Ethics in Psychoanalytic Psychotherapy

Integrated Child & Adult Psychoanalytic Psychotherapy (ICAPP)
2021-22, 1st Block — Mondays, 8:00-9:15pm
Julie Wood, MA


Introduction

The focus of these four weeks on ethics will be practicing how to think about clinical decisions and actions ethically. This requires more than a list of what not to do. Our ethical guidepost, like all health care providers is: do no harm. It may be easier to consider a therapist action as harmful, and it is equally important to consider lack of action as harm. If I do or do not do x, how will my patient be helped or harmed? By definition, the helping relationship includes a power dynamic. The helpee is seeking help and paying for such help, while the helper presumably has some skill and talent for provision of help. It is an inherently unbalanced relationship. It is not mutual or reciprocal. Each of us has a professional code of ethics. I encourage us to consider those and note the common threads (MSW, MA ACA, LMFT/AAMFT, PhD’s APA, MD’s AMA.)

Psychoanalytic psychotherapy is an intimate endeavor aimed at healing and growth for the patient. The relational nature of the practice, with a focus on free association, regression, transference/countertransference creates a more complex stew for consideration of relational ethics. These four weeks will focus on a capacity to reflect and think ethically specific to this mode of psychotherapy. While there are some readings to enliven our discussion, we will focus on thinking ethically about your current ethical dilemmas in your clinical practice, including in training and supervision.

 

October 11, 2021 — Code of Ethics, Nuts and Bolts

Print and bring your professional Code of Ethics, Disclosure Statement, and Consent for treatment. We will consider all codes of ethics, similar threads, internal conflicts. We will cover the nuts and bolts, the “to-do’s” of practicing ethically, including: Disclosure Statements, disclosure of training status, privilege and confidentiality (including children, teens and families), professional wills, gifts, fees, treatment frame, risk of treatments, mandated reporting, suicidality, emergency policies.

Bring a current ethical dilemma to class.

October 18, 2021 — Treatment Decisions

When we are practicing ethically, how one thinks about diagnosis includes its meanings and implications; treatment recommendations, including forms of treatment we do not practice; and treatment failures.

Kächele, H. & Schachter, J. (2014) On Side Effects, Destructive Processes, and Negative Outcomes in Psychoanalytic Therapies: Why Is It Difficult for Psychoanalysts to Acknowledge and Address Treatment Failures?. Contemporary Psychoanalysis 50:233-258

October 25, 2021 — Freud’s talking cure, cure of “love” – sexual boundary violations

What is the role of “love” – in the transference and in the real relationship. What is a slippery slope and the meanings of touch.

Blechner, M.J. (2009). Erotic and Antierotic Transference. Contemp. Psychoanal., 45(1):82-92.

Celenza, A. (1998) Precursors to Therapist Sexual Misconduct: Preliminary Findings. Psychoanalytic Psychology 15:378-395

Blechner, M.J. (2014) Dissociation among Psychoanalysts about Sexual Boundary Violations. Contemporary Psychoanalysis, 50:23-33

November 1, 2021 — Non sexual exploitation, financial problems, and conflicts of interest or multiple roles

We will discuss the meaning of exploitation and how it may be enacted in the transference. This extends to other relationships in your professional community, including supervision, education, training, and colleagues.

Myers, K. (2008). Show Me the Money: (the “Problem” of) the Therapist’s Desire, Subjectivity, and Relationship to the Fee. Contemp. Psychoanal., 44(1):118-140.

Brodsky, H. (2017) Supervision Triangles and the Attempt to Turn a Blind Eye to Them. Contemporary Psychoanalysis 53:393-413