Therapist-client sex in psychotherapy: attitudes of professionals and students towards ethical arguments

Data suggest that a substantial proportion of psychotherapists engage in therapist-client sex (TCS), violating national and international ethical guidelines. The objective of our study was to find a new and effective starting point for preventive interventions.; Using an online questionnaire, this study explored professionals' attitudes toward aspects of a TCS-case example influencing the tendency to pursue colleagues' TCS, including self-interest and responsibility ascribed to clients.; A total of 421 participants expressed preferences for courses of action and rated given information in a questionnaire. Results indicate that TCS is most often condemned for its inherent carelessness towards clients, its exploitative nature, the abuse of dependency and for counteracting the inherent intention of psychotherapy. Partial responsibility for TCS was attributed to clients by 41.3% of the respondents. Although self-interest related information was rated as an acceptable reason against pursuing TCS, a strong tendency exists to confront an abusive colleague, even at the risk of own disadvantages.; In the detailed discussion ethical arguments against TCS (other than the certainly inflicted, but hardly measurable harm) are elaborated. In particular the incompatibility of TCS with a psychotherapeutic relationship, the responsibility for TCS in the asymmetrical client-therapist relationship and the legitimacy of self-protection are discussed.; Reasoning against TCS can and should be based on explicit, ethical requirements for psychotherapists. Furthermore, integrating the topic in psychotherapists' training is encouraged and a discrete procedure to report a colleague's TCS is requested

Deskriptive und präskriptive Aspekte des Entscheidens im medizinischen und psychologischen Berufskontext : eine explorative Fragebogenstudie

Zusammenfassung: Eine gelungene Berufsausübung im Gesundheitswesen erfordert ethische Kompetenzen. Die Voraussetzungen ihrer Erhebung wurden in der vorliegenden Arbeit anhand von N = 421 vollständigen Datensätzen untersucht, welche mittels eines sechs Dilemmata umfassenden Fragebogens an Probanden mit einem Altersdurchschnitt von 24,7 Jahren erhoben wurden. Es wurde angestrebt, mittels explorativer Faktorenanalyse über die manifesten Situationsmerkmalsbewertungen latente, entscheidungsbeeinflussende Werthaltungspräferenzen zu finden oder die intuitive Bewertung der Handlungsoptionen zu belegen. In den Daten konnten keine Einflüsse bewusster Werthaltungen gefunden werden. Hingegen stützen die Ergebnisse die Forschungsbefunde der jüngeren Forschung, die intuitiven Prozessen bei der moralischen Urteilsfindung eine dominierende Rolle zuschreibt. ---------- Summary: (1) Can an ethically valuable decision be determined? (2) How are moral decisions made? (3) Is it possible to identify trans-situational factors by which moral decisions could be prognosticated? The following research project tries to answer these questions, focused on the paramount aim to create a test instrument with which the ethical competence of physicians and psychologists can be surveyed. (re 1) The ethical discussion results in the insight that it is possible to determine and justify what an ethically valuable decision is. It follows the hierarchically ordered levels of expectations which arise from the will of the directly and indirectly affected persons. However, it cannot be justified in a generally accepted way why someone ought to act ethically in a valuable way. This claim of classical ethical theories for final justification is discussed using the examples of the deontological theory by Kant and the utilitarianism; it cannot be upheld and is thus being rejected. Afterwards, the principlism of Beauchamp and Childress, being based on the reflective equilibrium by Rawls, is outlined. It is argued that it is compatible with the theory of integrative ethics by Krämer and can be used for the ethical evaluation of decisions in the health care services. (re 2) According to the results of research, the decision-making process, which is the object of the second question, is strongly influenced by intuition. Hence, reasoning presumably does not reflect the real process and actual causes of decisions. To answer the second question, two possible paths of decision-making are derived from already existing psychological theories. The first approach is deduced from the value theories and the theories of cognitive consistency. It implies that decisions are made consciously on the basis of values so that statements about the process of decision-making can be realistic. The second approach is substantially based on younger psychological research about moral decisions. It says that moral decisions are first and foremost made intuitively and that their reasoning is rather like post-hoc-rationalization. Therefore, such statements should not allow any conclusions about the actual process of decision-making. In order to test both approaches against each other, a test instrument was developed which allows to answer the third research question as well. (re 3) The data collected for answering the third research question does not reveal any trans-situational factors by which moral decisions could be prognosticated. The test instrument created to gather the data contains six realistic case studies taken from the medical and psychotherapeutical professional practice. For every case study, the test persons are asked for a descriptive statement about the presumably executed action by oneself, as well as a prescriptive statement about the behavior expected from others. Furthermore, the test persons are asked for a rating concerning each individual piece of information presented in the case study whether the protagonist of the case study should assess it rather for or against the realization of the action. The pieces of information are conceived in such a way that they correspond to widely different values. The ratings of the individual units of information correlate substantially to the prescriptive and descriptive statements of the corresponding case study. In addition to that, the ratings of the individual units of information regarding one course of action also inter-correlate substantially. This is interpreted to the effect that the intuitive appraisal of the individual course of action decisively affects the assessments of the individual units of information on the specific course of action. To examine the data for trans-situational factors, a factor analysis about the ratings of the information of all case studies was calculated. However, the ratings do not correlate highly across situations even if the strong interrelation of the ratings of the units of information within the individual courses of action is partialled out. [...] In summary, it seems promising [...

Stimulatory Effect of Morning Bright Light on Reproductive Hormones and Ovulation: Results of a Controlled Crossover Trial

OBJECTIVES: Studies have shown a shortening of the menstrual cycle following light exposure in women with abnormally long menstrual cycles or with winter depression, suggesting that artificial light can influence reproductive hormones and ovulation. The study was designed to investigate this possibility. DESIGN: Placebo-controlled, crossover, counterbalanced order. SETTING: Medical centres and participants' homes in Novosibirsk (55°N), Russia. PARTICIPANTS: Twenty-two women, aged 19–37 years, with baseline menstrual cycle length 28.1–37.8 d and no clinically evident endocrine abnormalities completed the study. The study lasted for two menstrual cycles separated by at least one off-protocol cycle. INTERVENTIONS: During one experimental cycle, bright light was administered at home for 1 wk with a light box emitting white light at 4,300 lux at 41 cm for 45 min shortly after awakening. During the other experimental cycle, dim light was <100 lux at 41 cm with a one-tube fluorescent source. OUTCOME MEASURES: Blood samples and ultrasound scans were obtained in the afternoon before and after the week of light exposure, on day ∼7 and 14 after menstruation onset. Further ultrasound scans after day 14 documented ovulation. Serum was assayed for thyroid-stimulating hormone (TSH), prolactin (PRL), luteinizing hormone (LH), follicle-stimulating hormone (FSH), and estradiol (E2). RESULTS: Concentrations of PRL, LH, and FSH were significantly increased with bright versus dim light exposure, as was follicle size (ANOVA, intervention × day, p = 0.0043, 0.014, 0.049, and 0.042, respectively). The number of ovulatory cycles increased after exposure to bright compared to dim light (12 versus 6 cycles, Wilcoxon tied p = 0.034). CONCLUSIONS: Morning exposure to bright light in the follicular phase of the menstrual cycle stimulates the secretion of hypophyseal reproductive hormones, promotes ovary follicle growth, and increases ovulation rates in women with slightly lengthened menstrual cycles. This might be a promising method to overcome infertility