The Social Context of Psychotherapy

Posted on February 25, 2008

This is my last installment of the SCP blog for February. We are continuing our discussion of Tjeltveit’s book, Ethics and Values in Psychotherapy. Although I will not be able to finish the discussion of Tjeltveit’s book on the SCP blog, I will continue a discussion of it on my blog, and readers are welcome to follow along there (www.psychologyandchristianity.wordpress.com).

In Chapter 7 Tjeltveit discusses the “social context of psychotherapy.” That is, he locates the practice of psychotherapy in the context of how it functions within society. He discusses psychotherapy’s medical heritage including bioethics and medical ethics and the two emphases of “the idea of the professional and a focus on the individual client” (p. 132). Other influences from medicine include reductionism in the form of limiting psychotherapy’s focus to a medical focus of symptom reduction. He seems to suggest that there is much more to biopsychosocial problems than merely what is understood in terms of a “medical issue”.

The other major social context in which psychotherapy occurs is business. Psychotherapy has become a “business relationship” (p. 139) in which there is an exchange of services that occurs in the context of economics (in which resources either contribute or impeded goals being met) and limited financial resources (of third-party payors, including government, insurance companies, employers, and so on). Tjeltveit observes that there is a risk of a kind of “ethical reductionism” (p. 141) to the extent that businesses “consider economic considerations alone” (p. 141).

I agree with Tjeltveit that psychotherapy occurs in the social contexts of its medical heritage and business. The challenge for Christian psychology is to reflect upon these social contexts and make intentional decisions about how Christian psychology ought to function within culture and society – to cast a vision for such innovative practice. I dare say that most Christians practicing clinical psychology and related mental health disciplines – most Christians providing psychotherapy – do so out of these social contexts but do not reflect upon the heritage or consider the implications.

Let’s think about this: How do you see these social contexts shaping the field and the practice of Christian practice for good or for ill? For example, the use of the “50-minute hour,” the fee for service model, and billing services to insurance or employers. What would a distinctively Christian psychology have looked like had it not been shaped as much as it has been by these social contexts? Are there places in our culture where this is occuring? How might we develop innovative practice in this area?

Approaches to “Values”

Posted on February 18, 2008

We have been learning about ethics from Alan Tjeltveit’s book, Ethics and Values in Psychotherapy. Last week we discussed the distinction between being an ethicist and being a moralist. In Chapter 5 Tjeltveit takes on the issues related to ways people understand “values.” He says, “We need to move beyond recognizing that ‘Therapy is not value-free’ to a well-developed understanding of the ways in which it is value-laden.” (p. 83).He then unpacks a few approaches to values (from pp. 84-85):

• values as psychological (e.g., when Skinner defines something as good based on how much reinforcement it provides; it simply describes what is valued)
• values as ethical (e.g., what ought to be valued rather than merely an account of what is desired)
• values as a means by which the powerful impose their will on the weak (an assertion, really, by those in power)
• values as choices (to be a genuine, authentic value is to have been chosen freely)
• values as authentic expressions of an individual’s nature (self-actualization)
• values as cultural and historical (context-specific)

When I first read the various approaches to values, I was struck by the variety, of course, but also what is often implicit in psychotherapy today. There are a lot of implicit assumptions about values based upon what is a genuinely free choice, what is authentic (because of our field’s emphasis on self-actualization), and, more recently, perhaps due to the influence of post-modernism, what is valued within a culture and what is imposed (by the majority, the privileged) on others (the marginalized). It isn’t always consistent, either. Nor is it taught explicitly. But these approaches to values exist in the field today and enjoy their status without having been argued for explicitly.

So what do you think? What is your definition of values? What definition of values best reflects a distinctively Christian psychology? How might one’s definition influence one’s clinical practice? Can definitions (of values) be matched with specific purposes in psychotherapy?

On Being an Ethicist

Posted on February 10, 2008

[Editor's note: Mark Yarhouse is blogging for us during the month of February.]

Let’s continue our discussion of a couple of specific and relevant concepts from Alan Tjeltveit’s book, Ethics and Values in Psychotherapy, In chapter three Tjeltveit defines an ethicist, and he makes the distinction between psychotherapist as ethicist and moralist. An ethicist is someone who has knowledge and perhaps training, who shows discernment, careful evaluation, and good judgment, and who is recognized for these qualities within a community. Ethicists hold ethical convictions and influence others either directly or indirectly. According to Tjeltveit, a psychotherapist/ethicist can function in many ways, such as teaching, consulting, coaching, and advocacy, to name a few.

Tjeltveit contrasts being an ethicist with being a moralist. While an ethicist creates space for others to reason, draw their own conclusions, and make their own decisions, a moralist is one who attempts to impose his or her beliefs upon others.

One of the main fears secular psychologists appear to have about Christian psychologists is that Christian psychologists will function as moralists in therapy. My question is whether that is a legitimate concern? What influences exist that would lead a Christian psychotherapist toward being either an ethicist or a moralist? Do these same concerns exist for other psychotherapists? In other words, we do not want to treat Christian psychotherapists as different from other psychotherapists, if the same concerns exist for others who provide therapy out of central, organizing convictions about significant aspects of reality.

Values in Psychotherapy

Posted on February 4, 2008

[Editor's Note: This entry marks our first for February from guest blogger, Mark A. Yarhouse, PsyD. Mark is Professor of Psychology at Regent University in Virginia Beach, Virginia, where he is the integration coordinator and directs the Institute for the Study of Sexual Identity. Consider joining him on his blog, Psychology and Christianity, as he discusses integration in his spring courses (Ethics and Family Therapy).]

I teach in the Doctoral Program in Clinical Psychology at Regent University. In our Ethics course this spring we are reading Ethics and Values in Psychotherapy by Alan Tjeltveit. Although we read another book by Celia Fisher on the ethics code, we read Tjeltveit to think more rigorously about values in psychotherapy. In any case, we recently discussed the first couple of chapters. Here’s a brief summary.

Tjeltveit’s thesis is that psychotherapy is value-laden – that it is invariably value-laden. In the opening two chapters he lays this out and in chapter one, especially, identifies competing views. Here they are:
• Psychotherapy is inconsequentially value-laden
• Psychotherapy involves only mental health values
• Clients alone should choose therapy values
• Psychotherapy ought to be based on science, not values
• It is meaningless to claim that values or ethical assertions in psychotherapy can be true or correct
• Psychotherapy is not value-free. So what?

He unpacks the meaning of each competing claim and then points out the difficulties inherent in that claim. For instance, the claim that Psychotherapy is inconsequentially value-laden makes the assertion that, yes, the psychotherapist could say to a client, “You should honor your marriage vow and return to your spouse and fulfill your responsibilities to your children” (p. 3). But what do most psychotherapists actually do? They say something like, “Sounds like you’re really feeling sad. How long has this been going on?” (p. 4). Tjeltveit’s response is to say is such a response really neutral? Or are their implicit values in responses we commonly identify as neutral?

His thesis is that psychotherapy is value-laden and that therapy – all therapy – necessarily involves goals that are value-laden. Goals reflect commitments to values and an ethical theory (at least an implicit one), and Tjeltveit reasons that it can be helpful to reflect on ethical convictions and theories.

This may not sound groundbreakig depending upon your starting point. However, you may have come across professionals who make the competing assertions noted above.

Let’s get into it: What do you make of Tjeltveit’s thesis? What are your thougths about the competing views? What are the implications of the various approaches to values for a Christian psychology?

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