Ethical Issues in Cognitive-Behavioral Therapy

Abstract

This chapter identifies ethical challenges in Cognitive Behavioral Therapy (CBT). It focuses on cognitive and behavioral techniques separately. The first part examines cognitive techniques, where the authors show that evaluating cognitions in terms of validity and utility entails evaluating failures of epistemic and practical rationality. This reveals concerns for professional ethics. For instance, if evaluating cognition for utility involves evaluating practical rationality, then CBT’s evaluation of cognitions is more value laden than first supposed and consequently presents a richer set of challenges for the therapeutic alliance. The second part highlights ethical challenges in exposure-based therapy (EBT) for behavioral therapy. The initiation of EBT provides particular ethical concerns relating to the issues of harm and informed consent. The authors argue that under a will-oriented conception of harm, EBT involves harm. Therefore, clients encounter EBT with rational ambivalence. The possibility of using motivational interviewing (MI) to resolve this ambivalence is discussed.

Ethical considerations of theory-driven and disorder-driven practice.

“…There is a small research literature focusing solely on the ethics of engaging in exposure-based treatments that have been shown to be efficacious for the treatment of anxiety disorders (Abramowitz et al, 2019), stress disorders, PTSD, and OCD (Ratnayake & Poppe, 2021). The premise of this treatment approach is that repeated imaginative or in vivo exposure to a stressor will reduce the stress response.…”