily understand and react to human emotions. ((Marchand, W. R., Andersen, S. J., Smith, J. E., Hoopes, K. H., & Carlson, J. K. (2021). Equine-assisted activities and therapies for veterans with posttraumatic stress disorder: Current state, challenges and future directions. Chronic Stress, 5, 2470547021991556. https://doi.org/10.1177/2470547021991556)) And they’re not afraid to give you feedback. If you make a horse feel uncomfortable, you can trust it to let you know. This dynamic is intended to help you improve your self-awareness. Instead of acting on impulse, you’ll learn to control your emotional reactions to help the horse stay calm.

According to Story, horses act as mirrors, reflecting the client’s emotions back to them. “If the client needs to work on holding some boundaries, they might not know it, but the horse will show that to them,” she says. “And then at the same time, they’ll help them work through it. So it actually teaches them how to hold their boundaries.”

In that way, equine therapy differs from talk therapy. Janice points out that, in traditional therapy, “the issues might arise but sometimes the solution is not instant. Where with the horses, they’ll teach them at the same time.” This real-time feedback can help the client work through the issues that they’re dealing with right then and there.

Equine Therapy for Specific Mental Health Concerns

Equine therapy is used to treat various mental health concerns such as anxiety, depression, and post-traumatic stress disorder (PTSD). Many of these conditions occur alongside substance use disorders. And thus, equine therapy can be helpful in treating mental health concerns that arise because of, or separately from, drug misuse.

Post-Traumatic Stress Disorder (PTSD)

One study found that equine-assisted therapy can help alleviate PTSD symptoms. ((Earles, J. L., Vernon, L. L., & Yetz, J. P. (2015). Equine-assisted therapy for anxiety and posttraumatic stress symptoms. Journal of Traumatic Stress, 28(2), 149–152. https://doi.org/10.1002/jts.21990)) After just 6 weekly, 2-hour EAP sessions, participants reported feeling significantly less intense responses to trauma, and minimized PTSD symptoms. Additionally, they experienced less anxiety and reduced depressive symptoms.

Equine therapy may work especially well for symptoms of PTSD ((MacLean, B. (2011). Guest editorial: Equine-assisted therapy. Journal of Rehabilitation Research and Development, 48(7), ix–xii. https://www.rehab.research.va.gov/jour/11/487/pdf/pageix.pdf)) in part because horses are prey animals. This makes them hypervigilant, and unlike dogs, humans need to gain their trust over time. People with PTSD often experience the same hypervigilance, which can help them relate better to the horse. And because horses communicate primarily through body language, people can work to improve other PTSD symptoms, such as emotional numbness and bodily dissociation.

Anxiety

Numerous studies show that equine therapy helps reduce anxiety. A participant in one study said that therapeutic horseback riding helped her minimize her anxiety ((Gabriels, R. L., Pan, Z., Dechant, B., Agnew, J. A., Brim, N., & Mesibov, G. (2015). Randomized controlled trial of therapeutic horseback riding in children and adolescents with autism spectrum disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 54(7), 541–549. https://doi.org/10.1016/j.jaac.2015.04.007)) through the “teamwork” experienced between her and the horse. In this process, clients move “in sync with the horse’s body,” and the horse intuitively responds to the rider.

Aggression

One study found that equine-assisted psychotherapy can also treat aggression. ((Animal-assisted therapy with chronic psychiatric inpatients: Equine-assisted psychotherapy and aggressive behavior. (n.d.). https://doi.org/10.1176/appi.ps.201300524)) This may be due to the horse’s larger size, which can make them seem more intimidating. People may realize that, if they can’t control their anger impulses, there is a possibility that the horse can cause them harm. This helps them to learn to react calmly and carefully. And because the horse gives instant feedback, patients can learn quickly exactly which behaviors are hurtful and work to correct them.

Autism Spectrum Disorder (ASD)

Another study looked at children with autism spectrum disorder (ASD) who did 10 weeks of therapeutic horseback riding. ((Petty, J. D., Pan, Z., Dechant, B., & Gabriels, R. L. (2017). Therapeutic horseback riding crossover effects of attachment behaviors with family pets in a sample of children with autism spectrum disorder. International Journal of Environmental Research and Public Health, 14(3), 256. https://doi.org/10.3390/ijerph14030256)) Children with ASD are sometimes rough with pets, but participants in this study were reportedly more caring towards them after the study ended. The control group, which learned about horses but did not interact with them, did not show as much of a change in their behavior.

A similar study discovered that adolescents with ASD showed significant improvements in social behaviors and communication. ((Gabriels, R. L., Pan, Z., Dechant, B., Agnew, J. A., Brim, N., & Mesibov, G. (2015). Randomized controlled trial of therapeutic horseback riding in children and adolescents with autism spectrum disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 54(7), 541–549. https://doi.org/10.1016/j.jaac.2015.04.007)) The researchers theorized that the reason for these positive changes was due to the “shared attention experience” that came from working with the horse. Horses mirror and respond to humans’ body language, which can help those with ASD better understand social cues and behaviors. The children also showed decreased irritability and hyperactivity, which may be due to the relaxing effect of horse riding.

A Program for Veterans

The Professional Association of Therapeutic Horsemanship (PATH) International Equine Services for Heroes® program is an equine-assisted therapy program that specifically works with veterans. ((Lanning, B. A., & Krenek, N. (2013). Guest Editorial: Examining effects of equine-assisted activities to help combat veterans improve quality of life. Journal of Rehabilitation Research and Development, 50(8), vii–xiii. https://www.rehab.research.va.gov/jour/2013/508/pdf/JRRD-2013-07-0159.pdf)) Because veterans are more likely to experience PTSD after returning home from service, PATH developed this unique program just for them. Each veteran receives a horse intended to help them heal both physically and mentally. In this particular study, 13 veterans completed 24 weeks of both riding and ground activities (grooming and walking).

Afterwards, the veterans involved in the study reported feeling more confident, less isolated, and more trusting of others. Their depressive symptoms decreased over the course of treatment. “You’re forced to bring [problems] up and deal with them to the horse,” said one participant. “It’s pretty interesting. It’s amazing.”

Another participant stated that “I learned that even though I have issues in my life, I can come here to this program and get past my issues by working with the horse.”

Reconnect With Yourself Through Equine Therapy

Horses can teach you communication, confidence, and even interpersonal skills. Don Lavender may summarize it best: “Equine therapy is about connection, learning to connect to self by first learning to connect to another.”

Through your connection with a horse, you can learn how to reconnect with yourself.

To learn more about this powerful approach and see photos, reviews, insurance information, and more, visit our searchable directory of equine therapy rehab centers.

Reviewed by Rajnandini Rathod

Ketamine-assisted therapy, or KAT, is a newly popular treatment for depression, anxiety, and PTSD. Because many patients with these diagnoses often struggle to find effective treatment, doctors and researchers continue to seek out new options. And today, many people are finding that ketamine-assisted therapy helps with recovery from substance use disorders.

Despite its historical stigma as a street drug, KAT is being researched as a therapy for a variety of conditions. And the data is promising. When used in appropriate clinical settings, it can serve as a valuable component of a comprehensive recovery plan.

What is Ketamine?

Ketamine is a dissociative anesthetic, ((Gitlin, J., Chamadia, S., Locascio, J. J., Ethridge, B. R., Pedemonte, J. C., Hahm, E. Y., Ibala, R., Mekonnen, J., Colon, K. M., Qu, J., & Akeju, O. (2020). Dissociative and analgesic properties of ketamine are independent. Anesthesiology, 133(5), 1021–1028. https://doi.org/10.1097/ALN.0000000000003529)) and has long been used as a surgical analgesic. That is, anesthesiologists administer it to patients before surgery, usually in combination with other medications, to induce unconsciousness and provide pain relief. However, ketamine’s dissociative qualities may have a more direct impact on mental health.

Dissociation ((Dissociation and depersonalization: Causes, risk factors, and symptoms. (2019, May 17). https://www.medicalnewstoday.com/articles/262888)) is sometimes described as “a dreamlike state,” in which patients feel detached from present reality and even from their own identities. In its recreational use (or misuse), this is often the desired impact of ketamine. In a clinical setting, some physicians consider this a side effect. However, “it is possible that ketamine’s dissociative symptoms ((Ballard, E. D., & Zarate, C. A. (2020). The role of dissociation in ketamine’s antidepressant effects. Nature Communications, 11(1), 6431. https://doi.org/10.1038/s41467-020-20190-4)) are essential to the neurobiological mechanism of action required to produce antidepressant effects.” More research is needed on this subject.

Whether or not dissociation is a necessary component of the process, experts agree that ketamine is one of the most powerful antidepressants that we know of. In fact, according to one source, “no drug to date has been found to possess racemic ketamine’s rapid and robust antidepressant efficacy ((Ballard, E. D., & Zarate, C. A. (2020). The role of dissociation in ketamine’s antidepressant effects. Nature Communications, 11(1), 6431. https://doi.org/10.1038/s41467-020-20190-4)).”

The Uses of Ketamine

Experts believe ketamine is an appropriate treatment for a number of diagnoses. In addition to providing physical pain relief, it can also alleviate some symptoms of many mental health concerns, even those that resist other forms of treatment.

Depression

Ketamine is widely recognized as an effective treatment for both acute and chronic symptoms of depression. It is sometimes used to treat suicidal ideation in emergency situations, because its effects are both immediate and long-lasting. One study, assessing its applications for suicidal patients, found that ketamine provides “​​persistent benefits” for suicidal patients ((Abbar, M., Demattei, C., El-Hage, W., Llorca, P.-M., Samalin, L., Demaricourt, P., Gaillard, R., Courtet, P., Vaiva, G., Gorwood, P., Fabbro, P., & Jollant, F. (2022). Ketamine for the acute treatment of severe suicidal ideation: Double blind, randomised placebo controlled trial. BMJ, 376, e067194. https://doi.org/10.1136/bmj-2021-067194)) in acute crisis. After only 3 days of treatment, 46% of patients in this study experienced full remission of suicidal thoughts.

Ketamine can also be used for ongoing care. Evidence suggests that short-term or intermittent ketamine-assisted therapy for depression ((Mandal, S., Sinha, V. K., & Goyal, N. (2019). Efficacy of ketamine therapy in the treatment of depression. Indian Journal of Psychiatry, 61(5), 480–485. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_484_18)) may have long-term benefits. One study found “significant improvement in depression, anxiety, and the severity of illness after 2 weeks and 1 month of the last dose of ketamine.” This data implies that engaging in KAT during rehab may have a lasting impact on patients’ mental health, even if you don’t continue treatments after leaving the program.

Ketamine therapy is an effective treatment for several forms of depression, ((Mandal, S., Sinha, V. K., & Goyal, N. (2019). Efficacy of ketamine therapy in the treatment of depression. Indian Journal of Psychiatry, 61(5), 480–485. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_484_18)) including unipolar depression (also called major depression) and bipolar depression, which is one aspect of bipolar disorder. It is also “capable of significant and rapid symptom improvement” in the treatment of adults with treatment-resistant depression (TRD). ((McMullen, E. P., Lee, Y., Lipsitz, O., Lui, L. M. W., Vinberg, M., Ho, R., Rodrigues, N. B., Rosenblat, J. D., Cao, B., Gill, H., Teopiz, K. M., Cha, D. S., & McIntyre, R. S. (2021). Strategies to prolong ketamine’s efficacy in adults with treatment-resistant depression. Advances in Therapy, 38(6), 2795–2820. https://doi.org/10.1007/s12325-021-01732-8))

Anxiety

Ketamine can reduce the symptoms of anxiety disorders, ((Dore, J., Turnipseed, B., Dwyer, S., Turnipseed, A., Andries, J., Ascani, G., Monnette, C., Huidekoper, A., Strauss, N., & Wolfson, P. (2019). Ketamine assisted psychotherapy (Kap): Patient demographics, clinical data and outcomes in three large practices administering ketamine with psychotherapy. Journal of Psychoactive Drugs, 51(2), 189–198. https://doi.org/10.1080/02791072.2019.1587556)) which often co-occur with depression. And experts believe it may have fewer negative side effects than other anxiety drugs.

John Krystal, MD, chief psychiatrist at Yale Medicine, explains why ketamine can help with anxiety. “With most medications, like valium, the anti-anxiety effect you get only lasts when it is in your system. When the valium goes away, you can get rebound anxiety. When you take ketamine, it triggers reactions in your cortex that enable brain connections to regrow. It’s the reaction to ketamine, not the presence of ketamine in the body that constitutes its effects.” Because of its unique effects on the brain, ketamine can treat both depression and anxiety. ((How ketamine drug helps with depression. (n.d.). Yale Medicine. Retrieved from https://www.yalemedicine.org/news/ketamine-depression))

Ketamine can also treat social anxiety. ((Taylor, J. H., Landeros-Weisenberger, A., Coughlin, C., Mulqueen, J., Johnson, J. A., Gabriel, D., Reed, M. O., Jakubovski, E., & Bloch, M. H. (2018). Ketamine for social anxiety disorder: A randomized, placebo-controlled crossover trial. Neuropsychopharmacology, 43(2), 325–333. https://doi.org/10.1038/npp.2017.194)) And in fact, much of the research into ketamine as an anxiety drug centers around this condition. Because social anxiety is associated with alcohol misuse, this may be helpful during recovery from co-occurring anxiety and substance use disorders.

And this condition isn’t only associated with alcohol use disorder. In addiction, there is “a high degree of comorbidity” between social anxiety and post-traumatic stress disorder (PTSD). ((McMillan, K. A., Sareen, J., & Asmundson, G. J. G. (2014). Social anxiety disorder is associated with PTSD symptom presentation: An exploratory study within a nationally representative sample. Journal of Traumatic Stress, 27(5), 602–609. https://doi.org/10.1002/jts.21952)) If you have either or both of these conditions, KAT may be an appropriate treatment.

Post-Traumatic Stress Disorder (PTSD)

Preliminary research suggests that ketamine-assisted therapy may be an effective treatment for post-traumatic stress disorder. ((Davis, A. K., Mangini, P., & Xin, Y. (2021). Ketamine-assisted psychotherapy for trauma-exposed patients in an outpatient setting: A clinical chart review study. Journal of Psychedelic Studies, 5(2), 94–102. https://doi.org/10.1556/2054.2021.00179)) Specifically, a 2021 study found that “sublingual ketamine as an augmentation to somatic psychotherapy provided in a real-world clinic setting has the potential to meaningfully reduce PTSD and depression symptoms among a trauma-exposed population.”

Although much more data is needed, these results are promising. Because substance use disorders and PTSD ((Brady, K., Back, S., & Coffey, S. (n.d.). Substance Abuse and Posttraumatic Stress Disorder. In CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE (Vol. 13, pp. 206–209). http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.825.3022&rep=rep1&type=pdf)) are so strongly associated with each other, KAT may prove to be an especially helpful treatment for patients in recovery from addiction.

Healing From Substance Use Disorders With ​​KAT

If you’re in recovery from substance misuse, any type of pharmaceutical treatment is potentially triggering, or even dangerous. Despite this, some prescriptions—including ketamine—can help alleviate your symptoms. And research supports the idea that ketamine is an effective treatment for substance use disorders (SUDs). ((Ettensohn, M. F., Markey, S. M., & Levine, S. P. (2018). Considering ketamine for treatment of comorbid pain, depression, and substance use disorders. Psychiatric Annals, 48(4), 180–183. https://doi.org/10.3928/00485713-20180312-02))

According to the same study, “ketamine itself is a drug of potential abuse when used recreationally.” Despite this, “its lasting effects without repeated daily use have also shown promise for patients with SUDs.” This is especially true for patients with comorbid chronic pain, and those in recovery from opiate misuse. It’s also important to note the overlap between the latter two conditions; many people begin misusing opiates in response to preexisting chronic pain.

Ketamine-assisted therapy promotes abstinence among people with heroin dependence, ((Krupitsky, E. M., Burakov, A. M., Dunaevsky, I. V., Romanova, T. N., Slavina, T. Y., & Grinenko, A. Y. (2007). Single versus repeated sessions of ketamine-assisted psychotherapy for people with heroin dependence. Journal of Psychoactive Drugs, 39(1), 13–19. https://doi.org/10.1080/02791072.2007.10399860)) alcohol use disorders, and more. In fact, ketamine may be a helpful treatment for many different substance use disorders. ((Jones, J. L., Mateus, C. F., Malcolm, R. J., Brady, K. T., & Back, S. E. (2018). Efficacy of ketamine in the treatment of substance use disorders: A systematic review. Frontiers in Psychiatry, 9. https://www.frontiersin.org/article/10.3389/fpsyt.2018.00277)) “These results suggest that ketamine may facilitate abstinence across multiple substances of abuse and warrants broader investigation in addiction treatment.”

Although ketamine is not “classified as a highly addictive drug,” its use may still be triggering for people in recovery. Because of this risk, it is absolutely essential that patients only use ketamine in a controlled environment.

The Experience of Ketamine-Assisted Psychotherapy

Ketamine can be administered as either an IV treatment or a nasal spray. In 2019, the FDA approved the use of “Spravato (esketamine) nasal spray, in conjunction with an oral antidepressant” for adults with treatment-resistant depression. The FDA has not yet approved ketamine for other mood disorders, ((Wilkinson, S. T., & Sanacora, G. (2017). Considerations on the off-label use of ketamine as a treatment for mood disorders. JAMA, 318(9), 793–794. https://doi.org/10.1001/jama.2017.10697)) but physicians can and often do prescribe it off-label to treat various conditions.

KAT should always be closely supervised by medical professionals in a protected environment. Because it is an anesthetic, ketamine induces a dreamlike state, ((Dodge, D. (2021, November 4). The ketamine cure. The New York Times. https://www.nytimes.com/2021/11/04/well/ketamine-therapy-depression.html)) in which it would be unsafe for a patient to go about their daily life. One patient, speaking to a New York Times reporter, “said the treatment made him ‘sleepy’ and provoked an ‘out of body’ experience. He described these sensations as ‘pleasant’—though he struggled with his balance and a sense of being ‘dazed’ for several hours following each session.”

In some clinics, each patient undergoes treatment in a private room. In others, KAT is a group experience. Although it’s unlikely that patients will be physically able to interact during the treatment, simply sharing that time with other people can be an opportunity to bond.

Whether you’re treated alone or with a cohort, your session may begin or end with a talk therapy session. During that time, providers might ask you to set intentions for healing, process what you experienced during treatment, or—in a group setting—offer feedback to one another.

Ketamine treatments are especially effective when performed in combination with psychotherapy. ((McInnes, L. (2020, August 24). Combining Ketamine With Psychotherapy to Treat Depression [Interview]. https://www.hmpgloballearningnetwork.com/site/pcn/article/combining-ketamine-psychotherapy-treat-depression)) Dr. Lynne McInnes, psychiatrist, explains that anecdotally, many providers in this field “know that ketamine enhances the psychotherapeutic process by accelerating the transference, enhancing openness, and fostering empathy between the patient and provider. It also tends to reduce inhibitions, making it easier to talk about difficult subjects.” KAT and talk therapy, especially cognitive behavioral therapy, appear to work synergistically. Clients who engage in both these modalities at once may experience greater benefits.

Benefits of Ketamine

KAT can be helpful for patients with a wide variety of physical and mental health symptoms. For example, ketamine can be used to treat chronic pain. ((Niesters, M., Martini, C., & Dahan, A. (2014). Ketamine for chronic pain: Risks and benefits. British Journal of Clinical Pharmacology, 77(2), 357–367. https://doi.org/10.1111/bcp.12094)) There are “well-established associations” between chronic pain and substance use disorders. ((Treatment, C. for S. A. (2012). Chronic pain management. Substance Abuse and Mental Health Services Administration (US). https://www.ncbi.nlm.nih.gov/books/NBK92054/)) But managing this condition can be a huge challenge for people in recovery, because it’s hard to find pharmaceutical treatments that won’t trigger relapse. Depending on the exact treatment protocol, KAT can have either short- or long-term benefits for patients with these diagnoses.

In addition to treating mental health concerns like depression, anxiety, and PTSD, ketamine can also improve brain function. ((Ketamine: A transformational catalyst. (n.d.). Multidisciplinary Association for Psychedelic Studies – MAPS. Retrieved from https://maps.org/news/bulletin/ketamine-a-transformational-catalyst/)) According to experts, “ketamine research has shown that the substance creates a high degree of neuroplasticity in rats. This may explain the so-called ‘cumulative effect’ in humans that produces transformative results from multiple sessions in a relatively short time frame, often just two weeks.”

The immediate effects of KAT may be especially appealing to people in the early stages of recovery. However, it’s important to remember that no single treatment—including ketamine therapy—will permanently make your symptoms disappear. While KAT can be an effective component of recovery, it should always be combined with other therapeutic modalities.

The Limitations of Ketamine

Because of its potential for misuse, ketamine may be triggering for some patients with substance use disorders. And if you have a history of misusing ketamine itself, KAT is absolutely not an appropriate treatment during recovery.

This modality is not safe for patients with certain underlying conditions. According to Dr. McInnes, patients with “uncontrolled hypertension are not candidates” for ketamine therapy. KAT is also dangerous for patients with a hypersensitivity to ketamine, ((Rosenbaum, S. B., Gupta, V., & Palacios, J. L. (2022). Ketamine. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK470357/)) pregnant or breastfeeding patients, and anyone with schizophrenia.

If you’re interested in engaging in KAT, make sure to check in with your team of healthcare providers. Because this therapy has a significant impact on the body and the mind, it’s important that you have support from experts in both physical and mental health.

The Growing Interest in Ketamine-Assisted Therapy

In a few short years, the public interest in ketamine as mental health treatment has skyrocketed. As a result, considerable resources are being devoted to its research. Medical doctors, psychiatrists, and scientists are continuing to learn more about the potential applications of KAT.

This is an exciting time, but it’s important to proceed with caution. A growing body of research shows that ketamine can be hugely beneficial to patients with substance use disorders. However, it’s impossible to know what experts will learn in the future. If you decide to engage in KAT during recovery, make sure to look up the most recent available data before you begin treatment.

If you’d like to learn more about ketamine as a treatment for substance use disorders, you can browse a list of rehabs that offer ketamine-assisted therapy.

Reviewed by Rajnandini Rathod

If you’re healing from a substance use disorder, you already know that it isn’t a linear process. The recovery journey is full of ups and downs. And it’s normal to have mixed feelings when you’re trying to break any habit, especially one as powerful as addiction.

Although these feelings are normal, being uncertain can get in the way of healing. If you’re not sure whether you want to recover, it can be hard to commit to treatment. For patients in this position, motivational interviewing (MI) may be a helpful way to approach rehab. This counseling style is specifically designed to help patients resolve internal conflict.

What Is Motivational Interviewing?

Motivational interviewing, or MI, is a framework for having conversations about change¹. It’s based on the idea that motivation needs to come from within the person changing. It can’t be pushed or forced by someone on the outside. At its core, MI highlights each person’s own reasons for wanting to make a change—and in the case of substance use, their reasons for wanting to quit using.

Although MI was originally created as an intervention for people with alcohol addiction, it’s successfully used to help patients make all sorts of positive behavior changes, from eating well to taking their medications as prescribed.

The Uses of Motivational Interviewing for Substance Use Disorder

Dr. Bill Miller first started defining motivational interviewing in the 1970s, and its first description was published in 1983. Research has proven it to be an effective intervention for people with substance use disorders (SUDs). Here are some of the ways it can help:

• helping people with alcohol use disorder stop drinking²
• protecting against relapse³
• helping people heal from cannabis use disorders⁴
• reducing HIV risk⁵ due to substance use-related and other behaviors
• improving treatment engagement during recovery⁶ from substance use or mental health concerns
• helping adolescents recover from substance use disorder⁷

The Principles of Motivational Interviewing

Unlike many other modalities, MI is not a psychotherapy method. Because of this, it has some unique benefits and limitations. Anyone can use a motivational interviewing style, including medical practitioners, therapists, recovery coaches, and addiction counselors. It’s simply a framework for having conversations about change.

This framework can help you stay engaged with recovery. Research has found that people who receive an MI intervention before attending a treatment program are more likely to complete it. The basic principles of MI set it apart from more traditional addiction counseling frameworks.

Ambivalence

Ambivalence is the internal tug-of-war that many people experience when facing a major transition, such as recovering from addiction. One part of you wants to stop using, and another part of you doesn’t want to change. While some treatment providers may see ambivalence as a sign that you’re not ready for recovery, MI treats this conflict as a normal part of healing. This model is designed to help people resolve ambivalence instead of fighting against it.

Unlike some other therapeutic frameworks, MI never labels patients as “resistant.” Instead, your provider will respect your point of view, trusting that you know what’s best for yourself.

Partnership and Autonomy

When talking to a treatment provider who uses an MI approach, think of them as your partner in the journey of recovery. Their job is to respect that you’re the expert on your own life, and that you already have a lot of wisdom about what does and doesn’t work for you. They know you have irrevocable autonomy. You’re the only person in control of your actions.

Within an MI framework, your provider will never give you unsolicited advice. Instead, they may ask your permission before suggesting an idea, or wait for you to ask their opinion. This empowers patients to collaborate with their providers, giving you room to decide what’s best for your own healing process.

Change Talk

Most patients experience ambivalence during recovery. But having a provider push you to overcome that ambivalence can just intensify it. In MI, practitioners help patients uncover their personal reasons for wanting to make a change. These reasons are called change talk.

To elicit change talk, MI providers ask targeted questions that encourage you to consider what life would be like without substances. For example, they might ask you to reflect on how substance use has caused problems in your life, or interfered with your goals.

You may also reflect on why recovery is important to you. MI practitioners understand that your reasons for wanting to recover from addiction may be different from those of your partner, family, or friends. And ultimately, your reasons are the ones that matter.

Developing Discrepancy

MI providers may also help you resolve ambivalence through a practice called developing discrepancy. During this process, you’ll start to define your values.

Every person has core values that they live by, or would like to live by. Often, addiction keeps us from living a life that’s aligned with those values. MI practitioners invite you to consider how your behavior reflects your unique values. This is intended to increase your motivation and commitment to recovery.

For example, imagine that a patient considers family as a core value. But they lie to their family about their addiction. This not only hurts the people around them; it also undermines their commitment to their own values. It’s all too easy to harm yourself and your loved ones by disregarding your own values, even if you’re doing so unintentionally.

During an MI intervention, your provider will help you see any discrepancies between your values and the way substance use makes you behave. This is done in a non-judgmental way. The goal isn’t to make you feel guilty, but to help you commit to living a life that aligns with your own values.

Affirmations

MI is a strengths-based approach. This means that MI providers don’t see you as an “addict.” Instead, they see you as a whole person who already has strengths and resources to help you recover from addiction. They’ll always put your strengths at the forefront of the recovery process.

As you go through MI, your provider will also make sure that you are aware of your own strengths. They do this through the use of affirmations. It’s important that you know what your strengths and resources are, so you know what you can rely on for support during recovery.

The Stages of MI

Like most treatment models, MI doesn’t proceed in a strictly linear fashion. But there are some key stages of MI that you’ll often experience when you’re receiving an MI intervention:

Engagement

The provider will first work to develop a trusting relationship with you. If you feel attacked or judged by your provider, then no intervention (including MI) is likely to work. MI practitioners will build engagement with you by using a collaborative approach, which includes reflective listening techniques.

Focusing

MI is designed to help patients make a change. To do that, you and your provider need to agree about what change you actually want to make. Focusing is a collaborative process in which you will decide on a goal together. You might have other goals that you want to work on, in addition to overcoming addiction, and these goals will always be honored.

Evoking

Evoking is at the heart of motivational interviewing. In this process, your MI provider will draw out change talk, or your reasons for wanting to quit using a substance. Evoking involves asking you questions and reflecting your answers back to you in a meaningful way. However, your provider won’t give you unsolicited advice or try to pressure you into a particular course of action.

Planning

Planning is the only stage of MI that’s optional, meaning you may or may not ever get here. In this stage, you collaborate with your provider to create a plan for how to maintain your commitment in the future. While some patients find this helpful, others prefer to create a plan without the provider’s help.

It’s important to note that there is a manualized version of MI, called Motivation Enhancement Therapy (MET). This is a more rigid version of MI, in which patients go through these stages in a more linear and orderly fashion.

Benefits of Motivational Interviewing

Like any treatment model, MI has both benefits and limitations. It’s not a miracle cure, and it’s not intended to be. But it can be a good fit for people who feel ambivalent about recovery. This framework has several noteworthy benefits:

• It saves time. MI is a time-limited, cost-effective intervention. Practitioners don’t typically need a lot of time to help people make changes. In fact, just one MI intervention before treatment has been found to improve engagement⁸.
• It works. Hundreds of studies have been published about the use of MI to treat substance use disorders. One literature review found that motivational interviewing is more effective than traditional advice-giving⁸ approximately 80% of the time.
• It can help you commit. Unlike most other treatments, MI helps patients resolve their indecisiveness about substance misuse. This may be especially helpful for patients who want to make a change, but are unsure of how to commit to that process.
• It increases your self-efficacy. MI helps you build the confidence you need to stay committed to recovery, rather than depending on outside sources.
• It respects your agency. MI is a good treatment option for people who don’t like being told what to do. MI practitioners respect your autonomy. They understand that pushing patients too hard isn’t likely to work, and it may even intensify your resistance to change.
• It helps you get in touch with your reason for recovering. Often, people in recovery never take the time to pinpoint their personal “why” of substance use recovery. They may have a vague notion that they “should” quit using drugs and alcohol, but sometimes, that isn’t enough to see them through. MI can help you to discover and remember your reasons for doing so.

Limitations of Motivational Interviewing

Like any intervention, MI also has some limitations. This model may not be a good fit for every person, and isn’t meant to be used as a treatment for every issue.

• Motivational interviewing is not a comprehensive psychotherapy model⁹, so it’s not the right fit for every condition. For example, it may not be an appropriate way to approach depression or PTSD. However, research has found that MI may be an effective component of treatment for patients with dual diagnoses¹⁰.
• The effectiveness of motivational interviewing⁹ depends on who delivers it. This isn’t unique to MI; the therapeutic relationship is key to the success of most mental health interventions. However, since people who aren’t licensed therapists can use MI, their levels of training and competency may differ more widely than it does in other models of psychotherapy. If you decide to pursue MI, you may want to consider working with a counselor that has been trained by a member of the Motivational Interviewing Network of Trainers (MINT).
• Motivational interviewing may or may not be an appropriate intervention¹¹ for every type of substance use disorder. For example, more research is needed into MI for people with a history of opiate or methamphetamine misuse. If you have an opiate or methamphetamine addiction, there are other treatments specifically designed for you that may be more effective.

Committing to Change with Motivational Interviewing

Motivational interviewing can be extremely helpful for some patients, but it’s just one aspect of recovery. Because this framework can be integrated with other treatment models, it may be a good fit for people with a wide variety of mental health concerns.

Remember that no intervention, including MI, is a quick fix for healing from addiction. While this approach may help you resolve ambivalence, it won’t resolve all the underlying reasons you began misusing substances. If you’re interested in pursuing MI, talk to your team of providers about whether it would fit with the other treatments you’re engaged in.

If this approach interests you, visit our directory of rehabs offering MI to browse centers near you and see photos, pricing, reviews, and more.

Reviewed by Rajnandini Rathod