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The Ethical Attitude in Analytic Practice

Consultant Psychotherapist, Broadmoor Hospital, Crowthorne RG45 7EG

Hester McFarland Solomon & Mary Twyman (eds) London: Free Association Books, 2003, 184 pp., £18.99 pb, ISBN: 1 85343 558 9

Ethics is the discourse of ‘ought’ and ‘should’. The values of medicine have swung away from an attitude of uncritical paternalism to a more considered position which acknowledges the complexity of all therapeutic relationships; a complexity that is a function of factors such as time, depth and mutuality (Cox, 1976). Psychoanalysis, which started as a branch of medicine, therefore needs to consider and review its ethical identity, and this book is a collection of papers by therapists who offer a largely (although not exclusively) Jungian view of ethical issues in psychoanalytic practice.

One of the complications of this subject is that ethical thinking (by which I mean the process of reasoning about dilemmas of ‘ought’ and ‘should’ in clinical practice) overlaps with clinical thinking in psychotherapy. There is often no distinction between the clinical and the ethical; the fact and the value, as it were. It can therefore be hard for analysts not to impose their own value systems onto patients in the name of health, and this is why it is hard to argue that psychoanalysis is a purely therapeutic activity.

Some of the contributors to this book offer valuable reflections on this complicated theme. I particularly liked the chapters on confidentiality, and McKenna’s chapter for its clear and compassionate voice. Sher’s chapter about ethics and organisations is one that I will definitely be sharing with trainees and colleagues. Overall, I would recommend the book, especially to trainers of therapists and to trainees in psychiatry who want to know more about being a psychotherapist.

The only thing I disliked was the occasionally pompous and patronising tone taken about patients’ resistance to therapy, since it seems to me that the perception of ‘resistance’ itself represents a type of ethical judgement by the therapist. Reading this book also made me sad that it seems impossible for the different schools of psychoanalysis and psythotherapy to talk to each other and integrate their ethical visions, or at least to set out their similarities and differences in a comprehensive way.

References

COX, M. (1976) Structuring the Therapeutic Encounter: Compromise with Chaos. London: Jessica Kingsley.

This Article Full Text (PDF) Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Adshead, G. Search for Related Content PubMed Articles by Adshead, G.