PSYCHOTHERAPY AND HYPNOSIS TO EFFECTIVELY TREAT ANXIETY, STRESS, LACK OF CONFIDENCE, SMOKING, WEIGHT GAIN, POST-TRAUMATIC STRESS, ADDICTIONS, STAGE-FRIGHT, OBSESSIVE /COMPULSIVE DISORDERS, PANIC ATTACKS

 
     
An ethical framework
 
 
 
 

Introduction

The application of ethical standards lies at the very heart of therapeutic practice. A thorough understanding and adherence to a clearly defined set of ethical principles is therefore of crucial importance to the practicing therapist and is essential for a rewarding and successful career in hypno-psychotherapy. We will look for a definition of ethics before briefly contemplating the ethical beliefs of the pioneers of psychological thought. We will then consider established ethical guidelines and the necessity of comprehensive training before turning to the main part of this paper - addressing the ethical predicaments that can arise, focusing on two case studies where the application of ethical standards can lead the therapist into both moral and personal dilemmas.

Defining ethics

Ethics is a much used word that is notoriously difficult to define. The term itself derives from the Greek word ethos: meaning "moral character" The Dictionary of Psychology describes ethics as a "branch of philosophy concerned with that which is deemed acceptable in human behaviour, with what is good or bad, right or wrong with human conduct in pursuit of goals and aims" (1) while Webster's Dictionary defines the subject as the "study of standards of conduct and moral judgement - the system of morals of a particular person, religion or group"

Dr David Resnik, Director of the Centre for the Advancement of Ethics, University of Wyoming, sees these definitions as distinguishing between the study of ethics (otherwise known as moral philosophy) and the subject of that study ie: standards of conduct. "Ethics is fundamentally concerned with the questions, "what should I do?", "what kind of person ought I to be?" and "what things in life are worth wanting or pursuing?" (2)

Put simply, ethics can be defined as the individually or collectively accepted principles of right and wrong.

Pioneers on the question of ethics

Turning to the pioneers of psychological thought for general, collective, guidance on ethical matters can lead one down a long and rather confusing road. Alfred Adler had a great affiliation with "free-socialism", advocating in terms of ethics the "social tasks of man" Adler believed that our true task was for each of us to work for the development of culture as a communal project. He believed that a person's well-being and ethical progression was dependant on his commitment to his immediate community which encompassed equality, love, justice, reliability and openness - values that form the building blocks of a humane and ethical civil society.(3)

Sigmund Freud on the other hand considered ethics to be almost entirely irrelevant within the framework of psychotherapy, believing the subject to be of importance only to the religious minded. The example of Dora is typical of Freud's somewhat confusing attitude towards the question of ethics, and an argument can be made that he did indeed coerce the young woman into complaining about sexual advances by one of her father's friends at the instigation of the father, who was at the time having an affair with the accused's wife.(4)

Carl Rogers and Eugene Gendin's five-year involvement in a detailed study of compulsory treatments included the administration of electric shocks on long-term schizophrenics which was ethically highly questionable, as was Watson and Raynor's famous experiment with Little Albert that exposed the eleven-month-old child to a series of sudden, violent and excruciatingly loud noises (research that would probably be considered child-abuse today)

Jung viewed ethics in terms of the decision one makes between good and evil. "Harsh as it may sound, we must have the freedom in some circumstances to avoid the known good, and do what is considered to be evil, if our ethical decision so desires" (5) As these views are not particularly conclusive, we need to look at an established set of rules, regulations and guidelines to which the practicing therapist can clearly adhere to.

Codes of ethics

The British Association for Counselling and Psychotherapy's framework document "Ethical Principals of Counselling and Psychotherapy"(6) identifies six key "obligations" that the therapist must fulfil:

~ Fidelity: honouring the trust placed in the practitioner

~ Autonomy: respect for the client's right to be self-governing

~ Beneficence: a commitment to promoting the client's well-being

~ Non-maleficence: a commitment to avoid any harm to the client

~ Justice: the fair and impartial treatment of all clients and the provision of adequate services

~ Self-respect: fostering the practitioner's self-knowledge and care for self.

Personal qualities to which counsellors and psychotherapists are strongly encouraged to aspire to include:

~ Empathy: the ability to communicate understanding of another person's experience from that person's perspective

~ Sincerity: a personal commitment to consistency between what is professed and what is done

~ Integrity: commitment to being moral in dealings with others, personal straightforwardness, honesty and coherence.

~ Resilience: the capacity to work with the client's concerns without being personally diminished.

~ Respect: showing appropriate esteem to others and their understanding of themselves.

~ Humility: the ability to assess accurately and acknowledge one's own strength's and weaknesses.

~ Competence: the effective deployment of the skills and knowledge needed to do what is required.

~ Fairness: the consistent application of appropriate criteria to inform decisions and actions

~ Wisdom: possession of sound judgement that informs practice.

Training

Training, qualification, accreditation to a nationally recognised body and continuous personal development are now almost universally accepted to be the most standard and efficient ways of ensuring that the therapist behaves in an ethical manner, and gives comfort and reassurance to the client that, in the unlikely event of any misconduct arising, the therapist is answerable to a professional organisation that will at all times act in the public interest.

Training in itself does not guarantee that there would not from time to time be the occasional unethical therapist. Some therapists and institutions therefore believe that, as part of the induction process, a strict selection procedure, such as a psychometric test, would enable tutors and staff of colleges holding foundation courses to detect who, or who would not, be suitable as ethical therapists.

A comprehensive and accredited training programme equips the therapist with enough of an ethical framework to deal with the day-to-day realities of professional practice.

Rosemary Kent, training co-ordinator at the Prevention of Professional Abuse Network (POPAN) states in her study into the importance of ethics in psychotherapy that adequate training about ethical practice in the psychological therapies would not only mean that practitioners learnt to deal with their own vulnerability, "it would also instil a culture of transparency, accountability and vigilance in their professional organisations and employment environments" (9)

Ethical dilemmas

The BACP's statement of ethical principles places great importance in the dilemmas that therapists sometimes face: "Practitioners will encounter circumstances in which it is impossible to reconcile all the applicable principles, and choosing principles may be required" (10)

A conflict of ethics can arise when therapists allow their professional relationships with clients to be in some sense prejudiced by any personal views they may hold about lifestyle, age, disabilities, gender, race, religion, alternative lifestyles etc.

One example of such a conflict could be deeply held religious views by the therapist in relation to gay and lesbian clients. A study published in The Counselling and Psychotherapy Research quarterly revealed that, while out of a survey of therapists holding deeply religious views the majority felt that they were able to accept gay and lesbian clients, a significant minority were very judgemental about perceived gay/lesbian behaviours. "Counsellors with a literalist approach to the bible appeared to be lacking in acceptance and were unaware that they may not be offering the core condition of respect to gay and lesbian clients" (11)

Choosing the ethically correct course of action in difficult, emotional and deeply tragic circumstances will always be the therapist's worse moral dilema.

Carol Gibbons, a BACP registered therapist in primary care brings to light the tragic case of a client she names Jack, who disclosed to her during a session that a few nights previously, he had smothered his terminally ill mother who had repeatedly begged him to help her die. Jack had been her client for over a year, and had revealed on numerous occasions the emotional pain and torment that he was going through in relation to his suffering mother.

Gibbons felt that the most appropriate form of action was to remind Jack of the agreement he signed - particularly in relation to concerns about harming other people. She was adamant that not only his GP, but also the police be informed of what he had done. She nevertheless felt uncomfortable with her actions, and sought guidance from her supervisor and other colleagues in the profession. What surprised Gibbons was the diversity of comment regarding the case. A mental health specialist and counsellor for a leading NHS trust saw the therapist's role in such a situation as one of "compassionate confessional" stating that in fact it was the therapist's duty to support, and not pass judgement, on the client. "I would not be disclosing anything he had told me to anyone, but would want to explore with him what he needed to do for himself'

A senior practitioner at Norwich MIND disagreed, saying that she would be bound by her ethical framework to share the information with others, including the police.(12)

In concluding the framework document, the BACP concedes that no statement of ethics can totally overcome the tremendous difficulties in making judgements when faced with uncertain circumstances.

Conclusion

For many people, visiting a therapist for the first time will be one of the most important decisions that they will ever make. They will have reached a point in their lives where understanding and guidance will, at times, be desperately needed and they will be comforted in the assumption that the therapist will be adhering to a clear set of ethical standards. The long-term consequences of a breakdown in trust can cause irreparable damage to vulnerable clients at such a critical turning point in their lives, and it is the therapist's duty and responsibility to ensure that, in following clearly defined ethical principles, that trust is never betrayed.

Notes and references

1) Reber AS (1985) Dictionary of Psychology Viking Penguin/London

2) Extract from speech given by Dr David Resnik to the Centre for the Advancement of Ethics sym posium on "student issues" University of Wyom ing, August 1995

3) Burns J (1998) Adler on Individual Psychology: Individual Psychology as Applied Ethics Mackenthun/Berlin

4) Bond T (2004) An Introduction to the Ethical Guidelines for Counselling and Psychotherapy Counselling and Psychotherapy Research October 2004NoI 4 No. 2

5) Jung CG (1961) Memories, Dreams, Reflections Routledge/London pg 361

6) Available from the BACP directly or via their website: IN\NW.bacp.co.uk. The National Register of Hypnotherapists and Psychotherapist's 15 point Codes of Ethics and Practice (IN\NW.nrhp.co.uk) the Neuro Linguistic Psychotherapy & Counselling Association's Code of Ethics and Conduct (IN\NW.nlptca.com) and the Institute of Clinical Hypnotherapy & Psychotherapy's Article of Association, Code of Ethics, Practice and Standards (IN\NW.hvpnosiseire.com) were also consulted.

7) The statutory regulation details and timetable were announced by Rosalind Meade from the Department of Health in September 2004. The regulation will have three other functions beside ethical considerations: to establish training standards, to keep a register of those who meet the standards so that only registrants may use protected titles, and to provide a mechanism for dealing with those registrants who no longer meet the required standards. See the NCHP's Christmas 2004 newsletter pgs 1, 3, 4


9) Kent R (2003) Can Therapists be taught to be Ethical? Counselling and Psychotherapy Journal March 2003Nol14 No. 2 pgs 18-21

10) BACP Ethical Principles of Counselling and Psychotherapy pg 2

11)Evans M (2003) Christian Counsellors' Views on Working with Gay and Lesbian Clients Counselling and Psychotherapy Research March 2003NoI 3 No. 1 pgs 55-60

12) Gibbons C (2003) Client Discloses Act of Euthanasia Counselling and Psychotherapy Journal
August 2003Nol14 No. 7 pgs 35-37

 

 

 
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