Ethical Dilemmas in Treatment of Trauma

Adhering to moral and ethical practice standards is an expectation for all mental health professionals, whether they are in the disciplines of psychiatry, psychology, social work, marriage and family counseling, pastoral counseling, or substance abuse. Each discipline has a distinct code of ethics that must be followed and is reinforced by licensing boards and respective professional associations. Although there are some differences between disciplines, all share commonalities that will be addressed here. For simplicity's sake, hereafter these professionals will be referred to as therapists. The domain of ethical practice is meant for every therapist-client professional relationship, but it is especially important in working with trauma survivors, who may already be emotionally vulnerable as a result of their experiences and may find it difficult to establish a trusting relationship with others.

The foremost ethical principle for all helping professions involves the obligation to “first do no harm.” One method to accomplish this is to adhere to treatments that have scientific merit. For example, exposure-based treatments and cognitive-behavioral [Page 234]approaches have been demonstrated by rigorous empirical studies to be efficacious in the treatment of trauma. However, many other forms of trauma treatments have surfaced in recent years and been promoted as “cure-alls,” perhaps by the media, pop psychology circles, or by those selling their “brand of treatment.” Some of these are based on very tenuous science at best or what some have termed as pseudoscience. The result of utilizing unfounded treatment approaches is that these may actually be harmful to clients. For example, in the case of disaster- or crime-related trauma work, critical incident stress debriefing as a method of intervention has been found to do more harm than good. Furthermore, in cases where the treatment approach is questionable, it is the therapist's ethical duty to inform the client (i.e., through informed consent) that the treatment is “not usual and customary,” and the client should be advised of alternative treatments that have empirical basis. The therapist is also held responsible in offering an explanation to the client with regard to the rationale of using a treatment that is not considered usual and customary. The principle of informed consent is grounded in the notion of client autonomy and self-determination, whereby the therapist is respecting the client's right to make his or her own decisions. Additionally, therapists are expected to maintain the highest standards of competence, to recognize limitations in their expertise, and to keep within their scope of practice.