ETHICAL AND LEGAL ISSUES IN PSYCHOTHERAPY
THE IRISH PERSPECTIVE
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ETHICAL AND LEGAL ISSUES IN PSYCHOTHERAPY
THE IRISH PERSPECTIVE
The line between ethical and unethical behaviour in psychology is so thin that it is often hard to reach one single treatment decision at times amongst the different professionals within the field. This distinction is in no way insignificant, for it dictates which treatments and approaches come under humanistic gauges, and which don’t. Psychology has been used through the ages as a treatment as well as a weapon, and its effects are very strong. Therefore, a true psychologist can only perform wisely when he or she knows this boundary of ethical and unethical behaviour.
‘Ethics’ is defined on the Internet Encyclopaedia of Philosophy as follows:
“The field of ethics or moral philosophy involves systematizing, defending, and recommending concepts of right and wrong behavior” (Internet Encyclopedia of Philosophy, IEP, 2010)
Where psychology is concerned, ethics considers many areas of the human psyche. These include egoism and altruism, emotion and reason, and morality issues of both sexes respectively. Much research is available relating to ethics and its impact on psychological behavior. However, the main concern of this paper is to identify the ethical and legal issues pertaining to psychotherapy. Each field of human interest has its own codes and ethics, and it defines a cultural and social boundary for an individual to operate in. In the same manner, the ethical issues in psychotherapy are very diverse, and differ from case to case. Identifying these ethical issues in psychotherapy is important so that the clinician can observe them and prevent committing a serious medical, ethical or legal offence (IEP, 2010).
Where ethics are concerned, there are certain relevant pitfalls that affect different decisions in psychiatric practice. There is a fine line between deciding if some decision is ethical or not. For instance, the decision to give medication to a person undergoing psychotherapy is important for many reasons, the first and foremost of which is to identify the ethical principle involved here. What are the motivations of the person, without considering the outcomes of certain behaviour? Through predictive outcomes, which actions can be considered as right or wrong? What is the personality of the person making a certain decision and, therefore, the virtue on which his ethics are based? Although these may sound like any psychological assessment, it is important to understand the by knowing the personality of the person and his motives, one can make informed decisions about the different treatment plans (Transactional Analysis and Ethics, Introductory Notes on the Principles of Ethics, 2010).
Another important feature in psychotherapy involves the legal aspects of counselling and decision making. Legal issues pertain to many ethical concerns during psychotherapy; therefore, most of the time, these may become intertwined. It is true that unethical procedures or methods are also concerned illegal most of the time. But while these two areas are interconnected, it is important to give them an independent assessment in order to understand the contributions of both areas in the proper management of the patient (Gabbard, Beck and Holmes, 2007, pp 487). The decision to not undertake any treatment falls in this grey area, where the patient may not be lucid to decide what is better for himself, while, on the other hand, the psychiatrist has not taken any steps to prevent a serious mishap.
Both legal and ethical issues follow the Mental Health Act, 2001, which emphasizes the protection of the patient as well as therapist on all levels of psychiatric evaluation, treatment and care (Mental Health Act, 2001, pp 7 and 8). In all of these cases, it is the therapist’s duty to identify those cases who suffer from severe mental disorder, and identify those cases who cannot make correct decisions about their treatment plan (Mental Health Act, 2001, pp 9).
REVIEW OF LITERATURE
Almost all areas of psychotherapy practice involve some part of ethical decision making. Whether it is making the right decision in a multicultural setting, considering ethics during the assessment sessions, trying to create evidence based practice system, or managing issues of dual and multiple relationships, all require a consideration of the various ethical issues pertaining to it (Ponterotto, Suzuki, Casas, Charlene M Alexander, 2009, pp 128).
Based on the type of issue being considered, ethics in psychiatric practice are considered to have two main categories. The mandatory ethics include issues which are least concerned with professional issue, whereas the aspirational ethics aims to provide the patients with treatment options that are best for them (Brems, 2001, pp 40). In all types of decisions, the main concern is to practice ‘positive practice’, and in this way carry out their professional duties (Brems, 2001, pp 40 and 41).
Psychotherapy in many ways is treated differently when ethical issues are involved. There are many research-based changes that have taken place to integrate such an approach in this field. The gradual integration of psychotherapy in the field of psychology was perhaps one of the most significant milestones in the field, since prior to it the field was viewed somewhat sceptically.
As well as this, the identification of the need to create good therapeutic relationships within psychotherapy became a very important milestone in the development of psychotherapy practice (Leahy and Dowd, 2002, pp 8). Finally, the shift from practice based psychotherapy to evidence based psychotherapy led to innovations in the ethical dimensions of the field as well (Leahy and Dowd, 2002, pp 9).
A significant contributor to ethical and legal aspects of psychotherapy was the addition of the 2005 Health and Social Care Professionals Act. It not only created a safety net for
psychotherapists, but also created outlines for proper legal and ethical psychotherapy practice. This act helped the psychotherapists to identify their range of working and to identify to what limit they are responsible for the welfare of their patients (Health and Social Care Professionals Act, 2005, pp 17).
As in all medical fields, patient confidentiality is of utmost importance and forms the basis of patient and medical practice ethics. Similarly, in the field of psychotherapy, it is important that counsellors and practitioners ensure their patient is completely aware of the confidentiality issues. These laws are very important and therefore, should the patient not understand these rules due to his or her illness, a witness and family member can take responsibility. However, it is an important concern for the psychotherapist himself who should ensure that he has completed all the pre-requisites of ethical and legal requirements in psychotherapy (Gabbard, Beck and Holmes, 2007, pp 487).
This development has admittedly been a slow one in the field of psychotherapy. Legally, there was confusion as to how to apply ethical issues and consent in psychotherapy cases. This issue has been resolved now (Applebaum, 1997). The second issue that has helped in the advancement of this area of psychotherapy is the gradual shift to short therapy sessions. The therapists now inform the patients about the ethical considerations beforehand, in order to avoid confusion later on (Applebaum, 1997).
The implications are very serious, and not only for the patient. Psychotherapists sometimes have to face serious allegations from their patients. Among the most filed include claims of sexual violence, incompetence in treating the patient, loss from evaluation, any form of breech in confidentiality, and improper diagnosis etc. Male psychotherapists are more likely to face such charges than female psychotherapists, so are more vulnerable arguably.
As a result of many efforts, there are now four areas which govern the ethical and legal boundaries in psychotherapy practice. The first is the ethical codes of the Irish Alcohol and Addiction Counsellors, under which are included psychological issues related to addiction, such as substance abuse, addictive behaviours such as food, sex, internet etc. Under the Irish Code of Ethics for Alcohol and Addiction Counsellors, the therapists are expected to follow full protocols in maintaining confidentiality of the patient’s condition (IAAAC Code of Ethics, pp1, nd).
The IACP code calls for observation of four basic ethical and legal principles in psychotherapy practice. The first is respecting the rights and the dignity of the client. The second is the demonstration of competence and full professional responsibility during management of patients. The third area for psychotherapists to focus on is responsibility regarding handling and management of the patients. And finally, the aim of the code is in placing emphasis on the integrity of the patient (IACP Code of Ethics and Practice, np, nd).
Psychotherapists usually apply the “abstinence principle” in managing cases of psychotherapy. In all cases, the psychotherapist has to ensure that he maintains his limits and boundaries with the patient. He must prevent exploiting the patient for his mental, professional or any other form of gratification. Any carelessness on his part can lead to charges of exploitation by the patient (Gabbard, Beck and Holmes, 2007, pp 492).
The Irish Code of Ethics also highlights the importance of immediately seeing the patient at the time of crisis. This can lead to serious legal accusations against the physician as well as the psychotherapist (Gabbard, Beck and Holmes, 2007, pp 471).
However, the question arises as to why is there so much emphasis on the legal and ethical aspects of psychotherapy alone? The answer lies in the types of patients that are usually handled by psychotherapists (Gabbard, Beck and Holmes, 2007, pp 237). As mentioned before, most of the patients are those who face some form of addictive behaviour. In such behaviours, a significant proportion will also consist of people who have committed some serious legal offence as a result of their behaviour and addiction. Therefore, extremes of behaviour can be expected. These include problems such as suicide or physical attacks. Therefore, psychotherapists need to follow their protocols very strictly, due to possible legal litigations and ramifications in the future (Gabbard, Beck and Holmes, 2007, pp 237).
There are many steps in ensuring all legal and ethical aspects are covered or considered. For this, obtaining informed consent of the person, either from the patient himself or from someone who can continue to take the responsibility of the patient is necessary (Beahrs and Gutheil, 2001, pp 4 and 6). There are two stated benefit for using informed consent among the patients. These include “empowering patients’ self-therapeutic activity and protecting them against the cult like information-control elements that are sometimes present within psychotherapy (Bearhrs, Gutheil, 2001, pp 6).
Another effort of the Irish government is the creation of the Vulnerable Adults and Law Report (2006). This particular report was involved in the protection of legal rights of adults who are undergoing psychological treatment (Vulnerable Adults and Law Report, 2006, pp 11). It has discussed some very important issues about to approach the psychiatric cases from a legal perspective, and creating boundaries between the need for treatment and protection of the patient’s rights. By creating specific guidelines depending on the psychological condition of the patient, the therapist as well as the family will be able to take proper legal and ethical decisions for the benefit of the patient. Included in the report are also those laws which reserve the right for the patient to have no treatment at all (Vulnerable Adults and Law Report, 2006, pp 19).
Psychotherapy is a relatively new and different genre in psychology that aims to provide different services to patients within its ethical and legal boundaries. Due to a very large portion of such patients having addiction problems, the cases may have legal ramifications. Psychotherapists should be well aware of the ethical and legal issues pertaining to psychological treatment and care, and in areas of consent and decision making.
Due to emphasis in reaching critical psychotherapy decisions in accordance with laws and ethics laid down by the Irish Mental Health Act, 2001, the new research interest is in creating a team approach in such treatment planning. With the rise in individual and private practice, this trend has been on the decline; however, it is believed that should such practice continue, it will help in preventing many ethical and legal problems that frequently arise in psychotherapy care and practice (Clarke and Rowan, 2009, pp 89 and 92).
In conclusion, psychotherapy practice is among the most difficult areas of treatment due to its ethical and legal implications. Therefore, by remaining informed about the different developments in the Irish government and health policies, one can minimise the risk of problems arising or developing in psychotherapy practice, for the benefit of patient and practitioner alike.
Applebaum Paul S, 1997. Informed Consent to Psychotherapy: Recent Developments. Psychiatric Services April 1997, Vol, 48, No. 4, pp 445 and 446.
Beahrs John O, and Thomas G Gutheil, 2001. Informed Consent in Psychotherapy. American Journal of Psychiatry 158;4-10
Brems Christiane, 2001. Basic Skills in Psycotherapy and Counselling. Brooks/Cole Thomson Learning, 2001.
Clarke Grania and Alan Rowan, 2009. Looking Again at the Team Dimension in Systemic Psychotherapy: Is Attending a Group Process A Critical Context for Practice? Journal of Family Therapy Vol 31, Issue 1, pp 85-107.
Gabbard Glen O, Judith S Beck, and Jeremy Holmes, 2007. Oxford Textbook of Psychotherapy. Oxford University Press, 2007
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The IACP Code of Ethics and Practice/ Code of Ethics and Practice-Summary of the Code, nd. Site last accessed on October 10th, 2010 from http://www.irish-counselling.ie/index.php/iacp-code-ethics-practice
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Health and Social Care Professional Act, 2005. Number 27 of 2005. Site last accessed on October 10th, 2010 from http://www.irishstatutebook.ie/2005/en/act/pub/0027/index.html
Transactional Analysis and Ethics… Introductory Notes on the Principles of Ethics. A Few Introductory Notes on the Principles of Ethics. Site last accessed on October 16th, 2010 from http://www.ta-psychotherapy.co.uk/