Motivational therapy (or MT) is a combination of humanistic treatment and enhanced cognitive-behavioral strategies, designed to treat substance use disorders. It is similar to motivational interviewing and motivational enhancement therapy.

The focus of motivational therapy is to encourage a patient to develop a negative view of their substance use (contemplation), along with a desire to change their behavior (determination to change). A motivational therapist does not explicitly advocate change and tends to avoid directly contradicting their patient, but instead expresses empathy, rolls with resistance, and supports self-efficacy. Relapses in addictive behaviors are part of the treatment and are not considered a step back or a failure to advance in treatment.

Often, a methadone or similar program is used in conjunction with motivational therapy.

Some suggest that the success of motivational therapy is highly dependent on the quality of the therapist involved and, like all therapies, has no guaranteed result. Others explain the frequent successes of motivational therapy by noting that the patient is the ultimate source of change, choosing to reduce their dependency on drugs.

Motivational therapies are focused specifically on a person's needs, or on what their problems may be. Sessions are usually short the first time you see a patient, but time can vary the next few sessions. During these times there are different methods and techniques used by the therapist. Techniques consist of:

First publicized by Miller and Rollnick in 1991, motivational therapy is now seen as a highly effective treatment strategy for substance use disorders, especially in the case of opiate and euphoric-enhancement drugs, where users tend to resist traditional negative reinforcement strategies. Motivational Therapy was brought to public awareness by William Miller in a 1983 article published in Behavioural Psychotherapy. In 1991, Miller and Stephen Rollnick expanded on the fundamental approaches and concepts, while making more detailed descriptions of procedures in the clinical setting. He later defined it as a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. Compared with non-directive counseling, Motivational Therapy is more focused and goal-directed. The examination and resolution of ambivalence is its central purpose, and the counselor is intentionally directive in pursuing this goal. Since Miller and Rollnick, other psychologists have introduced models and various techniques to try to implement within the Motivational Therapy realm to help with substance use. Carlo DiClemente introduced models that linked motivation with change, proposing the Stages of Change Model, and using it to explain relapse, and the struggle of addiction being a matter of behavior change. The model states seven different stages of change, and a brief description of each stage:

The models, along with the techniques formulated by Rollnick and Miller have helped create a client-driven form of therapy that has been known to help clients with substance use and different caliber athletes in achieving success. Motivational Therapy was designed to be less confrontational than other therapies that encourage clients to realize that they have a problem that they need to confront in order to change. MT is different from those therapies that:

The aforementioned therapy techniques are known to violate the essential spirit of motivational therapy. MT is designed to be an interpersonal style of therapy that is not restricted to formal counseling settings. It focuses on the understanding of what initiates change while utilizing a guiding philosophy, and fosters a balance of components that are both directed and client-centered.