Professional guidelines in psychotherapy

A profession is a body of people who have acquired a set of skills and a knowledge base with which to use those skills. As opposed to a trade, in which a skill is performed for money, a professional brings his expertise in his knowledge to bear on a problem; he interprets and considers different possibilities. Professional roles are generally complex ones, and they have a social structure, such that one acquires a social identity when one is admitted to the profession of one’s choice.

Professions generally (but not all!) have altruism as part of their role—working for the benefit of others. For this reason, most professional bodies have guidelines about the conduct of their members. These guidelines set out what may be expected of a professional by the public and by the profession as a whole.

Professional guidelines for therapists set standards for performance and conduct of therapy. They do not have the force of law; but, if there is legal dispute which involves a professional’s performance, then the courts will consider professional guidelines seriously. If unsure as to the right course of action, the professional guidelines may be a source of direction, and, when making a difficult decision in the course of a professional career, it is essential to be aware of the guidelines and what they say.

For medical psychotherapists, the GMC is the professional body that regulates entry into the profession and retention in it. Professional guidelines for doctors are set out in Good Medical Practice (GMP), which sets out the duties of doctors and what is expected of them professionally. The GMC also has specific guidance on a number of common ethical dilemmas in medicine, especially in relation to consent and refusal of treatment, the disclosure of private health information to third parties, and decisions about withholding treatment and end-of-life decision-making.

All doctors need to be familiar with GMP and the subspecialty documents such as Good Psychiatric Practice and the Royal College of Psychiatrists Code of Ethics. These documents are only guidelines and may not be able to offer definitive answers to all dilemmas. In complex cases, it is vital to document all thinking and reflecting processes, especially if one is going to depart from the guidelines in any significant way. It is also advised that one consults several different colleagues with experience in the issue at hand.

There is no specific professional guidance for medical psychotherapists. However, they are expected to meet the professional obligations of all doctors and psychiatrists generally, and specifically to meet the professional duties of psychological therapists, such as are set out in by the main voluntary professional regulatory bodies of psychotherapists in the uK—the uKCP and the BPC. For medical psychotherapists, there may be little difference between the therapist who is ‘good’ professionally and the therapist who is personally ‘good’. In this sense, medical psychotherapists may be held to a higher standard than other psychiatrists (see E ue ethics and psychotherapy in Chapter 9, pp. 445-6; Boundary setting and maintenance in Chapter 9, pp. 454-5; Boundary violations in psychotherapy in Chapter 9, pp. 455-60).

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