Ethical dilemmas, good intentions, and the road to hell: A clinical-ethical perspective on Yalom's depiction of Trotter's therapy

FICTION in literature can assist in the analysis of therapeutic and ethical dilemmas in psychotherapy. Lying on the Couch (Harper Collins, 1997), Yalom's account of Dr. Seymour Trotter and Mrs. Belle Felini's therapeutic encounter, describes a complex series of issues and dilemmas. In the present article a reanalysis of the case from the perspective of a clinical and ethical consultation is presented. The therapeutic crisis that preceded the sexual relationship and the initial presentation of the client are considered in detail. Following the discussion of each of these periods, alternative modes of understanding and intervening in the treatment are presented. The in-depth exploration of a fictional case such as this one allows therapists to critically evaluate the decisions that underlie problems in the therapeutic encounter. The article concludes with specific recommendations for clinical and ethical practice.