Ethics and ethical code is important in any sphere of human activity, and psychotherapy is not an exception. Moreover, it won’t be an exaggeration to say that psychotherapy is one of the disciplines where ethics has a dominant role ”“ mostly because of the fragile matters it has to deal with. However, ethics codes are ambiguous and difficult, and any attempt to narrow ethics to a certain code of rules or prohibitions will lead to problems because ethics, first of all, needs to be regarded within a context.
Modern view on ethics requires that a compromise could be found between the abstract and theoretical principles of ethics itself and the finiteness and distinctness of actions in real life. The book by Kenneth Pope and Melba Jean Trinidad Vasquez “Ethics in Psychotherapy and Counseling”ť represents a practical guide to solving ethical dilemmas in psychotherapy. It is a book that answers to the questions “how?”ť rather than analyze “why”ť. The aim of this essay is to discuss 5 chapters from this book and analyze them.
1. Culture, context, and individual differences
Cultural differences, different perception of ethics and finally, different ethical codes can become problem in psychotherapist’s work, especially if he or she is unfamiliar with possible troubles which may arise due to differences in origin with client. The chapter concerning culture, context and individual differences is greatly important, in my opinion. It both gives a lot of examples when culture or upbringing may lead to misunderstanding and mistreatment and make the professional pay attention to aspects that left unnoticed previously.
The questions of confidentiality are central at psychotherapy and at first glance, it is obvious that information about the client and anything said or done during the session or even outside it, should remain solely between the psychotherapist and the client. However, in reality there are plenty of situation where the specialist is either exposed to a temptation of sharing the information or placed before a difficult ethical dilemma (such as presented on page 255).
The most common dangers for a psychotherapist concerning confidentiality breaches are discussing situation with a colleague, gossiping, even in indirect form, keeping notes and other information about the patients or any form of messaging in places available for others etc.
Also, slippery situations occur when group therapy takes place, or when case studies are published. Written consent is also a necessary feature in case some information needs to be disclosed.
In my opinion, this chapter is very useful from the point of view that it shows practical situations where ethical problems might appear and shows both the examples of ethical behaviour and the situations where disclosure of information led to problems of the psychotherapist or even lawsuit against him. The common troubles and situations where confidentiality breach is possible, are discussed. On the other hand, several citations and reasoning are outdated and may not reflect the nuances of acting in current society.
There was one more thing that is, in my opinion, important to criticize: it is the tolerant opinion of the authors to sharing confidential information with loved people. From my point of view, it is also unethical: first of all, there exists a high possibility that these people might interact with the client in future ”“ maybe simply meet in the street, maybe ”“ collaborate on working purposes etc. Secondly, if spouses divorce, for example, the other half might disclose the confidential information, on some personal purposes. Therefore, in my opinion the psychotherapist should not reveal the confidential information to anyone, even to the loved people. If this is very difficult for the specialist, this questions his or her professionalism, in my opinion.
3. Responding to suicidal risk
The chapter about suicidal risk is, in my opinion, rather important for any psychotherapist from a practical point of view because it discusses the issues and questions the underestimation of which may lead to fatal results. Moreover, any practitioner may deal with the suicidal client, and if he or she is not familiar with the peculiarities of the situation and possible troubles, the situation might become worse due to improper actions. The importance of constant attention to client’s state, keeping in contact all the time and not staying indifferent to the changes in patient’s mood and actions is essential for a therapist, and the one which is not ready to help in time clearly breaks the ethics concerning patients with risk of suicide. The necessity of paying special attention to adolescents and analyzing their state and actions was also emphasized.
There are several things which I have found extremely useful in this chapter. Firstly, the 21 clinical factors that may indicate at high suicidal risk or its possibility may help the professional to distinguish suicidal tendencies or situation when risk is very high. Secondly, there are practical recommendations towards the treatment of suicidal clients and the environment where the treatment takes place. The striking example about importance of clear communications (p. 266) is a remarkable warning as well. The advices of experts in this chapter also represent a very useful set of materials. The problem areas of therapists (such as feeling uncomfortable with the subject of suicide, not appreciating enough the client’s problems, forgetting about preventive factors and wrong consulting)Â In general, there are no visible things to criticize in the discussed chapter and plenty of useful practical ideas and advice.
4. Supervisory relationship
The chapter about relationship between supervisors and supervisees contains a lot of interesting issues concerning the rotation of trainees, the questions of transferring patients when the trainee receives license, and competence of the supervisor. The aspects concerning inadmissibility of sexual contacts with trainee and corresponding statistics are also very informative.
However, there are some doubtful places in this chapter, in my opinion. One of them is the attitude to conflicts appearing between supervisor and trainee: “the ways that unaddressed conflicts affect the therapy and supervision are a normal part of training”ť. In my opinion, such conflicts should be discussed at the very beginning, without letting them interfere therapy and the relationship of client and trainee. Pope and Vasquez do state that client’s health should be above all in the triad supervisor-trainee-client, but they do, as I think, contradict this statement in the part concerning conflicts. In my opinion, the ethics of supervising should not let conflicts leave unaddressed; moreover, the supervisor should prevent such situations and create from the very start of training the atmosphere of trust with the trainee.
In general, the chapter about supervising contains a lot of theorizing what a supervisor should avoid and what he or she should reach. But there are not many practical recommendations here in what way and by what methods the supervisor can reach the desired objectives.
Moreover, in my opinion, the chapter lacks mentioning the fact the supervisor needs to have outstanding pedagogical qualities (though in several places one can see somewhat similar ideas).
5. Sexual relationship with clients
“The prohibition of sexual involvement with a patient is one of the oldest ethical mandates in the health care professions”ť (Pope & Vasquez 2007). Despite that, statistics shows that 6.8% of male therapists and 1.6% of female therapists reported they had sexual relationship with client.
The questions about sexual relationships with clients have been discussed long before Hippocrates’ claim. However, despite the code of ethics and the fact that everybody knows about the ban on this, such occasions still have place, and authors have described several common reasons why therapists justify their relations. Also, interesting statistical reviews and analysis concerning the feelings of the patients and the consequences of sexual contacts with clients is presented in the chapter. However, in my opinion, there are no revolutionary statement or practical implication of the given theory and statistics in the book, and this chapter cannot be named revolutionary for those therapists who are used to analyze own actions and feelings.
“A central theme of this book is that inattention or lack of awareness is a ”“ if not the most ”“ frequent cause for therapist’s violation of his or her clinical responsibilities an of the client’s trust”ť (Pope & Vasquez 2007). This statement describes the whole atmosphere of the book ”“ care about the client and practical advice for those who share this attitude to work. In general, the book contains numerous examples and clarifications which may be of great use to practitioners. The value of the book is high because it does not focus on theory but rather pays attention to practice and issues that may remain unnoticed in theory.
However, sometimes there are doubtful ethical places and the citations are sometimes outdated. But all in all, this book represents a wonderful combination of analysis, witty and exact formulations and practical advice and will be useful for any psychotherapist.