We are continuing our discussion of Tjeltveit’s book, Ethics and Values in Psychotherapy. In Chapter 7 Tjeltveit discusses the “social context of psychotherapy,” that is, he locates the practice of psychotherapy in the context of how it functions within society. He discusses psychotherapy’s medical heritage including bioethics and medical ethics and the two emphases of “the idea of the professional and a focus on the individual client” (p. 132). Other influences from medicine include reductionism in the form of limiting psychotherapy’s focus to a medical focus of symptom reduction. He seems to suggest that there is much more to biopsychosocial problems than merely what is understood in terms of a “medical issue”.
The other major social context in which psychotherapy occurs is business. Psychotherapy has become a “business relationship” (p. 139) in which there is an exchange of services that occurs in the context of economics (in which resources either contribute or impeded goals being met) and limited financial resources (of third-party payors, including government, insurance companies, employers, and so on). There is a risk of a kind of “ethical reductionism” (p. 141) to the extent that businesses “consider economic considerations alone” (p. 141).
For reflection: Do you agree with Tjeltveit that psychotherapy occurs in the social contexts of its medical heritage and business? How do you see these social contexts shaping the field and the practice of psychotherapy for good or for ill?