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Ethical Dilemmas in Psychotherapy: Positive Approaches to Decision Making


Ethical Dilemmas in Psychotherapy: Positive Approaches to Decision Making, as implied by the title, confronts a diverse selection of scenarios that illustrate commonly occurring ethical dilemmas in psychotherapy. Alongside the illustrations are diagnostic and reframing tools intended for use by therapists in order to troubleshoot during sensitive, potentially problematic developments with clients. Written for therapists of all manner of professional experience, the book is highly conscious of the inherent ethical nuances and issues therapists need to be aware of and work through in their practices. It seeks to encourage readers to edit and restructure the tools and guidelines suggested here to better suit individual needs and purposes. Furthermore, Ethical Dilemmas in Psychotherapy concentrates on highly sensitive topics. For example: how to handle potentially dangerous patients; how to balance personal moral considerations with neutral and objective ones; and how to provide effective self-assessment, among other crucial subject matter relevant to the profession. Though there is naturally more to explore beyond what the book discusses outright, it may nevertheless prove extremely useful for professional readers in its approaches to common issues.

Ethical Dilemmas in Psychotherapy is structured such that ethical dilemmas and considerations are first discussed generally before diagnostic models for assessing and approaching them are presented. The book is split into two parts, with the first covering three models for addressing complex ethical situations, and with the second discussing their application for different aspects of professional practice. The first part initially addresses why making ethical decisions is inherently difficult. After this, the three models are broken down for readers. In order, they are the ethical decision-making model, the quality enhancement model, and the ethics acculturation model. These models deal directly with the conflict between personal ethics, APA ethics and their limited scope of enforcement, legal and professional ethics, and pragmatic ethics and where these might be both useful and problematic. The second part applies these different assessment models to professional competence, boundary issues, informed consent, beneficence with dangerous patients, and social justice. Within the later topical analyses, as well as during the outlining of the models, numerous real-world vignettes are included for illustration. Extensive references are also included.

Professional readership will find Ethical Dilemmas in Psychotherapy useful as it touches upon many of the most ethically sensitive areas of psychotherapy. The book ultimately seeks to alleviate professional worry and maximize effectiveness in treatment of patients despite pitfalls, speed bumps, and common problematic scenarios. Primarily, the book looks at those situations that are most difficult to respond to in the moment. This makes it quite valuable as a means for self guidance, re-evaluation, and analysis, especially for those professionals not in regular contact with other professionals who can provide guidance or second opinions. The book offers a multifaceted, diagnostic, objective approach that takes differing individual scenarios into account. It makes the conversation of ethics in psychotherapy both contemporary and historical, and one which has no clear cut answer or definition. Because the book represents a step toward more effective standards and practices, it might prove it to be, even for those professionals who feel they don’t need overt tools for self-diagnosis, an important entry in the contemporary discourse about psychotherapeutic practice.

Samuel Knapp, EdD, has been the director for the Pennsylvania Psychological association since 1987 and teaches ethics in clinical psychology at the Philadelphia College of Osteopathic Medicine and at Lehigh University. Michael Gottlieb, PhD has completed terms on the APA’s ethics committee. Mitchell Handelsman served as associate editor of the APA Handbook of Ethics in Psychology and is a nationally acclaimed educator in clinical psychology.

Knapp, S., Gottlieb, M., and Handelsman, M. (2015). Ethical Dilemmas in Psychotherapy: Positive Approaches to Decision Making. Washington, DC: APA. ISBN: 978-1-4338-2012-0.
Paperback. 202 pages.
Key words: ethics, morals, standards and practices, moral dilemmas, decision making