Yes to “mandatory psychological treatment”
in the new Code of Conduct of the Order of Psychologists
I don’t like the term “psychological”. The psychological does not exist.
Let’s say that you can improve a person’s biography…
J.P. Sartre
The referendum for the revision of the Code of Ethics for Psychologists ended with a positive opinion, the modification of which lends itself to some critical notes which are worth reflecting on. The proposal to revise the articles was made public in April by the National Council of the Order of Psychologists (CNOP), and received approval through an online referendum on 25 September, in which a small number of psychologists participated: they were 16,909 voters (out of a total of 131,584 members of the order and entitled to vote), of which 9,034 gave a favorable opinion, 7,617 gave a contrary opinion, and 258 blank ballots.
The code of ethics of a professional association is not comparable to the law but constitutes an internal ethical reference to the category, which is based on moral principles and rules of conduct to protect users, the category and society; as such it has a high ethical value because it does not require simple attention to the non-violation of ethical rules – as happens in the case of jurisprudence – but invites professionals to active ethics, and therefore to the assumption of a participatory attitude in the choice of one’s own way of being in care and in relation to others.
The changes that have been introduced in the new Code of Ethics for Psychologists need to be the subject of critical reflection, especially for some ethical/deontological changes that go towards a progressive sanitation of the profession, rather than encouraging professionals to take of a habitus, or a moral disposition that favors respect for the human person, and which at the same time facilitates the construction and maintenance of a relationship of mutual trust with the individual and between significant people. In particular, here we want to shed light on some changes that risk distorting the profession, reducing the free will of people and parental figures and, last but not least, decreasing the value of the aspects founding professional practice, such as the relationship and reciprocity in the relationship between those who ask for and those who provide support. An exhaustive analysis of the Code will not be presented in this article, therefore the reader is invited to delve deeper into the text, in particular regarding some important changes listed below:
in the new Code the profession of psychologists is assimilated to the medical model. The previous wording “professional service” has been replaced with “health treatment” (Art. 31); the indication to comply with the “guidelines and good clinical-care practices” was introduced (Art. 22); reference is no longer made to “psychological knowledge” but to “methods and techniques” (Art. 21); and terms such as “diagnosis and prognosis” have been introduced (Art. 24). Please remember that psychologists who are not psychotherapists cannot work within the National Health System. With the modification of the article on “informed consent of capable adults” (Art. 24) the psychologist must update the person regarding the “consequences of any refusal of healthcare treatment”. In the new Code the concept of “secrecy” of the professional relationship is replaced with that of “confidentiality” (Art. 17). With the update made, there is a de-regulation of non-health psychological services (Art. 24, Art. 31), which are instead recurrent in the psychology profession, such as those provided at school, in the perinatal context, in the psychology of work and organizations, in human resources, in psychological counseling, etc. In the articles concerning the “informed consent of capable adults” (Art. 24) and the “informed consent of minors or incapable subjects” (Art. 31) the term ” disqualified” is replaced with “incapable”, without a clear specification of the concept.
It is important to focus on an unclear and controversial change which has sparked a wide debate in recent days, and which concerns the Art. 31 regarding “Informed health consent in cases of minors or incapable persons”, in which the psychologist is given a broad decision-making possibility to report to the judicial authority the need for “psychological treatment” without informed consent. Below you can read the Art. 31 in the first version and in the revised version.
Article 31 (before revision)
Article 31 (revised)
Informed health consent in cases of minors or incapable persons
Professional services to minors or prohibited persons are generally subject to the consent of those who exercise parental authority or guardianship over them. The psychologist who, in the absence of the consent referred to in the previous paragraph, deems professional intervention necessary as well as its absolute confidentiality, is required to inform the Guardianship Authority of the establishment of the professional relationship. This is without prejudice to cases in which such services take place on the order of the legally competent authority or in legislatively designated structures.
Health treatments aimed at minors or incapable persons are subject to the informed consent of those who exercise parental responsibility or guardianship over them. The psychologist and psychologist take into account the wishes of the minor or incapacitated person in relation to their age and degree of maturity in full respect of their dignity. In cases of total or partial absence of the informed consent referred to in the first paragraph, where the psychologist instead deems that medical treatment is necessary, the decision is left to the judicial authority.
The question that emerges is how such a modification can stimulate the moral willingness in psychologists to understand the person in his different way of being, and whether this indication does not rather orient towards the medicalization of the need and the normalization of behaviors considered “non-aligned” to the norm. It is plausible to think that a code of ethics that does not highlight the importance of always keeping the person and their needs at the center could, in some way, determine in psychologists a lower capacity to accept dissent, in favor of a broader directiveness in professional practice.
The other doubt that arises is whether it was appropriate to introduce into the Code of Ethics a construct borrowed from medicine, such as that of “necessary health treatment”, which undoubtedly refers to a semantic horizon and an ethical posture decidedly far from the objectives of an ethical code , and which also distances itself from the orientation and support function that psychologists are called upon to carry out in their professional practice. I remember that psychologists are the figures responsible for welcoming and supporting the suffering and needs of people and families, accompanying them in achieving a broader awareness of their own frailties and resources, thus orienting them towards a greater capacity for autonomy, self- determination and therefore well-being. Reading the new Code, however, it is not clear how all this can be promoted. Furthermore, one wonders how compulsory psychological treatment can be implemented without the collaboration and active involvement of the person, and what the virtues of a similar approach could be, but above all how this possibility can encourage psychologists to know how to be in the treatment, in the broadest sense of the term.
It is also necessary to understand why in a code of ethics that does not replace the law, emphasis has been given to aspects that aim at greater directivity of operators and adherence to science, and instead the importance of exercising that capacity for wisdom and reasonableness, unfortunately residual today, fundamental for those preparing for such a delicate profession. An ethical code, which can be called such, should be a stimulus for psychologists to exercise virtues, such as moderation, prudence, temperance, with respect for the person and beyond their state of suffering, difference or of illness. In a society that has changed a lot compared to the period in which the Code of Conduct for Psychologists was established (1998), it would have been important to facilitate knowing how to be in treatment, in the humanistic meaning that the concept brings with it, as an exercise in availability on the part of psychologists in provide, with one’s behavior, an ethical model of integrity and moral responsibility to which the user could refer. In this way the Code would have remained an important ethical tool for users, for the professional category and for society. But it seems instead that all this is disregarded by choices that do not at all respect the intent for which the Code was established, namely that of offering a shared horizon of values that first of all gives relevance to the person, to his irreducible singularity, not as object of care but as subject of care.
We know that one of the protective factors for every individual is precisely the possibility of being the protagonist of their own life and treatment path. The opportunity to have one’s dignity as a human person recognized – regardless of one’s illness or other condition [legge 180, 1978] – constitutes a right that was obtained with much effort and sacrifice, and which still remains today an ethical reference of inestimable value for every operator. Trying to think about our contemporaneity, looking at the values that in the past have led to the conquest of a more human vision of need, can undoubtedly still be a good way today to encourage critical reflection on today’s choices regarding professional ethics, reminding those who approach the profession that to “take care” of someone you must know, first of all, take into account what the “good” is for that person.