臨床心理師心理治療中知後同意專業倫理之行為、省思與改變行動之探究

Informed Consent in Psychotherapy: A Qualitative Study of Ethical Behaviors, Reflections and Actions for Change of Clinical Psychologists

本研究旨在探究臨床心理師心理治療中，知後同意之倫理行為脈絡、對現況的省思，以及可採取之改變行動與建議。本研究之研究方法為邀請七位臨床心理師進行焦點團體訪談及個別深度訪談，蒐集質性資料，並以紮根理論研究法進行資料分析。研究結果發現，在臨床實務上，參與者未實踐知後同意倫理行為原因包括：機構因素、屬已知訊息、依情況告知、僅一般性說明、治療者抗拒、提供訊息困難及不熟悉倫理規範差異等；參與者的倫理省思則涵蓋：對當事人權益的關注不足、執業場域的影響、對治療的影響、治療者的自我保護、治療者本身因素等；在可採取的改變行動與建議方面則有：強化資訊呈現與口頭說明、重視分享專業訊息、治療者個人的提升及提高專業倫理標準等。本文最後依據研究結果進行相關議題討論，進而提出對臨床實務、倫理守則修訂、倫理教育規劃，以及未來研究之建議。

 

The purpose of the study is to explore the ethical context of informed consent in psychotherapy practiced by clinical psychologists, reflecting on the current situation, and offering suggestions and potential courses of action for improvements. Seven experienced clinical psychologists were invited to participate in both focus group interview and one-on-one intensive interview. Grounded theory was used to analyze the collected data. The results of the study revealed that the reasons for the participants not to practice informed consent include: institutional factors, assumption that the information was already known to the clients, not necessary to tell everything (telling by condition), only general information given, therapist’s resistance, difficult to provide information, and unfamiliar with the differences of ethics code; Participants’ ethical reflections include: insufficient attention to the clients’ rights and interests, the influence of the practice field, the impact on treatment, self-protection by therapists, and the therapist’s own factors; Recommended actions and changes include: enhancing the presentation of information and verbal explanations, emphasizing the sharing of professional information, personal development of therapists, adopting higher ethical standards. According to the results and findings, related issues are discussed, and the study offers suggestions for clinical practices, amendments to the ethics code, planning for ethics education, and future research.