American Psychologist

© 2020 American Psychological Association 2020, Vol. 75, No. 5, 644 – 654
ISSN: 0003-066X http://dx.doi.org/10.1037/amp0000661

Ethical Considerations for Psychologists in the Time of COVID-19

Tiffany Chenneville Rebecca Schwartz-Mette

University of South Florida, St. Petersburg University of Maine

Psychologists are in a position to respond to the COVID-19 pandemic through research,

practice, education, and advocacy. However, concerns exist about the ethical implications
associated with transitioning from face-to-face to online or virtual formats as necessitated by
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

stay-at-home orders designed to enforce the social distancing required to flatten the curve of
This document is copyrighted by the American Psychological Association or one of its allied publishers.

new COVID-19 cases. The purpose of this article is to review potential ethical issues and to
provide guidance to psychologists for ethical conduct in the midst of the current crisis and its
aftermath. In addition to contextualizing relevant ethical considerations according to the
principles and standards of the current American Psychological Association’s ethics code,
vignettes are presented to exemplify the ethical dilemmas psychologists in various roles may
face when responding to COVID-19 and to offer suggestions and resources for resolving
potential conflicts.

Public Significance Statement

This article provides psychologists with guidance for addressing ethical issues that may arise while
providing services during the COVID-19 pandemic. The information included in this article will be useful
for psychologists working across settings (e.g., independent practice, hospitals, clinics, universities or
colleges, research centers) and various roles (e.g., clinicians, scientists, educators, advocates).

Keywords: ethics, ethical considerations, COVID-19, coronavirus, telehealth

The World Health Organization (WHO, 2020b) first re-
ceived notice of cases of pneumonia with an unknown cause
in Wuhan, China, in December 2019. Shortly thereafter, the
underlying cause of pneumonia in these cases was identified
as coronavirus, later named COVID-19, which is a zoonotic
disease similar to the SARS coronavirus but even more
contagious (Liu, Gayle, Wilder-Smith, & Rocklöv, 2020).
By the end of January 2020, the WHO (2020b) declared
COVID-19 a public health emergency of international con-
cern. Since then, cases of COVID-19 have rapidly increased
This article was published Online First May 21, 2020.
X Tiffany Chenneville, Department of Psychology, University of South
Florida, St. Petersburg; X Rebecca Schwartz-Mette, Department of Psy-
chology, University of Maine.
Although the authors are the vice chair and chair, respectively, of the
American Psychological Association’s (APA’s) Ethics Committee, the views
presented in this article are those of the authors and do not necessarily reflect
the views of the APA or the APA Ethics Committee. During the preparation
of this manuscript, Rebecca Schwartz-Mette was supported by an R15 Award
(MH116341) from the National Institute of Mental Health.
Correspondence concerning this article should be addressed to Tiffany
Chenneville, Department of Psychology, University of South Florida, St.
Petersburg, 140 7th Avenue South, St. Petersburg, FL 33701. E-mail:
chennevi@usf.edu
644
in countries across the world, including the United States.
According to the WHO (2020a), most people who contract
COVID-19 will experience mild illness. However, people
who are older or who have underlying health conditions
(e.g., cardiovascular disease, diabetes, or lung or chronic
respiratory disease) are at increased risk for severe disease
and/or death.
Not only is COVID-19 taking a significant toll on health
care systems, but it is taking a significant toll on individuals
and communities. Consistent with recommendations by the
WHO (2020a) and Centers for Disease Control and Preven-
tion (2020) to social distance to prevent the spread of
COVID-19, most states in the United States have issued
stay-at-home orders. As a result, many people are unem-
ployed or underemployed, which has huge economic impli-
cations (Atkeson, 2020; Maital & Barzani, 2020), not to
mention the psychosocial issues associated with COVID-
19. Those directly affected by the virus are dealing with
personal illness or the illness and, in some cases, death of
loved ones, resulting in grief. Meanwhile, many people are
living in fear that they or someone they love will contract
the virus (Ornell, Schuch, Sordi, & Kessler, 2020; Pakpour
& Griffiths, 2020). In addition, people are facing stressors
associated with the dramatic and unforeseen changes to
 COVID-19 ETHICAL CONSIDERATIONS
their daily lives. Because schools have transitioned to re-
mote instruction, many families are faced with juggling the
demands of having school-age children at home while oth-
ers are coping with the negative effects of social isolation.
Unfortunately, the psychosocial implications of COVID-19
are likely to extend beyond the immediate crisis as people
across the United States and the world try to rebuild their
lives even after the virus is contained or a vaccine is
developed. Therefore, the need for psychologists has never
been greater.
Indeed, psychologists are responding to the COVID-19
pandemic through research, practice, education, and advo-
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
cacy, yet may face concerns about ethical issues related to
This document is copyrighted by the American Psychological Association or one of its allied publishers.
working in the COVID-19 environment. The purpose of this
article is to review potential ethical issues and to provide
guidance to psychologists for ethical conduct in the midst of
the current crisis and beyond. Relevant ethical consider-
ations will be presented within the context of the principles
and standards of the current American Psychological Asso-
ciation’s (APA, 2017) Ethical Principles of Psychologists
and Code of Conduct, hereafter referred to as the APA
ethics code, and APA guidelines and other resources will be
shared. Vignettes are used to exemplify the ethical dilem-
mas psychologists in various roles may face when respond-
ing to COVID-19 and to offer suggestions for resolving
potential conflicts.
Relevant Ethical Principles
The current APA (2017) ethics code outlines five general
principles, which serve as aspirational goals for the profes-
sion. Unlike the ethical standards outlined in the APA ethics
code, the principles are not enforceable but, rather, are
intended to provide guidance to psychologists about the
ethical ideals of the profession. In the context of COVID-
19, Principle A, “Beneficence and Nonmaleficence,” ad-
dresses the need for psychologists to strive to benefit those
with whom they work or for whom their work affects, and
to minimize harm, as they transition their clinical, research,
education, and advocacy activities to account for social
distancing requirements. Principle B, “Fidelity and Respon-
sibility,” is relevant within the context of COVID-19 as
relationships of trust with clients, students, and research
participants are critical and collaboration with other profes-
sionals and organizations is particularly important during
the time of a pandemic. Establishing trusting relationships
online may require unique considerations as described be-
low when discussing telehealth services (see Relevant Eth-
ical Standards). Given the economic impact of COVID-19,
there is likely to be increased need for pro bono services
and, depending on individual circumstances, some psychol-
ogists may find they have more time to volunteer their
services during the COVID-19 crisis. For psychologists
responding to the COVID-19 crisis, Principle C, “Integrity,”
645
highlights the need to acknowledge what is known versus
what is not known regarding the impact of COVID-19 on
mental health and to avoid taking advantage of the chaos
created by this pandemic for the purpose of personal gain
(e.g., by engaging in fraudulent behavior such as inappro-
priate billing or compromising the integrity of research
protocols to avoid delays in data collection). Amid the
COVID-19 pandemic, Principle D, “Justice,” implores psy-
chologists to provide equitable access to their services
which will vary by role. For example, clinicians should be
thinking about ensuring equitable access to therapy, assess-
ment, and other psychological services; researchers should
be thinking about how to provide equitable access to the
benefits and burdens of research, which may be particularly
important for studies designed to address aspects of the
COVID-19 crisis; educators should be thinking about how
to ensure their students have access to the remote instruction
required for social distancing practices; and all psycholo-
gists should be thinking about how best to advocate for the
individuals and communities most affected by COVID-19.
Finally, Principle E, “Respect for People’s Rights and Dig-
nity,” reminds psychologists to respect the individuals and
communities they serve during the COVID-19 crisis by, for
example, informing stakeholders about the potential limits,
risks, and/or implications of virtual modalities for therapy,
assessment, research, and education and by taking extra
safeguards to protect the privacy of the recipients of their
services. Principle E also calls on psychologists to be aware
of personal biases that may exacerbate health disparities
related to COVID-19.
Relevant Ethical Standards
In the sections to follow, readers will find a description of
how each standard in the APA (2017) ethics code might
apply to situations related to COVID-19 while recognizing
that many aspects of the Code maintain the same relevance
outside the pandemic. Ethical considerations are offered not
to exaggerate ethical hazards but, rather to, help psycholo-
gists who are implementing changes to the way they typi-
cally function to think through ethical questions that may
arise. It is important to note that some ethical issues are
addressed in multiple standards (e.g., informed consent is
addressed in Standard 4, “Confidentiality”; Standard 8, “Re-
search and Publication”; Standard 9, “Assessment”; and
Standard 10, “Therapy”), and many ethical dilemmas in-
volve multiple standards. These complexities are exempli-
fied in the case vignettes included at the end of this article.
Standard 1: Resolving Ethical Issues
Within this standard, the most salient ethical issue psy-
chologists may face in response to the COVID-19 crisis
relates to 1.03, “Conflicts Between Ethics and Organiza-
 646 CHENNEVILLE AND SCHWARTZ-METTE
tional Demands,” which addresses situations wherein psy-
chologists are asked to engage in behaviors to benefit the
organization or members of the organization that put them
at risk for violating the APA (2017) ethics code. For exam-
ple, psychologists working in hospital or other health care
settings where access to personal protective equipment
(PPE) is limited may be asked to see patients or clients
without wearing PPE even after exposure to COVID-19. In
this example, the organizational demands place psycholo-
gists at risk for violating Standard 3.04, “Avoiding Harm.”
Consistent with Standard 1.03, in cases such as this, psy-
chologists should explain the nature of the potential conflict
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and make their commitment to the APA (2017) ethics code
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known. Standard 1.03 also requires psychologists to take
reasonable actions to resolve the conflict in a way that is
consistent with the code. In this situation, psychologists
may be able to offer telehealth services (see sections below
for ethical considerations relevant to the transition to and
provision of telehealth services). Psychologists also may be
asked to provide services for which they have not acquired
competence. Although this may be viewed as a conflict
between ethics and organizational demands, the APA
(2017) ethics code does allow for psychologists to provide
services outside the areas of their competence in emergency
situations as described in more detail below.
Standard 2: Competence
Typically, psychologists’ work is guided by their adher-
ence to 2.01, “Boundaries of Competence,” which states
that psychologists do not extend themselves outside the
realm of their own training, experience, and abilities. Al-
though the spirit of 2.01 remains relevant, the APA ethics
code provides encouragement for psychologists’ flexibility
in responding to emergency situations, such as the
COVID-19 pandemic, which presents unique social and
emotional challenges. Specifically, Standard 2.02, “Provid-
ing Services in Emergencies,” permits psychologists to ex-
tend the boundaries of their competence in a time-limited
capacity to ensure that the needs of the public are not denied
during times of crisis. Psychologists may provide services
to those in need, even if they have not yet obtained the
necessary training. For example, a clinician who has not
obtained specialized training in providing therapy to older
adults or leading a skills-based therapy group would be
permitted to provide such services during this time. Psy-
chologists are further enjoined to reflect on the utility of
their foundational skill sets for remote delivery of services,
even if they lack previous training or experience in this
modality. Additionally, psychologists are encouraged to
gain familiarity with currently relaxed regulations for inter-
jurisdictional practice. As clients (and clinicians) may be
dispersed from their previous locations due to the pandemic,
the increased flexibility of interjurisdictional practice at this
time may aid psychologists in their efforts to meet client
needs. Often the provision of such services can be supple-
mented with peer consultation, supervision, and/or continu-
ing education. Upon resolution of the crisis, psychologists
are expected to discontinue these emergency services.
Standard 2.06, “Personal Problems and Conflicts,” also is
relevant here, as it should be underscored that psycholo-
gists, like those whom they treat, may also be experiencing
ambiguity, stress, and mental and/or physical health needs.
Psychologists should remember their ethical duty to care for
themselves and their colleagues, so that they are able to care
for those in need. Finally, it is acknowledged that adherence
to competency standards is, at least in part, predicated on
accurate self-assessment, which is complicated by inconclu-
sive evidence that professionals excel in this area (Dunning,
Heath, & Suls, 2004) and constructs that impact all profes-
sionals, such as implicit bias (Katz & Hoyt, 2014). As such,
it is strongly recommended that psychologists reach out and
rely on their “competent community” (see Johnson, Barnett,
Elman, Forrest, & Kaslow, 2013) of colleagues to get sup-
port, feedback, and consultation regarding limits of compe-
tence.
Standard 3: Human Relations
Standard 3 is highly relevant to the work of psychologists
during the COVID-19 situation. Standard 3.01, “Unfair
Discrimination,” prohibits psychologists from unfairly dis-
criminating against people based on individual differences
(e.g., age, gender, sexual orientation, disability, socioeco-
nomic status). In states where mental health professionals
are deemed essential workers exempt from stay-at-home
orders, psychologists working in settings or in roles that do
not mandate the treatment of patients with COVID-19 (e.g.,
working in an independent practice vs. working as a psy-
chologist in a nursing home) may question whether or not it
is ethical to deny face-to-face services based on COVID-19
risk factors. Indeed, many health professionals not tasked
with the direct treatment of patients with COVID-19 have
implemented screening practices to minimize risk of trans-
mission, and doing so is perfectly reasonable given the high
degree of contagion associated with the coronavirus. After
all, health professionals, including psychologists, should not
feel obligated to put themselves at risk by offering face-to-
face services as refusal to treat high risk clients not only
benefits the psychologist, but also other clients that the
psychologist serves. However, it is important to be fair and
consistent in treatment delivery practices to avoid unfair
discrimination based on age or preexisting conditions alone
even though these are known risk factors for contracting
COVID-19. For example, a client who is older but who lives
alone and has not been exposed to COVID-19 may be at
significantly lower risk than a younger person who works in
a grocery store where there has been a COVID-19 outbreak.
 COVID-19 ETHICAL CONSIDERATIONS
Rather than screening clients for COVID-19, which falls
outside the purview of psychologists, the use of universal
precautions is the best way to avoid discrimination. When
delivering face-to-face services, universal precautions may
involve social distancing and/or the use of PPE, depending
on the setting. Where feasible, transitioning to telehealth
may be the best solution for avoiding potential issues related
to unfair discrimination. More information about telehealth
is contained in other sections of this article.
As psychologists alter standard practices related to their
various roles (e.g., clinician, researcher, educator, advocate)
in response to COVID-19, it is important that they take
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reasonable steps to adhere to Standard 3.04, “Avoiding
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Harm,” while also recognizing the potential harm that social
distancing creates. Such steps could include, but are not
limited to, psychologists not requiring clients or trainees to
place their health at risk (e.g., violate stay-at-home orders),
offering flexibility to students remotely completing assign-
ments in their classes, and advocating for relaxation of
regulations pertaining to telehealth so as to ensure clients’
continued access to care. As noted above, in the midst of the
coronavirus crisis, psychologists may be asked to take on
roles that require them to carefully consider Standards 3.05,
“Multiple Relationships,” and 3.06, “Conflict of Interest.” It
is important for psychologists to remember that not all
multiple relationships are considered harmful or unethical.
Therefore, psychologists must carefully weigh the pros and
cons of entering into multiple relationships directly related
to attempting to help others in the emergency situation
created by the COVID-19 pandemic, such as the provision
of psychological services to a family member or a personal
acquaintance suffering from mental health issues related
social isolation (e.g., depression, anxiety). In these cases,
psychologists need to examine whether or not a conflict of
interest exists and, if so, if the conflict impairs professional
competence or objectivity or otherwise harms or exploits
the potential client. Thus, self-awareness is critical.
Standard 3.09, “Cooperation With Other Professionals,”
may be particularly important for meeting the needs of
clients suffering from COVID-19. For instance, psycholo-
gists may need to expand their professional networks to
cooperate with colleagues known or new for the purposes of
consultation, supervision, and/or referral. Standard 3.10,
“Informed Consent,” also is an important consideration for
psychologists transitioning to online formats. For clinicians
and researchers, alike modifications to existing consent
forms and processes will be required to ensure that clients
and participants are fully informed of the risks and benefits
of remote therapy and research. Finally, Standard 3.12,
“Interruption of Psychological Services,” is particularly rel-
evant in the time of a pandemic. Unfortunately, most psy-
chologists and other health professionals, for that matter,
were not prepared for the abrupt interruption of services
caused by COVID-19. Even clinicians with comprehensive
647
plans for transferring services at the time of retirement or in
cases of illness or death were ill equipped for ensuring client
needs during a pandemic. This is because everyone is af-
fected across the United States and world, albeit to varying
degrees. In situations where clinicians cannot or choose not
to transition to telehealth formats, they should make reason-
able efforts to refer clients to other practitioners who are
offering such services.
Standard 4: Privacy and Confidentiality
Standards relevant to the protection of personal informa-
tion are particularly relevant, given the necessity to shift
psychologists’ work online. Above all, psychologists are
required to maintain confidentiality (4.01, “Maintaining
Confidentiality”). Informed consent processes for research
and clinical work should include frank discussions of the
limits of confidentiality (4.02, “Discussing the Limits of
Confidentiality”) in the age of telepsychology. This would
include the potential for outside parties (e.g., individuals in
the participant’s/client’s home, hackers) to gain access to
teletherapy sessions or stored information. Clinicians’ use
of platforms that are not compatible with the Health Insur-
ance Portability and Accountability Act (although currently
permissible as per federal regulations) and clients’ comfort
and competence with using technology may further define
the limits of confidentiality, and these should be directly
addressed with clients during the informed consent process.
Note that psychologists must still follow state regulations
that exceed Health Insurance Portability and Accountability
Act standards, if they are in place and the state has not
waived them. Clients have a right to consent or veto record-
ing sessions (4.03, “Recording”) and to know the circum-
stances for preserving the confidentiality of such record-
ings. Psychologists should be aware that clients,
themselves, may be able to record sessions without psychol-
ogists’ knowledge or consent. Finally, given the expansion
of many psychologists’ area of practice during this emer-
gency, seeking peer consultation and supervision has never
been more important (4.06, “Consultations”; see also 4.04,
“Minimizing Intrusions on Privacy,” and 4.05, “Disclo-
sures”).
Standard 5: Advertising and Other
Public Statements
On the surface, Standard 5 may not seem to have any
particular relevance to the COVID-19 pandemic. However,
psychologists should consider several elements of this stan-
dard. For example, Standard 5.01b, “Avoidance of False or
Deceptive Statements,” dictates that psychologists not make
false or deceptive statements about their competence. As
described above (see Standard 2, “Competence”), the
threshold for competence is lowered in emergency situa-
 648 CHENNEVILLE AND SCHWARTZ-METTE
tions, allowing psychologists to intervene in ways they
might not otherwise. However, Standard 5.01b requires that
psychologists be honest about the limitations of their com-
petence even in emergency situations such as COVID-19.
More specifically, psychologists should not mislead the
recipients of their services about their experience or exper-
tise. This applies to clinicians, researchers, and educators.
For example, a pediatric psychologist working in a hospital
setting who is called on to consult with physicians about the
mental health needs of older adults suffering from
COVID-19 will want to make clear that she is not an expert
in geriatric psychology. This is not to say that providing
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consultation under these circumstances is inappropriate but,
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rather, that psychologists not mislead others about their
expertise. Similarly, well intended psychologists wishing to
advocate for people affected by COVID-19 should attend to
5.04, “Media Presentations,” and be careful to avoid making
public statements that fall outside their expertise or are
inconsistent with the existing psychological literature. For
example, psychologists should not make definitive state-
ments about the psychological impact of COVID-19 on
mental health until research findings on this topic are avail-
able. However, it would be appropriate for psychologists to
make general statements about the impact of social isolation
on mental health, assuming they are familiar with the avail-
able literature in this area.
Standard 6: Record Keeping and Fees
As indicated above, a shift to telehealth practices is surg-
ing in response to the social distancing requirements asso-
ciated with the COVID-19 pandemic. Adherence to Stan-
dard 6.01, “Documentation of Professional and Scientific
Work and Maintenance of Records,” may require clinicians
transitioning to telehealth to meet the needs of their clients
while also practicing social distancing to adapt their docu-
mentation and billing practices to conform to telehealth best
practices. For example, the APA’s (2013) guidelines for the
practice of telepsychology suggest that billing documenta-
tion should include information about the type of technol-
ogy used, the telepsychology services provided (e.g., video
vs. audio only), and the fee structure (e.g., based on the type
of telepsychology services provided, charges or fee reduc-
tions for service interruptions). Similarly, researchers tran-
sitioning to online platforms for data collection during the
COVID-19 crisis will need to carefully record their methods
to allow for replication both during and after COVID-19.
Even educators transitioning to remote instruction may be
tasked with specific documentation requirements to meet
institutional demands during the COVID-19 pandemic.
Standard 7: Education and Training
Across the country, graduate and professional training
programs have acted quickly to maintain trainees’ access to
educational opportunities that may previously have been
delivered only face-to-face, such as in-person classes, su-
pervision and research mentoring meetings, and practicum
experiences. This has largely required shifts to remote learn-
ing, virtual meetings, and telepsychology services. These
transitions reflect a commitment to 7.01, “Design of Edu-
cation and Training Programs,” which articulates programs’
responsibilities to design (and in this case, adjust) training
activities to ensure that students can continue to progress
toward and meet their educational goals (e.g., program
milestones, internship completion, licensure) despite social
distancing and stay-at-home restrictions. Programs must act
flexibly and equitably to ensure that students’ progress is
not adversely affected. For example, when COVID-19 re-
strictions prohibit face-to-face interactions, shifting practi-
cum experiences to telehealth allows trainees to continue to
accrue necessary clinical hours, and making reasonable
adjustments to dissertation projects facilitates consistent
progress toward research goals. Additionally, in line with
7.06, “Assessing Student and Supervisee Performance,”
trainers must continue to provide both formative and sum-
mative feedback to trainees so that any difficulties in prog-
ress or the acquisition of competence are readily identified
and managed. Trainers also would do well to contextualize
any observed trainee difficulties in light of any COVID-
related physical or mental health issues trainees may dis-
close, if relevant, and to offer appropriate support and
feedback.
Standard 8: Research and Publication
Given that social distancing requirements and stay-at-
home orders related to COVID-19 are limiting data collec-
tion for studies requiring in-person interactions, many psy-
chological researchers are transitioning to virtual or other
remote strategies for collecting data. Consistent with Stan-
dard 8.01, “Institutional Approvals,” it is important for
psychologists to consult with the institutional review board
(IRB) that approved their study (for studies involving hu-
man participants) when modifying methods to allow for
data collection during the COVID-19 pandemic. Most IRBs
will require that protocol amendments be reviewed and
approved by the IRB before any changes to data collection
or analysis are implemented. In most cases, this also will
require changes to the informed consent or assent processes
and/or documents so that participants are aware of changes
and the potential impact of those changes, particularly re-
lated to the use of audio or visual recordings associated with
modified procedures (see Standards 8.02, “Informed Con-
sent for Research,” and 8.03, “Informed Consent for Re-
cording Voices and Images in Research”). Regardless of
whether or not changes to the informed consent/assent doc-
uments or processes are required by the IRB, it will be
important for researchers to communicate with participants
 COVID-19 ETHICAL CONSIDERATIONS
when interruptions to studies occur as a result of COVID-
19.
Standard 9: Assessment
Conducting assessments remotely via telepsychology
presents unique challenges related to informed consent
(9.03, “Informed Consent in Assessments”) and confiden-
tiality (see Standard 4), as previously noted, but also to the
tools and procedures used. At a basic level, psychologists
should be sure that all conclusions and recommendations
rendered as a function of assessment be grounded in the use
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of appropriate, reliable, and valid tests and processes (9.01,
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“Bases for Assessments”; 9.02, “Use of Assessments”). When
transitioning to remote assessment, psychologists must
carefully examine their existing tools and procedures for
various referral questions to determine whether they can
translate these directly online. Regarding assessment tools,
in some cases, particular instruments may be copyrighted or
otherwise unable to be shared online. For example, psychol-
ogists should check with publishers to determine what, if
any, test materials can be shared virtually, what materials
must be mailed, and/or what materials may not be translated
to telehealth at all (see 9.11, “Maintaining Test Security”).
Psychologists should also carefully examine whether stan-
dard assessment procedures translate well to online plat-
forms. For example, early childhood autism evaluations rely
heavily on behavioral observations of the child. In some
cases, creative thinking may facilitate good enough solu-
tions; in other cases, standard assessment protocols may not
be possible to carry out as planned.
With the acknowledgment that many instruments have
not been normed using telepsychology samples and that
some assessment procedures may not be possible online,
psychologists should take great care in contextualizing their
findings. Specifically, when interpreting assessment find-
ings (9.06, “Interpreting Assessment Results”) and relaying
test results to clients (9.10, “Explaining Test Results”),
psychologists should be clear about the limitations of the
use of particular measures and/or protocols in the context of
telepsychology.
Standard 10: Therapy
Similarly, psychologists should take care to make sure
that all telepsychology clients are provided with a full and
ongoing informed consent process (10.01, “Informed Con-
sent to Therapy”) that clearly (and with a focus on the
unique nature of telehealth) articulates the nature of services
to be rendered, fees (and insurance considerations, if rele-
vant), limits of confidentiality, and potential risks and ex-
pected benefits. The location of client and therapist (and
supervisor, if involved) also should be disclosed and dis-
cussed for the purposes of practicing within appropriate
649
jurisdiction and for safety planning, should clients experi-
ence any level of risk. Keep in mind that certain entities,
such as the Veteran’s Affairs system, allows telehealth
across state lines, many states have standing agreements
about interstate practice Psychology Interjurisdictional
Compact (PSYPACT), and some federal interjurisdictional
practice regulations have been recently relaxed during this
time. However, as previously discussed, psychologists
should be aware of their state regulations and keep abreast
of COVID-related practice regulation developments, as sit-
uations may change quickly.
If they have not already, psychologists should prepare for
unexpected interruptions in therapy should they arise due to
therapist or client illness, technology failures, or time
needed to appropriately transition to telepsychology service
(10.09, “Interruption of Therapy”). Such preparation could
include articulation of plans for clients to receive short-term
or crisis support in the event of a therapist’s absence and the
identification of technology supports to quickly address
hardware or software issues. For psychologists unable to
transition to or continue with telehealth for any reason,
Standard 10.10, “Terminating Therapy,” provides useful
guidance. Psychologists should take care to process termi-
nation fully via telehealth, just as once was done in person,
and/or to provide timely and appropriate referrals for clients
who continue to need services that the psychologist cannot
currently provide.
APA Guidelines and Other Resources
In addition to familiarizing themselves with the APA
ethics code and how specific principles and standards apply
to their response to the COVID-19 pandemic, psychologists
may also want to familiarize themselves with best practice
guidelines and other resources that will help ensure that
modified practices across roles and settings maximize ben-
efit and minimize harm to the recipients of psychological
services (e.g., clients, research participants, students, gen-
eral public). For example, APA’s Joint Task Force for the
Development of Telepsychology Guidelines for Psycholo-
gists (2013) published guidelines for the practice of tele-
psychology, which are likely to be particularly useful as
COVID-19 has mandated many clinicians to begin or in-
crease their use of telehealth practices. The APA Education
Directorate (2020) provides a full and centralized listing of
telepsychology continuing education resources. The APA’s
(2013) Guidelines for Psychological Practice in Health
Care Delivery Systems also may be useful for psychologists
working in hospital or integrated care settings responsible
for treating people with COVID-19. Given that survivors of
previous pandemics have been shown to be at risk for
symptoms of posttraumatic stress disorder (Luyt et al.,
2012), the Clinical Practice Guideline for the Treatment of
PTSD (APA Guideline Developmental Panel for the Treat-
 650 CHENNEVILLE AND SCHWARTZ-METTE
ment of Posttraumatic Stress Disorder in Adults, 2017) may
be useful during and after the COVID-19 crisis.
The APA also offers guidelines for educators, some of
which may be particularly relevant for ensuring the proper
training of graduate students and postdoctoral trainees who
may be responsible for responding to psychological needs
stemming from the COVID-19 pandemic. For example, the
APA Guidelines for Clinical Supervision in Health Service
Psychology (APA Board of Educational Affairs Task Force
on Supervision Guidelines, 2014) and the Guidelines on
Trauma Competencies for Education and Training (APA,
2015) may be useful for supervisors and their trainees. The
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
APA has also recently posted COVID-19 related informa-
This document is copyrighted by the American Psychological Association or one of its allied publishers.
tion and resources for psychological scientists on the APA
website (e.g., APA, 2020e and APA, 2020c). Finally, the
APA (2020b) offers guidance on advocacy for psycholo-
gists, which may be particularly useful amid the coronavirus
pandemic.
Case Vignettes
Below are fictional vignettes designed to represent some
of the situations psychologists across various roles likely are
facing in their attempt to adjust to the COVID-19 pandemic.
For each vignette, a review of relevant principles and stan-
dards and ethical considerations is provided along with
recommendations and/or resources that may be useful for
psychologists attempting to resolve ethical dilemmas in
ways that maximize benefit and minimize harm.
Vignette 1: Psychologist Working in an
Academic Setting
Dr. Academia is a faculty member in a clinical psychology
doctoral program at a large, research intensive university.
Due to COVID-19, student dormitories have been evacuated,
and the campus is closed to “nonessential” personnel. This
means all face-to-face courses must be offered using remote
instruction, and many faculty members, Dr. Academia in-
cluded, do not have access to their research labs, resulting in
a halt in studies requiring face-to-face data collection for both
Dr. Academia and the graduate students whose theses or
dissertations she supervises. Furthermore, stay-at-home or-
ders in Dr. Academia’s state have, in some cases, disrupted
student practicum and/or internship placements and, in other
cases, placed graduate student interns at risk for exposure to
COVID-19. Dr. Academia is struggling to juggle all of the
responsibilities related to her position as a faculty member
while also caring for her young school-age children who are
at home with her due to K–12 school closures.
Several potential ethical issues are raised in this vignette
including dilemmas related to remote instruction, research,
clinical supervision, and self-care. The relevant ethical prin-
ciples and standards for each of these potential issues, along
with recommendations and/or available resources are de-
scribed below, taking into account that Dr. Academia must
follow the guidance and disaster plans of her university,
accreditation authorities, state regulators, and federal grant
agencies notwithstanding.
Remote instruction. As Dr. Academia transitions her
face-to-face courses to remote instruction, Principles A
(“Beneficence and Nonmaleficence”) and D (“Justice”) and
Standard 7 (“Education and Training”) are salient. When
considering instructional modalities, Dr. Academia should
aspire to maximize benefit and minimize harm to students
(Principle A) by taking steps to ensure that students have
equal access to course materials (Principle D). Although
synchronous modalities may be preferred from a pedagog-
ical perspective, Dr. Academia should keep in mind that not
all students have sufficient Internet access or access to
software not made available through the university. There-
fore, requiring real time virtual meetings or software outside
that which is provided by the university may prohibit aca-
demic success for some students. Dr. Academia should
therefore consider asynchronous modalities and use
university-licensed software available to students in courses
where not all students have access to adequate Internet
services or software not made available for free to students
through the university. Consistent with Standard 7.03, “Ac-
curacy in Teaching,” Dr. Academia should modify her
course syllabi to reflect changes associated with the transi-
tion to remote instruction. Dr. Academia may also want to
make herself familiar with the education, training, and dis-
tance learning resources available on the APA website
(APA, 2020a).
Research. Like many psychologists working in gradu-
ate programs across the United States, Dr. Academia is
faced with how best to address her ongoing research proj-
ects as well as the student-led theses, dissertations, or other
research projects that she is supervising. Principles A (“Be-
neficence and Nonmaleficence”), D (“Justice”), and E (“Re-
spect for People’s Rights and Dignity”), and Standard 8
(“Research and Publication”) are of most relevance here.
Dr. Academia must determine which, if any, of her or her
students’ research protocols are amenable to a transition to
virtual data collection methods, keeping in mind the impor-
tance of ensuring equal access to the benefits and burdens of
research. Dr. Academia and her students may benefit from
resources made available through the APA about conduct-
ing research during the COVID-19 pandemic (APA, 2020c),
taking into account that her university may have specific
institution-specific policies for conducting research in emer-
gency situations such as COVID-19. Dr. Academia also
should seek guidance from external agencies (e.g., National
Institutes of Health, National Science Foundation) for
funded projects. In addition, it may be prudent for Dr.
Academia to consult with her university’s IRB when con-
sidering protocol amendments. IRB approval will be re-
quired for changes to data collection methods and informed
 COVID-19 ETHICAL CONSIDERATIONS
consent or assent procedures. With regard to supervising
student research, Dr. Academia should be particularly mind-
ful of helping her supervisees to problem solve ways to
complete research projects in a timely manner to avoid
delays in academic progress. This is true not only for
research projects that were designed for face-to-face data
collection and being transitioned to online data collection
but also for research projects that are delayed due to the
general disruptions to life and schedules related to
COVID-19 that are facing both faculty members and stu-
dents (e.g., disruptions related to moving, caring for chil-
dren who are out of school or other loved ones in the
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
household, having limited access to campus including lim-
This document is copyrighted by the American Psychological Association or one of its allied publishers.
ited access to research labs, scheduling virtual thesis or
dissertation defenses).
Clinical supervision. The situation Dr. Academia is
faced with in this vignette is threefold: (a) how to address
delays in student progress toward degree requirements in
cases where practicum students or student interns are fur-
loughed, (b) how to address cases where practicum students
or student interns are at increased risk for exposure to
COVID-19 because of their practicum or internship place-
ments, and (c) how to provide adequate clinical supervision
to practicum students and interns in ways that respect social
distancing requirements. Principles A (“Beneficence”), D
(“Justice”), and E (“Respect for People’s Rights and Dig-
nity”) and Standards 7 (“Education and Training”), 9 (“As-
sessment”), and 10 (“Therapy”) are particularly relevant for
the issues facing Dr. Academia. Dr. Academia is encour-
aged to think flexibly to address ethical concerns. She may
want to consult with practicum and internship site supervi-
sions to encourage the use of telehealth services where and
when appropriate. For students completing internships ap-
proved by the Association of Psychology Postdoctoral and
Internship Centers (APPIC), Dr. Academia should familiar-
ize herself with information related to COVID-19 available
on the APPIC (2020) website. Consultation with an APPIC
representative also may be necessary. Dr. Academia should
transition to remote supervision. Ideally, this will occur
virtually using university-sponsored software that allows for
synchronous meetings. However, as noted above, Dr. Aca-
demia should keep in mind that some graduate students may
not have access to the Internet bandwidth required to sup-
port synchronous technologies, in which case Dr. Academia
may want to consider conducting telephone supervision. For
more information about addressing ethical issues related to
student interns, Dr. Academia is encouraged to review in-
formation provided by the APA (2020d). More information
specific to telehealth services is contained in Vignette 2.
Self-care. Principle A (“Beneficence and Nonmalefi-
cence”) and Standard 2 (“Competence”) are relevant to Dr.
Academia’s situation. Specifically, Dr. Academia should
aspire to maximize benefit and minimize harm to her stu-
dents and research participants by acknowledging personal
651
issues that may affect her work as a teacher, a researcher,
and clinical supervisor. Consistent with Standard 2.06,
“Personal Problems and Conflicts,” it will be important for
Dr. Academia to acknowledge her own stressors in dealing
with COVID-19 and take steps to minimize the negative
impact of these stressors. Dr. Academia may benefit from
adhering to the APA’s (2020f) recommendations regarding
the importance of prioritizing, pivoting (when necessary),
establishing routines, creating a separate workspace, check-
ing in with colleagues, exercising, staying connected, lim-
iting news consumption, practicing mindfulness or other
relaxation techniques, learning something new, and being
kind to oneself during the COVID-19 crisis.
Vignette 2: Clinician Transitioning to Telehealth
Dr. Traditional has 20 years of clinical experience treating
children, adults, and families as the head of a large, suburban
independent practice. The practice includes six other licensed
psychologists, two practicum students from a nearby doctoral
training program, and a postdoctoral resident nearing com-
pletion of hours for licensure. A significant portion of the
practice’s revenue streams from developmental assessments
(attention-deficit/hyperactivity disorder, learning disability)
and an intensive dialectical behavior therapy program involv-
ing individual sessions, group sessions, and daily telephone
coaching. Dr. Traditional has always disliked technology,
preferring face-to-face interactions and eschewing the tele-
health movement, as he feels it is too ethically and legally
risky. The other psychologists in the practice are divided.
Some are energized by the opportunity to expand service
delivery via telehealth, and others, like Dr. Traditional, prefer
to wait out COVID-19 until their clients can join them again
in the office. The two doctoral trainees are eager to incorpo-
rate what they are learning about telehealth from their home
program, and the postdoctoral resident has experience with
community telehealth from internship. Dr. Traditional feels
increasing tension at the office among his staff, and increas-
ingly strict stay-at-home orders are bringing fewer and fewer
clients into the office. Some clinicians have started doing brief
phone check-ins with their clients as a stop-gap measure, but
Dr. Traditional is aware a decision needs to be made soon
about the immediate future of his practice.
This vignette again highlights the centrality of the APA
ethics code’s general principles when working with clients
and colleagues in the midst of a global health crisis. Psy-
chologists are to seek to continue to benefit clients, col-
leagues, and trainees and to do no harm (Principle A);
psychologists also aspire to make reasonable adjustments to
their practices to meet these needs (Principle B). If psychol-
ogists decide to adjust traditional protocols, they must be
sure to avoid overextending or making unreasonable prom-
ises to those with whom they work (Principle C), and should
keep in mind a call to advocate for issues of access and
social justice as they relate to potentially underresourced
clients and colleagues.
 652 CHENNEVILLE AND SCHWARTZ-METTE
With regard to clinical care issues, Dr. Traditional and
his colleagues must work together to directly address the
tension in how to proceed with provision of assessment
and intervention services during the pandemic. Dr. Tra-
ditional may be unaware that pressures related to finan-
cial interests may be driving his hesitation to adjust his
approach to practice (3.06, “Conflict of Interest”). Such
discourse with colleagues is in line with psychologists’
mandate to first attempt to resolve ethical dilemmas
directly with relevant parties (1.04, “Informal Resolution
of Ethical Violations”). Although Dr. Traditional is un-
comfortable with a move toward telepsychology, others
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may not be as reticent and may be able to offer their
This document is copyrighted by the American Psychological Association or one of its allied publishers.
energy and expertise to ease the transition. As discussed,
psychologists are permitted (and, some might argue, en-
couraged) to make reasonable extensions of their prac-
tice, even including working beyond the identified limits
of their competence, to provide services in emergencies if
they are able (2.02, “Providing Services in Emergen-
cies”). Of course, the provision of such services should
be bolstered with appropriate training and consultation,
and emergency services should be discontinued once
restrictions associated with the pandemic are eased.
Perhaps ironically, Dr. Traditional’s hesitations around
telehealth may create increased liability for his practice,
should he not make appropriate adjustments. Continuing
to provide in-person clinical care (and presumably with-
out proper PPE) places both providers and clients at
unnecessary health risk. Moreover, it is possible that the
choice of some colleagues to provide brief phone check-
ins could be construed as provision of clinical services
via telehealth. This lack of clarity on the part of psychol-
ogists providing these check-ins could cloud the process
of ensuring that any services delivered via phone are
conducted in accordance with accepted practice stan-
dards.
On the other hand, if deciding to pursue a transition to
telehealth, Dr. Traditional and his colleagues must main-
tain awareness of the potential limits of telehealth. Spe-
cifically, there may be certain procedures (e.g., particular
types of cognitive testing) that are not possible to fully
carry out remotely and without an examiner present, due
to copyright restrictions or administration difficulties for
required instruments. Other types of assessment, such as
attention-deficit/hyperactivity disorder evaluations, may
lend themselves better to telepsychology so long as
proper precautions to maintain confidentiality of clients’
personal health information and the security of test ma-
terials are in place. Of course, any conclusions drawn
from telehealth assessments that deviate from accepted
practice standards should be articulated in light of these
limitations, given psychologists’ responsibility to base
professional judgments on the available science and to
articulate where the science is lacking or unavailable
(2.04, 9.01).
Additionally, given that provision of intensive dialec-
tical behavior therapy services often is employed with
higher-risk populations, such as those individuals strug-
gling with chronic suicidality, Dr. Traditional and his
colleagues should carefully consider how each aspect of
these outpatient services could be transitioned online.
Didactic skills groups and individual therapy sessions for
these clients may work well via telehealth, so long as
thoughtful attention is paid to safety planning in the event
of technology failure, client distress, or other unexpected
interruption. For example, prior to commencing remote
sessions, a comprehensive safety plan should be con-
structed for each client that includes contact information
for the client (including phone number[s] and physical
address), contact information for a support person in the
client’s life in the event the client is unreachable (with
appropriate releases of information in place), and how to
contact the therapist and/or other emergency services if
crises occur. Therapists must also be aware of local 911
processes in the client’s location, should emergency ser-
vices be required. Dr. Traditional and his colleagues may
decide that some services will move forward via phone or
online, while others may not continue during this crisis.
Any clients for whom services are not available should be
provided with appropriate referrals to the extent possible,
in line with 3.12, “Interruption of Psychological Ser-
vices,” and 10.09, “Interruption of Therapy.” It is impor-
tant to note that making all reasonable efforts to provide
telehealth services to clients who need ongoing care and
risk management, particularly in shelter-in-place commu-
nities, may also reflect psychologists’ ethical obligations.
As the practice director and as a trainer, Dr. Traditional
must also consider his ethical obligations to his col-
leagues and trainees. The trainees and postdoctoral resi-
dent may feel pressure to continue to see clients face-to-
face, both because of Dr. Traditional’s stance against
telehealth and because they have a legitimate need to
accrue hours to progress through supervised training.
This pressure may motivate these individuals to make
unsafe choices (e.g., continue to see patients in person
and without proper PPE) that could put the health of
themselves and of their clients at risk. This tension could
reflect a conflict between ethics and organizational de-
mands (1.03, “Conflicts Between Ethics and Organiza-
tional Demands”), and the trainees themselves could ini-
tiate an attempt to resolve this conflict informally with
Dr. Traditional (1.04, “Informal Resolution of Ethical
Violations”). If Dr. Traditional and his colleagues do
decide to transition some or all of their services to
telehealth, they must be sure to assign work appropriately
(2.05, “Delegation of Work to Others”) and take proper
steps to provide adequate supervision, including making
 COVID-19 ETHICAL CONSIDERATIONS
arrangements for appropriate recording of trainees’ ses-
sions (4.03, “Recording”).
Conclusion
Across the various roles and settings within which they
work, psychologists are in a unique position to respond to
the COVID-19 pandemic through clinical work, research,
teaching activities, and advocacy efforts. However, given
stay-at-home orders and social distancing requirements,
psychologists are tasked with finding new and creative ways
for meeting the needs of the people they serve including
clients, colleagues, students, research participants, and the
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
general public. Psychologists are encouraged to embrace the
This document is copyrighted by the American Psychological Association or one of its allied publishers.
challenges associated with helping to respond to the
COVID-19 crisis, but also must keep in mind their commit-
ment to the APA (2017) ethics code and take into consid-
eration ethical issues that may arise as they acclimate to
working remotely or in other novel ways. As outlined in this
article, all of the principles and standards in the current APA
ethics code apply in one way or another to psychologists’
response to COVID-19. It is important to note that the APA
ethics code currently is being revised, and more direct
guidance on some of the ethical dilemmas raised in this
article may be included in the next version of the APA
ethics code. In the meantime, there are many resources
available to help psychologists resolve the ethical chal-
lenges they face. Psychologists are encouraged to make use
of the available resources provided by the APA and other
organizations within which they work or interact for the
purpose of promoting ethical behavior within the discipline.
Although not discussed in this article, psychologists also are
encouraged to make use of available ethical decision-
making models (e.g., see chapter on ethical decision making
in Nagy, 2011 and Knapp & VandeCreek, 2012) when faced
with COVID-19 related ethical dilemmas for which resolu-
tions are not obvious or for which resources are not readily
available to guide ethical decision making.
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Received April 15, 2020
Revision received May 4, 2020
Accepted May 6, 2020 䡲