Ethics in Psychotherapy and Counseling. Kenneth S. Pope
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professional status was not created or defined by charging high fees, spending long years in training, or reaching a high level of skill. The professional’s defining characteristic was an ethic of placing the client’s well-being foremost and not allowing professional judgment or services to be drawn off course by one’s own needs and wants. A major purpose of professional ethics codes is to help us use our knowledge, skills, status, and other forms of powers to help our clients and not to take advantage of, endanger, cheat, undermine, abuse, or otherwise mistreat or harm them. “Professional ethics protect the public against the abuses of professional power, specialized knowledge, and prominent positions. They place protecting the public interest above advancing the profession’s self-interest” (Pope, 2019, p. 186). Professional ethics help keep us from being biased or blinded by our own self-interest so that we can no longer see clearly or care about our clients, their legitimate interests, and our responsibilities to them.
The touchstone for the approaches discussed in this book is caring for and about our clients. This book’s concept of caring avoids passive, empty sentimentality. Caring includes responding to a client’s legitimate needs and recognizing that the client must never be exploited. Caring also includes assuming personal responsibility for working to help and to avoid harming or endangering our clients. Caring involves learning to contextualize experiences and realities that may be completely different from our own so that we do not pathologize, misdiagnose, or misattribute behaviors that may be culturally congruent or blaming our clients for their reactions to oppression. Furthermore, caring means that we work on addressing our biases and prejudices as a way to ensure that we are able to treat all of our clients with the same level of respect and dignity. Caring is being a healing presence in the lives of those we serve.
Unfortunately, the concept of caring may not receive adequate attention in graduate training programs. As Seymour Sarason (1985) wrote:
On the surface, trainees accept the need for objectivity—it does have the ring of science, and its importance can be illustrated with examples of the baleful consequences of “emotional over-involvement”—but internally there is a struggle, as one of my students put it, “between what your heart says you should say and do and what theory and your supervisor say you should say and do.” Many trainees give up the struggle but there are some who continue to feel that in striving to maintain the stance of objectivity they are robbing themselves and their clients of something of therapeutic value. The trainee’s struggle, which supervisors gloss over as a normal developmental phase that trainees grow out of, points to an omission in psychological-psychiatric theories. Those theories never concern themselves with caring and compassion. What does it mean to be caring and compassionate? When do caring and compassion arise as feelings? What inhibits or facilitates their expression? Why do people differ so widely in having such feelings and the ways they express them? It is, of course, implicit in all of these theories that these feelings are crucial in human development, but the reader would be surprised how little attention is given to their phenomenology and consequences (positive and negative) (p. 168).
Sarason made some excellent recommendations for how to encourage and develop caring, compassion, and empathy in clinical training programs, and more recently other innovative approaches have begun to emerge (see, for example, Condon & Makransky, 2020; Fragkos & Crampton, 2020; Han & Kim, 2010).
We still have a long way to go in ensuring that clinical training programs, internships, professional organizations, clinics, hospitals, and other settings are doing all they can to support caring, compassion, and empathy among clinicians. Unfortunately, there is evidence that such qualities may actually decline in some settings (see, for example, Hegazi & Wilson, 2013; Hojat et al., 2004, 2009). In “Empathy Decline and Its Reasons: A Systematic Review of Studies with Medical Students and Residents,” Neumann and her colleagues noted that the evidence of declines of empathy over the course of medical training, they describe:
Some of the studies included in our review reported significant increases in cynicism among medical students. Crandall et al. also found students’ commitment to caring for medically underserved patients to be greater when they entered medical school than at graduation. This result was independent of gender and curriculum type (problem-based versus traditional; Neumann et al., 2011).
Caring about clients and what happens to them is at the heart of the formal rules and regulations that are society’s attempt to hold us accountable, of our professional ethics codes, and of our personal ethical responsibilities to each patient.
Chapter 6 COMPETENCE, HUMILITY, AND THE HUMAN THERAPIST
When patients seek our services, they hope we know how to help them. Ethical practice hinges on competence, including our ability to use our skills effectively to help our clients heal and cope with the challenges they face. Society gives us the power and privileges to help our clients, while holding us accountable for competence through the courts and licensing boards.
Cynthia Belar (2009) discusses our ethical responsibility to train competent psychologists and to maintain our own competence as our “social contract.” She emphasizes that a central question for our training programs
is whether we are producing what we say we are producing—a psychologist competent for entry to practice. This question comes from prospective students, prospective employers, and the public. Indeed our social contract with the public as an independent profession requires that we self-regulate in these matters (p. S63).
The importance of that social contract was emphasized by The European Association of Clinical Psychology and Psychological Treatment (EACLIPT) Task Force on Competences of Clinical Psychologists (2019): “Politicians, societies, stakeholders, health care systems, patients, their relatives, their employers, and the general population need to know what they can expect from clinical psychologists” (p. 1).
Some patients may expect magic. For them, competence means that we can guarantee results, act flawlessly, and meet all needs. While this superhero, shero, or theyro role can be tempting, and some of us find it difficult to turn down potential worshippers, it is not realistic. We don’t have a magic wand that can disappear our clients’ distress, pain, and difficulties. Unfortunately some therapists indulge their ego and take up residence in this delusional state.
This chapter is a reminder that as therapists, we are all human and imperfect. We all have weaknesses, blind spots, and biases, as well as strengths, abilities, and insights. Hence, it is important for us to keep a healthy dose of humility.
Failures of competence often spring from our human vulnerabilities. We face temptations, pressures, distractions, demands, and countless other forces. These forces can weaken our ability to know the limits of our competence and can sometimes block our ability to act effectively altogether. Consider, for example, the ways in which we have been socialized to respond to members of various groups. Unless challenged, this socialization affects our attitudes, beliefs, biases, and prejudices which may impact our competence to provide therapy or counseling to members of diverse groups. In addition, each of us has our own personal history, individual experiences, and an array of group-based reactions which can also impact our competence. See if the following self-assessment turns up any challenges to competence for you. Imagine you are in your office and a new patient walks in. Set aside for the moment whether you have training to work with a member of the group. Focus only on whether the patient’s membership in a specific group evokes any reactions in you that might weaken your competence to welcome, become interested in, listen openly to, empathize with, and create a positive working relationship with them. Also, consider how you may respond if you are a member of a social group that has a history of being harmed by the new client’s social group (Chapters 7 and 23 provide more discussion). The array of patients you meet may include:
A rich, young White man dressed in designer clothing and speaking in a condescending tone of voice.
An extremely aggressive malpractice attorney who rarely loses a case, specializes