Ethical Issues in Psychotherapy Punishment Informed consent Transference Abreaction Value systems Psychoanalysis an hedonism

Punishment Reject psychotherapy as punishment Some neurotic px may perceive it as such

Punishment Penological reform by the court – Decide first on the facts of criminal action – Secondly: moral responsibility of the person – * Moral freedom can be destroyed by mental confusion Based on expert testimony from psychiatrist – Should be directed to determining the defendant’s freedom limited by the psychological factors – Why the accused chronic or temporary psychological condition did or did not render him so unfree – Whether he cant be held responsible for the act – If he is partially responsible, in what degree or in what respect

It is unjust to punish someone for acts for which he or she was not MORALLY responsible

Role of the psychiatrist in the process of punishment – Limited to 2: 1. diagnose inmates who develop mental illness and thus treatment 2. As consultants to penologists in setting up routines that make good for mental health and discipline

Informed consent Issue of comptency Mentall disturbed pxs: – Unable to understand the risk or purpose of treament – May not be truly free to make a decision Fear Masochistic tendecies (desire to suffer or to be humiliated) Narcississm

Informed consent If impossible for the patients: patient’s guardian with observance of legal process Treatment without consent: – Must have the objective to bring the patient as as soon as possible to the level of mental integration Use of drugs or psychosurgery

transference Primarily in therapy Termination of therapy: patient is sufficiently autonomous and under self control Issue of responsibility by the therapist – Must be trustworthy – Maintain secrecy – True concern for the px – Prompt in appoinments *avoid manipulating the patient for personal gratification