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Ethical reflection is a process that comes from the deeper attitudes and values of the therapist and supervisor. The capability to recognize one's perspectives and ethical dimensions and how they affect own practice is one of the crucial tasks of a responsible therapist. Attitudes and values of an individual or a group may significantly influence the therapeutic process and a choice of strategies and behaviour towards the patient, often working at an unconscious, unreflected levels. Ethics is closely connected with psychotherapeutic treatment. Basic principles, such as expediency, honesty, integrity, justice, and respect, apply to all people equally, including psychologists, psychiatrists, psychotherapists, and supervisors. The goal of supervision is to cultivate the therapeutic process in the client's best interest. The supervisor-supervisee relationship is then grounded on principles similar to those in the therapeutic relationship.

Background: Eating disorders are serious conditions which also impact the families of adult patients. There are few qualitative studies of multifamily therapy with adults with severe eating disorders and none concerning the practice of therapists in multifamily therapy., Objectives: The aim of the study is to explore therapists' practice in multifamily therapy., Research Design and Participants: A grounded theory approach was chosen. Data were collected through participant observation in two multifamily therapy groups and qualitative interviews with the therapists in those groups., Ethical Considerations: The study conforms to the principles outlined in the Declaration of Helsinki. All participants in the multifamily therapy groups received information about the research project and signed consent forms. The data are treated confidentially and anonymised., Findings: The core category was identified as 'having many strings to one's bow', consisting of three subcategories: 'planning and readjusting', 'developing as therapist and team' and 'regulating the temperature of the group'. This article discusses the empirical findings in the frame of Aristotelian virtue ethics.

Media outlets are reporting that cognitive enhancement is reaching epidemic levels, but evidence is lacking and ethical questions remain. The US Presidential Commission for the Study of Bioethical Issues (Bioethics Commission) has examined the issue, and we lay out the commission's findings and their relevance for the scientific community., (Published by Elsevier Ltd.)

Cognitive behavioural therapy (CBT) has risen to prominence as an orthodox treatment option which is commonly recommended to patients with anxiety and depressive disorders. Mainstream healthcare institutions (including the National Health Service in the UK (NHS) and National Institute for Mental Health (NIMH)) assume that CBT works by helping patients to challenge and overcome 'faulty cognition'. Even if we accept the empirical evidence which shows that CBT (like other forms of psychotherapy) is a beneficial treatment there are still problems with this therapy: mainstream medicine and psychotherapy are continuing to ignore established research that CBT does not work according to its core theoretical tenets. This paper presents evidence that psychotherapy is entrenched in such conventional 'wisdom' and that practitioners are failing to meet their own codified requirement of informed consent. I examine ethical arguments for and against upholding current informed consent procedures and focus, in particular, on the relationship between respect for patient autonomy and the duty of beneficence. I argue that (so far) there are no strong grounds for the claim that patient autonomy undermines therapeutic outcome. The modest conclusion of this paper is that psychotherapy (including CBT) needs to begin to adapt informed consent procedures to comply with ongoing scientific research into its efficacy., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

We report on two areas in which UK law and ethics seem out of step with each other. 2013 saw the passing of the Human Transplantation (Wales) Bill, which will introduce an opt-out system of organ donation in Wales from 2015. In the first section, we discuss the convoluted evolution of the Bill and some potential problems that we consider may prevent it from achieving its intended goal of increasing the number of organs transplanted. The prospect of being able to enhance human cognition through cognitive-enhancing drugs ("smart drugs") also presents a nexus of questions associated with future ambitions, hopes, and concerns as a society. How these drugs might affect the future of work and employment is beginning to generate wide public engagement in the UK and forms the focus of the second section.

Humanistic psychology historically defined itself in part by its opposition to behavioral psychology, but the conditions now exist for a fundamental reconsideration of the relationship between these two traditions. Behavioral psychology includes contextualistic variants and is no longer limited to principles drawn from animal learning. Behavioral and cognitive therapies commonly address humanistic topics and have developed process accounts that cast new light on them. In that context, a reconsideration of this relationship could prove to be beneficial for both traditions., ((c) 2012 APA, all rights reserved.)

Objective: The Internet is a frequently used platform for research in pediatric and health psychology. However, there is little pragmatic guidance as to ethical best practice of this research. The absence of guidance is particularly prominent for online research with children. Our objective is to outline ethical issues in e-health research with children and adolescents using two exemplar studies in pediatric pain research., Methods: The first study is an asynchronous message board discussion amongst teenagers with pain who are frequent internet users.The second study is a web-based behavioral intervention for the management of adolescent pain., Results: Each exemplar study is discussed in the context of specific ethical considerations related to recruitment, informed consent and debriefing, privacy and confidentiality, and participant safety. Ethical issues regarding the evaluation of online psychological interventions are also discussed., Conclusions: Guidance on optimal ethical practice in e-health research is summarized.

In recent years, early intervention services have attempted to identify people with a first episode of psychosis as early as possible, reducing the duration of untreated psychosis and changing the timing of delivery of interventions. The logic of early intervention is based partly on accessing people in a more treatment responsive stage of illness in which psychosocial damage is less extensive, and partly on remediating a putatively active process of neuroprogression that leads to pathophysiological, symptomatic and structural changes, hence improving symptomatic and functional outcomes. However, as in other areas of health care, earlier identification of new patients may mean that different treatment approaches are indicated. The corollary of early detection is that the sequence and complexion of treatment strategies for first episode psychosis has been revaluated. Examples include the minimal effective dosage of antipsychotic medication and the content of psychosocial interventions. With the substantial reductions of DUP now seen in many early psychosis services, based on clinical staging and stepped care principles, it is even possible that the immediate introduction of antipsychotic medication may not be necessary for all first episode psychosis cases, but that potentially safer interventions, which may be more acceptable to many patients, such as comprehensive psychosocial intervention, may constitute effective treatment at least for a subgroup of patients. In this paper, we review this theoretical background and describe a randomised controlled trial currently underway at the Early Psychosis Prevention and Intervention Centre (EPPIC) in Melbourne designed to test outcomes for first episode psychosis patients in response to two different treatments: intensive psychosocial intervention plus antipsychotic medication versus intensive psychosocial intervention plus placebo. This is a theoretically and pragmatically novel study in that it will provide evidence as to whether intensive psychosocial intervention alone is sufficient for a subgroup of first episode psychosis patients in a specialised early intervention service, and provide a test of the heuristic clinical staging model. By experimentally manipulating duration of untreated psychosis, the study will also provide a methodologically strong test of the effect of delaying the introduction of antipsychotic medication, as well as helping to disentangle the effects of antipsychotic medications and the putative neurobiological processes associated with brain changes and symptom profiles in the early phase of psychotic disorders. The study has been carefully crafted to satisfy critical ethical demands in this challenging research domain., (Crown Copyright (c) 2010. Published by Elsevier B.V. All rights reserved.)

The treatment of pelvic floor disorders using biofeedback, behavioral therapies, and other applied psychophysiological treatments has been well documented as effective. Practitioners must take due care to ensure that they practice within the boundaries of what is common practice for their discipline and within the scope of practice allowed by their professional license as outlined by the appropriate state licensing law(s), the ethical principles and practice guidelines and standards for their discipline, and those of the Association of Applied Psychophysiology and Biofeedback if using a biofeedback assessment or treatment. Being competent to provide a particular treatment does not necessarily make it legal and/or ethical. This paper provides a set of recommended practice guidelines for use in the assessment and treatment of pelvic floor disorders. Please note that they have not at this time been endorsed as an official position of the Association of Applied Psychophysiology and Biofeedback or any other professional organization.

[table: see text] Physical, psychological and social factors interact in IBS. Evidence for the efficacy of CBT in its management is available. The cognitive-behavioural model can also be used to inform medical care for IBS. In designing and evaluating a cognitive-behavioural intervention, it is important to consider the particular strategies included, the goals being worked towards, the selection of patients to whom the intervention is offered and how far it is tailored to their needs. Other important factors are the skills of the therapist, the setting in which therapy is delivered and whether it is offered together with medication.

Cognitive behaviour therapy (CBT) has been acknowledged as one of the most successful treatments for mental health problems. However, only a small number of practitioners engage in CBT with people with learning disabilities. A group of eight clinical psychologists who currently use CBT with this population gave details about their work in an attempt to gain a consensus on how to adapt CBT. The collective experiences of a wider group of experts produced a wealth of knowledge and suggestions to promote the use of CBT with this client group. Results suggested that although CBT needs to be creatively delivered, it does not necessarily need extensive adaptation.

The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial is a multi-site effectiveness study funded by the National Institute of Mental Health (NIMH) with the aim of identifying successful, acceptable and cost-effective treatment strategies for outpatients with unremitted depression. With enrollment of 4,041 adults with major depressive disorder (MDD), it is the largest controlled psychiatric treatment study ever undertaken. In the course of developing procedures to ensure that ambitious enrollment goals were met, a number of ethical and practical issues became apparent that underscore the conflicts between effectiveness research and human subject protections. These are delineated as they relate to study design; eligibility criteria; incentives to subjects; investigators and clinical sites; the complementary roles of clinical research coordinators (CRCs) and study clinicians; and recruitment and consent procedures. The STAR*D trial exemplifies the interplay and tension between those strategies that integrate research and clinical aims and roles in the service of enhancing external validity, site participation, and recruitment and retention versus those strategies that differentiate research and clinical treatment in the service of research integrity and human subject protections. We hope that a discussion of these key challenges and dilemmas and how they have been addressed will help inform future discussions concerning design and conduct of ethical effectiveness trials designed to optimize care in real world clinical settings.