Final Learning Report
Steven Typa
RGP6564: Professional Ethics for Psychotherapy & Spiritual Care
Dr. Desmond Buhagar
December 16, 2022
2
Introduction
I came into the Masters of Pastoral Studies program with a call to psychotherapy. I knew
little about spiritual care. When I started this program, my future goal was to work with
Catholics as a therapist at Catholic Family Services. Through my first semester, my eyes have
been opened to more possibilities for future careers. After this first semester, I could also see
myself working in spiritual care in the future. In the Foundations in Counselling & Spiritual Care
course, I had the opportunity to learn and practice counselling skills. I plan to do my first
practicum this summer. Either through psychotherapy or spiritual care, I would like to assist
people that have had spiritual experiences, such as near-death experiences, to integrate those
experiences into their lives.
I am in the first semester of my studies in spiritual care and psychotherapy coming in
with almost no knowledge or experience with psychotherapy and spiritual care. Through this
course, Professional Ethics in Psychotherapy & Spiritual Care, and my course in Foundations in
Counselling & Spiritual Care, I have begun my clinical-therapeutic formation. The most salient
topics for me from this course have been relationships, ethical decision-making, boundaries,
cultural diversity, confidentiality, consent, competency, online psychotherapy, and virtue. While
all these topics are important, the client-therapist relationship seems to be at the center of
professional ethics for psychotherapy.1
Relationships
Professional ethics looks at whether a group of professionals, such as psychotherapists
adhere to a system of values, such as the College of Registered Psychotherapists of Ontario
1
College of Registered Psychotherapists of Ontario (CRPO). Professional Practice Standards for Registered
Psychotherapists (2016). Section 3: Client-Therapist Relationship, p. 26. (Course Reader, p. 132).
3
(CRPO) code of ethics.2 The CRPO code of ethics aligns with the CPA code of ethics with
respect to a desire to uphold respect for the dignity of all persons, responsible caring, integrity in
relationships, and responsibility to society. Relationships with individuals and groups seem to be
prioritized.3 The client is not the only person affected by the decisions, the process, and the
results of the therapeutic relationship. Family, friends, co-workers, and the client’s broader
community may be affected by the client-therapist relationship.4
While the therapeutic relationship may be the most central relationship for the client-
therapist relationship, the therapist is not to neglect their other relationships, such as their
relationships with supervisors, social institutions, colleagues, students, other professionals and
the community.5 As therapeutic professionals we are not only accountable to our clients but to
the broader community through a code of ethics and as part of a governing organization such as
CRPO or the Canadian Association for Spiritual Care (CASC).6
Ethical Decision Making
Governing organizations such as CRPO and CASC cannot rely solely on relational ethics
for regulating psychotherapy and spiritual care due to the subjective and experiential nature of
relational ethics. Relational ethics is only one-quarter of Truscott’s 4-Quadrant Model of Ethical
Decision Making. The other three categories for ethical decision-making are virtue ethics,
2
Derek Truscott and Kenneth H. Crook, Ethics for the Practice of Psychology in Canada (Edmonton, Alberta: Pica
Pica Press, an imprint of University of Alberta Press, 2021), 3.
3
Desmond Buhagar. PowerPoint: Understanding Ethics. Class 1, Sept 14, 2022. Professional Ethics in
Psychotherapy and Spiritual Care, p. 15.
4
Derek Truscott and Kenneth H. Crook, Ethics for the Practice of Psychology in Canada (Edmonton, Alberta: Pica
Pica Press, an imprint of University of Alberta Press, 2021), 28-29.
5
Desmond Buhagar. Handout: Truscott’s 4 Quadrants of Ethical Decision Making. Professional Ethics in
Psychotherapy and Spiritual Care, 2022. Core Documents: Quercus. p. 2.
6
Richard Gula. Just Ministry: Professional Ethics for Pastoral Ministers. Mahwah: NJ. Paulist Press, 2010. Ch 2:
Ministry as Profession, p. 37-38
4
deontology and teleology.7 Relational ethics focuses on relationships and calls us to listen to the
client and others. Virtue ethics focuses on our motives and calls us to get in touch with our
feelings about a situation or ethical dilemma. Deontological ethics focuses on duties and calls us
to review relevant professional documents such as codes of ethics or professional guidelines.
Teleological ethics focuses on consequences and calls us to consider the potential consequences
of a potential action. Each category of ethical decision-making is to be utilized and incorporated
together to make the best decision. They inform and build on each other, starting with relational
ethics.8
Boundaries and Dual Relationships
Before beginning this course, I had not considered the boundaries between a therapist and
a client. I did not understand the issue of clients and therapists being friends. I now understand
the need for therapists to set professional boundaries with clients. The College of Register
Psychotherapists in Ontario (CRPO) is clear that it is the role of the psychotherapist to maintain
boundaries in a therapeutic relationship. A psychotherapist is not to engage with a client outside
of their role as a psychotherapist.9 When the therapist has a relationship with the client in
addition to the therapeutic relationship, a dual relationship exists.10 Dual relationships can be a
slippery slope leading to the accidental crossing of boundaries.11 There is a power imbalance to
7
Desmond Buhagar. Handout: Truscott’s 4 Quadrants of Ethical Decision Making. Professional Ethics in
Psychotherapy and Spiritual Care, 2022. Core Documents: Quercus. p. 1.
8
Derek Truscott and Kenneth H. Crook, Ethics for the Practice of Psychology in Canada (Edmonton, Alberta: Pica
Pica Press, an imprint of University of Alberta Press, 2021), 25-27.
9
College of Registered Psychotherapists of Ontario (CRPO). Professional Practice & Jurisprudence for Registered
Psychotherapists (2019). Section 2: Client-Therapist Relationships, C. Boundaries, p. 25. (Course Reader, p. 45).
10
College of Registered Psychotherapists of Ontario (CRPO). Professional Practice & Jurisprudence for Registered
Psychotherapists (2019). Section 2: Client-Therapist Relationships, C. Boundaries, III. Dual Relationships, p. 26.
(Course Reader, p. 46).
11
Desmond Buhagar. PowerPoint: Maintaining Boundaries. Class 8, Nov 9, 2022. Professional Ethics in
Psychotherapy and Spiritual Care, p. 8.
5
acknowledge and respect between a therapist and a client.12 Client-therapist relationships are in
danger when they assume mutuality. It is important to recognize the power imbalance in a
therapeutic relationship. Boundaries are not just physical, they can be informational, such as the
therapist discussing irrelevant personal information about themselves or others. Being a therapist
requires being assertive, being knowledgeable about boundaries, and being able to say no when
necessary.13 Boundary setting is not to be begrudgingly accepted but to be seen as a form of
respect for the sanctity of everyone in a relationship.14
In the article, “Fetters or Freedom: Dual Relationships in Counselling,” the author, Syme
discusses how difficult it can be to avoid dual relationships, especially in small, isolated
communities where the therapist has dual relationships with clients. While a therapist living in a
small, isolated community may focus on providing therapy online, the therapist may find it
difficult to refer friends that would like to see a therapist in person to another therapist if they are
the only therapist in town. 15 Syme acknowledges that sexual dual relationships are never
appropriate and provides helpful advice in the form of a list of safeguards when considering a
non-sexual dual relationship. Among the safeguards for a dual relationship, discussing the
potential dual relationship in supervision is mentioned twice. The question of whether the
potential dual relationship is a cultural norm is important to consider.16 The idea that it is best to
avoid dual relationships comes from an individualistic western culture. Working within a more
12
Desmond Buhagar. PowerPoint: Maintaining Boundaries. Class 8, Nov 9, 2022. Professional Ethics in
Psychotherapy and Spiritual Care, p. 3.
13
Desmond Buhagar. Lecture: Boundaries. Class 8, Nov 9, 2022. Professional Ethics in Psychotherapy and Spiritual
Care.
14
Video: A Sacred Trust: Boundary Issues for Clergy and Spiritual Teachers, FaithTrust Institute (2003). Part 1.
15
Gabrielle Syme, “Fetters or Freedom: Dual Relationships in Counselling,” International Journal for the
Advancement of Counselling 28, no. 1 (2006): pp. 57-69, https://doi.org/10.1007/s10447-005-8499-7, 65.
16
Gabrielle Syme, “Fetters or Freedom: Dual Relationships in Counselling,” International Journal for the
Advancement of Counselling 28, no. 1 (2006): pp. 57-69, https://doi.org/10.1007/s10447-005-8499-7, 67-68.
6
communal-based culture, it may not only be difficult to avoid dual relationships but avoiding all
dual relationships could be harmful to forming a trusting therapeutic relationship. 15
Cultural Diversity
Psychotherapists are challenged to be considerate of people from cultures outside of their
cultural group, learn about other cultures, and have some understanding of various cultural
groups. There can be tensions between the universal and particular as psychotherapists may
attempt to apply universal norms to clients from different cultures.17 Psychotherapists have a
responsibility to be mindful of not imposing their worldview and cultural preferences onto
clients.18 In the article titled “Ethnography in Counselling Research”, the author, Suzuki outlines
an essential balance of counselling psychology: being close enough to form a trusting
relationship, yet distant enough to preserve healthy boundaries.19
Confidentiality
During initial communication with a client or potential client, to manage boundaries
effectively it is important to outline the limits of confidentiality.15 The limitations of
confidentiality are important because confidentiality is fundamental to the practice of
psychotherapy. 20 Circumstances in which psychotherapists may need to breach confidentiality
include the mandatory reporting of child abuse, reporting real threats of serious physical harm or
17
Desmond Buhagar. PowerPoint: Appreciating Diversity. Class 9, Nov 16, 2022. Professional Ethics in
Psychotherapy and Spiritual Care, p. 8.
18
Desmond Buhagar. PowerPoint: Appreciating Diversity. Class 9, Nov 16, 2022. Professional Ethics in
Psychotherapy and Spiritual Care, p. 9.
19
Lisa A. Suzuki et al., “Ethnography in Counseling Psychology Research: Possibilities for Application.,” Journal
of Counseling Psychology 52, no. 2 (2005): pp. 206-214, https://doi.org/10.1037/0022-0167.52.2.206, 207.
20
College of Registered Psychotherapists of Ontario (CRPO). Professional Practice Standards for Registered
Psychotherapists (2016). Section 3: Client-Therapist Relationship, 3.1, Confidentiality, p. 26. (Course Reader, p.
132).
7
death, a call to provide evidence in a civil trial, and if a client initiates a civil lawsuit against a
psychotherapist.21 Psychotherapists have a professional and legal responsibility of confidentiality
to their clients within legal limits to confidentiality.20 Confidentiality is the second most
important matter in a client-therapist relationship after consent.22 As an autonomous person, a
client has a right to privacy.23 A right to privacy empowers the client to control the extent to
which their thoughts, feelings and information is shared or withheld from others.24
Consent
For a client’s consent to be considered valid, it must be informed, voluntary, specific and
not involve misrepresentation or fraud.25 Clients are to be informed of possible risks, adverse
effects and alternative treatment options.26 While ongoing consent can be implied by a client’s
ongoing voluntary attendance to therapy sessions, any changes in the therapist’s therapeutic
approach should not only be noted but should receive consent from the client.25 Starting a
question with the word “may” helps ask for consent. Keep the client’s consent in mind for every
therapeutic moment. Consent is a therapeutic instrument used to measure the willingness of a
client to participate in therapy.27
Competency
21
Desmond Buhagar. PowerPoint: Protecting Confidentiality. Class 6, Oct 19, 2022. Professional Ethics in
Psychotherapy and Spiritual Care, p. 6-11.
22
Desmond Buhagar. PowerPoint: Protecting Confidentiality. Class 6, Oct 19, 2022. Professional Ethics in
Psychotherapy and Spiritual Care, p. 2.
23
Derek Truscott and Kenneth H. Crook, Ethics for the Practice of Psychology in Canada (Edmonton, Alberta: Pica
Pica Press, an imprint of University of Alberta Press, 2021), 105.
24
Desmond Buhagar. PowerPoint: Protecting Confidentiality. Class 6, Oct 19, 2022. Professional Ethics in
Psychotherapy and Spiritual Care, p. 3.
25
College of Registered Psychotherapists of Ontario (CRPO). Professional Practice Standards for Registered
Psychotherapists (2016). Section 3: Client-Therapist Relationship, 3.2, Consent, p. 30. (Course Reader, p. 136).
26
College of Registered Psychotherapists of Ontario (CRPO). Professional Practice Standards for Registered
Psychotherapists (2016). Section 3: Client-Therapist Relationship, 3.2, Consent, p. 29. (Course Reader, p. 135).
27
Desmond Buhagar. Lecture: Consent. Class 5, Oct 12, 2022. Professional Ethics in Psychotherapy and Spiritual
Care.
8
While a client can theoretically consent to psychotherapy from anyone, a psychotherapist
should be competent when providing psychotherapy. Competent psychotherapists can help their
clients without harming them. Competence can be understood by understanding three
components of competency: knowledge, skills and judgement. Knowledge is the understanding
and comprehension of relevant information, such as codes of ethics. Skill is the effective
application of knowledge in practice, including personal skills such as self-awareness. Judgment
is the ability to discern and decide when the application of a particular set of knowledge is
appropriate.28
Online Psychotherapy
The practice of psychotherapy over the internet adds a layer to competency regarding
utilizing communications technology effectively and appropriately. Prepare for potential
technical difficulties with the communications technology. Recognize and communicate the
limits of confidentiality in using communications technology to the client.29 Communication over
email or text message should be very limited due to confidentiality issues of private information
being accessed or read by a third party.30 Asynchronous communication is not only unsafe in
terms of confidentiality but can result in confusion, frustration or anxiety from clients that may
expect an immediate response.31
Virtue
28
Derek Truscott and Kenneth H. Crook, Ethics for the Practice of Psychology in Canada (Edmonton, Alberta: Pica
Pica Press, an imprint of University of Alberta Press, 2021), 123-124.
29
College of Registered Psychotherapists of Ontario (CRPO). Electronic Practice Professional Practice Guideline
(2019). (Course Reader, p. 174).
30
Desmond Buhagar. PowerPoint: Protecting Confidentiality. Class 6, Oct 19, 2022. Professional Ethics in
Psychotherapy and Spiritual Care, p. 11.
31
Jason M. Murphy and Andrew M. Pomerantz, “Informed Consent: An Adaptable Question Format for
Telepsychology.,” Professional Psychology: Research and Practice 47, no. 5 (2016): pp. 330-339,
https://doi.org/10.1037/pro0000098, 331.
9
It is not always easy to respond well to a distressed client. While our emotions can help
us to act, emotions cannot be used as the sole guide to decide on the most appropriate action. 32
As a human being, the therapist is oriented to being a good person. To develop into humble,
kind, and patient therapists we must nurture and develop our virtuous character. We can develop
our character through observation, imitation and practice. There is a moral feedback loop
between what we do and who we become.33
Conclusion
At the end of my first semester in the Masters of Pastoral Studies program, I still feel
called to psychotherapy, but I recognize the knowledge, skills, and judgment I will need to gain
to become an excellent psychotherapist. I will strive to not neglect any of my relationships,
including fellow students, professors, supervisors, clients, others, and the broader community.
Professional boundaries are crucial for healthy relationships with clients. Dual relationships are
advised against unless it is more harmful to shut down a dual relationship with a client. It is best
to approach other cultures with an openness of curious humility to learn about other cultural
experiences. Trust in the client-therapist relationship relies on confidentiality. Consent is to be
informed and ongoing, so that therapist may be certain of the client’s willingness to continue
with therapy. Conducting therapy through the internet presents new challenges in the form of
confidentiality, competency, and consent. A therapist must not only be a good person but also
competent in their therapeutic skills. I look forward to developing my therapeutic skills
throughout my studies, practicum and work.
32
Desmond Buhagar. PowerPoint: The Virtuous Minister. Class 3, Sept 28, 2022. Professional Ethics in
Psychotherapy and Spiritual Care, p. 6
33
Richard Gula. Just Ministry: Professional Ethics for Pastoral Ministers. Mahwah: NJ. Paulist Press, 2010. Ch 3:
The Minister’s Character, p. 68-69.
10
Bibliography
Buhagar, Desmond. Handout: Truscott’s 4 Quadrants of Ethical Decision Making. Core
Documents: Quercus. p. 2. Professional Ethics in Psychotherapy and Spiritual Care, 2022.
Buhagar, Desmond. Lecture: Boundaries. (Class Eight: Nov 9). Professional Ethics in
Psychotherapy and Spiritual Care, 2022.
Buhagar, Desmond. Lecture: Consent. (Class Five: Oct 12). Professional Ethics in
Psychotherapy and Spiritual Care, 2022.
11
Buhagar, Desmond. PowerPoint: Appreciating Diversity. (Class Nine, Nov 16, p. 8-9).
Professional Ethics in Psychotherapy and Spiritual Care, 2022.
Buhagar, Desmond. PowerPoint: Maintaining Boundaries. (Class Eight, Nov 9, p. 3-8).
Professional Ethics in Psychotherapy and Spiritual Care, 2022.
Buhagar, Desmond. PowerPoint: Protecting Confidentiality. (Class Six, Oct 19, p. 2-3).
Professional Ethics in Psychotherapy and Spiritual Care, 2022.
Buhagar, Desmond. PowerPoint: The Virtuous Minister. (Class Three, Sept 28, p. 6).
Professional Ethics in Psychotherapy and Spiritual Care, 2022.
Buhagar, Desmond. PowerPoint: Understanding Ethics. (Class One, Sept 14, p. 15). Professional
Ethics in Psychotherapy and Spiritual Care, 2022.
College of Registered Psychotherapists of Ontario (CRPO). Electronic Practice Professional
Practice Guideline (2019). Course Reader, p. 174. Professional Ethics in Psychotherapy
and Spiritual Care, 2022.
College of Registered Psychotherapists of Ontario (CRPO). Section 2: Client-Therapist
Relationships, C, Boundaries, p. 25-26. Professional Practice & Jurisprudence for
Registered Psychotherapists (2016). Course Reader, p. 45-46. Professional Ethics in
Psychotherapy and Spiritual Care, 2022.
College of Registered Psychotherapists of Ontario (CRPO). Section 3: Client-Therapist
Relationship, p. 26-30. Professional Practice Standards for Registered Psychotherapists
(2016). Course Reader, p. 132-136. Professional Ethics in Psychotherapy and Spiritual
Care, 2022.
Gula, Richard M. Just Ministry: Professional Ethics for Pastoral Ministers. Mahwah, NJ: Paulist
Press, 2007.
Murphy, Jason M., and Andrew M. Pomerantz. “Informed Consent: An Adaptable Question
Format for Telepsychology.” Professional Psychology: Research and Practice 47, no. 5
(2016): 330–39. https://doi.org/10.1037/pro0000098.
A Sacred Trust: Boundary Issues for Clergy and Spiritual Teachers, Faith Trust Institute. Part 1:
Boundaries, Power and Vulnerability. USA: FaithTrust Institute, 2003.
Suzuki, Lisa A., Muninder K. Ahluwalia, Jacqueline S. Mattis, and Cherubim A. Quizon.
“Ethnography in Counseling Psychology Research: Possibilities for Application.” Journal
of Counseling Psychology 52, no. 2 (2005): 206–214. https://doi.org/10.1037/0022-
0167.52.2.206.
12
Syme, Gabrielle. “Fetters or Freedom: Dual Relationships in Counselling.” International
Journal for the Advancement of Counselling 28, no. 1 (2006): 57–69.
https://doi.org/10.1007/s10447-005-8499-7.
Truscott, Derek, and Kenneth H. Crook. Ethics for the Practice of Psychology in Canada.
Edmonton, Alberta: Pica Pica Press, an imprint of the University of Alberta Press, 2021.
