Ethics Workshop Series: Four Parts 2017-2018

Western Branch Canadian Psychoanalytic Society | Extension Program
Judith Setton-Markus, R. Psych. FIPA, Coordinator

The Western Branch Canadian Psychoanalytic Society Extension Committee is pleased to offer a second four part series on ethics in the clinical setting. Each workshop is three hours and will consist of a theoretical discussion, followed by the opportunity to review case vignettes that apply to the theme of the workshop. Participants are encouraged to bring clinical case examples from their own practices. Participants may register for each workshop separately or for all four.

Part I: Boundaries in Psychotherapy
Facilitator: Rene Weideman, Ph.D., R.Psych.
Date: June 16, 2017

Appropriate boundaries in psychotherapy are essential for ethical practice. It is salutary to revisit the nature of boundaries as they are described in ethical standards and codes of professional conduct. It is also salutary to go further. Choices concerning boundaries may be made and events may unfold before their effects are fully experienced. Even well trained and conscientious therapists can get into difficulties. Every patient and every therapist has internal boundaries that can affect the boundaries in the therapeutic relationship. Thoughtful attention enhances therapy and protects patients and therapists alike.

Rene Weideman, Ph.D., R.Psych. is a psychotherapist in private practice, is a registered psychologist and a Clinical Associate Professor in the Department of Psychiatry at UBC.

Learning Objectives:
By the end of the workshop, participants will have/be able to:
1. Cover key points in the literature concerning boundaries;
2. Consider how therapists get into trouble;
3. Consider implications for practice.

Readings:
1. Casement, P. (2002). Appendix: Some pressures on the analyst for physical contact during the reliving of an early trauma. 129-139. In Learning from Our mistakes: Beyond Dogma in Psychoanalysis and Psychotherapy New York: Guilford. Reprinted from: Casement, P. (1982). International Review of Psychoanalysis, 9, 279-286.
2. Casement, P. (2002). To hold or not to hold a patient’s hand: further reflections. In Learning from Our mistakes: Beyond Dogma in Psychoanalysis and Psychotherapy. Chapter 7, 86-95.
3. Gabbard, G.O. & Lester, E.P. (1995). Nonsexual boundary violations. In Boundaries and Boundary Violations in Psychoanalysis. Washington: American Psychiatric Publishing, Chapter 7, 122-147.

Part II: Ethics, Money and Conflicts of interest between the therapist and the patient
Facilitator: Paul Steinberg, MD, FRCPC, FIPA
Date: November 17, 2017

The handling of financial matters by psychotherapists and patients involved an intersection between ethical concerns, countertransference and transference. Anxieties about money in both therapist and patient may affect the therapy adversely if they are not observed, thought about, and explored within the therapeutic couple. The frame of psychotherapeutic relationships usually involves financial considerations, even when the therapist is a physician. Exploring threats to or crossings of this aspect of the frame can be valuable psychotherapeutically. Often therapist’s inhibitions about money, and concerns about being or seeming greedy, can interfere not only with the therapist being appropriately paid for his or her work and time, but also can limit progress in psychotherapy.

Paul Steinberg, MD, FRCPC, FIPA is a clinical professor in the Department of Psychiatry at the University of British Columbia. He is a member of the Canadian Psychoanalytic Society and the International Psychoanalytic Association. He maintains a private practice in psychoanalysis and psychotherapy in Vancouver. Recent publications include articles on threats of violence in group psychotherapy, structured groups in psychiatric day treatment, and projective identification in group psychotherapy, and a coauthored book chapter on psychodynamic day treatment of patients with personality disorders.

Learning Objectives:
By the end of the workshop participants will:
1. Have an enhanced appreciation of the importance of maintaining the therapeutic frame as it applies to financial considerations;
2. Be more aware of countertransference difficulties and potential and actual enactments between therapist and patient regarding their financial arrangements;
3. Acquire some therapeutic approaches towards handling issues regarding finances in psychotherapy.

Readings:
1. Hirsch H (2008). Money and the therapeutic frame, in Hirsch H, Coasting in the Countertransference. New York: The Analytic Press.
2. Hirsch H (2008). Money and the ongoing therapeutic relationship, in Hirsch H, Coasting in the Countertransference. New York: The Analytic Press.

Additional reading:
3. Aron L & Hirsch H (1992). Money matters in psychoanalysis, in Skolnick NJ & Warshaw SC, Relational Perspectives in Psychoanalysis. Hillsdale NJ: The Analytic Press.

Part III: Self-revelation and Self-disclosure in Psychotherapy
Facilitator: Elizabeth Wallace, MD, FRCPC
Date: January 26, 2018

We reveal ourselves to our patients in a myriad of ways. Patients observe how we decorate our offices, our choice of clothing, changes in our body’s appearance and size, the smell of our lunch, the books placed on our shelves, the change in our tone of voice when we feel embarrassed or confused. The traditional ideal of “analytic anonymity” is seen by many as a myth due to the bi-directional stream of information arising naturally throughout the therapeutic relationship, yet it remains a powerful “rule” for some therapists that inhibits open exploration of what patients see about us. We may experience an ethical bind when deciding whether to address our inadvertent self-revelations with patients who may perceive us quite accurately, but in ways that are personally exposing. And discussing our self-revelations may lead to self-disclosure, another complex and thorny area of controversy in psychoanalysis and psychotherapy. How do we judge whether a self-disclosure is in the patient’s best interest and will further the process, or whether it will be deleterious? How do we respond when patients pick up information, more or less accurate, about our personal lives?

We will discuss several papers exploring whether and when to tell the truth but not the whole truth about ourselves, handling of self-revelations and self-disclosures, and uncanny ways that patients may intuit personal information about the therapist. Participants are encouraged to bring their own clinical examples for discussion.

Elizabeth Wallace, MD, FRCPC is a psychoanalyst and psychiatrist, and member of the Western Branch of the Canadian Psychoanalytic Society. She has a private practice of psychoanalysis and psychotherapy in Calgary, Alberta as well as consulting to an outpatient mental health program through Alberta Health Services. She is a Clinical Associate Professor in the Department of Psychiatry at the University of Calgary, where she teaches and supervises psychiatry residents.

Learning Objectives:
By the end of the workshop participants will be able to:
1. Compare and contrast therapist self-revelation and self-disclosure in psychotherapy.
2. Outline ethical pros and cons of making self-disclosures in the therapeutic situation.
3. Consider the impact of inadvertent self-revelations on the therapeutic process, and factors influencing whether to address these with patients or not.
4. Discuss ways to address the patient’s knowledge of the therapist’s personal life.

Readings:
1. Levenson, E.A. (1996). Aspects of self-revelation and self-disclosure. Contemp. Psychoanal., 32:237-248.
2. Levine, S. (2007). Nothing but the truth: Self-disclosure, self-revelation, and the persona of the analyst. Journal of the Amer. Psychoanal. Assn., 55:81-104.
3. Crastnopol, M. (1997). Incognito or not? The patient’s subjective experience of the analyst’s private life. Psychoanal. Dialogues, 7:257-280.

Part IV: “The Knights in Shining Armor”: using psychoanalytic tools such as transference, countertransference, projection to assist in maintaining an ethical child therapy practice.
Facilitator: Carolyn Steinberg, BSC, MSC, MD, FRCPC
Date: April 27, 2018

Using the readings and our rich clinical experiences as a jumping off point, we will explore ethical problems in child psychotherapy and child psychoanalysis. We will explore how these arose, and reflect on how the use of our person, via transference, countertransference, and projection may assist us to understand the looming ethical issue. We will focus on means of prevention, and therapeutic use of the incident.

Carolyn Steinberg, BSC, MSC, MD, FRCPC graduated from the Faculty of Medicine, University of Toronto, to train as a Family Physician. She retrained at University of Alberta to become a Child Psychiatrist specializing in Early Childhood Mental Health. She was hired to start up an Early Childhood Mental Health Service in Richmond BC, a suburb of Vancouver, and has worked there for 10 years. She teaches at UBC, and has published and presented in her areas of interest. She served on AACAP’s Infancy Committee and as a consultant to the developmental Pediatric Association of China. She is a senior candidate in psychoanalysis at NPSI in Seattle. Currently she has an active practice both with parents, infants and young children, as well as a private practice of psychoanalysis and psychotherapy of all ages.

Learning Objectives:
At the end of this presentation participants will be able to:
1. Discuss some typical ethical issues
2. Define transference, countertransference projection and give examples.
3. Use these constructs for therapeutic intervention
4. Discuss methods to prevent ethical pitfalls

Readings:
1. Schmukler, A.G., Atkeson, P.G., Keable, H. and Dahl, E.K. Ethical Practice in Child and Adolescent Analysis and Psychotherapy, Protecting Safety in a Therapeutic Environment, 1-45.
2. Ascherman, L., M.D. and Rubin, S. Ethical Aspects of Supervision of Work with Children and Adolescents, Potential Pitfalls, Chapter 6, 69-87.