Ethical reasoning and relational responsibility in psychology interns\u27 educational and clinical relationships

Historical accounts, clinical theory, and empirical research converge in suggesting that intimate attachment and feelings of attraction permeate the psychotherapy relationship. When ignored or mismanaged, feelings of attraction can result in transgressions of the therapeutic boundary, often in the form of therapist sexual misconduct. This study explored predoctoral psychology interns\u27 clinical judgment and ethical reasoning in response to incidents of attraction in their clinical and educational relationships. Survey data from a cluster sample of 160 interns revealed that in the course of training, 95% experienced attraction in one or more of their clinical relationships, although 96.9% never seriously considered engaging in sexual contact with a client, and none actually engaged in contact. Similarly, 83.3% experienced attraction in one or more of their educational relationships, with 13.1% seriously having considered engaging in erotic contact with an educator, and 4.4% having done so. Content analysis indicates that attraction in clinical dyads is more likely to be evaluated as growth-promoting, whereas attraction in educational relationships is more likely to be evaluated as growth-inhibiting. Training environments are more likely to be described as supportive in their response to incidents of attraction within clinical dyads, and more likely to be described as unsupportive in their response to incidents of attraction within educational dyads. Ethical reasoning was assessed by means of analysis of self-generated narrative accounts of incidents of attraction in psychotherapy relationships. Narratives were interpreted for level of ethical reasoning using a model operationalized by Arnold (1945) and derived from Bakhtin\u27s (1981) paradigm of authoritative discourse and internally persuasive discourse. Level of ethical reasoning was found to be unrelated to interns\u27 global rating of their ethical training and their experiences of attraction. These results suggest that further examination is needed to identify the dimensions of ethical training which facilitate the development of more complex levels of ethical reasoning