Discussion Paper on the Ethics of the Use of Motivational Interviewing
Motivational interviewing is premised upon the social psychology concepts of cognitive dissonance (Festinger, 1957) and attribution while using empathic client centred processes as outlined in the methods of Carl Rogers (1957, 1959). The technique of motivational interviewing has been applied to various areas of concern, including eating disorders and adherence to health treatments with mixed success, however this paper will concentrate on its application in a substance use setting. There have been suggestions that the use of motivational interviewing may subvert the principal of informed consent and that it is “manipulative” in nature. It will be argued that if motivational interviewing is used in the spirit of Miller and Rollnick’s (1991) suggestions, motivational interviewing is an appropriate, effective and ethical tool for social workers working in the area of substance use. There are however important ethical issues to be considered when using motivational interviewing with involuntary clients.
First, this paper will examine the principles and techniques of motivational interviewing, as well as the efficacy of the method. Second, it will be questioned whether motivational interviewing is an ethical technique. This section will raise questions and queries to be addressed in the third section of the paper. Third, this paper will examine the technique of motivational interviewing in the light of the biomedical ethics framework as established by Beauchamp and Childress (2001). The Beauchamp and Childress (2001) framework examines biomedical ethics through the principles of respect for autonomy, non-maleficence, beneficence and justice.