Among the empirically supported psychiatric treatments, psychotherapy has produced a strong record of scientific evidence. This is especially so when looking at long-term, sustainable treatment gains. However, when performing psychotherapy, psychiatrists may encounter particular challenges regarding the following four basic ethical principles: respect for the patient's autonomy; beneficence; nonmaleficence; and justice. In balancing these principles, and applying them to an individual problem during psychotherapeutic treatment, the consequences to the patient and to others of different courses of action will have to be examined (utilitarian reasoning); comparing the problem with other, apparently similar problems may be another way of finding a solution; finally, in certain situations, absolute rules will be applied, e.g. the rule that therapists shall not exploit patients sexually or in other ways. A number of frequently occurring specific issues will be discussed: confidentiality and its possible exceptions, conflicts of interest, and consent to treatment. In addition, problems that arise specifically from the psychotherapeutic treatment setting will be addressed, such as imposing values in psychotherapy, sexual and non-sexual boundary violations. Ethical issues must be dealt with pro-actively and transparently throughout the psychiatrist's professional career. This can be done, e.g., in individual or group supervision and intervision. Awareness regarding ethical issues should be raised in psychiatric residents and psychotherapy trainees right from the beginning of their training.