Thesis on "Professional Ethics and Potential Conflicts"

Thesis 7 pages (1765 words) Sources: 4 Style: APA

[EXCERPT] . . . .

Professional Ethics and Potential Conflicts

Introduces the subject matter of ethical issues in the therapist-

patient relationship. Distinguishes conduct prohibited outright by applicable ethical guidelines from that subject to subjective beliefs of the therapist. Introduces the typical classes of potential ethical violations and their respective sources of potential problems with respect to therapeutic goals.

Dual Relationships

Outlines the four types of dual relationships typically occurring in therapist-patient relationships: (1) double roles; (2) double professions; (3) double financial relationships; and (4) unavoidable dual relationships.

Emotionally Intimate of Sexual Relationships

Outlines those types of extra-therapeutic relationships that are strictly prohibited by ethical codes and penal law.

Boundary Issues

Explains the fundamental concept of boundaries in the context of psychological therapy. Distinguishes between boundary crossing and boundary violation.

Conclusion-

Summarizes the substance and conclusion of previous sections.

Abstract:

Ethical concerns are important throughout the medical professions, but the nature of psychological therapy gives rise to a wider range of ethical issues, partly because of the specific relationship dynamics that exist between therapist and patient. The natural process of psychological transference, the inherent power differential between therapist and patient, and the detrimental effects on future prospects for beneficial therapeutic results after failed therapeutic experiences arising from ethical violations are all important considerations. Various types of dual relationships have been addressed by formal APA ethical guidelines, based primarily on their conceivable potential for harming patients or undermining therapeutic efforts. Ultimately, most ethical issues come down to matters of psychological boundaries between therapist and patients, and in that regard, the principal distinction is between boundary crossing and boundary violation.

Introduction:

As with other professional fields, psychology is governed by strict ethical rules and codes of conduct that define appropriate standards of professional behavior. While all medical professionals take the Hippocratic Oath, in the field of psychology, the inherent nature of the doctor-patient relationship is more delicate and complex; it is also potentially susceptible to a wider range of conceivable negative outcomes for patients than comparable situations involving the delivery of physical medicine (Gerrig & Zimbardo, 2007). While this does not necessarily preclude every possible type of non-professional relationship between practitioners and patients, it does impose stricter criteria to justify them in terms of traditional ethical concepts of doctor-patient relationships (Gerrig & Zimbardo, 2007; Tong, 2007).

Generally, ethical concerns arise in professional psychology in the context of (1)

dual relationships; and (2) conflicting relationships. In most cases, there are also issues of degree or (different descriptive characterization) that distinguish incidental or superficial extra-therapeutic relationships from more extensive or blurred boundaries (Gerrig & Zimbardo, 2007). One formal standard is based on somewhat general principle of the practitioner's clinical objectivity and the concept of potential harm to the patient; another deals more directly with specific types of inappropriate relationships (Gerrig & Zimbardo, 2007; Tong, 2007).

Dual Relationship Issues:

Double role situations involve therapists who share another specific extra-therapeutic relationship with patients, such as those in the nature of academic advisor, social acquaintance, relative, or coworker (Zur, 2009). In principle, it may not be impossible, to negotiate both relationships simultaneously without undermining the quality of the therapist-patient relationship, as a practical matter, such dual relationship are inadvisable for several reasons. According to the American Psychological

Association

(APA) Ethical Standard 1.17:

"Psychologists must always be sensitive to the potential harmful effects of other contacts on their work and on those persons with whom they deal. A psychologist refrains from entering into or promising another personal, scientific, professional, financial, or other relationship with such persons if it appears likely that such a relationship reasonably might impair the psychologist's objectivity or otherwise interfere with the psychologist's effectively performing his or her functions as a psychologist, or might harm or exploit the other party."

Prevailing understanding of psychotherapy and other forms of psychological counselling suggests that the likelihood of adverse effects on the patient make double role situations extremely inadvisable (Pope & Vetter, 1992; Zur, 2009). More specifically, the natural dynamics of psychological transference in long-term psychological therapy is extremely easy to disrupt or change in ways that undermine effective treatment and the best interests of the patient.

Second, the inherent power differential that exists in the realm of psychological therapy is not readily compatible with extra-therapeutic relationships between therapist and patient. Third, even where the therapist is vigilant in recognizing any potentially harmful situation and terminates the therapeutic relationship, the patient is invariably harmed by virtue of closing the door of a successful therapeutic course. In addition, such resolution exposes the patient to detrimental effects of abandonment issues in the context of therapy that could easily reduce the patient's ability to establish the necessary relationships with new therapists necessary to achieve the goals of treatment (Pope & Vetter, 1992; Zur, 2009).

Double profession issues are those where the therapist and patient share other professional relationships besides the professional therapist-patient, such as where the therapist is also the patient's lawyer or accountant (or vice-versa). Together with the principles and prohibitions in APA Ethical Standard 1.17, two other provisions (1.18 and

1.25) provide additional guidance in that regard. Specifically, they address situations where the nature of the second professional relationship is harmful to the patient or where it presents potential for conflicts of interest or exploitation of the patient.

In that regard, certain arms-length, straightforward business transactions may be benign (such as where one of the individuals involved merely prepares taxes or other impersonal services, especially where the second industry is also strictly governed by formal ethical rules designed to protect the integrity of the professional relationship). On

the other hand, practitioners may not ethically maintain double professional relationships where any potential exists for the interests arising from objectives or aspirations in the second professional relationship to be conducive to exploitation or inappropriate intermingling of affairs (Pope & Vetter, 1992; Zur, 2009).

Finally, with respect to potentially permissible dual relationships are those that are unavoidable (Zur, 2009). Typically, therapists working in very small communities whose inhabitants are more familiar with one another than in larger metropolitan communities may experience unavoidable dual relationships somewhat regularly. In those situations, the therapist must scrupulously respect patient confidentiality and the applicable provisions of the APA Code of Ethics to avoid potentially harmful relationships.

At the other end of the spectrum, some of dangerous types of relationships ethically prohibited by the applicable provisions of the APA Ethics Code are double financial relationships such as where the nature of the extra-therapeutic involvement commingles the affairs of therapist and patient, especially (but certainly not exclusively) where they share a monetary interest (Pope & Vetter, 1992; Zur, 2009).

Typical examples of impermissible double financial relationships would include direct employment, collaborative investing, or any bartering situation in which the therapist accepts any non-monetary payment for therapeutic services rendered (Gerrig & Zimbardo, 2007; Zur, 2009). Again, the inherent power differential between therapist and patient and the natural evolution through the psychological transference phenomenon raise tremendous issues of exploitation at worst, and compromised effectiveness of therapeutic goals at best in virtually all of such situations (Pope & Vetter, 1992).

Emotionally Intimate or Sexual Relationships:

While certain types of potentially benign dual relationships are discouraged but not strictly prohibited, others are absolutely antithetical to the therapist-patient relationship, such as any sexual relationship. Even many seemingly benign dual

relationships are strongly discouraged because the potential for harm to the patient may not always be capable of being perceived accurately by the therapist in connection with evaluating their affects on therapeutic objectivity (Zur, 2009).

Naturally, to whatever extent transference issues, power differentials, and potential for exploitation exists by virtue of extra-therapeutic relationships, none is more directly harmful than sexual (or other emotionally intimate personal) relationships (Pope & Vetter, 1992; Zur, 2009). That is precisely why they are strictly prohibited both by formal APA guidelines as well as by criminal statutes (Gerrig & Zimbardo, 2007; Pope & Vetter, 1992; Zur, 2009).

Distinguishing Boundary Crossing from Boundary Violations:

In principle, when it comes to ethical concerns that are not necessarily prohibited by the APA Code of Ethics outright, the controlling issue frequently involves the concept of boundaries (Pope & Vetter, 1992; Zur, 2009). More specifically, they are determined by the fundamental distinction between boundary crossing and boundary violations (Pope & Vetter, 1992; Zur, 2009). Ordinarily, boundary crossing is not necessarily unethical, although it is always the responsibility of the therapist to make sure to maintain the appropriate distance that distinguishes one from the other. For example, exchanges of pleasantries (such as small appropriate and inexpensive gifts), attendance at commemorative events, and token gestures or even non-sexual hugs or other such displays of empathy are boundary crossings that are not necessarily boundary (and therefore ethical) violations (Zur, 2009).

In fact, in many cases, certain types of therapeutic processes may actually require activities between therapist and patient that ordinarily would raise legitimate ethical issues. For example, the treatment of anorexia or bulimia could conceivably require a therapist to join a patient for lunch at a public restaurant. Meanwhile, the same arrangement for social… READ MORE

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