By Jimmy Judge
In this article, I am attempting to explore some of the less obvious, yet equally important areas of ethics in Counselling and Psychotherapy. This issue can sometimes be a highly contentious one, particularly among therapists who find themselves comfortable with different, or even opposing, systems of thought or belief. Therapists who belong to a particular agency or centre may be bound to the code of that place, assuming, of course, that the agency is recognised, credible and a professional body. So far so good. However, the questions that arise for me around this area are: what makes someone a Professional Counsellor or Therapist? How do we really know we are credible or worthy? The late Frank Lake addresses this issue as follows:
“To counsel professionally is a different matter. The questions arise, by what right do I offer counsel? Who vouches for me? I am a member of the Royal College of Psychiatrists but would what I practice meet with their approval? In a tight corner from where do I derive my resources? On certain matters I might well consult a colleague who is a member of the college, in other matters I would have more confidence in my spiritual director, or prayer.”¹
It would seem that the kernel of the ethical situation often falls within religious and spiritual territory. Because, after all, we are meeting the very heart of humanity in psychotherapy, and anyone attempting to counsel without support, belief and guidance from a spiritual source, is indeed treading on shaky ethical ground. The whole area of qualification and the hotly debated realm of accreditation are, in my opinion, vital aspects of ethical concern. There are other practical and extremely important considerations to reflect on and discuss, such as the delicate complexities around confidentiality in psychotherapy. I do acknowledge the efficacy of this and other aspects of ethical concern, yet I am drawn to the more uncomfortable and sometimes unspoken (especially among therapists) questions which ask: does therapy really work? Is it a big con job? A power trip on behalf of the therapist? Jeffrey Masson, who has been described by Dorothy Rowe as a ‘Trouble Maker’ would certainly believe (and goes to great lengths to point out) that the practice of psychotherapy is basically damaging, harmful and deceitful to those who seek help. In his challenging, provocative best seller Against Therapy Masson conducts a direct assault on psychotherapy from all the various disciplines:
“To attempt to impose one’s own views on patients goes against the canons of most forms of therapy, but in reality this is what most therapists do. Freud, at the age of eighty two. wrote a strong statement against attempts to turn patients into mirror images of their analysts. However much the analyst may be tempted to become a teacher, model and ideal for other people and to create men in his own image, he should not forget that this is not his task in the analytic relationship, and, indeed, that he will be disloyal to his task it he allows himself to be led by his inclinations. If he does, he will only be repeating a mistake of parents who crushed their child’s independence by their influence, and he will only be replacing the patient’s earlier dependency by a new one.”²
Masson raises some interesting points that I believe ought to be explored fully by anyone actually practising psychotherapy or those thinking of doing so. After all, it is impossible for any human being to be completely wrong all of the time. In the same book, Masson not only attacks the older styles of therapy with their rigid, harsh and sometimes obvious lack of concern for the clients well-being, but also prods irritatingly at what we assume are more humane ‘person centred approaches.’ One of the more poignant points for reflection raised by Masson is this:
“The therapist is not a real person with the client. If he were, he would have the same reactions he would have with people in his real life, which certainly do not include “unconditional acceptance, lack of judging or real empathetic understanding.” We do not really accept everyone we meet, we are constantly judging them, rejecting some, avoiding some (and they us) with good reasons. No real person does any of these things Rogers prescribes – in real life.”³
It is important to note that, however important these views are, they are the views of one person and do not represent the world of psychotherapy. However, ethically, we cannot refuse to acknowledge what may be the shadow self of psychotherapy. For me, these questions are the core of ethics: how I feel about myself, my client, the world around me and God’s existence, or not, as the case may be. These issues could very well determine how we adhere to ethical codes and what they might be. As far as I can see, the key area in ethics in psychotherapy is that of power, in line with the medical model of therapy (from which, in my opinion, we are still suffering unpleasant side effects). The doctor, psychiatrist, counsellor or helper’ are clearly in control. They assume total power, make the decisions, determine the therapy style, duration and, of course, the financial cost. Even though the person seeking help may outwardly accept this arrangement, her inner feelings about the direction of her life may not find appropriate expression. Staying with this model and its basic assumptions, any decision around confidentiality, sexual orientation, finance, legal complications, religious and spiritual practice, and the clients’ basic rights to freedom are completely in the hands of the ‘expert therapist.’ This seems quite scary, really, because one is really depending on the counsellor’s ‘basic goodness’ or what kind of mood he or she might be in at a given time. If the therapist is not affiliated to an agency or association which requires personal therapy for the counsellor, ongoing supervision and consultation, the client may well be side open to abuse in many subtle forms, even if the therapist has the best of intentions (I trust that most human beings do). It would appear that many people find it difficult to resist the seductive feelings and sensations that accompany being in control, or having power - which is often disguised and cloaked in “what’s best for the client.” Obviously personal therapy for the counsellor is crucial in order to work through these various transferences and projections, reinforcing our commitment to honour our own journey and not allow it to become entangled with the client’s story. The counsellor’s own therapy needs to go hand in hand with ongoing supervision with experienced, open minded practitioners. This is imperative if we are to journey effectively with another human being, embracing all of the various ethical difficulties that may arise along the way.
The psychotherapeutic movement has progressed considerably since the time of Freud and his disciples. The gradual shifts away from the ‘mechanistic world view’ is indeed a welcome one, which I believe has tremendous ethical significance. Professor Stanislas Grof, who is well known for his pioneering work evoking deeper aspects of consciousness as a way towards healing and wholeness, offers some interesting insights into the whole area of mental health and what is deemed to be normal and okay. With the more recent approaches to psychotherapy, the client is seen (and rightly so) as the expert, in control and totally responsible for bringing about change in his or her situation. The key role of the therapist is to acknowledge this and to assist the client to tap into their own rich, resourceful healing process… therefore it is the client who decides what is mentally healthy for him or herself. In the following quote, Grof highlights the irony and arrogance of how we have been taught to live and what we should aspire to. As we will see, it is anti-therapeutic and does great violence to the human soul; “Mental health is defined in terms of absence of psychopathology “psychiatric disease”. It does not require active enjoyment or appreciation of existence and the full life process. This can best be illustrated by Freud’s famous description of the goal of Psychoanalytic therapy: “to change the extreme suffering of the patient into normal misery of everyday life.” In this sense an individual leading an alienated, unhappy and driven existence dominated by excessive power needs, competitive urges and insatiable ambition, could still fall within the broad definition of mental health if he does not suffer from manifest clinical symptom.”(4)
To conclude, I willingly acknowledge that I did not highlight the more ‘obvious ’ practical ethical issues, yet I feel that the areas I have attempted to address – the more undercurrent forces – are crucial to psychotherapy and those who practice it. Therefore, those of us working in this complex, demanding field ought to maintain the highest degree of personal honesty and self reflection, involve ourselves deeply and seriously in our own ‘inner journey’ and avail of regular supervision with an experienced person or group if we are to encounter with any sense of competency and sound judgement, the intricate delicate ethical labyrinth that may become obvious to us as we journey with our clients.
Jimmy Judge is a psychotherapist working in the Rutland Centre
1. Frank Luke Tight Comers in Pastoral Counselling P56 Darton, Longman and Tod
2. Jeffrey Masson Against Therapy p. 43 Fontana l990
3. Ibid p.4
4. Stanislav Grof Beyond the Brain, p.396 Suny