The Oxford Handbook of Psychotherapy Ethics

Description

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. Cover Psychotherapy Ethics Copyright Dedication Foreword Acknowledgements Detailed Table of contents Table of Contents List of Contributors Section I: Background And Historical Context Chapter 1: Why Ethics Matter In Psychotherapy Psychotherapy And Visions Of The Good: Beyond Effectiveness Ethical Challenges In Psychotherapy Goals Of The Oxford Handbook Organizational Features Of The Oxford Handbook Of Summary Reflections On The Sections Of The Oxford Handbook Of Section I: Background and Historical Context Section II: Concepts and Theories for Psychotherapy Ethics Section III: Common Ethical Challenges in Psychotherapy Section IV: Ethical Issues within Specific Psychotherapy Modalities and Formats Section V: Ethical Challenges Involving Specific Settings and Populations Section VI: Ethics of Psychotherapy Education, Training, Quality Assurance, and Research Conclusion: The Future Of Psychotherapy Ethics Psychotherapy as Treatment Modality and Professional Identity The Ethical Fates of Psychotherapy Craft and Psychotherapy Science Intersectional Psychotherapy Ethics Ethics and Automated Psychotherapy The Future of Psychotherapy Ethics Research References Chapter 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 References Chapter 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) Ethical Values and Codes The Concept of “Profession” Expectations of Moral Character Influence of Moral Theory The History Of Professional Ethics During The Transitional Eighteenth And Nineteenth Centuries Ce Ethical Values and Codes The Concept of “Profession” Expectations of Moral Character Influence of Moral Theory A Brief History Of Modern Professional Ethics (twentieth And Twenty-first Centuries Ce) Attention to the Ethics of Psychotherapy The Influence of World War II Concerns Related to the Concept of “Profession” Other Influences Conclusion References Chapter 4:The History and Ethics of the Therapeutic Relationship Introduction Relationship as Method Relationship as Skill Relationship as Foundation Discussion Empathy as Therapist Attitude Empathy as a Practice Resulting from a Nondirective Attitude Empathy as a Conduit for Love Empathy as a Relational Ethic or Morality Empathy as Cooperative Intent/Power With and Minimizing Power-Over Honesty: A Partial Synonym for Congruence Honesty and Genuineness Honesty and Transparence Honesty: A Partial Synonym for Congruence Integrity: Internal Empathy and Unconditional Positive Regard Integrity: Extensionality and Fully Functioning Practical Implications Typical Implication: Practicing PCT When the Unexpected Occurs: Avoiding Power-Over Conclusion References Section II: Concepts And Theories For Psychotherapy Ethics Chapter 5: Autonomy As A Goal Of Psychotherapy Introduction Autonomy Respecting Autonomy Promoting Autonomy Autonomy As A Goal Of Psychotherapy Conclusion References Chapter 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 Acknowledgments References Chapter 7: Empathy, Honesty, And Integrity In The Therapist: A Person-Centered Perspective Introduction Empathy Empathy as Therapist Attitude Empathy as a Practice Resulting from a Nondirective Attitude Empathy as a Conduit for Love Empathy as a Relational Ethic or Morality Empathy as Cooperative Intent/Power With and Minimizing Power-Over Honesty: A Partial Synonym For Congruence Honesty and Genuineness Honesty and Transparence Integrity: A Closer Synonym For Congruence Integrity: Internal Empathy and Unconditional Positive Regard Integrity: Extensionality and Fully Functioning Practical Implications Typical Implication: Practicing PCT When the Unexpected Occurs: Avoiding Power-Over Conclusion References Chapter 8: Fairness, Justice, and Economical Thinking in Psychotherapy Introduction Theories of Justice Outcomes Cost-Effectiveness The Global Context Summary and Conclusions References Chapter 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 Acknowledgments References Chapter 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 Appropriate I-VValues/Situations Fees and Appointments Practice Specializing in Feminist Therapy Practice Specializes in Christian Therapy Couple Therapist Privately Advises Batteree to Seek Shelter Therapist Wants to Practice EBP (Evidence-BasedPractice) with Alternative Treatment-Seeker Therapist Treating a Family Discourages Spankings Therapist Uses Motivational Interviewing to Promote a Denying Alcoholic Patient to Address Problem Drinking Therapist Refuses to Remove Accurate Diagnosis from Medical Record Inappropriate I-VValues/Situations Therapist Practices Conversion Therapy (Homosexuality to Heterosexuality) Therapist Has a Practice Restricted to the Care of Aryans “Dubious” and “It Depends” Appropriateness of Imposing Values by Therapists Dubious V-ICases Military Therapist Imposes Return-to-DutyDate (or Commanding Officer Forces) on a Persistently Ill Soldie Therapist Supports BIID Treatment by Affirming Amputation “It Depends” V-ICases Boundary-ViolatingT-Pin the Context of a Private, Self-Referred Therapy Relationship Boundary-ViolatingT-Pin the Context of a Training-Program/ Institutional Referral Therapist Recommends a Mode of Therapy (e.g., Psychodynamic, CBT, Medications) The Training Director Tells You You Don’t Have Enough (Psychotherapy) Experience with a Particular Psychotherapy Modality to Graduate/ Qualify/Satisfy Requirements Therapist Recommends Divorce to a Patient Therapist Recommends Sexual Surrogacy Therapy for a Client with a Sexual Disorder Therapist Arranges Involuntary Treatment of Suicidal Patient Therapist Wants to Transition to New Therapy Approach Summary/Conclusions References Chapter 11: Virtue Ethics In Psychotherapy Introduction Virtues And The Psychotherapist Moral And Intellectual Virtues Courage Benevolence Temperance Phronesis Sophia Conclusion References Chapter 12: How Do People Make Moral Medical Decisions? Introduction Informed Consent And Bioethical Principlism Contemporary Approaches To Moral Medical Decision Making Theoretical Concerns Empirical Investigations Moral Decision Making In Psychotherapy Practice Conclusion References Chapter 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 References Chapter 14: PhenomenologicalHermeneutic Resources For An Ethics Of Psychotherapeutic Care Introduction The Dialogical Principle Attunement Recognition Intimacy Conclusions References Chapter 15: Free Will, Responsibility, And Blame In Psychotherapy Why Should We Consider Free Will In Psychotherapy? Concepts Of Free Will The Threat and the Commonsense Response The Importance of Determinism Pessimist View of Determinism The Optimists’ Response The Compatibilist Approach Free Will And Mental Disorder The Importance Of Free Will For Responsibility And Blame In Psychotherapy Conclusion Acknowledgments References Chapter 16: Dignity In Psychotherapy Introduction Respect For Human Dignity Human Dignity In Medical Ethics And Law The Importance Of Dignity In Psychotherapy Conclusion References Section III: Common Ethical Challenges In Psychotherapy Chapter 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 References Chapter 18: Ethics Of The Psychotherapeutic Alliance, Shared Decision Making And Consensus On Therapy Goals Background And Introduction Legal Aspects Ethical Framework: Issues Reflecting The Practice Of Ethics In Psychotherapy: Particular Ethical Challenges Illustration Of Ethical Difficulties And Support From Clinical Ethics When the Psychotherapeutic Alliance is Challenged When the Psychotherapeutic Alliance is Jeopardized and Shared Decision Making Fails When Multiple Crises Occur: No Treatment Alliance, No Shared Decision Making, and No Consensus on Therapy Goals Lessons Learned From The Examples References Chapter 19: Evidence, Science, And Ethics In Talk-based Healing Practices Introduction Non-clinical Counseling: Premises, Practices, Ethics, And Evidence/ Accountability Philosophical Counseling Peer-Support Services (Sometimes Called Service-User Support) Existential Therapy Mainstream Psychotherapy Practices Evidence, Values, And Ethics In Caring For Mental Distress Knowing What You Don’t Know in NCC Practices Evidence and Accountability in Mainstream Practice Philosophy Of Psychiatry As A Core Discipline Of Clinical Interpretation References Chapter 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 Placebo Effects and Placebos Placebo Effects Placebos as Controls Placebos as Clinical Interventions Placebo-ControlledRCTs in Psychotherapy Research Specificity of Treatments and Common Factors Ethical Debate about Disclosure of Evidence to Patients The Nature and Timing of Information Disclosure Up-to-Date,Impartial Disclosure about Treatment Options Disclosure of Information about Specific and Common Factors Disclosure of Harms Patients as Sources of Evidence Conclusions appendices Appendix 1: Disclosure of Common Factors Appendix 2: Disclosure of Harms References Chapter 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 References Chapter 22: Privacy And Confidentiality In Psychotherapy: Conceptual Background and Ethical Considerations in the Light of Clinical Challenges Introduction What Are Privacy And Confidentiality? Origins On The Relevance Of Privacy And Confidentiality In Psychotherapy How Can We Deal With Ethical Conflicts About Privacy And Confidentiality In Clinical Practice? Scope and Limits of Privacy and Confidentiality Considerations in Cases of Conflict Summary And Final Remarks References Chapter 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 Personal/Friendship Sexual Business/Financial Collegial Supervisory Time Frame Relationships That Existed before Psychotherapy Relationships That Develop during Psychotherapy Relationships That Begin after Termination Considerations Avoidability Client/Patient Autonomy Boundary Violations Vs. Boundary Crossings Violations Incursions and Crossings Relationships And The Supervisory Relationship Other Issues Bartering Collegial Conclusion References Chapter 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 The Limits of Clinical Research What Counts as Evidence? The Personhood of the Therapist The Client’s Values and Intentions Training and Competence of the Therapist Constraints and Limits on the Task of Participating in Therapy The Translation of Theory into Practice The Role of Psychotherapy within a Comprehensive Treatment Plan Ethics And Values In Psychotherapy Modality/format Selection Humility Phronesis Self-knowledge Perseverance and Flexibility Empathy Integrity Unselfing Clinical Hermeneutics And The Ethics Of Psychotherapy Modality/format Choice Conclusions References Chapter 25: Psychotherapist Self-disclosure Introduction Boundaries In Psychotherapy Managing Boundaries In The Psychotherapy Relationship Ethical Decision-making The Slippery Slope Self-disclosure Unavoidable Self-Disclosure Self-Disclosure as a Planned Therapeutic Intervention Self-Disclosure and the Role of Treatment Setting Self-Disclosure and Culture Self-Disclosure in the Internet Age Summary And Recommendations References Chapter 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 Acknowledgment References Chapter 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 References Chapter 28: Mental Health Care Funding Systems And Their Impact On Access To Psychotherapy Introduction Principles Of Distributive Justice Welfare-Based Principles Egalitarian Principles Desert-Based Principles Libertarian Principles Psychotherapy Access In Practice Health Care Financing Psychotherapy Coverage Criteria Reimbursement Models Conclusion References Chapter 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 References Chapter 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 Pers “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” References Chapter 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 References Chapter 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 Respect Integrity Competence Concern Three Prominent Ethical Challenges Blurred Boundaries Case Example 1: Dr. Z Bias Case Example 2: Dr. A Destructive Beliefs and Practices Case Example 3: Jim Focusing on Best Practices Conclusions and Future Directions References Chapter 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 Case 1 Case 2 Conclusions References Section IV: Ethical Issues With Specific Psychotherapy Approaches Chapter 34: Ethical Issues in Cognitive-Behavioral Therapy Introduction to Cognitive Behavioral Therapy Part A: Ethical Issues in the Evaluation of Cognitions Competence Competence and Validity Competence and Utility Client Agency and the Therapeutic Alliance Client Agency, the Therapeutic Alliance, and Validity Client Agency, the Therapeutic Alliance, and Utility Part A: Conclusion Part B: Ethical Issues in Exposure-Based Treatments Harm and Exposure-BasedTherapies Current Issues with EBT and Informed Consent Intending EBT: First- and Second-OrderPreferences Motivational Interviewing and Informed Consent Part B: Conclusion Conclusion Acknowledgments References Chapter 35: Ethical Processes In Psychoanalysis And Psychodynamic Psychotherapy Introduction Ethical Constructs In Psychoanalysis Ethical Dimensions Of Psychoanalytic Process Ethical Obligations In Psychoanalytic Technique The Ethics of Unconscious Exploration The Ethics of “Working in the Transference” The Ethics of Exploratory Technique The Ethics of Treatment Intensity Conclusion References Chapter 36: Ethical Issues in Systemic Psychotherapy Introduction Types of Therapy Are Types of Culture Ethics of Therapeutic Practice Fundamental Stance Professional Quality Professional Self-Care Confidentiality Transparency and Information Anti-Discriminationand Interdiction of Exploitation Abuse of Psychological Knowledge Basic Foundations and Ethical Demands in the Systemic Approach Consider and Involve the Context: The Client Is Part of a System Respect Complexity, Look for Circularity Respect Self-Regulation,Enhance Self-Organization Increase Viability, Foster Resilience Encourage Capacity Building Allow for Diversity, Expand to a Multi-PerspectiveStance Practice Constructivist Modesty Respect Client’s Expertise and Autonomy: Contract Orientation The Stance of Not-Knowing Information Regarding the Process Contract Orientation Conclusion of Contract Find and Understand: Symptoms Carry a Meaning Neutrality Take a Neutral Stance, Sometimes Neutrality with Regard to Outcome Respect Family Secrets, Most of the Time Ethical Discourse References Chapter 37: Ethical Issues in ExistentialHumanistic 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 References Chapter 38: Ethical Considerations in Emotion-Focused Therapy Introduction General Practice Principles of Emotion-Focused Therapy as Instances of Broader Professional Ethical Principles Empathic Attunement Therapeutic Bond Task Collaboration Differential Emotional Processing Emotional Deepening through Work on Key Therapeutic Tasks Self-Development Key Ethical Dilemmas in Emotion-Focused Therapy Necessary Emotion Arousal versus Risks on the Path to Core Pain Transient Emotional Dysregulation versus Protection of the Self Freedom to Choose versus Process-Guidingor Control Conclusions References Chapter 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 References Chapter 40: Psychotherapy Integration as an Ethical Practice Introduction What is Psychotherapy Integration? Four Forms of Psychotherapy Integration in More Detail Technical Eclecticism Theoretical Integration Common Factor Integration Assimilative Integration Ethical Issues Encountered with Psychotherapy Integration Ethical Issues Shared by the Four Forms (1) Beneficence (2) Respect for Autonomy (3) Nonmaleficence (4) Justice Distinctive Ethical Issues Posed by Each of the Forms (1) Theoretical Integration (2) Technical Eclecticism (3) Common Factors Approach (4) Assimilative Approach Framing Questions for Research into Integrative-Psychotherapy Ethics Clinical Responses to Ethical Issues Raised in Integrative Therapy References Section V: Ethical Challenges Of Specific Settings And Populations Chapter 41: Identifying and Resolving Ethical Dilemmas in Group Psychotherapy Introduction Challenges Created by Intimacies among Strangers Competence Confidentiality Evaluation of Treatment Progress Dual Relationships Impediments to Sound Ethical Decision-Making in Group Psychotherapy Lack of Knowledge and Skills Human Factors Affecting the Decision-MakingProcess The Therapist’s Biases Processing Errors Affect Stimulation Laying the Foundation for Ethical Practice of Group Psychotherapy Conclusions References Chapter 42: Ethics in Couple and Family Psychotherapy Introduction Multiple Relationships as a Fundamental Problem in Couple and Family Therapy A Systemic Perspective Ethical Codes and Principles as Bases of Ethical Behavior in Couple and Family Therapies Ethical Codes by Professional Associations Ethical Principles Central Ethical Questions for Couple and Family Counselors Autonomy Justice Beneficence and Nonmaleficence Models of Help The Four “Models of Help” Pros and Cons of Each Model A Shift from Principles and Codes to Relational Ethics The Importance of Relationship Relation-OrientedEthics Relational Ethics in Practice Ethics as a Therapeutic Process Limits to an Ethics of the Therapeutic Process Conclusion References Chapter 43: Psychotherapy with Children and Adolescents Fundamental Conceptual Issues Legal Age and Developmental Age Main Ethical Challenges Contextual Considerations Competence Practitioner Competence Children’s Decisional Competence Confidentiality Mandated Reporting Dangerousness Bullying Electronic Communications Physical and Social Boundaries Technique Based Ethical Issues Conclusion References Chapter 44: Psychotherapy In Old Age: Ethical Issues Introduction Contexts And Cohorts Cohort Issues The Context of Psychotherapy Decision-Making Capacity Cognitive Impairment Including Dementia Ageism and the Ethical Need for Equity of Service Provision Moving Beyond Standard Ethical Theories And Approaches Case Vignette 1: Mrs. Margaret Smith Ethical Commentary on Case Vignette 1 Case Vignette 2: A Psychotherapy Group For People Who Have Recently Been Diagnosed With Dementia Ethical Commentary on Case Vignette 2 Case Vignette 3: The Shah Family Ethical Commentary on Case Vignette 3 Conclusion Unknown Informed Consent Who Is the Client? Competence Practitioner Values Identifying the Limits of Confidentiality Integrity References Chapter 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 Respect for Autonomy Informed Consent Who Is the Client? Beneficence and Nonmaleficence Competence Justice Practitioner Values Patient–Professional Relationships Identifying the Limits of Confidentiality Integrity Practitioner Values Patient–Professional Relationships Identifying the Limits of Confidentiality Integrity Conclusion References Chapter 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 Tarasoff: A Duty to Warn and Protect Victims’ Rights and Justice Conclusion: Relational Autonomy and Changing for the Better Acknowledgment References Chapter 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 Physical and Practical Reasons Clinical Reasons Case Management Reasons Cultural Reasons 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 References Chapter 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 Professional Competence Confidentiality Multiple Relationships Overarching Recommendations Conclusion References Chapter 49: Ethical Aspects of Online Psychotherapy Introduction Ethical Aspects of Online Psychotherapy Ethical Arguments in Favor of Online Psychotherapy Improvement of Psychotherapeutic Processes Anonymity Cost Effectiveness Ethical Arguments against Online Psychotherapy Impairment of the Therapeutic Process Confidentiality, Security, and Privacy Informed Consent Patient Identification and Emergency Legal Issues Professional Competence Fictitious Clinical Vignette Conclusion References Chapter 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? Artificial Intelligence Apps as a Supplement to Psychotherapy Artificial Intelligence Apps as Supervised Primary Treatments Ethical Principles To Reflect On Artificial Intelligence In Psychotherapy Global Landscape of Ethical Principles for Artificial Intelligence Principles for Apps in Mental Health Evidence-Based Research as the Gold Standard to Ensure Beneficence and Non-Maleficence The Need For More Ethical Perspectives Conclusion References Chapter 51: Ethical Issues in Psychotherapy of Other Therapists: Description, Considerations, and Ways of Coping Introduction Ethical Dilemmas Managing Dual Relationship Dilemmas Managing Boundary Issues Boundary between Psychotherapy and Supervision Boundary between Psychotherapy and Evaluation (between the Role of the Therapist and the Role of a “Professional Gatekeeper”) Confidentiality and the Duty to Report The Importance of Professional Organizations and Regulatory Bodies Conclusion References Chapter 52: Ethics Of Psychotherapeutic Interventions In Palliative Care Introduction Psychotherapeutic Interventions In Palliative Care Psychodynamic Psychotherapy Systemic Psychotherapy Cognitive and Behavioral Psychotherapy Existential Psychotherapy Indication For Psychotherapeutic Interventions In Palliative Care Ethical Implications In Psychotherapy Specific Ethical Challenges In Palliative Care Psychotherapy Beneficence Non-Maleficence Respect for Autonomy Justice Conclusions References Chapter 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 References Chapter 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 References Chapter 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? Linguistic Competence Skills in the Process of Interpreting 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 References Chapter 56: “Even Therapists Need Therapists”: Ethical Issues in Working with LGBTQ+ Clients Introduction Competence The Problem The Way Forward Examples Nonmaleficence The Problem The Way Forward Example Non-discrimination The Problem The Way Forward Examples Confidentiality The Problem The Way Forward Examples Navigating Multiple Relationships The Problem The Way Forward Examples Using and Conducting Research The Problem The Way Forward Example Financial Matters The Problem The Way Forward Examples Advertising The Problem The Way Forward Example Assessment and Diagnosis The Problem The Way Forward Example Supervision The Problem The Way Forward Example Conclusion References Chapter 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 References Chapter 58: Ethics Of AnimalAssisted Psychotherapy Introduction Animal-assisted Psychotherapy Institutionalization And Ethics Quality Assurance and Legal Situation Ethical Standards for the Therapist Ethical Standards for the Client Ethical Standards for the Therapy Animal Animal Ethics: Moral Obligations to Animals Animal Welfare The Ethical Dimension of Relationships in AAT: Negative and Positive Duties Conclusion References Chapter 59: The Ethics Of Mindfulness-based Interventions: A Population-level Perspective Introduction The Ethics Of Mindfulness-based Interventions What are Mindfulness-Based Interventions? MBIs through Thick and Thin? A Normative Framework Thinness Worries Thickness Worries And MindfulnessBased Interventions In Schools Religious Thickness Axiological and Ethical Thickness and MBIs in Schools Conclusions References Section VI: Ethics Of Psychotherapy Education, Training, Quality Assurance, And Research Chapter 60: Virtue Ethics and the Multicultural Clinic Introduction Defining “Psychotherapy” Cases Case 1: Post-PartumDepression and Breast-Feeding Case 2: Adult Daughter’s Mother Will Not Leave Case 3: Suspected FBI Attention Case 4: Disability Waiver Request Case 5: Clan Status and Mother-in-Law Virtues Some Key Additional Virtues in Cross-Cultural Psychotherapy Open-Mindedness,Intellectual Curiosity, and Other Epistemic Virtues Additional Virtues to Avert Burnout Conclusion References Chapter 61: Toward an Evidencebased 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 References Chapter 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 Recommendations for Personal Self-Care Personal Therapy Being Gentle and Kind to Ourselves Social Support Taking Time Away from Work Personal Health and Well-Being Self-care As A Professional Responsibility: A Form Of Risk Management Recommendations for Professional Self-Care Leaving Work at Work Setting Boundaries and Saying “No” Using Technology Supervision and Consultation Malpractice Insurance The Good Enough Therapist Self-care As A Shared Responsibility: Community Self-care Recommendations for Community Self-Care Joining Associations and Unions Conclusion References Chapter 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? Must, Should, Shall, Will Guidance and Disclosure of Confidential Information Conclusion References Chapter 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 Sexual Misconduct Non-Sexual Misconduct Consequences The Abusive Psychotherapist: Slipping, Stumbling Or Walking Across Boundaries? Development of Professional Identity Characteristics of Offending Professionals Interventions Teaching Professional Conduct Education and Information Ethics In Psychotherapy Training What Can Be Done When One Is Confronted With Misconduct? Conclusions References Chapter 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 References Chapter 66: Psychotherapy Ethics in Film Introduction Popular Images of Psychotherapy and Their Clinical Impact A “Strange Bedfellowship”: Psychotherapy and Film Psychotherapy Ethics in Film Between Madness, Badness, and Sex: Psychotherapist Stereotypes as an Index of Ethical Misconduct A Virtue out of Necessity: Film in Teaching Psychotherapy Ethics References Chapter 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 References Chapter 68: Ethical Issues in Psychotherapy Research Introduction Designing Ethical Psychotherapy Research Balancing Risks and Benefits Risk Monitoring and Management Strategies Selection and Recruitment of Participants Vulnerable Populations and Sensitive Topics: Striking an Ethical Balance Informed Consent: More than a Signature Evaluation of Decision-MakingCapacity Knowledge is Power: Provision of Information in the Informed Consent Process Voluntariness in the Informed Consent Process Quantitative and Qualitative Research Designs: Ethical Questions and Processes Quantitative Research Designs Qualitative Research Designs Documentation and Dissemination: Ethical Safeguards Psychotherapy Research Ethics in Different Context Diverse Cultural Settings Research via Online Platforms Ethical Decision Making: Committees and Regulatory Frameworks Conclusions References Index of Names Subject Index