Internet Editor’s Note: Dr. Jeffery Barnett recently published an article titled “The Ethical Practice of Psychotherapy: Clearly Within Our Reach,” in Psychotherapy. You can find a free copy of the article: here.
While all psychotherapists aspire to practice ethically, this can at times prove challenging. It may seem at first glance that practicing ethically means simply following the ethics code of one’s profession. While this is a good place to start, unfortunately this is not sufficient for ensuring ethical practice. There are several reasons for this:
1. No ethics code can address every possible dilemma and challenging situation that psychotherapists face. In fact, as is stated in the Ethical Principles of Psychologists and Code of Conduct ([APA Ethics Code], APA, 2017) the Ethics Code is intended to augment our professional judgment, not to replace it. Thus, to practice ethically, knowledge of and use of the Ethics Code is necessary but not sufficient for ensuring ethical practice.
2. The profession’s underlying values as articulated in the aspirational General Principles of the Ethics Code may provide useful guidance and direction when facing dilemmas, but they often cannot provide specific answers for the correct or right course of action to follow. As a result, psychotherapists must utilize ethical decision-making models to assist in applying the Ethics Code and other available sources of guidance in an effort to make a thoughtful decision on how to proceed (See the website of the Markkula Center for Applied Ethics https://www.scu.edu/ethics/ethics-resources/ and Cottone & Claus, 2000 for a review of decision-making models).
3. Ethics codes are continually revised and updated over the years. This is necessitated by changes in our profession, in the world in which we live and work, and in societal standards and expectations. The APA Ethics Code was first published in 1953, has undergone nine major revisions since then, and is presently going through another major revision. Issues such as the integration of various technologies into psychotherapy practice and tele-mental health, interprofessional practice in multi-disciplinary settings, and the focus on self-care and the promotion of wellness were not addressed in early versions of the APA Ethics Code. As the practice of psychotherapy continue to evolve, our ethics code must be revised to keep up with this. Further, numerous societal changes, such as our understanding of and views on diversity, have impacted our profession and as a result, our ethics code. While revisions of the Ethics Code can be very helpful in providing updated guidance to psychotherapists, the frequency of revisions of the Ethics Code falls short of the rapidity of developments that impact the nature and practice of psychotherapy.
4. Ethics codes set minimal expectations for ethical practice, what Knapp, VandeCreek, and Fingerhut (2017) describe as the ethical floor. Yet, it is hoped that no psychotherapist sets their sites on doing the least amount possible to meet minimum requirements for ethical practice. Rather, we each should endeavor to do the best we can for each client and to do everything reasonably possible to fulfill the aspirational General Principles of the APA Ethics Code (Beneficence and Nonmaleficence, Fidelity and Responsibility, Integrity, Justice, and Respect for People’s Rights and Dignity). Unfortunately, the Ethics Code cannot tell us specifically how to meet these obligations. It can only steer us in the right direction. We are left to make our own decisions on the specific actions to take, or to avoid to, achieve these goals.
5. At times, conflicts between various General Principles and Ethics Code Standards may be experienced. Conflicts between the Ethics Code and other requirements psychotherapists are obligated to follow such as laws, regulations, and institutional policies may also occur. The Ethics Code provides very general guidance for how to approach these conflicts but once again, the process for deciding the most appropriate action to take, and the actual decision on this, are left up to us.
6. There may be other factors that impact psychotherapists’ efforts to practice ethically. One is that psychotherapists tend to do their work independently and in private. Our focus on working alone with clients and on protecting their privacy may negatively impact our willingness to consult with colleagues when faced with ethical dilemmas and challenges in our work with clients. There may also be discomfort with opening up our work with clients to others. Consultations tend to be needed when we face challenges and when things may not be going well in a client’s treatment. Thus, when most in need of input and assistance from colleagues we may be most reluctant to seek this input and guidance.
7. The practice of psychotherapy is emotionally demanding and challenging. Further, psychotherapists face numerous stressors in our professional and personal lives. Failure to adequately manage these many stressors can have a deleterious effect on our professional competence, to include our ethical decision-making and practice. As numerous authors (e.g., Dunning, Heath, & Suls, 2004) point out, the more impacted by various stressors we are, the less we are able to accurately assess these effects, and as a result, the less we are able to accurately assess the need for input, support, and assistance.
Based on these points it may seem like the ethical practice of psychotherapy is beyond our reach. Fortunately, that is not the case. Psychotherapists should not limit their efforts to practice ethically to use of the APA Ethics Code. While this is a starting point it is essential that we view ethical practice more broadly, to include the following points:
- Take a preventative approach to ethical practice rather than waiting for a dilemma or challenging situation to arise. This may include ongoing participation in a peer support or consultation group, participation in continuing education that focuses on ethics in emerging areas of psychotherapy practice, attending professional conferences and reading journals and newsletters (and websites!) to stay current on changes in the profession and emerging aspects of ethical practice.
- Do not isolate yourself! This is true for psychotherapists in solo practice as well as for those who work in group practices or for agencies. It is easy to be surrounded by others who we never interact with as we move from client to client throughout the day. With the busy lives most people live, we may need to intentionally schedule time with colleagues and friends to make sure these interactions occur.
- Be on the lookout for the gray areas of ethics in clinical practice. When no easily identifiable best or most appropriate course of action is apparent, utilize an ethical decision-making model and be sure that this includes the important step of consultation with expert colleagues.
- Understand the role of consultation; to obtain different perspectives and to gain input and ideas that can help us to make better decisions. This can only occur when we share openly and honestly with our colleague consultants. Attempts to present ourselves and our work positively can significantly limit the value and benefit of the consultation. We must approach consultation with our clients’ best interests in mind.
- Value self-care and practice it regularly, seeing it as mandatory for being able to practice psychotherapy ethically. Keep in mind that there is no perfect self-care and that we all struggle with life’s many challenges. Once again, it is vital that we do not isolate ourselves and that we seek out assistance when needed, to include our own psychotherapy.
We must see each of these as positive practices that are part of what it means to be an ethical and effective psychotherapist, not flaws or signs of weakness. As the practice of psychotherapy and the world around us continue to change, presenting new challenges to us, it is hoped that following the suggestions shared in this brief article will assist us to fulfill our ethical obligations to those we endeavor to serve.
Cite This Article
Barnett, J. E. (2020, March). The evolving nature of the ethical practice of psychotherapy. [Web article]. Retrieved from https://societyforpsychotherapy.org/the-evolving-nature-of-the-ethical-practice-of-psychotherapy
American Psychological Association (APA). (2017). Ethical principles of psychologists and code of conduct (2003, including 2010 and 2016 amendments). Retrieved from www.apa.org/ethics
Cottone, R. R., & Claus, R. E. (2000). Ethical decision-making models: A review of the literature. Journal of Counseling and Development, 78, 275–283. http://dx.doi.org/10.1002/j.1556-6676.2000.tb01908.x
Dunning, D., Heath, C., & Suls, J. M. (2004). Flawed self-assessment: Implications for health, education, and the workplace. Psychological Science in the Public Interest, 5, 69–106. http://dx.doi.org/10.1111/j.1529-1006.2004.00018.x
Knapp, S. J., VandeCreek, L. D., & Fingerhut, R. (2017). Practical ethics for psychologists: A positive approach (3rd ed.). Washington, DC: American Psychological Association. http://dx.doi.org/10.1037/0000036-000