Professional Documents
Culture Documents
Full download The Oxford Handbook of Psychotherapy Ethics Trachsel file pdf all chapter on 2024
Full download The Oxford Handbook of Psychotherapy Ethics Trachsel file pdf all chapter on 2024
https://ebookmass.com/product/the-oxford-handbook-of-ethics-and-
economics-white/
https://ebookmass.com/product/the-oxford-handbook-of-ethics-and-
art-james-harold/
https://ebookmass.com/product/oxford-handbook-of-medical-ethics-
and-law-anna-smajdor/
https://ebookmass.com/product/the-oxford-handbook-of-the-history-
phenomenology-oxford-handbooks/
eTextbook 978-1305089723 Ethics in Counseling &
Psychotherapy
https://ebookmass.com/product/etextbook-978-1305089723-ethics-in-
counseling-psychotherapy/
https://ebookmass.com/product/the-oxford-handbook-of-daniel-
defoe-oxford-handbooks-seager/
https://ebookmass.com/product/the-oxford-handbook-of-religious-
space-jeanne-halgren-kilde-2/
https://ebookmass.com/product/the-oxford-textbook-of-clinical-
research-ethics-reprint-edition/
https://ebookmass.com/product/the-oxford-handbook-of-polling-and-
survey-methods-oxford-handbooks/
OUP CORRECTED AUTOPAGE PROOFS – FINALS, 27/05/21, SPi
OUP CORRECTED AUTOPAGE PROOFS – FINALS, 07/06/21, SPi
T h e Ox f o r d H a n d b o o k o f
PSYC HOT H E R A PY
ET H IC S
OUP CORRECTED AUTOPAGE PROOFS – FINALS, 07/06/21, SPi
Oxf ord
H a ndb o ok s
in Philo sophy
a nd P sychiat ry
PSYCHOTHERAPY
ETHICS
Edited by
MANUEL TRACHSEL,
JENS GAAB,
NIKOLA BILLER-ANDORNO,
ŞERIFE TEKIN
and
JOHN Z. SADLER
1
OUP CORRECTED AUTOPAGE PROOFS – FINALS, 07/06/21, SPi
1
Great Clarendon Street, Oxford, ox2 6dp,
United Kingdom
Oxford University Press is a department of the University of Oxford.
It furthers the University’s objective of excellence in research, scholarship,
and education by publishing worldwide. Oxford is a registered trade mark of
Oxford University Press in the UK and in certain other countries
© Oxford University Press 2021
The moral rights of the authors have been asserted
First Edition published in 2021
Impression: 1
All rights reserved. No part of this publication may be reproduced, stored in
a retrieval system, or transmitted, in any form or by any means, without the
prior permission in writing of Oxford University Press, or as expressly permitted
by law, by licence or under terms agreed with the appropriate reprographics
rights organization. Enquiries concerning reproduction outside the scope of the
above should be sent to the Rights Department, Oxford University Press, at the
address above
You must not circulate this work in any other form
and you must impose this same condition on any acquirer
Published in the United States of America by Oxford University Press
198 Madison Avenue, New York, NY 10016, United States of America
British Library Cataloguing in Publication Data
Data available
Library of Congress Control Number: 2020952081
ISBN 978–0–19–881733–8
Printed and bound in the UK by
TJ Books Limited
Links to third party websites are provided by Oxford in good faith and
for information only. Oxford disclaims any responsibility for the materials
contained in any third party website referenced in this work.
OUP CORRECTED AUTOPAGE PROOFS – FINALS, 07/06/21, SPi
To all those who seek help and support through psychotherapy, and to those
who seek to provide it to the best of their knowledge and ability.
OUP CORRECTED AUTOPAGE PROOFS – FINALS, 07/06/21, SPi
OUP CORRECTED AUTOPAGE PROOFS – FINALS, 07/06/21, SPi
Foreword
Bruce E. Wampold, Ph.D.
Madison, WI, USA
Professor Emeritus, University of Wisconsin—Madison
and Senior Researcher, Research Institute, Modum
Bad Psychiatric Center, Vikersund, Norway
In an evidence-based world, the emphasis in health services is on finding the most effective
treatment for a particular disorder. In the latest iteration of the application of evidence to
improve health, the notion of personalized medicine has been introduced, turning the
focus on what is the most effective treatment for this particular patient with this particular
disorder. In many ways this has been a technological endeavor, with attempts to increase
longevity by days, it seems, and mortality by minute percentages. In this technological
effort to make incremental advances by focusing on treatments, or even for treatments for
individual patients, the patient and their context are secondary, if not ignored. Lip service
is paid to patient preferences and the “psycho” and “social” aspects of the biopsychosocial,
but the person as an agentic participant is too frequently ignored.
If health service is to retain the essence of healing practices, with a respect for the patient,
health care ethics must be central to all aspects of health systems. Ethical considerations are
not simply “add-ons” to satisfy society’s demands for such services—rather they should be
endemic to the study of services, to the training of clinicians, to the delivery of services, to
the evaluation of quality—all aspects of health services must be saturated with a consider-
ation of ethics. This is an imperative for an effective health care system—one that not only
demonstrates caring and respect for the patient, but one that is sustainable, is utilized by
those who need services, and effective. Too many mistakes in health care have been com-
mitted by ignoring ethics.
Much has been written about ethics generally and, despite the focus on treatments, in
health care specifically. Indeed, there is a name for the field in health care—bioethics. There
are bioethics academic programs (usually in medical schools), graduate degrees, and pro-
fessors of bioethics. There is a plethora of experts to comment on thorny problems in bio-
ethics that are raised in public.
Although bioethics is ubiquitous, the ethics of psychotherapy is neglected. This is quite
surprising, and frankly disturbing, because the practice of psychotherapy raises ethical
issues by its very nature. Psychotherapy is an intimate relationship between two persons but
a very specialized one—and this raises a host of ethical issues. Moreover, each type of ther-
apy creates a different type of relating. In each, the therapist takes a different stance.
OUP CORRECTED AUTOPAGE PROOFS – FINALS, 07/06/21, SPi
viii Foreword
This volume is a must read for everyone in the psychotherapy field: clinicians, educators,
trainees, researchers, policy makers, and managers of mental health care. Unless this
material is read and understood, we are “flying blind” when it comes to becoming ethical
professionals.
OUP CORRECTED AUTOPAGE PROOFS – FINALS, 07/06/21, SPi
Acknowledgements
Dr. Manuel Trachsel would like to thank his great fellow editors for their constant engage-
ment, support, and hard work in developing the present Oxford Handbook of Psychotherapy
Ethics over the last four years. I have very much enjoyed all the excellent discussions and
creative exchanges with them that made it such a pleasure to work on this groundbreaking
volume. I am also indebted to the members of my research group at the Institute of
Biomedical Ethics and History of Medicine (IBME) at the University of Zurich, where lively
debate on issues of medical ethics with my colleagues and my PhD and MD students has
been a source of ongoing delight. I am especially grateful to my mentor and role model
Nikola Biller-Andorno, who has provided constant and trustful support in shaping my
career. I am also grateful to the Swiss Academy of Medical Sciences for supporting my
research.
I could not have brought this work to fruition without tapping into the intellectual inspi-
ration provided by some great earlier thinkers, including Aristotle, Epicurus, Marcus
Aurelius, Michel de Montaigne, David Hume, John Stuart Mill, Søren Kierkegaard,
Arthur Schopenhauer, Friedrich Nietzsche, Jean-Paul Sartre, Albert Camus, William James,
Carl R. Rogers, and Irvin D. Yalom.
I thank my family and friends for their emotional support over the years, among them
my parents Elsbeth and Kurt, my sister Rahel, my nephews Joshua and Aaron, my parents-
in-law Elisabeth and Hansueli, my friends Gieri Maissen, Simon Lieberherr, Sebastian
Haas, Tobias Krieger, and Tobias Zürcher.
Finally, my wholehearted thanks to my wonderful wife Barbara, and to my children Liv,
Jon, May, and Eli.
OUP CORRECTED AUTOPAGE PROOFS – FINALS, 07/06/21, SPi
x Acknowledgements
Dr. Biller-Andorno would like to thank the wonderful administrative team of the Institute
of Biomedical Ethics and History of Medicine of the University of Zurich, who has been
tremendously helpful with the many searches, mails and calls that were needed to bring this
volume together. Special thanks to my children – Sophia, Leticia and Luca – , who are at the
same time relentless critics and a wonderful source of inspiration.
Dr. Sadler would like to thank his fellow editors for their creativity, collegiality, and hard
work. I also want to thank my steadfast and highly competent assistant, Ruth Vinciguerra,
for her help with this book and all the other goings-on in our office in the four years that
went into developing the Oxford Handbook of Psychotherapy Ethics. I am also grateful
for my department chair, Carol Tamminga, MD for her encouragement and commitment
to a strong ethics presence in our department and our field. As always, my family is a source
of renewal and joy, making affairs private and professional more glorious: Abbie, Evan,
and Cole.
OUP CORRECTED AUTOPAGE PROOFS – FINALS, 07/06/21, SPi
SE C T ION I I : C ONC E P T S A N D T H E OR I E S F OR
P S YC HO T H E R A PY E T H IC S
5. Autonomy as a goal of psychotherapy 87
Paul Biegler
Personal autonomy describes the exercise of self-determination through informed
and rational decisions that reflect an agent’s authentic values. The nexus between
autonomy and psychotherapy is broad, with both respect for client autonomy
through informed consent, and promotion of client autonomy through therapy
itself representing key instances of the significance of autonomy in the consulting
room. While inadequate disclosure of information poses a major threat to personal
OUP CORRECTED AUTOPAGE PROOFS – FINALS, 07/06/21, SPi
devoted to treating mental illness, and on the other hand, with a variety of social
services that promote mental health and human flourishing. This chapter focuses
on different theories of justice to consider (a) whether a case might be made for
the unique value of psychotherapy amongst other competing services, and (b) if
not, what criteria might be relevant in assessing its relative cost and value. The
chapter begins by reviewing some relevant concepts of justice and how they might
be applicable to allocation of psychotherapy resources, specifically, Rawlsian,
capabilities, utilitarian, and communitarian theories. It then discusses how these
concepts of justice can be used to navigate research about psychotherapy outcomes
as well as its cost-effectiveness. Decisions about which outcomes to consider are
not value-neutral and can be guided by relevant theories of justice. The chapter
concludes with a brief discussion of lower-income countries.
one hand we are deeply in need of relationships to other human beings; on the
other hand we are thrown into the world alone and will always stay like this, no
matter how close we get to another person. Further, addressing freedom and
destiny as two extremes of one dimension can serve as a basis for orientation in
life and also for dealing with the separation between responsibility and guilt.
SE C T ION I I I : C OM MON E T H IC A L C H A L L E NG E S
I N P S YC HO T H E R A PY
17. The ethics of informed consent for psychotherapy 259
Alastair J. McKean, Manuel Trachsel, and Paul E. Croarkin
Informed consent, enshrined in many of the codes of conduct of psychology and
psychiatry professional organizations, is an integral component behind the
ethical practice of psychotherapy. Foundationally, informed consent respects
patient autonomy and should be a knowledge sharing process that allows patients
greater agency and improved alliance with their clinician. Psychotherapy differs
from medical and surgical interventions in that it is a longitudinal, collaborative
and interpersonal treatment. As many psychotherapists are not trained in
traditional medical models of care, a medically based framework for informed
consent may not be as familiar and appropriate for psychotherapy. These nuances
do not diminish the need for informed consent but rather emphasize the
distinctiveness of psychotherapy and necessity of adapting to this treatment
modality. In this chapter, the informed consent process for psychotherapy is
examined, detailing its historical development, legal and ethical foundations, as
well as the subtleties and challenges regarding implementation.
than expected. At the same time, meta-level ethical reflection can help to
coordinate previously diverging interests and efforts and remove obstacles
towards problem-solving. Complexity as well as problem solving will be
illustrated by referring to problems with confidentiality concerning sexual
abuse, coercion in treating dependency disorders, and responding to wishes of
assisted suicide.
several professional but also value decisions: what is negative? What is proper
treatment? What is treatment related? Scientifically there is a lack of generally
accepted instruments and of guidelines on how to assess side effects in clinical
trials. There is growing evidence that about 10% of psychotherapy patients
experience relevant negative consequences of psychotherapy. Therapist should
be aware of the possibility of side effects and inform patients. Acknowledgement
of side effects can improve treatment and also advance the development the field
of psychotherapy.
»Siis:
Kirosin hengessäni. Miksi piti tässä maassa vallita niin kurjat olot,
että virkoihin pääsemiseksi vaadittiin vieraan kielen taitoa? Eikö
rakkaassa Suomessa tultu maan omalla kielellä toimeen, kun
virkamiesten piti osata »venskat» ja »vassokuut», ennenkuin leipä
lähti? Hyvää päivää, Aatami Kuuskoski, osaatko kiinaa?
Totta kai.
Marssin lennätinkonttoriin ja lähetin seuraavan sähkösanoman:
»Maaherra
Helsinki.
Aatami Kuuskoski.»
»Luehan tuosta.»
»Lue!»
Santrakin hymyili.
»Sinä et sitten koskaan muutu, vaikka sinusta tehtäisiin keisari.»
Hän esitti minulle asian. Runoilija Jouko Touko oli hänelle kertonut.
Arvasinhan minä.
Asiasta sovittiin ja kahden viikon kuluttua meidän piti tavata
Kohisevalla.
Johtaja Muru oli jo teettänyt lautat valmiiksi. Niillä piti minun nyt
Helsingin herrojen kanssa hursalluttaa alas Kohisevan kuohuista.