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Arnold Goldberg, a psychoanalytic psychiatrist in Chicago, has provided a discussion of what he sees as issues of morality in the process of analytic psychotherapy. Through the examination of a number of case studies, Goldberg purports to demonstrate his point that a good deal of what psychoanalytic therapists confront involves moral issues of one kind or another. He argues that most psychiatrists or other psychoanalytic psychotherapists do not recognize the significant moral components of a good deal of what they do. He invokes an interesting discussion of the conflict that sometimes arises between confidentiality and morality and seems to come down on the side of moral relativity for the most part. Ultimately, though, Goldberg's work speaks to a relatively small audience and provides jejune bromides obvious to most of us involved in the practice and intellectual analysis of psychotherapy; the idea of psychotherapy as itself a moral practice remains, disappointingly, largely untouched by Goldberg.
In each of his thirteen chapters in this brief (140 pages) volume, Goldberg presents at least one moral quandary, often reframing it as such when colleagues did not recognize the moral aspect of their behavior in psychoanalysis. Through the use of extended case studies, Goldberg makes fine distinctions as he describes ethical and moral lapses, many of which have harmed psychoanalysts' clients (note: Goldberg uses the term "patients," as do most psychoanalysts). Goldberg spends a fair amount of time discussing the morality of providing case presentations to other psychoanalysts, particularly at conventions or in peer-reviewed papers (it must be noted that Goldberg does not discuss the morality of his presentation of case studies or whether full and complete consent was obtained from the subjects of his case presentations!). He concludes that "moral ambiguity" (p. 41) may be best when confronting difficult issues in psychoanalysis, believing that hard and fast rules serve no one: "We must resist these psychological resting places in ourselves" (p. 41). In other words, Goldberg says that psychoanalysts have an obligation to adopt situational ethics, based on the therapist's judgment about what is best for the client. Instead of damning a client for lying to get a seat on a plane (Chapter Twelve) or for misbehaving at work (Chapter Seven), Goldberg argues that psychoanalysts must recognize and embrace "a state of puzzlement, a condition that must necessarily precede that of understanding and eventual resolution" (p. 77). So, he says, the good psychoanalyst will scrutinize himself and his motives (and most of the analysts discussed are male, interestingly) before taking a moral stance with a client. This is probably good advice for most of us, in fact.
Additionally, Goldberg argues against a steadfast or automatic adherence to the rules of psychoanalysis (and he seems, in fact, to believe that what he calls "assumptions" about things taken for granted--in other words, culture--are bad almost in and of themselves). This comes to fruition especially in Chapter Five, "A Risk of Confidentiality." In a succession of cases illustrating the breach of confidentiality through, for instance, supervision of psychotherapists (pp. 53-54) or management of psychopharmaceutical treatment (pp. 54-55), among others, Goldberg argues for flexibility when considering issues of confidentiality. In part, Goldberg asserts, psychoanalysts must put confidentiality issues in context because clients are often incompetent: "Unfortunately, we have learned that patients are often unable to be free enough of transference issues to be in a position to really give informed consent" (p. 57). The analyst, or at least the Goldbergian version of him, presumably knows what is best for the client.
Ultimately, then, Moral Stealth reminds us of the unreflective embeddedness of psychoanalysis in American culture, of its patronizing stance towards those who seek help from "the doctor," and of its arrogance, ultimately. Goldberg is speaking to a very small audience about a set of ideas that have been covered more thoroughly, and more successfully, outside of psychoanalysis. While it is a shame that psychoanalytic training does not include, apparently, a discussion like this, it is one that has been plain in most other psychotherapeutic training programs. Goldberg's discussion fails, finally, as he does not recognize the culturally contingent nature of psychoanalysis--and, indeed, all of psychotherapy--and its congruence with American and, more broadly, western culture. His book will be of use in psychiatric training courses, to be sure, given what appears to be a dearth of discussions such as this, but it adds little to the larger intellectual project of understanding the place of psychotherapy in western society.
© 2008 Elizabeth A. Throop
Dr. Elizabeth A. Throop is a psychological anthropologist familiar with the psychoanalytic paradigm; she also holds a MSW and has practiced systemic family therapy with abusive, neglectful, and eating-disordered families (among others). She is the chair of the Department of Anthropology, Sociology, and Social Work at Eastern Kentucky University. She has conducted ethnographic fieldwork on family life in Ireland and published a book on the subject. She also has researched mental illness in cross-cultural context as well as issues of family life, marriage, and child-rearing cross-culturally. Her forthcoming book, Psychotherapy, American Culture, and Social Policy: Immoral Individualism, will be published by Palgrave Macmillan in early 2009.
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