Ethics Commentary: The Psychotherapeutic Relationship

Abstract

Immanuel Kant once observed, “We are not gentleman volunteers; we are conscripts in the army ofmoral law” (Murdoch 1992, p. 35).We recognize that many individuals act primarily, perhaps exclusively, in self-interest. But Kant’s observation that there is a moral imperative—what he called a “categorical imperative”—is indeed compelling. We cannot ignore the fact that moral demands are placed upon us by virtue of our living in a social order with other human beings. Physicians and health professionals in particular live in a moral order, with obligations incumbent on them by virtue of the needs of those who seek their help. Acknowledging that there are scoundrels among professionals, those motivated solely by self-interest and not in the service of others, we recognize that there are certain demands that health professionals cannot escape. Specific moral obligations are imposed on them by virtue of their relationship with patients or clients. This relationship is shaped by the clinician’s promise and expertise to heal and by the imbalance that naturally exists between a person in need and a person who seeks to provide treatment, answers, and comfort in relation to that need. Whether one understands those obligations as allegiance to conscience, allegiance to God, allegiance to society, or a more direct allegiance to the patient or client, the obligations are present. PROFESSIONALISM IN THE PSYCHOTHERAPEUTIC RELATIONSHIP