Newsgroups: bit.listserv.psycgrad
Date:         Wed, 15 Apr 1992 13:48:31 -0400
              <PSYCGRAD@UOTTAWA.BITNET>
From:         SETOM@QUCDN.BITNET

Date: 15 April 1992, 13:06:16 EDT
From: Solace                                         SETOM    at QUCDN
To:   PSYCGRAD at UOTTAWA
Subject: Re: Legitimate therapies

It seems that everyone is agreeing on the first principle of "Do no harm."
But another ethical consideration is the provision of effective
services.  Therapies which aren't peer-evaluated (usually by empirical
research, although not always) are problematic because noone knows if it
works or not.  This doesn't mean that you can't use it or try it out, but
ethically the therapist is obligated to let the client know that.  The
medical analogy is the use of clinical trials for an experimental drug;
the first consideration is that it does no harm, or that the possible
benefits clearly outweigh the side effects, but the second consideration
is that the trial patients know it is an experimental drug and that
they may or may not benefit.
If you want to experiment with massage therapy, go ahead, but it is
dishonest and unethical if you present it as an effective treatment without
being able to objectively support it, e.g., referring to research.  A lot
of pretty terrible treatments have been perpetrated (and I use the word
knowingly) against clients seeking mental health services, see insulin
shock "therapy" etc.  Understandably so, I think consumers and pros
alike are wary of unsupported and controversial treatments.

A side point: Judging the efficacy of a treatment/therapy based on the
client's perceptions, i.e., did he or she like it and feel better afterwards,
is an important criteria but I do not believe it is the main
one.  Besides the placebo effect (which is arguably the most
effective component of psychotherapy as it exists now!), there is the
question of actual change.  Someone presenting with agoraphobia
may feel better after receiving information about the nature of phobias
and discussing relevant issues with their therapist, but the original
problem hasn't changed.  It isn't until, if you have a behavioural orientation,
the person actually goes out and challenges the phobic stimuli (e.g., a
shopping mall) that you can measure change.  Another side point is that
the person is likely to experience a lot of anxiety at first; if you
define treatment success as feeling better then the treatment has failed, so
there is the question of how one balances short-term distress vs. long-term
changes.  Of course, ethically the hypothetical client above should be
forewarned of the anxiety response and the rebound during the extinction
of his' or her's phobic behaviour, in order to get fully informed consent
to the treatment.  I believe fully informed consent includes a summary
of the evidence for and against the treatment as well as other options
that may be available.
With unlicensed therapists, whether they are using conventional or
unconventional techniques, I believe there is an ethical responsibility
on the part of licensed practitioners to inform the public about the
value of having licensing bodies and concerns with unproven treatments.
I am not supporting an elitist attitude that ONLY Ph.D.s are able to
provide effective therapy: Many people have benefitted from seeing
peer counsellors (individuals who have themselves experienced the same
problems) who do not have any formal training, such as incest survivors,
substance abusers, etc.  Also people have benefitted from seeing
therapists with different backgrounds and training such as
clergy, nurses, social workers, community advocates, etc.  However,
the naive consumer could be harmed by spending their money and time and
effort on treatments with therapists who do not meet minimum standards
set out by consensus, usually at the provincial or state level through
self-regulatory bodies.
Similarly, consumers can be harmed by participating
in treatments that are not demonstrated to be effective, or worse, are
controversial and potentially harmful in themselves.  A therapy
based on astrology and crystals in itself might not be harmful,
but it could still have negative effects if the client ends up believing
that they have a hopeless case because they did not benefit.

I appreciate any comments.
____________________________________________________________________________
Mike Seto    "Life!  Don't tell me about life."  Marvin the Paranoid Android
Queen's University       BITNET:  setom@qucdn.queensu.ca
Kingston, Ontario
Canada, Earth
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