Book Review: Ethics and Values in Psychotherapy

Ethics is often thought of as an abstract subject, accessible to relatively few and sadly relevant to even fewer. One reason for this may be the assumed equivalence between moral philosophy and ethics, an assumption that results in ethics being viewed as necessarily abstract. Yet, moral philosophy is really only one dimension of ethics, of equal importance are the conversations that people have about right and wrong, good or bad in their lives and the lives of others. Even when not perceived as abstract, ethics is sometimes treated as if it were an optional activity, something to be undertaken when we have 'major confrontations with either our colleagues or our consciences' (Barker & Baldwin, 1991). While ethical concerns in such circumstances are understandable, they are often the exception. Most of the time matters of right and wrong go unstated and although we may not routinely reflect on such matters, scratch below the surface and one will find a whole host of values, assumptions and ethical standards that determine peoples lives and conduct. Thus, it is an interesting fact that while ethics and values underpin the work of all therapists there remains a 'complicity' of silence surrounding their discussion. Moreover, while most therapists appear to be quite comfortable asking colleagues about their theoretical orientation, to ask about their ethical or value position is just not done. It is both too personal and too dangerous, after all ethics demands justification. Tjeltveit deals a blow to such concerns by showing that ethics is more than morality and that far from being optional it poses 'challenging, inescapable questions.'

For professionals working within the mental health field the question of professional ethics is probably the area of greatest familiarity. Psychologists, psychotherapists and other professionals all have codes of conduct and ethical codes that indicate what is and what isn't permissible. While the intent of such ethical codes is to indicate to members of a profession what they are or are not allowed to do, things are rarely that clear-cut and many codes of professional ethics are open to interpretation. Moreover, as Tjeltveit notes 'codes of professional ethics rarely contain a rationale for the principles and standards that they contain.' One of the main criticisms of professional ethics of course is that they are just that - professional ethics. They are written by professionals for professionals. It could be argued that in a situation where there is an unequal distribution of power as in most forms of therapy, that this is far from satisfactory. It is perhaps not surprising that service users harbour suspicions that professionals are primarily concerned with covering each other's backs and that current professional disciplinary procedures are less than transparent. This is not an issue that Tjeltveit deals with explicitly.

One of the strengths of Tjeltveit's book is the way in which he broadens the classification of ethics in psychotherapy to include theoretical ethics, clinical ethics, virtue ethics, social ethics and cultural ethics as well as professional ethics. Social ethics for instance broadens the interest away from the individual to the wider social community and is a salient issue for psychotherapists, particularly those who acknowledge the political nature of seemingly neutral acts. Social ethics by focusing on the ethical dimensions of personal partnerships (e.g. marriage), families (variously defined), various social structures, communities, and society as a whole poses questions that psychotherapists cannot easily ignore. Thus, the nature of justice, the proper relationship between individuals and larger social entities, social policies, the "good society", and the general welfare are for Tjeltveit part of the therapists legitimate concern.

There is far more to the book than a discussion of the dimensions of ethics, but it is this part of the book which struck me as particularly important. Interestingly the book serves works both as a sourcebook for certain issues and as a relatively coherent thesis. The detailed references also allow the reader to follow up the sources of Tjeltveit's arguments.

Finally, Tjeltveit avoids the obvious trap of telling his readers what they should do and his use of case studies allows readers to approach the issues through the formal arguments but with an air of familiarity.

Reference

Barker, PJ & Baldwin, S. (1991). Ethical Issues in Mental Health. London: Stanley Thornes Publishers Ltd.

R.G. Hill