Jain Shaili, Roberts Laura Weiss
Aurora Psychiatric Hospital, 1220 Dewey Avenue, Wauwatosa, WI 53213, USA.
Psychiatr Clin North Am. 2009 Jun;32(2):299-314. doi: 10.1016/j.psc.2009.03.005.
The practice of psychotherapy gives rise to many ethical dilemmas. In this article we offered a "primer" on the most commonly cited ethical concerns in psychotherapy related to professionalism and therapeutic boundaries and confidentiality. There is no single answer to the varied and complex ethical issues that therapists may encounter in their treatment of patients. Such dilemmas are dynamic, nuanced, complex, and highly context dependent. Although professional codes offer guidance on optimal standards of conduct, they do not always offer clear answers; hence, therapists need to be able to critically evaluate and interpret such codes in relation to their daily practice. The contemporary therapist continues to face new dilemmas in an ever-evolving and dynamic twenty-first-century practice environment. Ethical therapists serve the well-being of their patients above all other interests or commitments. Therapists who are attentive to the professional obligations they possess can adopt several strategies to increase their ethical competence, including constantly evaluating their own attitudes and behaviors in addition to those of their patients, engaging in dialog and developing expertise in relation to ethics issues, having a solid grasp of relevant professional codes of conduct, and demonstrating an openness to consultation with peers and exposure of their work to peer review.
心理治疗实践引发了许多伦理困境。在本文中,我们提供了一份“入门指南”,介绍心理治疗中最常被提及的与专业精神、治疗界限和保密性相关的伦理问题。对于治疗师在治疗患者过程中可能遇到的各种复杂伦理问题,没有单一的答案。此类困境是动态的、细微的、复杂的,且高度依赖具体情境。尽管专业准则为最佳行为标准提供了指导,但它们并不总是能给出明确答案;因此,治疗师需要能够根据日常实践批判性地评估和解读这些准则。在不断演变且充满活力的21世纪实践环境中,当代治疗师持续面临新的困境。有道德的治疗师将患者的福祉置于所有其他利益或承诺之上。关注自身所承担专业义务的治疗师可以采用多种策略来提高其伦理能力,包括不断评估自己以及患者的态度和行为、就伦理问题展开对话并培养专业知识、扎实掌握相关专业行为准则,以及展现出向同行咨询并将自己的工作接受同行评审的开放态度。