How psychotherapists handle treatment errors - an ethical analysis

Background: Dealing with errors in psychotherapy is challenging,
both ethically and practically. There is almost no empirical
research on this topic. We aimed (1) to explore psychotherapists'
self-reported ways of dealing with an error made by themselves or
by colleagues, and (2) to reconstruct their reasoning according to
the two principle-based ethical approaches that are dominant in the
ethics discourse of psychotherapy, Beauchamp & Childress
(B\&C) and Lindsay et al. (L). Methods: We conducted 30
semi-structured interviews with 30 psychotherapists (physicians and
non-physicians) and analysed the transcripts using qualitative
content analysis. Answers were deductively categorized according to
the two principle-based ethical approaches. Results: Most
psychotherapists reported that they preferred to an disclose error
to the patient. They justified this by spontaneous intuitions and
common values in psychotherapy, rarely using explicit ethical
reasoning. The answers were attributed to the following categories
with descending frequency: 1. Respect for patient autonomy (B &
C; L), 2. Non-maleficence (B\&C) and Responsibility (L), 3.
Integrity (L), 4. Competence (L) and Beneficence (B\&C).
Conclusions: Psychotherapists need specific ethical and
communication training to complement and articulate their moral
intuitions as a support when disclosing their errors to the
patients. Principle-based ethical approaches seem to be useful for
clarifying the reasons for disclosure. Further research should help
to identify the most effective and acceptable ways of error
disclosure in psychotherapy.