Ethical dilemmas in psychotherapy: comparison between patients, therapists and laypersons.
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.
Fennig
Silvana
S
Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel. sfennig@clalit.org.il
Secker
Aya
A
Treves
Ilan
I
Ben Yakar
Motti
M
Farina
Jorje
J
Roe
David
D
Levkovitz
Yechiel
Y
Fennig
Shmuel
S
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