ETHICAL ISSUES

Ethics is the branch of philosophy that concerns morality—questions of right and wrong. What a society considers ethical hinges on its beliefs about what is most important; thus ideas about ethics vary across times, cultures, and subcultures. 

 Professional codes of ethics attempt to govern the conduct of members of a profession by promulgating certain rules on which the framers of these codes can agree.  Their agreement is based on shared beliefs and values, including shared ideas about the goals of the profession. 

 At present, the practice of psychoanalysis is governed by professional codes of ethics in psychology, psychiatry, counseling, and social work.  Key assumptions shared by the framers of these codes are that persons who seek psychotherapy are ill or disordered and that the goal of therapy is to cure them.  Many things follow from these assumptions.  Increasing numbers of psychoanalytic practitioners in the United States and elsewhere do not share these assumptions and therefore may not view the rules enshrined in these codes as defining ethical practice for them.

 The Academy is interested in fostering a thoroughgoing rethinking of ethical issues in psychoanalysis. The papers presented here are intended to stimulate such debate.

ARTICLES ON ETHICAL ISSUES

Confidentiality of Mental Health Information: Ethical, Legal & Policy Issues: U.S. Surgeon General Report on Mental Health in America ( 1999 )

"Health care increasingly is delivered and paid for by for-profit corporations with business in many states. This shift has several relevant consequences. First, individual health care information may be held and disseminated far beyond the office of the practitioner providing care. Second, cost containment...[procedures] have resulted in increased demands for patient-specific information before care is approved. In addition, private health care information may be distributed for the purpose of marketing commercial products, such as pharmaceuticals, a growing business that many believe constitutes an improper use of such information....Finally, private health information is used to create much larger databases, for various purposes including treatment and research, thereby increasing the number of people with access to such information."

  EST, MCE, MCC: The Abbreviating of Psychology  Linda J. Young

"As I see it, the abbreviations in the title of this opinion piece are working to define and delimit the status quo in such a way that options and freedoms currently enjoyed and taken for granted are being significantly curtailed. Some of these forces are subtle, others less so. I fear that once in place within our political and professional landscape, they will have a half-life that far exceeds what can be easily envisioned now, and that our professional lives as clinicians will be foreshortened and abbreviated in all kinds of ways."

On the Duty of Civil Disobedience   Henry David Thoreau 

“Must the citizen ever for a moment, or in the least degree, resign his conscience to the legislator? Why has every man a conscience then? I think that we should be men first, and subjects afterward. It is not desirable to cultivate a respect for the law, so much as for the right. The only obligation which I have a right to assume is to do at any time what I think right.”

An Ethic of Free Association: Questioning a Uniform and Coercive Code of Ethics   Patrick B. Kavanaugh

An “ethic of free association recognizes, acknowledges, and appreciates that we are born into preexisting systems of meaning and signification. However, this understanding does not in any way abrogate nor remove notions of individual self-reliance…. The abridgement of this freedom and responsibility constitutes a deep and profound evil and does violence against the person.” 

On the Loss of Confidence in Psychoanalysis   Christopher Bollas

“The psychoanalyst is not simply custodian of psychoanalysis. For better or for worse, wished for or not, the psychoanalytical profession is guardian of a social right – the right to speak one's mental life assured that such disclosure will be held in strictest confidence–that will need continuous representation within the dynamic vicissitudes of a free society.  It is time to take a stand”

Mandatory Continuing Education (MCE)- Industrializing and Deprofessionalizing Psychology    Patrick B. Kavanaugh

"Once again, an essential question is posed to each member of our profession: At what cost do we limit our collective response to adapting to the redefinitions of our profession by policymakers, legislative action, and bureaucratic decision-making? The industrialization of the professions is an ongoing process; as a healthcare profession, psychology is continuously at risk. In the forefront of such risks at this time is the threat to professional autonomy and judgment posed by the regulation of our educational activities."

Mandatory Continuing Education (MCE)- The Question of Ethics and Ethical Discussions in the Psychological Community - Patrick B. Kavanaugh, Ph.D.    Patrick B. Kavanaugh

"This new image and role of the psychologist as a participant-observer is guided by an ethic that could be stated as follows: the psychologist has a moral and ethical obligation to watch over the profession of which (s)he is a member; to pre-serve and safeguard its essential and defining characteristics such as the exercise of individual discretionary judgment in professional activities; and, to oppose and counter those industrializing trends that impact the space in which a psychological discourse takes place (Kavanaugh, 2003, in press). It is this spirit and ethic that provided the impetus for the grass roots petition in Colorado and that underlies a similar effort in Michigan."

The Myth of Confidentiality   Judy C. Roberts

“In the current cultural climate, clinicians might actually do well to “Mirandize” their patients prior to their first session:  1. You have the right to remain silent. 2. Anything you say can and will be used against you…. I wonder how many patients would actually proceed with therapy?” 

Proposal for an Archive for the Preservation of Psychotherapy    Bernard McDowell

"In some cases, using the principle of  “respectable minority”, the courts have upheld the treatment methods of just a handful of practitioners.  In a much longer article cited below, I outlined the context for the value of a democratically maintained archive to protect appropriate therapy from corporate power.  Now, I propose a very modest beginning ... I would like to invite a dialogue of psychotherapists towards taking our collective responsibility to legally define therapy via petitions or an Archive--rather than leave it to corporate boardrooms. I suggest that with widespread cooperation, it would be extremely difficult for courts to outright dismiss a large group of professionals’ signed statements in favor of certain practices, especially if collated and registered in an on-line archive.  Imagine if 35 states had signed petitions like the one in Colorado ."  

Recommended Principles and Practices for the Provision of Humanistic Psychosocial Services: Alternative to Mandated Treatment Guidelines    Task Force for the Development of Practice Recommendations For the Provision of Humanistic Psychosocial Services

"Most versions of  'empirically supported treatments' (EST) guidelines are based on traditional natural science criteria, modified to appeal to business and governmental agencies which think in medical model terms. The criteria rank the randomized controlled clinical trial (RCT) at the top of a purported validity hierarchy of methods for evaluating psychotherapy. In addition, to be considered by supporters of the EST movement as an 'empirically supported treatment' a given therapy must have been validated in studies in which the therapy is manualized, and where the therapy is studied as a treatment for a particular problem or disorder. . . . Such criteria are biased towards certain types of therapies, and lists of empirically supported treatments have tended to exclude therapies which emphasize personal discovery and relationship, including many psychodynamic, feminist, constructivist, narrative, and family systems approaches, as well as humanistic therapies."

Thinking About Psychoanalytic Thinking- A Question(ing) of Identity, Purpose, and Ethics     Patrick B. Kavanaugh

"In recognition of the epistemological and theoretical pluralism of contemporary times, perhaps the question before us this weekend, What Is Psychoanalysis?,  might best be restated as: What is the particular concept and meaning of the psychoanalysis that is under consideration? And in that particular version of psychoanalysis, what are the implications for the Identity, the Purpose and the Ethics of the analyst in the lived experiences of everyday professional life? It seems to me that thoughtful and searching inquiry into this question begins with thinking ... thinking about psychoanalytic thinking. And more specifically, thinking about the assumptions underlying the Medical Model of psychoanalysis. Critical inquiry into these cherished assumptions has been most noteworthy by its absence in the analytic community."

Legal,  Ethical,  and  Professional  Issues  in  Psychoanalysis  and  Psychotherapy   

ACADEMY FOR THE STUDY OF THE PSYCHOANALYTIC ARTS