Ethics and Psychotherapy – 10


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?

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?



Ethics and Values in Psychotherapy – 2


In Chapter 3 of his book, Ethics and Values in Psychotherapy, Alan Tjeltveit defines an ethicist, and he makes the distinction between psychotherapist as ethicist and moralist. An ethicist is someone who has knowledge and perhaps training, who shows discernment, careful evaluation, and good judgement, and who is recognized for these qualities within a community. Ethicists hold ethical convictions and influence others either directly or indirectly. According to Tjeltveit, an psychotherapist/ethicist can function in many ways, such as teaching, consulting, coaching, and advocacy, to name a few. While an ethicist creates space for others to reason, draw their own conclusions, and make their own decisions, a moralist is one who attempts to impose his or her beliefs upon others.

For reflection: What influences exist that would lead a Christian psychotherapist toward being an either an ethicist or a moralist?  

Ethics and Values in Psychotherapy – 1


In our Ethics course this spring we are reading Ethics and Values in Psychotherapy by Alan Tjeltveit. We recently discussed the first couple of chapters. Here’s a brief summary.

Tjeltveit’s thesis is that psychotherapy is value-laden; that it is invariably value-laden. In the opening two chapters he lays this out and in chapter one, especially, identifies competing views. Here they are:

  • Psychotherapy is inconsequentially value-laden
  • Psychotherapy involves only mental health values
  • Clients alone should choose therapy values
  • Psychotherapy ought to be based on science, not values
  • It is meaningless to claim that values or ethical assertions in psychotherapy can be true or correct
  • Psychotherapy is not value-free. So what?

He unpacks the meaning of each competing claim and then points out the difficulties inherent in that claim. For instance, the claim that Psychotherapy is inconsequentially value-laden makes the assertion that, yes, the psychotherapist could say to a client, “You should honor your marriage vow and return to your spouse and fulfill your responsibilities to your children” (p. 3). But what do most psychotherapists actually do? They say something like, “Sounds like you’re really feeling sad. How long has this been going on?” (p. 4). Tjeltveit’s response is to say is such a response really neutral? Or are their implicit values in responses we commonly identify as neutral?

His thesis is that psychotherapy is value-laden and that therapy – all therapy – necessarily involves goals that are value-laden. Goals reflect commitments to values and an ethical theory (at least an implicit one), and Tjeltveit reasons that  it can be helpful to reflect on ethical convictions and theories.

For reflection: What do you make of Tjeltveit’s thesis? What are your thougths about the competing views? More Tjeltveit to come!