Understanding Moral Values in Psychotherapy John D. Gavazzi, PsyD, ABPP Independent Practice, Mechanics urg, PA !

a"uel #napp, $dD, ABPP Director o% Pro%essional A%%airs Psychotherapy is not a value&%ree e'perience( hence, "orality plays a role in the helping relationship. )he psychologist*s role in psychotherapy inherently entails "ore po+er in the relationship. )here%ore, to +or, in their patient*s est interest, psychologists need to re"ain a+are o% the po+er i" alance and their potential in%luence on the elie% syste"s and values o% their patients. All psychologists have the a ility to in%luence their patients in "any areas o% their lives including the do"ains o% "orality, values, and ethics. In ter"s o% psychotherapy training, psychologists need to e a+are o% their "oral elie%s as these apply to a variety o% topics in psychotherapy. Patients co"e to psychotherapy +ith diverse elie%s and ac,grounds, so psychologists need to e open to the diversities o% "odern A"erican li%e. Psychologists also need to e a+are o% their li"its o% +hat is accepta le versus unaccepta le, in ter"s o% their patients* thoughts, %eelings, and ehaviors. Psychologists and patients +ho have congruent elie% syste"s rarely discuss ho+ their synchronous values +or, to+ard a positive outco"e, although congruence et+een the value syste"s o% clients and psychologists is correlated +ith success%ul outco"es in psychotherapy -Beutler . Bergen, /00/1. 2urther"ore, research supports the idea that patient values shi%t to+ard psychologist values during therapy -3illia"s . 4evitt, 56671. )his %inding is a less o vious result o% psychotherapy, and typically not a planned goal o% therapy.

3hen the values and "orals o% psychologists and patients are "isaligned, the therapeutic relationship "ay e in 8eopardy, depending on the psychologist*s reaction to or tolerance %or discrepant vie+s. I% psychologists and patients each ring di%%ering elie% syste"s or "odels o% "orality into therapy, ho+ do psychologists alance their notions o% "orality +ith those o% their patients9 3hat can e done to ,eep psychologists %ro" unintentionally i"posing their value syste" on their patients during the course o% psychotherapy9 )he %irst step in understanding ho+ "orals shape the psychotherapeutic relationship is y heightening a+areness o% ho+ our values a%%ect our +or,. Patients co""only discuss "oral dile""as in psychotherapy, such as considering ending a "arriage, conte"plating end&o%&li%e issues +ith a parent, or having an e'tra "arital a%%air. 4ess co""on types o% "oral con%licts "ay occur such as +hen a patient intends to ac:uiesce to an arranged "arriage +ith e'tre"e ine:ualities in gender roles, or +hen a patient says that she is considering entering into a polyga"ous "arriage -+here such "arriages are legal1. In each case, the patient arrived to the therapy session +ith a "oral issue as the topic o% discussion. $'cept +hen the situation involves an i""inent danger o% serious har" to sel% or others, psychologists need to allo+ patients to retain "oral responsi ility %or the decision&"a,ing process. Psychologists need to re%rain %ro" directly e'pressing their value syste"s or inserting their "orality in therapy. ;I% I +ere you, then I +ould<.= is the eginning o% psychologists inserting their "orality into the therapeutic dialogue. >% course, that does not "ean that psychologists should avoid discussing the issue. It is :uite appropriate %or psychologists to direct the patient to conse:uences o% the decision that she or he "ay not have considered, or have considered only in a per%unctory "anner. ?o+ever, usurping a patient*s "oral agency is a signi%icant oundary crossing in psychotherapy. !o"e psychologists "ay vie+ it as enevolent

as it solves the patient*s dile""a( ho+ever, allo+ing and encouraging the patient to struggle +ith +eighty "oral issues is an i"portant part o% e"otional gro+th. 3or,ing +ith "oral pro le"s can e %rustrating and ti"e consu"ing, as these are typically co"ple', unco"%orta le, and e"otionally&charged issues. >%ten, the "oral issues raised in psychotherapy are su tle or nuanced. @onsider the %ollo+ing e'a"pleA During the course o% a session, a patient revealed that he regularly too, o%% %ro" +or, even though he +as not su%%ering "entally or physically. )he patient rationalized his ehavior as ;ta,ing a "ental health day.= ?e openly ad"itted that he lied to his e"ployer a out +hy he did not sho+ up %or +or,. In this less glaring e'a"ple o% right and +rong, i% the psychologist could rein%orce the patients choice i% she agreed overtly or tacitly +ith the patient*s action. ?o+ever, a psychologist +ho gently e'presses concern a out the patient*s action opens an opportunity to e'plore or clari%y the patient*s elie% syste". In e'ploring "oral elie%s and ehaviors, the psychologist "ay suggest other %or"s o% re%lection, such a 8ournaling, %or the patient to clari%y his value syste". )his type o% intervention needs to e used s,ill%ully, as the goal is not to induce sha"e or hu"iliation. Bather, the psychologist encourages conte"plation to pro"ote a+areness o% values, "orals, and choices. Di%%erent dyna"ics "ay eco"e salient during psychotherapy sessions +hen psychologists eco"e sensitive to the "oral i"plications o% patient issues. 2or e'a"ple, a psychologist "ay :uestion a "issed opportunity %or discussing "oral elie%s, such as a patient descri ing a punitive tirade to+ard a su ordinate at +or, +ho received ;her 8ust deserts.= A psychologist "ay eco"e a+are o% overtly rein%orcing deceit%ul ehavior, as illustrated a ove. >r, a psychologist "ay recognize ho+ a patient*s negative sel%&state"ents are anchored to a

"oral intolerance %or individuals +ho are helpless or +ea,&+illed. In these clinical situations, understanding ho+ "orality plays into li%e choices and interpersonal relationships is i"portant. In this %our&part series, +e have tried to highlight the connection et+een psychology and "orality. 3e hope that psychologists can eco"e attuned to their "oral values and ho+ these play out in o vious and su tle +ays in their daily +or,. 2urther"ore, the "ore co"%orta le +e a out highlighting and discussing "oral issues that per"eate psychotherapy, the greater the li,elihood that +e are eing respect%ul o% our patients and +or,ing to+ard providing the est care possi le.

Be%erences 3illia"s, D @., . 4evitt, ?. M. -56671. A :ualitative investigation o% e"inent therapistsC values +ithin psychotherapyA Developing integrative principles %or "o"ent&to&"o"ent psychotherapy practice. Journal of Psychotherapy Integration, 17(2), /D0&/EF. Beutler, 4. $, .( Bergan, J. -/00/1. Value change in counseling and psychotherapyA A search %or scienti%ic credi ility. Journal of Counseling Psychology, 38(1), /G&5F.