Ethics and Psychotherapy – 5

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In Chapter 6 Tjeltveit discusses “the intellectual contexts of psychotherapy.” He argues that psychotherapy is necessarily rooted in ethics precisely because the goals of therapy involve aiding clients in living better lives. The implicit (if not explicit) assumption is that some ways of living are better than other ways of living. This is a similar critique to those who have addressed this concern from an explicitly Christian worldview, such as Jones and Butman’s Modern Psychotherapies and Robert Roberts’ Taking the Word to Heart. In other words, it has been argued that each model of therapy provides a “map” for getting from one place (disorder, dysfunction, etc.) to another (health, improved functioning, etc.). But these are more than just ways to get from “here” to “there”; they are theories with assumptions about what is wrong and what is right – including assumptions about what better ways to live and relate to others and understand oneself.

In any case, Tjeltveit goes on to discuss “old” and “new” psychology and the contributions of each to ethical contours in therapy. He then discusses the perspective of those who think psychotherapists essentially strive to base decisions on science alone in responding to ethical issues. He has a great quote from Beutler (1989, p. 4):

Our mentors have implied, if not overtly said, that if it only were possible surgically to remove the therapist’s values, he or she would be a more effective clinician. In the greatest of therapeutic paradoxes, a valueless clinician is valued. (p. 111)

Tjeltveit unpacks a number of issues, and he reasons that “The scientific context of psychotherapy has both shaped and obscured psychotherapy’s ethical dimensions in a variety of ways” (p. 130). But we have erred on the side of avoiding “ethical discourse” based upon our current “understandings of science” (p. 130). Tjeltveit sees both science and ethics as interrelated in part because scientists themselves necessarily rely upon ethics in so many facets of their work. For the author the ability to reflect on ethics is helpful in part because scientists can then either decide to reduce the influence of those values or recognize and use specific values more intentionally (or “wisely”) as he puts it (p. 128).

For reflection: In what ways is your approach to (or practice of) psychotherapy based upon science? In what ways is your approach to (or practice of) psychotherapy based upon ethics? How do you experience these as related?

7 Comments

  1. So which came first the chicken or the egg? I found myself amused by the logic of those who desire to work from a science only perspective. Their dead end arguments only serve to emphasize their own ethically constructed beliefs. “One should not combine ethics and psychotherapy.” Isn’t that an oxymoron?

    As I start my career as a psychologist, it is imperative that I turn to science in order to make sound judgments concerning the appropriate choice of treatment for client’s problems, but I also need to be sensitive to who is in the therapy room. For example, cognitive therapy may be the suggested treatment of choice for depression, but if my client has limited intellectual capacity, then a more behavioral approach may be in order.

    Every decision I make as a psychologist is a culmination of science and ethics, whether it is the scientist following ethical procedures in testing hypotheses for treatment modalities, or my standing on the intrinsic psychotherapeutic conviction that some ways of living are better than others, when choosing a treatment approach.

  2. I completely agree with you, Lori. I hold firmly to the belief that science and research have paved the way for me in my career as a psychologist. It would be foolish to try to help somone with methods that have not been proven. Such practice could certainly do more harm than good as seen in the reparenting theories.

    I find myself surprised that anyone in support of psychology would come from a stance that is completely scientific and neglecting of ethics. Is not the APA Code of Ethics proof enough that one must operate in part from an ethical position. If one could operate soley from a scientific position, there would be no need for guidelines that determine the action steps one must take when working as a clinician.

    I believe it is a bit of a fine line that we must walk as psychologists. On one side of the line we have a completely ethical view and on the other a completely scientific view. We should not try to choose one and ignore the other. Instead, we must learn to have the proper balance. Like most things in life; extremes can be quite dangerous.

  3. Both of you guys make excellent points. Both science and ethics are needed in the practice of psychotherapy, without either one clients could be harmed. Science provides psychologists with a great way to test theories and new treatments to help build evidence that it is a good theory or a good treatment. It gives a way to refine treatments to help make them more effective and better understand the problems for which they work best. Ethics also helps to guide a psychologist’s decision making and to protect the client’s welfare. The APA code provides guidelines and standards to give a more consistent approach about how to work with clients. By combing science and ethics an appropriate balance can be found and clients can benefit from the best of both worlds.

  4. Nice synthesis. I do think that the way we’ve approached psychology as a science has made it difficult to articulate the ethical underpinnings of our clinical practice. Yes, we have standards and guidelines, but we do not have a compelling ethic for the standards and principles themselves, and this can make discussions of values in psychotherapy particularly challenging.

  5. It seems that Christians have been the ones leading the field on evaluating ethics in psychology. Would you say that I’ve made an accurate evaluation with that satement?

    I can appreciate that I could be a part of examining ethics in psychology because it is incredibly important, but I wonder why it has not been looked at as much from the purely scientific practicioners. While I can see how the study of values can seem contradictory to science, it seems that anything that negates the “best practice” as a clinician (rather that be the practice of adding values or removing them from therapy) should be emprically studied so that the field can be advanced. Have you heard of any studies regarding the presence or absence of values in the clinical process and how such influences the outcome?

  6. I think there has been a lot of good work done in this area by psychologists interested in philosophical analysis of our field. (There is a division dedicated to that in the APA.) And I don’t know the religious affiliations of those who have been doing that work. But I have appreciated people like Tjeltveit who are able to analyze the issues and bring them to the field for serious considerations. His work is especially important because he is able to reflect on these issues in ways that are accessible to psychotherapists, whether they are religiously affiliated or not.

  7. I just noticed you second question. There have been studies in which client and therapist values have been matched, and some studies seem to support the idea of having clients work with therapists who share their values. Other studies (if I recall correctly) seem to suggest that conservative Christian clients, for example, prefer to work with a therapist who understand their faith even if they never discuss it explicitly. So there is not a great deal of research in this area, but the findings I’ve seen are certainly interesting.

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