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An ethical dilemma in psychotherapy

North Devon District Hospital, Raleigh Park, Barnstaple, Devon EX31 4JB;

Gwen Adshead, Lecturer

Department of Forensic Psychiatry, Institute of Psychiatry, De Crespigny Park, London SE5 8AF;

Jeanette Smith, Senior Registrar

Fromeside Clinic, Blackberry Hill, Bristol BS16 1EP

This paper examines the ethical principles of justice and autonomy in psychotherapy. A case history is presented which illustrates how ethical dilemmas concerning the type of psychotherapy to be offered are powerfully influenced by often unconscious counter-transference feelings in the resource allocators. The question of how autonomous a psychotherapy patient can be, when unconscious motivations could be affecting rational choice, is also explored and possible answers provided.