in such trouble! One of my patients is involved in a nasty law suit, and I received a court order to produce all my records. The patient had given me consent to turn them over because she and her attorney believe they will be the key to their winning the case. So, I sat down to print them out and … they’re gone! My hard drive crashed and when I hired a company to rescue what they could, they retrieved some of the files but all the files for that patient are gone. What do I do now?”
Although the room was getting crowded, the fifth therapist slouched in, collapsed in a chair, and said, “I’m doomed. I kept all my records on my laptop. But while I was at lunch today, someone broke into my car and stole it. Then I got worse news. I thought at least the files would be safe because I encrypted them, but I just found out from a colleague that since the program I used to encrypt and unencrypt them is on that computer and since many thieves have software that enables them to get past passwords and gain use of the encryption program, it would be pretty easy for a hacker to unencrypt my files.”
When the final member of their group practice failed to show up with bad news, they grew concerned and went down the hall to her office. She was sitting at her desk with a big smile on her face. She said, “I can’t tell you how good I feel. I’ve been so concerned about keeping records on my computer that I finally decided it just wasn’t worth the worry. I printed out all my records, made extra copies that I put in my safe deposit box, and got rid of my computer. It was such a good move for me. I haven’t felt this good in days.”
It was only months later that she discovered, when reading the complaint filed against her, that she had done a poor job of trying to erase her hard drive before selling her computer, and that the person who had bought it had little trouble retrieving the supposedly erased files and reading all the details about her patients.
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These scenarios remind us of the need for constant alertness, constant awareness of the ways that seemingly simple and abstract ethical principles in the ethics codes can find their way into our work, often in unexpected ways and at unexpected times. Anticipating potential problems like these begins with our understanding of the ethics codes themselves, the topic of the next chapter.
Chapter 3 ETHICS THEORIES AND CODES
The work we do as therapists is complex, difficult, and emotional. Yet, as a mental health profession we have often struggled to capture with words exactly what we do and even what we profess to do as therapists. The challenge of describing what we do has been debated from the start of our profession.
In 1949, the Boulder Conference tried to define psychotherapy in a way that it could be used to train clinical and counseling psychologists. Carl Rogers, then president of the American Psychological Association (APA) in 1947, appointed David Shakow to chair a committee on defining and teaching psychotherapy. The Shakow Report, adopted at the 1947 APA convention, resulted in the Boulder Conference two years later.
On August 28, 1949, the recorder for the Boulder Task Force for defining both psychotherapy and the criteria for adequate training provided the following summary: “We have left therapy as an undefined technique which is applied to unspecified problems with a nonpredictable outcome. For this technique we recommend rigorous training” (Lehner, 1952, p. 547).
Since the Boulder Conference, other conferences and various groups have tried to define psychotherapy and the practice of psychology. For example, the 2002 Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology (Kaslow et al., 2004), identified competencies in professional psychology and discussed effective strategies for teaching and assessing these competencies (Kaslow, 2004; see also Belar, 2009; Fouad et al., 2009; Hatcher, 2015; Hatcher et al., 2013; Rodolfa et al., 2013). Similarly, the European Association of Clinical Psychology and Psychological Treatment (EACLIPT) Task Force on Competences of Clinical Psychologists (2019) developed “a list of competences that should be acquired during regular studies of psychology with a clinical specialisation” (EACLIPT Task Force, 2019; see also Prado-Abril et al., 2019).
THEORIES OF ETHICS
The difficulty reaching agreement on a definition of therapy is echoed in the difficulty agreeing on a basic theory of ethics. In this section we briefly review four theories of ethics to illustrate the vast diversity of ethics theories, which can be viewed as a strength. Put succinctly, having multiple lenses through which we can examine and question professional ethics codes and our own ethical decision-making is an advantage.
Utilitarianism
Utilitarianism, developed by Epicurus, Jeremy Bentham, John Stuart Mill, Katarzyna de Lazari-Radek, and Peter Singer among others, holds that a guiding principle of ethics involves choosing whatever brings the most happiness and produces the least pain to the majority. According to Bentham (1780):
Nature has placed mankind [humankind] under the governance of two sovereign masters, pain and pleasure. It is for them alone to point out what we ought to do, as well as to determine what we shall do. On the one hand the standard of right and wrong, on the other the chain of causes and effects, are fastened to their throne. They govern us in all we do, in all we say, in all we think …. The principle of utility recognizes this subjection, and assumes it for the foundation of that system, the object of which is to rear the fabric of felicity by the hands of reason and of law …. By the principle of utility is meant that principle which approves or disapproves of every action whatsoever … according to the tendency it appears to have to augment or diminish … happiness …. (p. 232–245).
Similarly, Mill (1863) wrote:
The creed which accepts as the foundation of morals, Utility, or the Greatest Happiness Principle, holds that actions are right in proportion as they tend to promote happiness, wrong as they tend to produce the reverse of happiness. By happiness is intended pleasure, and the absence of pain; by unhappiness, pain, and the privation of pleasure (p. 9).
This may seem like a fairly simple, almost easy, approach to ethics. However, de Lazari-Radek and Singer (2017) emphasize that figuring out what promotes the most happiness in every situation may present more of a challenge than following a set of rules.
The core precept of utilitarianism is that we should make the world the best place we can. That means that, as far as it is within our power, we should bring about a world in which every individual has the highest possible level of well-being. Although this may seem like mere common sense, it is often in opposition to traditional moralities. Most communities prescribe rules to be followed irrespective of whether the outcome will make the world better or worse. It is much easier to follow rules than to try to assess, each time one acts, which of the available options will have the best consequences (p. 711–717).
Kantian Ethics
Utilitarianism focuses on results, consequences. Kantian ethics focuses on will and intention. Kant (1785/1998) wrote:
Nothing can possibly be conceived in the world, or even out of it, which can be called good, without qualification, except a good will. Intelligence, wit, judgement, and the other talents of the mind, however they may be named, or courage, resolution, perseverance, as qualities of temperament, are undoubtedly good and desirable in many respects; but these gifts of nature may also become extremely bad and mischievous if the will which is to make use of them, and which, therefore, constitutes what is called character, is not good …. A good will is good not because of what it performs or effects, not by its aptness for the attainment of some proposed end, but simply by virtue of the volition; that is, it is good in itself …. and
