VERIFIED
●
Ethical
and
Legal
Issues
in
Psychotherapy
INTRODUCTION
●
Psychotherapeutic
interventions
are
part
and
parcel
of
the
management
of
various
psychiatric
disorders.
Pharmacotherapy
for
most
psychiatric
disorders
is
often
combined
with
psychotherapy
to
improve
the
overall
outcome.
Over
the
years,
different
types
(Psychoanalytic,
Cognitive
Behaviour ,
Family ,
Interpersonal,
Supportive,
Eclectic,
and
Brief
therapies)
and
different
schools
of
psychotherapy
have
emer ged
and
the
modality
of
carrying
out
psychotherapy
has
also
changed
from
in
person
psychotherapy
to
e-therapy .
E-therapies
are
being
carried
out
by
using
synchronous
and
asynchronous
methods.
Despite
all
this,
it
is
evident
that
there
are
certain
common
ingredients
for
all
kinds
of
psychotherapies.[
1
] ●
The
Government
of
India
has
recently
issued
Telemedicine
Practice
Guidelines[
2
]
which
formalize
teleconsultations.
These
guidelines,
however
do
not
talk
much
about
psychotherapeutic
interventions.
These
changing
methods
of
carrying
out
psychotherapy
are
going
to
bring
in
more
and
more
ethical
and
legal
issues.
Hence,
it
is
important
to
understand
various
ethical
and
legal
issues
pertinent
to
the
practice
of
psychotherapy . ●
Multiple
efforts
have
been
made
to
define
psychotherapy .
However ,
till
today
the
definition
of
psychotherapy
given
by
Wolber g[
1
]
is
considered
to
be
comprehensive,
which
defines
it
as
“a
treatment
,
by
psychological
means
,
of
problems
of
an
emotional
natur e
in
which
a
trained
person
deliberately
establishes
a
professional
relationship
with
the
patient
with
the
objective
of
removing
,
modifying
or
retarding
existing
symptoms;
mediating
disturbed
patterns
of
behavior
and
promoting
positive
personality
growth
and
development.” VERIFIED
●
Indian
Psychiatric
Society
(IPS)
formulated
the
guidelines
for
various
specific
psychotherapies
in
the
year
2010.
However ,
the
guidelines
for
ethical
and
legal
issues
in
psychotherapy ,
which
were
published
for
the
first
time
by
the
IPS
was
not
updated.
Accordingly ,
these
guidelines
are
an
update
of
the
previous
version
of
guidelines[
3
]
for
ethical
and
legal
issues
in
psychotherapy .
The
basic
aim
of
these
guidelines
is
to
establish
minimum
ethical
standards
for
practice
of
psychotherapy
by
the
psychiatrists.
These
guidelines
provide
a
broad
outline,
which
can
be
applied
to
the
wide
range
of
approaches
used
by
individual
psychiatrists
in
their
clinical
practice.
These
guidelines
address
the
common
ethical
and
legal
issues
arising
out
of
common
ingredients
of
psychotherapy .[
1
] ●
The
three
most
important
issues
for
the
best
ethical
practice
include
positive
ethics
,
risk
management
,
and
defensive
practice
.[
4
]
Positive
ethics
basically
focuses
on
the
constant
efforts
made
by
the
psychotherapist
for
achieving
the
best
possible
ethical
standards.
This
is
mainly
guided
by
aspirational
virtues
of
the
therapist
to
do
good
and
provide
maximum
benefit
to
the
client
(beneficence),
avoid
exploitation
and
harm
to
the
clients
and
those
associated
with
the
client
(non-maleficence),
faithful
to
the
explicit
and
implicit
obligations
that
a
therapist
is
expected
to
be
with
their
client
(fidelity),
promoting
independence,
rather
than
dependence
of
the
client
on
the
therapist
through
own
actions
(autonomy),
providing
fair
and
equal
treatment,
and
access
to
treatment,
to
all
individuals
(justice)
and
taking
care
of
own
physical
and
psychological
wellbeing
so
that
they
are
able
to
implement
the
required
virtues
effectively
(self-care).[
5
]
Risk
management
specifically
focuses
on
reducing
the
risks
for
the
therapist
in
the
form
of
complaints
to
the
ethics
bodies
or
malpractice
claims.
Risk
management
basically
addresses
the
issues
of
informed
consent,
effective
documentation,
and
consultation.[
5
,
6
]
Defensive
practice
focuses
on
the
direct
protection
of
the
psychotherapist
and
involves
decision-making
based
on
reducing
the
possibility
of
adverse
outcomes
for
the
psychotherapist.[
4
,
6
]
For
example,
restricting
the
type
of
clients
taken
up
for
the
therapy
and
refusing
to
take
up
a
certain
type
of
clients,
such
as
those
with
active
suicidal
ideation
and
suicidal
behavior
or
those
with
severe
personality
disorders,
in
view
of
the
increased
risk.[
5
,
7
] VERIFIED
●
Based
on
these
three
principles,
these
guidelines
cover
the
ethical
and
legal
issues
in
psychotherapy
under
the
broad
headings
of
competence
of
therapist,
responsibilities
of
therapists
towards
their
clients,
therapeutic
contract,
informed
consent,
confidentiality ,
privilege
and
psychotherapy
supervision,
documentation,
self-disclosure,
matters
of
business
(advertising,
fees,
etc.),
research,
counter -transference,
boundaries,
professional
negligence,
termination,
and
post-termination
issues. ●
However ,
it
is
important
to
remember
that
these
guidelines
provide
a
broad
framework,
and
these
are
not
a
substitute
for
professional
knowledge,
clinical
judgment,
and
formal
legal
advice.
These
guidelines
cannot
specifically
address
every
situation
or
dilemma
that
a
therapist
may
face. ●
BASIC
TENETS
OF
A
GOOD
PSYCHOTHERAPIST
●
A
good
therapist
is
expected
to
be
competent,
responsible
for
the
client
and
self,
seek
proper
informed
consent
and
assent
(if
required)
[
Table
1
]. ●
Table
1
●
Basic
tenets
of
a
good
psychotherapist
Competence VERIFIED ·
Possess
skill
and
knowledge
required
to
carry
out
a
particular
kind
of
therapy ·
Awareness
of
own
emotional
state
while
dealing
with
their
clients ·
Irrespective
of
the
level
of
training,
seek
supervision
from
colleagues
Responsibility
for
the
client
and
self ·
Remain
aware
of
their
responsibilities
towards
the
clients
and
self ·
Take
the
therapy
with
a
professional
intent
