A clinical guide to psychiatric ethics, by Laura Weiss Roberts

Laura Weiss Roberts A CLINICAL GUIDE TO PSYCHIATRIC ETHICS The American Psychiatry Association Publishing, 2016, Pp. XVII + 364 $ 75.00 (Paperback).

[ Book Review by Prof. Andrea Castiello d'Antonio. www.castiellodantonio.it ]

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This book is much more than a reflection on professional ethics in psychiatry: the reader will progressively develop - through the pages of this book, and consulting the topics covered in it, across various chapters - an interest in a topic that transcends psychiatric practice and embraces every profession and technical intervention of psychological care. Laura Weiss Roberts, the Author, holds important roles in the “Department of Psychiatry and Behavioral Sciences” at Stanford University School of Medicine, Stanford (California), and has written many works of great interest. This book about the ethics in psychiatry is based on the contribution of twelve people who have signed, with the author, all the twenty chapters, divided into the following three sections: (1) basic concepts, (2) care of special populations, and (3) new issues that are now emerging in the context of psychiatric professional ethics. The first chapters are devoted to illustrate the basic principles of ethics and professionalism in psychiatry – which are declined by recalling a number of definitions offered by different clinicians from the Eighties to the present days –, immediately addressing the thorny issue of decision-making in difficult patients, dubious clinical cases, or cases when acting in an authoritative way on the person it appears necessary. Regarding the latter issue, the Author focuses on 1

the patient's ability to access the psychiatric treatment, the issue of informed consent in the context of confidentiality, and the need to communicate authentically with the person in trouble. The context of the psychotherapeutic relationship, and the constant attention to the therapist-patient interaction process, are the background to all discussions just mentioned. The professional skills required for a mental health worker to act in a correct way are many. Psychiatrists - and all those who deal with mental health – have to carefully consider the global psychological experience of the human being, avoiding to elicit only a list of symptoms. Psychiatrists always have to try to understand how their own motivations, their subjective characteristics, but also their theoretical inclinations can influence the course of therapeutic process. “In psychiatry, patients, who are at times dependent and vulnerable, need to be able to trust that their psychiatrists are knowledgeable, skilled and compassionate and will put the patient’s interests before their own self-interests” (p. 207). The second section of the book deals with the care of particular clinical populations, starting from persons in the evolutionary age, to the people in latelife. Particular emphasis is given to those who suffer from HIV / AIDS and dependency related substances, while a chapter of the so-called difficult patients – including those that bring up powerful emotions to the therapist, and seem to regularly address the therapy towards a dead end – is dedicated to the treatment of veterans, given the importance of such theme in the US. In all these cases, and in others still, it constantly emerges the issue of confidentiality and privacy in comparison to the need to protect other people, or the community, from possible destructive actions carried out by aggressive patients - see paragraph Confidentiality and Truth- Telling in the sixth chapter -. The third section brings the reader to explore a wide range of issues, all focused on the future of the nursing profession, the training of mental health workers and researchers in psychiatry and related disciplines. The seven chapter that are placed here revolve around the building of professional ethics and personal integrity of the physician, giving space to the need – that every therapist should feel - to maintain optimum health conditions and avoid running into situations of overexertion, distress and workaholism; this recall is in line with that advocated by the movement called Healthy Doctor = Healthy Patient¸ which resulted, for instance, in Stanford Medicine Program WellMD. Moreover, it is interesting to note that the therapeutic alliance factor - very well-known in the fields of psychodynamic psychotherapy, and now accepted as a basic element of virtually any instance of theoretical and clinical psychology - is also often recalled in the specific field of clinical psychiatry across the pages of 2

this important book. It hence figures among the ethical principles to be applied during the everyday work of the clinician, together with other elements such as professional integrity, commitment to "make things right" for the patient, accountability, and what is called beneficence and nonmaleficence. On the same comprehensive topics the readers may consult the following texts: Professionalism in Psychiatry, written by Glen O. Gabbard, Laura Weiss Roberts, Holly Crisp-Han, Valdesha Ball, Gabrielle Hobday, and Funmilayo Rachal (The American Psychiatry Association Publishing, Washington, DC, 2012. This book has been translate into Italian by Raffaello Cortina Publishing in 2013, and reviewed by the undersigned on Italian psychoanalytical journal Psicoterapia e Scienze Umane / Psychotherapy and Human Sciences, 2013, XLVII, n. 3), and the new edition of the classic work of Owens Glen Gabbard, Boundaries and Boundary Violations in Psychoanalysis (the American Psychiatry Association Publishing, Washington, DC, 2012), currently in the Italian translation by Raffaello Cortina Publishing.

Book Review published on Italian Hogrefe Newsletter “Qi. Questioni e Idee in Psicologia” No. 38, June 2016 http://qi.hogrefe.it/rivista/cat/recensioni/

http://qi.hogrefe.it/it/

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