Clinical Psych: Chapter 5: Ethical & Professional Issues in Clin. Psych.

American Psychological Association's General Ethical Principles: - Ethical Principle: Beneficence and Nonmaleficence - Sample Sentence From Description in Ethical Code?

"Psychologists strive to benefit those with whom they work and take care to do no harm."

American Psychological Association's General Ethical Principles: - Ethical Principle: Fidelity and Responsibility - Sample Sentence From Description in Ethical Code?

"Psychologists establish relationships of trust with those with whom they work. They are aware of their professional and scientific responsibilities to society and to the specific communities in which they work."

Competence: - One specific ethical standard in the section on competence (2.01a) addresses the boundaries of competence:

"Psychologists provide services, teach, and conduct research with populations and in areas only within the boundaries of their competence, based on their education, training, supervised experience, consultation, study, or professional experience"

American Psychological Association's General Ethical Principles: - Ethical Principle: Justice - Sample Sentence From Description in Ethical Code?

"Psychologists recognize that fairness and justice entitle all persons to access and benefit from the contributions of psychology and to equal quality in the processes, procedures, and services being conducted by psychologists."

American Psychological Association's General Ethical Principles: - Ethical Principle: Respect for People's Rights and Dignity - Sample Sentence From Description in Ethical Code?

""Psychologists respect the dignity and worth of all people, and the rights of individuals to privacy, confidentiality, and self-determination."

Competence: - Professional guidelines sponsored by the American Psychological Association, such as ......?

"Multicultural Guidelines: An Ecological Approach to Context, Identity, and Intersectionality," "Guidelines for Psychological Practice With Transgender and Gender Nonconforming People," "Guidelines for Psychotherapy With Lesbian, Gay, and Bisexual Clients," and "Guidelines for Providers of Psychological Services to Ethnic, Linguistic, and Culturally Diverse Populations," can also be important contributors to cultural competence for clinical psychologists.

American Psychological Association's General Ethical Principles: - Ethical Principle: Integrity - Sample Sentence From Description in Ethical Code?

"Psychologists seek to promote accuracy, honesty, and truthfulness in the science, teaching, and practice of psychology."

Competence: - The American Psychological Association's (2002) code of ethics also recognizes that psychologists' own personal problems can lessen their competence: ...?

"When psychologists become aware of personal problems that may interfere with their performing work-related duties adequately, they take appropriate measures, such as obtaining professional consultation or assistance, and determine whether they should limit, suspend, or terminate their work-related duties" = Standard 2.06

CONTEMPORARY ETHICAL ISSUES: - The aforementioned requirement that clients must be diagnosed with a DSM disorder for their managed-care companies to pay for treatment can present another ethical dilemma for clinical psychologists. - If a client is struggling with a problem that does not meet the criteria for any DSM disorder, or if a family or couple has problems that don't stem directly from an identifiable disorder in one person, the psychologist can face pressure to falsely assign a diagnosis to ensure that the managed-care company will pay the bill * Or the psychologist may be tempted to ......?

"upcode," or assign a more serious diagnosis than the client's symptoms actually merit, to increase the number of sessions or amount of money the managed-care company will devote to treatment - Even if the psychologist's motivation is the client's welfare, such actions are unethical and can constitute the illegal act of insurance fraud as well

INFORMED CONSENT: - If you have participated in a psychological study, you probably received written information about the study first, and only after you provided consent by signing your name did the research begin. Research is certainly an important application of the ethical standards involving informed consent, but it is not the only one.

- Assessment and therapy also require informed consent according to the ethical code - in any professional activity conducted by psychologists, informed consent is an essential process

When the Client Is a Child or Adolescent: Consider some of the behaviors in which minor clients might engage: smoking, drinking, sex, drug use, crime, and "cutting" (self-mutilation), to name a few. - what is the concern for the psychologist?

- At what point or under what conditions do these behaviors constitute harm that merits the psychologist's informing the child's parents? To what extent is the child's age a factor?

CONFIDENTIALITY: * Tarasoff and the Duty to Warn - In 1969, Prosenjit Poddar was a student at the University of California at Berkeley. He became romantically interested in Tatiana Tarasoff, and when their relationship did not advance as he hoped, his mental state worsened and he sought psychotherapy at the university counseling center from a psychologist, Dr. Lawrence Moore. * What happened at the session and afterwards?

- During a session in August 1969, Poddar told Dr. Moore that he intended to kill Tarasoff. Dr. Moore believed that Poddar's comment was credible, so he broke therapist-client confidentiality and contacted campus police. The campus police interviewed Poddar but did not hold him, bc he promised to avoid Tarasoff and seemed rational at the time of the interview. Poddar never returned to therapy. - Two months later, on October 27, 1969, Poddar killed Tarasoff by stabbing and shooting her. Tarasoff's parents later sued Dr. Moore and the others involved in the case for wrongful death. The court found that the psychologist was liable for failure to warn Tarasoff of the danger.

Psychologists' Ethical Beliefs: - In the years since the 1987 study by Pope et al.(large-scale survey of APA memberss), other researchers have used similar methodologies to further examine the ethical beliefs of psychologists. - what other were some studies found on psychologists' ethical beliefs? - what does this conclude?

- One study found that psychologists' ethical beliefs may vary according to the point in time or the region of the country in which they are collected, whereas others found that psychologists' ethical beliefs may vary according to the gender or age of the clients toward whom the behaviors may be directed. - Thus, although the American Psychological Association's (2002) ethical code serves as a guiding force, the beliefs psychologists actually hold, which correspond strongly with the behaviors they act out, may be subject to other influences.

CONFIDENTIALITY: One of the characteristics most closely associated with the ethical practice of clinical psychology is confidentiality. - In fact, confidentiality is specifically mentioned among the general principles -in ___________- and in numerous specific ethical standards—including Standard ....?

- Principle E: Respect for People's Rights and Dignity - Standard 4.01, "Maintaining Confidentiality," which begins, "Psychologists have a primary obligation and take reasonable precautions to protect confidential information"

Psychologists' Ethical Beliefs: - as a group, what ethical beliefs do psychologists hold? - This question, especially as it applies to psychotherapy-related behaviors, was addressed in a large-scale survey of American Psychological Association members - What were the results?

- Results indicated that a few behaviors—for example, sex with clients or former clients, socializing with current clients, and disclosing confidential information without cause or permission—are viewed as blatantly unethical. - In contrast, a few other behaviors—for example, shaking hands with clients, addressing clients by first name, and breaking confidentiality if clients are suicidal or homicidal—are viewed as unquestionably ethical. - But most of the 83 behaviors fell in the gray area b/w ethical and unethical, illustrating both the challenges that psychologists face in making wise judgments regarding ethical issues and the importance of a sound model of ethical decision making

Aspirational and Enforceable: - In contrast to the General Principles section, the Ethical Standards section of the ethical code includes enforceable rules of conduct. - what does this mean?

- Thus, if a psychologist is found guilty of an ethical violation, it is a standard (not a principle) that has been violated. - These standards are written broadly enough to cover the great range of activities in which psychologists engage, but they are nonetheless more specific than the general principles.

Aspirational and Enforceable: * Remedial vs Positive Approach to Ethics: - Psychologists with a remedial approach to ethics might do the bare minimum to make themselves competent for a particular activity such as......?, but psychologists with a positive approach to ethics will strive to become as competent as possible such as .....?

- e.g., taking courses, getting supervision - e.g., additional courses, extra supervision, self-study, self-care

ETHICS IN CLINICAL ASSESSMENT: - Additionally, psychologists must not select tests that have become obsolete or ...? - Sometimes, psychologists find themselves in a position of ...?

- have been replaced by revised editions that are better suited to the assessment questions being addressed. - constructing a new test rather than selecting from existing tests.

CONFIDENTIALITY: * Tarasoff and the Duty to Warn - In its application, however, the duty-to-warn/protect issue is fraught with difficult questions for the clinical psychologists expected to uphold it. For example, - The main concern?

- 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, such as drunk driving or intimate partner violence as well. - main concern: At what point in therapy and to what extent should psychologists prioritize the protection of potential victims over the treatment of their clients?

Psychologists' Ethical Beliefs: - as a group, what ethical beliefs do psychologists hold? - This question, especially as it applies to psychotherapy-related behaviors, was addressed in a large-scale survey of American Psychological Association members * What happened in this study?

- more than 450 members of Division 29 (Psychotherapy) of the American Psychological Association rated the ethicality of 83 separate behaviors that a psychologist might perform toward, with, or in response to a client.

What Makes Multiple Relationships Unethical? * Ethical Standard 3.05a: - A psychologist refrains from entering into a multiple relationship if the multiple relationship could reasonably be expected to impair the psychologist's ......?

- objectivity, competence, or effectiveness in performing his or her functions as a psychologist, or otherwise risks exploitation or harm to the person with whom the professional relationship exists. Multiple relationships that would not reasonably be expected to cause impairment or risk exploitation or harm are not unethical.

INFORMED CONSENT: If the study is an investigation of a treatment method, what should the psychologists inform clients about?

- psychologists should also inform clients that the treatment is experimental in nature, that some clients may be assigned to groups that receive no treatment (control groups), and of available alternative treatments outside the scope of the current study.

CONFIDENTIALITY: * Tarasoff and the Duty to Warn - Adding to the confusion for many psychologists is the fact that different states have adopted different interpretations of the rules and precedents created by the Tarasoff case and others like it. - ex?

- some states require the breaking of confidentiality in situations where other states allow (but don't require) it - States also differ on their definitions of a warning and what should trigger it. - Some states' rules even mention that the protecting the client could take the form of intensified treatment or hospitalization of the client (without notifying the client), while other states' rules make no such mention

CONFIDENTIALITY: * Tarasoff and the Duty to Warn - What happened 2 years later after the court found Dr. Moore liable for failing to warn Tarasoff of the danger she was in?

- the court reheard the case and slightly revised their verdict, from a duty to warn to a duty to protect (which could involve something other than a direct warning by the therapist); however, the "duty to warn" language is still commonly used. - Both "duty to warn" or "duty to protect" decisions suggest that the court saw Dr. Moore's actions as insufficient. Although he broke confidentiality and contacted campus police, the court determined that he should have made additional efforts to ensure that Tarasoff knew that she was in harm's way.

Ethical Decision Making: - What is Celia Fisher's model for ethical decision making ?

1. Prior to any ethical dilemma arising, make a commitment to doing what is ethically appropriate. 2. Become familiar with the American Psychological Association's 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. 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.

What are the 10 Categories of American Psychological Association Ethical Standards

1. Resolving Ethical Issues 2. Competence 3. Human Relations 4. Privacy and Confidentiality 5. Advertising and Other Public Statements 6. Record Keeping and Fees 7. Education and Training 8. Research and Publication 9. Assessment 10. Therapy

What Makes Multiple Relationships Unethical? * Ethical Standard 3.05a: - there are essentially two criteria for impropriety in a multiple relationship ......?

1. The first involves impairment in the psychologist; if the dual role with the client makes it difficult for the psychologist to remain objective, competent, or effective, then it should be avoided. 2. The second involves exploitation or harm to the client.

When the Client Is a Child or Adolescent: * Considering Culture :Confidentiality, Ethnicity, and Family - How does the book, Ethics, Culture, and Psychiatry (Okasha, Arboleda-Florez, & Sartorius, 2000), describe Scandinavian culture in their views on confidentiality ?

1. The key role of patient autonomy has been increasingly emphasized in recent years. A patient has the right to make decisions about his or her treatment without interference from family 2. Emphasis on autonomy is part of Scandinavian culture, and . . . lack of autonomy is considered the greatest unhappiness of the modern person. .The ideal is to be able to live independently, without the need for support from others

When the Client Is a Child or Adolescent: * Considering Culture :Confidentiality, Ethnicity, and Family - How does the book, Ethics, Culture, and Psychiatry (Okasha, Arboleda-Florez, & Sartorius, 2000), describe Arab culture in their views on confidentiality ?

1. issues of illness are dealt with as family matters. Whether a patient is hospitalized, for example , is dependent not on what the patient wants himself or herself but on the estimation, need, or wish of the extended family. 2. a person may actually change doctors . . . if the doctor persists in considering the patient the only decision maker 3. the norm is to convey the [diagnostic] information to the family first and then leave it up almost entirely to the family to decide whether to inform the patient.

Aspirational and Enforceable: - the Ethical Standards section of the ethical code includes enforceable rules of conduct. - Although each general principle could apply to almost any task a psychologist performs, each ethical standard typically applies to a more targeted aspect of professional activity. * The ethical standards are divided into ___ categories, and, collectively, these _____ categories include ____ individual standards.

10/ 10/ 89

AMERICAN PSYCHOLOGICAL ASSOCIATION'S CODE OF ETHICS: The American Psychological Association published its first code of ethics in ________. - The appearance of the initial code corresponded with the rise of ______________ ______________around that time period. - Subsequently, _____ revised editions of the ethical code have been published, including the most recent edition published in _______

1953 - professional psychology - nine / 2002

Competence: In one study of more than ______ licensed psychologists practicing therapy, more than one third reported that they had experienced high levels of some aspects of burnout, especially emotional exhaustion. - the factors that increased a psychologist's susceptibility to burnout included .......?

500 - feeling overcommitted to clients, having a low sense of control over the therapy, and earning a relatively low salary.

Competence: - About ____% of therapists, including _____% of psychologists, seek their own therapy at some point during their careers - Such efforts fall under the heading of self-care, a priority that should be near the top of the list for psychologists -and graduate students- for their own sake and for the sake of their clients - At the same time, it is important for psychologists to .....?

80% / 92% - remain alert to signs that they are experiencing impairment—which, to some extent, is a universal experience for those who stay in the profession—and take appropriate action when such situations arise

Aspirational and Enforceable: What is a remedial approach to ethics?

A remedial approach to ethics would involve doing just enough to avoid any trouble that might come from a violation of ethical standards, but a positive approach to ethics would involve making every effort to ensure that one's professional behavior was as consistent with ethical principles as possible.

When the Client Is a Child or Adolescent: - As a final note on confidentiality, it is important to note the difference between legal standards and ethical standards.

Although they may differ in rare situations, the directives for clinical psychologists listed in this section—duty to warn in Tarasoff-like situations and required reporting of suspected child abuse—often represent both legal standards and ethical standards. - That is, state law typically requires such behavior by clinical psychologists, and the American Psychological Association's (2002) ethical code includes standards that are consistent with these laws. In fact, one ethical standard (4.02, "Discussing the Limits of Confidentiality") specifically instructs clinical psychologists to "discuss .the relevant limits of confidentiality" with clients . -Such a discussion is a key component of the informed consent process

Technology and Ethics: - Any clinical psychologist who creates or uses unscientifically sound tests of this type may be engaging in unethical practice. - And online assessment raises many more ethical questions * how?

As the client is taking the test, are the testing conditions standardized? Will the client keep the test materials secure? Is the client distracted by other tasks? Is the client actually the person completing the test? Are there important behavioral observations the psychologist might be missing because of the remote nature of the assessment?

What Makes Multiple Relationships Unethical? - As an example of an ethical "slippery slope" of this type, consider Dr. Greene, a clinical psychologist in private practice

Dr. Greene finishes a therapy session with Annie, a 20-year-old college student, and soon after the session, Dr. Greene walks to his car in the parking lot. On the way, he sees Annie unsuccessfully trying to start her car. He offers her a ride to class, and she accepts. As they drive and chat, Annie realizes that she left her backpack in her car, so Dr. Greene lends her some paper and pens from his briefcase so she will be able to take notes in class. Dr. Greene drops off Annie and doesn't give his actions a second thought; after all, he was merely being helpful. However, his actions set a precedent with Annie that a certain amount of nonprofessional interaction is acceptable. Soon, their out-of-therapy relationship may involve socializing or dating, which would undoubtedly constitute an unethical circumstance in which Annie could eventually be exploited or harmed.

Aspirational and Enforceable: - The current American Psychological Association (2002) ethical code features two distinct sections: ....?

General Principles and Ethical Standards

CONFIDENTIALITY: * Tarasoff and the Duty to Warn - In recent decades, clinical psychologists have faced a version of the duty-to-warn decision regarding clients with ...?

HIV/AIDS - Ex. Paul, a 30-year-old, single, HIV-positive client, is seeing Dr. Reed, a clinical psychologist, for depressive symptoms. During the course of their conversations, Paul mentions to Dr. Reed that he is sexually active, that he sometimes engages in sexual activity that could put his partner at risk, and that he has withheld from his partner that he is HIV positive. - Dr. Reed immediately faces numerous challenging questions: Does Paul's behavior constitute a threat worthy of a warning to the potential victim? How does it compare with Poddar's threat to kill Tarasoff? If Dr. Reed breaks confidentiality to warn a potential victim, what effect will that have on the therapeutic alliance with Paul and, ultimately, on Paul's well-being? To whom does Dr. Reed have a primary obligation—Paul or someone whom Paul might endanger?

INFORMED CONSENT: What does it ensure?

It ensures the person with whom the psychologist is working the opportunity to become knowledgeable about the activities in which they may participate, and it facilitates an educated decision. Moreover, it affords individuals the opportunity to refuse to consent if they so choose.

Ethics in Small Communities: - _______ __________ are a distinctively difficult ethical issue for clinical psychologists in small communities. - In fact, "nonsexual overlapping relationships are not a matter of if as much as when in the daily lives of many small- and contained-community psychologists" - Unlike clinical psychologists in larger communities, ....?

Multiple relationships - those in small communities may not be able to live in one population and practice in another, so keeping personal and professional aspects of their lives entirely separate may prove impossible.

Ethical Decision Making: When any ethical issue arises, a clinical psychologist should be equipped with a process by which to make the most ethical decision possible. The American Psychological Association's (2002) ethical code does not offer any such decision-making models per se, but such models have been recommended by a number of experts in the field. - Who is Celia FIsher?

One such expert is Celia Fisher, who served as chair of the American Psychological Association's Ethics Code Task Force, the committee responsible for creating the 2002 revision of the ethical code. - In her book Decoding the Ethics Code, Fisher (2017) proposes a model for ethical decision making.

CONFIDENTIALITY: - There is good reason for the emphasis on confidentiality in the profession of psychology: ......?

Our profession is entrusted by the public to provide professional services without sharing the private, personal details offered in the process. - However, the public may be unaware of the fact that confidentiality is not absolute.

When the Client Is a Child or Adolescent: - Koocher and Daniel (2012) offer this script as a prototype of what the psychologist may say to an adolescent client and his or her parent(s) together at the outset of therapy: ...?

Psychotherapy works best when people have confidence in the privacy of their conversations. At the same time, parents do want to feel confident about their child's well-being and safety. Since parents were once teenagers, you certainly know that an adolescent may want to use therapy to talk about sex, alcohol, smoking, or other activities that parents may not approve of. Let's talk about how we can assure your child of confidentiality so s/he can talk openly about what's on her/his mind and at the same time assure your parents about your safety.

ETHICS IN CLINICAL ASSESSMENT: - _____ ________ represents another specific area of focus of the American Psychological Association's (2002) ethical code. - Psychologists should make efforts to protect the security and integrity of the test materials they use. * In other words, .....?

Test security - psychologists should prevent the questions, items, and other stimuli included in psychological tests from entering the public domain

AMERICAN PSYCHOLOGICAL ASSOCIATION'S CODE OF ETHICS: ______ amendments were added in 2010, emphasizing the fact that psychologists cannot use particular ethical standards to justify or defend the violation of human rights. - These amendments relate to the disclosure that high-ranking members of the American Psychological Association had worked with the U.S. Department of Defense in their interrogation efforts, described by some as torture, of detainees during the war on terror

Two / 2010

When the Client Is a Child or Adolescent: - A separate confidentiality issue for clients who are minors involves child abuse. - Every state has laws requiring mental health professionals to break confidentiality to report known or suspected child abuse Many states have similar laws pertaining to abuse of vulnerable adults as well * what is the rationale behind these laws ? * how are they similar to the rationale behind the Tarasoff ruling and duty-to-warn situations?

The rationale behind such laws is similar to the rationale behind the Tarasoff ruling; namely, some situations demand that the clinical psychologist's primary responsibility shift to the immediate prevention of harm. - And, like duty-to-warn situations, child abuse situations often require the clinical psychologist to make difficult judgment calls

What Makes Multiple Relationships Unethical? - Sometimes, major violations of the ethical standard of multiple relationships are preceded by "a slow process of boundary erosion" - That is.....

a clinical psychologist may engage in some seemingly harmless, innocuous behavior that doesn't exactly fall within the professional relationship—labeled by some as a "boundary crossing" and although this behavior is not itself grossly unethical, it can set the stage for future behavior that is. - These harmful behaviors are often called "boundary violations" and can cause serious harm to clients, regardless of their initial intentions

Defining Multiple Relationships: - 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.

Defining Multiple Relationships: - Ethical Standard 3.05a (American Psychological Association, 2002) states that a multiple relationshipoccurs when a

a psychologist is in a professional role with a person and (1) at the same time is in another role with the same person, (2) at the same time is in a relationship with a person closely associated with or related to the person with whom the psychologist has the professional relationship, or (3) promises to enter into another relationship in the future with the person or a person closely associated with or related to the person

Technology and Ethics: - Along with managed care, technological advances have led to changes in the practice of clinical psychology in recent years, and new ethical challenges have also arisen. * For example....?

a quick Internet search will yield a wide array of so-called psychological tests of one kind or another, claiming to measure intelligence, personality, and other variables. - Many of these tests have questionable validity or reliability, and the feedback they provide may be inaccurate and distressing to clients

ETHICS IN CLINICAL ASSESSMENT: Psychologists involved in test construction should do their best to establish ....?

adequate reliability and validity, minimize test bias, and accompany the test with a coherent, user-friendly test manual

When the Client Is a Child or Adolescent: - Those specified conditions should, at the very least, include...? - Even if the clinical psychologist offers the rationale that such an agreement would benefit the child's well-being, parents may refuse it, and the acceptability of such an arrangement may depend on .....?

any situation in which children might be harmed by the behavior of others or themselves, as well as general information about the child's psychological condition or progress in therapy. - cultural variables involving parent-child relationships.

ETHICS IN CLINICAL RESEARCH: - When clinical psychologists conduct empirical studies to measure how well a particular therapy works, they typically conduct the therapy in question with one group of participants, whereas a second group does not receive this therapy. What should the second group receive? This is a question with important ethical implications. - Although studies of this type may ultimately benefit many clients via the identification of evidence-based treatments, psychologists should ......?

be careful not to mistreat or harm some of their clients/research participants in the process.

Competence: - Of course, personal problems that impede psychologists' performance can stem from any aspect of their personal or professional lives - On the professional side, the phenomenon of _______ among clinical psychologists has been recognized in recent decades.

burnout

Competence: A more recent study confirmed that overinvolvement with clients correlates strongly with...? - Another study of more than ______ clinical psychologists found that about ______ _________ had experienced mental health problems themselves, with the most common being........

burnout, particularly in the form of emotional exhaustion - 600 / two thirds / depression, anxiety, and eating disorders

Competence: Ethical psychologists do not assume a "one-size-fits-all" approach to their professional work. Instead, they realize that.....?

clients differ in important ways, and they ensure that they have the competence to choose or customize services to suit culturally diverse clients - Such competence can be obtained in many ways, including through coursework, direct experience, and efforts to increase one's own self-awareness.

Competence: - Collective efforts can also be helpful; that is, not only can each psychologist look out for herself or himself, but ......?

clinical psychologists can look out for one another, both informally (e.g., among colleagues) and formally via efforts by professional organizations to promote self-care among their members

Competence: Psychologists not only need to become competent, but they must also remain competent: "Psychologists undertake ongoing efforts to develop and maintain their competence" - This standard is consistent with the _________ ________regulations of many state licensing boards. - what is this ?

continuing education - That is, to be eligible to renew their licenses, psychologists in many states must attend lectures, participate in workshops, complete readings, or demonstrate in some other way that they are sharpening their professional skills and keeping their knowledge of the field current

Competence: - Among the many aspects of competence that clinical psychologists must demonstrate is _________ competence. - Ethical Standard 2.01b (American Psychological Association, 2002) states that when .......?

cultural - an understanding of factors associated with age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, or socioeconomic status is essential for effective implementation of their services or research, psychologists have or obtain the training, experience, consultation, or supervision necessary to ensure the competence of their services.

Competence: - Clearly, burnout and other factors can contribute to a level of impairment—in the form of ........?—that directly interferes with clinical work

depression, substance use, or other manifestations

CONFIDENTIALITY: * Tarasoff and the Duty to Warn - As stated in the first Tarasoff ruling, "The confidential character of patient-psychotherapist communications must yield to the extent to which .......

disclosure is essential to avert danger to others. The protective privilege ends where the public peril begins"

Ethics in Small Communities: - Although they have become increasingly acknowledged and researched in recent decades, the ethical challenges unique to small communities are certainly not a recent development. - Clinical psychologists who work and live in small communities have always experienced these challenges - Rural areas and small towns may be the most obvious examples of small communities, but there are many others as well. Even within large cities, clinical psychologists can find themselves living and working in small communities defined by...?

ethnicity, religion, or sexual orientation, or on military bases, at small colleges, or in similar settings

Competence: - Burnout refers to a state of

exhaustion that relates to engaging continually in emotionally demanding work that exceeds the normal stresses or psychological "wear and tear" of the job

Defining Multiple Relationships: - The nonprofessional involvement between client and clinical psychologist need not be sexual to constitute a multiple relationship or to cause the client harm. Indeed, psychologists may have opportunities to engage in a wide variety of nonsexual multiple relationships: .....?

friendships, business or financial relationships, coworker or supervisory relationships, affiliations through religious activities, and many others

Competence: - The impairment associated with burnout can definitely translate into less effective treatment. - One study found a strong correlation between ......?

higher rates of therapist burnout and lower therapy outcomes in clients with depression and anxiety, mostly because of disengagement by the therapists

INFORMED CONSENT: - Especially in psychotherapy, the informed consent process presents the clinical psychologist the chance to begin to establish a collaborative relationship with the client - this kind of relationship is central to the success of psychotherapy of all kinds. - Thus....

it can be beneficial for clinical psychologists to invite clients to participate actively in the informed consent process and genuinely to join in the decision-making process regarding their treatment plan

INFORMED CONSENT: - Regarding research, Standard 8.02 ("Informed Consent to Research") of the American Psychological Association's (2002) ethical code instructs psychologists to inform prospective participants about numerous aspects of the study, including...?

its purpose, procedures, and length of time it may require; any predictable risks or adverse effects; incentives for participation; and the right to decline or withdraw from participation.

INFORMED CONSENT: - Finally, the phrase "provide sufficient opportunity for the client/patient to ask questions and receive answers" has been addressed by the publication of ......?

lists of questions that psychologists could offer to clients at the outset of therapy or at any other relevant point - From this list, clients could choose the questions in which they have interest, some of which may not have occurred to them on their own.

CONTEMPORARY ETHICAL ISSUES: - To deal with this issue, the clinical psychologist could tell the client about ....?

loyalties to managed-care companies—and much more about managed care for that matter—during the informed consent process.

When the Client Is a Child or Adolescent: - It can be exceedingly challenging to determine with confidence whether child abuse is likely to have taken place, especially with children who .....?

may not be entirely forthcoming, who may exaggerate claims against their parents, or whose communication skills may be limited.

ETHICS IN CLINICAL RESEARCH: - The American Psychological Association's code of ethics includes numerous standards that apply to research of all kinds, including clinical research. - So, just like psychologists from other specialty areas, clinical psychologists who conduct research are ethically obligated to....?

minimize harm to participants, steer clear of plagiarism, and avoid fabrication of data, among other things

BOUNDARIES AND MULTIPLE RELATIONSHIPS: - In general, it can be problematic for clinical psychologists to know someone professionally—as, say, a therapy client or student—and also to know that person in another way—as, say, a friend, business partner, or romantic partner. The term used to describe such situations is ......?

multiple relationships. - sometimes called dual relationships

When the Client Is a Child or Adolescent: - Sometimes, clinical psychologists can discuss this confidentiality dilemma openly with child clients and their parents, and a mutually agreeable arrangement can be reached. - In other words, "therapists working with minor clients often...

negotiate an arrangement with their clients and their parents whereby the parents will not expect to be informed of what the client discloses in therapy except under specified conditions"

ETHICS IN CLINICAL RESEARCH: - the participants in therapy efficacy studies who don't receive the treatment being studied are placed in one of three conditions: ....? - Is it ethical to provide any of these options to people who have psychological problems and have chosen, presumably with the hope of improvement, to participate in a study on its treatment?

no treatment or "wait-list control" group, a placebo treatment -some kind of interpersonal interaction with a professional but with presumably therapeutic techniques deliberately omitted-, or an alternate treatment

Ethics in Small Communities: - Some of these concerns apply to online therapy practices as well - When therapy is done via computer, the clinical psychologist and client may.....?

not be able to fully appreciate all aspects of communication (e.g., nonverbals). - Moreover, online therapy gives rise to concerns about confidentiality and client identity that don't exist when the clinical psychologist works with the client in person

INFORMED CONSENT: Psychotherapy requires an informed consent process as well. Ethical Standard 10.01 ("Informed Consent to Therapy") explains that

psychologists inform clients/patients as early as is feasible in the therapeutic relationship about the nature and anticipated course of therapy, fees, involvement of third parties, and limits of confidentiality and provide sufficient opportunity for the client/patient to ask questions and receive answers.

What Makes Multiple Relationships Unethical? - Although such "boundary erosion" is not inevitable , minor boundary infractions can foster the process. - As such, clinical psychologists should give careful thought to certain actions-- .....? --that may be expected and normal within most interpersonal relationships but may prove detrimental in the clinical relationship

receiving or giving gifts, sharing food or drink, self-disclosing their own thoughts and feelings, borrowing or lending objects, hugging

ETHICS IN CLINICAL ASSESSMENT: - Although psychologists should keep test materials secure, the American Psychological Association's (2002) ethical code explains that they are generally obligated to release test data to clients on request. - What is Test Data ?

refers to the raw data the client provided during the assessment—responses, answers, and other notes the psychologist may have made.

ETHICS IN CLINICAL ASSESSMENT: - Although previous editions of the ethical code instructed psychologists not to release test data to clients, the current edition instructs psychologists to ....?

release test data unless there is reason to believe that the data will be misused or will harm the client. - This revision reflects the more global shift toward patient autonomy in the health care field

Aspirational and Enforceable: Knapp and VandeCreek (2006) describe these two approaches to ethics as "_________" and "___________" ethics.

remedial and positive

Defining Multiple Relationships: multiple relationships can take many forms... - Perhaps the most blatant and damaging are.....? - The American Psychological Association's (2002) code of ethics offers a direct and inflexible standard about such behavior: ....?

sexual multiple relationships, in which the clinical psychologist becomes a sexual partner of the client. - "Psychologists do not engage in sexual intimacies with current therapy clients/patients" = Standard 10.05 - Such behavior represents a fundamental breach of the healthy therapist-client relationship and often results in significant psychological or emotional damage for the client

Competence: - It is important to note that ethical violations involving cultural incompetence ---e.g., actions reflecting racism or sexism---are viewed just as negatively by nonprofessionals as other kinds of ethical violations, such as ....?

such as confidentiality violations and multiple relationships. - In other words, cultural competence is not only a wise clinical strategy; it is an essential component of the ethical practice of clinical psychology that can lead to detrimental consequences for clients when violated

Competence: - competent clinical psychologists are those who are ...?

sufficiently capable, skilled, experienced, and expert to adequately complete the professional tasks they undertake

CONTEMPORARY ETHICAL ISSUES: - Indeed, there are many aspects of managed mental health care that could be included in the informed consent process. - For example, managed-care plans typically require....?

that a Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnosis be assigned to a client to qualify for payment. - Also, managed-care companies typically require that the clinical psychologist share at least some clinical information about the problem or its treatment with the company. - To what extent should clinical psychologists discuss this and other facts of managed-care therapy with clients at the outset of therapy?

ETHICS IN CLINICAL RESEARCH: - it is essential to inform participants before they consent to the study that some of them may not receive the treatment being studied or any treatment at all. - Even if participants agree to this arrangement, ....?

the ethicality of the treatment they receive throughout a study of this type has been questioned. - Indeed, it is a significant ethical challenge for clinical psychologists to determine empirically the efficacy of their therapies without unduly exploiting or failing to help some of the participants while doing so.

When the Client Is a Child or Adolescent: *More confidentiality-related challenges arise when clinical psychologists provide services to minors. -One particular challenge centers on the fact that for many children and adolescents, the establishment of a close, trusting relationship with a clinical psychologist depends on....?

the extent to which the psychologist reveals details of one-on-one conversations with the child's parents - Simply put, kids might choose to withhold rather than discuss important personal issues if they know that their psychologists will subsequently share the information with the kids' parents. -Of course, as legal guardians, parents are ultimately entitled to be informed about their children's progress in therapy; moreover, it's effective clinical practice to keep parents actively engaged in a child's therapy.

INFORMED CONSENT: - It is also necessary to obtain informed consent for psychological assessments. - According to Standard 9.03 ("Informed Consent in Assessments" [American Psychological Association, 2002]), psychologists should offer information about .....?

the nature and purpose of the assessment; any relevant fees; the involvement of other parties, if any; and limits of confidentiality -i.e., duty-to-warn or child abuse situations-

Competence: An important implication of this standard is that having a doctoral degree or a license in psychology does not automatically make a psychologist competent for all professional activities. Instead, .....? - Example on Dr. Kumar, a clinic. psychologist who attended a doctoral training program?

the psychologist must be specifically competent for the task at hand - Dr. Kumar, a clinical psychologist who attended a doctoral training program in which she specialized in child clinical psychology. All her graduate coursework in psychological testing focused on tests appropriate for children, and in her practice, she commonly uses such tests. Dr. Kumar receives a call from Rick, an adult seeking an intelligence test for himself. - Although Dr. Kumar has extensive training and experience with children's intelligence tests, she lacks training and experience with the adult versions of these tests. Rather than reasoning, "I'm a licensed clinical psychologist, and clinical psychologists give these kinds of tests, so this is within the scope of my practice," - Dr. Kumar takes a more responsible, ethical approach. She understands that she has two options: Become adequately competent (through courses, readings, supervision, etc.) before testing adults such as Rick, or refer adults to another clinical psychologist with more suitable competence.

ETHICS IN CLINICAL ASSESSMENT: - the American Psychological Association's (2002) code of ethics obligates psychologists to select tests that are appropriate for the purpose of the assessment and the population being tested. - Test selection should entail a number of factors, including....?

the psychologist's competence; the client's culture, language, and age; and the test's reliability and validity.

What Makes Multiple Relationships Unethical? * Ethical Standard 3.05a: - Psychologists must always remember that the therapist-client relationship is characterized by unequal power, such that......? - hus, ethical psychologists remain vigilant about

the therapist's role involves more authority and the client's role involves more vulnerability, especially as a consequence of some clients' presenting problems - exploiting or harming clients by clouding or crossing the boundary between professional and nonprofessional relationships. --> Above all, the client's well-being, not the psychologist's own needs, must remain the overriding concern.

AMERICAN PSYCHOLOGICAL ASSOCIATION'S CODE OF ETHICS: Since its inception, the code has applied not only to clinical psychologists but also to psychologists of all specialties. Some of its guidelines are especially relevant to the most common professional activities of clinical psychologists, such as .....?

therapy, assessment, research, and teaching.

CONFIDENTIALITY: * Tarasoff and the Duty to Warn - From the Tarasoff case, the duty to warn (and duty to protect) was born. Since the Tarasoff case set the legal precedent, clinical psychologists (and other therapists) have understood that ....?

there are limits to their confidentiality agreements with clients and that they have a duty to warn or protect people toward whom their clients make credible, serious threats.

INFORMED CONSENT: - Ethical Standard 10.01 ("Informed Consent to Therapy" - Several phrases of this ethical standard highlight the fact that therapy stands apart from other professional activities of clinical psychologists. - For one, the phrase "as early as is feasible" suggests that.....?

there may be different points at which information could be presented to clients. - In fact, a survey of psychologists providing therapy found that in general, they are comfortable providing some generic information, such as payment and confidentiality policies, at the outset of therapy, but more specific information, such as the length, goals, and substance of psychotherapy, requires more time for therapists to get to know their clients. - As a result, 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

Aspirational and Enforceable: The items in the General Principles section are aspirational. - what does this mean?

they describe an ideal level of ethical functioning or how psychologists should strive to conduct themselves. They don't include specific definitions of ethical violations; instead, they offer more broad descriptions of exemplary ethical behavior.

CONTEMPORARY ETHICAL ISSUES: * Managed Care and Ethics *managed care exerts a strong influence on the current practice of clinical psychology. Among the new challenges it has presented are numerous ethical issues. - To begin, managed-care companies can put clinical psychologists in a position of divided loyalty. Although psychologists are ethically committed to "strive to benefit" and "safeguard the welfare" of their clients, ...?

they may be professionally pressured to minimize the services they provide to limit the cost of mental health care. - In other words, clinical psychologists may find themselves in a tug-of-war between the managed-care companies' profits and their clients' psychological well-being -Moreover, to the extent that clients can perceive that the clinical psychologist has divided loyalties, the therapeutic relationship may suffer.

ETHICS IN CLINICAL ASSESSMENT: When psychologists allow test materials to be taken home by clients, photocopied, or posted on Internet sites, not only might they be violating copyright laws, but ......? - As described by Knapp and VandeCreek (2006), depending on the test in question, such invalid test results could ....?

they might also be allowing prospective test takers inappropriate access to tests. - This could lead to preparation or coaching for psychological tests, which could, in turn, produce invalid test results. - place a nongifted student in a school's gifted program, a psychologically unstable police officer on the streets, or a child in the custody of an emotionally unfit parent.

Competence: - Other research suggests that burnout is more common among therapists who repeatedly

think about frustrating aspects of their work, therapists with relatively little experience, and therapists who have high levels of neuroticism and perfectionism, but burnout is less common among therapists who believe they have sufficient social support

INFORMED CONSENT: - Another noteworthy phrase in Standard 10.01 is "the involvement of third parties"; it has been a subject of debate exactly what or how much......

to tell clients about managed care's influence on the therapy process

Competence: - the ethical standard suggests, psychologists should take action to prevent or minimize their own impairment, including professional burnout. - Such actions can include ......?

varying one's work responsibilities, keeping one's expectations reasonable, consulting with other professionals, maintaining a balanced and healthy personal life, or seeking their own psychotherapy as necessary