The Ethics and Effectiveness of Exposure

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Exposure therapy has garnered attention for its effectiveness and timeliness to cure diagnoses like posttraumatic stress disorder (PTSD), obsessive-compulsive disorder, phobias, and other anxiety disorders. Manuals have been created, self-help books have been published, and online support groups have been developed all for the purpose of establishing an exposure therapy community. Most of the literature around the ethics of it focuses on intentionally causing anxiety and causing harm for the client. In response to this, proponents and advocates of exposure therapy have published numerous articles on the importance of using this therapy for anxiety disorders; and how unethical it is not to use exposure therapy. After a year of an undergraduate internship working with adults who had had traumatic psychological injuries, I was given the privileged position of hearing a client’s perspective on exposure therapy. Some loved it, some hated it but felt compelled to complete, and some refused to do portions of it. Without having a knowledge base in ethical practices, I continued my participation in it: relaxation training. Unbeknownst to me, one of the clinicians who had been conducting exposure therapy with one of our mutual clients was suddenly fired. The client, after finding this out, terminated his treatment with all services. After an internal investigation was conducted, we learned the clinician had a sexual relationship with the client. It should be noted that this clinician was not a psychologist, and the client was referred to another clinic for treatment. However, as an undergraduate student keen to continue her education in counselling, I was became alerted to the detriments of exposure therapy.

I believe exposure therapy can...

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Leo, R. J. (1999). Competency and the capacity to make treatment decisions: A primer for primary care physicians. Primary Care Companion to the Journal of Clinical Psychiatry. 1. 131–141.

Olatunji, B. O., Deacon, B. J., Abramowitz, J. S. (2009). The cruelest cure? Ethical issues in the implementation of exposure-based treatments. Cognitive and Behavioural Practice, 16, 172-180.

Strasburger, L. H., Jorgenson, L., & Sutherland, P. (1992). The prevention of psychotherapist sexual misconduct: avoiding the slippery slope. American Journal of Psychotherapy, 46(4), 544-555.

Wolitzky-Taylor, K. B., Viar-Paxton, M. A., Olatunji, B. (2012). Ethical issues when considering exposure. In T. E. Davis III et al. (Eds.), Intensive One-Session Treatment of Specific Phobias, Autism and Child Psychopathology Series (p. 195- 208). New York, NY: Springer Science + Business Media.

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