(Midterms) Chapter 5: Ethical Issues in Clinical Psychology

Fidelity and Responsibility

"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."

Standard 2.01a, "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."

Justice

"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."

Respect for People's Rights and Dignity

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

Integrity

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

Beneficence and Nonmaleficence

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

Standard 2.03, "Maintaining Competence"

"Psychologists undertake ongoing efforts to develop and maintain their competence."

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."

impairment in the psychologist

(criterion for impropriety in a multiple relationship) if the dual role with the client makes it difficult for the psychologist to remain objective, competent, or effective, then it should be avoided

exploitation or harm to the client

(criterion for impropriety in a multiple relationship) psychologists must always remember that the therapist-client relationship is characterized by unequal power, such that the therapist's role involves more authority and the client's role involves more vulnerability

duty to warn (duty to protect)

- from the Tarasoff case, this was born; used to refer to the consequences of the Tarasoff case - clinical psychologists have understood that there are limits to their confidentiality agreements with clients, and that they have a duty to warn people toward whom their clients make credible, serious threats

informed consent

- in any professional activity conducted by psychologists (e.g. research, assessment, therapy), this is an essential process - it ensures the person with whom the psychologist us 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

remedial approach to ethics

- involve doing just enough to avoid any trouble that might come from a violation of ethical standards - psychologists with this approach to ethics might do the bare minimum to make themselves competent for a particular activity

positive approach to ethics

- involve making every effort to ensure that one's professional behavior was as consistent with ethical principles as possible - psychologists with this approach to ethics will strive to become as competent as possible

confidentiality

- one of the characteristics most closely associated with the ethical practice of clinical psychology - our profession is entrusted by the public to provide professional services without sharing the private, personal details offered in the process

Celia Fisher

- served as the chair of the APA's Ethics Code Task Force. - in her book, "Decoding the Ethics Code", she proposes a model for ethical decision making

General Principles

- the items in this section of the ethical code are aspirational - 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

Ethical Standards

- this section of the ethical code includes enforceable rules of conduct - these 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

- shaking hands with clients - addressing clients by first name - breaking confidentiality if clients are suicidal or homicidal

3 behaviors that are viewed as unquestionably ethical

1. feeling overcommitted to clients 2. having a low sense of control over the therapy 3. earning a relatively low salary

3 factors that increased a psychologist's susceptibility to burnout

- therapy - assessment - research - teaching

4 most common professional activities of clinical psychologists

1. threats of hurting oneself 2. threats of hurting others 3. suspicion of vulnerable adult abuse 4. suspicion of child abuse

4 reasons to breach confidentiality

1. Beneficence and Nonmaleficence 2. Fidelity and Responsibility 3. Integrity 4. Justice 5. Respect for People's Rights and Dignity

5 APA General Ethical Principles

general principle; ethical standard

Although each _________________________ could apply to almost any task a psychologist performs, each _________________________ typically applies to a more targeted aspect of professional activity.

1. boundary crossing 2. boundary violation

Boundary Crossing or Boundary Violation 1.) beyond a usual boundary that may help a client. (e.g. touch, helping outside the office, self-disclosure) 2.) hurt, exploit, or harm. (sexual contact, improper self-disclosure)

child abuse

Every state has laws requiring mental health professionals to break confidentiality to report known or suspected ________________.

informed consent process

especially in psychotherapy, this process presents the clinical psychologist the chance to begin to establish a collaborative relationship with the client

Standard 8.03, "Informed Consent to Research"

ethical standard that 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

Standard 4.02, "Discussing the Limits of Confidentiality"

ethical standard that 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.

- friendships - business or financial relationships - coworker or supervisory relationships - affiliations through religioes activities

examples of nonsexual multiple relationship (4)

test security

protection of the integrity of psychological test materials by preventing them from entering the public domain

- the point in time or the region of the country in which they are collected - the gender or age of the clients toward whom the behaviors may be directed

psychologists' ethical beliefs may vary according to.... (2)

test data

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

APA code of ethics

since its inception, it 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

Standard 4.01, "Maintaining Confidentiality"

specific ethical standard which begins, "Psychologists have a primary obligation and take reasonable precautions to protect confidential information."

sexual multiple relationships

the clinical psychologist becomes a sexual partner of the client

American Psychological Association's Ethics Code Task Force

the committee responsible for creating the 2002 revision of the ethical code

Ethical Standard 3.05a

this ethical code states that a multiple relationship occurs when 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

Standard 10.01, "Informed Consent to Therapy"

this ethical standard explains that psychologists should 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 limit of confidentiality and provide sufficient opportunity for the client/patient to ask questions and receive answers

"as early as is feasible"

this phrase from the Standard 10.01, "Informed Consent to Therapy" suggests that there may be different points at which information could be presented to clients

ethical code

this should be understood not only as a list of rules to follow and mistakes to avoid but also as a source of inspiration for ethical behavior of the highest order

continuing education

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

multiple relationships (dual relationships)

to know someone professionally, and also to know that person in another way

9

total number of revised editions of the ethical code that have been published including the most recent edition

informed consent to therapy

unlike informed consent to research or assessment, this may be best understood as an ongoing process rather than a one-time event

TRUE; It is effective clinical practice to keep parents actively engaged in a child's therapy. However, 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' parent. This is why sometimes, therapists working with minor clients 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.

~TRUE or FALSE~ As legal guardians, parents are ultimately entitled to be informed about their children's progress in therapy.

TRUE

~TRUE or FALSE~ Burnout is more common among therapists who repeatedly think about frustrating aspects of their work, and less common among therapists who believe they have sufficient social support.

TRUE; situations arise in which psychologists are obligated to break confidentiality

~TRUE or FALSE~ Confidentiality is not absolute.

TRUE; In one study of more than 500 licensed psychologists practicing therapy, more than one third reported that they had experienced high levels of some aspects of burnout, especially emotional exhaustion.

~TRUE or FALSE~ Due to the nature of the work they often perform, clinical psychologists can find themselves quite vulnerable to burnout.

TRUE; In some settings, such as small communities, such multiple relationships may be difficult to avoid.

~TRUE or FALSE~ It is possible to engage in a multiple relationship that is neither impairing to the psychologist nor exploitative or harmful to the client.

TRUE; Surveys of psychologists and other therapists suggest that such feelings do in fact occur. The important issue is how psychologists deal with such feelings: preferably by discussing them in consultation with other professionals or perhaps their own therapist, but certainl y not by acting on them.

~TRUE or FALSE~ Psychologists are human, and they may experience feelings of attraction toward a client from time to time.

1. remedial 2. positive

2 approaches to ethics according to Knapp and VandeCreek

1. impairment in the psychologist 2. exploitation or harm to the client

2 criteria for impropriety in a multiple relationship

1. General Principles 2. Ethical Standards

2 distinct sections of the current APA ethical code

- sex with clients or former clients - socializing with current clients - disclosing confidential information without cause or permission

3 behaviors that are viewed as blatantly unethical

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

10 Categories of APA Ethical Standards

protecting; warning

A second ruling of the Tarasoff case emphasized more broadly "____________" rather than specifically "____________" the potential victim.

generally ethical people with sound values

Before turning to any step-by-step ethical decision-making model, psychologists best prepare themselves to deal with ethical dilemmas by becoming...

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

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. 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.

Celia Fisher's model for ethical decision: (8)

standard; principle

If a psychologist is found guilty of an ethical violation, it is a _____________ (not a ______________) that has been violated.

remain competent

Psychologists not only need to become competent, but they must also...

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

Psychologists should take action to prevent or minimize their own impairment. Such actions include... (5)

competence

clinical psychologists who are sufficiently capable, skilled, experienced, and expert to adequately complete the professional tasks they undertake display...

1953

The American Psychological Association published its first code of ethics in ________.

read p. 216, very interesting!!

The Tarasoff case and the duty to warn.

10; 89

The ethical standards are divided into ____ categories, and, collectively, these categories include ____ individual standards.

2002

The most recent edition of the APA code of ethics was published in ________.

- Principle E: Respect for People's Rights and Dignity - Standard 4.01, "Maintaining Confidentiality"

confidentiality is specifically mentioned among the general principles (__________________________) and in numerous ethical standards including ________________________

"Decoding the Ethics Code"

a book by Celia Fisher where she proposes a model for ethical decision making

burnout

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

Standard 9.03, "Informed Consent in Assessments"

according to this ethical standard, 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

"Ethics, Culture, and Psychiatry"

book by Okasha, Arboleda-Florez, & Sartorius that focuses on cultural differences regarding confidentiality and other ethical issues

Scandinavian culture

in this culture, a patient has the right to make decisions about his or her treatment without interference from family

Arab culture

in this culture, issues of illness are dealt with as family matters