Ethics in Psychotherapy and Counseling

I can understand why the first edition (1998) of this book received the many accolades it did.  As the book’s sub title indicates, this is indeed a practical guide to ethical behavior for therapists and counselors.  This means it’s primarily a “How to” book, rather than a “Why” book.  There’s little discussion of meta-ethical themes such as how ethical principles are arrived at, which ethical theory works best in what situation, or why one should bother to be ethical.  The first six chapters offer basic information on how to develop ethical awareness, the relationship between the law and ethics, and the relationship between the personality of the mental health care provider and ethical principles of behavior.  Included in the first chapter is a fascinating list of arguments that have been used to justify unethical conduct such as, It’s not unethical as long as no one can prove you did it, It’s not unethical as long as your client wanted you to do it, and It’s not unethical as long as you don’t know a law, ethical principle, or professional standard that prohibits it.  Chapter six deals with a central issue in all of therapy and counseling:  the problem of how to ask questions that don’t unintentionally manipulate the patient or client into giving the kind of answers the questioner wants to hear.  There is a commendable critical discussion of the issue of “false memory syndrome” as a case in point, both from the perspective of how and why therapists were able to lead patients into developing “memories” of events which never happened, and from the ironic perspective of therapists who are now treating the so-called syndrome that their profession itself created, then diagnosed and labeled, and now claims to be able to treat.

From chapter seven onwards topics include how to begin and end a therapeutic relationship, the meaning and importance of informed consent, the pitfalls inherent in testing and diagnosing, the problem of sexual relations with clients, the question of the appropriateness of non-sexual social relationships with clients, the effects of cultural differences on the therapeutic relationship, the limits of confidentiality, the therapist’s responsibilities when it comes to a suicidal patient, and the supervisory relationship between instructor and student therapist.  Each of these chapters ends with a section titled  “Scenarios for Discussion” in which several fictitious problems and brief case studies are presented, followed by a number of pointed questions to be considered by the individual reader or discussed by the class of students.

At the end of the book are four appendices with useful information and a detailed example of a code of ethics for psychologists, a statement of patients’ mental health rights, ethical guidelines for professional care in a managed care environment, and a sample informed consent form.

I found one area of discussion especially interesting in light of the fears about litigation I’ve heard expressed by counselors on many occasions.  The authors point out that, contrary to popular belief, therapists and counselors are not sued primarily by hostile clients out for irrational revenge.  By far the overwhelming reason they’re dragged into court (20% of total claims) is because of sexual impropriety or improper personal relationships with their clients/patients.  At the same time 35 per cent of disciplinary actions taken against practitioners by licensing boards were also due to sexual misconduct.  Civil suits against a therapist/counselors for incompetence account for only 14 percent of all claims.  Claims of incompetence include inadequately trained therapists/counselors working with specific populations such as rape victims or incest perpetrators, and attempting to use specific techniques such as hypnotism.  Practitioners who believed that so-called malpractice suits are always perpetrated against innocent therapists by malicious clients just wanting to make a quick buck will be relieved to know that litigation is in fact most often precipitated by therapists’ unprofessional conduct.

I must admit that I found it disturbing to note how often the issue of sexual misconduct comes up in this book.  There are two whole chapters  (and a sizable list of index entries) that deal specifically with sexual misconduct and unprofessional relationships with clients/patients.  Also appearing in a number of assessment questionnaires in various other locations in the book are questions dealing with issues such as the therapist/counselor having sexual feelings for the client/patient, the therapist having sexual dreams about the patient, improper sexual holding and touching between therapist and patient, and so on.  Perhaps I’m naïve, but I had no idea, prior to reading this book, that sexual misconduct is such pervasive ethical issue in the fields of therapy and counseling. 

While I suggest that this book be on every therapist’s shelf, I have to admit I found myself becoming uncomfortable with the dates on some of the data to which the authors have referred.  For example they write,  “. . . married teenagers show an extremely high suicide rate”  and cite a source dated 1975  (p. 247).  In the next sentence they admit that data is generally not static and that new research  “is refining our understanding as well as reflecting apparent changes.”  But their attention then turns to the comparison of suicide rates for women and men.  This means that the comment made about the 1975 statistics on married teenager suicides stays in the reader’s mind as relevant and current.  But surely there is more up to date data available on suicides among married teens than this!

Again, this book lives up to its subtitle:  “A Practical Guide.”  In my opinion this is the sort of information that ought to be carefully studied by every practitioner and student of therapy or counseling.  But it’s also an easy to read resource for mental health services consumers.  Students and practitioners will gain a very thorough understanding from it of how to behave in a professional manner, while mental health services consumers will learn what they may legitimately expect and demand from their therapists and counselors.

© 2002 Peter B. Raabe

Peter B. Raabe teaches philosophy and has a private practice in philosophical counseling in North Vancouver, Canada. He is the author of the books Philosophical Counseling: Theory and Practice (Praeger, 2001) and Issues in Philosophical Counseling (Praeger, 2002).