The ethics of psychotherapy

Processing of Formal Complaints against Psychologists

The multiplicity of procedures for dealing with formal complaints against psychologists is subjected to a critical review and analysis in the context of an in-depth case study. It is evident that there are sources of confusion and hazards for both the client-plaintiff and the therapist-defendant in the current network of professional, administrative, and legal procedures. Recommendations for changes are presented.

Ethics in psychotherapy: a focus on professional boundaries and confidentiality practices

The practice of psychotherapy gives rise to many ethical dilemmas. In this article we offered a "primer" on the most commonly cited ethical concerns in psychotherapy related to professionalism and therapeutic boundaries and confidentiality. There is no single answer to the varied and complex ethical issues that therapists may encounter in their treatment of patients. Such dilemmas are dynamic, nuanced, complex, and highly context dependent. Although professional codes offer guidance on optimal standards of conduct, they do not always offer clear answers; hence, therapists need to be able to critically evaluate and interpret such codes in relation to their daily practice. The contemporary therapist continues to face new dilemmas in an ever-evolving and dynamic twenty-first-century practice environment. Ethical therapists serve the well-being of their patients above all other interests or commitments. Therapists who are attentive to the professional obligations they possess can adopt several strategies to increase their ethical competence, including constantly evaluating their own attitudes and behaviors in addition to those of their patients, engaging in dialog and developing expertise in relation to ethics issues, having a solid grasp of relevant professional codes of conduct, and demonstrating an openness to consultation with peers and exposure of their work to peer review.

Sleeping with the past: the ethics of post-termination patient-therapist sexual contact

OBJECTIVE

The aim of the paper is to devise an ethical argument to support the contention that post-termination patient-therapist sexual contact (PTSC) is always unethical.

METHOD

Arguments both defending and condemning post-termination PTSC are reviewed and their strengths and weaknesses explored.

RESULTS

Analysis of these arguments reveals a strong case for the universal condemnation of post-termination PTSC.

CONCLUSIONS

Ethical codes, including that of the Royal Australian and New Zealand College of Psychiatrists, should be amended to explicitly prohibit post-termination PTSC.

[Informed consent: a prerequisite for psychotherapy?]

Is it desirable to extend the practice of explicit informed consent to psychotherapy? Is it possible? How? This article offers preliminary answers to these questions following a literature review and reflection on the theory of informed consent and psychotherapy. It explores the advantages and the possibility of using explicit informed consent in place of the implicit consent obtained currently. Explicit consent for psychotherapy would be interactive, iterative, repeated and revokable. It would take into account specific characteristics of psychotherapy, such as the fact that it is a process rather than a procedure, its relative unpredictability, the active part the patient plays in treatment, and the importance of the unconscious, transference and counter-transference. It would have the advantages of respecting the patients' autonomy without sacrificing their well-being, of having meaning not only for medico-legal protocols but for the patient, and would improve satisfaction with and the efficacy of psychotherapy as a treatment modality. The proposed model provides direction for future research, both empirical and theoretical.

Sex and gender and the impaired therapist

A brief review of the problem of impaired therapists is followed by a more comprehensive review of sexual relationships arising in and following psychotherapy. The prevalence of this latter problem is approximately 10%. Offenders are predominantly male, one half are said to be "ruthless" and "exploitative", whilst the remainder are often "lovesick". The author relates these phenomena to processes of repudiation of the relational/feminine self of the highly masculinised clinician. Characteristics of offenders and consequences for patients are presented and issues of detection, sanctions, legislation, and prevention are addressed. Studies suggest that the vast majority of patients are harmed by the experience and that neither improved training, licensing, personal therapy, nor supervision of therapists will guarantee against its occurrence.

Ethics in behaviour therapy: historical aspects and current status

Ethical problems in clinical practice arise when clinicians confront competing value systems. Historically, behaviour therapy has been criticized because of alleged special ethical, moral and legal problems. These problems are no greater or smaller than in other forms of psychotherapeutic practice. But they can differ in emphasis. This article describes partial responses to selected ethical dilemmas facing general psychotherapy, and outlines relatively novel issues raised by certain features of behavior therapy practice.