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Article Excerpt
This study employed the Consensual Qualitative Research method (Hill, Thompson, & Williams, 1997) to reanalyze interview data from a previous qualitative study of the personal characteristics of master therapists (Jennings & Skovholt, 1999). Previous research has demonstrated that therapists utilize a variety of resources when making ethical decisions, including professional codes of conduct and their own values. The current study's analysis of 10 master therapists' interviews resulted in the identification of nine ethical values related to their clinical practice: (a) relational connection, (b) autonomy, (c) beneficence, (d) nonmaleficence, (e) competence, (f) humility, (g) professional growth, (h) openness to complexity and ambiguity, and (i) self-awareness. Conducting oneself ethically is a critical task of the competent therapist (American Psychological Association, 2002). Making the best ethical decisions can be extremely challenging for most therapists due to the multitude of complex ethical situations that arise in practice. The goal of this study is to examine the ethical values of therapists considered to be "the best of the best" by their professional colleagues. It is hoped that such an examination will help to illuminate the ethical values that these master therapists seem to draw upon in their work.
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Ethics are beliefs about conduct and principles that inform rules for proper behavior (Corey, Corey, & Callanan, 1998; Knauss, 1997). In mental health professions, ethics codes are intended to "set out expected professional behavior and responsibility" (Eberlein, 1987, p. 354). However, studies involving ethical dilemmas have found a discrepancy among therapists between knowledge of proper actions and actual behavior (Bernard & Jara, 1986; Bernard, Murphy, & Little, 1987; Smith, McGuire, Abbott, & Blau, 1991; Wilkins, McGuire, Abbott, & Blau, 1990).
Why the inconsistencies? Researchers suggest that when therapists thought the ethical infraction violated a clear professional code, they were more likely to act as they felt they should, especially when the violation was bolstered by a legal precedent (Bernard et al., 1987; Smith et al., 1991). However, in situations that depended more on individual judgment, practitioners were less likely to do the right thing. It appears that when written ethical guidelines are unclear, mental health practitioners rely on their own individual value systems and their interpretation of the ethics code (Bersoff & Koeppl, 1993; Eberlein, 1987). One possibility for the discrepancy between knowing and doing what is right is that some clinicians suffer from deficits in principles such as integrity and honesty (Smith et al.). Rest (1984) theorized that a therapist who is reluctant to follow through with understood ethical behavior may lack the courage to act. To date, studies on therapist values have tended to focus on their conceptualizations of what constitutes good mental health (Consoli & Williams, 1999; Haugen, Tyler, & Clark, 1991; Jensen & Bergin, 1988; Kelly, 1995; Khan & Cross, 1983; Myers & Truluck, 1998).
Kitchener (1984) believed that some parts of formal organizational ethical codes are too broad, whereas other sections are too narrow. The fundamental ethical principles identified by Kitchener are autonomy, beneficence, non-maleficence, justice, and fidelity. Meara, Schmidt, and Day (1996) expanded on Kitchener's work by defining principle ethics (i.e., formal, obligatory codes) as distinct from virtue ethics (i.e., focus on character traits and ideals). Virtue ethics are rooted within the traditions of a cultural group and, therefore, present a more complete account of moral life than actions based on prescribed rules. Meara et al. proposed that virtue ethics complement principle ethics by assisting helping professionals to achieve the ideals of being competent, serving the common good, and retaining professional autonomy. Given that the authors argue professional decision-making is "seldom either totally absolute or completely relative and thus requires virtuous, competent individuals to exercise careful professional judgment" (p. 5), the concept of ethics should encompass issues of character as well as professional obligations. The work of Kitchener and Meara et al. supports the idea that ethical decisions in psychology are complex and rarely absolute. In order to understand ethical decision-making, it seems important to know the therapist's ethical values that influence each unique situation.
The majority of empirical studies that examine ethical decision-making in practice have focused on therapists' responses to particular ethical dilemmas (Conte, Plutchik, Picard, & Karasu, 1989; Haas, Malouf, & Mayerson, 1988; Smith et al., 1991; Wilkins et al., 1990). Another approach has been for researchers to survey practicing clinicians in an open-ended way about their critical ethical challenges. This method, as described by Pope and Vetter (1992), mirrors the original process that the American Psychological Association (APA) used to create the first ethics code for psychologists. In 1952, the APA surveyed its membership in an attempt to develop guidelines for ethical conduct that reflected the concerns of practitioners. These surveys, although providing valuable information, did not investigate the cognitive process involved in ethical decision-making.
Thus far, little research on ethical values has focused on seasoned or expert therapists. However, studies have examined clinicians' years of experience, providing some information about the growth of professional ethical judgment over the course of a career (Conte et al., 1989; Haas et al., 1988: Jensen & Bergin, 1988). Conte et al.'s survey of therapists found that beliefs about ethical standards varied widely. The authors concluded that certain behaviors were thought by some therapists to be inappropriate, but not necessarily unethical, whereas other therapists felt that similar behaviors were either clearly unethical or grounds for malpractice. In addition, therapists with more experience were (a) more likely to feel that pledging to cure a client's symptoms was unethical and (b) less likely to break confidentiality to warn a potential victim of harm.
Jensen and Bergin (1988) found that years of professional experience did not predict desirable mental health values. In addition, Haas et al. (1988) found the length of time after attaining one's professional degree to be inversely related to the mental health practitioner's willingness to take the most ethically preferred course of action. The authors hypothesized that this surprising result may be due to burnout factors or to a recent training focus for younger practitioners on specific ethical obligations. Pope and Bait (1988) surveyed ethically knowledgeable senior psychologists (e.g., served on boards of ethics, authors of ethics textbooks, American Board of Professional Psychology...
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