Chapter 5Ethical 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

APA Code of Ethics: Aspirational and

Enforceable Aspirational

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

1. Beneficence and Nonmaleficence2. Fidelity and Responsibility3. Integrity4. Justice5. Respect for People’s Rights and Dignity

Categories of Ethical Standards

1. Resolving Ethical Issues

2. Competence3. Human Relations4. Privacy and

Confidentiality5. Advertising and

Other Public Statements

6. Record Keeping and Fees

7. Education and Training

8. Research and Publication

9. Assessment10. Therapy

Ethical Decision Making 8-step model

1. Prior to any ethical dilemma arising, make a commitment to doing what is ethically appropriate.

2. Become familiar with the APA ethical code.3. Consult any law or professional guidelines

relevant to the situation at hand.4. 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.

Ethical Decision Making (cont.)

8 step model (cont.)5. Generate and evaluate your alternatives.6. Select and implement the course of action

that seems most ethically appropriate.7. Monitor and evaluate the effectiveness of

your course of action.8. 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?

Confidentiality: When theClient 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 (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)

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