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Ethics and Values in PsychotherapyReview - Ethics and Values in Psychotherapy
by Alan C. Tjeltveit
Routledge, 1999
Review by Heike Schmidt-Felzmann
May 4th 2001 (Volume 5, Issue 18)

Among the recently increasing number of publications on ethics in psychotherapy, Alan Tjeltveit's Ethics and Values in Psychotherapy stands out as one of the few books in the field that do not give primary importance to the ethical issues that are addressed in the current professional ethics codes. Alan Tjeltveit, who is Assistant Professor of Psychology at Muhlenberg College, Allentown, and also a practicing psychotherapist, aims at nothing less than "unraveling the mystery of the ethical character of therapy" (ix). This project, however, does not entail any recourse to mysticism -- to the contrary, Tjeltveit joins substantial (and very much down to earth) psychological/psychotherapeutic observation with equally substantial philosophical reflection. His book is therefore addressed to practicing psychotherapists as well as philosophers, challenging both of them to think beyond the boundaries of their respective disciplines. He considers such a transdisciplinary approach to be necessary in order to be able to do justice to the ethical intricacies of psychotherapeutic practice, both intellectually and practically (x).

Tjeltveit first challenges both the philosopher and the practitioner to acknowledge the complexity of the practical and terminological issues that will be necessary to capture the ethical dimension in psychotherapy. He thereby sets the stage for his project of developing a comprehensive conceptual framework for a "more sophisticated analysis of values and ethics in therapy" (12). His initial claim that no psychotherapist can escape taking the role of "ethicist" is then elaborated throughout the book.

He starts his more detailed discussion with an overview over ethical theories in philosophy. Contrary to what one normally encounters in chapters of this kind, Tjeltveit largely manages to present different philosophical approaches without trivializing them more than necessary, while still making them seem relevant to practitioners. Thanks to his repeated reference to clinical vignettes in his more theoretical discussion, his tour de force through what philosophical ethics has to offer becomes surprisingly bearable.

When Tjeltveit turns to the ethical evaluation of therapeutic interventions and the therapeutic relationship and critically analyzes the role of therapists' self-understanding, this book is at its best. Instead of referring mainly to professional ethics codes, as would be normally done in this context, Tjeltveit uses philosophical concepts to access and map out the ethical dimension of therapeutic practice. He thereby manages to develop a deeper understanding of some often neglected ethical issues in psychotherapy and also provides a clarifying vocabulary concerning the ethical intricacies of the therapeutic situation. Particularly valuable are his reflections about determining the ends of psychotherapy, about the varieties of implicit influence on the client, and about the possibilities and dangers of working explicitly with clients' moral conceptions.

In addition to analyzing the ethical characteristics of the therapist-client dyad, Tjeltveit also extends his focus to the ethical role of psychotherapy and psychotherapist in society at large. He not only argues for reflecting on the constantly changing role of psychotherapy within the public health care system, but goes even further and urges therapists and philosophers to develop a comprehensive, "non-minimalist" professional ethics (265) and - even more broadly conceived - "a public philosophy for psychotherapy" (232).

Overall, this book is a valuable addition to the literature on ethical issues in psychotherapy. Tjeltveit is one of the very few authors who manage to illuminate the ethical complexities of psychotherapeutic practice by combining practical experience and an extensive knowledge of moral philosophy. His writing shows, however, that such a combination is not always easy - often his desire to give a full account of these complexities from the philosophical as well as the practical side wins out over the clarity and systematicity of exposition. At times he seems to be primarily concerned with not leaving out any possibly relevant philosophical approach and looses sight of establishing his own position.

Now, transdisciplinary projects always face the danger that they might end up not being suited to any readership. How does Tjeltveit's book fare in this respect? In my opinion, it largely escapes that danger - even though it clearly is no easy reading for either practitioners nor philosophers (for different reasons). Psychotherapists who are interested in a deeper understanding of the ethical issues that are involved in their daily practice should be able to find much food for thought in this book (supported by an extensive reference section). And even though, not surprisingly, philosophers should not expect to find original philosophical theory here, Ethics and Values in Psychotherapy might perhaps motivate some of them to pay renewed attention to psychotherapy as a particularly interesting field of applied ethics - and to thereby help end "[p]sychology's curious estrangement from bioethics" (136).

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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