Psychotherapeutic Notes: Ethical chaos in the consulting room

IN THE world of psychotherapy and counselling, the word "ethics" is usually used in a very narrow sense to mean, basically, that therapists and counsellors should not take advantage of their patients or clients - be that sexually, emotionally or financially.

This is, of course, important and all therapists and counsellors are required to abide by certain agreed ethical codes. There is, however, a more important sense in which psychotherapy is, or at least ought to be, an ethical undertaking.

The French-Jewish philosopher Emmanuel Levinas who lived from 1906 to 1995 argued that ethics was something far deeper and more complex than just a set of simple (or even complicated) rules about how to behave. For him, ethics was ultimately a question of my responsibility for the other and his point was that this responsibility precedes knowledge of that other. It is something thrust upon me as a human being. Indeed, responsibility is what constitutes me as a human subject. To use a word which Levinas was fond of, responsibility makes me hostage to the other. I do not need to know someone, in other words, in order to be responsible to them.

For Levinas, the most important philosophical question is not "To be or not to be". It is, rather, how being justifies itself. For Levinas, the answer lies in responsibility.

One of the things that differentiates Levinas's ideas about responsibility from those of others is that, for him, responsibility is not about reciprocity. I do not do things for the other because I hope to gain something, even if this is just a hope that I shall be treated in the same way, as in the maxim "Do as you would be done by". Whether or not someone chooses to exercise her responsibility, towards me or anyone else, is their business, as it were. It does not, or should not, affect my exercise of my responsibility.

It is in this sense, I believe, that psychotherapy is - or ought to be - an ethical endeavour. The psychotherapist is called upon to be responsible to the other who has sought help and, of course, the therapeutic relationship is not a reciprocal one. As in life in general, we cannot know in advance what the content of our responsibility to the other will be, what demands it will place upon us. The exact nature of our responsibility will depend on the particular circumstances. Codes and rules are therefore of limited value. Above all, we have to be open to the other.

What does this openness mean? For a start it means abandoning a great deal of what we think of as knowledge, for such knowledge (or presumed knowledge) is questionable. This is particularly relevant to psychotherapists' theories about personality and mental suffering.

There is a place for these when they are offered as possible stories which might be helpful to individuals trying to come to terms with their situation. But, when they are held out as supposed truths about the human condition, we are on dangerous ground. The danger then is that adherence to a theoretical position or way of understanding gets in the way, not only of seeing what is before us, someone unique, utterly different, but also of being with them. It reduces people to types, to categories. Too often, such presumed knowledge or understanding is a flight from the difficulties of uncertainty and not knowing.

It is understandable that doctors, when faced with the chaos, confusion, disorder and disease that we see in our consulting rooms, should reach for the theories which seem to make sense of it all. And yet, all too often, this is a certain violence against the patient and their own uniqueness. This can be an obstacle in the way of a genuine meeting which is what, in some way, those coming to therapy are seeking.

Paul Gordon is author of `Face to Face: therapy as ethics' (Constable, pounds 15.99)