title: Ethical dilemmas in psychotherapy: comparison between patients, therapists and laypersons.
abstract: BACKGROUND
  The attitudes of patients towards ethical dilemmas in psychotherapy have been reported in only a few studies.
  
  
  OBJECTIVE
  We investigated whether the attitudes of patients undergoing psychotherapy to confidentiality and boundaries are different from those of therapists and laypersons.
  
  
  METHODS
  Clinical vignettes describing ethical dilemmas of confidentiality and boundaries were presented to 103 patients undergoing psychotherapy (patient group), 93 psychotherapists of different professional backgrounds (professional group), and 55 staff and students from the fields of law and the humanities (lay group). Patients were asked how they think therapists should act in the situations presented and therapists were asked how they should behave in such situations.
  
  
  RESULTS
  In general, the patient group showed a greater tendency to view their therapists as breaching confidentiality than the professional and lay groups. Regarding boundaries, the majority of psychotherapists were against initiating any sexual relationship with current patients, former patients, students or supervisees, whereas both patients and laypersons showed a less stringent attitude; these differences were statistically significant. The vast majority of therapists (96.7%) disapproved of accepting money in advance compared to only 31.1% in the patients group and 54.4% of the lay group. Analysis of the patients group by gender did not reveal any significant relationships.
  
  
  CONCLUSIONS
  (1) Patients have different ethical codes from therapists and laypersons regarding the issues of confidentiality. (2) Patients and lay persons are less strict than therapists regarding issues of boundaries.
authors.affiliation: Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel. sfennig@clalit.org.il
authors.forename: Silvana
authors.initials: S
authors.lastname: Fennig
authors.forename: Aya
authors.initials: A
authors.lastname: Secker
authors.forename: Ilan
authors.initials: I
authors.lastname: Treves
authors.forename: Motti
authors.initials: M
authors.lastname: Ben Yakar
authors.forename: Jorje
authors.initials: J
authors.lastname: Farina
authors.forename: David
authors.initials: D
authors.lastname: Roe
authors.forename: Yechiel
authors.initials: Y
authors.lastname: Levkovitz
authors.forename: Shmuel
authors.initials: S
authors.lastname: Fennig
mesh_terms: D000328:Adult; D001294:Attitude to Health; D003219:Confidentiality; D004995:Ethics, Professional; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006809:Humanities / Q000193:education; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology* / Q000628:therapy*; D010361:Patients / Q000523:psychology*; D026684:Personal Autonomy; D011369:Professional-Patient Relations; D011613:Psychotherapy / Q000941:ethics*; D013334:Students; D011795:Surveys and Questionnaires