Case Study

Guilt affects one's relationship with their partner, and one’s attempts to deal with it can become a serious problem. Guilt is a source of unrelenting pain, anger, and resentment, which could cause depression and hinder one from fulfilling obligations in a relationship. Therefore, the need to seek aid from a psychotherapist is of paramount importance but with adherence to stipulated guidelines and procedures. Such is the case of Reggie, who seeks an appointment with Savannah, who has had two years’ experience as a practicing therapist. Reggie’s case involves dealing with guilt after having affairs despite being in a relationship. However, Savannah prefers having a couple’s session as the issues in consideration involve a relationship with the partner. Therefore, it is a scenario analysis of ethical dilemma by professionally practicing psychotherapy and counseling.

There are no defined solutions for the various complicated and multilevel ethical queries that therapists confront during treatment procedures for clients. Ethical dilemmas in psychotherapy are contextual, dynamic, and nuanced with ethical matters in such categories having a relationship with profession activities, therapeutic limits, and confidentiality. Guilt is a major ethical issue that therapists find most challenging to deal with. The attitudes and beliefs coming between the relationships of legal arguments and guidelines for moral reasoning usually give a prediction towards breaking of rules either directly or indirectly. Ethical therapists are dedicated to serving a client’s well-being amongst other benefits and duties, as noted by Gorman (2001). Principally based medical ethics has necessary tools for building resolutions to ethical dilemmas in psychotherapy by noting other means of expressing therapeutic aspects. Dilemma results from diverse psychotherapy practices (Sue, 1998).

However, the ethics of modern psychotherapy in matters governing relationships is formed based on two major traditions of ethics (Sue, 1998). The latter are deontological and teleological components characterizing the ethics of affairs. Deontological component is a normative type of position that gives judgment to the morality of actions based on compliance with rules that are not justifiable by consequences. Common sense stipulates that a choice can be deemed right if it conforms to morally renowned norms. On the other hand, teleological ethics argue that an act is judged as being right or not depending on how it presents its end. Decisions in psychotherapy are deemed optimal if they consider traditions and have ethical dilemmas preceding offers for the best attainable therapies to a client.

Assessment and Treatment

In Reggie’s case, the process of assessment ought to look at the possible influences on the problems affecting Reggie and to form a holistic view of current levels of functioning. During the assessment process, the therapist collects all necessary information on diverse aspects characterizing the life of the client. On the other hand, the practitioner remains tuned to the stories as presented by the client while seeking to establish the reason why they require professional guidance. According to some writers, it is fundamental to understand the clients’ religious background and merge their beliefs into their assessment and treatment procedures. According to Frame (2003), there are numerous reasons for doing an assessment on religious beliefs, including the need to understand the clients’ worldview as well as contexts for their living. In addition, the clients are able to grapple with queries attributed to the need for living and what they value most by digging deeper into religion and establishing the best interventions that can be adopted. In the assessment criteria, a counselor gets an opportunity to note the likely negative influences that religion could have on clients’ problems. Conducting an assessment for Reggie will help create a platform for the therapist to give aid to the client by a manner of exploring religious matters. From the results of a thorough assessment, a determination is determined regarding the necessity of involving a client's spiritual belief in the process of psychotherapy.

Indeed, the integration of psychology and spiritual affiliation is perceived to continue in the discussion of psychotherapy and it will likely evolve in ways that could be of benefit to psychotherapy clients. A large portion of Americans and other world populations are founded on religious grounds and, therefore, those closely involved with spiritual matters have a higher possibility of seeking the services of psychologists and professionals in this field. There is an ongoing research in the application of modern research techniques that integrate the psychotherapy and spiritual topics, hence creating a more scientific foundation. Although for thousands of years people have had interests in religious matters, it is only in the recent decades that psychology as both a discipline and profession has advanced to accommodate and realize interests towards their professional careers. According to Hartz (2005), it is rather apparent that spiritual and psychology integration is bound to stay and maybe develop numerous benefits for the clients and professionals. It is critical to do a close monitoring of issues that are emerging or are likely to emerge in the processes of professional work. In addition, it is of the essence to become seriously thoughtful of principles governing ethics such as becoming responsible, competent, and concerned and integrity conscious as well as likely ethical dilemmas while obtaining training to help navigate professionally (Pope & Vetter, 1992).

There are four major principles characterizing bioethics that include justice, autonomy, non-maleficence, and beneficence, and these principles are essential in ensuring better results for ethics in psychotherapy. A reflection of the context is necessary owing to the exceptions in adopting the general concepts. However, psychotherapy clients may feel exploitation from economic, emotional, and sexual affiliated factors that are either intentional or unintentional. Moreover, there is another form of a dilemma, which is assuming dual roles in psychotherapy. In this case, there is tension between the obligations of beneficence to the psychiatrists and the associated dilemma with clients, hence creating a conflict with society. Equally, confidentiality is a key cause of ethical dilemmas since confidentiality is paramount for the clients to be involved in therapy. Ideally, confidentiality is an elemental idea in the application of therapeutic practices (Pope & Vetter, 1992).

Since the ancient times, people have always sought for ways to mitigate cases of psychotherapy within their communities with a necessity to establish the very basic procedures that make coexistence a possibility. The basic instincts could not be served enough as they were formed under natural selection in many years of tribal coexistence. As a result, commandments became part of every religion in governing a society by defining a code of conduct and ethics that watch over unwanted behaviors. Indeed, ethical issues began to become questions for philosophy while the conclusions of the Socrates and Plato are bent towards ethical behaviors (Sieber, 1980).

Modern philosophy is significant for ethical contribution with Reggie’s case since it contributes to psychotherapy and growth of ethics more so with ideologies of limit situations as well as pluralism. In limit situations, the individual’s life is bound by existential events or crises that are seen as an opportunity for authentic living. Transcendence, on the other hand, is characteristic of freedom being a fundamental aspect for a human to exist. Maybe, pluralism in Reggie’s case may be deemed as a creative idea, and it still fails to become the most preferred among psychiatrists. Innovation means being able to understand methods of acquiring knowledge alongside the axioms as well as limitations to these methods.

Ethical Issues

The numerous complex and multilevel questions on ethical basis are a common occurrence among therapists and they do not have definite answers. Despite the presence of professional codes being an indication of high standards of function, they never produce clear solutions thereby therapists must always comprehend such codes in reference to daily practices (Sieber, 1980). Ethical therapists are considerate on the well-being of clients irrespective of other benefits or duties. They are obliged to adopt specific strategies that draw attention towards professional obligations for increasing ethical competencies. The competency, in this case, includes aspects such as constant self-reflection on ideologies, behaviors, and attitudes. In addition, they must show comprehension of the relevance of professional codes of ethics and exemplify openness for supervision. The question arises regarding the limit for psychotherapeutic approach with regard to life’s conduct. The most influential limitation is attributed to the unbreakable connection existing between the conduct of a person’s life and the transpersonal senses for which life is not altered by falsifiable knowhow.

Diagnosis for Therapeutic Cases

Many psychotherapists have no enthusiasm to continue working with clients suffering from severe personality disorders mainly because they have the perception that psychotherapy may not be helpful. Personality disorders at a severe stage are alluded to cause morally complex problems. Social constructionists have developed an approach for which they offer insights in therapeutic engagement. The discourse presented is constructed to subjects for diagnosis of personality disorder that is characteristically different from the rest of the population. An ethical question arises as to what the determinant of a subject to be regarded as morally responsible for one’s behavior is. Research categorizes complicated personality disorders under a moral division within the frameworks of terms of whether it is good or bad or an obligation of moral concept. It seems that in severe cases, the client can rarely recognize or comprehend morality from a different angle (Jacobson & Truax, 1991).

Cases of dilemma that involving sexual emotions in psychotherapy like those of Reggie and Savannah are a common phenomenon in society. Nevertheless, if there is anxiety that surrounds psychotherapy dilemmas and are exclusively limited to some levels of difficulty in distinguishing a plan of action, then sexual intimacy cannot be regarded a dilemma (Richardson & Handal, 1995). Ethical rules found amongst psychological professionals like marriage and family therapy are very clear in stating that a dual relationship is irresponsible and it cannot be accepted. Acceptance of the latter is deemed as a compromise towards treatment to some extent. The aspects of viable relationships are not attributed to any judgment calls. Equally, similar standards ought to hold for other forms of professional relationships like legal practices. Although it is an incumbent character for psychotherapists to adopt behaviors that go hand in hand with professional boundaries, it wrong to make conclusion that the professional guidelines stop making it a dilemma for working in such complicated human endeavors. However, the majority of authorities working in the area hold different opinions in that if the personal feeling is repressive and punitive, it is equally a disastrous endeavor for the therapist.

Theoretical Orientation for Treatment

The work of a psychotherapist is of great importance in making contributions towards values for things, behavior, and people. Psychoanalytic theories, as well as other forms of therapies that have developed from it or in reaction to it, are not explicit about ethics and values. However, each aspect of psychopathology and development theory have an implication of viewing human nature and the value of certain behaviors, structures that build on one’s character and the mind status. According to Duff and Campbell (1973), the practices of psychotherapy are inclusive of vulnerable persons, especially in emotional difficulties. Adequately informed and implemented consent procedures are substantiating factors for a therapist’s respect towards the rights to autonomy for a client by constituting therapeutic relations, enhancing reciprocal trust and providing a sense of ownership (Richardson & Handal, 1995).

Major elements of informed consent for psychotherapy relates to real world occurrences (Richardson & Handal, 1995). In some cases, a client in multiple affairs could end up disappointed by each of them and may ultimately opt for suicide. Suicide is a common experience for many therapists, though it leaves behind massive emotional impacts and creates worries for psychotherapists. If not adequate measures are taken, Reggie’s guilt could build towards nurturing the thoughts of a suicidal act. Indeed, psychotherapy has a role in facilitating a client’s work in a manner that accords respects to values of a client, creating a platform for self-determination and facilitating personal resources (Duff & Campbell, 1973). The objective, in this case, is to empower clients and give encouragement for them to control their lives freely. In fact, psychotherapy can only be realized when a therapist and client have an explicit agreement for a therapy relationship. Just like in Reggie’s case, the argument by Savannah was duly valid in consideration of the need to have both partners involved in order to reach a consensus. If this is not put into consideration, there is a likely potential value conflict, affecting both the therapist and client in a manner that the client may conceal some information. The client must then be accorded the opportunity to make informed consent and whose impact is potential for breaching the principle of non-maleficence (Rounsaville & Kleber, 1985).

To sum it all, Reggie’s case evaluates issues that relate to psychotherapy, and it is the responsibility of each partner to hold considerations for personal, ethical, and moral perspective within a range of issues around relationships. Hopefully, in such scenarios, individual psychotherapists will adopt different forms of therapeutic judgments in expressing the guiding standpoints. After reviewing the professional standards and codes, Reggie is obliged to hold psychotherapy sessions along with his partner to seek mitigation for dealing with guilt.

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