1. Legal & Ethical Issues in Psychopathology

2. Current Legal/Ethical Issues
Legal Issues:
Civil Commitment
Criminal Commitment
Duty to Warn
Ethical Issues (in Treatment):
Confidentiality
Competence
Dual Relationships

3. Legal Issues

4. Legal Issues Rights of patients vs. rights of public
Few laws govern therapy
Required to be competent
To have a license
Can use collection agencies if clients fail to pay
Several unique legal issues with therapy
Complex questions
Burden therapist, state, others

5. Civil Commitment Most hospitalizations are voluntary
Voluntary is in best interest b/c can check out
In some cases, patients are involuntarily hospitalized
Danger to oneself (suicidality)
Danger to others (homocidality)
Majority of commitments are male schizophrenics

6. Civil Commitment Judge hears case & decides
Hearing is requested by police, mental health provider
Civil commitment must legally be lifted when patient is no longer dangerous
Requirements protect patients - historically, anyone could have someone committed
But, goals are re: danger, not helping

7. The Right to Treatment Established 1972 by Wyatt v. Stickney
Rationale for commitment = treatment
Thus, if hospital is unwilling or unable to provide, patient can petition for commitment overruled
Why suspend a patient’s rights unless there is a benefit?
First attempt to have minimum criteria for mental health treatment

8. The Right to Treatment
Staffing levels, # of bathrooms, size of facility, variables that impact quality of life
Rulings required states to provide facilities that met minimal requirements
State provides most treatment for the severely and chronically mentally ill

9. The Insanity Defense
Based up on premise that people cannot be held responsible for crimes if they were unaware of the nature of their actions or were unable to control their actions
We have free will to commit or not commit crime
Legal insanity is a very narrow definition
Psychological insanity: products of antecedents (a disorder is not something we choose)

10. Insanity Defense Reform Act (1984)
Made it more difficult to prove insanity
Unable to appreciate wrongfulness as result of severe mental illness
Defense now has burden of proof
Previously, prosecution had to prove sanity
Reduced advantages of pleading insanity
Fixed minimum periods of incarceration
Eliminated automatic release following reduction of danger

11. Guilty But Mentally Ill
Individual will be incarcerated, but acknowledges presence of mental illness
Suggests that treatment is needed during incarceration

12. Public Opinions of Insanity Pleas
90% of the public believes that:
The insanity defense is used too much
Lots of guilty people get to go free
Public estimates of how many felony cases involve insanity pleas: 33%
Actual number: <1%
Public estimates of success: 50%
Actual number: 25%

13. Public Opinions of Insanity Pleas
Public estimate of how many “insane” people are released: 50%
Actual number: 15% (minor offenses that do not result in incarceration anyway)
Public also tends to believe successful insanity pleas = short time in hospital
They actually spend 50% longer in hospital then they would have in prison if guilty

14. Competency to Stand Trial
Is the person capable of understanding the charges and helping attorney to prepare the case?
This is independent from sanity at the time of crime
Trial is postponed; defendant is held for treatment
Protects public from possible danger

15. The Right to Refuse Treatment
Can usually refuse treatment if desired
Unless refusal is based on psychosis or delusions
Before all commitments, independent evaluation is required (not connected to the hospital)

16. Therapist’s Duty to Warn
Tarasoff v. Regents of the U. of CA (1974, 1976)
Therapists have a legal responsibility to warn potential victims when they may be at risk from a client
1969 Tatiana Tarasoff is murdered by a grad student who suggested, in therapy, that he was going to kill her
Therapist informed police, who told grad student they were aware of his threats
Grad student assured police he had no intentions of murder

17. Therapist’s Duty to Warn
Therapists are required to warn/protect potential victims
By telling the police
By committing the client
By informing the potential victim
Involves breaking a client’s confidentiality

18. Ethical Issues

19. Ethical Issues in Treatment
Competence
Integrity
Professional & Scientific Responsibility
Respect for People’s Rights & Dignity
Concern for Others’ Welfare
Social Responsibility

20. Confidentiality
Therapy is a protected relationship - information is not shared without explicit permission
Exceptions:
Knowledge of child abuse
Threats to others (Tarasoff)
Threat to self
Can consult with other therapists openly

21. Competence Maintain the highest standards of competence
Recognize & respect the limits of competence
Provide only those services we are qualified to provide
Competence is a combination of: education, training, experience

22. Competence E.g. Conducting a neuropsyc assessment without training
Be familiar with culture, gender, other differences & how those differences will effect one’s work
Remain current in the field on research and professional information

23. Record Keeping
Maintain records of client contact to facilitate & document treatment
Provide a basis for decisions
Covers the therapist in case of legal action
E.g. decisions regarding suicidality
Records are often requested by insurance companies to determine if more services are needed

24. Who is the Client? (Esp. Children)
Psychologists may work with more than one person
Especially with children, who have parents & teachers, and other providers
Ethics do not offer a clear line in this case
Avoid multiple roles
Clarify roles if they are ambiguous
Often ask parents for child’s confidentiality

25. What if No Treatment Exists?
Experimentation is required to further the field
Clients should be informed of experimentation
Clients also should be informed of other options that are established
Often try experimental tx if an EST has been tried and failed (in clinical work)
Design based on available science

26. Dual Relationships
When therapist/client relationship exists at the same time as another
E.g. friend/friend or boss/employee
Should therapists treat their friends?
Should therapists treat/listen to their students?

27. Some Practical Issues - Science vs. Pseudoscience

28. The Widening Gap Between academic psychology & popular psychology
Between research and general public knowledge

29. Characteristics of Pseudoscience
Overuse of ad hoc hypotheses to escape refutation
Emphasis on confirmation, not refutation
Absence of self-correction
Reversed burden of proof
Overreliance on anecdotal evidence
Use of obscurantist language
Absence of “connectivity” with other disciplines

30. Pseudoscience in Psychopathology
Explosion of unvalidated tx for trauma
Use of demonstrably ineffective tx for autism
Continued use of inadequate assessments
Widespread use of herbal tx w/o testing
Subliminal self-help tapes
Explosion of self-help books and programs
Suggestive techniques for memory recovery

31. Why Should We Care?
Why should we monitor the general public? Can’t they use whatever they want to buy?
Techniques may be harmful to the public
Consumers waste time & $ they could use in therapy
Damage to our reputation & integrity
Our ethical guidelines of social responsibility

32. What Should Psychologists Do?
Actively study & “debunk” pseudoscience
Evaluate self-help materials
Standardize training programs
Popularize our findings & methods to the general public, convey our scientific excitement to outsiders & show the successful applications of it
The general public is often unaware of what is proven, and what is not