Transactional Analysis Journal

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A Transactional Analysis Decision-Making Model

and Ethical Hierarchy

Valerie Nash Chang

To cite this article: Valerie Nash Chang (1994) A Transactional Analysis Decision-
Making Model and Ethical Hierarchy, Transactional Analysis Journal, 24:1, 15-20, DOI:
10.1177/036215379402400104

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 A Transactional Analysis Decision-Making
Model and Ethical Hierarchy
Valerie Nash Chang
Abstract
Making ethical decisions is often difficult.
This article discusses a five-step process that
moves from identifying a problematic situa-
tion, to determining its professional rele-
vance, and then to sorting out the differences
between ideals, values, and ethics. The last
steps relate to legal duties and ethical obliga-
tions. Even with this type of thorough con-
sideration, problems may stiD exist because
there are frequent conflicts between ethical
obligations and between ethical obligations
and legal duties. Using a hierarchy of ethics,
some of these dilemmas can be resolved. A
hierarchy of TA ethics and legal duties is
proposed.
Decisions related to ethics are often complex
and difficult, in part because there are so many
issues to consider and so many possible conse-
quences for colleagues, clients, and trainees.
In an attempt to address some of these dif-
ficulties, this article discusses a decision-
making model that includes an ethical
hierarchy.
There are five steps in this process. First, the
problematic situation is clearly identified. Sec-
ond, one decides whether the behavior has pro-
fessional relevance. If it does, then one moves
to the third step and considers whether it is in
violation of personal and professional ideals and
values. If the behavior still appears to be
possibly unethical, then one critically evaluates
whether it is in violation of legal obligations,
step four, or ethical obligations, step five. This
five-step model is useful as a training tool and
in supervision, as well as when facing ethical
dilemmas in one's own practice.
Step One: Identify the Behavior
Using this model, the first step is to identify
the specific behavior, action, or decision that
Vol. 24, No. I, January 1994
may be unethical. Following this, a series of
areas are evaluated in order to arrive at a defen-
sible decision about what action to take.
Step Two: Determine Professional Relevance
After identifying the behavior, the second
step is to decide whether the behavior in ques-
tion has professional relevance, that is, does it
in some way pertain to the individual's profes-
sional role. Usually this decision is fairly sim-
ple, but sometimes even professional relevance
can become an area of question. For example,
one small-town newspaper publishes a list of
arrests that take place there. Many people read
and discuss these lists. One Saturday night, a
therapist was arrested for driving under the in-
fluence of alcohol. This professional worked
primarily with teenagers who had problems
with legal authorities. His agency believed that
many of these adolescents and their parents
would read about the arrest. After considerable
discussion, it was decided that although this
professional was not working at the time of the
arrest, he was a role model at all times and
should not be working with adolescents until
he could maintain better self-control.
Step Three: Differentiate Personal and/or
Professional Ideals and Values
Having decided that the behavior is profes-
sionally relevant, the third step considers
whether it violates personal or professional
ideals and values about how people should act
and how they should treat each other.
Starting with personal ideals, psychothera-
pists sometimes confuse behavior that is incon-
sistent with their personal ideals or standards
with behavior that is unethical. For example,
when a client tells me about a family therapist
who was seen yelling at his young children, I
might think this behavior had professional
relevance because it is a public display of
15
VALERIE NASH CHANG
behavior the therapist tells his clients not to use.
The behavior is also in violation of my personal
standards, but a review of the ITAA Statement
of Ethics (ITAA, 1992) would show that it is
not unethical.
It is often more complicated to consider pro-
fessional values. Values can be defined as
learned preferences that are thought of as im-
portant and that are put into operation
behaviorally. In a discussion with several trans-
actional analysts, we identified three core
assumptions that function as central values in
transactional analysis. The first is that people
are born OK or acceptable, so one should in-
teract from a position of "I'm OK-You're
OK" (Berne, 1972). This principle underlies
many therapeutic practices, such as valuing
straight communication and avoiding game in-
vitations and parental directives. Second,
clients are capable of understanding their prob-
lems and should be actively involved in their
healing (Steiner, 1974). These values establish
the type of working relationship TA therapists
are supposed to develop. The third core
assumption is that people can take charge of
their lives, are responsible for the creation and
maintenance of their life plans, and can make
cognitive, affective, and behavioral changes
(Goulding & Goulding, 1978). This principle
or value has been put into operation behavioral-
ly in many TA techniques and is often discussed
in the TA literature. The use of contracts,
which is based on these three values, is central
to TA therapy. Working within contracts
developed by the therapist and the client honors
the client's OKness and his or her capacity to
understand and to take responsibility. It also
creates an expectation of change.
Sometimes questionable behavior is in viola-
tion of professional values, but not in violation
of ethics. For example, if a therapist consistent-
ly treats clients from a one-up position, acting
as if clients cannot understand the process of
their therapy, this behavior is in violation of
TA values, but it is not unethical.
Professional ideals are imagoes about how
good therapists should act. Often these are
created as a trainee identifies with her or his
image of the trainer. This idealized image
becomes the standard for professional behavior.
As the trainee matures and becomes more
aware of the complexities of being a therapist,
she or he should develop a broader and more
16
realistic good-enough standard and realize that
even that standard cannot be consistently main-
tained and should be in process as new infor-
mation becomes available.
What if there is a question about the effect
of alcohol or other drugs on one's work with
clients? Or what if a Certified Transactional
Analyst (CTA) seems to be taking on too many
clients and/or too many responsibilities and is
stressed, overworked, and/or burned out and
thus functioning within the basic valued
behavior patterns but without energy or en-
thusiasm, possibly providing less than optimal
treatment to clients? Certainly these behaviors
fall below professional ideals for CTAs-but
is the behavior unethical? In such cases, if the
therapist's limitations are not causing harm to
clients, then the behavior may not be unethical.
However, if the therapist's behavior is the
possible cause of harm to clients, one should
continue on to step four.
Another example of the difference between
professional ideals and ethics is the question
many feminists are raising about therapists who
reinforce gender stereotypes in their work
(Bricker-Jenkins & Hooyman, 1989; Dominelli
& McLeod, 1989; Goodrich, 1991; Goodrich,
Rampage, Ellman, & Halstead, 1988; Walters,
Carter, Papp, & Silverstein, 1988). Reinforc-
ing gender stereotypes is in clear violation of
my professional ideals, but it is not unethical.
It is possible to treat someone as responsible
and OK while consciously or unconsciously
supporting patriarchal gender stratification and
limitations.
Confronting behavior that violates profes-
sional ideals or values in oneself, a colleague,
or a trainee is appropriate and can be the begin-
ning of helping that individual resolve the prob-
lem. This intervention should clearly identify
the less-than-ideal behavior and point out possi-
ble consequences of continuing the behavior.
Use of this model helps one to be clear about
the level of the problem and thus to choose an
appropriate level of intervention.
Step Four: Consider Legal Duties
Having determined that a behavior is profes-
sionally relevant and is in violation of profes-
sional ideals or standards and professional
values, the fourth step is to decide whether it
constitutes a breach of the therapist's legal
duties. There are six clearly identified legal
Transactional Analysis Journal
 A TRANSACTIONAL ANALYSIS DECISION-MAKING MODEL AND ETHICAL HIERARCHY
duties for helping professionals in the United
States (Everstine & Everstine, 1983). Although
legal duties are not the same throughout
the world, and professionals in other countries
need to identify legal duties that apply to them,
there is considerable agreement on certain
points.
Two of the duties relate to the protection of
clients and others. The first is the duty to care.
This includes making an assessment and
developing a treatment plan based on sound
theoretical and professional judgment, being
available to clients in emergencies (including
having coverage when one is away), taking ap-
propriate action to protect clients who might
hurt themselves, consulting with or referring
to a more experienced therapist or a specialist
when appropriate, and using good judgment
when terminating treatment (Cournoyer, 1991).
The second legal duty is to warn. If a client
reveals an intention to harm another person,
one must determine if it is a serious threat. If
you believe the threat to be serious, you must
arrange for protection, such as having the client
hospitalized and/or warning the intended vic-
tim(s) and a law enforcement agency (Mills,
Sullivan, & Eth, 1987).
The next four duties relate to information
management. The third duty is to respect the
privacy of clients and not to use professional
authority to gain information that is un-
necessary for the client's treatment.
The fourth duty is to maintain confidentiali-
ty. If therapists fail to advise clients of con-
fidentiality rules or they break:those rules, they
can be sued for negligence (Corey, Corey, &
Callanan, 1988). Group therapists have an ad-
ditional duty because they can be held legally
liable if a group member breaks confidentiali-
ty; however, as of 1989, there has been no
litigation on this issue (pardise & Kirby, 1990).
The fifth duty is to inform. This involves in-
forming clients about the nature, cost, probable
length, risks, and alternatives to treatment be-
ing offered and notifying them about laws
related to service, such as the requirement to
report child abuse and, in many areas, elder
abuse. In many states in the United States,
therapists are also required to tell clients about
their qualifications and areas of training (Cour-
noyer, 1991).
The sixth legal duty is to report such activities
as child abuse, neglect, molestation, and elder
Vol. 24, No.1, January 1994
abuse and neglect, as well as exploitation of the
mentally retarded and disabled.
Unfortunately, when fulfilling one of these
duties-such as the duty to warn-one may be
breaching another duty, that is, to maintain con-
fidentiality. In spite of this dilemma, failure to
follow these legal duties has resulted in lawsuits
against therapists (Besharov & Besharov,
1987).
There are also cases in which a legal duty
is in conflict with an ethical obligation. For ex-
ample, in keeping with Indiana law, I must in-
form the appropriate authorities if a child is be-
ing abused or is at serious risk for abuse. By
doing so, I violate ethical statements regarding
confidentiality (ITAA [1992) Statement of
Ethics, Number 8) unless I inform my clients
of the limits of confidentiality. Another exam-
ple involves a client whom I believe to be a
serious suicide risk and from whom I am unable
to get a no-suicide contract. Following the du-
ty to care rules, I inform a relative of the poten-
tial problem in the hope that this person can
help me to care for the client. However, this
breaches obligations of confidentiality. There
have been cases in which clients-who claimed
they were not at serious risk-have sued
therapists for negligence related to breach of
confidentiality.
Step Five: Assess Ethical Obligations
Having moved through the previous four
steps, the final step involves determining
whether a behavior is in conflict with an ethical
obligation. For a transactional analyst, this
means evaluating the behavior in relation to the
ITAA Statement of Ethics, although conflict
among ethical obligations are also common
(Callahan & Bok, 1980; Laken, 1988; Reamer,
1982). How can such conflicts be resolved?
Some professional organizations are creating
a hierarchy of ethical obligations to assist pro-
fessionals in situations in which ethical conflicts
arise (Loewenberg & Dolgoff, 1982). With the
help of a hierarchy, the professional first iden-
tifies relevant ethical and legal duties. If con-
flicts occur, he or she can use the hierarchy to
determine the stronger or higher obligation and
then act accordingly (Cournoyer, 1991).
Hierarchy for the ITAA Statement of Ethics
I think it would be helpful if we in the ITAA
created a hierarchy related to the ITAA
17
VALERIE NASH CHANG
Statement of Ethics. Presently any ITAA
member or group of members can decide on
a hierarchy to follow. However, if a hierarchy
is given some authority by the organization as
a whole, it will be useful not only in helping
transactional analysts make ethical decisions,
but also in training and supervision. It would
probably also be helpful in possible legal or
ethical challenges. Toward this end, I am pro-
posing a hierarchy.
The development of this hierarchy began dur-
ing ethics seminars with my training group.
First, I divided the ITAA Statement of Ethics
into three headings to promote easier use of the
document. The headings are in order of impor-
tance: ethical philosophy first, followed by
responsible provision of services, and then
responsibility to colleagues and the profession.
Within each heading, I ranked each ethical
statement so that, in a conflict, the first state-
ment would take priority over the second, and
so on. In addition, the directives in the first
statement should be followed before going on
to the next statement. All statements in quotes
are from the latest version of the ITAA State-
ment of Ethics (1992).
Ethical Philosophy
1. "Members of the ITAA should strive to
develop in their clients awareness of and func-
tioning from a position of dignity, autonomy,
and personal responsibility."
2. "The ethical practice of Transactional
Analysis involves entering into an informed
contractual relationship with a client which the
member of the ITAA and the client should have
the competence and intent to fulfill. When a
client is unable or unwilling to function
autonomously and responsibly within this con-
tractual relationship, the member of the ITAA
must resolve this relationship in such a way as
to bring no harm to the client."
3. "An ITAA member acknowledges the
dignity of all humanity regardless of
physiological, sociological, or economic
status. " (I would add the duty to care and the
duty to warn at this level of importance.)
Using this proposed hierarchy in work with
a possible suicide threat, the ITAA member
would first strive to facilitate the client func-
tioning with personal responsibility. The next
goal would be a no-suicide contract that the
therapist believed the client was willing and
18
able to fulfill. If these things could not be ade-
quately achieved, the therapist would move on
to fulfilling the duty to care, possibly by ar-
ranging for hospitalization.
Responsible Provision of Services
4. "Members of the ITAA will not enter in-
to or maintain a professional contract where
other activities or relationships between ITAA
members or clients might jeopardize the pro-
fessional contract. " (If the ITAA adds a state-
ment about dual relationships [for an interesting
discussion of this issue see Ryder & Hepworth,
1990] and/or boundary problems [covered well
by Peterson, 1992], it would fit at this point.)
5. "It is the primary protective responsibili-
ty of members of the ITAA to provide their best
possible services to the client and to act in such
a way as to cause no intentional or deliberate
harm to any client."
6. "A member of the ITAA will not exploit
a client in any manner, including, but not
limited to, financial and sexual matters. Sex-
ual relations between ITAA members and their
clients are prohibited."
7. "If members of the ITAA become aware
that personal conflicts or medical problems
might interfere with their ability to carry out
a contractual relationship, they must either ter-
minate the contract in a professionally respon-
sible manner, or ensure that the client has the
full information needed to make a decision
about remaining in the contractual relation-
ship." (I would add the duty to inform at this
level of importance.)
8. "Members of the ITAA will operate and
conduct services to clients with full respon-
sibility to existing laws of the state and/or coun-
try in which they reside. " (The duty to report,
of course, is part of this ethical obligation.)
9. "In establishing a professional relation-
ship, members of the ITAA assume respon-
sibility for providing a suitable environment,
including such things as specifying the nature
of confidentiality observed, providing for
physical safety appropriate to the form of ac-
tivity involved, and obtaining informed consent
for high-risk procedures. " (The duty to main-
tain confidentiality is part of this statement.)
10. "The professional relationship between
a member of the ITAA and the client is defined
by the contract, and that professional relation-
ship ends with the termination of the contract.
Transactional Analysis Journal
 A TRANSACTIONAL ANALYSIS DECISION-MAKING MODEL AND ETHICAL HIERARCHY
However, certain professional responsibilities
continuebeyond the termination of the contract.
They include, but are not limited to, the follow-
ing: a) maintenance of agreed-upon confiden-
tiality; b) avoidance of any exploitation of the
former relationship; c) provision for any need-
ed follow-up care. "
Because the relationship is defined by the
contract, the duty to respect privacy in areas
not related to the contract is implied.
Responsibility to Colleagues
and to the Profession
11. "Members of the ITAA accept respon-
sibility to confront a colleague whom they have
reasonable cause to believe is acting in an
unethical manner, and, failing resolution, to
report that colleague to the appropriate profes-
sional body."
12. "Members of the ITAA shall in their
public statements, whether written or verbal,
refrain from derogatory statements, inferences
and/or innuendoes that disparage the standing,
qualifications, or character of members, bear-
ing in mind their responsibility as represen-
tatives of the ITAA and of Transactional
Analysis. ' ,
I would include in the hierarchy the follow-
ing statement, which has been recommended
but not officially adopted by the ITAA.
13. Professional members of the ITAA will
demonstrate a commitment to continued pro-
fessional and personal development and will
keep current in their areas of expertise through
activities such as training workshops, con-
ferences, formal coursework, professional
writing and reading, and involvement in pro-
fessional organizations.
Utilitarian Theory
Even with the help of a hierarchy and the use
of a contractual approach that emphasizes duties
and obligations, it will not always be possible
to decide which principle or duty to honor
(Rawls, 1971; Woody, 1990). In such cases,
utilitarian theory can be the basis for critical
analysis and a defensible decision. Utilitarian
theory defines a good decision as one that
results in the greatest good to the greatest
number of persons who are affected by the deci-
sion (Hare, 1981; Smart & Williams, 1973).
One must give equal weight to all and not give
special consideration to one's client or one's
Vol. 24, No.1, January 1994
friend. Using this theory is difficult because it
requires not valuing self-interest above the in-
terest of others, imagining the effect on each
person, and predicting future outcomes
(Woody, 1990). Negative utilitarianism states
that in a conflict one should minimize harm to
the greatest number of people. With this
method, minimizing harm takes precedence
over maximizing happiness, pleasure, good, or
possibilities for intimacy, spontaneity, and
autonomy. Either the ITAA or individual TA
therapists must decide which of these theories
to follow.
As professionals we must understand and ac-
cept the values of our profession, follow legal
duties and ethical obligations, and have a
system for ethical decision making that is
workable even in the face of conflicting
demands. The hope is that as we strive to
develop a system for resolving ethical dilem-
mas, we will both heighten our consciousness
about ethical issues and improve the quality of
the services we provide to our clients.
Valerie Nash Chang, Ph.D., is an ITAA
Clinical Supervising and Teaching Transac-
tional Analyst. She is an Associate Professor
ofSocial Work at Indiana Universityand main-
tains a private practice in Indianapolis. Please
send reprint requests to Dr. Valerie Chang,
5354 North Kenyon Drive, Indianapolis, IN
46226.
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