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?