Comparison of the attitudes of Israeli therapists and lay persons to ethical dilemmas int psychotherapy

The issues of confidentiality and boundaries cause ethical dilemmas for psy chotherapists. We investigated whether therapists have ethical attitudes to confidentiality and boundaries that are unique to their professional group compared with lay persons and whether gender or professional characteristi cs are associated with these attitudes. Clinical vignettes capturing ethica l dilemmas regarding confidentiality and boundaries were presented to 93 ps ychotherapists of different professional backgrounds (professional group) a nd 55 staff and students from the fields of law and the humanities (lay gro up). In general, the lay group showed a greater tendency to maintain confid entiality than the professional group. Regarding boundaries, the majority o f psychotherapists were against initiating any sexual relationship with cur rent patients, former patients, students, or supervisees; the differences b etween the groups in this area were statistically significant. The vast maj ority of therapists (96.7%) disapproved of accepting money in advance compa red with only 54.4% of the lay group. Analysis of the psychotherapists by p rofessional background revealed that for the majority of the vignettes, the re was no difference in attitude to confidentiality and boundaries between psychiatrists, psychologists, and social workers. The present study shows that therapists have different ethical codes from n ontherapists regarding the issues of boundaries and the treatment contract. Therapists are stricter than nontherapists regarding issues of boundaries but less strict regarding issues of confidentiality, and there are some min or differences in the attitudes to these issues among different types of th erapists.