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The last few years have seen a marked increase of interest in the ethics of psychotherapy. As the field of mental health has recently taken on a new level of prominence, renewed commitment to the ethical analysis of psychiatric and psychological treatment is clearly required. In this review essay, we survey recent work on psychotherapy ethics, taking a critical yet generally sympathetic view of the new literature. There are important considerations that remain neglected or overlooked entirely, in our view, and several substantive and methodological trends are in need of diagnosis and critical response. We structure the discussion around several themes, including the inherently moral nature of psychotherapy, the heterogeneity of such practices, the significance of social, cultural, and historical context, and, finally, questions concerning prevailing methodological assumptions. [ABSTRACT FROM AUTHOR]

Sexual attraction between human beings is a pervasive phenomenon, impacting the process of psychotherapy, as well as other areas of social engagement. However, within ethical psychotherapy practice the experience of attraction could not lead to enactment without ethical misconduct or premature therapeutic termination. This qualitative study focused on female therapists' experiences of working with male clients who were sexually attracted to them. It employed Hollway and Jefferson's (2008) hybrid method 'free association narrative interview', which involved multiple unstructured interviews with five female participants. The results of the study suggested that participants' experience differed depending on whether they felt reciprocal sexual attraction. On occasions when therapists were not attracted towards their clients, they struggled with unwanted sexual attraction because they feared having to reject their client and the retaliation this may entail. On such occasions, therapists expressed a sense of vulnerability, discomfort with power inequality and a sense of being at fault. Conversely, when therapists felt sexually attracted to their clients, they managed the dynamic by framing it within a context of loving as opposed to purely erotic feelings. The study suggests that working directly with sexual feelings is a challenge for female therapists, requiring personal development work, supervision and institutional support to address the complex interplay of individual, clinical and societal issues, which appear to play a part in this difficulty. [ABSTRACT FROM AUTHOR]

Studies have generally supported telehealth as a feasible, effective, and safe alternative to in-office visits. Telehealth may also be of particular benefit to couples/families interested in relational treatments, as it addresses some of the barriers that may be more prominent for families, such as childcare and scheduling difficulties. Therapists interested in expanding their practice to include telehealth should understand ethical and practical considerations of this modality. This article discusses areas unique to the delivery of telehealth to couples and families. Each broad domain is then elaborated upon with case examples from actual clinical practice and specific recommendations for addressing potential difficulties. Authors recommend further empirical research examining differences in modality outcome, as well as feasibility of the suggestions proposed here. [ABSTRACT FROM AUTHOR]

This paper aims at continuing the conversation, slowly building over time, concerning the inclusion of the social-political sphere within our analytic/therapeutic dialogues and theories. Exploring examples of how larger cultural contexts always flow through us, the paper also notes our tendency through the years to narrow our own field of vision and quiet our anxieties about the world in which we, our patients and ourselves, live. This constriction affects our therapeutic work. If we do not listen for the contextual flow, or wonder about the absence of the social-political in our therapeutic dialogues, then we are in danger of reinforcing “malignant normality” and abdicating our moral responsibility. [ABSTRACT FROM AUTHOR]

Philip Cushman is right to call our attention to the Hoffman Report, the formal detailing of the American Psychological Association’s (APA’s) collusion with the torture program implemented by the U.S. government in the aftermath of September 11. My perspective differs from Cushman’s in viewing the APA’s collusion as fundamentally a failure of moral action, as opposed to a failure of moral reasoning; in questioning the value of a hermeneutic perspective as offering a way of forestalling such ethical disasters; and in questioning the role that a relationally refashioned psychotherapy can play in the “remoralization” project he calls for. [ABSTRACT FROM AUTHOR]

The article discusses the highlights of the 50th annual meeting of Cheiron: The International Society for the History of the Behavioral and Social Sciences held from June 21-24, 2018, held at the University of Akron in Ohio. Topics covered include the problems in the use of inferential statistics in psychology publications, cases of unethical conduct in psychological research and therapy, and a demonstration on ways to guide undergraduates into primary sources in history of psychology.

Past life regression therapy is used by some physicians in cases with some mental diseases. Anxiety disorders, mood disorders, and gender dysphoria have all been treated using life regression therapy by some doctors on the assumption that they reflect problems in past lives. Although it is not supported by psychiatric associations, few medical associations have actually condemned it as unethical. In this article, I argue that past life regression therapy is unethical for two basic reasons. First, it is not evidence-based. Past life regression is based on the reincarnation hypothesis, but this hypothesis is not supported by evidence, and in fact, it faces some insurmountable conceptual problems. If patients are not fully informed about these problems, they cannot provide an informed consent, and hence, the principle of autonomy is violated. Second, past life regression therapy has the great risk of implanting false memories in patients, and thus, causing significant harm. This is a violation of the principle of non-malfeasance, which is surely the most important principle in medical ethics. [ABSTRACT FROM AUTHOR]

Clinical supervision for psychotherapies is widely used in clinical and research contexts. Supervision is often assumed to ensure therapy adherence and positive client outcomes, but there is little empirical research to support this contention. Regardless, there are numerous supervision models, but it is not known how consistent their recommendations are. This review aimed to identify which aspects of supervision are consistent across models, and which are not. A content analysis of 52 models revealed 71 supervisory elements. Models focus more on supervisee learning and/or development (88.46%), but less on emotional aspects of work (61.54%) or managerial or ethical responsibilities (57.69%). Most models focused on the supervisee (94.23%) and supervisor (80.77%), rather than the client (48.08%) or monitoring client outcomes (13.46%). Finally, none of the models were clearly or adequately empirically based. Although we might expect clinical supervision to contribute to positive client outcomes, the existing models have limited client focus and are inconsistent. Therefore, it is not currently recommended that one should assume that the use of such models will ensure consistent clinician practice or positive therapeutic outcomes. Key Practitioner Messages There is little evidence for the effectiveness of supervision., There is a lack of consistency in supervision models., Services need to assess whether supervision is effective for practitioners and patients. [ABSTRACT FROM AUTHOR]

Values nonpaternalism—the ethical imperative to avoid imposing values onto clients—is implicit in most widely used ethical frameworks employed by psychotherapists. Although changes in client values may represent desired psychotherapeutic outcomes, some such changes may be ethically problematic. Interventions are characterized by values paternalism when they are intended to promote client welfare but are accompanied by impositions against client values. Providers and consumers of psychotherapy may routinely lack awareness of this consideration. Psychotherapists may have a duty to be informed about ethically problematic value change accompanying psychotherapy and to inform clients about this phenomenon. [ABSTRACT FROM PUBLISHER]

Some people want to modify their bodies through hormonal and surgical treatments in order to resolve gender dysphoria, the distress they experience when their bodies do not align with their gender identity. The World Professional Association for Transgender Health (WPATH) offers guidelines to clinicians regarding treatment of people wanting to modify their bodies for this reason. Prior to these modifications, WPATH advises that mental health screening is needed and that psychotherapy is recommended though not a requirement. In fact, these advisories allow clinicians some freedom in applying the standards to specific cases. Although some variation from the WPATH Standards of Care can be clinically acceptable, informed consent remains an essential component of clinical encounters involving body modifications. [ABSTRACT FROM AUTHOR]

Advances in neuroscience research are often enlisted as evidence for the belief that mental disorders are biologically based diseases of the brain, and have contributed to the continued prominence of the biomedical model within the field of mental health. Psychologists' use of neuroscience in marketing their services, explaining behavioral phenomena, and legitimizing the efficacy of psychotherapeutic treatments may contribute to "neurocentric" understandings of psychology, at the expense of a more comprehensive biopsychosocial model of mental disorders. These issues raise concerns about the ethical and responsible use of neuroscience language and research findings by psychologists in the promotion and practice of psychotherapy. This article reflects critically on the ethical principles and standards of the ethics code of the American Psychological Association (2010a) regarding competency, the basis of professional judgments, and the veracity of statements about psychotherapy, and provides considerations and recommendations for practicing psychologists, faculty, and graduate students when making use of neuroscience research. [ABSTRACT FROM AUTHOR]

This article is about ethics, specifically, the myriad of unethical practices characterizing recruitment for psychiatric trials. Using a case study approach, honing on recruitment material, and examining the typical, the author explores recruitment in two studies—one involving electroconvulsive therapy, the other, a psychiatric drug. The bulk of the article is on these trials. The ethical problems which surface include minimization of risk; euphemism; lack of transparency; false and misleading claims, unfair inducement; failure to mention most of the common and serious negative effects; and a predatory quality. The author also identifies some worrisome new trends. Of special interest to the humanistic counselor is the attempt to implicate people’s own counselors and therapists in recruitment. The article ends with reflections on the onus that such practices place on all practitioners striving to be ethical. The author concludes that it is critical that counselors and therapists not be complicit and beyond that they take it on themselves to confront and expose. Concrete practice suggestions include adopting an explicit policy against such referrals, alerting any clients who may be considering such trials of the danger, and countering false claims. [ABSTRACT FROM AUTHOR]

While agreeing with the mainstream view that psychotherapeutic practice must be grounded in science, including research on the effectiveness of psychotherapy, the author advocates giving more weight to the venerable philosophical literature on ethics that bears directly on what patients bring to therapists: problems in living. These problems have been the domain of ethics since Socrates, who-like psychotherapists-promoted reflective dialogue. This article reviews some contemporary thought regarding the importance of reflection and the limits that patients and therapists face in promoting it. Relying on attachment theory and the process of mentalizing, the author identifies a convergence of science and ethics in the therapeutic aspiration to cultivate epistemic trust and illustrates this convergence with a case example. [ABSTRACT FROM AUTHOR]

In the past 20 years, mindfulness therapeutic programs have moved firmly into the mainstream of clinical practice and beyond. As they have, we have also seen the development of an increasingly vocal critique. At issue is often less whether or not these mindfulness practices "work," and more whether there is a danger in dissociating them from the ethical frameworks for which they were originally developed. Mindfulness, the argument goes, was never supposed to be about weight loss, better sex, helping children perform better in school, helping employees be more productive in the workplace, or even improving the functioning of anxious, depressed people. It was never supposed to be a merchandized commodity to be bought and sold. The larger clinical and religious community, however, has not always been troubled by the idea that meditation might sometimes be used as a highly pragmatic remedy for various ailments. Why, then, are people troubled now? This essay is an effort to recapture a bigger historical perspective on current ethical qualms: to move beyond criticism and instead to try to understand the anatomy of our discontent. [ABSTRACT FROM AUTHOR]

The deployment cycle presents unique challenges for military couples. Marital outcomes have been shown to be negatively impacted throughout the deployment process, and at-home stressors can serve as distractions for service members that can compromise their effectiveness and safety. Tele-mental health, specifically the delivery of therapy via videoconferencing, has been shown to be an effective therapy medium, particularly for reaching underserved or isolated populations. A case can be made for the use of tele-mental health as a means of delivering therapy to military couples throughout the deployment process in an effort to strengthen their relationship and enhance service member well-being during deployment. This form of therapy may be particularly valuable to couples experiencing barriers to care due to stigma, rural location, or limited access to military resources (i.e. National Guard service members). Three general recommendations for this form of treatment are first provided, which include (1) work within the military culture, (2) capitalize on existing support structures, and (3) receive training in tele-mental health delivery. Five additional recommendations are provided which are specific to delivering couples therapy while the service member is deployed. These recommendations include (1) tailor treatment to fit the service member's context, (2) prioritize service member safety, (3) encourage the development of couple skills in therapy, (4) be intentional about session management, and (5) engage the at-home spouse. Legal and ethical considerations, as well as intended benefits for this method of treatment are also discussed. [ABSTRACT FROM AUTHOR]

Important change in competent practice in psychological therapy is increasingly being influenced by evidence-based practice. This paper explores major issues related to the evidence-based literature with regard to specific techniques and common factors. Increasing evidence that support common factors provides validity for the psychotherapy integration movement. This movement is explored in relation to the three waves of behavior therapy that indicate an increasing integration of a wide range of therapies. The discussion concludes with implications for therapists who wish to adopt an ethical and evidence-based approach. [ABSTRACT FROM AUTHOR]

This article covers the relatively new topic of writing an ethical will as part of conveying the testator’s values, beliefs, and lessons learned in living to one’s relatives, particularly one’s beneficiaries. It addresses how the ethical will may become an addendum or codicil to one’s legal/financial will or be crafted as a separate document. The meaning of and reasons for ethical wills are highlighted as are its value to the progenitor and those who will be affected by the document. We consider how and when to broach this topic with clients, when one may be serving as a consultant, coach or therapist, as well as some of the reasons people who learn about the possibility of writing an ethical will may decide against it. When beneficiaries (and would-be beneficiaries) first learn the contents of a recently deceased person’s will when it is read at probate, surprise can lead to negative consequences such as turning them against one another. An ethical will can temper the surprise and remind the beneficiaries of the testator’s values, beliefs, and lessons. Five brief case vignettes, each based on the combining of several real life situations, are recounted. The concluding section summarizes the efficacy of promulgating (and even self-authoring), and discussing one’s ethical will with the intended beneficiaries as well as some of the reasons posited by those, including many estate attorneys, who are not in favor of such documents. Our clinical and consulting experiences with those who have drawn up ethical wills have been predominantly positive; perhaps this reflects the self-selective nature of those who choose to engage in this process. [ABSTRACT FROM PUBLISHER]

Clinical social workers' use of digital and other technology to provide distance counseling services is proliferating. Increasing numbers of contemporary practitioners are using video counseling, email chat, social networking websites, text messaging, smartphone apps, avatar-based websites, self-guided web-based interventions, and other technology to provide clinical services to clients, some of whom they may never meet in person. The advent of this technology has produced a wide range of ethical challenges related to social workers' application of traditional social work ethics concepts: client informed consent; client privacy and confidentiality; boundaries and dual relationships; conflicts of interest; practitioner competence; records and documentation; and collegial relationships. The principal purpose of this article is to identify pertinent ethical and ethically-related risk-management issues that clinical social workers need to consider if they contemplate using this technology to assist people in need. The author addresses compelling ethical issues concerning (1) social workers' use of digital technology to communicate with clients in relatively new ways, and (2) whether social workers' use of digital technology alters the fundamental nature of the therapeutic relationship and clinicians' ability to provide clients with a truly therapeutic environment. [ABSTRACT FROM AUTHOR]

The article focuses on the clinical and ethical problems that may arise when an interpreter is introduced into the psychodynamic psychotherapy patients in a resident-run clinic. Clinical cases in which interpreters are involved in a psychotherapeutic sessions include a patient diagnosed with adjustment disorder with anxiety and social anxiety disorder, a patient who experienced depression and anxiety, and a patient diagnosed with generalized anxiety disorder and panic disorder.

The article focuses on the clinical and ethical problems that may arise when an interpreter is introduced into the psychodynamic psychoterapy patients. These complications include a possible break of the psychotherapist-patient bonding, the dilution of the meaning of countertransference and transference, and the boundary crossings and enactments between the interpreter and patient. The difficulty by which professionalism could develop between an interpreter and patient is discussed.

Providing psychotherapy changes the therapist in a variety of ways. This article discusses one doctoral student's perceptions of these changes, such as increasing her patience, gratitude, and reliance on faith; stretching her ability to tolerate ambiguity; and influencing her interpersonal relationships. [ABSTRACT FROM AUTHOR]

Hope has long been identified as an important therapeutic factor in counselling. Further, research evidence for the importance of hope to counselling practice and outcome is abundant. However, the field is only beginning to explicitly consider how hope can be effectively and intentionally practised. One of the most challenging dilemmas encountered by counsellors committed to working with this important therapeutic factor is that of so-called unrealistic hope. In this paper, we outline two real-life counselling vignettes illustrating unrealistic hope, and consider these scenarios alongside relevant scholarship and practice experience. Guiding principles and practices for conceptualising and working with unrealistic hope are offered as a means of beginning the conversation about this complex aspect of working with client hope. [ABSTRACT FROM AUTHOR]

Although the psychotherapist's personal psychotherapy has received considerable research attention in recent years, little systematic investigation of the ethical issues involved has been published. This article provides a rigorous interrogation of mandatory personal psychotherapy (MPP) as a training requirement for mental health professionals, a topic that remains ethically contentious. The article begins with a discussion of why MPP is an explicitly ethical issue, before debating the ethics of MPP under six questions, each worded to capture a salient ethical issue relevant to the appropriateness of making personal treatment a mandatory training requirement. Using principle, virtue, and care ethics perspectives, the arguments for and against MPP are critically investigated. The article concludes with an ethical position statement. [ABSTRACT FROM PUBLISHER]

A common rhetoric of the intellectuals of the State in Greece is that what impedes the economic 'development' of the country is the deficient and insufficiently developed selfhood of its people. Amidst the so called 'Greek crisis', namely the pressing and intensified demands on the part of the elites for the deepening of the neoliberalisation of the country and the imposition of an entrepreneurial ethic, the reconfiguration of the Greek psyche has become an imperative. Psychology and generic psychotherapy have shown a striking rapidness in tuning themselves to the spirit of the times echoing its underlying logic, and promoting social atomisation and social selection based on personal skills and capabilities. In the current article, I explore the discursive affinities between the entrepreneurial ethic and the spirit of psychotherapy within the context of the 'Greek crisis'. I develop my argument on the resonance of the two, along three, albeit intersecting and often overlapping, dominant social logics: the importance to develop one's creativity, the need to adapt and build one's personal defenses against the hostile outside and the understanding of the crisis as an opportunity for personal betterment, development and rediscovery of the meaning of life. It is my argument that more than ever in this country, generic psychotherapy is totally deprived of a language of its own and parrots unashamedly the language of entrepreneurial neoliberalism, showing both its theoretical and practical destitution, as well as its undisputable role as a State and corporate technology of control. [ABSTRACT FROM AUTHOR]

The article presents a report on a conference on moral and ethical aspects of psychiatry and psychotherapy, convened from July 24-25, 2013, in Frankfurt an der Oder, Germany. Topics of discussion included involuntary commitment and treatment, the work of Polish psychiatrist Antoni Kępiński, and the use of art in psychotherapy.

This article questions a number of widely held views of the role of values in psychotherapy. It begins with a discussion of the now largely discredited view that psychotherapy can be value free. It also broadens this challenge to question the popular idea that values form an inescapable part of the therapeutic encounter. While this view is correct in outline, it is necessary to reject the underlying conception of values as largely arbitrary preferences that the client and the therapist bring to the encounter, as this fails to do justice to the inherently ethical nature of psychotherapy. It argues that we should recover the Greek notion of therapy as essentially concerned with the character of a person. In other words, the goal of therapy is virtue. [ABSTRACT FROM AUTHOR]

In this article, we propose that emotional reactivity can influence dialogue around the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the wider issues included in the debate. We explore this emotional process and the impact that it has on our clinical practice, our clients' experiences, our experience of ourselves as clinicians and the ways we work with other professionals. We begin by presenting clinical scenarios, then briefly summarise key ideas from the DSM-5 debate, and draw on Bowen Family Systems Theory to explore a number of ways that emotional reactivity to these ideas can manifest itself in multidisciplinary and collegial relationships. We conclude that it is helpful to increase awareness of our own emotional processes to best avoid becoming reactive to, or dismissive of, alternative paradigms or knowledge bases that may be of use to our clients. We describe a number of principles and ideas that we have found useful in this context and identify ongoing dilemmas in our practice. [ABSTRACT FROM AUTHOR]

The purpose of this phenomenological study was to examine how therapists use prayer in the therapeutic process. Researchers recruited via a maximum variation sampling method 17 diverse participants in terms of race and faith, including Muslim, Buddhist, Jewish, Catholic, Protestant, and Latter-Day Saints. Results revealed seven themes across faiths: (a) definition of prayer; (b) prayer as connection with God/transcendent and with client; (c) ethical boundaries; (d) use of prayer depends upon the context of therapeutic practice; (e) direct versus indirect prayer interventions; (f) prayer as use for self-of-therapist care; and (g) use of prayer changes as the therapist grows and develops over time. [ABSTRACT FROM PUBLISHER]

The purpose of the article is to present a literature review regarding mechanical restraint in psychiatry. The main area of analysis is directed at the untitethical relationship between "restraint" and "containment", in the light of legal, ethical, medical and psychodynamic factors, in specific the concept of "setting". The ensuing assumption is that "mechanical restraint" constitutes "breach" of "setting"; namely, it is considered to be "non-treatment", "malpractice" and "maltreatment". The concept of "restraint" is given an operational definition, in contrast with that of "containment", and is stated as the distancing of the therapeutists from the patient with consequential damage to the therapeutic relationship. An alternative to restraint can be found by training the group of therapeutists. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Treatment of sexual minority youth presents psychologists with a number of challenging ethical considerations. The APA Ethics Code is a valuable resource for addressing these issues, but psychologists require additional guidance in order to provide ethical treatment. This article provides relevant background, an overview of the ethical considerations of treating sexual minority youth, and recommendations to improve upon the current state of awareness and available resources. Psychologists must continually strive to improve our understanding of ethical decisions around treatment, training, and research that will serve to address this vulnerable population's unmet mental health needs. [ABSTRACT FROM AUTHOR]

The article discusses the protection of psychotherapy notes under the "Privacy Rule" of Health Insurance Portability and Accountability Act of 1996 (HIPAA) of the U.S. Department of Health and Human Services (HHS). It presents three ethical principles for treating patients including psychotherapist-patient confidentiality, ethical record keeping, and ethical goal of sharing information. It reflects that changes should be made to the "Privacy Rule" to enhance protection of psychotherapy notes.

Background: A three‐stage independent audit of complaints made to the British Association for Counselling and Psychotherapy was conducted. The second stage is discussed in this paper. Primary objective: This project set out to examine complaints made under the Article 4.6 process, which allows the Association to respond swiftly to serious allegations of misconduct. The main aim was to gain a detailed picture of who complains, who is complained against, and the outcomes of such complaints. Method: Information from these cases was entered into a database to produce descriptive statistics. Main outcomes and results: A total of 91 cases covering the period from 1998–2007 were identified. Figures have been combined with totals from the first stage of the audit and show that the total number of complaints received represents less than two complaints for every 1000 members per year. Conclusions: Male members of the Association are over‐represented in the complaints and the majority of complaints are brought by people who are themselves involved in counselling. Further research into complaints made to other UK counselling and psychotherapy organisations is recommended as is research examining what prevents members of the public from making complaints. [ABSTRACT FROM AUTHOR]

Ethical approaches to practice and research in counselling and arts/psychotherapies demand an urgent attention to body politics. Bodies are not neutral; gender, sexuality, ethnicity and class are socio-political aspects that shape our mental, emotional and physical selves and inform our ethical values. Drawing from the author's embodied practice as interdisciplinary practitioner-researcher, the aim of this paper is to examine the inseparability of ethics and bodies and explore how autobiographical, relational and political aspects of our selves-in-motion give rise to and build upon ‘ethically important moments’. The paper concludes with expanding possibilities; that highlighting ethical tensions within the lived experiences of bodies-in-motion allows for politically progressive approaches to practice that reflect the emerging paradigm shift of a post-Cartesian and interdisciplinary age. [ABSTRACT FROM PUBLISHER]

Objective: Some critics of treatment manuals have argued that their use may undermine the quality of the client-therapist alliance. This notion was tested in the context of youth psychotherapy delivered by therapists in community clinics. Method: Seventy-six clinically referred youths (57% female, age 8-15 years, 34% Caucasian) were randomly assigned to receive nonmanualized usual care or manual-guided treatment to address anxiety or depressive disorders. Treatment was provided in community clinics by clinic therapists randomly assigned to treatment condition. Youth-therapist alliance was measured with the Therapy Process Observational Coding System--Alliance (TPOCS-A) scale at 4 points throughout treatment and with the youth report Therapeutic Alliance Scale for Children (TASC) at the end of treatment. Results: Youths who received manual-guided treatment had significantly higher observer- rated alliance than usual care youths early in treatment; the 2 groups converged over time, and mean observer-rated alliance did not differ by condition. Similarly, the manual-guided and usual care groups did not differ on youth report of alliance. Conclusions: Our findings did not support the contention that using manuals to guide treatment harms the youth-therapist alliance. In fact, use of manuals was related to a stronger alliance in the early phase of treatment. [ABSTRACT FROM AUTHOR]

Schizophrenia-spectrum disorders have a chronic and episodic course that results in impairment of all life domains. Pharmacological and psychosocial treatments provide symptom relief, but there is not a cure for schizophrenia and many patients suffer chronic impairment. In addition, it is expensive both in economical terms and also in terms of personal costs for both patients and their families. International interest has grown over the past 15 years in the prognostic potential of early identification and intervention in the prodromal and first-episode phases of psychotic illness. This focus is associated with increasing optimism about the benefits of implementing treatment as early as possible in the course of psychosis at least to help improve the course of illness, reducing its long-term impact. The most recent epidemiological studies have shown that patients with longer duration of untreated psychosis (DUP) have worse short-term outcomes in terms of treatment response, positive symptoms, negative symptoms, and global functioning. Neuroimaging studies have also indicated that prolonged untreated illness is associated with more pronounced structural brain abnormalities, while this is less prominent earlier in the course of the disorder. Therefore, early detection aims to reduce treatment delay in the hope of improving prognosis and reducing illness severity. Early intervention in psychotic disorders has gained momentum in the last decades, and there is now an estimated 200 centers worldwide offering specialized services for young people experiencing their first episode of psychosis. Each of these programs has unique characteristics and distinctive features in terms of treatment modalities and assessment tools, but most have a number of common elements and goals: a) early detection of new cases, b) reducing DUP, and c) providing better and continued treatment during the «critical period» of the early years of the disease. Moreover, the role of family work in early psychosis can be crucial given that relatives are the main informal caretakers of persons with mental health problems. Family interventions in early psychosis usually offer psychoeducation and/or individual and group family therapy, communication and problem solving training, which can help to develop coping strategies and reduce distress and burden. Intervention programs in early psychosis are usually composed by interdisciplinary teams, providing a wide range of integrated services that typically include psychoeducation, clinical case management, and group interventions. Specific interventions generally include pharmacotherapy, stress management, relapse prevention, social and employment rehabilitation support, and cognitive and family therapy. Given the complex etiology and clinical manifestation of psychosis, treatment packages for people experiencing early psychosis need to be individually tailored to specific needs rather than applied homogenously across early psychosis patients. The current challenge in the implementation of psychological interventions in the early stages of psychosis are: 1. to adapt treatment modalities that have been proven effective in stable and residual stages of the disease to its early stages; 2. to develop new forms of therapy tailored to the specific characteristics of these early stages of psychosis (prodromal and ultra high-risk phase, onset and first episode psychosis, and «critical period» or post-crisis psychosis); and 3. treatment packages need to be individually tailored to their specific needs rather than applied homogenously across a group of patients. The aims of this paper are: 1. to present the basic concepts, rationale and state of the art of the early detection and intervention paradigm; 2. to review and present the main detection and intervention programs in early psychosis and 3. to provide an overview of the current psychotherapeutic approaches in early psychosis. [ABSTRACT FROM AUTHOR]

A dialogue with the anonymous psychiatrist, Dr. E., is presented, dealing with the nature of the ethical values underlying psychoanalytic psychotherapy. A difficult clinical case is the focus of the discussion-that of a woman who was not to be deterred from committing suicide and whose deadly plans appeared to raise serious ethical questions for the clinician. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The paper consists of several interrelated layers. Although the foreground is the main topic of ethical dilemmas which includes work with children and young people, my intention is also to clarify the basics of ethics as a philosophical discipline. It seems that basic knowledge and understanding of ethics is important for psychotherapists and trainees that they do not expect universal and unique answers. I will use an example from Schlink's novel The Reader as the basis for the explanation of the two basic approaches in traditional ethics. The questions raised will then be related to the issues of psychotherapy and pedagogy as well. The whole will thus demonstrate the importance of relational approaches in ethics, psychotherapy and pedagogy. [ABSTRACT FROM AUTHOR]

Although unusual, psychodynamic psychiatrists engage in the practice of treating multiple members, and constellations of members, of families with psychodynamic psychotherapy as well as other treatment modalities. Such clinicians are considered the 'Family Psychiatrist.' Psychological characteristics of such families who cannot be referred to other clinicians are articulated. The literature on psychotherapy in small rural communities is reviewed as having relevance to define the ethical issues that arise in such treatments. These issues include: maintaining therapeutic neutrality; creating functional, flexible, and appropriate boundaries; maintaining confidentiality; promoting patient autonomy and growth; as well as managing conflicts of interest. Relevant countertransference issues are examined. [ABSTRACT FROM AUTHOR]

If placebos have been squeezed out of medicine to the point where their official place is in clinical trials designed to identify their own confounding effect, the placebo effect nevertheless thrives in psychotherapy. Not only does psychotherapy dispose of placebo effects that are less available to medicine as it becomes increasingly technological and preoccupied with body parts, but factors of the sort inhibiting the use of placebos in medicine have no equivalent in psychology. Medicine today is disturbed by the placebo effect in a way psychotherapy is not. Psychotherapy does not have to grapple with such a disconcerting paradox as successful sham surgery, and unlike those physicians who once pretended to treat the patient’s body while actually attempting to treat the mind, the psychotherapist can treat the mind in all frankness. Perhaps it is because psychotherapy is less burdened by doubts about the placebo effect that it was able to come to its aid when it was orphaned by medicine. It is vain to expect something with so long a history as the placebo effect to disappear from the practices of healing. [ABSTRACT FROM PUBLISHER]

The effective provision of psychotherapy services to individuals with intellectual disability requires consideration of ethical issues related to clinical competence, access to services, obligations to multiple parties, guardianship, and appropriate assessment practices. This article provides an overview of major ethical considerations with guidance for clarifying and resolving common ethical concerns. Psychologists are encouraged to expand access to psychotherapy services for this population while maintaining awareness of potential modifications, training needs, and boundaries of professional competence. The authors provide recommendations and resources for effective and ethical treatment of psychotherapy clients with intellectual disabilities. [ABSTRACT FROM AUTHOR]

This paper considers various threads woven into the fabric of an ethics of psychoanalytic psychotherapy. A call is made for a mature ethic, residing and held within the person of the psychotherapist, within the wider network of reflective openings afforded through supervision and other forms of inquiry. From this mature ethical position, various realities are poised in a balancing act: that of the psychotherapist's clinical objectives and the nature of the analytic container created to encourage these objectives, as it exists within a particular legal-socio-historical context, which is informed by idioms of the practice of psychoanalytic psychotherapy. The psychotherapist sustains an ethic that is particular to the needs of the individual patient through maintaining a flexible membrane that frames the therapy space from the wider context, yet realistically considers the nature of external reality. The whole is considered in the specific. Particular reference is made to the application of this mature ethical position to the principles of confidentiality and self-determination, particularly considering the patient's threat to harm his or her own person. [ABSTRACT FROM AUTHOR]

The scientist-practitioner model, which is based on positivistic methodological assumptions, is influential in the development, training and practice of cognitive behavioural psychotherapists. As the emergence of 'Nurse Cognitive Behavioural Therapist' training in the early 1970s in Britain, many of those trained have been mental health nurses and with the emergence of the Increased Access to Psychological Therapies agenda many more are likely to undergo training. Despite some acceptance of its relevance, the scientist-practitioner model is subject of criticism on the grounds of its achievability and contemporary relevance, and its exclusion of other modalities of counselling and psychotherapy without an, as yet, disseminated evidence base. In line with key policy-related work, the empirical and political issues inscribed within the scientist-practitioner model have direct implications for the educational preparation and ongoing professional development of cognitive behavioural practitioners. Specifically, in this polemical paper it is argued that there is a moral and educational need for 'senior' practitioners to question the philosophy of science assumptions underpinning the overwhelming dominance of the quantitative-experimental approach in cognitive behavioural psychotherapy. Such a critically evaluative and pluralistic stance would arguably distinguish senior practitioners in terms of them being able to make broad rather than narrow appraisals of the evidence base for their practice. A recognition of the relevance of paradigmatic and epistemological pluralism in cognitive behavioural work would, it is argued, confer considerable advantages on our practice communities and clients. A range of emerging implications for cognitive behavioural education, practice and relational ethics are described and discussed. [ABSTRACT FROM AUTHOR]

Narrative therapy allows the family to create new meanings for each member of a family while integrating family history. Narrative family counseling should be examined by family counselors for its effects on families and individuals. Potential ethical issues arise when the counselor using narrative methods explores the family's knowledge of itself and each individual's experience within the family. In this article, ethical dilemmas in narrative family therapy are examined and discussed. [ABSTRACT FROM AUTHOR]

This paper is a summary of the ideas presented in Mark Wheeler's keynote speech to the 2008 First International Phototherapy Symposium held at University of Turku, Finland. Ideas from art psychotherapy, psychological aesthetics, systemic therapy and photography combine to address the processes by which phototherapy, phototherapy techniques and therapeutic photography affect the psychological states of makers and viewers of photographic images in a variety of contexts. The ideas presented in Photo-Psycho-Praxis arise from domestic photography, fine-art photography, art history, art therapy, neuroscience and psychological aesthetics. This paper weaves together ideas from these diverse areas of enquiry to generate insight into the psychological dimensions of making and viewing photographs and how these impact on therapy when photographs enter the process. [ABSTRACT FROM AUTHOR]

Client gift giving is an interesting interpersonal event, and scholars have considered the ethical and clinical complexities involved in receiving gifts from clients. Attention to the cultural relations of client gift giving invites a more nuanced discussion of psychologists' decisions to accept or decline client gifts. In recognition of how cultural issues affect the therapeutic relationship, the American Psychological Association has instituted guidelines regarding multicultural competence and has urged psychologists to practice in a culture-centered manner. This article reviews the ethical decision making of 40 licensed psychologists to accept or decline gifts from clients. Results indicated that psychologists were more likely to accept gifts from clients when the gift was inexpensive, informed by cultural context, and presented with gratitude for good work at the end of psychotherapy treatment. Psychologists were more likely to decline gifts that were expensive, were presented during treatment rather than at the end of treatment, and had sentimental or coercive value. Two psychologists indicated they would not accept client gifts because they perceived gift acceptance to be a violation of their code of ethics. [ABSTRACT FROM AUTHOR]

Psychotherapists must deal with practical business matters such as advertising, billing, collecting fees, and other practice management topics. We review the enforceable standards of the American Psychological Association's (2002) Ethics Code that deal with advertising, fees, billing, and related business matters in psychotherapy. Using a principle-based perspective, we link each of the standards to overarching ethical values and illustrate the concerns with case vignettes. We argue that understanding the moral foundations of ethical standards helps psychotherapists to implement with greater integrity the spirit and the letter of the standards with regard to advertising and business practices. © 2008 Wiley Periodicals, Inc. J Clin Psychol: In Session 64: 1–13, 2008. [ABSTRACT FROM AUTHOR]

Psychotherapists confront a myriad of ethical dilemmas as they endeavor to provide effective services. This issue of the Journal of Clinical Psychology: In Session on Ethics in Psychotherapy provides psychotherapists with thoughtful reviews, case examples, and practical guidance in the major areas of ethics. Following this brief introduction, the subsequent seven articles cover Informed consent; confidentiality, privilege, and their limits; treatment of minors and their families; business matters of practice (e.g., money, fees, bartering, advertising); clinical competence and scope of practice; boundaries and nonsexual multiple relationships; and termination and abandonment. This issue is designed to promote ethical practice, to provide guidance on common ethical dilemmas, and to prevent ethical challenges before they occur. © 2008 Wiley Periodicals, Inc. J Clin Psychol:In Session 64: 1–7, 2008. [ABSTRACT FROM AUTHOR]