[Ethics in psychotherapy].

Abstract

After introducing the terms "morality" and "ethics" as defined by Patzig, the discussion focuses on applying to the practicing of psychotherapy the guidelines for ethics in medicine formulated by Beauchamp and Childress, i.e. respect of the autonomy of the patient, the doctor's duty to prevent injury, the obligation to give assistance and the principle of fairness. In particular, it is pointed out that to hale respect for the autonomy of the patient, a thorough and patient inquiry concerning diagnosis, indication and therapy is necessary in order for the patient to develop intrinsic motivation based on insight into his condition and evaluation of the prognosis. In connection with the discussion of the nil nocere, reference is made to the therapist's duty to take a patient's various limits of tolerance into account. Emphasis is also placed on the psychotherapist's duty to "service" his own psychic apparatus with the help of continued education and in-service training, supervision and self-analysis. Applied to psychotherapy, the obligation to give assistance means encouraging the patient to go in the direction of greater autonomy which means the reduction of helplessness. In psychotherapy, problems of distributing resources fairly may be manifested in unjustifiably long waiting lists or in the form of patient selection carried out in a way that is not justifiable on medical grounds but based rather on a tendency to eliminate certain groups of disorders by using contra-indications that are basically rationalizations of countertransference reactions and which are not in keeping with the professional and personal identity of therapists.