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Wouldn't it be nice to have a portable ethicist that you could
consult whenever you had doubts about how to proceed ethically
in your mental health practice? If you now feel inclined to buy
The Portable Ethicist, there is something you should know
in advance: this book would have probably been more aptly entitled
The Portable Malpractice Lawyer than The Portable Ethicist.
(One reason the authors chose this title may be that they had
already written The Portable Lawyer for Mental Health Professionals.)
The authors, Bernstein and Hartsell, are both lawyers who have
ample experience with advising and representing clients who want
to file ethical complaints as well as mental health professionals
who are in danger of facing such complaints. This experience has
clearly shaped the scope and content of their book. They do not
have much patience for those who feel that there is more to dealing
with ethical issues than the steps one should take to avoid malpractice
suits, problems with licensing boards, and with professional associations.
Their principal aim is to deliver the information that is needed
to help professionals avoid these kinds of trouble, and not to
engage in discussions about the "big questions", as
they call it. That is, their main concern is with fulfilling the
letter of the existing professional ethics codes.
There is clearly need for such a book. Malpractice suits and ethics
complaints against mental health professionals are on the rise
in the US, while many professionals are still barely acquainted
with the ethics codes of their professions. It is increasingly
important to follow closely the ever more detailed provisions
of the professional ethics codes. Accordingly, it will be helpful
to know the different issues related to the therapy practice that
may come up in ethics complaints (part I), how the complaint process
proceeds (part II), how you should organize your practice (part
III), what specific requirements outside of the practice of therapy
come with the role of the professional (part IV), and what the
challenges are in specific areas of practice (part V). The authors
address many issues that are relevant for organizing everyday
practice and give useful practical advice. This includes e.g.
a detailed checklist for the items that should be mentioned in
an informed consent form, a sample letter of termination, advice
for how to close a practice, and other helpful material. In addition,
their material is well presented: they offer case vignettes, highlight
important points in the margins, and provide a list of "Ethical
Flash Points" as well as a summary at the end of each chapter.
Moreover, in drawing on a variety of different ethics codes, they
do not only provide important information, but also manage to
illustrate the degree of convergence between the ethics codes
of different mental health professions.
Nevertheless, despite being aware of the practical purpose of
the book, I could not help being dissatisfied with the general
defensive stance that was apparent throughout the text. There
is little engagement with the positive ethical ideals behind the
ethical standards of the different professions. This is all the
more surprising given that most ethics codes contain a part in
which the basic principles or ideals of the profession are explicitly
stated. Instead, the authors focus nearly exclusively on the question
of how to avoid trouble, and the patient is treated above all
as a potential source of danger for the professional. They repeat
so often that no therapist can feel safe, that even the best and
innocent therapists can face devastating ethical complaints, while
clients do not have to fear anything when they file frivolous
claims (cp. especially chapter 24), that one gets the impression
that the mental health professions nowadays are ethically under
siege. It should at least be kept in mind that there is much reason
to assume that most cases of seriously unethical behavior never
reach the public, and also that successful ethics complaints that
result in the revocation of a license to practice are still extremely
Depicting the client primarily as potential adversary has consequences
for how the ethical task of the therapist is understood. For example,
in their treatment of informed consent, the authors hardly convey
the impression that the main point of the duty of informed consent
is that the client actually understand the information
that the therapist offers. Also, their decision to strictly advocate
the most restrictive practice ("if in doubt, don't do it"),
reasonable as it is in view of possible malpractice suits, will
not necessarily lead to what, legal consequences aside, will be
regarded as the ethically most acceptable solution. However, for
the authors at least there is apparently no doubt that following
the defensive road does not leave any ethical questions open.
I would therefore strongly advise anybody who is interested in
purchasing The Portable Ethicist to at least take into
account other literature on ethical issues in psychotherapy that
tries to do justice not just to the letter, but also to the spirit
behind the development of the professional ethics codes (e.g.
Kitchener's Foundations of Ethical Practice, Research and Teaching in Psychology,
or Pope's and Vasquez' Ethics in Psychotherapy and Counseling: A Practical Guide).
Provided the reader has access to such other sources that do not
reduce professional ethics to defensive practice, I would then
not hesitate to recommend The Portable Ethicist for much
potentially useful advice.
© 2002 Heike Schmidt-Felzmann. First serial
Heike Schmidt-Felzmann holds
graduate degrees in philosophy and psychology from the University
of Hamburg, Germany. She is currently a doctoral candidate in
philosophy and works on ethics in psychotherapy.
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