Some Ethical Problems in Psychotherapy of Unhappiness

Opinion

One reason that clients come to a psychotherapist is that they are unhappy because of the way they think, feel and act. They believe help from an expert might relieve that unhappiness. Reasons for unhappiness vary. Sometimes it is associated with a negative balance of hedonistic pleasure, and sometimes with a lack of feeling of general well-being because of failure to achieve personal goals. Even when struggling to achieve your goals is painful, the struggle may make you feel happier [1]. Therapists look for reasons for unhappiness based on their theoretical perspectives and what they believe can be successfully treated. A cognitive-Behavioral therapist analyses how the client’s thoughts are causing negative emotions such as anxiety and poor self-esteem. Clients are taught to change the irrational assumptions that maintain those thoughts. A therapist with a conditioning perspective has the client reinforce desirable behaviours and extinguish undesirable ones. A therapist with a psychoanalytic perspective looks for unconscious reasons for the unhappiness and helps the client uncover those reasons and give up the defences that maintained them.

A therapist with an existential perspective helps clients find meaning in their lives despite a person’s unavoidable separation from others and ultimate death. There is scientific evidence for the usefulness and efficacy of each of these theoretical approaches, strongest for the cognitive-Behavioral and weakest for the existential [2]. Whatever their perspective, psychotherapists are expected to try to optimize each individual client’s ultimate happiness, which means a change in their client’s emotions and behavior. They are supposed not to prescribe exactly how clients should act to be happy, but let clients explore new possibilities, which will have consequences for how their clients interact with other people. Unfortunately, the changed behavior may negatively affect the happiness of others, who may retaliate making the clients unhappier too. In this case, the psychotherapist’s customary role is to act in a way that puts the happiness of their clients first and the happiness of others, second.

Only when more than one person is a client, as in marriage therapy, and when a decision to leave one’s, partner would make the other unhappy, is it usual to aim for a compromise that balance the unhappiness between them. An ethical problem arises when clients find they are made happier by deliberately causing others to suffer, in extreme cases by violent acts. Laws have been enacted to require mental health providers to report to the judiciary when plausible threats of violence are made [3]. The argument that mental health experts are like priests in the confessional and should not be forced to reveal their client’s bad thoughts and behavior is rejected. How to treat the unhappiness of sexual minorities (the LGBTQ spectrum) also raises ethical problems [4]. According to one point of view, if your intentions and actions are those of a sexual minority and your unhappiness is related to social consequences of your sexual orientation, any therapy attempting to change your sexual orientation is unethical even if that is your wish. Behavior therapy delivering painful shocks when images elicit deviant sexual thoughts elicit penile tumescence is condemned as barbaric.

There has been legislation outlawing any kind of so-called “conversion therapy,” words recalling coerced religious conversions. Opponents of conversion therapy aver that it is impossible to alter one’s innate sexual orientation. Another ethical problem for psychotherapists is when unhappy clients want to commit suicide. Usually, suicide is associated with a diagnosis of depression, a form of unhappiness that therapies are usually able to treat. Meanwhile, clients with a plan to commit suicide can legally restrained against their wishes [3]. However, in cases of painful terminal illnesses, it is controversial whether suicide should be discouraged or even assisted in so-called mercy killing [5]. The controversial nature of this is reflected by differing laws in different places. Thus, in three situations therapists face difficult ethical problems: when client happiness lies in making others unhappy, in changing their sexuality, or in suicide. Popular opinion is not unanimous. Therapists are left to comply with the relevant laws or to oppose them. That decision will be agonizing.

References

• Haybron Dan (2020) "Happiness" The Stanford Encyclopedia of Philosophy (Summer 2020 Edition) Edward N Zalta (Eds.).
• Vandenbos GR Meidenbauer E, Frank McNeil J (eds.) (2014) Psychotherapy theories and techniques: a reader. American Psychological Association Washington D C pp.368.
• Testa M, West SG (2010) Civil commitment in the United States. Psychiatry (Edgmont) 7(10): 30-40.
• Brazelon, Emily (2022) The Battle Over Gender Therapy. New York Times published.
• Goodwin JS (1991) Mercy Killing: Mercy for Whom? Journal of the American Medical Association 265: 326.