Psychology – Ethical Dilemma in Psychotherapy
Psychologists often encounter situations where their acute ethical decision making abilities are tested. They have to take various factors into consideration such as age of the subject, sanity of the subject to comprehend situations and take appropriate decisions, influence of environmental factors on the subject’s decisions and many others. Facing difficult ethical dilemmas and determination of best course of action in such situations requires years of practice and effective training of counselors.
P J Graham and D M Foreman conducted a case study in 1991 where they assessed the condition and progressive results of psychotherapy treatment of an eight year old girl Clare. Clare showed heightened symptoms of medical ailments at the time of admission and any efforts routed to discover the underlying cause were futile. She was known to be a bright, affectionate and amiable girl before showing signs of medical, physical and mental dilapidation. Her family history was evaluated but no direct connection of affectation could be established except her father’s extra marital affair. Counselors deliberated over incidence of physical abuse due to her reluctance to spend time with family but refrained from investigating further into the issue due to lack of symptoms or evidence; such investigation itself being an abusive intervention. Family interviews as well as individual interviews did not yield any viable results. After nine months of continued therapy, Clare showed signs of improvement and increased acceptability towards her family members. Her medical condition improved and she was eventually discharged at the end of a year in a much better state. Graham evaluates Clare’s case as one that posed severe ethical dilemmas since her behavior and medical ailments could not be traced back to their roots and psychologists were in a fix regarding what would work best in her favor. Neither her condition, nor the results of therapy pointed towards the exact cause of problem – whether she was suffering from some metal ailment or reacting understandably to family stress. Foreman assesses that psychotherapy of subjects is not enough in itself and the associated family members need to be taken into consideration. He also embarks on the fact that the decisions of subject or family members might not always be in their best interests and it’s an important responsibility on the part of counselor to take the right decisions when confronted with such conflicts. He states that justice should be the basis of such decisions by counselors.
Jeremy Holmes conducted a study on 35 year old teacher David, who had become alcoholic and suicidal due to excessive emotional stress. Disturbed childhood due to father’s long standing absence and sacrifice of personal life to take care of mother’s emotional needs left him drained and unwilling to lead a progressive existence. Counselors faced an ethical dilemma on the form of therapy that would suit him best. He appeared to be a severely damaged individual who was in need of long term intense psychotherapy. However, there was a team of psychotherapists who believed that short term supportive psychotherapy treatment was more suitable to his condition. The major factor that influenced the decision in this case was that a short term therapy vacancy existed and David was admitted to the program. At the conclusion of therapy sessions, David displayed alcohol abstinence and comparatively cheerful disposition towards life. Several interesting observations can be made from this case. The decision regarding suitability of therapy sessions was made on the basis of availability of therapy program which shows lack of ethical judgment and justice. Influence of David’s reluctance to get admitted to prolonged therapy on therapist’s decision is also clearly evident. The most important concern is reliance on subject’s decision on making an informed choice best suited for his well being from the presented options. Adshead and Smith argued that adequate steps should be taken to identify if the subject to be admitted is autonomous. Consequently his consent should be taken regarding the type of treatment needed. They also believe that ethical decisions in psychiatry are often determined by counter transference of feelings at a subconscious level which generally have a powerful impact on clinical care and service delivery.
Resolution of ethical dilemma in psychotherapy is not an easy task to accomplish. There are many factors that need consideration and psychotherapists need to take situation based decisions founded on previous experiences. Several factors of paramount importance that need consideration are –
- Autonomy of the subject
- Justice of the decision
- Benevolence on the part of Psychotherapist
- Non-maleficence on the part of Psychotherapist
- Fidelity
Every case should be evaluated on the above listed factors before a final decision regarding the type of therapeutic treatment required for a subject is arrived at. Also, the importance of guidance provided by experienced counselors can’t be emphasized enough in dealing with ethical dilemmas. Extensive study of previous situations and utilization of that experience in taking best decisions in favor of subjects is the ideal resolution to dealing with ethical dilemmas.
References
- Jeremy Holmes, Gwen Adshead and Jeanette Smith (1994). The Psychiatrist. Retrieved from http://pb.rcpsych.org/content/18/8/466.full.pdf
- P. J. Graham and D. M. Foreman (1995). The Psychiatrist. Retrieved from http://pb.rcpsych.org/content/19/2/84.full.pdf
- Holly Forester and Thomas Davis (1996). American Counseling Association: A Practitioner's Guide to Ethical Decision Making. Retrieved from http://alabamacounseling.org/pdf/ACAguide.pdf
