The field of psychology can be likened to a prism with many unique, albeit related facets – i.e., various theoretical orientations which serve as both the foundation for an explanation of psychological phenomenon and the basis for further research questions. These varying, and sometimes conflicting perspectives, also have associated implications for the practice of therapy. Specifically, the manner in which therapists conduct a session, the techniques they utilize, and the outcomes they expect to achieve, are all influenced by the theoretical viewpoint they embrace. In this way, practicing ethically involves a clear understanding of the theoretical grounding, purpose and goal for each procedure used in the course of therapy and why it represents the most appropriate choice for each individual client.
As Ivey, D’Andrea, Ivey & Simek-Morgan (2002) indicate, “Theories of counseling are based on worldviews, each with its own values, biases, and assumptions of how best to bring about change in the therapeutic process” (p. 357). Thus, while therapists must use their best judgment regarding the approach they take with clients, they must also remain sensitive to issues of culture, race, ethnicity, religion, and life orientation which represent world views different from their own. Acting in the best interest of clients includes negotiating the balance between respecting their individual perspectives and directing them toward psychologically healthy world views.
Keith-Spiegel & Koocher (1998) summarize the need for collaboration stating, “If a client and psychotherapist are to form a therapeutic alliance, they must share some basic goals and understandings about their work together. Implicit in the development of a therapeutic alliance process is the assumption that the therapist will be able to take the client’s unique fame of reference and personal psychological ecology into account when deciding whether and how to organize treatment” (p. 80).
Similarly, Brown (1994) introduced the notion of “empowered consent” as a means of ensuring genuine and comprehensive informed consent. To provide empowered consent, as opposed to mere informed consent, “the therapist considers the quality of information and the manner in which it is presented to maximize the client’s optimal capacity to consent freely and knowingly to all aspects of the therapy relationship without feeling in any way coerced. The goal of such a process is to reduce the risk that a therapist might unilaterally impose a risky or unwanted intervention on an unwitting client” (p. 81). While this viewpoint certainly seems intuitively appropriate, it can manifest in ethical dilemmas surrounding issues of consent for treatment, right to refuse therapy, use of medication, implementation of directive, coercive or fringe therapies and associated therapeutic questions.
Closely related to issues of theoretical orientation and therapeutic perspective are controversies surrounding the use of diagnostic measures, psychological testing and research in counseling. The professional community is deeply divided on these issues. As Corey, Corey and Callanan (2002) indicate, proponents of the use of diagnostic procedures in the therapeutic setting argue that “such procedures enable the therapist to acquire sufficient knowledge about Ivey, A. E., D’Andrea, M. Ivey, M. B. & Simek-Morgan, L. (2002). Theories of counseling and psychotherapy: A multicultural perspective, 5e. Boston: Allyn & Bacon.
the client’s past and present behavior to develop an appropriate plan of treatment” (p. 364). Collectively they view diagnosis as a professional and even legal obligation in the ethical practice of therapy. Conversely, opponents of psycho-diagnosis maintain that because the emphasis of diagnosis is “pathology, deficits, limitations, problems and symptoms, individuals are not encouraged to find and utilize their strengths, competencies and abilities” (p. 366). They further argue that diagnosis fosters compartmentalization of clients and their symptoms, narrowing the therapist’s perspective of the presenting behaviors.
Similar arguments exist surrounding the use pf psychometric testing in counseling and research settings. Opponents cite the potential misuse of these measures and the resulting harm that can befall clients. While testing yields necessary and important information and research represents the process which keeps the field dynamic and vital, both areas represent serious ethical challenges with respect to protecting the best interest of the clients. Corey, Corey and Callanan (2002) summarize the necessary balance of progress and caution, stating, “Perhaps the most basic ethical guideline for using tests is to keep in mind the primary purpose for which they were designed: to provide objective and descriptive measures that can be used by clients in making better decisions” (p. 374). By maintaining the focus of a client-centered purpose as a guiding principle, ethical questions can be better judged in their proper perspective.
Brown, L. S. (1994). Subversive dialogues: Theory in feminist therapy. New York, NY: Basic Books.
Corey, G., Corey, M. and Callahan, P. (2002). Issues and ethics in the helping professions (6th ed.). Pacific Grove, CA: Brooks/Cole Publishing Company.
Ivey, A. E., D’Andrea, M. Ivey, M. B. & Simek-Morgan, L. (2002). Theories of counseling and psychotherapy: A multicultural perspective, 5e. Boston, MA: Allyn & Bacon.
Keith-Spiegel, P. & Koocher, G. (1998). Ethics in psychology: Professional standards and cases. New York, NY: Oxford University Press.