Ethical Considerations for Providing In-Home Mental Health Services for Homebound Individuals

The number of homebound individuals in the United States is on the rise, causing health-care professionals to expand in-home health services to help meet the increased demand. Due to the prevalence of feelings of isolation and depression in this population, it is imperative that mental health professionals join this effort to increase access to mental health services. Delivering psychotherapy in clients’ homes presents many advantages to these homebound individuals, but there is a dearth of literature addressing how therapists should handle unique ethical issues that arise in this type of setting. This article addresses ethical considerations and guidelines for in-home provision of mental health services. General ethical issues related to home-based psychotherapy include boundaries, confidentiality and privacy, competency, insurance coverage, and autonomy. Issues pertaining to different categories of homebound individuals, including persons with agoraphobia, chronic illnesses, and older adults, are then discussed in turn. Recommendations on how to best manage these issues by applying the American Psychological Association’s, the American Counseling Association’s, and the National Association of Social Workers’ Ethics Codes are provided.     

How does evidence-based practice in psychology work? – As an ethical demarcation

Evidence-based practice in psychology (EBPP) is ordinarily understood to demarcate between legitimate and illegitimate psychotherapy practice, based upon the epistemic demarcation distinguishing scientific from non-scientific knowledge. EBPP emphasizes the value of effective and efficient interventions identified through randomized controlled trials and cost-benefit analyses. Basing the template for choice of action or strategy on randomized controlled trials and cost-benefit analyses create a deceptive appearance of ethical neutrality. However, there is an implicit ethical demarcation at work in EBPP, which favors a non-articulated specific position in normative ethics. More particularly, evidence-based practice in psychology is structured according to a utilitarian framework, severely limiting the kinds of ethical perspectives available to assess psychotherapy practice. The latter point is illustrated through a new mode of delivering psychotherapy services called “Internet-based guided self-help” (IBGSH). In EBPP the only relevant ethical question is to what extent any intervention, such as IBGSH, is effective and efficient. Some of the limiting effects of the ethical, utilitarian, demarcation are showcased by presenting three alternative ethical perspectives by which psychotherapy practice in general and IBGSH in particular can be analyzed. The analysis concludes that EBPP is not suited to ethically regulate the practice of psychotherapy.     

Integrating Spirituality and Religion Into Psychotherapy: Persistent Dilemmas,Ethical Issues,and a Proposed Decision-Making Process

Religion and spirituality are important aspects of the lives of most psychotherapy clients. Unfortunately, many psychotherapists lack the training to effectively and ethically address these issues with their clients. At times, religious or spiritual concerns may be relevant to the reasons clients seek treatment, either as areas of conflict or distress for clients or as sources of strength and support that the psychotherapist may access to enhance the benefit of psychotherapy. This article reviews persistent ethical issues and dilemmas relevant to providing psychotherapy to clients for whom issues of religion and spirituality are clinically relevant. Ethical considerations include assessment, advertising and public statements, informed consent, competence, boundary issues and multiple relationships, cooperation with other professionals, and how to effectively integrate religious and spiritual interventions into ongoing psychotherapy. A decision-making process is presented to guide psychotherapists in their clinical work with clients for whom religious and spiritual issues are salient or clearly linked to their presenting problems.     

Prayer in psychotherapy: a model for its use, ethical considerations, and guidelines for practice

Although few guidelines exist, many therapists use prayer as a part of psychotherapy. The immense variance inherent in prayer behaviors and the paucity of literature on its use beckons the profession to develop a model for its use in therapy, examine the ethical implications for such use, and prepare guidelines for practice. A tripartite model for the conceptualization and localization of prayer in therapy is presented, ethical issues of therapist bias and competence and clients' right to autonomous decision making are considered, and guidelines for employing prayer in psychotherapy are developed.     

Ambulante Psychotherapie in Deutschland aus Sicht der Patienten

This study analyzed the provision of outpatient psychotherapy services in Germany in typical practice settings. In a representative survey (from June 2008 to September 2009) 1,212 subjects who received outpatient psychotherapy during the past 6 years were questioned about their experiences with outpatient psychotherapy via telephone interviews. Socio-economic data, reasons for seeking treatment, access paths, financial resources and psychosocial support data were collected. Therapeutic settings and modalities and concomitant medication treatment are described. The findings illustrate the problem of multiple psychiatric morbidity in the clinical practice and confirm the urgent need for patient access to professional psychotherapeutic services. Improving access to these services requires close cooperation between care providers.     

Ambulante Psychotherapie in Deutschland aus Sicht der Patienten

This study analyzed the provision of outpatient psychotherapy services in Germany in standard practice settings. A total of 1,212 subjects who received or were still receiving outpatient psychotherapy during the past 6 years provided information about their experiences via a telephone survey. Outpatient psychotherapy was sought for many different conditions and was rated as highly effective. The improvement rates for all complaints were higher than 50%, except for obesity (37%) and sexual dysfunctions (44%). Patient ratings of worsening were less than 8% throughout. Treatment had very positive results not only for target symptoms but also for other aspects of patients?? lives. Almost 90% of those questioned stated that they were satisfied with their therapist. High agreement ratings were reported specifically with respect to positive therapeutic relationship, stable working alliance, experience of autonomy during therapy and therapists?? competency and ethical conduct. Patients gave their psychotherapists excellent evaluations and were highly satisfied with the changes achieved through treatment.     

Ethics and endings in group psychotherapy: saying good-bye and saying it well

Endings in group psychotherapy are suffused with complexity and potential conflict, some of which entail ethical quandaries. Ethical issues attending endings in group therapy are explored through a discussion of informed consent, time and role boundaries, privacy and confidentiality, unplanned endings, therapist-initiated termination, and competence. Findings from an exploratory survey of members of the American Group Psychotherapy Association and clinical-ethical vignettes are presented to highlight these issues. Clinicians need to develop and maintain ethical fitness and awareness, including attunement to personal responses, to endings and loss.     

Modern Advances in Genetic Testing: Ethical Challenges and Training Implications for Current and Future Psychologists

The ethical implications for psychological practice of genetic testing are largely unexplored. Predictive testing can have a significant impact on health and well-being, and increasing numbers of individuals with knowledge of their risk for various disorders are likely to present for psychotherapy. In addition, more people will struggle with the decision of whether to obtain information regarding their genetic material. Psychologists will need to have the appropriate knowledge and clinical skills to effectively counsel this population. This article highlights the relevant ethical issues surrounding psychological treatment of individuals pursuing or considering undergoing genetic testing. These issues are extended to psychologists working in research, education, and policy domains. Recommendations for graduate training programs to facilitate current and future practitioner competence are also discussed.     

Ethical Considerations for Therapists Working With Demographically Similar Clients

The increasing emphasis on multicultural competence within psychotherapy continues to highlight the need for being sensitive to key differences between therapist and client. However, this attunement to the psychotherapeutic impact of therapist–client differences may obscure the equally critical need to evaluate ethical problems associated with therapist–client similarities. It will be argued that therapists treating clients who are demographically similar to themselves encounter a unique set of ethical challenges that warrant careful consideration and caution precisely because of therapist–client matching. The extant research on matching therapists and clients based on demographic similarities is discussed, with a particular emphasis on psychotherapeutic outcomes and client preferences. Attention then turns to the nonrational heuristics and biases that can often cloud therapists’ ethical decision making regarding the appropriate uses versus contraindications for demographically matching therapists and clients. Within the discussion of nonrational heuristics and biases, suggestions are offered for managing related challenges for ethical decision making.     

Ethical Challenges and Legal Issues for Mental Health Professionals Working With Family Caregivers of Individuals With Serious Mental Illness

Mental health professionals frequently work with family caregivers in the provision of psychotherapy services to individuals with serious mental illness. To address the need for ethical guidelines for working with family caregivers, an analysis of relevant ethical and legal issues is provided within the context of dynamic mental health care and legal systems. When working with family caregivers, practitioners utilize the American Psychological Association’s Ethics Code (2010), legal codes, and a complex decision-making plan; identify and communicate ethical obligations to family caregivers; consider the unmet needs of this population; avoid harm resulting from multiple relationships; and balance ethical duties of beneficence and respect for autonomy.     

Attending to diversity in group psychotherapy: an ethical imperative

Ethical issues can arise in dealing with diversity when practicing group psychotherapy. In this paper, a case is presented of a therapist-in-training who is attempting to determine whether a particular psychotherapy group composed exclusively of heterosexual males would be an appropriate and effective treatment venue for a gay male; the clinical vignette is designed to illustrate a process of ethical and culturally competent decision making. The discussion of this vignette articulates the multiple steps through which the group psychotherapist must proceed to successfully resolve ethical dilemmas that are related to diversity.     

Making a case for case studies in psychotherapy training: A small step towards establishing an empirical basis for psychotherapy training

The evidence debate in psychotherapy pays little attention to developing an evidence base for training practices. Understanding effective training requires an examination of what makes training work. This article examines the role of case studies in psychotherapy training. This has not been articulated explicitly or researched systematically in spite of its cardinal importance. An analysis of the role of case studies in psychotherapy training is presented. Reading, watching, or hearing about cases can offer novice psychotherapists access to a closed world; access to psychological theory in action; access to whole courses of therapy; access to different approaches; access to significant moments; access to the therapeutic relationship; access to a wide range of client types; access to working in different contexts; and the opportunity of identifying with therapists and clients. Writing or presenting cases offer students the opportunity of: learning to integrate information into a relevant whole; being in the ‘hot seat’; learning to give appropriate feedback; assessing the validity of interpretations, inferences, and interventions; adapting methods to suit the client; and learning to collaborate with other professionals. The paper presents directions for future research into psychotherapy training, specifically proposing an international survey of training practices at psychotherapy training institutions.     

E-Therapy: Ethical Considerations of a Changing Healthcare Communication Environment

This paper outlines the current ethical guidelines for electronic therapy services, and the sufficiency and implications of these guidelines in a culturally diverse population as found in the United States. The paper limits the discussion of ethical deliberations to: what is considered adequate competency to practice mental health therapy electronically; the disclosure and identity verification requirements; confidentiality issues when different social norms exist; the social responsibility of public institutions or individuals; and issues that relate to miscommunication due to different cultural or educational backgrounds. It concludes that since E-Therapy helps to reach underserved populations and significantly reduces costs associated with mental health services, compliance with ethical guidelines must be enforced to benefit from the latest communication technologies. This paper is relevant for various professions related to psychology and psychotherapy, including pastors and pastoral counselors, because various forms of E-therapy are emerging in the 21st century and can serve as resources for “E-pastoral counseling.”     

Benefits and Challenges of Conducting Psychotherapy by Telephone

Telephone-delivered psychotherapy has increased utility as a method of service delivery in the current world, where a number of barriers, including economic hardships and limited access to care, may prevent people from receiving the treatment they need. This method of service provision is practical and has the potential to reach large numbers of underserved people in a cost-effective manner. The aim of this paper is to review the state-of-the-art of telephone-delivered psychotherapy and to identify improvements and possible solutions to challenges. Results of randomized controlled trials indicate high client acceptance and positive outcomes with this method of delivering psychotherapy. Nonetheless, psychotherapists wishing to deliver psychotherapy by telephone face a number of challenges, including a lack of control over the environment, potential compromises of privacy and confidentiality, developing therapeutic alliance without face-to-face contact, ethical and legal issues in providing psychotherapy by telephone, handling crisis situations at a distance, and psychotherapist adjustment to conducting psychotherapy in an alternative manner. There remains a need for further research, including direct comparisons of face-to-face psychotherapy with telephone-delivered psychotherapy and feasibility of telephone delivery of psychotherapies other than cognitive behavioral therapy.     

The virtue of multiculturalism: personal transformation, character, and openness to the other

The social, intellectual, and moral movement known as multiculturalism has been enormously influential in psychology. Its ability to reshape psychology has been due to its ethical force, which derives from the attractiveness of its aims of inclusion, social justice, and mutual respect. The cultivation of cultural competence, presented as a developmental process of acquiring self-awareness, cultural knowledge, and skills, is an important emphasis in the multicultural literature. The authors place the cultural competence literature in dialogue with virtue ethics (a contemporary ethical theory derived from Aristotle) to develop a rich and illuminating way for psychologists to understand and embody the personal self-examination, commitment, and transformation required for learning and practicing in a culturally competent manner. According to virtue ethics, multiculturalism can be seen as the pursuit of worthwhile goals that require personal strengths or virtues, knowledge, consistent actions, proper motivation, and practical wisdom. The authors term the virtue of multiculturalism openness to the other and conclude by describing how attention to cultural matters also transforms virtue ethics in important and necessary ways.     

When Sport psychology consultants and graduate students are impaired: Ethical and legal issues in training and supervision

Abstract

Impaired sport psychology consultants, that is, professionals and graduate students whose behavior, inadequate training, personal situations, or psychopathology are having a negative influence on the delivery of services, have the potential to do harm to athlete-clients, damage their own professional standing, and bring disrepute to the field. The applied sport psychology literature is replete with guidelines and suggestions for referring athletes for counseling or psychotherapy when appropriate (e.g., Heyman & Andersen, 1998), but the ethical, legal, and procedural problems associated with sport psychology consultants whose training or mental conditions suggest the need for remediation, rehabilitation, or psychotherapy, and possible removal from seeing clients, has not been addressed. We describe a variety of situations where student and professional functioning might be impaired, discuss the possible ramifications (legal, ethical) of impairment, and provide suggestions for ways to proceed when sport psychology consultants are in psychological difficulty.     

When Psychotherapy Is Not Working: Ethical Considerations

Evidence-based practice (EBP) models have been developed, in part, to enhance the likelihood that the outcome of health care treatment, including psychotherapy, leads to positive improvement. However, two additional outcomes can occur: no change and poor outcome (e.g., harm, worsening of symptoms). What does the clinician do when psychotherapy is not working? When faced with various treatment decisions, such as this, the EBP model posits that therapists should apply their clinical expertise in considering the “best available research” within the context of various patient characteristics. In part because of various limitations of this approach, I suggest that another important set of principles are important to consider in tandem when faced with this clinical dilemma—that is, ethical concerns. Borrowing from the American Psychological Association’s (2017a) Ethics Code, I discuss how the following issues exist when clinicians wrestle with this question: avoidance of harm, competence, conflicts of interest, and informed consent. I conclude this paper with a list of suggestions that can potentially foster the application of ethical principles when making treatment decisions.     

后现代心理治疗及其伦理问题思考

文章通过论述后现代对现代认识论和思维模式的质疑与超越,分析了后现代语境下心理治疗与现代心理治疗的差异,并关注在后现代这一新的思维模式下,心理治疗领域可能产生的伦理问题。作者指出,后现代心理治疗的不确定性、价值干预和文化介入,使心理治疗的伦理挑战被进一步复杂化,对治疗师也提出了更高要求。