Ethical questions and dilemmas in psychotherapy

BACKGROUND: The authors emphasize the importance of regular questioning of ethical dilemmas in psychotherapy, because of the special status of psychological treatment as a potentially hazardous field in practice, and because of substantial relationship between client and therapist with a thin border and potential use of power or abuse. Although professional codes indicate guidance on highest possible standards of function, they do not always give clear answers; hence, clinicians must be able to critically weigh up and understand these codes in relation to everyday practice. ETHICAL DILEMMAS IN PSYCHOTHERAPY: There is no distinct answer to the various, complex and multilevel ethical questions that therapists may be exposed to during treatment of their clients. Such dilemmas are nuanced, contextual, dynamic, and highly complex. The most frequently cited ethical concerns in psychotherapy are related to professionalism, therapeutic boundaries and confidentiality. Beliefs and attitudes intermediate the relationship between legal arguments and rule-violating behavior and moral reasoning can predict rule-breaking behaviors directly as well as indirectly. Ethically oriented therapists serve the well-being of their clients above all other benefits or obligations. Principle-based medical ethics is a valuable tool for resolving ethical dilemmas in psychotherapy in that the therapeutic aspects of ethical dilemmas can be better expressed than in other methods. The main four principles of bioethics, i.e. autonomy, beneficence, non-maleficence and justice, may be adapted for ethics in psychotherapy. However, the context must be reflected because of exceptions in the use of this general concept. On the other side, a client in psychotherapy can be abused economically, sexually and emotionally. This process may be intentional as well as unintentional. Another important dilemma is the dual role in psychotherapy. This dilemma is linked to the tension between psychiatrists' obligations of beneficence towards their clients and conflicting obligations to the society, third parties, other health care colleagues or the continuation of knowledge in the field. The issue of confidentiality often causes ethical dilemmas for the psychotherapist. Since confidentiality is essential for clients to engage in therapy, it is important to protect psychotherapy notes. On the other hand, there is a difference between confidentiality and legal right; how, why and when it can be broken. And the reasons for doing so are not well understood by many therapists. Superficially, confidentiality might seem to be an elementary idea to apply in therapeutic practice. In fact, it is quite complex and filled with exceptions that frequently differ from situation to situation and from country to country. CONCLUSIONS: Ethical question is an important part of psychotherapeutic practice. There exist many dilemmas in these issues which must be reflected by ethical therapists and many of them are in connection with self-reflection and supervision.