Fennig Silvana, Secker Aya, Treves Ilan, Ben Yakar Motti, Farina Jorje, Roe David, Levkovitz Yechiel, Fennig Shmuel
Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel.
Isr J Psychiatry Relat Sci. 2005;42(4):251-7.
The attitudes of patients towards ethical dilemmas in psychotherapy have been reported in only a few studies.
We investigated whether the attitudes of patients undergoing psychotherapy to confidentiality and boundaries are different from those of therapists and laypersons.
Clinical vignettes describing ethical dilemmas of confidentiality and boundaries were presented to 103 patients undergoing psychotherapy (patient group), 93 psychotherapists of different professional backgrounds (professional group), and 55 staff and students from the fields of law and the humanities (lay group). Patients were asked how they think therapists should act in the situations presented and therapists were asked how they should behave in such situations.
In general, the patient group showed a greater tendency to view their therapists as breaching confidentiality than the professional and lay groups. Regarding boundaries, the majority of psychotherapists were against initiating any sexual relationship with current patients, former patients, students or supervisees, whereas both patients and laypersons showed a less stringent attitude; these differences were statistically significant. The vast majority of therapists (96.7%) disapproved of accepting money in advance compared to only 31.1% in the patients group and 54.4% of the lay group. Analysis of the patients group by gender did not reveal any significant relationships.
(1) Patients have different ethical codes from therapists and laypersons regarding the issues of confidentiality. (2) Patients and lay persons are less strict than therapists regarding issues of boundaries.
仅有少数研究报道了患者对心理治疗中伦理困境的态度。
我们调查了接受心理治疗的患者对保密和边界的态度是否与治疗师及外行人员不同。
向103名接受心理治疗的患者（患者组）、93名不同专业背景的心理治疗师（专业组）以及55名法律和人文学科领域的工作人员及学生（外行组）呈现描述保密和边界伦理困境的临床案例。询问患者他们认为治疗师在呈现的情境中应如何行动，询问治疗师他们在这种情况下应如何表现。
总体而言，与专业组和外行组相比，患者组更倾向于认为他们的治疗师违反了保密原则。关于边界问题，大多数心理治疗师反对与当前患者、以前的患者、学生或被督导者建立任何性关系，而患者和外行人员的态度则不那么严格；这些差异具有统计学意义。绝大多数治疗师（96.7%）不赞成提前收钱，相比之下，患者组中只有31.1%，外行组中只有54.4%持此观点。按性别对患者组进行分析未发现任何显著关系。
（1）在保密问题上，患者与治疗师及外行人员有不同的伦理准则。（2）在边界问题上，患者和外行人员比治疗师宽松。
