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EdenOut of Its MindOut of the ShadowsOverdosed AmericaOxford Handbook of Psychiatric EthicsOxford Textbook of Philosophy of PsychiatryPassionate DeliberationPatient Autonomy and the Ethics of ResponsibilityPC, M.D.Perfecting VirtuePersonal AutonomyPersonal Autonomy in SocietyPersonal Identity and EthicsPersonhood and Health CarePersons, Humanity, and the Definition of DeathPerspectives On Health And Human RightsPharmacracyPharmageddonPhilosophy and This Actual WorldPhilosophy of BiologyPhilosophy of Technology: The Technological ConditionPhysician-Assisted DyingPicturing DisabilityPilgrim at Tinker CreekPlaying God?Playing God?Political EmotionsPornlandPowerful MedicinesPractical Autonomy and BioethicsPractical EthicsPractical Ethics for PsychologistsPractical RulesPragmatic BioethicsPragmatic BioethicsPragmatic NeuroethicsPraise and BlamePreferences and Well-BeingPrimates and PhilosophersPro-Life, Pro-ChoiceProcreation and ParenthoodProfits Before People?Progress in BioethicsProperty in the BodyProzac As a Way of LifeProzac on the CouchPsychiatric Aspects of Justification, Excuse and Mitigation in Anglo-American Criminal Law Psychiatric EthicsPsychiatry and EmpirePsychological Concepts and Biological PsychiatryPsychology and Consumer CulturePsychology and LawPsychotropic Drug Prescriber's Survival GuidePublic Health LawPublic Health Law and EthicsPublic PhilosophyPunishing the Mentally IllPunishmentPursuits of WisdomPutting Morality Back Into PoliticsPutting on VirtueQuality of Life and Human DifferenceRaceRadical HopeRadical VirtuesRape Is RapeRe-creating MedicineRe-Engineering Philosophy for Limited BeingsReason's GriefReasonably ViciousReckoning With HomelessnessReconceiving Medical EthicsRecovery from SchizophreniaRedefining RapeRedesigning HumansReducing the Stigma of Mental IllnessReflections On How We LiveReframing Disease ContextuallyRefusing CareRefuting Peter Singer's Ethical TheoryRelative JusticeRelativism and Human RightsReligion ExplainedReprogeneticsRescuing JeffreyResponsibilityResponsibility and PsychopathyResponsibility and PunishmentResponsibility and PunishmentResponsibility from the MarginsResponsible GeneticsRethinking CommodificationRethinking Informed Consent in BioethicsRethinking Mental Health and DisorderRethinking RapeReturn to ReasonRevolution in PsychologyRightsRights, Democracy, and Fulfillment in the Era of Identity PoliticsRisk and Luck in Medical EthicsRobert NozickRousseau and the Dilemmas of Modernity Rule of Law, Misrule of MenRunning on RitalinSatisficing and MaximizingSchizophrenia, Culture, and SubjectivityScience and EthicsScience in the Private InterestScience, Policy, and the Value-Free IdealScience, Seeds and CyborgsScratching the Surface of BioethicsSecular Philosophy and the Religious TemperamentSeeing the LightSelf-ConstitutionSelf-Made MadnessSelf-Trust and Reproductive AutonomySentimental RulesSex Fiends, Perverts, and PedophilesSex OffendersSexual DevianceSexual EthicsSexual PredatorsSexualized BrainsShaping Our SelvesShock TherapyShould I Medicate My Child?ShunnedSick to Death and Not Going to Take It AnymoreSickoSide EffectsSidewalk StoriesSister CitizenSkeptical FeminismSocial Inclusion of People with Mental IllnessSocial JusticeSociological Perspectives on the New GeneticsSome We Love, Some We Hate, Some We EatSovereign VirtueSpiral of EntrapmentSplit DecisionsSticks and StonesStories MatterSubjectivity and Being SomebodySuffering, Death, and IdentitySuicide ProhibitionSurgery JunkiesSurgically Shaping ChildrenTaking Morality SeriouslyTaming the Troublesome ChildTechnology and the Good Life?TestimonyText and Materials on International Human RightsThe Aims of Higher EducationThe Almost MoonThe Altruistic BrainThe American Psychiatric Publishing Textbook of Forensic PsychiatryThe Animal ManifestoThe Art of LivingThe Autonomy of MoralityThe Beloved SelfThe Best Things in LifeThe Big FixThe Bioethics ReaderThe Biology and Psychology of Moral AgencyThe Blackwell Guide to Medical EthicsThe Body SilentThe BondThe Book of LifeThe Burden of SympathyThe Cambridge Companion to Virtue EthicsThe Cambridge Companion to Virtue EthicsThe Cambridge Textbook of BioethicsThe Case against Assisted SuicideThe Case Against PerfectionThe Case Against PunishmentThe Case for PerfectionThe Case of Terri SchiavoThe Challenge of Human RightsThe Code for Global EthicsThe Colonization Of Psychic SpaceThe Commercialization of Intimate LifeThe Common ThreadThe Connected SelfThe Constitution of AgencyThe Creation of PsychopharmacologyThe Criminal BrainThe Decency WarsThe Difficult-to-Treat Psychiatric PatientThe Disability PendulumThe Disability Rights Movement: From Charity to ConfrontationThe Domain of ReasonsThe Double-Edged HelixThe Duty to ProtectThe Emotional Construction of MoralsThe End of Ethics in a Technological SocietyThe End of Stigma?The Essentials of New York Mental Health LawThe Ethical BrainThe Ethical Dimensions of the Biological and Health 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Philosophy to LifeThe Right Road to Radical FreedomThe Right to Be ParentsThe Righteous MindThe Root of All EvilThe Rules of InsanityThe Second SexismThe Second-Person StandpointThe Silent World of Doctor and PatientThe Sleep of ReasonThe Social Psychology of Good and EvilThe Social Psychology of MoralityThe Social Psychology of MoralityThe Speed of DarkThe Stem Cell ControversyThe Stem Cell ControversyThe Story of Cruel and UnusualThe Story WithinThe Stubborn System of Moral ResponsibilityThe Suicide TouristThe Terrible GiftThe Theory of OptionsThe Therapy of DesireThe Trauma of Psychological TortureThe Trauma of Psychological TortureThe Triple HelixThe Trolley Problem MysteriesThe Trouble with DiversityThe Truth About the Drug CompaniesThe Ugly LawsThe Varieties of Religious ExperienceThe Virtues of HappinessThe Virtuous Life in Greek EthicsThe Virtuous PsychiatristThe Voice of Breast Cancer in Medicine and BioethicsThe War Against BoysThe War for Children's MindsThe Whole ChildThe Woman RacketThe Worldwide Practice of TortureTherapy with ChildrenThieves of VirtueThree Generations, No ImbecilesTimes of Triumph, Times of DoubtTolerance Among The VirtuesTolerance and the Ethical LifeTolerationToxic PsychiatryTrauma, Truth and ReconciliationTreatment Kind and FairTrusting on the EdgeTry to RememberUltimate JudgementUnborn in the USA: Inside the War on AbortionUndermining ScienceUnderstanding AbortionUnderstanding CloningUnderstanding EmotionsUnderstanding EvilUnderstanding Moral ObligationUnderstanding Physician-Pharmaceutical Industry InteractionsUnderstanding TerrorismUnderstanding the GenomeUnderstanding the Stigma of Mental IllnessUnderstanding Treatment Without ConsentUnhingedUnprincipled VirtueUnsanctifying Human Life: Essays on EthicsUnspeakable Acts, Ordinary PeopleUp in FlamesUpheavals of ThoughtUsers and Abusers of PsychiatryValue-Free Science?Values and Psychiatric DiagnosisValues in ConflictVegetarianismViolence and Mental DisorderVirtue EthicsVirtue, Rules, and JusticeVirtue, Vice, and PersonalityVirtues and Their VicesWar Against the WeakWar, Torture and TerrorismWarrior's DishonourWeaknessWelfare and Rational CareWhat Genes Can't DoWhat Is a Human?What Is Good and WhyWhat Is Good and WhyWhat Is the Good Life?What Price Better Health?What Should I Do?What We Owe to Each OtherWhat Would Aristotle Do?What's Good on TVWhat's Normal?What's Wrong with Children's RightsWhat's Wrong with Homosexuality?What's Wrong With Morality?When Is Discrimination Wrong?Who Holds the Moral High Ground?Who Owns YouWho Qualifies for Rights?Whose America?Whose View of Life?Why Animals MatterWhy Animals MatterWhy I Burned My Book and Other Essays on DisabilityWhy Not Kill Them All?Why Punish? How Much?Why Some Things Should Not Be for SaleWisdom, Intuition and EthicsWithout ConscienceWomen and Borderline Personality DisorderWomen and MadnessWondergenesWould You Kill the Fat Man?Wrestling with Behavioral GeneticsWriting About PatientsYou Must Be DreamingYour Genetic DestinyYour Inner FishYouth Offending and Youth Justice Yuck!
I can understand why the first edition
(1998) of this book received the many accolades it did. As the books sub title indicates, this is
indeed a practical guide to ethical behavior for therapists and
counselors. This means its primarily a
How to book, rather than a Why book.
Theres little discussion of meta-ethical themes such as how ethical
principles are arrived at, which ethical theory works best in what situation,
or why one should bother to be ethical.
The first six chapters offer basic information on how to develop ethical
awareness, the relationship between the law and ethics, and the relationship
between the personality of the mental health care provider and ethical
principles of behavior. Included in the
first chapter is a fascinating list of arguments that have been used to justify
unethical conduct such as, Its not unethical as long as no one can prove you
did it, Its not unethical as long as your client wanted you to do it, and Its
not unethical as long as you dont know a law, ethical principle, or
professional standard that prohibits it.
Chapter six deals with a central issue in all of therapy and
counseling: the problem of how to ask
questions that dont unintentionally manipulate the patient or client into
giving the kind of answers the questioner wants to hear. There is a commendable critical discussion
of the issue of false memory syndrome as a case in point, both from the
perspective of how and why therapists were able to lead patients into
developing memories of events which never happened, and from the ironic
perspective of therapists who are now treating the so-called syndrome that
their profession itself created, then diagnosed and labeled, and now claims to
be able to treat.
From chapter seven onwards topics include how to
begin and end a therapeutic relationship, the meaning and importance of
informed consent, the pitfalls inherent in testing and diagnosing, the problem
of sexual relations with clients, the question of the appropriateness of
non-sexual social relationships with clients, the effects of cultural
differences on the therapeutic relationship, the limits of confidentiality, the
therapists responsibilities when it comes to a suicidal patient, and the
supervisory relationship between instructor and student therapist. Each of these chapters ends with a section
titled Scenarios for Discussion in
which several fictitious problems and brief case studies are presented,
followed by a number of pointed questions to be considered by the individual
reader or discussed by the class of students.
At the end of the book are four
appendices with useful information and a detailed example of a code of ethics
for psychologists, a statement of patients mental health rights, ethical
guidelines for professional care in a managed care environment, and a sample
informed consent form.
I found one area of discussion
especially interesting in light of the fears about litigation Ive heard
expressed by counselors on many occasions.
The authors point out that, contrary to popular belief, therapists and
counselors are not sued primarily by hostile clients out for irrational
revenge. By far the overwhelming reason
theyre dragged into court (20% of total claims) is because of sexual
impropriety or improper personal relationships with their clients/patients. At the same time 35 per cent of disciplinary
actions taken against practitioners by licensing boards were also due to sexual
misconduct. Civil suits against a
therapist/counselors for incompetence account for only 14 percent of all
claims. Claims of incompetence include
inadequately trained therapists/counselors working with specific populations
such as rape victims or incest perpetrators, and attempting to use specific
techniques such as hypnotism.
Practitioners who believed that so-called malpractice suits are always
perpetrated against innocent therapists by malicious clients just wanting to
make a quick buck will be relieved to know that litigation is in fact most
often precipitated by therapists unprofessional conduct.
I must admit that I found it
disturbing to note how often the issue of sexual misconduct comes up in this
book. There are two whole chapters (and a sizable list of index entries) that
deal specifically with sexual misconduct and unprofessional relationships with
clients/patients. Also appearing in a
number of assessment questionnaires in various other locations in the book are
questions dealing with issues such as the therapist/counselor having sexual
feelings for the client/patient, the therapist having sexual dreams about the
patient, improper sexual holding and touching between therapist and patient,
and so on. Perhaps Im naïve, but I had
no idea, prior to reading this book, that sexual misconduct is such pervasive
ethical issue in the fields of therapy and counseling.
While I suggest that this book be
on every therapists shelf, I have to admit I found myself becoming
uncomfortable with the dates on some of the data to which the authors have
referred. For example they write, . . . married teenagers show an extremely
high suicide rate and cite a source
dated 1975 (p. 247). In the next sentence they admit that data is
generally not static and that new research
is refining our understanding as well as reflecting apparent
changes. But their attention then
turns to the comparison of suicide rates for women and men. This means that the comment made about the
1975 statistics on married teenager suicides stays in the readers mind as
relevant and current. But surely there
is more up to date data available on suicides among married teens than this!
Again, this book lives up to its
subtitle: A Practical Guide. In my opinion this is the sort of
information that ought to be carefully studied by every practitioner and student
of therapy or counseling. But its also
an easy to read resource for mental health services consumers. Students and practitioners will gain a very
thorough understanding from it of how to behave in a professional manner, while
mental health services consumers will learn what they may legitimately expect
and demand from their therapists and counselors.
© 2002 Peter B. Raabe
Peter B. Raabe
teaches philosophy and has a private practice in philosophical counseling in
North Vancouver, Canada. He is the author of the books Philosophical
Counseling: Theory and Practice (Praeger, 2001) and Issues
in Philosophical Counseling (Praeger, 2002).
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