Ethical dilemmas experienced by clinical psychology trainee therapists

Abstract

Ethical dilemmas are inevitable during psychotherapeutic interactions, and these complexities and challenges may be magnified during the training phase. The experience of ethical dilemmas in the arena of therapy and the methods of resolving these dilemmas were examined among 35 clinical psychologists in training, through an anonymous and confidential online survey. The trainees' responses to four open-ended questions on any one ethical dilemma encountered during therapy were analysed, using thematic content analysis. The results highlighted that the salient ethical dilemmas related to confidentiality and boundary issues. The trainees also raised ethical questions regarding therapist competence, the beneficence and non-maleficence of therapeutic actions, and client autonomy. Fifty-seven per cent of the trainees reported that the dilemmas were resolved adequately, the prominent methods of resolution being supervision or consultation and guidance from professional ethical guidelines. The trainees felt that the professional codes had certain limitations as far as the effective resolution of ethical dilemmas was concerned. The findings indicate the need to strengthen training and supervision methodologies and professional ethics codes for psychotherapists and counsellors in India.

How To, or Not To Intervene – Some Ethical Dilemmas Encountered by Mental Health Professionals

“…Consequently, the clients extended similar beliefs and emotions towards the contemporary healers-the health professionals, exhibited similar relationship dynamics in professional relationships [5,15]. Perhaps, the clients trusted their therapists and held strong blind faith unto them [4,7]. However, living up to the ideal image of a healthcare professional impinged upon other inter-related ethical principles such as self-disclosure.…”

“…Ethical dilemmas and concerns are an important part of any healthcare system, but ethical treatment needs to be tailored to local realities and constraints [1][2]. Indian mental health care professionals share some ethical concerns similar to those of their Western counterparts [3] such as boundary violations, confidentiality issues, caregiving by multiple healthcare workers of varying competence, however, they also face additional challenges like-issues around decisional autonomy, cultural issues around psychometric assessments and chiefly, hierarchical relationships with healthcare workers [4][5][6][7][8]. Ethical dilemmas and concerns are thus a part and parcel of the Indian medical system.…”

“…The plausible reasons for toleration of these boundary violations are that such behaviors are believed to be culturally sanctioned [10], out of fear of making the patient feel rejected [7] as well as lack of appropriate guidelines defining the professional boundaries of a doctor patient relationship in keeping with our social milieu [11]. Therapists in addition face peculiar dilemmas when faced with patients whose belief systems, values and moral principles are incongruent with their own: around marriage, gender identity, abusive violent interpersonal relationships or extramarital relationships [7,12]. Likewise, certain psychotherapeutic principles may not resonate with therapist or patient, and their regular clinical use risks wounding the mind, spirit and body of the patients [13][14].…”

Ethical controversies in mental health services delivered through videoconference platforms

“…The problem is that none is able to cover all the ethical quandaries in a single IC, this is unrealistic. In this regard, identifying ethical dilemmas is important to train psychologists and counselors 58,59 . With this, practitioners may have better ethical reasoning skills to deliberate over the ethical controversies that escape from what is written and explained through the IC process.…”

Ethical Issues in Delivering Psychological Therapies in Geriatric Psychiatry in India

“…From our review of the literature, we noted a shortage of specific resources for geriatric mental health clinicians in India to guide their ethical practice, an issue highlighted by others as well. 33 …”