1. Ethical Issues in Clinical Psychology
Chapter 5
Ethical Issues in Clinical Psychology

2. 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

3. 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.

4. 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

5. 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.

6. 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.

7. 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.

8. 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.

9. 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

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

11. 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

12. 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

13. 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?

14. 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

15. 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.

16. 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

17. 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.

18. 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

19. 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

20. 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

21. 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?

22. 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

23. 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

24. 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