Sexual feelings about clients, colleagues spreading malicious gossip and the burden of keeping the secrets of the counselled, not to mention fears about their own competence, are all enough to drive the therapists to therapy themselves.
A survey of 1,000 randomly chosen psychotherapists in Britain found that many were troubled by concerns about confidentiality, sexual issues and competence. Only a fifth of the therapists had not experienced some kind of ethical dilemma.
A British Psychological Society conference was told yesterday that practitioners' biggest worry is confidentiality, with one in three therapists having some sort of problem.
"Psychotherapists provide a great deal of confidentiality to their clients but there may be occasions where in order to keep someone's confidentiality, someone else may be endangered. There may be a case of a parent battering a child, for example. Do you keep working with the parent and hope they will eventually stop the battering or is it more important to let someone know?" said Dr Petruska Clarkson of Surrey University, consultant psychologist and author, who carried out the survey with Professor Geoff Lindsay of Warwick University.
One in eight had problems with colleagues' conduct. "This includes concern that a colleague is engaging in sexual behaviour with clients or attempting to destroy the reputation of a colleague by spreading malicious gossip about them," said Dr Clarkson.
Around one in 12 therapists had dilemmas with sexual issues, ranging from sexual affairs with clients or trainees to inappropriate sexual conduct.
"Sexual issues include sexual exploitation of a client or where sexuality impinges in an unprofessional manner. The kind of example one comes across is when a therapist says they find a client sexually attractive," said Dr Clarkson.
In the survey participants were asked to describe an incident that they or a colleague had faced in the past year or two that was ethically troubling.
Dr Clarkson said that more research is now needed. "Ethical responsibility is the backbone of any profession. We must constantly strive to deepen our understanding of ethical and moral issues and how these effect the practice of psychotherapy and psychology."
Yesterday's conference in Stratford-upon-Avon also heard that therapists believe they need more training to give therapy to lesbians and gay men.