Ethical Issues in Clinical Psychology Chapter 5 Ethical Issues in Clinical Psychology

Ethical Issues in Clinical Psychology APA Code of Ethics guides the behavior of clinical psychologists Relevant issues include Confidentiality Informed consent Multiple relationships Competence Others

APA Code of Ethics First published in 1953 Revised 9 times Most recent edition was published in 2002 Two amendments in 2012 Two amendments were added in 2012, emphasizing the fact that psychologists cannot use particular ethical standards to justify or defend the violation of human rights.

APA Code of Ethics: Aspirational and Enforceable General Principles section describes an ideal level of ethical functioning, or what to strive for Enforceable Ethical Standards section includes rules of conduct that can mandate minimal levels of behavior and can be specifically violated

APA Ethical Principles Beneficence and Nonmaleficence Fidelity and Responsibility Integrity Justice Respect for People’s Rights and Dignity See Table 5.1 American Psychological Association Ethical Principles.

Categories of Ethical Standards Resolving Ethical Issues Competence Human Relations Privacy and Confidentiality Advertising and Other Public Statements Record Keeping and Fees Education and Training Research and Publication Assessment Therapy See Table 5.2 Categories of American Psychological Association Ethical Standards.

Ethical Decision Making 8-step model Prior to any ethical dilemma arising, make a commitment to doing what is ethically appropriate. Become familiar with the APA ethical code. Consult any law or professional guidelines relevant to the situation at hand. Try to understand the perspectives of various parties affected by the actions you may take. Consult with colleagues (always protecting confidentiality) for additional input and discussion. Before turning to any step-by-step ethical-decision making model, psychologists best prepare themselves to deal with ethical dilemmas by becoming a generally ethical person with sound values. Functioning as an ethical psychologist should not be a rote exercise in which a predetermined model for decision-making is the sole guide. Models work best when they are utilized by a person who has already examined his or her own values and aligned them with the ethics of the profession.

Ethical Decision Making (cont.) 8 step model (cont.) Generate and evaluate your alternatives. Select and implement the course of action that seems most ethically appropriate. Monitor and evaluate the effectiveness of your course of action. Modify and continue to evaluate the ethical plan as necessary.

Psychologists’ Ethical Beliefs Some behaviors are viewed as absolutely unethical (e.g., sex with clients) Some behaviors are views as absolutely ethical (e.g., addressing clients by first name) Many behaviors fall in “gray area” in between Lots of difficult judgment calls

Confidentiality In general, psychologists are ethically obligated to maintain confidentiality Some situations can arise in which breaking confidentiality is appropriate

Confidentiality: Tarasoff and the Duty to Warn Tarasoff is a court case regarding a college student client who told his therapist he was going to kill his girlfriend (Tatiana Tarasoff) Therapist contacted campus police who detained him, but after he was released, he killed her

Confidentiality: Tarasoff and the Duty to Warn (cont.) Her family sued and won Tarasoff v. The Regents of the University of California The finding was that the therapist had the “duty to warn” the potential victim This finding now sets a precedent for all therapists for breaking confidentiality

Confidentiality: Tarasoff and the Duty to Warn (cont.) How credible are clients’ threats? What kinds of threats merit warnings? How should the unsafe behavior of clients with HIV/AIDS be understood in terms of threat? How accurately can clinical psychologists assess the credibility of their clients’ threatening statements, or their intent to follow through with them? What kinds of threats merit warnings—only blatant life-or-death threats or other kinds of harm—like drunk driving or intimate partner violence? At what point in therapy and to what extent should psychologists prioritize the protection of potential victims over the treatment of their clients?

Confidentiality: When the Client is a Child Often, children will confide more if they can be assured that psychologists will not repeat everything to their parents Parents, of course, have a right to be informed Psychologists often make arrangements by discussing this with families up front Some issues, such as child abuse, require breaking of confidentiality to protect the child

Informed Consent Required for research, assessment, therapy, and other professional activities For therapy, informed consent is an ongoing process rather than a one-time event As psychologist learns more about client, more information can be shared Informed consent to therapy—unlike informed consent to research or assessment—may be best understood as an ongoing process rather than a one-time event.

Informed Consent (cont.) Informed consent for therapy must allow client the opportunity to ask questions and receive answers Informed consent process can be an early part of a strong therapeutic relationship

Boundaries and Multiple Relationships Knowing someone professionally and in some other way Romantic/sexual, friendship, business, etc. Unethical when: Psychologist’s objectivity, competence, or judgment can be impaired Exploitation or harm could result Boundary crossings (minor, often harmless) can lead to boundary violations (major, often harmful) Multiple relationships can form not only when a psychologist knows one person both professionally and nonprofessionally but also when a psychologist has a relationship with someone closely associated with or related to someone the psychologist knows professionally. Not every multiple relationship is, by definition, unethical. To be unethical, a multiple relationship must impair the judgment of the psychologist and exploit or harm the client.

Competence Sufficiently capable, skilled, experienced, and expert to complete the professional tasks they undertake Boundaries of competence Psychologists should know their limits and seek additional training or supervision when necessary

Competence (cont.) Continuing education can maintain competence Importance of cultural competence Burnout can impair competence Burnout can be minimized by efforts by the psychologist to keep job varied, keep life balanced, keep expectations reasonable, and keep self healthy

Ethics in Clinical Assessment Test selection Consider competence, culture, test’s reliability and validity Test security Don’t allow test materials to enter public domain Test data Raw data collected during assessment Should generally be shared at client’s request

Ethics in Clinical Research Psychotherapy efficacy research What should control group receive? No treatment (“Wait-list” control) Placebo treatment Alternate treatment What ethical issues arise when any of these three options are used?

Contemporary Ethical Issues: Managed Care Managed care companies’ emphasis on financial bottom line can cause ethical conflicts Perhaps include info about managed care in the informed consent process Diagnostic decisions can be influenced by managed care companies’ requirements

Contemporary Ethical Issues: Technology “Psychological tests” on Internet Many have questionable reliability and validity Other issues include Identity of client Testing conditions Inability to observe behavior during testing Similar concerns about online therapy

Contemporary Ethical Issues: Small Communities Small communities can be rural areas or defined by ethnicity, religion, or other variables Multiple relationships can be unavoidable Discuss up front with clients Clarify boundaries Avoid impaired judgment and exploitation