Ethics

Authored by Henry Strick van Linschoten

Ethics and morality are about right and wrong. Many ethical issues are controversial, perhaps especially in the field of sexuality. As counsellors we have a “Code of Ethics” (at least one!) to abide by – which will get less attention in this module, as it tends to be the most discussed, and gets a reasonable place in most of our basic training. Apart from up-to-date guidance from the ethics committees of our membership organization, there are a number of well-known books that give good guidance in this area, e.g. Bond and Mitchels (2014), Gabbard (2016), Jenkins (2018a), Jenkins (2018b), Mitchels and Bond (2010), Tribe and Morrissey (2015).

Ethics can have different bases: authority; general rules (but do they in turn rely on authority? If not, on what else?); an evaluation of the consequences of actions. Systems of ethics are very diverse, and it is unlikely that the ethical values of therapist and client will fully coincide. There are issues specific to doing research, which are highly important, but will not be covered here. It can be beneficial in the general field of ethics, unless you have a previous background, to read a general introduction to ethics such as Driver (2006).

Important guidance on ethical matters needs to come from self-reflection, from supervision, from consulting the counselling organisation(s) we belong to, and when needed from taking legal advice. It is important to separate legal obligations from ethical / moral ones, not to put us as psychotherapists in the chair of a doctor, or become a representative of the criminal justice system, or even to apply our own ethical standards to our clients’ behaviour. If we need to maintain boundaries and make these separations internally, this may lead to feelings that do not belong in the therapy room, but that we need to discuss in supervision and sometimes with figures of authority who are personally relevant to us.

Ethics and sexuality

One of the easiest and clearest of standards is that we should never have a sexual relationship or engage in sexual activity with a client – not even if we believe or claim to believe that it would be for their good, or that it was justified by being consensual. Maintaining this standard does not mean that we will not have feelings, fantasies or dreams that involve sex. These are not covered by the ethical prohibition, but need to be noted, taken seriously, and disclosed and reviewed in supervision.

Dual relationships

Dual relationships are a major topic. They always need to be managed, and as such must be identified and questioned, as is brought out in most Codes of Ethics. At the same time, they cannot always be avoided. Rather than a standpoint that they simply should not happen at all, it is important that when something happens that comes close to it, the situation is carefully reflected on, discussed in supervision, and managed. There are several good background books on this topic – which unfortunately often concentrate too much on the legal or formal position, and too little on practical matters. Some general, and practical, sources in this difficult area are Clarkson (1994), Gabbard (2016), Gabriel (2005), Lazarus and Zur (2002), Syme (2003), and Zur (2017).

Dual relationships can usually be discussed in terms of different roles. When therapists or counsellors have other roles than working therapeutically with a client, this is possible, as long as care is taken that there is no confusion, that client and therapist are entirely clear, and that there is no overlap or slippage from one role to another. This is true when the roles in question are quite far apart (e.g. being a plumber, electrician, running a restaurant, being a lawyer or accountant – as well as being a psychotherapist), or when they are much closer, and involve other activities that entail working with people, possibly one to one, or are “helping professions”. A major example of this are psychiatrists, who are doctors – a medical role, but many of them also practise psychotherapy.

Compatibility of psychotherapy with roles with a sexual component

It gets more difficult when a counsellor has other roles that directly focus on sexuality or sexual problems, and / or if these involve ways of working that would be prohibited in psychotherapy. This could be massage, reiki, hypnosis, hypnotherapy, but it would also apply to nursing, midwifery, physiotherapy or occupational therapy. There are also forms of working with clients such as different schools of body psychotherapy, and of sexological bodywork, with their own accrediting bodies, standards, codes of ethics, practices and techniques. Finally there are the roles of sexual surrogates, and a range of forms of sex work (formerly and still largely legally called prostitution) proper, including stripping, lap dancing and BDSM / kink sessions which may or may not involve genital contact. All these involve issues that have received little discussion but are clearly difficult and controversial.

As many of these dual roles and relationships take place without controversy, it must be assumed that dual or different roles, when clearly separated and discussed, can at least sometimes be managed. But there are concerns and fears that suggest differently, when sexuality is involved. There is little literature on this subject when the non-psychotherapeutic role directly involves or includes sexuality and / or body contact. There is a clear need for further study and professional discussion.

Touch

As a specific liminal condition, the subject of touch is notoriously divisive. Outside the issue of dual relationships, and with full agreement on the unacceptability of sexual relationships or activity, different schools of counselling, different practitioners and different institutes have held widely disparate views on the allowability of touch. There is no consensus, other than that it is one signal area where unreflective, naive, spontaneous or unconscious acting is risky and undesirable. Whatever is done or not done must be controlled and fully considered, taking into account the widest interests of the client, and of the therapy and therapeutic relationship, short-term, long-term effects, unconscious and transferential aspects. One of few serious attempts at reflective discussion has been Galton (2006).

Consent

Consent is highly central for good sex, as well as for ethical sex. There is a real shortage of good literature about consent – often it is assumed that it is ‘evident’ what consent is; and it is the cultural norm of many countries that if there is no overt distress, or if a person does not explicitly say no (which is rare in many cultures, including British culture), you are safe to assume that there is consent. However, the latter is not a good-enough or even acceptable basis. Ideas about “informed consent” advocated in bioethics textbooks (e.g. Beauchamp and Childress, 2013), used by lawyers and in hospitals (again often devised by lawyers), are mostly too legalistic for most people to be realistically helpful. One of the best practical and yet detailed texts on a higher standard of consent that takes into account relational psychology, is chapter 5 in Barker and Hancock (2017).

References

Barker, M.-J., & Hancock, J. (2017). Enjoy sex (how, when and if you want to): A practical and inclusive guide. London: Icon Books.

Beauchamp, T. L., & Childress, J. F. (2013). Principles of biomedical ethics (7th ed.). New York: Oxford UP.

Bond, T., & Mitchels, B. (2014). Confidentiality and record keeping in counselling and psychotherapy (2nd ed.). London: Sage.

Clarkson, P. (1994). The therapeutic relationship. London: Whurr.

Driver, J. (2006). Ethics: The fundamentals. Oxford: Blackwell.

Gabbard, G. O. (2016). Boundaries and boundary violations in psychoanalysis (2nd ed.). Arlington, VA: APA Publishing.

Gabriel, L. (2005). Speaking the unspeakable: The ethics of dual relationships in counselling and psychotherapy. Abingdon, Oxon: Routledge.

Galton, G. (Ed.). (2006). Touch papers: Dialogues on touch in the psychoanalytic space. London: Karnac.

Jenkins, P. (2018a). Ethics. In M. Robson & S. Pattison (Eds.), The handbook of counselling children and young people (2nd ed.). London: Sage.

Jenkins, P. (2018b). Law and policy. In M. Robson & S. Pattison (Eds.), The handbook of counselling children and young people (2nd ed.). London: Sage.

Lazarus, A. A., & Zur, O. (Eds.). (2002). Dual relationships and psychotherapy. New York: Springer.

Mitchels, B., & Bond, T. (2010). Essential law for counsellors and psychotherapists. doi: 10.4135/9781446288818

Syme, G. (2003). Dual relationships in counselling and psychotherapy: Exploring the limits. London: Sage.

Tribe, R., & Morrissey, J. (Eds.). (2015). Handbook of professional and ethical practice for psychologists, counsellors and psychotherapists (2nd ed.). Hove, East Sussex: Routledge.

Zur, O. (Ed.). (2017). Multiple relationships in psychotherapy and counseling: Unavoidable, common, and mandatory dual relations in therapy. New York: Routledge.