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