Chapter 5

Ethical Issues in Clinical Psychology

 Ethical Issues in Clinical
Psychology
 APA Code of Ethics guides the behavior of
clinical psychologists
 Relevant issues include
 Confidentiality
 Informed consent
 Multiple relationships
 Competence
 Others
 APA Code of Ethics
 First published in 1953
 Revised 9 times

 Most recent edition was published in

2002
 Two amendments in 2012
 APA Code of Ethics:
Aspirational and Enforceable
 Aspirational
 General Principles section describes an ideal level
of ethical functioning, or what to strive for
 Enforceable
 Ethical Standards section includes rules of conduct
that can mandate minimal levels of behavior and
can be specifically violated
 APA Ethical Principles
1. Beneficence and Nonmaleficence
2. Fidelity and Responsibility
3. Integrity
4. Justice
5. Respect for People’s Rights and Dignity
 Categories of Ethical Standards
1. Resolving Ethical 6. Record Keeping and
Issues Fees
2. Competence 7. Education and
3. Human Relations Training
4. Privacy and 8. Research and
Confidentiality Publication
5. Advertising and 9. Assessment
Other Public 10. Therapy
Statements
 Ethical Decision Making
 8-step model
1. Prior to any ethical dilemma arising, make a
commitment to doing what is ethically
appropriate.
2. Become familiar with the APA ethical code.
3. Consult any law or professional guidelines
relevant to the situation at hand.
4. Try to understand the perspectives of various
parties affected by the actions you may take.
Consult with colleagues (always protecting
confidentiality) for additional input and
discussion.
Ethical Decision Making (cont.)
 8 step model (cont.)
5. Generate and evaluate your alternatives.
6. Select and implement the course of action
that seems most ethically appropriate.
7. Monitor and evaluate the effectiveness of
your course of action.
8. Modify and continue to evaluate the
ethical plan as necessary.
 Psychologists’ Ethical Beliefs
 Some behaviors are viewed as absolutely
unethical (e.g., sex with clients)
 Some behaviors are views as absolutely ethical
(e.g., addressing clients by first name)
 Many behaviors fall in “gray area” in between
 Lots of difficult judgment calls
 Confidentiality
 In general, psychologists are ethically
obligated to maintain confidentiality
 Some situations can arise in which

breaking confidentiality is appropriate

 Confidentiality: Tarasoff and the
Duty to Warn
 Tarasoff is a court case regarding a college
student client who told his therapist he was
going to kill his girlfriend (Tatiana Tarasoff)
 Therapist contacted campus police who
detained him, but after he was released, he
killed her
 Confidentiality: Tarasoff and the
Duty to Warn (cont.)
 Her family sued and won
 Tarasoff v. The Regents of the University of
California
 The finding was that the therapist had the
“duty to warn” the potential victim
 This finding now sets a precedent for all
therapists for breaking confidentiality
Confidentiality: Tarasoff and the
Duty to Warn (cont.)
 How credible are clients’ threats?
 What kinds of threats merit warnings?
 How should the unsafe behavior of clients with
HIV/AIDS be understood in terms of threat?
 Confidentiality: When the
Client is a Child
 Often, children will confide more if they
can be assured that psychologists will not
repeat everything to their parents
 Parents, of course, have a right to be
informed
 Psychologists often make arrangements by
discussing this with families up front
 Some issues, such as child abuse, require
breaking of confidentiality to protect the
child
 Informed Consent
 Required for research, assessment,
therapy, and other professional activities
 For therapy, informed consent is an

ongoing process rather than a one-time

event
 As psychologist learns more about client,
more information can be shared
 Informed Consent (cont.)
 Informed consent for therapy must allow
client the opportunity to ask questions and
receive answers
 Informed consent process can be an early part
of a strong therapeutic relationship
 Boundaries and Multiple
Relationships
 Knowing someone professionally and in some other
way
 Romantic/sexual, friendship, business, etc.
 Unethical when:
 Psychologist’s objectivity, competence, or judgment can be
impaired
 Exploitation or harm could result
 Boundary crossings (minor, often harmless) can lead
to boundary violations (major, often harmful)
 Competence
 Sufficiently capable, skilled, experienced, and
expert to complete the professional tasks they
undertake
 Boundaries of competence
 Psychologists should know their limits and seek
additional training or supervision when necessary
 Competence (cont.)
 Continuing education can maintain
competence
 Importance of cultural competence
 Burnout can impair competence
 Burnout can be minimized by efforts by the
psychologist to keep job varied, keep life balanced,
keep expectations reasonable, and keep self
healthy
 Ethics in Clinical Assessment
 Test selection
 Consider competence, culture, test’s reliability and
validity
 Test security
 Don’t allow test materials to enter public domain
 Test data
 Raw data collected during assessment
 Should generally be shared at client’s request
 Ethics in Clinical Research
 Psychotherapy efficacy research
 What should control group receive?
 No treatment (“Wait-list” control)
 Placebo treatment

 Alternate treatment

 What ethical issues arise when any of these

three options are used?
 Contemporary Ethical Issues:
Managed Care
 Managed care companies’ emphasis on
financial bottom line can cause ethical
conflicts
 Perhaps include info about managed care in
the informed consent process
 Diagnostic decisions can be influenced by
managed care companies’ requirements
 Contemporary Ethical Issues:
Technology
 “Psychological tests” on Internet
 Many have questionable reliability and
validity
 Other issues include
 Identity of client
 Testing conditions

 Inability to observe behavior during testing

 Similar concerns about online therapy

 Contemporary Ethical Issues:
Small Communities
 Small communities can be rural areas or
defined by ethnicity, religion, or other
variables
 Multiple relationships can be unavoidable
 Discuss up front with clients
 Clarify boundaries
 Avoid impaired judgment and exploitation