Ethics in Psychoanalytic Practice

by Ian Parker

The drive to state regulation often appeals to the notion of ethics, but attempts by psychotherapeutic training and registration bodies to enforce ethical behaviour in line with the demands of the state, or what organisations imagine the state demands, may only serve to bind its practitioners all the more firmly to dubious unethical practices. To untangle the ‘ethics’ that is being assumed in these debates we can start by identifying some of the problems with theoretical vantage points on ethics in Western culture, then we might know better what assumptions we may unwittingly fall into when we attempt to formulate an ethics appropriate to psychoanalytic work. Then, against this background, we can outline some elements of ethics in psychoanalytic practice.

A first common approach is one that presumes that we can all agree what a ‘Good’ is that we should be aiming at and against which we can easily define what falls below it as the ideal standard. This is a notion of ethics that we find in Aristotle onwards. There are, of course, theoretical frameworks in psychotherapy that would be compatible with this notion of the Good and of ethics. Specifications of essential underlying human nature, perhaps deriving from the secular humanist tradition, for example, would presume that we do know what it is to do right and wrong. The idea that a therapist can have an objective sense of their qualities, both rational and irrational, for example, buys into this approach to ethics.

The problem is that once we start to take psychoanalysis seriously the perception of the Good is thrown into question. The Good is not something that already exists somewhere to be intuited and aimed at, but it is something that is constructed by us. First because it functions as an ideal which we set up ourselves based on our own idiosyncratic experience of what is delightful and alluring to us, an image of what we would like to be or a point from which we would like to seen as likeable. And second because every notion of the Good that we too easily conflate with what is beautiful to us, is suffused with fantasy. What may be good to us as an ideal that is suffused with fantasy, then, may turn out to be quite horrific to other people.

The second approach appeals to an imperative to follow the right course of action, which we assume to be potentially if not actually present in each individual human being. This is the way of Kant, and the categorical imperative, in which we are asked to assess our action according to the maxim that we should imagine it to be carried out by all other human beings, applicable to them; this maxim is designed to bring some measure of universality directly into the moral decision-making of any particular individual. Again, this is an ethical paradigm that we can imagine certain traditions in psychotherapy adopting with ease. The image of the person as containing within themselves a conscience by virtue of which they are able to participate in a society as a civilised enlightened human being can then even be translated into certain psychoanalytic models of the personality that psychotherapists sometimes draw upon. Here, images of ‘the public’, ‘norms’ and ‘good practice’ are compressed into the idea that there is some shared moral framework that we should all adhere to.