Ethical Issues in the Patient-Therapist Relationship / John A. Caliso and Sandra Lee.

The patient-therapist model, the oldest form of mental health treatment, is at the core of reconstructive psychotherapy. Because this therapeutic partnership is subtle and vague, ethical concern is at the heart of the reconstructive therapeutic process. The aims of reconstructive therapy can be defined in terms of an existential, a psychoanalytic or an ego-psychoanalytic framework. In the therapist-patient relationship, usually only the therapist is knowledgeable about how the therapeutic process works to relieve symptoms. The patient has only hope and faith, which provide the groundwork for therapeutic influence. Emotional growth seems related to the patient's cognitive or perceptual response to the healer's curing powers, or the influence of personality. Thus, essential features of the psychoanalytic process include the therapist's characteristics and competencies, the working alliance, transference and countertransference, submission, and the nature of the therapist's authority. Factors that may lead to unethical practice include a God-like complex the therapist may derive from unrealistic feelings of superiority and power, and a strong narcissistic tendency that may be expressed through a need to control. Preventive measures for the therapist include personal analysis, case supervision with a mentor, and interdisciplinary as well as social relationships. (JAC)

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