Ethics and Psychotherapy – 8

In our ongoing discussion of Alan Tjeltveit’s book, Ethics and Values in Psychotherapy, we turn to Chapter 9, which is titled “Ethical Dimensions of the Goals and Outcomes of Therapy: Therapy as Means to Which (Ethics-Laden) Ends?” You have to just pause and appreciate the titles of these chapters…. Okay, Tjeltveit wants to press the issue that psychotherapy has ethical dimensions in its goals and outcomes, and that “normal” people can vary in how they are “normal,” suggesting that good outcomes or positive outcomes in psychotherapy can vary and be normal simultaneously. It is part of the heterogeneity of being “normal” (p. 208). He suggests that ideals can be evaluated based on how they affect the individual, others, and over time. They can be assessed with respect to humanity in general, therapy itself, or for a specific individual at a set point in time. Tjeltveit suggests we discuss (and choose) desired outcomes and then work toward those, selecting goals that will lead to the desired outcomes.

Tjeltveit identifies a number of unsuitable solutions when thinking about outcomes in psychotherapy. They include ignoring the outcomes; denying that any assertions can be meaningful; insisting on one and only one answer to what is best; making no universal assertions; judging an oucome on whenter it works (pragmatism); and improving psychological functioning (please note the qualifier that “improving psychological functioning” may be defined differently for different parties).  

For reflection: How about the quote on page 97: “… if the goals of therapy are based on conflicting ethical sources, and therapy’s effectiveness is evaluated in ways that vary with evaluators’ ethical ideasl, is psychotherapy (or in what sense is therapy) a coherent professional practice?




  1. I don’t look at the vast differences that can occur in goal and outcome planning for therapy, as something incoherent, I see it as opportunity. We are not resigned to using the same treatment in all situations. We are provided with many choices in which to evaluate against. For example, two patients may be struggling with depression, but the goals and outcomes could be very different. The first may have lost their job, so needs to build confidence back up, and explore different avenues for the future, and the second could be a chronic inpatient client who needs to learn how to live outside the hospital setting. Thank goodness we have so many ideals to bring to the therapy room.

    I understand that therapy could result in conflicting ideals, such as Bob looking out for himself at the cost of his children, but I would like to hope that well educated professionals will take the time to explore the outcomes, so that ”the person who has completed a successful course of therapy is a better person” (p. 220).

  2. Let me preface what I am going to say with a definition of the word “coherent”. Webster’s dictionary defines coherent as “logically or aesthetically ordered or integrated, consistent; having clarity or intelligibility”. It does not mean that every single piece of information fit perfectly. It merely has to be of a consistent nature. This leaves some room for differences of opinion. That being the case, I don’t believe that we can necessarily say that psychology is incoherent.

    In fact, psychology is no more incoherent than Christianity. Christianity has several denominations, all of which have their own traditions and teachings, but all of which fall under the belief that Christ is the only way to God. In the same way, psychology has many theories. Self-actualization and an increased ability to cope with life stress would being the end goal, while theory is comparable to denomination within Christianity. Can any be called wrong? Can all be called right? I don’t believe that we can say psychology as a whole has no coherency simply because there are different theories to get a client to the end result of self-actualization.

  3. You both seem to be saying that psychotherapy is sufficiently coherent. That it actually needs the flexibility it has to provide services to a range of clinical presentations (even by people who share the same diagnosis). Also, that it is not less coherent than Christianity, for instance, and that maybe there is a coherent core – a “consistent nature” – that defines its coherence.

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