Short Course 24 – Gregg Bloche, MD, JD – Psychotherapy and the Hippocratic Dilemma
Like other health professionals, psychotherapists identify closely with the Hippocratic ideal of undivided commitment to the patient and to her or his well-being. Yet psychotherapists are called upon to serve myriad social purposes, often at odds with the interests of their patients. Sometimes, tension between the Hippocratic ideal and other purposes is overt – for example, when forensic psychologists or psychiatrists opine in court on child custody or criminal responsibility. Other times, it’s more subtle, as when therapists (consciously or otherwise) conform their diagnoses or treatments to the expectations of health insurers focused on restraining clinical spending. At times, contradiction between Hippocratic and other purposes explodes into scandal, as it did when CIA and military psychologists designed the post-9/11 “enhanced interrogation” strategy that rose to the level of torture, and then won the American Psychological Association’s tacit approval. Other times, this contradiction is all but invisible, as when undiscussed cultural and moral premises underlie diagnostic categories and modes of therapy. This presentation will shine a light on this ethical tension and its pervasiveness in clinical practice. I’ll conclude by offering some strategies for management of the many ethical challenges to which this tension gives rise.
- Identify the many conflicts that can arise in clinical practice between duties to patients and society’s demands.
- Analyze how to manage these conflicts – and to distinguish between social expectations and demands that are legitimate, questionable, or plainly wrong.
- Identify concrete examples of such conflicts, including insurers’ cost-containment pressures, forensic consultation (child custody, mental competence, criminal responsibility, etc.), the cultural/moral content of clinical diagnosis, and the bitter controversy over psychologists’ role in post-9/11 national-security interrogation.