Book Review: Thought-provoking stories bring ethics home

By V. Gayle Spears, Ph.D.
September 10, 2014



Thought-provoking stories bring ethics homePatricia Keith-Spiegel, Ph.D., has authored an intriguing and original book on professional ethics – Red Flags in Psychotherapy: Stories of Ethics Complaints and Resolutions. Her approach is unique in that each chapter is a cleverly crafted story of a professional relationship between a psychologist and a client that illustrates a serious violation of ethics by the psychologist.

Keith-Spiegel spins each tale into the client filing a complaint to the Ethics Committee of the “League of California Psychologists.” a fictional psychological association. The reader is brought into the process as the Ethics Committee hears, considers and decides each case. This unique format is absorbing and informative. The format also helps the reader experience the proverbial slippery slope that can lead to ethics violations.

While the cases cover a breadth of ethical issues, the degree to which the psychologist in each scenario recognizes and cares about ethical implications in the clinical relationship varies considerably. The reader is given the vantage points of both the psychologist and the client in looking at the evolution of their interaction into a violation of professional ethics.

Some psychologists characterized seem cavalier about ethics and too self-focused to recognize or understand the path that leads to the client’s complaint and to the Ethics Committee’s recommendations for educative and/or punitive actions. Other psychologists are portrayed as the well-meaning types who start down a path with some trepidation but fairly quickly recognize that the relationship is leading in unwanted directions.

Still other psychologists are struggling to do their best work and navigate ethically but find themselves in an unexpected and unwanted situation with the client. For those of us involved in the field of professional ethics, experience teaches us that these three types of scenarios accurately reflect real life ethics cases.

Keith-Spiegel goes on to illustrate that the psychologist is viewed by the Ethics Committee quite differently depending on the psychologist’s approach to the adjudication process. The message is clearly sent by the author that the committees that consider and decide these cases are sensitive to the demeanor and level of cooperation of the psychologist.

Psychologists who take personal responsibility, acknowledge mistakes (even if unintended) and then cooperate with remediation and education on the relevant ethical issues receive greater consideration and leniency. By contrast, psychologists who approach the adjudicatory process defensively and hostilely are much more likely to be viewed negatively and as greater potential threats to the welfare of members of the public.

The format of the book lends itself to applications that are scholarly and educational, as well as clinically practical. Each chapter has an extensive list of references relevant to the case. However, the more unique inclusion is a set of questions that could serve as the basis for self-study. Keith-Spiegel has developed questions that tend to be thought-provoking and prompt nuanced consideration of the cases. The questions also lend themselves to vigorous conversation and learning.

In the Introduction, Keith-Spiegel provides one of the most concise and direct lists of “potentially risky conditions ripe for encouraging unfortunate decisions that could result in ethical mistakes.” The situations listed are ones that all psychologists need to fully consider – early and often. It is completely our responsibility to heed red flags and to take appropriate measures to protect our clients from any unethical misuse of our influence in their lives.

Red Flags in Psychotherapy: Stories of Ethics Complaints and Resolutions (2014) by Patricia Keith-Spiegel, Ph.D. Routledge. New York, N.Y. Paperback $49.95. Hardbound $160.

V. Gayle Spears, Ph.D., is a licensed psychologist and clinical associate professor at the University of Georgia in the counseling psychology doctoral program. She currently serves as the chair of the Ethics Committee for the Georgia Psychological Association and is a past-president of the Kentucky Psychological Association.

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