Practical viewpoints on ethical questions and dilemmas in schema therapy

BACKGROUND: Ethics is an inherent part of psychotherapy that protects the interests and rights of all parties engaged in the therapeutic relationship. This article focuses on ethical issues and dilemmas that may arise when using schema therapy.

METHOD: We created a narrative review by searching the databases PubMed, Web of Science, and Scopus with the keywords "psychotherapy", "schema therapy", "therapeutic relationship", "ethics", "ethical questions", and "ethical dilemmas". In addition, we focused on the clinical experience of therapists, training instructors, and supervisors.

RESULTS: Ethical psychotherapy requires adherence to ethical codes and standards. Among the most important ethical principles are confidentiality, informed consent, boundaries of the therapeutic relationship, and dual relationships. Understanding transference, countertransference, and one's modes and schemas is essential to ethical reflection in schema therapy. The article presents examples of ethical dilemmas in schema therapy and suggests possible solutions. At the same time, we point out the need for further research in this field.

CONCLUSION: Similarly to other psychotherapeutic approaches, one of the schema therapist's core competencies is following the profession's ethical principles and productively finding solutions to the occasional ethical dilemmas. Ethics is a prominent part of all psychotherapeutic sessions. Still, it becomes even more central when working with challenging issues such as personality disorders that schema therapy routinely treats. More research on the topic is needed.