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Ethische Fragen im Kontext der Verhaltenstherapie

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Ethische Reflexion und Kompetenz, Leitlinien und Beratung – diese Ansätze sollen in erster Linie Klienten und Patienten in Verhaltenstherapie dienen. Sie unterstützen aber zugleich die beteiligten Berufsgruppen und stärken die professionelle Identität. Auch als Wissenschaftsgebiete brauchen Psychologie und Psychotherapie die Ethik: Voraussetzungen und Folgen der Forschung am Menschen müssen geprüft und bewertet werden. Und im Lichte der gesellschaftlichen Verantwortung der Psychologie und ihrer Mitgestaltung der gegenwärtigen und zukünftigen Lebensbedingungen ist die ethische Dimension sogar ganz entscheidend. Ethik in der Psychotherapie bedeutet auch, neue Forschungsfragen gezielt zu untersuchen: die Rezeption und Umsetzung von ethischen Leitlinien, Brennpunkte der Patientenversorgung wie z. B. vulnerable Gruppen oder Phänomene wie Altersdiskriminierung. Modelle der ethischen Beratung und Qualifizierung bedürfen der Begleitforschung. Schließlich kann die psychologische Forschung selbst auch die Ethikforschung bereichern – und umgekehrt.

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Im Bereich des Case Managements hat die Deutsche Gesellschaft für Care und Case Management (DGCC) als zuständige Fachgesellschaft und Fachorganisation Leitlinien zum Handlungskonzept Case Management entwickelt. Der Begriff Leitlinie wird unterschiedlich gebraucht. Allgemein bezeichnet Leitlinie einen bestimmenden Grundsatz, einen leitenden Gesichtspunkt oder richtungweisenden Anhaltspunkt (für das Handeln).
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Thesis
Ethische Probleme psychologischer Forschung. - Göttingen : Hogrefe, 1980. - 249 S. - Zugl.: Augsburg, Univ., Habil.-Schr., 1978
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In response to the author's article , A. C. Houts and L. Krasner and A. E. Bergin raised several issues that are briefly discussed here. It is argued that (a) behavior therapists really are ethical relativists and also sometimes ethical skeptics, (b) the version of ethical naturalism found in operant behavior therapy does entail ethical relativism, (c) one can maintain a distinction between facts and values without making the distinction an absolute, and (d) a "scientifically respectable" system of ethics is a controversial notion but is one exemplified by the theory of L. Kohlberg. The concern about scientism is a legitimate concern but is one that hopefully can be avoided in psychotherapy. (7 ref)
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Behavior therapists make value judgments and must be able to justify them; it is argued that being able to justify value judgments rules out, however, the common assumption of ethical relativism. Behavior therapists can give up ethical relativism only if they also abandon other cherished views about ethics: that values are just positive reinforcers, that values are individual, subjective preferences, that value judgments cannot be rationally defended, and so forth. Moreover, an examination of the behavior of behavior therapists reveals that, in practice, these principles are given up and that behavior therapists are not ethical relativists. (24 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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This report summarizes the activities of the American Counseling Association (ACA) Ethics Committee during the period of July 1, 2004, through June 30, 2005. Summary data of the complaints filed and the inquiries received are presented.
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Article
Definition of the problem: Decisions concerning treatment limitation and Palliative Care are often complex and accompanied by ethical problems. The crucial question is analyzed as to how helpful existing “Ethics Guidelines” actually are in clinical practice that should offer ethical orientation for decisions about treatment limitation and Palliative Care. The question of what benefit “Ethics Guidelines” give or can give when trying to take a decision, is analyzed in an exemplary way by taking a clinical case study from a collaborative Ethics Study in Intensive Care. “Ethics Guidelines” from Germany, Switzerland, and Great Britain that were the subject matter of a project analyzing international Guidelines are applied to the case and compared. Arguments: The possibilities and limitations of “Ethics Guidelines” in offering ethical orientation regarding problems of decision making about treatment limitation and in Palliative Care are discussed and illustrated in the case study. Conclusion: Finally, conclusions are drawn for the future development of ethical guidelines for clinical practice.
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Article
Zusammenfassung Es wird ein Modell der Ethikkonsultation vorgestellt, das wir im Bereich der Kinderpsychiatrie und Psychotherapie entwickelt und erprobt haben. Ausgangspunkt war die Suche nach einer Arbeitsform, die den beteiligten professionellen Kreisen vertraut ist und eine Nhe zu diskursiven Verfahren der Ethik aufweist. Dafr haben wir die Vorgehensweise des reflektierenden Teams gewhlt und fr unsere Fragestellung modifiziert. Der Konsultationsproze gliedert sich in 3 Phasen: 1. Prsentation des Problems, 2. Reflexion zunchst unter therapeutischer, dann unter ethischer Perspektive und 3. Evaluation der Reflexionen durch die Fallprsentatorin/den Fallprsentator und das gesamte Konsultationsteam. Das Modell bietet damit die Mglichkeit, sowohl ethische Dilemmata zu errtern als auch zwischen behandlungstechnischen und ethischen Problemen zu unterscheiden. Gleichzeitig werden ethische Grundprinzipien auf den Konsultationsproze selbst angewandt. Summary We present a model of case-related ethical reflexions developed and evaluated in the fields of child psychiatry and psychotherapy. Basically we looked for an approach which contains two aspects: familiarity to the professionals involved and proximity to discursive forms of ethical considerations. Therefore, the reflecting team approach seemed appropriate. We divided a modified version into three phases: (1) Presentation of the problem; (2) therapeutic and ethical reflexions; (3) evaluation of the reflexions. This model offers the opportunity to discuss ethical dilemmas as well as to discriminate between therapeutic and ethical problems. At the same time, basic principles of ethics are applied to as well as considered in the consultation process itself.
Article
The aim of this article is to provide recommendations concerning the use of exposure-based therapy for reduction of emotional responding to traumatic memories. Background for these recommendations consists of a summary of the literature on traumatic stress and symptoms of posttraumatic stress disorder (PTSD); an overview of biological, cognitive, and behavioral models for traumatic memory; and a selective review of evidence for the effectiveness of therapeutic exposure as a treatment for trauma memories and PTSD. The recommendations themselves demonstrate how clinical decision making during the course of treatment might be informed by empirical evidence and theoretical models concerning human memory, as well as ethical and legal considerations that mark this topic.
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Examples of ethical dilemmas, emerging in the context of a resident case-centered seminar, are used to illustrate a proposed approach to instruction in ethics for child and adolescent psychiatry residents. In addition to a rudimentary formal didactic curriculum, a teaching methodology is outlined that intentionally focuses on ethical problems, approaches to analyses, proposed courses of action, and attempts at resolution. Four representative issues are utilized: confidentiality, treatment refusal, treatment termination, and the interface of individual and family therapies. Educational objectives include the increased recognition by child and adolescent psychiatry trainees of potential ethical conflicts, of the utility of ethical analyses to inform choices of clinical interventions, and of the desirability of forestalling premature action before attempts at thoughtful resolution.
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The fact that unadaptive neurotic anxiety response habits are learned makes it necessary for the stimulus antecedents to be accurately defined in every case in order to plan effective treatment. This requirement has been frequently neglected in recent years that have witnessed a growing tendency to apply common treatments to cases with common labels, e.g. agoraphobia. This paper argues for the desirability of accurate individual diagnosis, and illustrates its benefits in unique cases and also in respect of three common syndromes--agoraphobia, panic attacks and depression.
Article
Argues that R. F. Kitchener's (see record 1980-05971-001) critique of behavior therapists' value judgments correctly reveals inconsistencies and probable deceptions in the way therapists define and implement values. Neither ethical relativism nor scientism is adequate to complex value issues. Transcendental, spiritual, and Kantian perspectives are needed additions to empiricism and reason. (13 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Ethical debates concerning the use of aversive versus nonaversive behavior management continue among those who treat children with autism, mental retardation, and related disabilities. To identify and discuss the crux of the aversive versus nonaversive debate by defining relevant terminology, examining assumptions and arguments that influence treatment approaches, and exploring the efficacy of nonaversive behavior modification techniques. A case study to illustrate the use of aversive and nonaversive techniques and to compare the findings of these different approaches to treatment As front-line interveners, nurses need to be aware of underlying philosophical and ethical issues if they are to implement the most effective treatment strategies while serving as advocates for the long-term welfare of children and their families.
Article
Psychiatric residents and psychiatrists have little difficulty in making judgments about a clinical course of action to take with patients. However, making ethical clinical decisions is more challenging, because psychiatric residents are usually provided little formal training in ethics. Further, many ethical dilemmas are complex, requiring knowledge of the psychiatric profession's ethics code, moral principles, law, and practice standards and of how they should be weighed in the decision-making process. The purpose of this article is to demonstrate this complexity in regard to the identification of potential ethical dilemmas, understanding the issues that these dilemmas raise, and formulating potential solutions to them. Two common but important areas of treatment in which ethical dilemmas arise (informed consent and competence of care) are used as examples for our presentation. The article demonstrates that to successfully engage in ethical analysis in psychiatry is impossible without substantial formal training in the process.
Article
Participants (62 students from 6 doctoral programs in professional psychology) were given 3 ethical dilemmas, asked to generate their own solutions, and asked to make judgments about a number of provided alternatives. Students were asked either to make decisions after seeking consultation or to make decisions independently of consultation. There were few significant between-group differences along a number of dimensions including participants' ratings of acceptability of provided alternatives and levels of certainty, justification, and satisfaction with personally generated solutions. For one of the vignettes, individuals using consultation, when compared with the control group, were significantly more likely to prefer their own solution to that of provided alternatives. The study was viewed as a needed first step in investigating a cherished assumption in clinical practice.
Article
Ethics consultations increasingly are being used to resolve conflicts about life-sustaining interventions, but few studies have reported their outcomes. To investigate whether ethics consultations in the intensive care setting reduce the use of life-sustaining treatments delivered to patients who ultimately did not survive to hospital discharge, as well as the reactions to the consultations of physicians, nurses, and patients/surrogates. Prospective, multicenter, randomized controlled trial from November 2000 to December 2002. Adult intensive care units (ICUs) of 7 US hospitals representing a spectrum of institutional characteristics. Five hundred fifty-one patients in whom value-related treatment conflicts arose during the course of treatment. Patients were randomly assigned either to an intervention (ethics consultation offered) (n = 278) or to usual care (n = 273). The primary outcomes were ICU days and life-sustaining treatments in those patients who did not survive to hospital discharge. We examined the same measures in those who did survive to discharge and also compared the overall mortality rates of the intervention and usual care groups. We also interviewed physicians and nurses and patients/surrogates about their views of the ethics consultation. The intervention and usual-care groups showed no difference in mortality. However, ethics consultations were associated with reductions in hospital (-2.95 days, P =.01) and ICU (-1.44 days, P =.03) days and life-sustaining treatments (-1.7 days with ventilation, P =.03) in those patients who ultimately did not survive to discharge. The majority (87%) of physicians, nurses, and patients/surrogates agreed that ethics consultations in the ICU were helpful in addressing treatment conflicts. Ethics consultations were useful in resolving conflicts that may have inappropriately prolonged nonbeneficial or unwanted treatments in the ICU.