When is It Necessary to Modify Treatment Approaches for Ethical Reasons?

In my role as a clinical psychologist, I had to modify my treatment approach for a client with severe depression who was experiencing serious side effects from their medication, including thoughts of self-harm. Initially focused on an evidence-based therapy approach involving thought challenging, our sessions shifted to prioritize the client's immediate safety due to these ethical concerns.

A thorough risk assessment was conducted, a safety plan was developed, and coordination of care was done with the client's psychiatrist to address the medication issues. The therapeutic focus was adjusted to more supportive and crisis-oriented interventions, utilizing different evidence-based techniques to manage acute distress.

More frequent sessions were scheduled, and detailed documentation of all decisions and communications was maintained. This experience highlighted the importance of flexibility, responsiveness, and ethical considerations in ensuring the client's safety and well-being.

As a Marriage and Family Therapist, I am required (not to mention I want) to "do no harm" to my clients. When I have a client come in and he or she is not jiving with my treatment plan or therapeutic modality, I have an ethical responsibility to change to another model in which I am trained. If I think they will benefit from a treatment in which I am not trained, I explain how they will benefit greatly from this other treatment and refer them to at least three practitioners who offer it.

I also let them know that I am available to them if they ever need to come back and work on something else. My goal is always to help clients feel held gently and nonjudgmentally. If they need to switch providers, I want them to be excited to do so. The few times I have had to do this, clients have been excited to move to the treatment they need and grateful I have helped them find it.

Ethical and cultural considerations often intertwine in my school-based psychological practice. When families have different conceptions around mental health, including the causes and interventions for mental illness, one must adapt their approach. Without thoughtful consideration and collaboration, families can feel unheard, invalidated, or plainly disrespected.

We must remember that we often represent the whole field of psychology to the individuals we interact with in our increasingly diverse world. We may 'know' the 'right' approach or intervention, but without cultural consideration, our clinical judgment may not be enough or could even cause harm.

One of our greatest concerns as psychologists is that we offer interventions that work. We can't ethically continue to treat a person if there's no evidence that the client is making progress.

When it appears that the client is not making progress, we must evaluate why progress is not being made.

Sometimes there's resistance to forward movement (it can be scary for some folks). Sometimes there's a disconnect between the client and clinical intervention (if you love to incorporate energy work into your therapy but your client is an atheist or very scientifically minded). And sometimes, the intervention you're using just isn't the most effective (like using Cognitive Behavioral Therapy for the treatment of grief).

These are all times when it's best to shift gears and tailor alternatives. If progress still isn't forthcoming, it's ethically time to refer to another clinician.