Volume 1, Issue 08 - October 1998

Ethical Self-Protection Within Psychology

The Concern

I hear it all the time, people denigrating the practices of certain mental health professionals or certain mental health institutions: "They shouldn't be allowed to get away with that," "I would never send a member of my family to see him", "she's probably doing more harm than good."

As a Ph.D. student in counseling psychology, poised to step into the world of professional psychology, I cannot help but be deeply concerned when I hear of complaints such as these. My hope has always been that these incidents are rather isolated and perhaps not as dire as they first seem. But over time my experience has been that ethically suspect practices are both prevalent within the mental health profession and undeniably serious. Being the curious type, I have tried to develop an understanding of how the current state of affairs has arisen.

Five possible reasons come to mind: 1) Perhaps in my naivet? have confused therapeutic necessity with what I perceive as negligent harm; 2) The profession implicitly and/or explicitly discourages its members from informing on others' harmful practices in the name of protecting the discipline's reputation; 3) Those working under psychologists refrain from reporting ethically questionable practices for fear of losing their jobs; 4) There exists a culture of conformity within professional psychology whereby taken-for-granted methods of practice are considered "the only way," and hence, ethically sound; 5) The nature of psychological theory is sufficiently indeterminate that it is difficult to identify what is and is not ethical practice. Though all of these reasons may be true to some degree, I am drawn to comment on the last, for in my view it is the most serious.

Uncertainty in Psychological Theory

When I write that much of psychological theory is indeterminate in nature, what I mean is that many of our psychological practices are based upon theories that are malleable to the needs of the user, or, one could say, user-friendly. Take, for example, the theory of resistance - which is widely embraced. If a therapy client does not conform to the methods and goals of therapy established by his/her therapist, that client will likely be considered "resistant" to care. Generally speaking, what do we do when we meet resistance? We often will apply more pressure so as to "break" through it. In psychology this sometimes leads to the application of abusive force. But this can all too easily be defended as a necessary component of treatment, and hence, an ethical practice - because the definition of necessary treatment is difficult to pin down. Thus, in this instance the idea of resistance is "user-friendly" in that it allows the psychologist to justify his or her actions, abusive or not, upon a supposedly sound theoretical premise.

The point made is that as psychologists, save for the most grievous of our offenses, we almost always have at our disposal a line of defense that deflects an ethical allegation, rendering the relevant ethical principle impotent. Because of the relative weakness of our clients, our notion of beneficence easily trumps client autonomy. Consider this arsenal of rationalizations, some of which are supposedly based on scientific fact, others upon supposed clinical wisdom: "The discomfort was a necessary and unavoidable feature of the treatment," "These accusations and complaints are to be expected considering their diagnosis," "It is a transference issue," "The literature supports this intervention," "Only pharmaceutical interventions help a person with this disorder".

The list of possible pseudoscientific rationalizations is endless, as are the potential harms the client can be brought to bear (good faith clauses not withstanding). Notable in all of these examples is the implicit message that it is the client who is responsible for the therapeutic failings. This potential to blame the victim for what I would argue is the unethical behavior of the psychologist is an unsettling possibility, and one that attests to the power differential between provider and consumer. Given this disparity, what recourse is available to keep the psychologist's power in check?

In psychology, as in other mental health care disciplines, the question of what constitutes ethical practice is largely established through codified principles set forth by the respective professional organizations. These principles serve as guides to practice, and in doing so must be considered the preeminent arbiter of ethical action and moral good. However, it is questionable whether they have met - or can meet - such a test. Though certainly needed and helpful in legislating against certain blatantly unethical practices, it is disconcerting that our ethical codes cannot call to accountability other more evasive unethical practices. Add to this a professional milieu more interested in self-protection and we have an ethic that protects the powerful while laying vulnerable all others.

This ethic of self-protection is exemplified in my own graduate course work in ethics, which might crudely be referred to as adhering to a "cover-your-ass" approach. It was all about what one must do or not do to avoid professional or criminal reprisal. The take-home message was always: "As long as you do (or don't do) this, you'll be okay." Such an approach leaves me wondering as to the values we are trying to instill in our psychology graduates and how these values will affect the nature of ethical relationships between psychologist and client in the future.

As a profession, I believe we have drifted away from an ethic of fostering humane relationships toward one that focuses on protecting the interests of the mental health practitioner. If, as I argue, part of the problem lies in the tenuous nature of our discipline's theoretical underpinning, it would undoubtedly be helpful to promote and foster a discipline-wide climate of self-reflection and meta-theoretical curiosity. Unfortunately once caught in the stickiness of our own theoretical web, it becomes difficult to escape the self-reinforcing circularity of our clinical reasoning. Thus, the much beleaguered maxim "Know thyself" becomes a ruse and we remain blind to the real, and potentially harmful, effects of our work. Meanwhile, electroconvulsive therapy continues to be freely handed out and vehemently defended, while a hug can spell the end of one's professional licensure.

Announcements

• Alberta's Freedom of Information and Protection of Privacy Act can be accessed on-line at: http://www.gov.ab.ca/foip/leg/actcont.html.

• The Network is considering co-hosting 2-hour morning discussion forums in a few areas of the province, on the impact of and issues raised by the Personal Directives Act, on or around the first anniversary of its proclamation - Dec. 1, 1998. If you think your organization/RHA would be interested in co-hosting such a session in the coming weeks, please contact a PHEN office.

• PHEN is currently in the process of engaging several volunteers to assist with various projects. PHEN encourages any members, especially those outside of Calgary and Edmonton, who are interested in contributing to Network activities to contact one of the offices.

• The Network has been enlisted to support the Calgary Regional Health Authority Ethics Council in revising its Terms of Reference and organizational structure. Any thoughts in regards to the function and potential contribution of this body are welcome and should be directed to Al-Noor at the Southern Alberta office.

• PHEN Board and Staff Notes
  • Regretfully, John Boksteyn, Chair of the Palliser Health Region, has resigned from the PHEN Board due to other commitments. We thank John for his contribution to the Network and wish him well.

  • Michael Stingl, a member of the PHEN Board and Professor of Philosophy at the University Of Lethbridge, is on a one-term sabbatical leave in Japan. He will continue to serve as board member and Education Sub-committee Chair through the wonder of the internet.

  • The John Dossetor Health Ethics Centre (JDHEC) and PHEN have engaged MaryAnn Bendfeld, a student in the Department of Philosophy at the University of Alberta, to assist in developing a joint database of up-to-date news media and journal articles and resources on important health ethics topics. These resources will be available to all PHEN and JDHEC members, clients and students.

  • Jannice Wong, a recent graduate in Engineering at the University of Calgary, will be taking on the role of Webmaster for the Network, contributing several hours a week to updating and expanding resources available through the internet.

PHEN Board Retreat

The PHEN Board of Directors held a retreat in Bragg Creek on Sep. 28, 1998. PHEN members who submitted feedback prior to this event indicated that, amongst others, the educational offerings, newsletters, and support for ethics committees were valuable resources provided by PHEN. Accordingly, the Board reaffirmed its commitment to providing these resources. Continued building and expanding of a "network" of interested individuals and organizations was still considered central to PHEN's mandate.

Increasing public awareness of and dialogue about health ethics issues was also recognized as an important long-term objective to be pursued as resources allow and the network grows. The Board recognized challenges and opportunities in PHEN's work and the need to expand and diversify its funding base was repeatedly raised as a significant challenge to long-term sustainability.

The renewal of its organizational mandate provided a clearer understanding of the resource and administrative needs of the Network. This will be valuable in the recruitment of a permanent Director and in prioritizing the many opportunities available to it.

Welcome!

The Board of Governors of St. Joseph's College, University of Alberta, is pleased to announce the appointment of Mary Lou Cranston, cnd, STD as Director, St. Joseph's College Ethics Centre.

St. Joseph's College Ethics Centre, an Alberta-wide community service, provides faith-based health care ethical consultation and education in a variety of settings, for individuals, families, groups and institutions. The Ethics Centre can be reached at (403) 439-2422 or by email at ethics@connect.ab.ca.

Views offered in this article are those of the author and do not necessarily reflect the position of the Provincial Health Ethics Network.