Background and aims: The association between ethics and psychotherapy is emphasized both by the main professional codes of ethics and by a scientific debate that has focused on the inextricable link between good ethics and good practice. However, the definition of patient personal autonomy and its possible violations in clinical practice (as a violation of professional boundaries) remain understudied and relatively absent topics in international codes of ethics. This multidisciplinary research project (clinical psychology and moral philosophy) aims to investigate, from a clinical and deontological point of view, the role of the psychotherapist and his interventions regarding patient autonomy. Methods: A semi-structured interview was constructed, exploring: i) recent episodes in which clinicians took a directive position (e.g., making judgments about conduct or aspects of a patient's life; suggesting, or prescribing a behavior, conduct, or action); ii) whether clinicians considered such interventions in continuity or discontinuity with their theoretical models, and; iii) clinicians’ opinions on the topic of autonomy, also proposing a fallacious dichotomy between "right choices" vs. "autonomous choices". Interviews’ transcripts have been analyzed with the method of Consensual Qualitative Research (CQR). Results: Forty-five psychotherapists were interviewed (mean age = 41.8). Several themes emerged, among those: patient requests for directive interventions, directiveness of the therapist's interventions, judgmental emotional reactions displayed by the therapist, continuity with one's theoretical model, therapist neutrality, and conception of patient autonomy in psychotherapy. Psychodynamic therapists showed a moral dilemma related to maintaining a position of neutrality and a need to assume paternalistic attitudes (which are common and egosyntonic among cognitive behavioral therapists) in extreme circumstances. Conclusion: Results are discussed according to the main orientations of moral philosophy on the concept of personal autonomy (internalist, externalist, expressivist), referring to their declinations in the field of bioethics and medical ethics.
Patient personal autonomy in psychotherapy: a qualitative research.
Tommaso Boldrini;
2022-01-01
Abstract
Background and aims: The association between ethics and psychotherapy is emphasized both by the main professional codes of ethics and by a scientific debate that has focused on the inextricable link between good ethics and good practice. However, the definition of patient personal autonomy and its possible violations in clinical practice (as a violation of professional boundaries) remain understudied and relatively absent topics in international codes of ethics. This multidisciplinary research project (clinical psychology and moral philosophy) aims to investigate, from a clinical and deontological point of view, the role of the psychotherapist and his interventions regarding patient autonomy. Methods: A semi-structured interview was constructed, exploring: i) recent episodes in which clinicians took a directive position (e.g., making judgments about conduct or aspects of a patient's life; suggesting, or prescribing a behavior, conduct, or action); ii) whether clinicians considered such interventions in continuity or discontinuity with their theoretical models, and; iii) clinicians’ opinions on the topic of autonomy, also proposing a fallacious dichotomy between "right choices" vs. "autonomous choices". Interviews’ transcripts have been analyzed with the method of Consensual Qualitative Research (CQR). Results: Forty-five psychotherapists were interviewed (mean age = 41.8). Several themes emerged, among those: patient requests for directive interventions, directiveness of the therapist's interventions, judgmental emotional reactions displayed by the therapist, continuity with one's theoretical model, therapist neutrality, and conception of patient autonomy in psychotherapy. Psychodynamic therapists showed a moral dilemma related to maintaining a position of neutrality and a need to assume paternalistic attitudes (which are common and egosyntonic among cognitive behavioral therapists) in extreme circumstances. Conclusion: Results are discussed according to the main orientations of moral philosophy on the concept of personal autonomy (internalist, externalist, expressivist), referring to their declinations in the field of bioethics and medical ethics.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
