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That psychiatrist followed risk-management guidelines to perfection. In his mind, given the way therapists are taught, he was probably also following the highest ethical tradition of "do no harm." But he almost certainly inflicted needless additional suffering on this woman. In his zeal to be perfectly professional, he sacrificed his humanity and, it can be argued, harmed the client by providing substandard care.

You wouldn't know it from this explosion of risk-management advice, but lawsuits and disciplinary actions are actually rare. According to documented reports, less than 2 percent of psychologists faced any licensing complaints between 1996 and 2000. Not all complaints are investigated, and of those that are, 30 percent are determined not to be in violation. All in all, less than 0.4 percent of psychologists have faced any reportable action by licensing boards. The percentage of complaints against counselors and social workers is even lower, and they're less likely to be held liable for malpractice. Accordingly, their insurance premiums are lower.

Why, given how unlikely disciplinary actions or lawsuits are, do we so often succumb to risk-management bugaboos? One possible answer, according to California psychologist, Martin Williams, lies in the human inclination toward phobias: exaggeratedly fearful responses to harmful, but relatively rare, occurrences.

For example, even though flying is much safer than driving, many people fear flying, because of the media's focus on dramatic airplane crashes. This phobia about board investigations didn't arise by accident: it's purposely generated by risk-management gurus with vast stores of horrifying anecdotes involving innocent, well-meaning therapists who, through some careless inattention to the holy writ of risk management, found themselves booted from the profession, sued, broke, and disgraced. One pernicious form of this propaganda involves the "slippery slope" argument, popularized by psychologist Kenneth Pope. According to this logic, nearly all boundary crossings or dual relationships—a therapist patting the hand of a grieving client, sitting on the same school board as a client, accepting a gift from a client—"while not unethical and harmful per se, foster sexual dual relationships." This is a truly breathtaking leap of logic. It seems to assume that most therapists are barely able to control their darker impulses in therapy and require the most stringent self-censorship to keep a comforting touch or passing acquaintanceship outside the consulting room from degenerating into a wild and illicit affair.

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stephen144  - Appreciative of clear thinking   |Registered |2011-02-25 13:19:06
I appreciated this article and your presentation on Digital Ethics. You made a
convincing argument and a clear distinction between standard of care and risk
management... very useful.

Thank you.
ivkennedy  - LCSW   |Registered |2011-02-24 10:22:07
Dr. Zur, Your presentation on digital ethics has been so helpful. The
information is good. Your emphasis on the importance of therapeutic competence
rather than fear and risk management offers more possibilities for solutions to
these dilemmas. Your ideas are refreshing and show you are a curious and
creative clinician. Thank you.
ggro@comcast.net  - The ethical eye   |Registered |2011-02-24 09:08:15
This is the clearest article on ethics that I've ever read. It is a much needed
rebuttal to the fear mongering that is so prevalent today. My thanks to the
author for both his learned and common sense thinking.
snordquist  - Thanks for clarity   |Registered |2011-01-23 00:22:30
For a new PsychoSocial Rehabilitation Practicianer working with children and
adolescents, I found freedom and wisdom in learning the ethical boundaries,
learning the importance of good records, and consulting with trusted colleagues
for advice. I'll be reading more of your articles at your website.
mitelpunkt   |2011-01-05 20:58:11
I don't remember who said that "there are patients that we build a set to
treat them, and patients that we treat them to build a set".
The most
impressive change in a psychotic patient acurred once that a made an "acting
out" inviting him to a drink. After this event, very significant in
repairing his (and mine) relation with his father, he never again felt inot
psychotic states!!!
I was then affraid of bringing it to supervision, I never
did it, but it was a truely therapeutic act.

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