A socio-cultural analysis of the ethical standards of care in psychotherapy professions in the United States: Psychiatry, psychology and social work

This qualitative study explores the development and modifications of ethical standards for the practice of psychotherapy in the professions of psychiatry, psychology and social work. Research methods for this study included ethnographic field observation of national and North Carolina professional meetings and unstructured interviews with members and staff of professions' organizations who shaped and implemented ethics standards and regulations. Archival records of professional meeting minutes and historical accounts were reviewed. Three iterations of each profession's ethics codes and discourses (1950s, 1970s, 1990s) were compared and analyzed and each profession's sanctioning history was examined. The moral culture in which ethics codes emerged was examined.;Each profession's ethical care standards became more detailed and binding over time. All professions' ethics codes required a treatment contract, which evidenced increasing respect for the authority of the patient/client in determining the course and nature of treatment. These professions' ethics standards reflected differing identities. Psychiatry was the most paternalistic, carrying the greatest burden of responsibility, and was oriented toward a biological understanding of people. Psychology was the most positivist and research-oriented, relying on psychological testing and research findings as the lens through which to determine treatment. Social work focused on social factors and considered psychotherapy interventions in the context of alleviating oppression and deprivation. All three professions imposed sanctions on professionals for criminal behavior, professional misconduct (including sexual relationships with patients/clients), substandard or incompetent care, and substance abuse.;Modern US culture, as reflected in these professions, revealed a steady movement toward utilitarian moral philosophy combined with a commitment to personal autonomy (client self-determination). Professions' ethical care standards for conducting psychotherapy evidenced increasing rationalization and bureaucratic structuring, and were influenced by the transition of healthcare to a commodity subject to market values. Findings from this study demonstrated the dependence of psychotherapy professions on society for the definition of moral/ethical standards. Diversity within professional membership and the decrease in the power of professions to dictate their own moral principles created an opportunity for communicative action, as described by Habermas. Accordingly, ethical principles and standards emerged from a dialogue between representatives of all groups subjected to them.