This book follows Gary Ford’s 2001 Ethical
Reasoning in the Mental Health Professions, and so is a second edition all
but in name. The new edition adds two chapters, one on computer-mediated
therapy, and the other on psychological principles in business contexts. These
come in addition to an already comprehensive set of chapters covering ethical
theory, codes of practice, decision making, clinical issues, the law, research,
education, and more. Developed in a format that enables it to structure a
university course in professional ethics, Ethical Reasoning for Mental
Health Professionals certainly provides a broad general introduction to the
field. Ford probably knows his market well, and will have developed this book
to be used for graduate psychology courses other than the one he teaches. My
reservations about what the book sets out to achieve relate partly to this
broad scope: such a wide coverage can mitigate against depth of analysis.
Beginning practitioners, for example, perhaps need less to know about ethics
applied to research (which should be covered in their research courses) but a
very sound grounding in issues such as consent and professional boundaries, not
to mention familiarity with the processes of ethical reasoning. A second
reservation is that despite its title this is a book for psychologists and counselors,
not for all mental health professionals. Medical and nursing texts, for example
usually give more space to issues of involving civil commitment, informed
consent, competence, and duty to protect. Nevertheless Ethical Reasoning for
Mental Health Professionals has a commendable scope. It is well focussed on
its target audience of graduate students, and together with the class
discussion and debates would provide graduating students with practical skills
in the ethical dilemmas they will inevitably encounter in clinical practice.

The book is roughly divided into
three sections. The first five chapters cover very broad issues of professional
ethics with special discussion of the history of ethical codes in psychology.
There is a chapter on psychology’s Code of Conduct, and one on counselling’s
Code of Ethics. These are followed by a brief chapter on ethical reasoning, and
a further chapter setting out a model of ethical decision making. The middle
section contains the meat of the book, with seven chapters exploring specific
ethical issues. These chapters cover psychotherapy, organizations,
psychological testing, computer technology, business settings, teaching, and
research. The third section has chapters on mental health and the law, and
professional ethics boards. Appendices include the 2002 psychologists’ Code of
Conduct, and the 2005 Code of Ethics of the American Counseling Association.
The focus is on the US context, so sections on the law and professional boards
would need to be supplemented with local material for those outside the US.

Any introduction to ethical issues
in professional practice needs to provide a decision making process backed by
reference to ethical theory. Ford provides a chapter on theory in which he
discusses the usual standards of utilitarianism and Kantian ethics, as well as
relativism and contextualism. In the following chapter he presents a sequential
decision making process which contains all the necessary elements for such a
mechanism. I’m not sure though, that distinguishing metaethical analysis (which
seems to mean consideration of principles) from "tertiary" analysis
(generating options) is especially helpful in a book that is primarily
practical. The many case examples sprinkled throughout the book are tantalizing
in that they stop short of analysis, simply presenting unresolved scenarios
from clinical practice. No doubt these would be valuable aids to a teacher
using the book as a class text, and for the student reader they provide an opportunity to formulate arguments about the ethical issues involved. The case examples seemed
realistic and plausible; real enough for the experienced reader to want to provide
an opinion, or point out where one of the protagonists is ‘wrong’. The
recurring use of ethical principles to discuss issues chapter by chapter gives
the book continuity and structure.

In any such broad book, those with
a special area of interest may find fault with how that area is covered. Ford’s
section on psychiatric commitment states that the key element in most instances
of involuntary treatment is "individuals’ ability to take care of their
own basic needs" (p. 255), but my reading of the US literature on civil commitment is that the criterion of danger to others looms large in
this process. For some reason Ford uses the term ‘parentalism’ rather than ‘paternalism’
to describe health professionals’ actions against patients’ autonomy. The long
discussion of suicide prevention in this chapter seems somewhat out of place,
as much of it turns on ethical rather than legal argument, particularly Szasz’s
notion that involuntary treatment of suicidal individuals is an unacceptable
breech of their autonomy. Ford does provide some discussion of the legal issues
of suicide, although mainly in terms of potential clinician liability. There’s
no harm in that; in a book for budding professionals a cautionary note about
how their clinical decisions might have implications for their professional
credibility is well in order. I thought competence could be better covered as
this is a major issue for psychologists when counselling people with
significant cognitive impairments. There are references to competence elsewhere
in the book, but I would have thought more on the legal determination of
competence would be helpful. The chapter on research is comprehensive, covering
consent, capacity, coercion and deception. Helpfully, this chapter also
includes authorship, plagiarism and publication, issues which are not always
discussed in detail with students, in my experience. Ford even includes a
section on the ethics of the peer review, and many will agree with his comment
that reviewers have an ethical responsibility to be fair in their assessments,
not simply take the opportunity to berate the hapless author on their
shortcomings.

The new chapters on computer
technology and industrial practice are worthy of comment as these represent
extensions to traditional texts on professional ethics. Internet technology has
spawned new modes of communication, new modes of community building, and new
modes of therapy. The medium nicely conforms to the definition of ‘crisis’ as
danger and opportunity. This chapter is brief, but it at least serves notice
that the traditional ethical principles of beneficence and non-maleficence can guide
such a novel technology as the Internet. With the Internet there is sometimes a
sense of ‘beyond the frontier’, that traditional moral codes no longer apply.
Ford shows that they can serve us well. Working for a corporation presents
psychologists with the conflict between their professional obligations as
psychologists, and the rather different business interests of the corporation.
Ford is unequivocal in declaring that psychologists, as long as they continue
to identify as psychologists, retain their professional obligations no matter
how deeply immersed they become in the management of the organization. This
might seem a tall order, but it is only by creating such clear boundaries that
the professional can protect themselves, their employer, and any individual
clients they see. As with the chapter on computer technology, Ford shows how
traditional ethical frameworks can be useful when faced with modern ethical conflicts.

The chapters on psychotherapy and counseling,
working in organizations, and assessment and teaching seem sound, and to pick
up on the many matter-of-fact issues psychologists will encounter in these
areas of practice. Students get the benefit of an overview of the scope of
their role, as well as guidance in areas that provide potential pitfalls. To
give just one example, sexual contact between therapist and clients, Ford is
able to cite the psychologists’ and counselors’ Codes which proscribe such behavior
with current clients. He then questions the Codes’ sanctioning of sexual
contact with former clients, providing what seems sound advice to beginners
never to entertain the possibility of such contact. This may be too black and
white for some, but if the interests of clients (and the emotional well being
of psychologists) are to be protected it seems wise.

To return to my earlier comment
about the scope of this book, there is no shortage of material here for a
graduate psychology student. Having the practice-focussed sections in the
middle, book-ended by the rather dry material about codes and boards had, for
me, the effect of presenting the subject as steeped in institutional authority
rather than a matter of self examination and philosophical analysis. To be fair
to Ford, the book is a practical one, and it definitely succeeds in displaying
the wide range of ethical dilemmas that psychologists may confront at some
point in their careers. But I wonder how much the book would encourage students
to engage with ethics as a discipline, rather than as a decision making
process. Again, to be fair to Ford, for a clinician, philosophical analysis is
must be linked to practical action, even in an area steeped in values.

Overall Ethical Reasoning for
Mental Health Professionals appears to be both a useful text for psychology
and counselling students, and a handy reference work as they embark on their
professional practice. Students are likely to find it a useful introduction,
and a practical source of advice on a range of professional issues. Psychology
lecturers and those planning graduate courses should consider at least
recommending this book as additional reading.

© 2006 Tony O’Brien

Tony O’Brien RN, MPhil, Senior
Lecturer, Mental Health Nursing, University of Auckland, a.obrien@auckland.ac.nz

Categories: Ethics