The Ethics of Change in Psychotherapy: A Lesson from Bungee Jumping

Ethics: In Search of Integrity and Responsibility in the Work Place

Ethics Committee Members: Damon Blank, Vivian Guze, Carole Light, Jack Mulgrew, Murray Scher, Avrum Weiss, Pat Webster, Marilyn Schwartz, Chair

By Marilyn Schwartz

To my surprise, a compelling ethical dilemma presented itself during my recent four-week trip to New Zealand. When our hiking group arrived at the Kawarau Bridge in South Island, the original bungee jumping venue, two of my younger traveling companions expressed an interest in bungee jumping.  Lisa, 31 years old, was a woman I identified with as a younger version of myself – athletic and drawn to challenging physical situations. Meg, 25 years old, was about to start college, having left the Marines after 5 ½ years of service mostly in Afghanistan.  Meg, clearest about wanting to jump, was holding back because of the pricey cost of the ticket.

Standing on the bridge as close to the bungee jumpers as we could, Lisa, Meg, and I were able to feel the jumpers’ palpable excitement and terror.  Lisa exclaimed, “Oh, I wish I could do it.  It certainly would cure my ridiculous fears such as speaking up to my difficult boss and avoiding conflict situations.”  Meg joined in: “I’ve done scary things in the last five years.  This actually looks like fun.” And I mumbled under my breath: “I wish I were 30 years younger and could jump without killing myself.”  

Then the therapist genie in me burst out: “You are two strong, brave women; you can do it.  You might learn something important from this. If not now, when?” I went further and told the women, “ We’re doing it, follow me,” and marched them off to the ticket counter. I planned to buy Meg a ticket. If she could risk five years of her life in Afghanistan for me/us, the least I could do was treat her to this bungee jump.  My offer clearly pushed Lisa over the edge. She said if Meg were jumping, she would too.

As I was paying for the ticket, I noticed my husband’s ashen face as he imagined that I was purchasing a ticket to jump to my death.  When he discovered what I was up to, he accused me of unethical behavior, saying that I was encouraging the girls to do something that might potentially harm them. He asserted that my own wish to jump and my words of encouragement to the young women had influenced and pushed them to make their decision.

Thankfully, both women survived the bungee jump.  Both expressed similar feelings of exhilaration and pride about their accomplishment. Each acknowledged that the jump had what we, as psychotherapists, might regard as a positive therapeutic effect on them.  They felt enlivened with a heightened sense of self-regard, gaining self-confidence from pushing through their fears.  Lisa laughed about how ridiculous it will seem to her now to tremble at the hands of her boss. Meg, who surprised all of us by screaming loudly, hysterically, from the moment she stepped off the bridge, said it was a relief for her to howl all the way down. My sense is that her screaming was therapeutic in terms of her being able to express fear in a way that she probably wasn’t allowed to do during her days in the military.  

So where do ethics come into play in our psychotherapist role as change agents? I suggest the starting point for this discussion is the important principle of beneficence and malfeasance: whether what we do is for the benefit of the patient or not.  Similarly important is the question of whether what we do is more for the benefit of our patients than for the benefit of ourselves. For example, do we encourage patients to move in one direction rather than another because it meets our conscious or unconscious needs?  Who defines therapeutic benefit and its recipient - the therapist or the patient?

Considering these questions, my behavior in the bungee jumping episode is suspect. True, I did provide a wonderful treat for a well-deserving military service person and a positive therapeutic experience for each of these young women.  But, my actions are questionable given my own heightened emotional state: not thinking through the situation carefully, not processing it with the women, and my acting impulsively – a set-up for a possible ethical transgression. As I stood on that bridge looking at others jump, my unconscious and conscious were screaming in unison: “Jump, Marilyn, jump!” Thankfully, I was the recipient through the generosity of my younger “surrogate jumpers” of one of the greatest thrills of my lifetime - vicariously jumping off one of the highest bungee jumps in the world.  

So, how to judge my therapist genie whose work appeared to benefit all? Join me, Phyllis Clymer, and David Loftis for a continuation of this discussion on the ethics of change in psychotherapy in the upcoming ethics workshop at the 2014 Summer Workshop.