6 Ethical Values of Master Therapists

Conducting oneself ethically is critical task of the competent therapist (http://www.Apa.org/ethics, January, 2003). Making the best ethical decisions can be extremely challenging for most therapist due to the multitude of complex ethical situations. The goal of this study is to examine the ethical values of master therapists considered to be “the best of the best” by their professional colleagues. It is hoped that such as examination will help to illuminate what ethical values master therapists seem to draw upon in their work.

Ethics are beliefs about conduct and principles that inform rules for proper behavior (Corey, Corey, & Callanan, 1998; Knauss, 1997). In psychology, ethics codes are intended to “set out expected professional behavior and responsibility” (Eberlein, 1987, p. 345). However, studies involving ethical dilemmas have found a discrepancy between therapists’ knowledge of what ought to be done and what they actually would do (Bernard & Jara, 1986; Bernard, Murphy, & Little, 1987; Smith, McGuire, Abbott, & Blau, 1991; Wilkins, McGuire, Abbott, & Blau, 1990).

Why the inconsistencies? Researchers suggest that when therapists though the ethical infraction violated a clear professional code, they were more likely to act as they felt they should. This happened especially when the violation was bolstered by a legal precedent (Bernard et al., 1987; Smith et al., 1991). However, in situations that depended more on individual judgment, practitioners were less likely to “do the right thing.” It appears that when written ethical guidelines are unclear, psychologists rely on their own individual value systems and their understanding of the ethics code (Bersoff & Koeppl, 1993; Eberlein, 1987). One possibility for the discrepancy between knowing and doing what is right is that some clinicians suffer from deficits in principles such as integrity and honesty (Smith et al., 1991). Rest (1984) theorized that a therapist who is reluctant to follow through with understood ethical behavior may lack the courage to act. To date, studies on therapist values have tended to focus on therapists’ conceptualizations of what constitutes good mental health (Consoli & Williams, 1999; Haugen, Tyler, & Clark, 1991; Jensen & Bergin, 1988; Kelly, 1995; Khan & Cross, 1983; Myers & Truluck, 1998).

Kitchener (1984) believes that parts of formal organizational ethical codes are too broad, whereas other are too narrow. The fundamental ethical principles identified by Kitchener are autonomy, beneficence, nonmaleficence, justice, and fidelity. Meara, Schmidt, and Day (1996) expanded on Kitchener’s work by defining principle ethics (formal, obligatory codes) as distinct from virtue ethics (focus on character traits and ideals). Virtue ethics are rooted within the traditions of a cultural group and, therefore, present a more complete account of moral life than actions based on prescribed rules. Meara et al. (1996) proposed that virtue ethics complement principle ethics by assisting helping professionals to achieve the ideals of being competent, serving the common good, and retaining professional autonomy. Given that the authors argue professional decision making is “seldom either totally absolute or completely relative and thus requires virtuous, competent individuals to exercise careful professional judgment” (p. 5), the concept of ethics should encompass issues of character as well as professional obligations. The work of Kitchener and Meara et al. supports the idea that ethical decisions in psychology are complex and rarely absolute. In order to understand ethical decision making, it seems important to know the core value of the therapist that influence each unique situation.

The majority of empirical studies that examine ethical decision making in practice have focused on therapists’ responses to particular ethical dilemmas (Conte, Plutchik, Picard, & Karasu, 1989; Haas, Malouf, & Mayerson, 1988; Smith et al., 1991; Wilkins et al., 1990). A limitation of this line of research is that it tends to be about specific areas of concern, such as sexual contact with clients. Another approach has been for researchers to survey practicing clinicians in an open-ended way about their ethically challenging critical incidents. This method, as described by Pope and Vetter (1992), mirrors the original process the American Psychological Association (APA) used to create the first ethics code for psychologists. In 1952, the APA surveyed its membership in an attempt to develop guidelines for ethical conduct that reflected the concerns of practitioners. Although useful, it appears that survey research cannot capture the complexity of the nuanced thinking involved in making ethical decisions.

In a departure from survey research, Prilleltensky, Walsh-Bowers, and Rossiter (1999) conducted a qualitative study exploring the underlying core values of practitioners. When examining practitioners’ professional ethics, three general principles emerge: respect for people’s rights, dignity, integrity, and privacy; compassion and responsible caring; and feeling a sense of responsibility for the community. Furthermore, the practitioners described additional values they believed were fundamental in their work: encouraging clients’ self-determination, advocacy for vulnerable clients, confidentiality and informed consent, strength-based empowerment, and paying attention to the best interests of the client under unique circumstances.

Thus far, little research on ethical values has focused on seasoned or expert therapists. However, studies have examined clinicians’ years of experience, providing a better understanding of the growth of professional ethical judgment over the course of a career (Conte et al., 1989; Haas, Malouf, & Mayerson, 1998; Jensen & Bergin, 1988). Conte et al.’s (1989) survey of therapists found that beliefs about ethical standards varied widely. The authors concluded that certain behaviors were ethical standards varied widely. The authors concluded that certain behaviors were thought by some therapists to be inappropriate, but not necessarily unethical, whereas other therapists felt that similar behaviors were either clearly unethical or grounds for malpractice. In addition, therapists with more experience were more likely to feel that pledging to cure a client’s symptoms was unethical and less likely to break confidentially to warn a potential victim of harm.

Jensen and Bergin (1988) found that years of professional experience did not predict desirable mental health values. In addition, Haas et al. (1998) found the length of time after attaining one’s professional degree to be inversely related to the psychologist’s willingness to take the most ethically preferred course of action. The authors hypothesized that this surprising result may be due to burnout factors or a recent training focus for younger practitioners on specific ethical obligations.

Pope and Bajt (1988) surveyed ethically knowledgeable senior psychologists (e.g., served on boards of ethics, authors of ethics textbooks, ABPP status) and found that a majority admitted having willingly violated ethical codes. Further, 77 percent of respondents felt that formal ethical standards should be broken when necessary for client welfare “or other deeper values” (p. 828). Instead of “textbook ethics,” these experienced practitioners perhaps used context-based ethics developed over years of practice.

Though the APA puts forth a set of ethical principles designed to guide psychologists to practice ethically, survey or dilemma-based research methods have yielded limited data on therapists’ values in general and have, at times, painted an unfavorable portrayal of the ethical practices of experienced therapists. What appears lacking in the literature is an examination of actual values—perhaps those “deeper values” that guide therapists’ ethical behavior. Even more useful may be an examination of the ethical values that expert of master therapists seem to draw upon in their work. Utilizing Consensual Qualitative Research (CQR) methods (Hill, Thompson, & Williams, 1997), the present study attempts to provide an understanding of the ethical values of master therapists. Please see A for a complete description of the study’s methodology.

The five most salient ethical values of master therapists identified were: (a) competence, (b) relational connection, (c) nonmaleficence, (d) autonomy, and (e) beneficence. Several quotations will be offered for each of the five ethical values. Hopefully, this will provide the reader with a better sense of the master therapists’ viewpoints that comprised each ethical value.

As outlined in the 2002 APA Ethical Standards, being competent in one’s work as a therapist is a hallmark of ethical practice. The master therapists in this study clearly value being exceptionally skilled in their clinical work. In fact, they are highly motivated to move beyond the minimum competency level required by ethical and practice standards and to be experts in their field. These therapists, even after years of experience and training that might have just as easily resulted in complacency, place a high value on building and maintaining their skill set. Throughout the interview data, references to becoming competent and maintaining competency as a practitioner lend support to this category. One master therapist recollects how the accumulation of experience aided in developing competence as a practitioner:

I’ve got a lot more experience, and as much as I used to want to believe when I was younger that age and experience didn’t count (and not just experience in the terms of being a therapist, but life experience), it counts a lot in terms of your ability to empathize and understand a wider range of things. The other parts is what I came out of school, I did not feel as though I knew much of anything. And the training and supervision and experience that I got during those years made an incredible difference.

Similarly, another master therapist also discussed the vital role of experience in building competency:

I am really shockproof, and it took a long time not to be jarred by the stories I hear. I can’t imagine how to create a graduate school program that would turn out expert seasoned therapists immediately. It’s a long process.

Master therapists continually seek out formal and informal training to broaden their clinical abilities. Being perpetually open to opportunities for learning and growth in their profession seemed to be another defining characteristic of these master therapists. The drive for competency combined with an awareness of limitations inspired master therapists to be “life-long learners.” It is likely that keeping current on the latest developments in the profession and exposing their work to others for feedback minimizes the potential for unethical behavior. The master therapists spoke of the importance of looking for professional growth experiences beyond didactic venues and supervision, as well as their own therapy, master therapists seemed continually to seek out the opportunity to have others critically evaluate their work. As one master therapist stated:

I meet with other people who are calling me on my stuff so I get a change to look at myself on the outside over and over and over again, through personal therapy, through lots of supervision, through ongoing consultation. That helps incredibly. I think that’s essential.

Amassing years of clinical practice is only one component of commitment to professional development. For master therapists, experience combined with clinical consultation, ongoing traditional academic training, and personal reflection yields a deeper level of professional growth. Again, this commitment to professional growth appears to bolsters one’s competence, which in turn is an important ingredient in conducting ethical work. Challenging the idea that experience alone equals expertise, the same master therapist spoke eloquently of the importance of bolstering the accumulation of clinical experience with sustaining professional relationships to grow professionally:

I don’t think years of experience by itself does it, does it, because I might have the same year of experience twenty times, and so I need to put that together with good consultation and a good collegial system. So that you actually are learning from what you’re doing and [learning] more about how you’re impacting and affecting people.

It appears that part of master therapists’ becoming more competent in their work involves looking less and less for an immediate answer to clients’ presenting problems because they believe tolerance for ambiguity is an important part of the therapist’s role. Master therapists tend to not see easy answers in their work with clients and to conceptualize the process of staying open as a hallmark of competent practice. They seem to be searching constantly for the uniqueness and intricacy of situations. This appreciation of complexity has ethical implications in that it helps prevent premature closure (Skovholt & Rønnested, 1995), which is a tendency of some therapists to reduce anxiety by, for example, latching onto one of the first solutions considered or to use the same techniques with virtually every situation. With a low comfort level for ambiguity and complexity, some therapists might hastily come to conclusions that primarily relieve their anxiety, yet may not be the best fit for the client. Thus, not being open to complexity and ambiguity leads to narrowing case conceptualization and treatment interventions, which can result in less than competent work. One master therapist said:

Every person is different. Therefore, any technique that one uses, to use it each time in the same way is in some ways denying the truth of the uniqueness of every individual and the uniqueness of every interaction.

Another master therapist noted how difficult it was to train therapists who were not open:

Having taught psychologists, they [often] grab onto an interpretation and come hell or high water, they’re going to prove they’re right. Instead of saying, here’s an interpretation, but does it fit?

The following examples further illustrate the therapists’ deep commitment to openness, which may lead to more competent, and therefore more ethical, interventions. For example, one master therapist said:

I think you have to have a certain amount of flexibility, in that you will hear things and you won’t make sudden decision and then push them through. You sort of wait and watch the pieces fit.

Similarly, one master therapist stated how important it is to avoid acting prematurely:

So, I think [it is important] to be open to not knowing and to an ambiguous situation, so that you can hear what it is that is emerging, rather than laying something on the situation… . When you don’t know, then you can listen more curiously and have more of an openness about what all might be coming here. So, I think the ambiguity is a part of that. It helps you stay more curious about sorting it out and understanding it, finding out more.

Establishing, maintaining, and honoring relationships is an extremely important ethical value for these master therapists, and an ethical value absent in the 1992 APA General Principles that we analyzed for this study. Master therapists seem to highly value the relational interaction and connection among colleagues, friends, clients, and the larger community. Developing sound professional relationship with colleagues is a core value of these therapists. They believe that in order to maintain competence and build expertise, therapists continually must be in relationship with others in the field, both for supervision or consultation for collegial support and friendship. One therapist commented on the need to avoid professional isolation through consistent contact with other professionals:

I have made sure to practice here with colleagues that are close by. When the lease are up and some move out, we get others in, and we meet once a week for a long lunch, to talk about cases or plants for the waiting room or whatever. That sort of collegial connect, especially on a day-in-day-out basis, is really quite important.

Similarly, master therapists spoke about the need for good relationship in their personal lives that often serve as a safeguard against burnout or impairment:

You know, if you have good friends in your life, if you have a good support system, folks will let you know that you’re feeling worn out or depended or whatever and then will support you getting some help.

As would be expected, all of the master therapists believed that the client-therapist relationship is the key to effecting positive change in clients. One therapist stated:

… [T]‌he core of psychotherapy to me is the development of that relationship and the connection, and so it’s development of a relationship… the purpose of which is to heal or help the order person. But to me, psychotherapy is the relationship, as opposed to, you know, a technique that I do or whatever else. It’s really about forming and working in the “in-between.”

Another master therapist also emphasized the relational aspect of effecting positive therapeutic change:

I really believe that [psychotherapy] is a two-person operation, so that it is about us together if change happens or doesn’t happens. So, I don’t think about it as if something is successful, that I did it. You know, I think it’s something that we did together, and I think if it’s not working, it’s something we’re not doing together.

One master therapist shared:

[Psychotherapy] sort of re-establishes that kind of bridge back to humanity, it re-establishes that sense of being in the community.

Many of the master therapists interviewed seem to uphold high ethical standards when interacting with others in both their professional and personal life. In most relationships, even those in the community at large, the master therapists strive for congruence between their values and how they relate to others. One therapist captured the commitment to maintaining positive relationships in a variety of settings:

It is honoring the integrity of the relationship. Whatever relationship I have, whether it’s with a friend that I’m having dinner with, or I am negotiating a price on a used car with a car dealer, or I am planning a vacation with my wife, or I’m talking with a client about his or her life, I’m going to be honest.

Not only do master therapists value helping others, they are also aware of the tremendous potential to do damage in the context of the therapeutic relationship. They seem mindful of the ways they may potentially harm their clients and have developed measures to minimize this risk. For example, one master therapist said:

I think one of the ways therapy goes away is that the therapist starts to use the client for their own emotional sustenance … regulation of the therapist’s self-esteem, all those sorts of things.

Master therapists strongly believed in managing their own personal and professional stressors that can lead to harming clients. One master therapist said it this way:

Those therapists who have been in consultation with me before who were not willing to do [personal therapy] were so difficult to deal with. Any time they were stuck for a period of time, they’d make it about the client, instead of about themselves or instead of about both of them. And when you do that, you’re going to be abusive to your client.

For master therapists, humility offsets the potential for grandiosity and arrogance, characteristics that may lead to harming clients. Because these master therapists realize they do not have “a corner on the truth,” they seem to have a healthy perspective on their limits as practitioners and human beings. In fact, awareness of these limitations seems to inspire them to continue growing professionally and personally. This attitude is in stark contrast to those who might think they have “arrived” as a therapist and therefore do not require ongoing training and development. In addition, some master therapists expressed concern for therapists who are not fully aware of their weaknesses. For example, one master therapist said:

One of the things that I tell people when they are looking for a therapist is to really ask them the question about what can’t they do. And boy, if they don’t have something they can’t do, get out!

Another master therapist said:

Bad therapists don’t know what they don’t know. They think they know everything, they have a “got to solve it” kind of perspective on everything. Their theory is very sound and [yet] they don’t really know how little they know.

Display humility, one master therapist spoke of the hazard of grandiosity in considering oneself an expert:

I think if one begins to think of oneself as a master therapist, it can lead to grandiosity. It can pave the way to all sorts of misuse of power. There is one phenomenon that has to do with the seasoned clinician who is so confident that the rules no longer apply.

Master therapists expressed a deep commitment to awareness of their own life issues. Their self-awareness seemed to center around two issues: (a) understanding and fulfilling their personal emotional and physical needs and (b) awareness of their own “unfinished business,” personal conflicts, defenses, and vulnerabilities. Most importantly, the master therapists were well aware of the potential for these issues to intrude upon the therapy session and possibly do harm to the client. Awareness of personal emotional needs and fulfilling those needs through various activities—including travel, exercise, spiritual practice, psychotherapy, contacts with colleagues, friends, and family—seemed paramount to the therapists. For example, one master therapist said:

When I think about therapists who’ve gotten themselves in difficulty, it’s often because there hasn’t been self-care, and there’s been a looking either to the client to provide something for them, or else not really being available for all that the client might need or want to do as part of their therapy work.

The ability to meet clients’ needs also becomes compromised when therapists do not obtain appropriate resources to meet their own personal needs. Although the therapist is (hopefully) not looking to the client to meet those needs, the client’s care still can suffer. One therapist said:

I think that self-awareness is really the key to helping you understand if you’re getting in the way or not getting in the way, of facilitating, being with and not being with.

In order to be therapeutically effective, awareness of personal problems, biases and conflicts is vital. The management and resolution of countertransference issues appears critical to these therapists in terms of providing quality care for their clients and minimizing the risk of harm to their clients. One master therapist said:

If I’m sitting here and you’re a client and I’m worried about your liking me—I’m worried about your thinking I’m competent, I’m worried about your not getting mad at me—any of those kinds of unfinished issues inside of me makes me powerless to help, makes me very self-centered, and isn’t going to do much for you.

The same master therapist illustrated the connection between self-awareness and ethical behavior with the following discussion of “unfinished issues”:

Well, what I had to start looking at was the fact that I came from an alcoholic family and hadn’t recognized it. So it faced me with needing to look at what it was about myself that had stopped me, I mean, what my countertransference issue was very clearly, in terms of not taking the drinking part seriously … It was the first real experience of running up against my own issues that were clearly getting in the way and harming my clients.

The right of individuals to determine the course of their own lives seemed to be another central value guiding master therapists when making ethical practice decisions. Master therapists appear to greatly respect the phenomenological worldviews of their clients and hold the belief that for change to occur, clients, for the most part, need to be allowed to determine the direction of the therapeutic process. One therapist made the point this way:

I think you always have to give people a choice. Our basic mission is to help them see their choices, and if they want to make bad choices … if somebody wants to go into a bar and scream that everybody in the bar is a son-of-a-bitch and get the hell beaten out of them, that’s their choice. My job is to help them see what the consequence will be if they do that.

Similarly, another master therapist emphasized the clients’ need to be responsible for helping themselves:

If you and I are a couple and I am saying “I am really wounded and it is your job to fix it,” or “help me not feel the pain,” we are going to be in deep, deep trouble. [Psychotherapy] is really [about] helping each of us to recognize our own woundedness and how to reparent that and how to face the disappointment that nobody else is going to do it, including your partner.

The interview data suggested that master therapists were aware of the ethical dangers of thinking they know what is best for their clients, and therefore worked to avoid imposing their own beliefs, values, and ideals on clients. Perhaps because autonomy has been such a central tenet of their own personal development, master therapists believe strongly in the ability of their clients to direct their own lives. One master therapist said:

I mean, we really know what’s best for ourselves and what the truth is about ourselves and own direction. I think that a big part of our job as therapists is to help get all the other voices out of the way for the clients, so they can hear their own and begin to have some faith in it.

Master therapists also defined their role as assisting clients in developing personal coping and growth skills. In reference to the author Sheldon Kopp, one master therapist said:

… another thing he said that impacted me was “A client comes into the room and throws himself at your feet, sort of hanging on to your ankles, hoping that you will save him. A good therapist will step back and let him fall on his face, and be there for him when he learns how to pick himself up.”

The master therapists seemed to believe that encouraging the client’s autonomy was a central part of ethical practice. One therapist referred to how experience and increased competence contributed to being able to better assist clients in discovering their own answers:

The better you get, the more you know how to help the person work, instead of your trying to do the work for them.

Master therapists feel moved to reduce human suffering and to work toward improving the welfare of others. In the unique role of therapist, they have the opportunity to demonstrate caring by helping to transform painful experiences into sources of personal strength. One master therapist viewed the role of a therapist this way:

Sometimes I think as therapists, we are like that second fairy godmother at the christening. I can’t change what was laid down earlier, but then I can help a person soften it or make it go in ways that are more interesting.

Another master therapist described how much she cared for a particular client this way:

There are some people who are very, very slow [to change]. I really get to care about [them] a lot. I would say to one client that I had, “You know, I could take you by the shoulders and shake you, because you won’t believe in yourself at all, and you have so much reason to.”

One master therapist used a metaphor that described being of help to others:

One of the metaphors I often use with my clients is the metaphor of the Wilderness Guide, and the way I [give] back is that they can hire me as a guide, because I know a lot about survival in the wildness, and I’ve through a lot of wilderness—my own, and other people’s wilderness. I’ve got a compass and I can start a fire in the rain. I know how to make it through.

Another master therapist shared this:

People bring in problems that are frightening and abhorrent to themselves and to most people in their lives. I try to create a situation where these problems are approachable and discussable, something that can kind of counteract the person’s embarrassment or shame or whatever and be able to go on to address the problems. I think [my] empathy has the effect of helping people be empathic to themselves.

The master therapists in this sample expressed a good deal of satisfaction in helping others. However, rather than acting out of completely altruistic motives, these therapists acknowledge that they entered this field to meet their personal need to be “useful” or to accrue other personal benefits in their professional work. One master therapist succinctly shared the personal satisfaction of doing therapy:

Where else would I even have this kind of intimate contact with such interesting people? I feel like I am doing a useful job.

Another master therapist enthusiastically described the potential of psychotherapy to be helpful this way:

It [psychotherapy] makes such a difference. Geez, does it make a difference!

Utilizing in-depth qualitative research methods, the current study unobtrusively examined master therapists’ ethical values by analyzing descriptions of their therapeutic work. Several of the study’s findings seem noteworthy. To begin, three of the five most salient ethical values (beneficence, nonmaleficence, and autonomy) paralleled the foundational principles described by Kitchener (1984). Master therapists in this study seemed to be operating out of the higher order virtue ethics, as described by Meara et al. (1996). Again, virtue ethics refer to character traits of the therapist and aspirational ideals instead of “principle ethics,” which focus on professional obligations of knowing specifically if a behavior is unethical. The master therapists did not appear “rule-bounded” on focused on specific rules of conduct such as confidentiality, or bartering. Rather, master therapists seemed to be operating from a far more sophisticated and principled mindset when dealing with the intricacies of ethical practice.

Curiously, Kitchener’s concepts of justice and fidelity did not emerge as ethical values. For example, in terms of justice, the interview data did not indicate that these master therapists worked toward equal access to psychological help for all through means such as providing pro bono work or sliding-scale fees to clients. One possible reason for this finding may be the limited demographic, cultural, and professional diversity of the participant pool. It could be hypothesized that among master therapists who served primarily disenfranchised groups, issues of fairness, equality, and justice may have been more salient, as they were for child guidance center workers studied by Prilleltensky et al. (1999). It also is possible that the absence of these concepts may be an artifact of the unobtrusive data collection method that did not allow for follow-up or probing questions that might have revealed other ethical values.

The master therapists held as extremely important the ethical value of competence. This value is explicitly addressed in the 1992 APA General Principles and the 2002 Ethical Standards. These master therapists worked hard to achieve a high level of skill as therapists and continue to hone their skills through peer consultation, continuing education, readings, self-reflection, and personal psychotherapy. The master therapists’ motivation to maintain a high level of competence was a pervasive theme in the interview data. They recognized that psychotherapy is complicated, difficult work that requires a high level of skill and commitment to continually maintain one’s competency. These therapists are strongly motivated to enhance their clinical work to best serve their clients. They seek out learning opportunities well beyond the minimal requirements of licensing boards. This high level of motivation to be outstanding in their work seems to be a critical trait enables them to achieve and maintain expertise in their field. The master therapists believe that holding an attitude of “not knowing” (all of the answers) keeps them curious. Staying curious seems to serve to minimize stagnation in their work and leads to new opportunities for growth and development.

The study’s most significant finding was the level of importance the master therapists placed on the ethical value of relational connection. The master therapists seemed to highly value interpersonal relationships in all areas of their lives. The interview data suggested that the therapists were very aware of their impact on others and strove for respectful, authentic interactions in professional relationships as well as casual encounters in everyday life. This finding is significant in part because the 1992 APA General Principles did not emphasize this concept as an ethical value. Gilligan’s (1982) ethic of care concept seems to be closely related to the ethical value of relational connection that emerged in these interviews. Gilligan emphasized that moral decision making for women often focuses on how decisions will impact the quality of one’s relationships. Whereas the 1992 APA General Principles seem to align more closely with Kohlberg’s (1984) justice orientation, master therapists seem to give greater weight to how their actions impacted the quality of their working relationships with clients and colleagues.

The ethical value of nonmaleficence seemed very important to the master therapists, who appeared to work hard at not imposing their own beliefs and values onto their clients. It is their belief that if therapists impose their worldview, clients are denied the growth and personal strength inherent in discovering one’s own way, thus doing the client a major disservice. In addition, if therapists do not look at how their own motives and issues may negatively impact their work, they risk harming their clients. Master therapists seemed exceptionally dedicated to the pursuit of self-knowledge in order to help them to recognize and manage countertransference issues that potentially could be harmful to clients.

Another important finding was the ethical value of autonomy. Master therapists seemed committed to encouraging clients’ self-determination, while working to avoid imposing their own beliefs and values. Belief in the client’s personal power may lead to a positive connection with the therapist Clients receiving affirmation of their personal power may feel stronger in their attachment to the therapist. Respectful attitudes toward clients’ self-determination may minimize the risk of harming clients.

Finally, the respectful and caring attitudes of the master therapists also are related to the ethical value of beneficence. It is clear that these master therapists care deeply about their clients’ well-being, and this caring attitude most likely enhances the therapeutic relationship. In keeping with the robust literature on the efficacy of the therapeutic alliance on therapy outcomes (e.g., Lambert, 1992), master therapists acknowledge the importance of and strive towards building therapeutic alliances.

The APA recently adopted a new version of the Ethical of Psychologists and Code of Conduct (http://www.APA.org/ethics, January, 2003). Interestingly, the revisions seems to reflect a shift toward a greater understanding of the deeper character issues and values involved in the ethical practice of psychology. The new principles now are categorized as beneficence and nonmaleficence, fidelity and responsibility, integrity, justice, and respect for people’s rights are dignity.

Overall, the new general ethical principles seem to reflect more fully that the practice of psychology is a value-laden endeavor and charge psychologists with the obligation to address the interpersonal and interpersonal issues believed to affect therapeutic practice. For example, psychologists are directed to explore and manage biases, take responsible steps toward their own functional mental and physical health, and make decisions within the context of mitigating human suffering. These more directive requirements seem to mirror the self-care and self-awareness components of the nonmaleficence value that emerged in the current study. Indeed, the new APA principles appear to pay more attention to the potential harm therapists might cause their clients as a result of the therapists’ powerful role and the clients’ vulnerability.

Relationships are afforded more overt attention in the new code than in the 1992 code. There are many possible reasons for the change, including that this shift may indicate the increased prevalence of Gilligan’s ethic of care decision-making orientation as a result of growing participation by women in the field of psychology. Regardless of the reason, the increased focus on relationships in ethical principles is a welcome modification and supported by the findings of this study.

The ethical principle category now titled justice, an apparently updated version of the 1992 social responsibility and concern for others’ welfare concepts, seems to present a less directive interpretation of the appropriate role of psychologists in promoting social equality and equal access to the benefits of psychology. Although justice continues to include equal opportunity to psychological services and processes, no longer do the codes states that psychologists are “encouraged to contribute a portion of their professional time for little or no personal advantage” (APA, 1992, p. 4). This might either be interpreted as less assertive activism on the part of the APA or as a move toward broader virtue concepts and further away from directive, rule-based codes.

A limitation of the study was the lack of a culturally diverse participant pool. Although the sampling was fairly representative of a northern, Midwestern state, exploring the ethical values only Caucasian, European American therapists limits the usefulness of the results. For example, the concept of autonomy, with its emphasis on the individual versus the group, fundamentally is representative of a Western worldview. Whether this or other ethical values from this study would emerge as primary themes for dialogues with master therapists of other cultural backgrounds remains unclear and warrants further investigation.

Another limitation of the study is that all ten master therapists were solely in private practice. Because clients seeking therapy in a private practice setting are a particular subset of psychotherapy clients, it is possible that other ethical values may have emerged in interviews with therapists working in more diverse settings. For example, the master therapists’ emphases on client autonomy with little mention of more directive approaches may be not hold for therapists working with other client populations (e.g., inpatient clients).

Another potential limitation was the use of existing interview data. Although use of this approach was elected because it is an unobtrusive, thus less reactive research method (Webb, Campbell, Schwartz, & Sechrest, 1966), and useful in identifying the values of the participants (Marshall & Rossman, 1999), it could be that other salient issues might have emerged if the researches had interviewed these master therapists directly about ethical values. In doing so, the researchers might have been able to follow up with questions and probe to elicit a more detailed perspective of ethical values. However, with direct questioning about the ethical aspects of their work (a potentially sensitive topic), the likelihood of socially desirable response would have increased. Despite these limitations, we found that numerous ethical values were clearly embedded in the description of the master therapists’ therapeutic practice.

The current research findings outlined several ethical values of master therapists. Further research can expand upon this list and seek to support or refute these themes. To date, most research related to ethical values has utilized survey methods to assess therapists’ responses to hypothetical ethical dilemmas. The logical subsequent progression for future research would be to ask expert therapists overtly about their ethical values in a qualitative study. Although this direct approach has the potential for reactivity, we believe that a dialogue with expert therapists would provide rich data on the topic. This research could be extended by contrasting the ethical values of expert therapists with novice or “typical” therapists. In an effort to move from self-report methodologies, research examining expert therapists’ ethical values and decision making through simulated or live counseling sessions would provide insights into their practice behavior. Although it is useful to learn what therapists report they would do when dealing with ethical situations, to actually observe therapists handling ethical dilemmas seems to be a more robust approach. Relatedly, simulated or actual interviews with clients could be used to examine the difficulties Bernard et al. (1987) and Wilkins et al. (1990) found that practitioners have in making ethical choices when they know the preferred course of action. Finally, future researchers would do well to investigate the Smith et al. (1991) hypothesis that, in part, therapists may lack certain personal characteristics to act on their ethical beliefs. Psychotherapy research examining Rest’s (1984) model of moral decision making, in which a major component of moral/ethical action is the willingness to act courageously when needed, would be a welcome contribution to the literature.

Knauss (1977) states that “[l]‌earning to practice ethically cannot be effective in an atmosphere that does not value or respect being ethical” (p. 292). Training programs and therapy worksites can promote ethical behavior by encouraging an open dialogue of ethical issues. In many graduate programs, evaluation is ethics courses is based upon the student’s ability to memorize ethical principles and often is measured by successfully passing written tests such as state ethics exams. Training methods that are more experientially based (e.g., role plays, stimulus material for discussion, values clarification exercises, videotapes) may be more likely to encourage self-awareness on behalf of the students and, therefore, nurture the development of ethical values.

Ethics classes also may tend to focus on deficit-based training strategies, such as becoming aware of biases and stereotypes, rather than on identifying the broader values unique to the profession or to each student (Carlson & Erickson, 1999). Reframing goals of values training to include providing space to talk about these personal and ambiguous issues would help to develop a shared language of ethical reflection (Vachon & Agresti, 1992). Additionally, the opportunity to talk with others about the role of particular values in ethical decisions may serve to amplify students’ consciousness of the important of critical reflectiveness (Assouline, 1989) and ultimately assist them in their decision making.

Carlson and Erickson (1999) recommend that value be highlighted from the beginning at therapists-in-training construct their individual theories of the composition of psychological change. Building personal theories around stems such as “I believe” or “I value” serves to integrate personal and theoretical beliefs and invests therapists in the process of therapy. This exercise would allow students to discover values implicit in theories and would set in motion the process of bringing values to the forefront of decision making. Ultimately, it may neither be feasible nor desirable for training programs to instill a particular set of ethical values in psychologists who are competent to make ethical decisions in therapy, more time spent teaching therapists how to identify their own existing underlying values is essential (Assouline, 1989; Corey, 1989; Kovel, 1982).

Another helpful suggestion for both trainees and current practitioners to go deeper into the question of how values influence their work is to spend significant time reflecting on their own experiences and personality. In a traditional feminist approach that incorporates the personal with the theoretical, Bogart (1999) recommends that students answer the question: “What is it about me and my personal history that leads me to these conclusions about people and the process of change?” (pp. 46–47). Examining the ways in which therapists’ backgrounds might shape the process of client assessment and conceptualization provides the opportunity to further develop self-awareness, a hallmark of competent, nonmaleficent ethical practice as highlighted by this study.

Skovholt and Rønnestad (1995) advocate the use of developmental contracts as one approach to therapist development within supervision. Constructing a formal contract that makes explicit the goal of developing awareness of particular values and their role in ethical decision may be a useful tool, particularly because values are such an ambiguous part of therapeutic work. For example, it might be advisable to contract with one’s supervisor to attend to “relational connection” for a particular time period or with a specific client population. As ethical issues then arise in supervision, both the therapist and supervisor are charged with examining how attending to relationships might be a part of finding an ethical solution to a particular dilemma. The structure of a developmental contract may increase both therapists’ and supervisors’ comfort level with higher-order character development because it makes value training a more overt part of the supervision process.

Based upon the findings of the current study, practitioners would do well not only to know their ethics code, but to continue to develop their character (i.e., virtue ethics) and find within themselves the ability to act courageously when dealing with ethically challenging situations. Due to the incomplete and fluid nature of professional ethical codes, it is important that therapists take note of the limitations of using only ethical guidelines as a guide to morally good practice (Grant, 1985).

Overall, this study reinforces the importance of several fundamental ethical principles found in the 1992 and/or 2002 APA General Principles such as doing good (beneficence), doing no harm (nonmaleficence), and respecting the self-direction of clients (autonomy). In addition, master therapists appeared to go beyond the APA guidelines to exceed the requirements to be competent, with their striving toward expertise. An important finding of the current study was the emphasis master therapists placed upon building and forming relationships and how this ability to practice ethically. The master therapists in this study demonstrated how involvement in many forms of relationships seemed to bolster their understanding of the ethical of their professional role.