The physically ill or dying psychotherapist: A review of ethical and clinical considerations.

Abstract

When a therapist becomes gravely ill, not only is the vital therapeutic frame disrupted, but the therapist's preoccupation with personal vulnerability-as well as defenses against such feelings-may preclude acting in the best interests of clients. Although theAPA (1992) provides ethical guidelines that apply to therapists in such situations, the clinical literature more tellingly captures the nature and difficulty of the specific dilemmas that arise. Three such dilemmas for therapists involve (a) self-disclosure to clients about the illness, (b) precautions against the abandonment of clients, and (c) decisions concerning return to practice following a period of absence. The explicit focus in the literature has been on clinical, rather than ethical, implications of various approaches to these dilemmas. A goal of this article is not only to review these clinical perspectives, but also to elucidate the particular ethical values that are embedded within them.One conceptualization of psychotherapy is that of a process whereby the therapist lends his/her ego strength to the client while the client tries to develop or internalize such resources (Gold,The author wishes to thank Annette Stanton, Ph.D., for her suggestions regarding preparation of the article.

Therapists' Experience of Loss: An Interpretative Phenomenological Analysis

“…A loss may lead to enhanced realization of one's own mortality and existential issues but also a normalization of feelings and the need to grieve (Boyden, 2006;Bozenski, 2006, Colao-Vitolo, 2006Millon, 1998). A loss experience might result in greater empathy and improved ability to communicate with clients (Allen & Miller, 1988;Bozenski, 2006;Givelber & Simon, 1981;Guy, 1987;Martin, 2011;Schwartz, 2004) but it can also negatively affect the therapeutic process through the therapists' emotional vulnerability (Balsam & Balsam, 1984;Bozenski, 2006;Millon, 1998;Rappaport, 2000;Schwartz, 2004;Ulman, 2001) and use of psychological defences (Bram, 1995;Chernin, 1976;Counselman & Alonso, 1993;Dewald, 1994;Halpert, 1982).…”

Therapists’ Bereavement and Loss Experiences: A Literature Review

“…Wong (1990) commented on her own illness and its meanings reporting a loss of her body as she knew it, of her control 24 over herself, of her competence and reasoning. Therapists' defences such as denial, omnipotence, narcissistic withdrawal and reaction formation against weakness (Bram, 1995;Chernin, 1976;Counselman & Alonso, 1993;Dewald, 1994;Halpert, 1982) may cause great harm to the neutrality, objectivity, empathy and general engagement with the client (Counselman & Alonso, 1993;Halpert, 1982). A therapist's unresolved losses may affect negatively the therapeutic process as any other unresolved issues (Hayes et al, 2007).…”

Therapeutic Use of Self: Theoretical and Evidence-Based Considerations for Clinical Practice and Supervision

“…Respect for the client and the ethic of integrity can provide guidance in those instances when decisions regarding use of self are more challenging and empirical guidance limited. For example, disclosing to the client a personal difficulty, particularly if this could compromise the therapist's ability to be helpful, such as illness or a significant loss, is preferable to withholding this information (Bram, 1995). This conveys respect for the client and treats the client as an equal.…”