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of the ten lepers (Lk. 17, 11ff). Which procedu- failure.” Not always is the “deeper” aim also the
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re to choose is a matter for client and therapist better one!
to negotiate together. Listed in increasing depth
of aim we have: On top of this, aims must be agreed fairly: “It
would be nothing less than false labelling to sell
1. Supporting, stabilising procedures to a patient, exploiting one’s own highly sugge-
have the aim of ensuring the healthiest possible stive position… an ethical re-evaluation of his
living (survival) in daily life. Personal motivati- life or way of life. Even the patient’s wish for
on to change is not a pre-condition. symptom control cannot be taken as an oppor-
tunity to suggest to the patient a deep-reaching
2. Training, advisory procedures analysis of unconscious conflicts without infor-
have the aim of extending the (psycho-social) ming him about other, less elaborate possible
competence of the client or to cause individual treatments.” 7
symptoms to disappear. Here the primary re-
quirement is motivation to learn or train. The aim-finding process
The ethical standard is “informed consent”.
3. Uncovering procedures How does one reach this? Three positions are
see unresolved biographical events or conflicts conceivable:
as the cause of the current problems and work
them. For this a motivation to change and a a. Service-provider model, which assumes a
certain introspective capacity on the part of the suitable level of responsibility in the client, i.e.
client is needed. the client sets the therapy aims. “What do you
want me to do for you?” (Lk. 18,41)
4. Procedures which change the value system or
life concept Problems: What happens if these aims aggravate
are often derived from certain personality ide- the client’s problems rather than ease them, if the
als or concepts of man and aim at developing justified interests of third parties or of the public
the faith or value system or the client’s life con- are disproportionately impaired or if the thera-
cept. The client should in this case be motiva- pist is not in agreement with the value concepts
ted towards comprehensive changes such self- of the client?
knowledge, personality maturity, discovering
meaning or spiritual fulfilment.. b. Paternalistic model, in which it is primarily
the therapist who determines the aims (in prac-
5. What depth of aim is selected? tice, particularly in in-patient settings, extreme-
In many therapies one will also find combina- ly common. “Your sins are forgiven.” (Lk. 7,48)
tions or chronological sequences of procedures
with different depths of aim. Here the conscious Problem: it is therapy of the patient and not of
choice and clear communication according to the therapist; self-determination and self-respon-
the scope of the client’s aims are decisive. sibility are thus essential.
With increasing depth, as a rule, the amount
of therapy work increases as well. On the one c. Negotiation model, in which both present
hand, more is “offered” to the client than in the- their envisaged aims and subsequently reach a
rapies which aim purely at the symptom level:
experience in relationships, inner enrichment
and possibly discovering meaning. On the 6 Kottje-Birnbacher, Leonore & Birnbacher, Dieter
other hand, “with the opportunities, the risks (1999): Ethische Aspekte bei der Setzung von Therapie-
grow too. The deeper the aims, the greater the zielen. In: Ambühl, Hansruedi; Strauß, Bernhard (ed.):
danger of lasting mental damage in the case of Therapieziele. Göttingen, p.21
7 Kottje-Birnbacher,L. & Birnbacher, D. (1995): Ethische
Aspekte der Psychotherapie und Konsequenzen für die
Therapeutenausbildung. Psychotherapeut, 40, p.62

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