This paper presents an ethical decision-making flow chart for use in situations involving sexual/relational involvement of a therapist with a client. The flow chart is constructed in terms of discrete sequential steps.
Step 1: Identify Ethical Dimensions of the Issue
The first step the therapist must take is to bring conceptual clarity to the problem. This involves consideration of the ethical dimensions of the problem, the ethical principles involved, and the possible consequences of decision-making options. The fundamental guide to adequate fulfillment of this step is identification of the primary ethical dimension.
With respect to the foregoing, it can be noted that this dimension relates to client choice. Feinberg (1986) has noted that our society does not consider choices to be valid when made under conditions where a person's decision-making capacity is substantially impaired, or when the person is coerced into making the decision, or when the decision is based on fraudulent representation by one of the interested parties. Legally, the occurrence of two or more of the just cited factors, even if no one of them is by itself sufficiently pronounced to justify disregard of a person's choice, increases the likelihood that the decision will not be recognized as legally competent.
It is this critical conceptual dimension that serves as the foundation for the unwillingness of ethical decision-making bodies (APA, civil and criminal courts, etc.) to respect the decisions of patients to engage in sexual contact with their psychotherapists during treatment. In other words, the likelihood is that the patient has a significantly impaired ability to decide for sexual intimacy with the therapist.
Addressing this impairment, Feldman-Summers (1989) has noted that the impairment results from two sources: (1) the underlying distress that motivated the client to seek treatment which may cloud the client's judgement; and (2) ...