Ethics and Psychotherapy – 10

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We are in the home stretch with Tjeltveit, and in Chapter 11 (“Profession and Professional Ethics”) he describes how psychotherapists are professionals, by which he means: 

 

 

When psychotherapists assert that they are professionals, they announce, they profess, they make public testimony that they possess specialized knowledge and technical skills that help people with psychological problems. (p. 255) 

 

 

More is expected of psychotherapists. This includes beneficence, because the work of the therapist is characterized by concern and service, as well as client welfare and social responsibility. It is in this chapter that Tjeltveit talks about an ethic for “moral strangers” (p. 262). He recognizes that psychotherapists work with moral strangers. Further, that psychotherapists are part of “ethical communities” that (drawing on Doherty and Cushman here) “encourage clients to consider their progressive political agendas, as do feminist therapists and therapists from particular religious communities” (p. 262). Tjeltveit says it is “appropriate only when client autonomy is preserved, clinical sensitivity employed, and informed consent obtained” (p. 262).  

 

 

 

Tjeltveit also points out a few weaknesses pointed out by others in various professional codes of ethics – as being too cautious or not validated or for failing to articulate their ethical foundations. He believes most psychotherapists draw upon even deeper ethical sources in the process of providing psychotherapy rather than rely on the minimal standards often articulated in codes of ethics.

 

For reflection: Do you agree that psychotherapists are part of ethical communities that have ethical claims that may be relevent to their clinical work? Is this best handled with sensitivity and informed consent? Should codes go “deeper” as an ethical source or is their current depth sufficient?

5 Comments

  1. This makes me think of the expression, “you are who you hang out with”. We are definitely influenced by the ethical communities that we belong. For example, if we immerse ourselves with people of faith, our beliefs are likely to be different than if we spend our time in secular settings. It is of utmost importance that we are aware of our convictions, so that we do not impose them on our clients, but I am not so firm in my belief that we need informed consent for all our differences, unless they are part of the flagship of our treatment modality. If I am planning on practicing Christian Counseling, then it will be important that my clients make an informed choice to participate, but I don’t think it is necessary to tell my clients I am a Christian if I working in a secular setting.

    I would not want the codes to put constraints on therapy, but on the other hand, publishing specific (not personally identifying) data regarding incidents that come before the governing boards, and the decisions made, might be helpful in interpreting specific situations, much like case law where precedents are sought.

  2. This is such a sticky issue. I have a supervisor that recently told me that the Code commands us to do no harm, but he makes it a point to at the same time to, “do some good”. I think at times we are so worried about doing no harm that we step aside from anything that may be seen as value judgments or moralistic in nature. It feels to me like we are so concerned with not pushing any kind of value system on the client that we forget how important it is to let the client know about beneficial changes s/he can make. I don’t believe that as therapists we have the right to tell a parent how to raise a child or tell a couple how to behave in marriage, however, with our scientific practice and results of a good deal of research, we know that certain techniques in parenting and marriage seem to bring about better communication, appropriate boundaries, and greater sense of “health” in these relationships. So, to not do harm, we could let the person stay in their old habits. Afterall, it isn’t my place to tell this person what is best. On the other hand, if we are willing to take the Code a little deeper, we can do some good and teach healthy techniques to our clients. Truly, just not doing harm does nothing to help the client. If we are to make any difference, we should aim to do some good, even if this means that our values must be known to the client.

  3. Boards do publish information on cases, but they tend not to be specific. They usually cite the standard that was violated, and there may be many sections to that standard. Ethics textbooks that draw on actual cases and show the decision-making of both the psychologist in question and the way the board reasoned about the decision can be quite helpful, in my view.

  4. jesshat: I have found it helpful to follow the research on what we know (and do not know) about things like parenting, and to make this available to the parents so that they can make an informed decision about what they choose to do. I’m not sure that letting people stay in “old habits” is the equivalent of “do no harm,” when those habits, while familiar to parents, may not be in the best interest of their children, themselves, or their family in general over time. That’s hard to predict, of course, but they are seeking help precisely because what they are doing is not working. So that gives the psychologist some room for reviewing what they are doing as well as other options that might be considered.

  5. I see what you are saying here, Dr. Yarhouse. I agree with you that when clients come in they are looking for help to change old, ineffective patterns. I just don’t see how we can say that this is done without values. Tjelveit has mentioned in the past that even deciding which treatment to use is a form of using values in therapy. It seems like a lost cause to be completely value-free. And, quite possibly, there is no reason to be value free. I guess it comes back down to being an ethicist and not a moralist.

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