Ethical dilemmas in psychotherapy: Comparison between patients, therapists and laypersons

Background: The attitudes of patients towards ethical dilemmas in psychotherapy have been reported in only a few studies. Aims of the study: We investigated whether the attitudes of patients undergoing psychotherapy to confidentiality and boundaries are different from those of therapists and laypersons. Methods: Clinical vignettes describing ethical dilemmas of confidentiality and boundaries were presented to 103 patients undergoing psychotherapy (patient group), 93 psychotherapists of different professional backgrounds (professional group), and 55 staff and students from the fields of law and the humanities (lay group). Patients were asked how they think therapists should act in the situations presented and therapists were asked how they should behave in such situations. Results: In general, the patient group showed a greater tendency to view their therapists as breaching confidentiality than the professional and lay groups. Regarding boundaries, the majority of psychotherapists were against initiating any sexual relationship with current patients, former patients, students or supervisees, whereas both patients and laypersons showed a less stringent attitude; these differences were statistically significant. The vast majority of therapists (96.7%) disapproved of accepting money in advance compared to only 31.1% in the patients group and 54.4% of the lay group. Analysis of the patients group by gender did not reveal any significant relationships. Conclusions: (1) Patients have different ethical codes from therapists and laypersons regarding the issues of confidentiality. (2) Patients and lay persons are less strict than therapists regarding issues of boundaries.