ETHICAL ISSUES IN CLINICAL PSYCHOLOGY

 Ethical behavior and desicion-making is rarely

black or white, right or wrong
BECAUSE
 The context and circumstances are everchanging
 Ethical dilemmas are not absolutely preventable
«… learning to live with some degree of
uncertainity»
«the best answer for each scenario lies in
reflection and the use of a systematic process»
DEFINING WHAT ETHICAL BEHAVIOR IS
 Derived from principles of religion and philosophy
 Focusing on respect and dignity toward others
 «above all, do no harm»

How do we know that we are doing the right thing, or at least following the
right process?
As happening on a continuum…
CRIMINAL BEHAVIOR SELFLESS GIVING FOR THE
BENEFITS OF OTHERS
• «Do not kill other people» • «treat your clients with
• «Do not steal» respect and dignity» ???
• «do no harm»
PSYCHOLOGISTS’ ETHICAL BELIEFS
 Some behaviors are viewed as
absolutely unethical (e.g., sex with
clients)
 Some behaviors are viewed as
absolutely ethical (e.g., addressing
clients by first name)
 Many behaviors fall in “gray area” in
between
 Lots of difficult judgment calls
MOST FREQUENT
COMPLAINTS
1. Inappropriate assessment
procedures (37.3% of all
complaints)
2. Lack of professional
competence (13.5%)
3. Client relationships – key
problems here are
confidentiality and boundary
violations (13%)
• may have a major impact in peoples’ life
• e.g., not receiving the disability pension
• may indeed harm a patient
• e.g., violations of confidentiality
• have received much attention over the last
two decades
• e.g., to sexually exploit a client who is
enthralled by the therapist
• Clinical psychologists’ and nonpsychiatric
physicians’ attitudes and behaviors in sexual
and confidentiality boundary violations
ETHICAL ISSUES IN CLINICAL PSYCHOLOGY
 APA Code of Ethics provides principles
and standards to guide psychologists
professional and scientific work
 Relevant issues include
 Confidentiality
 Informed consent
 Multiple relationships
 Competence
 Others
First published in 1953
Revised 9 times
Most recent edition was published in 2002
 Two amendments in 2012
 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
 5 General Principles:
1. Beneficence and Nonmaleficence
 Do Good; Avoid Harm
2. Fidelity and Responsibility
 Develop trust; accept responsibility of work; uphold
professional standards of conduct
3. Integrity
 Maximize benefits & minimize harm through accuracy, honesty
& truthfulness
4. Justice
 Exercise competence & reasonable judgment
5. Respect for People’s Rights and Dignity
 Respect autonomy; maintain professional boundaries;
preserve confidentiality & privacy
 10 Ethical Standards:
1. Resolving Ethical 6. Record Keeping
Issues and 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
 Avoid ethical pitfalls by applying the APA Ethical Code & Deborah Smith’s 10
pointers:
1. Understand Multiple Relationships
2. Protect Confidentiality
3. Respect Autonomy
4. Know Supervisory Responsibilities
5. Identify Client & Role
6. Document
7. Practice in Area of Expertise
8. Abandonment vs. Termination
9. Stick to the Evidence
10. Be Accurate in Billing
1. Understand Multiple Relationships:

“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.”
2. Protect Confidentiality:

 Psychologists are asked to provide information about their

patients to family members, other healthcare professionals,
and other agencies.
 APA Ethics Code states that only the minimum information
necessary should be disclosed in order to provide needed
services, obtain appropriate consultations, protect the client,
psychologist or others from harm, or obtain payment for
services from a client.
• Discuss limits of confidentiality with patient
• Protecting confidentiality by safeguarding confidential records
• Know state and federal laws
• Know organizational policies
2. Protect Confidentiality: «Tarasoff and the Duty to Warn»
2. Protect 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
 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
3. Respect Autonomy
 Competence
 Practice only within your limits of expertise, experience & training
 Disclosure
 If you are a trainee under supervision, this must be disclosed to the
patient (e.g., need to explain your role and goal of the interaction)
 Patient Understanding
 Clearly discuss confidentiality, privacy, treatment options,
documentation procedures, and emergency contact information
 Voluntariness
 The patient has the right to terminate therapy at any time, therapy is a
voluntary service
 Authorization
 Obtain documented authorization of patient consent
4. Know Supervisory Responsibilities
 Inform patients about supervision
 Utilize supervisory agreement form

5. Identify Client & Role

 Who, What, Where

6. Documentation
 Contact log, history, dates, impressions, informed consent, follow-up contact
 NEVER alter a record after the fact
 Append information to the health record per local policy
 Record only pertinent information as related to the treatment and health
services
7. Practice in Area of Expertise
Competency
Knowledge, Skills & Abilities
Be aware of your own impairment/limitations
Internal or external factors may interfere with your knowledge,
skills and abilities to appropriately treat patients
Stay informed
Continue professional education through seminars, conferences,
workshops, research
Know when to refer
8. Abandonment vs. Termination
Termination utilizes competency
Goals of beneficence & patient’s autonomy
Be aware when therapy is:
not benefiting the patient
the patient may be harmed from continuing treatment
the patient no longer needs therapy
9. Stick to the Evidence
 Be mindful of what you do and do not
know
 Know the referral question
 Evaluate, interview and assess thoroughly

10. Be Accurate in Billing

 Document every session and contact
accurately to ensure proper agency
billing
ETHICAL DECISION MAKING
 10-step model

1. Identify people and groups affected

2. Identify relevant issues
3. Consideration of personal biases
4. Alternative courses of action
5. Analysis of risks and benefits of available courses of
action
ETHICAL DECISION MAKING
(CONT.)
 10 step model (cont.)

6. Choose courses of action

7. Action
8. Evaluating the results of the course of the action
9. Taking responsibility for the consequences of action
10. Prevention of future occurences
 HAVE YOU READ TURKISH
PSYCHOLOGICAL ASSOCIATION
ETHICS CODE ???
“Principles have no real force except when one is
well-fed.”

Mark Twain (1835 - 1910)

“Grub first, then ethics.”

Bertolt Brecht (1898 - 1956)

(German Playwright)