Ethics and Psychotherapy – 7

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In Chapter Eight, which is titled “Ethical Dimensions of the Techniques, Strategies, and Processes of Therapy: Which Means to Therapeutic Ends?” Tjeltveit explores the ethical contours of what actually happens during the “50-minute hour.” These include the therapeutic relationship, specific techniques and methods, diagnosis, ways in which people change, and so on. Tjeltveit says each of these components of therapy have an ethical dimension and should be explored.

 

 

 

 

Do the ends justify the means? If so, you might be an ethical teleologist. Do you prefer to look at the means themselves? If so, you may be an ethical deontologist. Do you focus on therapist/client ethical characteristics, such as prudence? Then you may be a virtue ethicist when it comes to therapy processes. Tjeltveit then looks at five change processes: education, corrective emotional experiences, self-liberation, counterconditioning, and reevaluation. He wants psychotherapists to evaluate each of these five common change processes for their ethical dimensions. He turns his attention to overlapping aspects of the psychotherapy process, including preserving client autonomy, a non-manipulative therapist-client relationship, choice of therapy goals, and recognizing the potential influence on the client by the therapist. He distinguishes inappropriate from appropriate ethical influence, seeing a kind of paternalism as inappropriate, while informing clients of the ethical dimensions of not only therapy but also of their presenting concerns, so that they are making truly informed and autonomous decisions. 

 

 

 

 

 

For reflection: How ought psychotherapists communicate their ethical views to clients? Do both psychotherapists and clients function as ethicists?

3 Comments

  1. I believe it is necessary for the therapist to minimize the influence they have on their clients, especially during the beginning stages of therapy when clients may feel coerced or alienated. It is necessary for the therapist to provide a nonjudgmental environment in which clients can explore ethical issues. Addressing the ethical dimensions of the client’s life, and challenging disparity between belief and behavior is not to impose my own belief system, but to help clients understand how they may be defeating their own.

    In the ideal situation, the client fleshes out their beliefs in regards to their problems, and then takes a moral stand in which they choose what is best and right for themselves and those within their microcosm. If the situation is not perfect, and my client is going to compromise themselves through their choices, then it is my duty to use my practical wisdom to point out alternate routes, or even disclose my own belief.

  2. When I first read that clients also functioned as ethicists and not just the therapist it also struck me as a little odd. However, after the discussion in class today it began to make more sense. Because we do not want clients to become dependent on us as therapists, then in a way it is necessary that clients be able to at least reflect on and have convictions about ethical issues, so they can have a framework to deal with future problems or obstacles. It also seems that by merely coming to therapy, at least for those who elect to seek help, a judgment has been made that something in their life is not working for them and needs to be improved. Throughout the therapy process the client is also making decisions and changing thoughts and behaviors, hopefully because they have reflected on the options and decided that the change will benefit them and improve their quality of life and not just because the therapist pressured them. So according to Tjeltvieit’s (1999) definition of an ethicist, “a person who reflects on, has convictions about, and/or attempts to influence others about ethical questions and issues”, both therapist and client function as ethicists (p 35).

  3. Tjeltveit brings about an interesting point concering the values that are brought into therapy. The previous seven chapters have reminded the reader over and over again that therapy is indeed value-laden. However, in this chapter he mentions that, “It is also not possible, with rare exceptions, for therapists to impose their values on clients. Influence, yes; impose, no” (pg 157). He then speaks of the murky ground between value-freeness and value-imposing.

    This middle ground, according to Tjeltveit, is where the therapist operates. If it is nearly impossible to impose one’s values on a client, then giving the client an awareness of the therapist’s worldview should not be an ethical dilemma. I tend to believe that the client has an ethical right to understand the worldview that I will be operating under. It seems a bit egotistic to behave as though the woldview of the client is the only view under scrutiny in the process.

    I feel that allowing the client to uderstand my worldview brings about a greater freedom and awareness for the client. It shows the client that I will be forthright with them, and gives the client an opportunity to make a truly informed consent regarding therapy.

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