Notes

 
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How do these complexities interact with the particular nature of motivational
interviewing? If our conception of the method is correct, it has the potential,
within limits, to influence a person’s willingness, confidence, and readiness to
change in one way or another. Thus one concern is raised by the potential that
the method can be effective in altering motivation and volition, as well as related
behavior. This is not of particular concern when the client’s aspirations
are consonant with those of the counselor. When there is dissonance between
counselor and client aspirations, however, ethical consideration should be
given to any methods that are effective in changing client aspirations to more
closely match those of the counselor. This issue is further complicated when
the counselor’s “client” (the one desiring change) is not the person who is
seated in the consultation room but is another party—such as a court system,
parent, or school—asking for change in the person.
When a client’s aspirations differ from those of the counselor, it is also
the case that interventions designed to alter motivation for change are done
without the person’s permission, at least to some extent. One can point to
contextual factors that may mitigate this concern somewhat. A person voluntarily
seeking counseling at an addiction treatment program may profess no
desire to change his or her use of drug A (although motivation might be high
to stop using drug B), but will not be surprised that a counselor in this context
may seek to enhance the person’s motivation to stop drug A as well. Those being
seen at a religiously based counseling service may expect, or even desire,
that the counselor advocates values that conflict with their current behavior
and aspirations. Nevertheless, one cannot entirely dodge the point that in
seeking to alter what it is that a person desires, one is in some sense doing so
without the person’s direct assent or request.
This issue of assent is related to a further concern, which is that a method