stories of Psychotherapy
After reading the stories and material below, cut and paste the questions in a document, answer and submit. Grades will be based on completely answering all questions.
The following stories were written by practicing psychotherapist and based on actual cases. The first story, entitled Travels with Paula is by Irvin Yalom from his book Momma and the meaning of life: Tales of Psychotherapy. Dr. Yalom is a Professor Emeritus of the Department of Psychiatry at Stanford University. His website is www.yalom.com. This story was written in the 1960s when Dr. Yalom was a resident at Johns Hopkins University. Therefore, much has changed in terms of the standards of practice and ethics. After reading the story, please answer the following questions using the guidelines on the syllabus:
1. Dr. Yaloms work was ground breaking in the 1960s. However, such group work is very commonplace today. Identify at least two ethical issues that you feel may have been violated by todays standard. Refer to the part of the code that you think as been violated and explain the violation.
2. Overall, what did you think of Dr. Yaloms approach to this case. You may talk about his therapeutic approach or about his ethics.
The next three stories were written by George Weinberg, a psychologist and favorite author of mine. I use his stories to teach counseling skills. The first two stories are from The taboo scarf and other tales of therapy. It is, unfortunately, out of print, but it is worth buying through online bookstores that buy used books.
To be an effective and ethical therapist, you will have to become aware of your own biases and limitations. You may find that there are areas in which you might not want to practice based upon your own beliefs. Or you may choose to challenge and consider changing beliefs. The first story is entitled The triumph of frailty. In this story, Dr. Weinberg tells a story within a story about two men: Ken, who is awaiting his results from an AIDS test, and Eliot, who is studying to become a doctor. With both men, Dr. Weinberg refuses to help them change their sexual
orientation. In fact, in the 70s, due to similar cases with catastrophic endings, the diagnosis of homosexuality was taken out of the diagnostic manual. You can refer to the following link to see the text of a resolution by the American Psychological Association. I have also pasted the content of the resolution and press release at the end of this document.
The core issues are the same whether you look at sexual orientation, race, gender, religion or any number of issues. Reparative therapy, which purports to change sexual orientation from homosexual to heterosexual, was developed by a psychologist who believes that homosexuality is not a valid lifestyle. One ethical issue involved is whether you should treat someone from a group against which you hold a bias. If you have a bias against a particular sexual orientation, religion, race or gender, you should not treat someone from that group. The second ethical issue is about providing a treatment for something that is not a disorder. Reparative therapy is a treatment for something that has been deemed not to be a disorder and does not need a treatment. In this story, Dr. Weinberg deals with these issues.
3. Please discuss Dr. Weinbergs treatment of Ken. What ethical issues did he wrestle with? What do you think about his work with Ken?
4. Please discuss Dr. Weinbergs treatment of Eliot. What ethical issues did he wrestle with? What do you think about his work with Eliot?
The second story by Dr. Weinberg is titled The king of beasts. In this story, Dr. Weinberg struggles with ethical issue related to the treatment of a hospitalized man.
5. Dr. Weinberg had to circumvent the politics of the differing ambitions and opinions to help his patient. What do you think about the ethics of the doctors involved in making the decision about whether to release the patient?
6. Dr. Weinberg secures the release of the patient and takes him home. Do you think he made the right decision? What ethical issues did he struggle with?
The third story by Dr. Weinberg was from Nearer to the hearts desire: Tales of psychotherapy. The story is entitled The nonentity and deals with the ethical issue of the duty to warn.
7. Briefly discuss the duty to warn. How do you feel about Dr. Weinbergs decision-making in this case?
APA Council of Representatives Passes Resolution on So-Called Reparative Therapy
Resolution Raises Ethical Concerns About Attempts to Change Sexual Orientation, Reaffirms Psychologys Opposition to Homophobia and Clients Rights to Unbiased Treatment
(Chicago, August 14, 1997). The Council of Representatives of the American Psychological Association (APA) has passed a resolution affirming four basic principles with regard to treatments to alter sexual orientation, so-called conversion or reparative therapies.
These principles are:
? Homosexuality is not a mental disorder and the APA opposes all portrayals of lesbian, gay and bisexual people as mentally ill and in need of treatment due to their sexual orientation;
? Psychologists do not knowingly participate in or condone discriminatory practices with lesbian, gay and bisexual clients;
? Psychologists respect the rights of individuals, including lesbian, gay and bisexual clients to privacy, confidentiality, self-determination and autonomy;
? Psychologists obtain appropriate informed consent to therapy in their work with lesbian, gay and bisexual clients.
The resolution further states that the APA urges all mental health professionals to take the lead in removing the stigma of mental illness that has long been associated with homosexual
Supporters of the resolution, which passed the APA Council overwhelmingly by a voice vote, believed that it was critical for the Association to make such a statement due to the questions of the ethics, efficacy and benefits of conversion therapy which are now being debated within the profession and within society as a whole.
Our concern, stated Douglas Haldeman, Ph.D., President of APAs Society for the Psychological Study Of Lesbian, Gay and Bisexual Issues, is that a person, especially a young person, who enters into therapy to deal with issues of sexual orientation should be able to have the expectation that such therapy would take place in a professionally neutral environment absent of any societal bias. AIDitionally, therapists should be providing clients with accurate information about same-sex sexual orientation. This resolution reasserts the professions commitment to those two principles.
The APA Council of Representatives is the major legislative and policy-setting body of the organization. The American Psychological Association (APA), in Washington, DC, is the largest scientific and professional organization representing psychology in the United States and is the worlds largest association of psychologists. APAs membership includes more than 151,000 researchers, educators, clinicians, consultants and students. Through its divisions in 50 subfields of psychology and affiliations with 58 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting human welfare.
Resolution on Appropriate Therapeutic Responses to Sexual Orientation
Adopted by the American Psychological Association Council of Representatives
August 14, 1997
Whereas societal ignorance and prejudice about same-gender sexual orientation put some gay, lesbian, bisexual and questioning individuals at risk for presenting for conversion treatment due to family or social coercion and/or lack of information (Haldeman, 1994);
Whereas children and youth experience significant pressure to conform with sexual norms, particularly from their peers;
Whereas children and youth often lack adequate legal protection from coercive treatment;
Whereas some mental health professionals advocate treatments of lesbian, gay, and bisexual people based on the premise that homosexuality is a mental disorder (e.g., Socarides et al, 1997);
Whereas the ethics, efficacy, benefits, and potential for harm of therapies that seek to reduce or eliminate same-gender sexual orientation are under extensive debate in the professional literature and the popular media (Davison, 1991; Haldeman, 1994; Wall Street Journal, 1997);
Therefore be it resolved that APA affirms the following principles with regard to treatments to alter sexual orientation:
That homosexuality is not a mental disorder (American Psychiatric Association, 1973); and
That psychologists do not knowingly participate in or condone unfair discriminatory practices (Ethical Principles of Psychologists and Code of Conduct, American Psychological
Association, 1992, Principle D, p. 1600); and
That in their work-related activities, psychologists do not engage in unfair discrimination based on sexual orientation (Ethical Principles of Psychologists and Code of Conduct, American Psychological Association, 1992, Standard 1.10, p. 1601); and
That in their work-related activities, psychologists respect the rights of others to hold values, attitudes, and opinions that differ from their own. (Ethical Principles of Psychologists and Code of Conduct, American Psychological Association, 1992, Standard 1.09; p. 1601); and
That psychologists respect the rights of individuals to privacy, confidentiality, self-determination and autonomy (Ethical Principles of Psychologists and Code of Conduct, American Psychological Association, 1992, Principle D, p. 1599); and
That psychologists are aware of cultural, individual and role differences, including those due to sexual orientation and try to eliminate the effect on their work of biases based on [such] factors (Ethical Principles of Psychologists and Code of Conduct, American Psychological Association, 1992, Principle D, pp. 1599-1600); and
That where differences of sexual orientation significantly affect psychologists work concerning particular individuals or groups, psychologists obtain the training, experience, consultation, or supervision necessary to ensure the competence of their services, or they make appropriate referrals (Ethical Principles of Psychologists and Code of Conduct, American Psychological Association, 1992, Standard 1.08, p. 1601); and
That psychologists do not make false or deceptive statements concerning the scientific or clinical basis for their services, (Ethical Principles of Psychologists and Code of Conduct, American Psychological Association, 1992, Standard 3.03(a), p. 1604); and
That psychologists attempt to identify situations in which particular interventions may not be applicable because of factors such as sexual orientation (Ethical Principles of Psychologists and Code of Conduct, American Psychological
Association, 1992, Standard 2.04 (c), p. 1603); and
That psychologists obtain appropriate informed consent to therapy or related procedures [which] generally implies that the [client or patient] (1) has the capacity to consent, (2) has been informed of significant information concerning the procedure, (3) has freely and without undue influence expressed consent, and (4) consent has been appropriately documented (Ethical Principles of Psychologists and Code of Conduct, American Psychological Association, Standard 4.02(a), 1992, p. 1605); and
When persons are legally incapable of giving informed consent, psychologists obtain informed permission from a legally authorized person, if such substitute consent is permitted by law (Ethical Principles of Psychologists and Code of Conduct, American Psychological Association, 1992, Standard 4.02(b), p. 1605);.
That psychologists (1) inform those persons who are legally incapable of giving informed consent about the proposed interventions in a manner commensurate with the persons psychological capacities, (2) seek their assent to those interventions, and (3) consider such persons preferences and best interests (Ethical Principles of Psychologists and Code of Conduct, American Psychological Association, 1992, Standard 4.02(c), p. 1605); and
That the American Psychological Association urges all mental health professionals to take the lead in removing the stigma of mental illness that has long been associated with homosexual orientation (Conger, 1975, p. 633); and
Therefore be it further resolved that the American Psychological Association opposes portrayals of lesbian, gay, and bisexual youth and adults as mentally ill due to their sexual orientation and supports the dissemination of accurate information about sexual orientation, and mental health, and appropriate interventions in order to counteract bias that is based in ignorance or unfounded beliefs about sexual orientation.
American Psychiatric Association. (1973). Position Statement on Homosexuality and Civil Rights. American Journal of Psychiatry, 131 (4), 497.
American Psychological Association. (1992). Ethical Principles of Psychologists and Code of Conduct. American Psychologist, 47 (12), 1597-1611.
Conger, J.J. (1975). Proceedings of the American Psychological Association, Incorporated, for the year 1974: Minutes of the Annual Meeting of the Council of Representatives. American Psychologist, 30, 620-651.
Haldeman, D.C. (1994). The Practice and Ethics of Sexual Orientation Conversion Therapy. Journal of Consulting and Clinical Psychology, 62 (2), 221-227.
Socarides, C., Kaufman, B., Nicolosi, J., Satinover, J., and Fitzgibbons, R. (1997, January 9). Dont forsake homosexuals who want help. Wall Street Journal.
Letters to the Editor. (1997, January 23). Wall Street Journal, p. A17.