The Portable Ethicist for Mental Health Professionals

Wouldn't it be nice to have a portable ethicist that you could consult whenever you had doubts about how to proceed ethically in your mental health practice? If you now feel inclined to buy The Portable Ethicist, there is something you should know in advance: this book would have probably been more aptly entitled The Portable Malpractice Lawyer than The Portable Ethicist. (One reason the authors chose this title may be that they had already written The Portable Lawyer for Mental Health Professionals.)

The authors, Bernstein and Hartsell, are both lawyers who have ample experience with advising and representing clients who want to file ethical complaints as well as mental health professionals who are in danger of facing such complaints. This experience has clearly shaped the scope and content of their book. They do not have much patience for those who feel that there is more to dealing with ethical issues than the steps one should take to avoid malpractice suits, problems with licensing boards, and with professional associations. Their principal aim is to deliver the information that is needed to help professionals avoid these kinds of trouble, and not to engage in discussions about the "big questions", as they call it. That is, their main concern is with fulfilling the letter of the existing professional ethics codes.

There is clearly need for such a book. Malpractice suits and ethics complaints against mental health professionals are on the rise in the US, while many professionals are still barely acquainted with the ethics codes of their professions. It is increasingly important to follow closely the ever more detailed provisions of the professional ethics codes. Accordingly, it will be helpful to know the different issues related to the therapy practice that may come up in ethics complaints (part I), how the complaint process proceeds (part II), how you should organize your practice (part III), what specific requirements outside of the practice of therapy come with the role of the professional (part IV), and what the challenges are in specific areas of practice (part V). The authors address many issues that are relevant for organizing everyday practice and give useful practical advice. This includes e.g. a detailed checklist for the items that should be mentioned in an informed consent form, a sample letter of termination, advice for how to close a practice, and other helpful material. In addition, their material is well presented: they offer case vignettes, highlight important points in the margins, and provide a list of "Ethical Flash Points" as well as a summary at the end of each chapter. Moreover, in drawing on a variety of different ethics codes, they do not only provide important information, but also manage to illustrate the degree of convergence between the ethics codes of different mental health professions.

Nevertheless, despite being aware of the practical purpose of the book, I could not help being dissatisfied with the general defensive stance that was apparent throughout the text. There is little engagement with the positive ethical ideals behind the ethical standards of the different professions. This is all the more surprising given that most ethics codes contain a part in which the basic principles or ideals of the profession are explicitly stated. Instead, the authors focus nearly exclusively on the question of how to avoid trouble, and the patient is treated above all as a potential source of danger for the professional. They repeat so often that no therapist can feel safe, that even the best and innocent therapists can face devastating ethical complaints, while clients do not have to fear anything when they file frivolous claims (cp. especially chapter 24), that one gets the impression that the mental health professions nowadays are ethically under siege. It should at least be kept in mind that there is much reason to assume that most cases of seriously unethical behavior never reach the public, and also that successful ethics complaints that result in the revocation of a license to practice are still extremely rare.

Depicting the client primarily as potential adversary has consequences for how the ethical task of the therapist is understood. For example, in their treatment of informed consent, the authors hardly convey the impression that the main point of the duty of informed consent is that the client actually understand the information that the therapist offers. Also, their decision to strictly advocate the most restrictive practice ("if in doubt, don't do it"), reasonable as it is in view of possible malpractice suits, will not necessarily lead to what, legal consequences aside, will be regarded as the ethically most acceptable solution. However, for the authors at least there is apparently no doubt that following the defensive road does not leave any ethical questions open.

I would therefore strongly advise anybody who is interested in purchasing The Portable Ethicist to at least take into account other literature on ethical issues in psychotherapy that tries to do justice not just to the letter, but also to the spirit behind the development of the professional ethics codes (e.g. Kitchener's Foundations of Ethical Practice, Research and Teaching in Psychology, or Pope's and Vasquez' Ethics in Psychotherapy and Counseling: A Practical Guide). Provided the reader has access to such other sources that do not reduce professional ethics to defensive practice, I would then not hesitate to recommend The Portable Ethicist for much potentially useful advice.

© 2002 Heike Schmidt-Felzmann. First serial rights