Ethics in Psychotherapy

1
Ethics in Psychotherapy

• Obligatory directives and idealistic virtues

2
Why do we need ethical principles?

• Therapeutic relationships are unbalanced, with
  the therapist typically possessing significantly
  more power in the relationship.
• Therapeutic relationships are complicated, both
  due to the nature of the relationship itself and
  the nature of the clients issues/problems.
• Therapy relationships may be characterized by
  abrupt changes, some of which (e.g., suicidality)
  may have severe implications for the clients
  well-being.
• Therapists are human, and humans are fallible.
  Ethical guidelines provide accountability.

3
What are ethical principles?

• Ethical codes are guidelines for what therapists
  can and cannot do that have been developed by
  each therapeutic disciplines organizational
  body, including the American Counseling
  Association (ACA) and the American Psychological
  Association (APA).
• Ethical codes are not set in stone. They are
  principles upon which to guide practice. Each
  therapeutic situation is unique and sometimes the
  therapist must interpret the code.
• There are two dimensions to ethical decision
  making
• Principle ethics Overt ethical obligations that
  must be addressed.
• Virtue ethics Above and beyond the obligatory
  ethics and are idealistic.

4
Philosophical Guidelines

• Consequentialist Theories
• Act utilitarianism
• Rule-utilitarianism
• Deontological Theories
• Act is right or wrong, and we have duty to do
  what is right
• Obligatory, permissible, and forbidden duties
• Three best examples of where duties come from
• God
• Intuition
• Kantian categorical Imperative gt Universal Law
  

5
Ethical issues affecting clinical practice

• Therapist Competence Therapists need to only
  provide services for which they are qualified
• Client Welfare Client needs come before
  counselor needs and the counselor needs to act in
  the clients best interest.
• Informed Consent Counselors need to inform
  clients as to the nature of counseling and answer
  questions so that the clients can make an
  informed decision.
• Confidentiality Clients must be able to feel
  safe within the therapeutic relationship for
  counseling to be most effective.
• Dual Relationships When a counselor has more
  than one relationship with a client (e.g. The
  counselor is a friend and the counselor.)
• Sexual Relationships Professional organizations
  strongly prohibit sexual relationships with
  clients and in some states it is a criminal
  offense.

6
Competence and malpractice

• Therapists need to
• only provide services for which they are
  qualified, accurate
• accurately represent their credentials and
  qualifications.
• continue their education.
• keep up on current information of the field,
  especially in specialty areas.
• seek counseling when they have personal issues
• Malpractice
• occurs when a counselor fails to provide
  reasonable care that is generally provided by
  other professionals and it results in injury to
  the client.
• Four conditions must exist
• The counselor has a duty to the client.
• The duty of care was not met.
• The client was injured in the process.
• There was a close causal relationship between the
  counselors failure to provide reasonable care
  and the clients injury.

7
Informed consent

• All of the following should be covered in order
  for the client to be able to make an informed
  choice
• The financial costs of counseling
• Any special arrangements
• The competencies of the counselor
• Nature of treatment (experimental Tx should be
  indicated)
• Confidentiality (and its limits)

8
Privileged Communication (confidentiality)

• Legal protection of the client which prevents a
  counselor from disclosing what was said within
  the counseling session(s)
• This right belongs to the client and not the
  counselor
• Laws concerning privileged communication vary
  from state to state

9
When privileged communication doesnt apply

• Tarasoff vs. Board of Regents of the University
  of California A landmark case with the end
  result being that counselors have a duty to
  warn if a client threatens another persons life
  or with significant bodily harm.
• When the client is suicidal
• When a client needs hospitalization.
• When a counselor is performing a court ordered
  evaluation
• When the client sues the counselor
• When the client uses a mental disorder as a legal
  defense
• When an underage child (under 16) is being abused

10
The ethics of dual relationships

• Is the dual relationship necessary?
• Is the dual relationship exploitive?
• Who does the dual relationship benefit?
• Is there a risk that the dual relationship could
  damage the patient?
• Is there a risk that the dual relationship could
  disrupt the therapeutic relationship?
• Am I being objective in my evaluation of this
  matter?
• Have I adequately documented the decision making
  process in the treatment records? (the spirit of
  the law is "If it is not written down, it did not
  happen.)
• Did the client give informed consent regarding
  the risks to engaging in the dual relationship?

11
Legal Issues and Managed Care

• Counselors have the duty to appeal adverse
  decisions regarding their client(s).
• Counselors have a duty to disclose to clients
  regarding the limitations of managed care and the
  limits of confidentiality under managed care.
• Counselors have a duty to continue treatment and
  are not supposed to abandon a client just
  because the client does not have the financial
  means to pay for services.

12
Practice and Ethics

• Practical and ethical issues are inherent in
  counseling.
• Three Phases (DePauw, 1986)
• Precounseling
• Service Provision
• Termination

Sperry, Len, John Carlson, Diane Kjos.
Becoming An Effective Therapist. Allyn Bacon,
2003, pp. 181-199.
13
Pre-counseling Issues

• Accuracy of marketing and public communication
• Dual relationships
• Expertise/competence for given problem/client
• Evaluation of threat/crisis

14
Issues with on-going service

• Confidentiality
• Accurate record keeping
• Continuous personal growth
• Supervision, training, and/or consultation
• Cooperation with other service providers
• Proper action when a client poses a clear and
  imminent danger to themselves or others
• Laws regarding child abuse and neglect
• Referrals

15
Termination issues

• Evaluation
• Does the client have the ability to maintain
  gains made in therapy?
• What resources does the client have to manage
  threats to these gains?
• How has the change impacted family members or
  others?
• Be sensitive to the clients feelings regarding
  termination.
• Initiate termination when the client is not
  benefiting from services.
• Address the client's post-terminations concerns.
• Evaluate the efficacy of the counseling services.
• Consider referral needs

16
Ethical Quandaries What to do?

• Should I rent an apartment to a current client?
• I provided marital counseling to a couple, and
  they have asked me to serve as the mediator in
  their divorce. Should I agree to the request?
• Should I accept a gift from a client?
• Should I buy a car from a dealership owned by a
  client, when it is the only dealership in town?