Re-visiting professional ethics in psychotherapy: reflections on the use of talking therapies as a supportive adjunct …, 2024, Hunt & Blease

Re-visiting professional ethics in psychotherapy: reflections on the use of talking therapies as a supportive adjunct for myalgic encephalomyelitis/chronic fatigue syndrome and ‘medically unexplained symptoms’
Joanne Hunt; Charlotte Blease

Following years of debate over the effectiveness of cognitive behavioural therapy for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), public health bodies in the UK and beyond have determined that no psychotherapy is clinically proven for this patient group. In the field of ME/CFS and the wider arena of ‘medically unexplained symptoms’ (MUS), patient survey data and qualitative research capturing patient experiences and psychotherapist attitudes suggest that therapeutic practice may sometimes fall short of required ethical standards. This raises questions about how psychotherapists can safely support, as opposed to treat, people with these debilitating conditions.

We consider four ethical principles that feature throughout psychotherapists’ codes of practice, those of respect, competence, responsibility and integrity, and discuss examples of good and poor practice in this arena as evinced by recent empirical literature. Following this, we offer a variety of suggestions to help strengthen ethical psychotherapy practice with patients with ME/CFS and other MUS. In terms of practitioner education, we recommend greater emphasis on humility, reflexivity and disability-affirming practices, exploration of personal as well professional ethics, and integration of patient expertise-by-experience, accompanied with the latest evidence, into foundational and ongoing training. In terms of ongoing practice, we suggest consideration of formalised patient-focused feedback systems and greater transparency vis-a-vis patient access to clinical notes. Finally, we underline the importance of elevating patients from mere subjects to co-producers of psychotherapy research.


Link | PDF (Journal of Medical Ethics) [Open Access]

 

This actually understates the depth of the issue. It hasn't just been years, it's been DECADES. Which is extremely abnormal, as we are literally at the exact same stage as on day 1, despite all that happened. In fact time may as well have stood still. I am not aware of anything like this anywhere outside of politics and culture, which despite overall technological progress massively changing everything else, are also mostly static over time.

So, very good to put this up to the profession to examine itself. It it can. I doubt it will, sadly. Way too much sunk cost and egos.

 

Lots of good stuff in this paper. None of it surprising to S4ME members but still good to see it in the BMJ’s Journal of Medical Ethics.

Also touches on MUS in ways which are relevant to ME:

The recommendations at the end are thought provoking though perhaps not sufficient for the challenges identified in the paper.

 

There is an elephant in the room of therapists need to be prepared to discuss the harm the gaslighting , which includes their own (and I can’t tell you the shock when you go round everyone and realise how extreme their false beliefs are and how scarily strongly and scarily dangerous the implications they have for what they will do/how far they willl go at you is) has been. We’ve been abused and not wanting to talk about their colleagues and their own mistakes and the harm caused is unconscionable, as would be manipulating that it limiting what the victim can say. It’s another way our human rights have been abused and we still aren’t safe snd are kept in a situation where people feel licensed to both keep abusing them belittling the impact and extent of right removal that involved. Bring a therapist does not involve limiting some individuals right to talk about what injured them.

And to feel safe they need to be reassured these people have genuinely updated themselves and taken onboard the Shame for what they’ve done to these people. Otherwise it’s totally inappropriate and that means we are the one group with no access to safe psychotherapy at all ever at any time. Thanks gerada et al and the rest of the bps , and I mention this because it ‘being awkward’ needs to be reminded as not our, the victims fault. And it’s no accident this happened and was done to us and to those one the front line caught in the crossfire but with lesser impact on them. They should also realise who needs to be apologising to them for the ‘bum steer’. At the moment it feels the classic is for said people to be inciting those down the chain to further attack us ‘cos it wouldn’t be a problem if it weren’t for us [daring to stop extreme harm]’. Which is off course further outrageous and unjust and doubly no accident. People kidding themselves not accepting fault snd forcing victims to take on blame for harm done to then us acceptable is the most unprofessional and outrageous thing in all this.