The Oxford Handbook of Psychotherapy Ethics 1st edition by Manuel Trachsel, Nikola Biller Andorno, Jens Gaab, John Sadler, Serife Tekin 0192549499 9780192549495

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ISBN-10 :  0192549499 

ISBN-13 : 9780192549495

Author : Manuel Trachsel, Nikola Biller-Andorno, Jens Gaab, John Sadler, Serife Tekin 

Psychotherapy is an indispensable approach in the treatment of mental disorders and, for some mental disorders, it is the most effective treatment. Yet, psychotherapy is abound with ethical issues. In psychotherapy ethics, numerous fundamental ethical issues converge, including self-determination/autonomy, decision-making capacity and freedom of choice, coercion and constraint, medical paternalism, the fine line between healthiness and illness, insight into illness and need of therapy, dignity, under- and overtreatment, and much more. The Oxford Handbook of Psychotherapy Ethics explores a whole range of ethical issues in the heterogenous field of psychotherapy thereby closing a widespread perceived gap between ethical sensitivity, technical language, and knowledge among psychotherapists. The book is intended not only for a clinical audience, but also for a philosophical/ethical audience – linking the two disciplines by fostering a productive dialogue between them, thereby enriching both the psychotherapeutic encounter and the ethical analysis and sensitivity in and outside the clinic. An essential book for psychotherapists in clinical practice, it will also be valuable for those professionals providing mental health services beyond psychology and medicine, including counsellors, social workers, nurses, and ministers.

The Oxford Handbook of Psychotherapy Ethics 1st Table of contents:

Section I: Background and Historical Context
1. Why Ethics Matter in Psychotherapy
Psychotherapy and Visions of the Good: Beyond Effectiveness
Ethical Challenges in Psychotherapy
Goals of the Oxford Handbook of Psychotherapy Ethics
Organizational Features of the Oxford Handbook of Psychotherapy Ethics
Summary Reflections on the Sections of the Oxford Handbook of Psychotherapy Ethics
Conclusion: The Future of Psychotherapy Ethics
2. A Brief Moral History of Psychotherapy
Introduction
The Moral Dimensions of Psychotherapy
Moral Concomitants of Changing Sociocultural Contexts
Moral Challenges to Certain Forms and Understandings of Morality
The Historical Origins of Moral Ideals/Practices
Psychotherapies’ Moral Dimensions: Some Historical Trajectories
Professions and Professional Ethics/Moral Principles and Qualities
The Problems Psychotherapy Addresses
Goals/Outcomes
Psychotherapeutic Techniques and Relationships
Self and Society
Conclusion
3. What Do Psychotherapists Need to Know about Ethics? Lessons from the History of Professional Ethics
Introduction
Early History of Professional Ethics (Eighteenth Century bce to Seventeenth Century ce)
The History of Professional Ethics during the Transitional Eighteenth and Nineteenth Centuries ce
A Brief History of Modern Professional Ethics (Twentieth and Twenty-First Centuries ce)
Conclusion
4. The History and Ethics of the Therapeutic Relationship
Introduction
Relationship as Method
Relationship as Skill
Relationship as Foundation
Discussion
Section II: Concepts and Theories for Psychotherapy Ethics
5. Autonomy as a Goal of Psychotherapy
Introduction
Autonomy
Respecting Autonomy
Promoting Autonomy
Autonomy as a Goal of Psychotherapy
Conclusion
6. Patient Protection and Paternalism in Psychotherapy
Introduction
Patient Protection, Psychotherapy, and Involuntary Hospitalization
Paternalism, Autonomy, Beneficence, and Nonmaleficence
“Soft” vs. “Hard” Paternalism and the Challenge of Assessing Competency
Paternalism, Involuntary Hospitalization, and Mental Illness
Conclusion
7. Empathy, Honesty, and Integrity in the Therapist: A Person-Centered Perspective
Introduction
Empathy
Honesty: A Partial Synonym for Congruence
Integrity: A Closer Synonym for Congruence
Practical Implications
Conclusion
8. Fairness, Justice, and Economical Thinking in Psychotherapy
Introduction
Theories of Justice
Outcomes
Cost-Effectiveness
The Global Context
Summary and Conclusions
9. Ethics of Care Approaches in Psychotherapy
Introduction
Caring and Care Ethics: A Brief History
Caring in Psychotherapeutic Approaches and their Antecedents
Implications of Ethics of Care Approaches for Psychotherapy Ethics
Society and Politics
Personhood
Autonomy
Boundaries
Conclusion
10. Legitimate and Illegitimate Imposition of Therapists’ Values on Patients
Introduction
What Do We Mean by Values?
The Imposition of Values on Patients: Why Inevitable?
Values Appropriate and Inappropriate
Summary/Conclusions
11. Virtue Ethics in Psychotherapy
Introduction
Virtues and the Psychotherapist
Moral and Intellectual Virtues
Courage
Benevolence
Temperance
Phronesis
Sophia
Conclusion
12. How Do People Make Moral Medical Decisions?
Introduction
Informed Consent and Bioethical Principlism
Contemporary Approaches to Moral Medical Decision Making
Moral Decision Making in Psychotherapy Practice
Conclusion
13. Existential Philosophy and Psychotherapy Ethics
Introduction
Key Concepts of Existential Philosophy Relevant to Psychotherapy Ethics
Existential Philosophy and Phenomenology
Existential Philosophy and Authenticity
The Paradox of Human Existence
Isolation
Freedom and Responsibility
Conclusion
14. Phenomenological-Hermeneutic Resources for an Ethics of Psychotherapeutic Care
Introduction
The Dialogical Principle
Attunement
Recognition
Intimacy
Conclusions
15. Free Will, Responsibility, and Blame in Psychotherapy
Why Should We Consider Free Will in Psychotherapy?
Concepts of Free Will
Free Will and Mental Disorder
The Importance of Free Will for Responsibility and Blame in Psychotherapy
Conclusion
16. Dignity in Psychotherapy
Introduction
Respect for Human Dignity
Human Dignity in Medical Ethics and Law
The Importance of Dignity in Psychotherapy
Conclusion
Section: III Common Ethical Challenges in Psychotherapy
17. The Ethics of Informed Consent for Psychotherapy
Introduction
History of Informed Consent in Medicine and the Path to Informed Consent in Mental Health Care
Ethical Principles and Essential Components of an Adequate Informed Consent
The Process of Informed Consent in Psychotherapy
Therapeutic Benefits of Informed Consent
Psychotherapists’ Challenges in Implementing Adequate Informed Consent
Conclusion
18. Ethics of the Psychotherapeutic Alliance, Shared Decision Making and Consensus on Therapy Goals
Background and Introduction
Ethical Framework: Issues
Reflecting the Practice of Ethics in Psychotherapy: Particular Ethical Challenges
The impact of problems with confidentiality on the therapeutic alliance: treating a mother and a daughter within one therapeutic team?
A therapeutic team’s difficulties in managing a patient with capacity, but who has difficulty acting according to his own wishes
Illustration of Ethical Difficulties and Support from Clinical Ethics
Lessons Learned from the Examples
When an external clinician/therapist requests ethics support for a patient discharged from hospital
19. Evidence, Science, and Ethics in Talk-Based Healing Practices
Introduction
Non-Clinical Counseling: Premises, Practices, Ethics, and Evidence/Accountability
Mainstream Psychotherapy Practices
Evidence, Values, and Ethics in Caring for Mental Distress
Philosophy of Psychiatry as a Core Discipline of Clinical Interpretation
20. Patient Information on Evidence and Clinical Effectiveness of Psychotherapy
Introduction
Evidence and Ethics
Commitment to Evidence-Based Practice in Psychotherapy
Critical Responses to EBP
Challenges and Complexities of Psychotherapy Research
Ethical Debate about Disclosure of Evidence to Patients
Conclusions
Appendices
21. Ethical Dimensions of Psychotherapy Side Effects
Helping and Harming in Medicine
Definition of Psychotherapy Side Effects
What is Negative or Unwanted?
Where to Look for Unwanted Events?
What is Treatment Related?
Identification and Management of Side Effects
Patient Information, Informed Consent, and Patient Cooperation
Treatment Quality, Standards, and Progress in the Field of Psychotherapy
22. Privacy and Confidentiality in Psychotherapy: Conceptual Background and Ethical Considerations in the Light of Clinical Challenges
Introduction
What are Privacy and Confidentiality?
On the Relevance of Privacy and Confidentiality in Psychotherapy
How Can We Deal with Ethical Conflicts about Privacy and Confidentiality in Clinical Practice?
Summary and Final Remarks
23. Dual and Multiple Relationships in Psychotherapy
Introduction: What Is Meant by Dual and Multiple Relationships?
Why Are These Problematic?
Types of Dual/Multiple Relationships
Time Frame
Considerations
Boundary Violations vs. Boundary Crossings
Relationships and the Supervisory Relationship
Other Issues
Conclusion
24. Ethics Considerations in Selecting Psychotherapy Modalities and Formats
Introduction
A Mental Health Treatment Arc
Pragmatic Limitations and Constraints on Psychotherapy Modality and Format Choice
Ethics and Values in Psychotherapy Modality/Format Selection
Clinical Hermeneutics and the Ethics of Psychotherapy Modality/Format Choice
Conclusions
25. Psychotherapist Self-Disclosure
Introduction
Boundaries in Psychotherapy
Managing Boundaries in the Psychotherapy Relationship
Ethical Decision-Making
The Slippery Slope
Self-Disclosure
Summary and Recommendations
26. The Ethics of Placebo and Nocebo in Psychotherapy
So Great an Interest Merits Sacrifices
Neglected Ancestors and Extinct Birds
Unwanted Proximity
The Need for Ethics to Make a Difference
The Possibility and Necessity to Go Open
Nocebo and Psychotherapy
Conclusion
27. The Business of Psychotherapy in Private Practice
Diving In
Fuel for the Private Practice
To FB or Not to FB, that is the Question
From Code to Practice
Minding the “PIT” of Social Media Marketing
Oh No!
How Much Do You Charge?
Navigating the Gray while Staying in the Black
Summing Up
28. Mental Health Care Funding Systems and their Impact on Access to Psychotherapy
Introduction
Principles of Distributive Justice
Psychotherapy Access in Practice
Health Care Financing
Psychotherapy Coverage Criteria
Reimbursement Models
Conclusion
29. Psychotherapeutic Futility
The Origins of Futility in Classical Greek Thought
Plato and Hippocrates
The Rise of the Modern Concept of Futility
Futility in Medicine
Words Matter
The Analogy of Futility in Psychotherapy
Futility in Psychiatry: The Paradigm Case of Anorexia Nervosa
A Challenge to Futility Judgments in Anorexia Nervosa
The Ethical Justification of Futility in Anorexia Nervosa
Pseudo-Futility in Psychotherapy
Social Justice and Psychotherapeutic Futility
Future Directions in Psychotherapeutic Futility
30. The Moral Significance of Recovery
“First, Do No Harm”
The Loss of a Fundamental Sense of One’s Own Selfhood in Psychosis: “I Felt Like a Nobody Nowhere”
Implications of a First-Person Perspective on the Loss of a Sense of Self for Psychotherapy with Persons with Psychosis: “A Person is a Person through Other People”
“The Whole Story of my Health was a Very Difficult Experience Because I Had to Really Reconstruct Myself as a Person”
Conclusion: “To Awaken the Silenced Self”
31. Social Media Ethics for the Professional Psychotherapist
Introduction
Overview of the Social Media Landscape
A Therapist’s Personal Use of Social Media
The Therapist’s Interactions with Patients’ Social Media
The Use of Social Media in Therapeutic Settings
32. Relationship between Religion, Spirituality, and Psychotherapy: An Ethical Perspective
Dr. J: A Case Example of Challenges with Religion, Spirituality, and Psychotherapy
Definitions and History of Religion, Spirituality, and Psychotherapy Relationship
Contemporary Relationship between Religion, Spirituality, and Psychotherapy
Five Guiding Ethical Principles
Three Prominent Ethical Challenges
Focusing on Best Practices
Conclusions and Future Directions
33. Ethics and Expert Authority in the Patient–Psychotherapist Relationship
Introduction
Perspectives from the Consumer/Survivor/Ex-patient Movement
Preemptive Parentalism and Conflicting Claims to Epistemic Authority
Patient Expertise and the Therapeutic Relationship
Implications for Provider–Patient Relationship in Mental Health Contexts
Applying the Modified Split-Domain Account in the Clinic
Conclusions
Section IV: Ethical Issues with Specific Psychotherapy Approaches
34. Ethical Issues in Cognitive-Behavioral Therapy
Introduction to Cognitive Behavioral Therapy
Part A: Ethical Issues in the Evaluation of Cognitions
Part B: Ethical Issues in Exposure-Based Treatments
Conclusion
35. Ethical Processes in Psychoanalysis and Psychodynamic Psychotherapy
Introduction
Ethical Constructs in Psychoanalysis
Ethical Dimensions of Psychoanalytic Process
Ethical Obligations in Psychoanalytic Technique
Conclusion
36. Ethical Issues in Systemic Psychotherapy
Introduction
Types of Therapy Are Types of Culture
Ethics of Therapeutic Practice
Basic Foundations and Ethical Demands in the Systemic Approach
Find and Understand: Symptoms Carry a Meaning
Ethical Discourse
37. Ethical Issues in Existential-Humanistic Psychotherapy
Introduction
An E-H Theory of Human Change Processes
The Principles of E-H Therapy and Related Ethical Challenges
Ethical Challenges of Cultivating Therapeutic Presence
Ethical Challenges of Intimate Therapeutic Relationships
Attending to Therapists’ Contexts: Ethical Boundaries in Supervision
Exploring Existential Issues and Related Ethical Challenges
Conclusion
38. Ethical Considerations in Emotion-Focused Therapy
Introduction
General Practice Principles of Emotion-Focused Therapy as Instances of Broader Professional Ethical Principles
Key Ethical Dilemmas in Emotion-Focused Therapy
Conclusions
39. Ethical Considerations on Mindfulness-Based Psychotherapeutic Interventions
Introduction
Western Medicine Meets Buddhist Modernism
Modern and Traditional Definitions of Mindfulness
MBIs and Buddhism_ Merging and Diverging
Considering Vicious Appropriation
MBIs, Attribution, and Informed Consent
Teaching MBIs or Referring Clients to MBIs
Conclusion
40. Psychotherapy Integration as an Ethical Practice
Introduction
What is Psychotherapy Integration?
Four Forms of Psychotherapy Integration in More Detail
Ethical Issues Encountered with Psychotherapy Integration
Framing Questions for Research into Integrative-Psychotherapy Ethics
Clinical Responses to Ethical Issues Raised in Integrative Therapy
Section V: Ethical Challenges of Specific Settings and Populations
41. Identifying and Resolving Ethical Dilemmas in Group Psychotherapy
Introduction
Challenges Created by Intimacies among Strangers
Impediments to Sound Ethical Decision-Making in Group Psychotherapy
Laying the Foundation for Ethical Practice of Group Psychotherapy
Conclusions
42. Ethics in Couple and Family Psychotherapy
Introduction
Ethical Codes and Principles as Bases of Ethical Behavior in Couple and Family Therapies
Central Ethical Questions for Couple and Family Counselors
Models of Help
A Shift from Principles and Codes to Relational Ethics
Relational Ethics in Practice
Conclusion
43. Psychotherapy with Children and Adolescents
Fundamental Conceptual Issues
Legal Age and Developmental Age
Main Ethical Challenges
Contextual Considerations
Competence
Confidentiality
Physical and Social Boundaries
Technique Based Ethical Issues
Conclusion
44. Psychotherapy in Old Age: Ethical Issues
Introduction
Contexts and Cohorts
Moving beyond Standard Ethical Theories and Approaches
Case Vignette 1: Mrs. Margaret Smith
Case Vignette 2: A Psychotherapy Group for People Who Have Recently Been Diagnosed with Dementia
Case Vignette 3: The Shah Family
Conclusion
45. Ethical Considerations of Court-Ordered Outpatient Therapy
Introduction: Overview of Court-Ordered Outpatient Psychotherapy
The Efficacy of COT in Offenders
Ethical Principles Involved in COT
Conclusion
46. Ethical Issues in the Psychotherapy of High Risk Offenders
Note to the Reader
Introduction: Moral Enhancement and Behaving Better
Psychotherapy for Offenders: Early Thinking
Changing Violent Minds: Models of Intervention
The Ethics of Violence Reduction
Autonomy
Welfare and Outcomes
Justice
Breaching Duties of Confidentiality to Decrease Risk
Victims’ Rights and Justice
Conclusion: Relational Autonomy and Changing for the Better
47. Beyond the Office Walls: Ethical Challenges of Home Treatment, and Other Out-of-Office Therapies
Introduction
Home Visits, Home-Based Therapy, or In-Home Therapy
Reasons for Conducting In-Home Therapy
Clinical Interventions Not Possible in the Office
Outdoor or Adventure Therapy
Ethical Issues: Confidentiality, Time, Location, Unpredictability, and Safety Considerations
Ethics, Standard of Care, and Risk Management Considerations
Conclusion
48. Common Ethical Issues Associated with Psychotherapy in Rural Areas
Scope of this Chapter
Overarching Rural Mental Health Resource Concerns in the United States
Overview of Ethical Issues in Rural Areas
Common Ethical Issues in Rural Areas
Overarching Recommendations
Conclusion
49. Ethical Aspects of Online Psychotherapy
Introduction
Ethical Aspects of Online Psychotherapy
Conclusion
50. The Ethics of Artificial Intelligence in Psychotherapy
Background
Artificial Intelligence and Chatbot Apps for Mental Health
Artificial Intelligence Apps as Supplements to Psychotherapy Delivered by Persons or as Supervised Primary Treatments?
Ethical Principles to Reflect on Artificial Intelligence in Psychotherapy
The Need for More Ethical Perspectives
Conclusion
51. Ethical Issues in Psychotherapy of Other Therapists: Description, Considerations, and Ways of Coping
Introduction
Ethical Dilemmas
The Importance of Professional Organizations and Regulatory Bodies
Conclusion
52. Ethics of Psychotherapeutic Interventions in Palliative Care
Introduction
Psychotherapeutic Interventions in Palliative Care
Indication for Psychotherapeutic Interventions in Palliative Care
Ethical Implications in Psychotherapy
Specific Ethical Challenges in Palliative Care Psychotherapy
Conclusions
53. Ethical Psychotherapeutic Management of Patients with Medically Unexplained Symptoms: The Risk of Misdiagnosis and Harm
Introduction
Diagnostic Uncertainty versus Diagnosis of Psychological Causes
First Do No Harm_ Medical Risk and Medically Unexplained Symptoms
Do No Harm_ Psychological Risk and Medically Unexplained Symptoms
Informed Consent, Care Access and Social Concerns
Conclusions: Ethical Psychotherapeutic Management of Medically Unexplained Symptoms
54. Psychotherapy in a Multicultural Society
Introduction
The Stages of Migration
Transcultural Self-Concepts in the Globalized World
Generation Conflicts and Identity
Understanding Illness and Coping with It
Magical Ideas and Health
Psychotherapy and Ethical Aspects
Psychotherapeutic Treatment in the Transcultural Context
Casuistry
Summary
Initial examination
Comorbidity
Psychotherapeutic treatment
Drug treatment
Psychoeducation
Involving the family members
Sport involving movement and physiotherapeutic measures
Relaxation techniques
55. Conducting Psychotherapy through a Foreign Language Interpreter: Ethical Dilemmas
Introduction
Interpretation versus Translation
Legal Requirements for Employing Interpreters
Ethical Codes and Accompanying Principles
Is Interpreter-Mediated Psychotherapy Effective?
How do Psychotherapists Determine if an Interpreter is Competent?
The Tensions between Beneficence, Non-Maleficence and Competence
Training and Education for Psychotherapists
Defining the Interpreter’s Role
Dual Relationships and Confidentiality
Secondary Traumatization
Interpreters in the Context of Beauchamp and Childress’s Four Principles
Quality Interpretation, Organizational Factors, and Public Policy
Conclusion
56. “Even Therapists Need Therapists”: Ethical Issues in Working with LGBTQ+ Clients
Introduction
Competence
Nonmaleficence
Non-discrimination
Confidentiality
Navigating Multiple Relationships
Using and Conducting Research
Financial Matters
Advertising
Assessment and Diagnosis
Supervision
Conclusion
57. Intersectionality and Psychotherapy with an Eye to Clinical and Professional Ethics
Introduction
Having an Eye to the “Multiple Sites” of Experience
The Concept of Intersectionality
Refusal of a “Single-Axis” Analysis
Two Analogies to Explain Intersectionality
Intersectionality Is Opposed to Hierarchical Practices and Binary Logics
The Psychological Dimensions of Intersectionality
Intersectionality and the Matrix of Domination
Intersectionality: A Methodology and Practice
Conclusion
58. Ethics of Animal-Assisted Psychotherapy
Introduction
Animal-Assisted Psychotherapy
Institutionalization and Ethics
Conclusion
59. The Ethics of Mindfulness-Based Interventions: A Population-Level Perspective
Introduction
The Ethics of Mindfulness-Based Interventions
A Normative Framework
Thinness Worries
Thickness Worries and Mindfulness-Based Interventions in Schools
Conclusions
Section VI: Ethics of Psychotherapy Education, Training, Quality Assurance, and Research
60. Virtue Ethics and the Multicultural Clinic
Introduction
Defining “Psychotherapy”
Cases
Virtues
Conclusion
61. Toward an Evidence-based Standard of Professional Competence
Introduction
The Empirical Status of the Current Competence Criterion
Adding Effectiveness to the Criteria for Competence
The Trouble with Thresholds
Operationalizing a Dynamic, Evidence-Based Competence Standard
Improving the Outcome of Psychotherapy One Clinician at a Time
Implementing an Evidence-Based Standard of Professional Competence
Summary Conclusions
62. Ethical Importance of Psychotherapists’ Self-Care and When It Fails
Introduction
Self-Care
Research on Self-Care
Self-Care as an Ethical Imperative
The Complexities of Psychotherapy Practice and Self-Care
When Self-Care is Strained or Fails
Motivations for Self-Care
Self-Care as Personal Self-Care: A Form of Self-Compassion
Self-Care as a Professional Responsibility: A Form of Risk Management
Self-Care as a Shared Responsibility: Community Self-Care
Conclusion
63. The Metaethics of Psychotherapy Codes of Ethics and Conduct
Introduction
The Roles of Professional Organizations
The Regulation of Psychotherapy in the UK
Ethics, Law, and Professional Influences on Action
Codes of Ethics or Conduct?
Guidance and Disclosure of Confidential Information
Conclusion
64. Professional Conduct and Handling Misconduct in Psychotherapy: Ethical Practice between Boundaries, Relationships, and Reality
Introduction
Definition of Professional Conduct in Psychotherapy
Ethical Reasoning
Forms of Misconduct
Consequences
The Abusive Psychotherapist: Slipping, Stumbling or Walking across Boundaries?
Teaching Professional Conduct
Ethics in Psychotherapy Training
What Can Be Done When One Is Confronted with Misconduct?
Conclusions
65. Dealing with Moral Dilemmas in Psychotherapy: The Relevance of Moral Case Deliberation
Introduction
What is a Moral Dilemma?
Moral Case Deliberation and the Dilemma Method
A Clinical Case Example
Experienced Effects of Moral Case Deliberation
Comparing Moral Case Deliberation to Other Forms of Ethics Support
Conclusion
66. Psychotherapy Ethics in Film
Introduction
Psychotherapy Ethics in Film
A Virtue out of Necessity: Film in Teaching Psychotherapy Ethics
67. Psychotherapy Ethics in Twentieth-Century Literature
Introduction
Confidentiality
Sexual and Nonsexual Boundary Crossings and Violations
Professionalism and Informed Consent
Anti-Freudianism and Anti-Psychiatry
Conclusion
68. Ethical Issues in Psychotherapy Research
Introduction
Designing Ethical Psychotherapy Research
Informed Consent: More than a Signature
Quantitative and Qualitative Research Designs: Ethical Questions and Processes
Documentation and Dissemination: Ethical Safeguards
Psychotherapy Research Ethics in Different Context
Ethical Decision Making: Committees and Regulatory Frameworks

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