Ethical Concerns in Psychodrama

This paper emphasizes the need for specific ethical principles for psychodrama and suggests that professional ethics be included and discussed in training programs. As a basis for such discussions, some illustrative examples of ethical dilemmas are described around the following general principles: responsibility, competence, welfare, advertisement, confidentiality, therapeutic relationships and values. Ethical Concerns in Psychodrama Most schools of psychotherapy adhere to a professional code of ethics that define desired standards of moral conduct for practitioners. Psychodrama should be no exception, as suggested by Moreno (1957) in his "Code of Ethics for Group Psychotherapy and Psychodrama." Surely, if psychodrama is regarded as an approach to psychotherapy (Kellermann, 1992; JD Moreno, 1991), and not as an educational role playing method or as a creative form of theater, psychodramatists should also have some ethical principles of professional conduct. It is unclear, however, if these principles should be the same as those adopted by other mental health professions (Bond, 1993; Lakin, 1988) or if they should be specific to psychodrama. The need for a specific code of ethics in psychodrama is primarily reinforced by the fact that the emphasis on spontaneity and creativity allure participants into transgressing boundaries that would be impossible in other therapeutic settings. Secondly, the psychodrama group with its emphasis on public sharing and selfdisclosure put the principle of confidentiality in serious jeopardy. Furthermore, as psychodrama sessions are often conducted outside the confines of formal institutions such as hospitals, with non-medical para-professionals who have little or no traditional professional obligations, the dangers of violation and denunciation increase. Finally, the psychodramatic action-format, involving more emotional expression, more physical intimacy and more technical experimentation than other verbal approaches to psychotherapy, increase the need for safeguard for both participants and practitioners. For example, in psychodrama, a male therapist may gave his female protagonist an affectionate kiss or a fatherly hug, chairs may be thrown on a wall, a person may stand on the balcony talking as God, people may be lying together on the floor intermingled like in a snake-pit, a person may be vomiting, or a young woman may go through the movements of breast-feeding. These are just some of the things which may occur in psychodrama and which might evoke moral indignation (and perhaps formal complaints) in uninitiated persons who observe a session for the first time. In order to put adequate boundaries around such happenings and still allow for the necessary freedom of spontaneous action, specific ethical principles are badly needed for psychodrama. Some psychodrama associations and training institutes around the world have already developed such codes of ethics of their own, such as the American Society of Group Psychotherapy and Psychodrama (in revision), the British Psychodrama Association (1996), the Australian and New Zealand Psychodrama Association, the Finish Psychodrama Association and the Norwegian Psychodrama Association. Others have suggested that we adopt an elaborate code of ethics of a related mental health profession (e.g. APA, 1992) or that each practitioner adopts the code of his or her own basic profession. Furthermore, discussions on ethics in psychotherapy include a proposal by Meara, Schmidt & Day (1996) to aspire ideal and non-obligatory virtues (prudence, integrity, respectfulness, and benevolence) instead of or in addition to obligatory principles that sometimes, according to Lazarus (1994) might diminish therapeutic effectiveness, if adhered to in a dogmatic and rigid manner. This latter critique was reiterated in a recent discussion on ethics by a psychodramatist who exclaimed: "I would get completely paralyzed and unable to function spontaneously if all those ethical principles were thrown in my face and if I was under a constant threat of being charged by an ethics committee." Despite these reservations, however, 94% of all psychodramatists are in favor of a formal code of ethics, according to an American survey conducted by Kranz & Lund (1995). These respondents felt that psychodrama could benefit from a code of ethics that included definitions of a psychodramatist, boundaries of competence, standards of confidentiality, parameters of the therapeutic relationship, behavior that constitutes sexual exploitation and/or harassment, a process for reporting misconduct, standards for supervision of trainees, and termination of the professional relationship. In addition, ethical standards should include an appreciation of human differences, consultation and referral, keeping of records, fees and financial arrangements, informed consent to therapy, and standardization of education and training programs. Some of these issues were discussed by Blatner (1988) in a chapter on the principles and pitfalls of psychodrama, by Kane (1992) who described some potential abuses, limitations and negative effects of classical psychodramatic techniques, by Croghan (1974) who emphasized the necessity for ethical guidelines in encounter groups, and by Taylor & Gazda (1991) who focused on the ethical issues pertaining to concurrent individual and group therapy. Finally, in a series of papers, JD Moreno (1991; 1994) has perhaps contributed more than anyone else to our understanding of the importance of professional ethics in psychodramatic practice. Whether we develop a code of ethics of our own or adopt one from another school of psychotherapy, professional ethics has become increasingly important in psychodrama. As a consequence, a course in professional ethics should be regularly included in training programs in order to provide non-dogmatic knowledge of ethical principles to students and help practitioners be more aware of an accountable for their actions. An effective, stimulating and commonly practiced approach to teaching ethical principles is to confront students with ethical dilemmas (Abeles, 1980; APA, 1987; Bersoff, 1995; Herlihy & Golden, 1990; Lakin, 1991) in possible real situations of value conflicts. The purpose of the present paper is to suggest some illustrative examples of such troubling situations which may serve as a basis for discussions of ethical conduct and which might be incorporated in a teaching model. J.D. Moreno (1996) suggests that there may be various possible ways to frame principles of ethical conduct, such as the list recommended by Beauchamp & Childress (1995) which includes autonomy, beneficence, non-malificience, and justice. The code of ethics and practice of the British Psychodrama Association includes guidelines concerning the welfare of clients, professional requirements, society related requirements, child protection issues and audio-visual recording. Here, I have chosen the following principles for more in-depth exploration as they seem to be relevant for psychodrama: 1. Responsibility 2. Competence 3. Welfare