Electroconvulsive Therapy

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Chapter 13 Treatment of Psychological Disorders
are in harmony with that view (Dyche & Zayas, 2001; Pedersen & Draguns, 2002; Stuart,
2004; Ulrich, Richards, & Bergin, 2000). Minimizing misunderstanding and miscommunication is one of the many ethical obligations that therapists assume when working with clients (Tomes, 1999). Let’s consider some others.
Rules and Rights in the Therapeutic Relationship
Treatment can be an intensely emotional experience, and the relationship established
with a therapist can profoundly affect a client’s life. Professional ethics and common
sense require the therapist to ensure that this relationship does not harm the client. For
example, the American Psychological Association’s Ethical Principles of Psychologists and
Code of Conduct forbids a sexual relationship between therapist and client—during
treatment and for at least two years afterward—because of the severe harm it can cause
the client (American Psychological Association, 2002b; Behnke, 2004).
These ethical standards also require therapists, with a few exceptions, to keep strictly
confidential everything a client says in therapy. Confidentiality is one of the most
important features of a successful therapeutic relationship. It allows the client to reveal
unpleasant or embarrassing impulses, behaviors, or events without fear that this information will be repeated to anyone else. Professionals do sometimes consult with one
another about a client, but each is required not to reveal information to outsiders
(including members of the client’s family) without the client’s consent. The APA’s code
of ethics even includes standards for protecting confidentiality for the growing number of clients who seek psychological services via telehealth or e-health channels, which
include telephone, video conferencing, e-mail, or other Internet links (APA, 2002b;
Barnett & Scheetz, 2003; Christensen, Griffiths, & Jorm, 2004; Fisher & Fried, 2003;
Mohr et al., 2005; Ruskin et al., 2004). One of these standards requires therapists to
inform clients that others might be able to gain access to their e-mail messages and
that no formal client-therapist relationship exists in e-mail exchanges.
Professional standards about confidentiality are backed up in most U.S. states and
in federal courts by laws recognizing that information revealed in therapy (like information given to a priest, a lawyer, or a physician) is privileged communication. This
means that a therapist can refuse, even in court, to answer questions about a client or
to provide personal notes or recordings from therapy sessions. Only under special circumstances can therapists be legally required to violate confidentiality. These circumstances include those in which (1) a client is so severely disturbed or suicidal that hospitalization is needed, (2) a client uses his or her mental condition and history of
therapy as part of his or her defense in a civil or criminal trial, (3) the therapist must
defend against a client’s charge of malpractice, (4) a client reveals information about
sexual or physical abuse of a child, and (5) the therapist believes a client may commit
a violent act against a specific person.
Source: The Museum of the History of Medicine
of the University of Zurich, accessed on-line at
http://www.nobel.se/medicine/articles/moniz/.
Here are examples of the chains, straitjackets, belts,
and covered bathtubs that were used to
restrain disruptive patients in North
American and European mental hospitals
in the 1800s and well into the 1900s.
These devices were gentle compared with
some of the methods endorsed in the late
1700s by Benjamin Rush. Known as the
“father of American psychiatry,” Rush advocated curing patients by frightening or
disorienting them—for example, by placing them in a coffin-like box that was
then briefly immersed in water.
HOSPITAL RESTRAINTS
Biological Treatments
䉴 Is electric shock still used to treat disorders?
So far, we have described psychological approaches to the treatment of mental disorders. But biological treatments are also available—primarily through psychiatrists and
other medical doctors, who often work in cooperation with psychologists. Today,
biological treatments for psychological problems mainly involve the prescribing of
psychoactive drugs. In the mid-1900s, however, the most common biological treatment
for severe psychological problems was to create seizures using electric shock.
Electroconvulsive Therapy
In the 1930s, a Hungarian physician named Ladislaus Von Meduna used a drug to
induce convulsions in people with schizophrenia. He believed—incorrectly—that