8 Psychotherapy8.7 Psychotherapeutic psychiatry
8.7.11 Power, diversity and ethics in therapeutic work
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Written by Resident Doctor Committee · Published
New in the 2027 syllabus
The College added this topic for exams from January 2027.
Power in the relationship
The clinician and the patient do not hold equal power. The difference comes from several sources:
the clinician's professional authority
the clinician's control over access to treatment
legal powers
the patient's dependence on care.
Working collaboratively means being open about the options, the reasons for what you suggest and the limits of what is possible. It also means supporting the person to disagree or say no, within whatever legal framework applies.
Consent is an ongoing process of understanding and agreement. A signature at the start does not settle every later intervention, so revisit it as the work changes.
Culture and difference
Each area below comes with a question to ask in practice.
Area | Question for practice |
|---|---|
Language | Can the person speak freely and follow the discussion? |
Identity and culture | What meaning does the person give to their symptoms, relationships and recovery? |
Discrimination | How have exclusion or past harmful encounters affected their trust? |
Disability | What adjustments to communication or the environment do they need? |
Family and community | Who supports them, who has influence over them, and whom do they want involved? |
Cultural humility means asking questions and being willing to change your assumptions. Knowing about a group is not the same as knowing the individual in front of you.
Interpreters help keep communication accurate and confidential. Explain everyone's role and the practical arrangements before any sensitive work begins.
Boundaries and responsibility
Professional boundaries exist to protect the patient's interests. They cover contact, self-disclosure, gifts, social media, and sexual or emotional exploitation.
If you notice attraction to a patient, or a wish to rescue them, take it to reflection and supervision. These feelings are not a reason to involve the patient in meeting your own needs.
Confidentiality: explain it and its limits. This includes sharing information proportionately when safeguarding or serious risk requires it.
Capacity: this relates to a particular decision at a particular time. A person does not lose capacity automatically because they have a psychiatric diagnosis.
Coercion: when coercion or legal authority is present, say so honestly. Describing compulsory care as fully voluntary undermines trust.
Ethical reflection: weigh benefit, harm, autonomy and fairness. Consider these alongside the law and the patient's own account of what matters to them.