Sperry L, Prosen H
Department of Psychiatry & Behavioral Medicine, Medical College of Wisconsin, Milwaukee 53226, USA.
Am J Psychother. 1998 Winter;52(1):54-63. doi: 10.1176/appi.psychotherapy.1998.52.1.54.
Two contemporary ethical dilemmas facing psychotherapists have been noted and described: cosmetic psychopharmacology and the practice of psychotherapy in a managed care environment. Regarding cosmetic psychopharmacology: It was noted that whether a psychotherapist endorses the use of psychotropic agents for cosmetic purposes, such as self-transformation, seems to be a function of the severity of the client/patient symptoms as well as the psychotherapist's view of human nature and the human condition. However, recent research indicates that certain traits or reflections of the human condition, such as irritability, may actually be neurotransmitter deficiencies that are responsive not only to psychotropic agents but also to non-drug interventions. These findings add an additional dimension to discussions of the ethics of cosmetic psychopharmacology. Regarding psychotherapy in a managed care environment: Several ethical dilemmas, including confidentiality, were discussed. These dilemmas were outlined rather than analyzed in detail. Some of them will become major "thorns" of concern for the practice of psychotherapy. Others will be less consequential. Of critical concern is that limitations by managed care on the technique and optimal length of treatment of psychotherapy can conceivably lessen its efficacy for some patients and could possibly eliminate this powerful treatment procedure for others.
美容性精神药理学以及在管理式医疗环境中进行心理治疗的实践。关于美容性精神药理学：有人指出，心理治疗师是否认可将精神药物用于美容目的，比如自我转变，似乎取决于来访者/患者症状的严重程度以及心理治疗师对人性和人类状况的看法。然而，最近的研究表明，人类状况的某些特征或表现，比如易怒，实际上可能是神经递质缺乏，不仅对精神药物有反应，对非药物干预也有反应。这些发现为美容性精神药理学的伦理讨论增添了一个新的维度。关于在管理式医疗环境中进行心理治疗：讨论了包括保密在内的几个伦理困境。这些困境只是被概述，没有详细分析。其中一些将成为心理治疗实践中令人担忧的主要“刺头”。其他的影响则较小。至关重要的是，管理式医疗对心理治疗技术和最佳治疗时长的限制，可能会降低其对某些患者的疗效，甚至可能使其他患者无法接受这种有效的治疗方法。
