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Question:
Discuss about the Social, Legal and Ethical Frameworks.

 
Answer:
Introduction:

In treatment is a series film which is adopted from a Jewish popular show Be Tipul produced by Hagai Lei. The main film character is Psychologist Paul Weston who meets four patients every week and consequently encounters his therapist Mr. Amy Ryna on every Friday. The paper will focus on an episode in season three of the "In Treatment" to formulate a case study. The case study will focus on season three episode seven which involves Paul and Sunil who is a retired teacher from India and whose wife has died six months earlier thus seeking therapy from Paul the psychologist (Stern, 2014). He is also on deportation process due to a decision not to disclose the immigration papers to the police on request. On the other hand, Paul is angry with Sunil because he feels he was used by Sunil to achieve his intentions. The aim of the paper, therefore, is to analyze the ethical dilemma or issues touching on the characters in the episode as well as to offer an appropriate response by the ethical principles.

 

In episode seven of the season three, Psychologist Paul develops a caring therapeutic friendship with his client Mr. Sunil to a point of not keeping the professional boundaries required in the counseling sessions. Paul cultivates an intimate therapeutic relationship with Sunil as a result of empathy. It can be argued that this kind of a relationship result from Paul personal experiences as an immigrant from Ireland and as a divorcee. As a result, Paul works tirelessly to identify what holds back Sunil's life after the death of his wife. Some of the possible reasons Paul identifies include Sunil's manifest criticism of his Son's marriage. In addition, Paul sees the possibility of jealousy in Sunil's life due to the loss of his wife. As a result of this relationship build by Paul there lacks the requisite boundaries which must be maintained between a therapist and a client during a therapeutic session (Richards & Brown, 2011).   

Some of the ethical and the legal principles that emerge from the episode include failure to maintain the professionalism in the therapeutic encounter as well as dishonesty. Furthermore, Sunil willingly gives wrong information to the law enforcers hence committing a crime. It is essential that a psychotherapist set and maintain professional boundaries both within the office and without. To ensure that the therapeutic session remains focused to the client it is necessary, therefore, to work within the set boundaries during the session and outside the session. In therapeutic sessions boundaries refers to the psychologist's self-discloser to the client either through communication outside the session, exchanging of gifts, touching or establishment of relationship outside the therapeutic sessions.   In this case, there exist a dual relationship between the therapist and the client. This is from the fact that Paul treats Sunil as friend more than a client (Marxen, 2012).

In the psychotherapy, dual relationships are discouraged to protect both the client and the psychotherapist. In addition, this kind of a relationship compromises the healing process and the entire therapeutic process. Exploitation which results from dual relationship includes business and sexual exploitation. The concern is mainly that psychotherapist or counselors may take advantage of their client due to the power they have over them. A client who is in crisis is likely to be vulnerable hence must be protected. In addition, some client may take advantage over the psychotherapist and therefore he/she needs equal protection. Sunil in this episode takes advantage over Paul to achieve his intentions of traveling back to India (Kahr, 2011).

 


From such an instance, therefore, dual relationships in counseling sessions must be opposed to the latter. It is clear that failure to maintain the boundaries that hinder such a relationship threatens the entire therapeutic process hence, causing harm to the client. Furthermore, it is clear that failure to main boundaries has negative effects to the counseling profession. Traditional psychoanalyst theory holds that boundaries are necessary, and therefore anything contaminating the boundaries is a threat to the psychotherapist profession (Johnson, 2013). The theory advises that poor management of the boundaries must be avoided by the counseling professionals to ensure that the integrity of the clinical work is sustained. However, it is vital to distinguish between boundary violation and boundary crossing. Boundaries violation entails actions that are perpetrated by the therapist against the client which hurts client's dignity and the integrity of the profession. On the other hand, boundary crossing refers to a reasonable deviation from the traditional therapeutic format with an intention to benefit the client. It is unfortunate that though Paul is a professional psychotherapist he does not differentiate the two hence his inability to maintain the necessary professional boundaries (Hillman & Ventura, 2012).

The interaction of Paul with his client outside the therapeutic session facilitate to the friendship. At one point in the episode, Paul encourages Sunil to smoke and drink more alcohol contrary to what is expected of a therapist. In counseling interaction outside the office is highly discourage for ethical and legal reasons. Study on therapist confirms that more than seventy percent of the therapists disclose information about themselves to clients outside the office.   It is therefore widely agreed that association with a client outside the therapeutic session greatly hurt the therapeutic session (Bainbridge, 2012). Psychoanalyst advises that Psychotherapist must work to maintain the image of an omnipotent therapist a quality that lacks in the relationship between Psychologist Paul and his client Mr. Sunil. Furthermore, avoiding outside office encounters aids in maintaining confidentiality. Psychotherapy is mainly founded on confidentiality and privacy which result to trust.  Office settings, therefore, assure clients of his/her privacy and confidentiality as well as a sense of security and safety. Therapist interaction outside the office, however, must be distinguished into three types of encounters. One is perceived as part of the thought-out treatment plan. The second encounter is viewed as outside office strategy to enhance the therapeutic efficiency, and the third outside office encounter is referred to as overlapping relationship which entails the natural relationships that occur as a result of our habitats.  Interaction with clients outside the therapeutic session and within the ethical standards is beneficial to clients (Gottlieb, 2013).

 


Honesty is fundamental in the psychotherapy exercise, it only in honesty the client discovers his/her potential over the problem he or she is facing. It, therefore, necessary that client and the therapist exercise honesty during the therapeutic session. It is also essential that client accepts to honest with the self throughout the session. The aspect of honesty and maturity lacks in the sessions involving Paul and Sunil. It is demonstrated by the fact that Sunil doesn't want to be responsible for his decision and therefore uses Paul to achieve his ends. Similarly, Paul is not living his decision rather he is living the wishes of others. He fantasies on the illness that may be the avenue to get him out his situation. Paul is thus a clear illustration of unresolved experiences which has been carried forward to professional life. It is the primary task of a therapist to facilitate change hence important to deal with personal experiences apart from the clients. To be the desired agent of change in the psychotherapy one must not live in self-deception (Bainbridge, 2013).

Ethical dilemmas induce anxiety to counselors and therapist equally, yet little attention is given to the subject during formation period. The issue of ethics in the dual relationship, therefore, must be focused through adequate knowledge which facilitates the management of the boundaries. Principles such principle of autonomy, of fidelity, and of justice must be considered while evaluating the issue. Hence, a therapist needs appropriate prudence to deal with a case similar to the one discussed in the paper. It is vital for a therapist to strike a balance between the professional and the personal concerns during the relationship with a client. In addition, every counselor or a therapist must implement all the moral principles as well as the ethical codes to achieve the desired results in a therapy session. In instances where an ethical conflict persists and has affected the therapeutic process, it is then prudent for the therapist to refer the client to another therapist or terminate the client-therapist relationship (Breton, 2014).

 


In conclusion, it is necessary for the therapist to formulate reasoned and realistic social, legal and ethical frame works within which the profession must be practiced and from which the client-therapist relationship, as well as other communal connections, are managed and monitored. It is further advisable that therapist discusses with their supervisors any conflicting ethical issues they encounter during the practice. At times the horns of the ethical dilemmas are sharp and hurting hence inflicting serious damage. Hence there is a need for counselors and therapist to discuss realistic answers to the prevailing ethical dilemmas (Bainbridge & Yates, 2013). In addition, the role of supervision should be should be enhanced especially in the process of resolving an ethical dilemma.  It should also be understood that both the therapist and the client may fail to maintain the desired ideals due to their human nature. Thus, the need to train therapist and counselors appropriately as well as appreciate that ethical dilemma is real and demand practical response more than a theory. 

 
Reference

Bainbridge, C. (2012). Psychotherapy on the couch: Exploring the fantasies of In Treatment.

Psychoanalysis, Culture & Society, 17(2), 153-168. 

Bainbridge, C. (2013). In Treatment (2012). Began airing in the UK in 2009 as the. Television

and Psychoanalysis: Psycho-Cultural Perspectives, 47. 

Bainbridge, C., & Yates, C.(2013). Psychoanalysis and popular culture: reflections on the

development of a psycho-cultural approach. Psychoanalysis, Culture, and Society, 17(2). 

Breton, H. O. (2014). Coping with a crisis of meaning: Televised paranoia. In Media and the

Inner World: Psycho-cultural Approaches to Emotion, Media and Popular Culture (pp. 113-134). Palgrave Macmillan UK. 

Gabbard, G. O. (2016). Boundaries and boundary violations in psychoanalysis. American

Psychiatric Pub. 

Gottlieb, O. (2013). Media Studies Orientations for Israel Education: Lessons from In Treatment,

Homeland, and Z-Cars. Journal of Jewish Education, 79(1), 49-69. 

Hillman, J., & Ventura, M. (2012). We've had a hundred years of psychotherapy--And the

world's getting worse. San Francisco: HarperSanFrancisco. 

Johnson, D. R. (2013). The role of the creative arts therapies in the diagnosis and treatment of

psychological trauma. The Arts in Psychotherapy, 14(1), 7-13. 

Kahr, B. (2011). Dr. Paul Weston and the bloodstained couch. The International Journal of

Psychoanalysis, 92(4), 1051-1058. 

Marxen, E. (2012). Therapeutic thinking in contemporary art: Or psychotherapy in the arts. The

Arts in Psychotherapy, 36(3), 131-139. 

Richards, B., & Brown, J. (2011). Media as drivers of the therapeutic trend?. Free Associations,

(62), 18-30. 

Stern, D. N. (2014). Forms of Vitality: Exploring Dynamic experience in psychology, the arts,

psychotherapy, and development. Oxford University Press. 

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