When Psychotherapy Is Not Working: Ethical Considerations. Issue 4 (November 2020)

• Record Type: Journal Article
• Authors: Nezu, Arthur M.
• Is Part Of: Cognitive and behavioral practice. Volume 27:Issue 4(2020)
• Page Start: 417
• Page End: 425
• Publication Date: 2020-11
• Subjects: ethics -- evidence-based practice in psychology -- clinical decision making -- evidence-based interventions; Behavior therapy -- Periodicals; Cognitive therapy -- Periodicals; Behavior Therapy -- Periodicals; Cognitive Therapy -- Periodicals; 616.8914205
• DOI: 10.1016/j.cbpra.2020.05.006
• Languages: English
• ISSNs: 1077-7229

Abstract

Abstract: Evidence-based practice (EBP) models have been developed, in part, to enhance the likelihood that the outcome of health care treatment, including psychotherapy, leads to positive improvement. However, two additional outcomes can occur: no change and poor outcome (e.g., harm, worsening of symptoms). What does the clinician do when psychotherapy is not working? When faced with various treatment decisions, such as this, the EBP model posits that therapists should apply their clinical expertise in considering the "best available research" within the context of various patient characteristics. In part because of various limitations of this approach, I suggest that another important set of principles are important to consider in tandem when faced with this clinical dilemma—that is, ethical concerns. Borrowing from the American Psychological Association's (2017a) Ethics Code, I discuss how the following issues exist when clinicians wrestle with this question: avoidance of harm, competence, conflicts of interest, and informed consent. I conclude this paper with a list of suggestions that can potentially foster the application of ethical principles when making treatment decisions.