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Ethical Reasoning for Mental Health ProfessionalsReview - Ethical Reasoning for Mental Health Professionals
by Gary G. Ford
Sage Publications, 2006
Review by Tony O'Brien, RN, MPhil
Sep 26th 2006 (Volume 10, Issue 39)

This book follows Gary Ford's 2001 Ethical Reasoning in the Mental Health Professions, and so is a second edition all but in name. The new edition adds two chapters, one on computer-mediated therapy, and the other on psychological principles in business contexts. These come in addition to an already comprehensive set of chapters covering ethical theory, codes of practice, decision making, clinical issues, the law, research, education, and more. Developed in a format that enables it to structure a university course in professional ethics, Ethical Reasoning for Mental Health Professionals certainly provides a broad general introduction to the field. Ford probably knows his market well, and will have developed this book to be used for graduate psychology courses other than the one he teaches. My reservations about what the book sets out to achieve relate partly to this broad scope: such a wide coverage can mitigate against depth of analysis. Beginning practitioners, for example, perhaps need less to know about ethics applied to research (which should be covered in their research courses) but a very sound grounding in issues such as consent and professional boundaries, not to mention familiarity with the processes of ethical reasoning. A second reservation is that despite its title this is a book for psychologists and counselors, not for all mental health professionals. Medical and nursing texts, for example usually give more space to issues of involving civil commitment, informed consent, competence, and duty to protect. Nevertheless Ethical Reasoning for Mental Health Professionals has a commendable scope. It is well focussed on its target audience of graduate students, and together with the class discussion and debates would provide graduating students with practical skills in the ethical dilemmas they will inevitably encounter in clinical practice.

The book is roughly divided into three sections. The first five chapters cover very broad issues of professional ethics with special discussion of the history of ethical codes in psychology. There is a chapter on psychology's Code of Conduct, and one on counselling's Code of Ethics. These are followed by a brief chapter on ethical reasoning, and a further chapter setting out a model of ethical decision making. The middle section contains the meat of the book, with seven chapters exploring specific ethical issues. These chapters cover psychotherapy, organizations, psychological testing, computer technology, business settings, teaching, and research. The third section has chapters on mental health and the law, and professional ethics boards. Appendices include the 2002 psychologists' Code of Conduct, and the 2005 Code of Ethics of the American Counseling Association. The focus is on the US context, so sections on the law and professional boards would need to be supplemented with local material for those outside the US.

Any introduction to ethical issues in professional practice needs to provide a decision making process backed by reference to ethical theory. Ford provides a chapter on theory in which he discusses the usual standards of utilitarianism and Kantian ethics, as well as relativism and contextualism. In the following chapter he presents a sequential decision making process which contains all the necessary elements for such a mechanism. I'm not sure though, that distinguishing metaethical analysis (which seems to mean consideration of principles) from "tertiary" analysis (generating options) is especially helpful in a book that is primarily practical. The many case examples sprinkled throughout the book are tantalizing in that they stop short of analysis, simply presenting unresolved scenarios from clinical practice. No doubt these would be valuable aids to a teacher using the book as a class text, and for the student reader they provide an opportunity to formulate arguments about the ethical issues involved. The case examples seemed realistic and plausible; real enough for the experienced reader to want to provide an opinion, or point out where one of the protagonists is 'wrong'. The recurring use of ethical principles to discuss issues chapter by chapter gives the book continuity and structure.

In any such broad book, those with a special area of interest may find fault with how that area is covered. Ford's section on psychiatric commitment states that the key element in most instances of involuntary treatment is "individuals' ability to take care of their own basic needs" (p. 255), but my reading of the US literature on civil commitment is that the criterion of danger to others looms large in this process. For some reason Ford uses the term 'parentalism' rather than 'paternalism' to describe health professionals' actions against patients' autonomy. The long discussion of suicide prevention in this chapter seems somewhat out of place, as much of it turns on ethical rather than legal argument, particularly Szasz's notion that involuntary treatment of suicidal individuals is an unacceptable breech of their autonomy. Ford does provide some discussion of the legal issues of suicide, although mainly in terms of potential clinician liability. There's no harm in that; in a book for budding professionals a cautionary note about how their clinical decisions might have implications for their professional credibility is well in order. I thought competence could be better covered as this is a major issue for psychologists when counselling people with significant cognitive impairments. There are references to competence elsewhere in the book, but I would have thought more on the legal determination of competence would be helpful. The chapter on research is comprehensive, covering consent, capacity, coercion and deception. Helpfully, this chapter also includes authorship, plagiarism and publication, issues which are not always discussed in detail with students, in my experience. Ford even includes a section on the ethics of the peer review, and many will agree with his comment that reviewers have an ethical responsibility to be fair in their assessments, not simply take the opportunity to berate the hapless author on their shortcomings.

The new chapters on computer technology and industrial practice are worthy of comment as these represent extensions to traditional texts on professional ethics. Internet technology has spawned new modes of communication, new modes of community building, and new modes of therapy. The medium nicely conforms to the definition of 'crisis' as danger and opportunity. This chapter is brief, but it at least serves notice that the traditional ethical principles of beneficence and non-maleficence can guide such a novel technology as the Internet. With the Internet there is sometimes a sense of 'beyond the frontier', that traditional moral codes no longer apply. Ford shows that they can serve us well. Working for a corporation presents psychologists with the conflict between their professional obligations as psychologists, and the rather different business interests of the corporation. Ford is unequivocal in declaring that psychologists, as long as they continue to identify as psychologists, retain their professional obligations no matter how deeply immersed they become in the management of the organization. This might seem a tall order, but it is only by creating such clear boundaries that the professional can protect themselves, their employer, and any individual clients they see. As with the chapter on computer technology, Ford shows how traditional ethical frameworks can be useful when faced with modern ethical conflicts.

The chapters on psychotherapy and counseling, working in organizations, and assessment and teaching seem sound, and to pick up on the many matter-of-fact issues psychologists will encounter in these areas of practice. Students get the benefit of an overview of the scope of their role, as well as guidance in areas that provide potential pitfalls. To give just one example, sexual contact between therapist and clients, Ford is able to cite the psychologists' and counselors' Codes which proscribe such behavior with current clients. He then questions the Codes' sanctioning of sexual contact with former clients, providing what seems sound advice to beginners never to entertain the possibility of such contact. This may be too black and white for some, but if the interests of clients (and the emotional well being of psychologists) are to be protected it seems wise.

To return to my earlier comment about the scope of this book, there is no shortage of material here for a graduate psychology student. Having the practice-focussed sections in the middle, book-ended by the rather dry material about codes and boards had, for me, the effect of presenting the subject as steeped in institutional authority rather than a matter of self examination and philosophical analysis. To be fair to Ford, the book is a practical one, and it definitely succeeds in displaying the wide range of ethical dilemmas that psychologists may confront at some point in their careers. But I wonder how much the book would encourage students to engage with ethics as a discipline, rather than as a decision making process. Again, to be fair to Ford, for a clinician, philosophical analysis is must be linked to practical action, even in an area steeped in values.

Overall Ethical Reasoning for Mental Health Professionals appears to be both a useful text for psychology and counselling students, and a handy reference work as they embark on their professional practice. Students are likely to find it a useful introduction, and a practical source of advice on a range of professional issues. Psychology lecturers and those planning graduate courses should consider at least recommending this book as additional reading.

 

2006 Tony O'Brien

 

Tony O'Brien RN, MPhil, Senior Lecturer, Mental Health Nursing, University of Auckland, a.obrien@auckland.ac.nz


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