Ethics in Psychoanalytic Practice

The problem with this approach, which operates according to some notion of the existence of conscience under law, is that some people who carry out the most horrific actions do themselves feel themselves to be following some version of a moral injunction and to be in conformity with what human nature is like.

The third approach is concerned with the calculation of goods, of costs and benefits of actions for different individuals. This is the universe of Jeremy Bentham, which presumes that it is possible to determine what will be good for people and bad for them and to arrange roles and responsibilities so that the greatest possible good is distributed among them. Again, psychotherapy includes enough models of human behaviour to warrant this version of ethics. Here, some of the strands of work in the cognitive-behavioural tradition, which seem to refuse to adopt a specific moral standpoint, do actually rest on notions of what healthy and unhealthy patterns of behaviour are and how contingencies of reinforcement might be set up to bring benefit to people. The assumption that a ‘mapping document’ could lay out the field of therapeutic practice in a clear and objective manner, and that we could draw up criteria for the ‘evidence’ that would make our activity understandable and predictable is part and parcel of this notion of ethics.

The problem with this approach is that it rather conveniently overlooks what the stakes are for the individuals or groups that arrange the distribution of goods. Some neutral position outside the system is presupposed so that decisions can be made which are not themselves affected by certain benefits. Psychoanalysis, which is one of the most intense reflexive conceptual frameworks, would ask what the individual who arranges things gets out of it. And the problem lies not so much at the level of particular decisions as at a deeper systemic level – structurally distributed powers – in the very position accorded to those who will decide.

Critical appraisal of these three approaches to ethics is a ground-clearing exercise. It is not possible to do psychoanalytic clinical work if you operate on some ideal image of the Good, if you intend to strengthen conscience and conformity, or if you try to calculate the costs and benefits of actions.

Against these common taken for granted ideas about ethics, psychoanalysts make some quite different assumptions about the nature of the person we see in our clinical practice and the nature of the work. The human subject is divided between conscious experience and the unconscious, and the unconscious is itself divided and resistant to being understood. We can identify here six elements of ethics in psychoanalytic practice.

First, the individual subject is complex rather than ‘integrated’. While the illusion that integration of the self may be a comforting one, it is one that we question in our work. The nature of the unconscious, and its presence in every conception that a person has about themselves, not least in psychotherapy, is crucial to all forms of psychoanalysis.