There is as little doubt as much as there is empirical proof that psychotherapy is an effective intervention for psychological problems and disorders. However, there is ongoing controversy about the mechanisms underlying these often impressive, but also often overestimated effects, reaching back to the very origins of psychotherapy research. While this “great psychotherapy debate” vivifies both psychotherapy research and practice, it finally poses an ethical challenge for both psychotherapists and psychotherapy scholars. Basically, the lack of agreed and validated mechanisms impedes the attempt to inform patients about how changes of psychotherapy are brought about. Thus, even though patients can readily be furnished with possible and expectable benefits, costs and strains, the situation becomes more complex and less certain with regard to the specific mechanisms and determinants of change. In this chapter, psychotherapy scholars’ strivings and troubles for specificity will be briefly covered, touching the uncomfortable relationship with placebo and nocebo and finishing with an ethical plea for transparency in psychotherapy and of psychotherapists