Ethics in Psychotherapy and Counseling

Abstract

Ethics is a critical issue in every helping profession, in which the clients—patients—are in trouble and seeking help. This is especially the case in psychotherapy, for which the focus of intervention is targeting the most internal, sometimes hidden and intimate world of an individual. Since its first edition (1991),1 Ethics in Psychotherapy and Counseling: A Practical Guide has served as one of the most comprehensive texts providing practical guidance regarding ethical behavior for therapists and counselors. The book insightfully highlights the ethical values of respect, responsibility, integrity, confidentiality, competence, and concern in detail. It helps clinicians to be thoughtful about ethical principles, potential challenges, and dilemmas as well as about getting appropriate training and supervision that can help them better navigate these challenging waters. The strength of the current edition is that it deeply discusses the competence of a human therapist as well as the critical thinking on how to create strategies for self-care and—in general—how to help without hurting. It puts the codes and complaints into historical and empirical context and guides clinicians in how to respond to ethics, licensing, and malpractice complaints. The issues of beginnings and endings in therapy, absences and accessibility, and the use of informed consent are also explored in detail. One of the most important parts is the guidance on how to respond to suicidal risk and how to recognize the early warning signs when a supervisory consultation is required. Boundary issues and sexual relationships with clients are also very important aspects of ethical behavior discussed in the text. Although it is striking that the majority of disciplinary actions taken against practitioners by licensing boards are due to sexual misconduct, and civil suits against a therapist for incompetence account for only a minority of all claims, I have the impression that the issue of sexual misconduct is overwhelmingly discussed here and that the disproportionately large amount of discussion of the topic rather reflects the authors' research interest. Sexual abuse of clients is just the tip of the iceberg, but the vast majority of the ethical issues related to incompetence and other hurts usually and probably do not reach the threshold of legal claims. Although ethical principles and guidelines are common in all forms of psychotherapy, some fine tuning, distinction, and focus on special features would have been useful; e.g., detailed discussion of individual versus group therapy and of behavioral versus dynamic approaches could have highlighted the important aspects of ethical behavior related to the applied psychotherapy approach per se. Case vignettes or case reports also could have been helpful to illustrate the practical issues of some complex situations, especially since this is a “practical guide.” For those who would like to read extensive case studies that provide illustrative guidance on a wide variety of topics in ethics, I would recommend Gerald Koocher and Patricia Keith-Spiegel's Ethics in Psychology: Professional Standards and Cases.2 The appendices of Ethics of Psychotherapy and Counseling contain useful codes of conduct and ethical principles for psychologists as well as guidelines for ethical counseling in a managed care environment, all prepared by the American Psychological Association and Canadian Psychological Association. Although this book was probably intended to be used globally, and the ethical principles are general in every culture, comparisons of the different cultural environments and the codes and guidelines of ethics created by many respective associations in the field are slightly lacking. The text is easily readable, engaging the attention even for outsiders. I definitely recommended it for every practicing clinician, psychotherapy training program, primary care physician, residency program, and psychology course, and it is even worth reading by patients to increase their awareness of what they can expect if they meet a professional, ethical therapist.