Paternalism and autonomy: psychotherapists’ choices in dilemmas and their justifications as ethical aspects of the therapeutic relationship

Abstract

Aim: The aim of the study was to analyse solutions to ethical dilemmas based on the criterion of “paternalism-autonomism” in the context of psychotherapists’ professional experience and therapeutic modality. Another aim was to review the sources of choices of ethical decisions from the perspective of the “intuitiveness – ethical reflection” dichotomy, and to assess the percentage of ethical, ambiguous, and non-ethical justifications of solutions preferred in those ethical dilemmas. Method: It was a cross-sectional qualitative study. An original questionnaire describing three exemplary clinical and ethical dilemmas combined with a multiple-choice questionnaire containing recommended solutions to the presented dilemmas was employed in the study. The responses were correlated with the modality of psychotherapy (cognitive-behavioural, psychoanalytic-psychodynamic, psychodynamic-systemic, systemic, integrated) and the professional experience of therapists. The statistical analysis included questionnaires obtained from 191 respondents. Results: Statistical data indicate the general advantage of autonomous decisions in the entire group of therapists, regardless of their professional experience. A significant advantage of autonomic solutions over paternalistic solutions was demonstrated in all analysed therapeutic approaches with the exception of the cognitive-behavioural approach. Moreover, a statistically significant majority of psychotherapists reported the use of ethical reflection when choosing the solutions to the discussed dilemmas. A comparison of the total number of selected justifications revealed a significant advantage of ethical justifications over ambiguous and non-ethical ones, regardless of the professional experience of therapists and in all modalities except the psychoanalytic-psychodynamic and psychodynamic-systemic types. Conclusions: The principle of respect for autonomy plays an important role in the professional ethics of psychotherapists, and the preference for ethical considerations and justifications when choosing solutions to practical ethical dilemmas indicates a potential benefit of incorporating ethics into the professional training of therapists.