Effective Psychotherapy: Ethics, Empathy and Therapeutic Alliance

6/19/14

Cheryll Rothery, PsyD, ABPP

Relational Ethics©

“To Be Is to Be inRelationship”

The Primacy of Relationship in Psychotherapy

“Psychotherapy is rooted in and enhanced by a therapeutic alliance between therapist and client/patient that involves a bond between the psychologist and the client/patient…”

(APA Resolution on the Recognition of Psychotherapy Effectiveness, August 2012)

“Focus on whole people as interdependent moral agents and the quality of the commitments between them.”

(Bergum, V. & Dossetor, J., 2005)

“the complex medium through which decisions and interactions associated with a relationship are thoughtfully engaged with.”

(Gabriel, 2001a; 2005)

What is “Relational Ethics”?

What is “Relational Ethics”?

A way of being with a client that communicates consideration of the unique relational needs of the client in the context of an ethically grounded, empathic, therapeutic relationship.

(Rothery, 2012)

Criticisms of Ethics Codes“…in this avoidance of what it means to be with

another human being, what it means to be a healing presence, what it means to be truly ethical, we run the risk of conflating ethics with risk management, mistaking rules for relationships, and damaging those very people whom we so desperately want to help.”

(Birrell: An Ethic of Possibility: Relationship, Risk, and Presence, 2006)

The Goal of Relational Ethics Enhance our “Ethics of Rules” to an internally

driven relational ethic Ethical guidelines and implications emerge in

individuals from a common sense of caring and valuing one another

Ethics emerge as an attitude, not a linear, ten-commandments checklist of dos and don’ts

(The Values of Connection: A Relational Approach to Ethics, 2004)

Challenges to Teaching Relational Ethics The Value of the Black & White vs. The Gray in

Student Training

◦ Lack of experience◦ Risk management◦ Length of treatment

What in the Code is Non-Negotiable in a Therapeutic Relationship?

APA Ethics Code for Psychologists and Code of Conduct 2002

Standard 3: Human Relations◦ 3.02 Sexual Harassment

Standard 4: Privacy and Confidentiality◦ 4.02 Maintaining Confidentiality◦ 4.02 Discussing the Limits of Confidentiality

What is the Code is Non-Negotiable in a Therapeutic Relationship?

Standard 10: Therapy◦ 10.05 Sexual Intimacies with Current Therapy

Clients/Patients◦ 10.06 Sexual Intimacies with Relatives of Significant

Others of Current Therapy Clients/Patients◦ 10.07 Therapy with Former Sexual Partners◦ 10.08 Sexual Intimacies with Former Therapy

Clients/Patients

Acculturation to Therapy as a means to Facilitate Relational Ethics

Psychoeducation on the Culture of Therapy Standard 10. Therapy10.01 Informed Consent to Therapy◦ The nature of the therapy◦ Confidentiality and its limits◦ Potential costs and benefits of therapy◦ The boundaries of the therapeutic relationship◦ The limitations of the therapeutic relationship◦ The responsibilities of each person in the therapeutic

relationship

Relational Ethics and Boundaries Boundary: Therapeutic Frame

Boundary Crossing –◦ Decided on a case-by-case basis◦ Takes into account the context and situation-specific

factors

Boundary Violation◦ Harmful crossing of a boundary

Boundaries in Psychotherapy

“The legal system tends to apply the boundary concept mechanistically: any boundary crossing is bad, wrong, and harmful.”

“Sexual misconduct usually begins with relatively minor boundary violations…”

(Gutheil, T.G. & Gabbard, G.O.)

Boundaries in Psychotherapy

“A clear boundary violation from one ideological perspective may be standard professional practice for another.”

“Despite this…state licensing boards often believe that the presence of boundary violations (or even crossings) is presumptive evidence of, or corroborates allegations of, sexual misconduct.”

(Gutheil, T.G. & Gabbard, G.O.)

Boundary Setting

Therapist Role TimePlace and SpaceMoney

Gifts and ServicesClothing Title Self DisclosurePhysical Contact

How does Culture influence Relational Ethical Behavior in terms

of Boundaries?

Case examples with African American clients

Role

Time

Place & Space

Boundaries

How does Culture influence Relational Ethical Behavior?

How does Culture influence Relational Ethical Behavior?

BoundariesMoney

Gifts and Services

Clothing

How does Culture influence Relational Ethical Behavior?

Boundaries Title

Self-disclosure

Physical contact

Discussion

Thank you!

“Relational Ethics” PPA 2014 Annual Convention

6/19/14 Cheryll Rothery, PsyD, ABPP

Resources American Psychological Association Ethical Principles and Code of Conduct (2002). American Psychological Association, Washington, DC. Bergum, V. & Dossetor, J. (2005). Relational Ethics: The full meaning of respect. Hagerstown, MD:

University Publishing Group. Birrell, P.J. (2006). An ethic of possibility: Relationship, risk, and presence. Ethics & Behavior, 16(2),

95-115. Cook, R. Triumph or disaster?: A relational view of therapeutic mistakes. Transactional Analysis.42(1),

34-42. Gabriel, L. (2001a). A matter of ethical literacy. Counseling and Psychotherapy Journal. Rugby: BACP. Gabriel, L. (2005). Speaking the unspeakable: The ethics of dual relationships in counseling and

psychotherapy. London: Brunner-Routledge. Gabriel, L. Relational ethics, boundary riders and process sentinels: Allies for ethical practice. Based on a

program presented at the ACA Annual Conference & Exhibition. Honolulu, HI, March, 2008. Gabriel, L.G. & Casemore, R. (Eds.) (2009). Relational ethics in practice: Narratives from Counseling

and Psychotherapy. Hove: Routledge. Lee, R.G. (Ed.). (2004). The values of connection: A relational approach to ethics. Cambridge, MA:

Gestalt Press. Pope, K.S., Sonne, J.L., & Holroyd, J.C. (1993). Sexual Feelings in Psychotherapy: Explorations for

Therapists and Therapists-in-Training. Pope, K.S., & Vasquez, M.J.T. (2011). Ethics in psychotherapy and counseling: A practical guide (4th ed.). Hoboken, NJ: John Wiley & Sons, Inc. Vasquez, M.J.T. (2007). Cultural differences and the therapeutic alliance: An evidence-based analysis.

American Psychologist, 62(8), 878-885. *Multiple excellent resources can be found on Kenneth Pope’s website, “Articles, Research, & Resources in Psychology,” (http://kspope.com/).