ethics of exposure therapy

In contrast to Strasburger et al. (1992), some clinicians encourage boundary crossings as a way to increase the working alliance (Wolitsky-Taylor et al., 2012). Interestingly, Richard and Gloster (2007) found that maintaining proper boundaries was the most common ethical issue associated with exposure therapy. Not only would this be judicious information for any therapist to consider before conducting exposure therapy, it also may account as to why so few therapists engage in exposure therapy despite the evidence of efficacy. Therapists are careful to engage in any behaviours that may result in litigation, such as boundary crossings and violations with the slippery slope.

This could be a result of counsellors’ theoretical orientations. Deacon (2012) notes that clinicians with orientations emphasizing “neutrality, passivity, and nondirectiveness, exposure may involve an uncomfortably high level of active engagement with the patient” (p. 18). Exposure therapy is a treatment in cognitive behavioural therapy (and originally, behavioural therapy) which is notable for producing counsellors that are active, directive, and more authoritative (Corey, 2013). So, while the boundary crossings may be clinically helpful and relevant, it is reasonable to assume that most therapists who fit under this approach would feel uncomfortable with intentional boundary crossings. As a reiteration from my previous recommendation, a specialized training program or certification would address this.

Conducting exposure therapy outside of the office can increase the probability of more casual interactions, diversions in conversation away from therapeutically relevant topics, and maintaining confidentiality more challenging (Olatunji et al, 2012; ). By changing...

... middle of paper ...

...ng the ethics of using it in therapy. With so many other possible treatments shown to be effective, I am left wondering why someone would choose exposure therapy. It seems as the ‘quick and dirty’ treatment for anxiety problems that uses informed and consent as an umbrella that covers all indiscretions and ethical violations. Exposure therapy covers many different ethical realms. After researching all of these, I chose the three that I was most passionate about. While there are a wide range of exposure therapies, I attempted to stay general in order to properly apply these ethical considerations to all treatment methods. I am now able to understand this treatment from all angles, and through using the CPA Code of Ethics and the CAP Standards of Practice. I am left wondering how many newly graduated counselling students use exposure therapy. The thought is petrifying.