The practice of psychotherapy is governed by many rules. Since it is considered a medical procedure, there is a tightly controlled legal framework for it. For psychotherapy to be effective, the therapist must follow particular rules of engagement for the communication process, for instance not to talk about herself too much during the therapy sessions (this is called self-disclosure.) These are the clinical rules for the psychotherapy process. Finally, psychotherapy also has a business dimension, and there are rules that govern the business relation as well.
Ethical rules for psychotherapy build upon the body of principles established over the centuries by the healthcare professions. It begins with the ancient Greek Hippocratic Oath that defines the relationship between a doctor and her patient. Here is the updated and modernized version from the World Medical Association, last amended in 1994:
- I solemnly pledge to consecrate my life to the service of humanity;
- I will give to my teachers the respect and gratitude that is their due;
- I will practice my profession with conscience and dignity;
- The health of my patient will be my first consideration;
- I will respect the secrets that are confided in me, even after the patient has died;
- I will maintain by all the means in my power, the honor and the noble traditions of the medical profession;
- My colleagues will be my sisters and brothers;
- I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;
- I will maintain the utmost respect for human life;
- I will not use my medical knowledge to violate human rights and civil liberties, even under threat;
- I make these promises solemnly, freely and upon my honor.
The code of professional conduct for psychotherapists goes even further. Psychotherapy is a talking cure, therefore the ethics of psychotherapy is an ethics of speech. The therapist’s adherence to the ethical standards is not external to the procedures applied; it is itself a necessary condition for the proper outcome of psychotherapy. In other words, the ethical rules become to some degree the method of psychotherapy.
In the actual application of psychotherapy, the scientific, therapeutic, legal and ethical principles all have to come together. These rules inform all aspects of the treatment, the therapeutic choices, and the practical arrangements. The basic principle behind psychotherapy is the recognition that the therapist-patient relationship itself becomes the vehicle for important feelings, thoughts, and beliefs, and therefore it needs to be carefully set up and protected. Guarding the patient’s confidentiality, for instance, is essential to the therapeutic outcome of the treatment.
If the proper handling of the therapeutic relationship is the main tool of advancing the psycho-therapeutic process, then many other rules can be derived from this, for instance not to engage in sexual relations with clients, not to engage in dual relationships with them, or not to get involved in their actual lives. These boundaries protect the process; understanding them clearly is a condition for the therapeutic relationship to evolve.