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PHL383H1 Lecture Notes - Intimate Exchanges

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Thomas Mathien

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February 25, 2013 - Virtues for psychiatrists continued
Radden and Sadler, you can never get a completely clear case down on paper
Papers returned today
Next papers need to be submitted by March 11
Phronesis: cognitive capacity
But it’s not just cognitive capacities, but also the whole realm of the emotive that
make for a good mental health care provider
Gender vs. sex: the distinction is just a convenience, gender is much more a social
categorization, sex has more to do with biological markers that determine gender
But this is nothing that is too hard and fast
Gender self attribution based on a whole set of complex factors
People will fundamentally see themselves as male or female, straight or gay,
Distinguish between the features that constitute an identity for us, and other
features (social roles, symptoms, etc.)
Radden and Sadler make a strong claim about mental health care practitioners,
that the moral standards for doing it are very high, in 2 flavours: mental
healthcare givers have to present extra virtue, and that they have to also
possess/present extra virtues
Interested in trustworthiness (important for all professionals to be trustworthy)
Client expects to depend on the good service of the professional who provides
that service
Failure to be trustworthy is important in a profession, but there’s something more
in the case of mental health care provision, and it has more to do with the fact that
much of mental health in many of the standard approaches to therapy requires that
a patient reveals certain important facts about themselves and their behavior and
In order to do this the client will need to feel that they are able to trust the person
they are confiding in
Communication needs trust
Trust is not just framework for the transaction between the therapist and their
client, it’s one of the tools by which that transaction takes place, without it you do
not get the essential communication need for any therapeutic method
Even if the mode of therapy is primarily pharmacological the trust needs to be
there for good diagnoses to be achieved
This is especially true as many maintain that the care recipient think of you as an
Trustworthiness is a virtue in many moral situations but especially demanded in
the field of mental health care
Propriety is concern about appearances
The person who manifests propriety worries about their actions being perceived
as on the up and up
Do well and to be seen to do well
If they only care about appearances we might them of them being a little rigid
The therapist needs to be immune from accusations
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A closed door in intimate exchanges looks a little like an opportunity to be
exploited, so it’s important for caregivers to respect boundaries and that everyone
(patient and observers) recognize that the boundaries are being respected
This is done through the conduct of the professional outside the therapeutic
situations and in the everyday community
Both doing well and being seen to do well are both important
Propriety: a heightened concern for how one’s actions are perceived
A failure to engage in propriety can effect how you can conduct therapy in
general, and discredit the professional/the whole profession
Concerns for how things are perceived are very important in these cases
Impatience might be the right thing to show at the right time for the right reasons
Patience and perseverance (patience over a long term, sticking with continued
treatment of a patient in the face of set backs) are important
Communications difficulties between the therapist and the patient
The patient may be delusional and it will be difficult to figure out what the
implications of the strange things they say are
Impact on communication ability
Patience is required
Mental disorders never have a completely clear diagnoses
The problems are much more complex than any physical ailments
No cut and dry guarantee of success therapies
Individuals respond to various chemicals very differently
Decide sometimes whether a potential benefit is worth a considerable risk
Requires fortitude
Gender sensitivity a good thing for anyone to display gender sensitivity
Particularly important in the case of people giving care to others
People may feel extreme discomfort with their own physiology because of their
gender self attribution
In many cases the good psychiatrists is displaying virtues that would be moral
virtues elsewhere (professional or general, public or personal)
But there are extra virtues required for mental health care providers that need not
be required for others
For example: warmth
An accountant need not be warm, though they may be
Warmth helps build trust, and feeling an emotional connection with their
caregiver is another instrument that enables you to use that relationship
Warm caregiver may be a better ally
Empathy certainly seems to be an essential characteristic for a good mental health
care provider
Empathy is very central to a good understanding and a good diagnoses
In the case of mental health care you need to be able to imagine what it would be
like to be that person in that situation, in order to be able to come to understand
what may be going on in that situation
The claim that some psychotic situations are impossible to understand may be a
set back
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