Book Review
Psychotherapy
Ethics Case Book of the American Psychoanalytic Association. Paul Dewald, Rita Clark, editors. New York: American Psychoanalytic Association; 2001. 106 p. US$20.00.
Reviewer
rating*: Good
Review by: Paul Ian Steinberg, MD, FRCPC
Edmonton, Alberta
This slim text outlines the principles and standards of ethics for psychoanalysts, together with the provisions for implementing the same, under the following categories: professional competence, respect for persons, mutuality and informed consent, confidentiality, truthfulness, avoidance of exploitation, scientific responsibility, protection of the public and profession, social responsibility, and personal integrity. The chapter describing principles and standards focuses on the issues of confidentiality, avoiding exploitation, and safeguarding the public and the profession. The chapter on provisions for implementation goes into considerable detail regarding procedures that have been put in place to give teeth to these principles and standards. The American Psychoanalytic Association appears to be taking a leadership role among the health care disciplines not only in publishing guidelines but also in implementing these provisions.
An introductory chapter illustrates why this text is needed now: it acknowledges the ubiquity of ethical violations and boundary crossings, which have occurred more frequently than previously acknowledged, and it recognizes that consciousness raising and prevention are easier and less expensive to implement than handling violations after they have occurred. The authors emphasize the importance of open discussion and sharing of ethical concerns and differences of opinion so that consensus about ethical behaviours can become an expected part of the professional climate.
All the above introduce the meat of the book, a 7-section chapter of case vignettes with discussions of the issues encountered in applying ethical principles to clinical practice. The chapter’s 7 sections discuss the following: psychoanalytic competence; confidentiality; avoiding exploitation; relationships with colleagues, students, and supervisees; safeguarding the public and the profession; implementation of the code; and ethical violations vs technical variations. Each section is introduced with a preface outlining the salient issues. The vignettes themselves are organized in terms of their themes. For example, under the theme of competence are vignettes on temporary, progressive, and recurrent illness in the analyst, as well as vignettes on life stress, aging, and dying. The vignettes are in some cases followed by thoughtful and comprehensive discussions of the ethical issues raised. Many of the important questions do not have easy or clear-cut solutions, especially when competing ethical concerns are mutually irreconcilable. In my opinion, the discussions are valuable enough that every vignette should have been followed by a discussion; unfortunately, readers must sort out about one-half of them for themselves. These vignettes raise important questions for all mental health professionals. Many involve situations in which the professional cannot simultaneously protect the patient’s welfare, the psychoanalyst’s interests, society’s interests, and professional boundaries.
A recurring emphasis is the need for self-monitoring and self-examination. This text is explicit regarding a lifetime prohibition against sexual interactions between psychoanalysts and patients or families of patients. The authors recognize the timelessness of transference and that no statute of limitations should permit sexual contact with a patient after a certain time has elapsed—a standard that has not been accepted in other mental health disciplines. This book is laudable also in its outlining of indications for consultation with colleagues to protect both patients and the analytic work.
This otherwise very good and comprehensive text unfortunately contains several errors, including incorrect sentence structure, typographical errors, omitted words, and an editorial blooper on the first page that repeats an entire paragraph in a footnote. More careful editing might have been expected, given the care devoted to the content. That said, this is a generally good book that all psychiatrists could read to advantage and apply to their practices. Virtually all the standards described here apply to psychiatric practice. The book is clearly and tersely written. Although a trifle expensive for a softcover book, it should certainly be found in the libraries of all psychiatric departments, if not on the shelf of every psychiatrist. If a second edition eliminates the considerable number of editing errors and provides discussions for each vignette, it will be an excellent book.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
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