I can understand why the first edition
(1998) of this book received the many accolades it did. As the book’s sub title indicates, this is
indeed a practical guide to ethical behavior for therapists and
counselors. This means it’s primarily a
“How to” book, rather than a “Why” book. 
There’s little discussion of meta-ethical themes such as how ethical
principles are arrived at, which ethical theory works best in what situation,
or why one should bother to be ethical. 
The first six chapters offer basic information on how to develop ethical
awareness, the relationship between the law and ethics, and the relationship
between the personality of the mental health care provider and ethical
principles of behavior. Included in the
first chapter is a fascinating list of arguments that have been used to justify
unethical conduct such as, It’s not unethical as long as no one can prove you
did it, It’s not unethical as long as your client wanted you to do it, and It’s
not unethical as long as you don’t know a law, ethical principle, or
professional standard that prohibits it. 
Chapter six deals with a central issue in all of therapy and
counseling: the problem of how to ask
questions that don’t unintentionally manipulate the patient or client into
giving the kind of answers the questioner wants to hear. There is a commendable critical discussion
of the issue of “false memory syndrome” as a case in point, both from the
perspective of how and why therapists were able to lead patients into
developing “memories” of events which never happened, and from the ironic
perspective of therapists who are now treating the so-called syndrome that
their profession itself created, then diagnosed and labeled, and now claims to
be able to treat.

From chapter seven onwards topics include how to
begin and end a therapeutic relationship, the meaning and importance of
informed consent, the pitfalls inherent in testing and diagnosing, the problem
of sexual relations with clients, the question of the appropriateness of
non-sexual social relationships with clients, the effects of cultural
differences on the therapeutic relationship, the limits of confidentiality, the
therapist’s responsibilities when it comes to a suicidal patient, and the
supervisory relationship between instructor and student therapist. Each of these chapters ends with a section
titled “Scenarios for Discussion” in
which several fictitious problems and brief case studies are presented,
followed by a number of pointed questions to be considered by the individual
reader or discussed by the class of students.

At the end of the book are four
appendices with useful information and a detailed example of a code of ethics
for psychologists, a statement of patients’ mental health rights, ethical
guidelines for professional care in a managed care environment, and a sample
informed consent form.

I found one area of discussion
especially interesting in light of the fears about litigation I’ve heard
expressed by counselors on many occasions. 
The authors point out that, contrary to popular belief, therapists and
counselors are not sued primarily by hostile clients out for irrational
revenge. By far the overwhelming reason
they’re dragged into court (20% of total claims) is because of sexual
impropriety or improper personal relationships with their clients/patients.  At the same time 35 per cent of disciplinary
actions taken against practitioners by licensing boards were also due to sexual
misconduct. Civil suits against a
therapist/counselors for incompetence account for only 14 percent of all
claims. Claims of incompetence include
inadequately trained therapists/counselors working with specific populations
such as rape victims or incest perpetrators, and attempting to use specific
techniques such as hypnotism. 
Practitioners who believed that so-called malpractice suits are always
perpetrated against innocent therapists by malicious clients just wanting to
make a quick buck will be relieved to know that litigation is in fact most
often precipitated by therapists’ unprofessional conduct.

I must admit that I found it
disturbing to note how often the issue of sexual misconduct comes up in this
book. There are two whole chapters (and a sizable list of index entries) that
deal specifically with sexual misconduct and unprofessional relationships with
clients/patients. Also appearing in a
number of assessment questionnaires in various other locations in the book are
questions dealing with issues such as the therapist/counselor having sexual
feelings for the client/patient, the therapist having sexual dreams about the
patient, improper sexual holding and touching between therapist and patient,
and so on. Perhaps I’m naïve, but I had
no idea, prior to reading this book, that sexual misconduct is such pervasive
ethical issue in the fields of therapy and counseling.

While I suggest that this book be
on every therapist’s shelf, I have to admit I found myself becoming
uncomfortable with the dates on some of the data to which the authors have
referred. For example they write, “. . . married teenagers show an extremely
high suicide rate” and cite a source
dated 1975 (p. 247). In the next sentence they admit that data is
generally not static and that new research 
“is refining our understanding as well as reflecting apparent
changes.” But their attention then
turns to the comparison of suicide rates for women and men. This means that the comment made about the
1975 statistics on married teenager suicides stays in the reader’s mind as
relevant and current. But surely there
is more up to date data available on suicides among married teens than this!

Again, this book lives up to its
subtitle: “A Practical Guide.” In my opinion this is the sort of
information that ought to be carefully studied by every practitioner and student
of therapy or counseling. But it’s also
an easy to read resource for mental health services consumers. Students and practitioners will gain a very
thorough understanding from it of how to behave in a professional manner, while
mental health services consumers will learn what they may legitimately expect
and demand from their therapists and counselors.

© 2002 Peter B. Raabe

Peter B. Raabe
teaches philosophy and has a private practice in philosophical counseling in
North Vancouver, Canada. He is the author of the books Philosophical
Counseling: Theory and Practice (Praeger, 2001) and Issues
in Philosophical Counseling (Praeger, 2002).

Categories: Psychotherapy, Ethics