In investigating potential ethical issues of Vignette 5, Carla had knowledge that Simon was divorced which may have been an act of self disclosure on Simon’s behalf. In considering whether this disclosure was in Carla’s best interest, this could potentially be identified as an area of contravention of the Australian Psychological Society’s (APS) Code of Ethics (General Principal C; Integrity). Yallom (2002) argued that self disclosure from the therapist can foster self disclosure from the client, and that this can work to create an atmosphere of trust.
If however, Simon volunteered this information to serve his own interest, there may be a risk of causing harm to the client thus violating his profession responsibility by crossing the professional boundary into a more personal relationship (contravention B. 3. G). Although not explicitly stated, Simon may have been struggling with his own relationship issues stemming from his recent divorce. This may have obscured his judgment to remain objective when working with Carla and her marital issues.
Consequently, Simon’s emotional and mental state may have been impairing his ability to provide effective therapy and thus this may thus be in breach of competence (contravention B. 1. 2. E). In the first instance when Carla asked Simon out for a drink, although he declined the invitation, throughout the time after this Simon arguably demonstrated a lack of boundaries as he held a “special interest” in Carla even to the point of wearing shirts that he knew she liked.
Instead of addressing this directly through self reflection or consultation with peers and supervision to discuss the implications and management of the situation, he chose not to act (contravention B. 1. 3 and C. 3. 2). Finally, there could be a potential risk of harm as Simon not only avoided directly addressing Carla’s intentions to move to a personal relationship but also after disclosing her feelings, Simon still allowed a “sensual hug” which would arguably constitute crossing a professional boundary and exploitation (B. 1. 2. E and C. 4. 1).
Ethical and psychological theories In drawing on psychodynamic analytic theory of transference, specifically, ‘eroticized transference’(e. g Maroda,1991) appears to be at play between Carla and Simon. It could be seen that Carla was projecting her fantasy of an idealised relationship onto Simon. Therapy could arguably be a safe environment for Carla to explore these feelings to discern the meaning of her relationship themes, if handled appropriately by the therapist. There may be many reasons for her attraction towards Simon.
For instance, Carla was in an abusive and domestically violent relationship, and thus may play out a relationship theme of being exploited and experience a lack of power. This may have been a factor in her attraction to Simon who is also in a position of power. Also, in drawing on psychoanalytic theory (e. g McWilliams, 1999) Carla may also unconsciously view power as being a male prerogative and must therefore be seduced into sharing it in order to gain mastery. Carla also felt gratitude towards Simon which again, may places her in a powerless position just as she also attempted to ‘please’ her husband and this position was abused.
Whatever the reason, the risk of harm lays in the idea that Simon was holding a position of power and he had not addressed the transference at any point. Given the natural power imbalance in this dynamic, if not appropriately addressed and managed, Carla is vulnerable and open to exploitation. The countertransference issue in this dynamic may be that Simon felt validated by Carla’s advances and given that as he held a ‘special interest’ in her, he may not have been fully conscious of this, at least to begin with. Simon had recently experienced his own divorce and thus may have been over identifying with Carla’s relationship issues.
Simon may be using defense mechanisms such as denial to avoid addressing the transference as he may want to continue the dynamic for his own gain, placing his interest above Carla’s. The risk of harm lies in the idea that Simon is dealing with his own relationship issues of loss and grief that may perpetuate the maladaptive relational pattern that the client attempted to address in the first place. Proposed course of action In making decisions to move in an ethically sound direction, it would arguably be of benefit to consider more than one philosophical approach (Morrissey & Reddy, 2006).
Ideally, in drawing on a utilitarian and deontological ethics (Morrissey & Reddy, 2006), before beginning therapy, Simon would have benefited from addressing the loss of his own relationship through therapy. This could have assisted him to process his own issues and aid self reflection to circumvent adverse countertransference issues. In drawing on normative and emotivism ethics, after the first instance of a potential ethical dilemma (after Carla asked Simon out) Simon may have benefitted from firstly acknowledging his own feelings and seeking supervision.
From there, he could either refer Carla on or work with her to use this material for interpretation, confrontation, or limit setting depending on the result of the discussion and the relational meaning that Carla identifies. After Carla admitted her feelings and Simon allowed physical intimate contact, he remained feeling confused thus may not have been in a position to remain unbiased and objective. Throughout the process of therapy, Simon appeared to be in denial about the transference issues and in a sense was lying to himself in continuing treatment.
Kotter (2010) for example, argued that therapists are rarely neutral when dealing with clients and that as therapists, there is a responsibility to acknowledge this and act accordingly. Given Simon’s circumstances of dealing with his own relational issues and feeling “confused and conflicted” by Carla’s advances, it would be important for Simon to acknowledge and accept his feelings and in maintaining competent practice, seek supervision through consultation with a senior psychologist to make a final decision to refer Carla on or work through the transference.
Australian Psychological Society (2007) Code of Ethics. Melbourne.
Kotter, J. (2010). Lies we tell ourselves – and others. In: On being a therapist (4th ed.). San Fransisco, United States of America: Jossey-Bass.
Maroda, K.J. (1991). The power of countertransference: Innovations in analytic technique. New York, New York: John Wiley & Sons.
McWilliams N. (1999) Psychoanalytic Case Formulation. New York: Guilford Press,
Morrissey, S., & Reddy, P. (2006). Ethics and professional practice for psychologists. Australia: Thomson Social Science Press.
Yalom, I. D. (2002). The gift of therapy: An open letter to a new generation of therapists and their patients. New York, NY: Harper Collins Publishers