Module 2. Specialization in Clinical Psychology - Introduction/ Overview
The definitions of clinical psychology provide an important perspective on the nature and function of
modern clinical psychology. However, it is useful to describe other health care professions whose
services and client populations overlap those of clinical psychology.
Within the field of psychology, what is unique about clinical psychology? The definitions we presented
emphasized that clinical psychology is primarily concerned with the application of psychological
knowledge in assessment, prevention, and/or intervention in problems in thoughts, behaviours, and
feelings. Of course, in addition to providing psychological services, many clinical psychologists also
conduct psychological research and contribute important information to the science of psychology.
Nevertheless, the objective of research in clinical psychology is to produce knowledge that can be used
to guide the development and application of psychological services.
Clinical psychology shares many of the research methods, approaches to statistical analysis, and
measurement strategies found in other areas of psychology. Many areas of psychology, such as
cognitive, developmental, learning, personality, physiological, and social, generate research that has
direct or indirect applicability to clinical psychology activities. However, the key purpose of research in
these other areas of psychology is to generate basic knowledge about human functioning and to
enhance, in general terms, our understanding of people. The fact that some of this knowledge can be
used to assess and treat dysfunction and thereby improve human functioning is of secondary
importance.
Many psychologists apply their knowledge in diverse applied fields. You will learn later more about
health psychologists, forensic psychologists, and neuropsychologists—typically, these professionals are
trained in clinical psychology and also have specialized training in their specific areas of research and
practice. Two other areas of applied psychology, counselling psychology and school psychology, also
provide important mental health services to the public. Although there is some similarity to clinical
psychologists in their training and practices, these psychologists bring unique skills to the assessment,
prevention, and treatment of mental health problems.
Lesson 1.Specialization in Clinical Psychology
Community psychology, the study of human behavior in its multiple ecological, historical, cultural,
and sociopolitical contexts. Community psychology is a shift away from the broader field of
psychology's internal, cognitive, and nuclear family emphases toward the incorporation of greater
attention to the role of social systems and structures in human functioning.
Principles of Community Psychology
What “causes” problems?
Problems develop due to an interaction over time between the individual, social setting, and systems
(e.g., organizations); these exert a mutual influence on each other.
How are problems defined?
Problems can be defined at many levels, but particular emphasis is placed on analysis at the level of the
organization and the community or neighborhood.
Where is community psychology practiced?
Community psychology is typically not practiced in clinics, but rather out in the field or in the social
context of interest.
How are services planned?
Rather than providing services only for those who seek help, community psychologists proactively
assess the needs and risks in a community.
What is the emphasis in community psychology interventions?
An emphasis is placed on prevention of problems rather than treatment of existing problems.
Who is qualified to intervene?
Attempts are made to share psychology with others via consultation; actual interventions are often
carried out through self-help programs or through trained nonpsychologists/nonprofessionals.
KEY CONCEPTS
Ecological Levels of Analysis
One underlying principle of community psychology is that individuals and society are interdependent.
To understand and to enhance the lives of others, it is essential that we consider a variety of systems or
levels of analysis (Bronfenbrenner, 1979;
Dalton et al., 2001; Trickett, 2009).
Levels of analysis that are the subject of research in community psychology.
 Macrosystems
 Localities
 Organizations
 Microsystems
 Individuals
First, at the level of the individual, community psychologists study the relationships between
individuals and their environments. Individuals are influenced by their environments (e.g., the loss of a
job), and individuals also influence their environments. Second, the next level of analysis focuses on
the connection between individuals and microsystems  environments in which the individual is
directly engaged with others, whether they are family members, fellow students, friends, or business
associates. Organizations involve sets of larger microsystems (e.g., schools, religious organizations).
Individuals may be involved in an organization, but their participation is usually through a microsystem
of the organization. The level of localities (typically that of geographic localities) is comprised of
multiple sets of organizations of microsystems. For example, community coalitions exist to address
problems concerning drug abuse or local health care access. Finally, macrosystems include societies,
cultures, and governmental or economic institutions that reach beyond the local community. In addition
to these structural features of ecology, Kelly, Trickett, and associates (e.g., Trickett,2009; Trickett,
Kelly, & Todd, 1972) emphasize several ecological principles that can provide framework for
community psychology. First, every ecosystem, whether in biology or psychology, consists of multiple
parts that are interdependent. Change in one part of the system will affect other parts of the system. For
example, a change in school leadership will affect teachers, students, parents, and the community at
large. Second, ecosystems can be understood by examining the resources that are used and required for
their well-being. Many times, it is only when there is a stress in or problems with the ecosystem that it
becomes more apparent what the important resources are. Thus, certain resources may need to be
created, preserved, or strengthened. Third, individuals (and other levels of an ecosystem) adapt to the
environment by coping with restraints or demands and using available resources. Fourth, ecosystems
are dynamic, not static. Thus, over time, hey are likely to change due to patterns of interdependence, the
resources that are available, and the ensuing adaptive changes.
In summary, any individual or societal problem, because of the interdependence of different levels of
the ecosystem, can be examined at a number of levels; social environments change and are changeable.
Health psychology, also called medical psychology or behavioral medicine, is a branch of psychology
focusing on how biological, social, and psychological factors impact health and well-being. Health
psychologists strive to promote overall health and prevent illness. 
Health psychology has been specifically defined as the aggregate of the specific educational, scientific,
and professional contributions of the discipline of psychology to the promotion and maintenance of
health, the prevention and treatment of illness, and the identification of etiologic and
diagnostic correlates of health, illness and related dysfunction.
Behavior and Health. Behaviors, habits, and lifestyles can affect both health and disease.
Everything from smoking, excessive drinking, or poor diet to deficient hygiene practices have been
implicated. Such behaviors are often deeply rooted in cultural values or personal needs and
expectations. In any event, they are not easily changed.  These include cigarette smoking, alcohol abuse
and dependence, and weight control.
Cognitive variables may influence our decisions about adopting healthy or unhealthy
behaviors (Bandura, 2001). Self-efficacy,refers to “people’s beliefs about their capabilities to exercise
control over events that affect their lives” (Bandura, 1989, p. 1175). Self-efficacy is relevant to
a number of topics addressed by health psychologists, including major theories of health-related
behavior change. This construct plays a major role in the most prominent social cognitive models of
health behavior, including the health belief model (Rosenstock, 1974; Rosenstock, Strecher, & Becker,
1988), protection motivation theory (R. W. Rogers, 1975; Sturges & Rogers, 1996), and the theory of
planned behavior (Ajzen, 1985, 1988).
Protection motivation theory (PMT), for example, posits that behavior is a function of threat
appraisal (an evaluation of factors that will affect the likelihood of engaging in the behavior, such as
perceived vulnerability and perceived potential for harm) and coping appraisal (an evaluation of one’s
ability to avoid or cope with negative outcome). Coping appraisal is influenced by one’s self-efficacy,
or belief that one can implement the appropriate coping behavior or strategy (Maddux et al., 1995).
Problems can also arise from the ways in which people respond to illness. Some people may be unable
or unwilling to appreciate the severity of their illness and fail to seek timely medical help. When they
do get medical advice, they may fail to heed it. Among youth, decisions become more complex, as both
the perceptions of the youth and their caregivers influence health behavior decisions. All of these
behaviors can indirectly foster adverse outcomes.  tissue changes as ulcers, neurodermatitis, or essential hypertension. These kinds of symptoms have been
Personality Factors. Both directly and indirectly, personality characteristics can affect health and
illness in many ways (Smith & MacKenzie, 2006; Suls& Bunde, 2005). For example, (a) personality
features may result from disease processes; (b) personality features may lead to unhealthy behaviors; (c)
personality may directly affect disease through physiological mechanisms; (d) a third,
underlying biological variable may relate to both personality and disease; and (e) several causes and
feedback loops may affect the relationship between personality and disease.
Perhaps the most widely studied association between a personality trait/behavior pattern and illness is
that between Type A behavior and coronary heart disease. As mentioned previously, the notion of a
possible link between personality or coping style and adverse health consequences, specifically
coronary heart disease, was proposed by two cardiologists (Friedman & Rosenman, 1974).
They identified a set of discriminating personality characteristics and behaviors and proposed that these
constitute a Type A behavior pattern. Glass (1977) describes Type A individuals as those who tend to:
■ perceive time passing quickly,
■ show a deteriorating performance on tasks that require delayed responding,
■ work near maximum capacity even when there is no time deadline,
■ arrive early for appointments,
■ become aggressive and hostile when frustrated,
■ report less fatigue and fewer physical symptoms, and
■ are intensely motivated to master their physical and social environments and to maintain control.
Selected Items from the Behavior Pattern Interview
Does your job carry heavy responsibility?
a. Is there any time when you feel particularly rushed or under pressure?
b. When you are under pressure, does it bother you?
When you get angry or upset, do people around you know about it? How do you show it?
When you are in your automobile, and there is a car in your lane going far too slowly for you, what do
you do about it? Would you mutter and complain to yourself? Would anyone riding with you know that
you were annoyed?
 If you make a date with someone for, oh, two o’clock in the afternoon, for example, would you be there
on time?
a. If you are kept waiting, do you resent it?
b. Would you say anything about it?
Do you eat rapidly? Do you walk rapidly? After you’ve finished eating, do you like to sit around the
table and chat, or do you like to get up and get going?
How do you feel about waiting in lines: Bank lines, or supermarket lines? Post office lines?
In an important methodological and conceptual analysis of the research examining hostility and
health, Smith (1992) presented several theoretical models that might explain the link between them. The
psychophysiological reactivity model posits that hostile individuals experience larger increases in heart
rate, blood pressure, and stress-related hormones in response to potential stressors. Increased
psychophysiological reactivity is believed to encourage the development of coronary artery disease and
the symptoms of coronary heart disease. The psychosocial vulnerability model proposes that hostile
individuals are more likely to experience a more stressful psychosocial environment because they have
higher levels of mistrust and are scanning their environments for possible future mistreatment. A
transactional model of stress reflects a combination and integration of the psychophysiological and
psychosocial models. This integrative model proposes that those high in hostility create
potentially stressful situations in their lives because of their general mistrust and their subsequent
actions.
Finally, the health behavior model, unlike the previous models, does not assume that the physiological
aspects of stress are the crucial link between hostility and health. Rather, the health behavior model
proposes that hostile individuals tend to engage in poor health habits (e.g., smoking, excessive drinking
of alcohol, poor exercise habits) and thus are more susceptible to coronary heart disease. This
parsimonious explanation of the findings of an association between hostility and coronary heart disease
needs further evaluation. conditioned emotional reactions that, if chronic, can produce such persistent
treated by health psychologists in various ways. In the case of respondent techniques, extinction or
systematic desensitization interventions are commonly used.
Respondent Methods
Over time, a neutral stimulus (conditioned stimulus) that is paired with a naturally eliciting
stimulus (unconditioned stimulus) may itself become capable of eliciting a particular response. This is
the classic Pavlovian paradigm. Emotional reactions may, for example, become associated with
formerly neutral, innocuous stimuli. This process may then produce conditioned emotional reactions
that, if chronic, can produce such persistent tissue changes as ulcers, neurodermatitis, or essential
hypertension. These kinds of symptoms have been treated by health psychologists in various ways. In
the case of respondent techniques, extinction or systematic desensitization interventions are commonly
used.
In extinction, a conditioned emotional reaction is eliminated by creating a situation in which
the conditioned stimuli are no longer associated with the environmental stimuli that generated
the behavior. This approach can be used, for example, to eliminate children’s fears of visiting the
dentist. The child is brought to the dentist’s office, familiarized with the office personnel, allowed to
meet other children who have successfully negotiated the terrors of dentistry, and so on. In short,
the child’s emotional reactions are extinguished because, over time, less anxiety is aroused in
the dentist’s office.
Systematic desensitization is a good example of counterconditioning. If the patient can be taught to
relax in the face of anxiety-provoking stimuli, the anxiety diminishes. Relaxation techniques are
designed to enable individuals to produce a state of lowered arousal through their own efforts. As a
preliminary step, patients are usually taught the basic behavioral principles related to their symptoms
and how therapy relates to the implementation of these principles. For example, a patient whose
stressful lifestyle has led to some physical problems would be taught the relationship between lifestyle
and illness by means of a fairly extensive verbal explanation (or reading material). Following this, a
thorough psychophysiological assessment might be conducted using recording equipment, self-ratings
of tension, and the therapist’s own observation.
Next, patients are taught to self-monitor. For example, they might be trained in how and when to record
the presence of headaches. They would be taught to record data on the presence of environmental
stimuli that precede the headache, their own response to the headache, and the consequences that follow
from the symptoms. To record the presence of headaches. They would be taught to record data on the
presence of environmental stimuli that precede the headache, their own response to the headache, and
the consequences that follow from the symptoms. Finally, patients receive specific training in
relaxation. Positive expectancies for a good outcome are engendered, and the physical conditions are
arranged so that relaxation will be easy to achieve (assuming a comfortable position, loosening tight
clothing, adjusting lighting). Regular practice in the therapist’s office is followed by practice at home.
Operant Methods
Learned responses may be either maintained or eliminated through the consequences they bring about.
Behaviors that are reinforced tend to recur, whereas behaviors that are not reinforced or are punished
tend to decrease in frequency. Operant conditioning can be used in health psychology and behavioral
medicine either to increase behaviors said to lead toward health or to decrease those said to contribute
to health problems. For example, health psychologists have used operant methods in addressing pain
behaviors (Brannon & Feist, 2010; Roelofs, Boissevain, Peters, de Jong, & Vlaeyen, 2002). From an
operant perspective, many of the behaviors displayed by pain patients (complaining, moaning, etc.)
have been initiated and maintained because of positive reinforcement. Family members and medical
staff may have paid more attention to the patient following these behaviors. Additional reinforcers
might include sympathy, time off from work, or fewer expectations from the family. To change these
pain behaviors, family members and medical staff may be trained to reinforce more desirable behaviors
(e.g., attempts to become more physically active) and to ignore less desirable behaviors (e.g., constant
complaining). Research suggests that these approaches to pain behaviors do show some success, as
indicated by increased physical activity and decreased intake of pain medication (Brannon & Feist,
2010). Finally, health psychologists may use contingency contracting. In this method, the therapist and
patient draw up a formal agreement or contract that specifies the behaviors that are expected as well as
the consequences for certain behaviors. For example, patients may be reinforced for participating
more in physical therapy, taking their medication, or reducing their number of somatic complaints.
Reinforcement may take the form of tokens that can be exchanged for something of value to the patient.
Cognitive-Behavioral Methods
Health psychologists use a variety of cognitive behavioral techniques. These techniques may be used
alone or in concert with other strategies, such as relaxation or biofeedback.
All of them emphasize the role of thinking in the etiology and maintenance of problems. Cognitive-
behavioral interventions seek to change or modify cognitions and perceptions that are believed to be
related to a patient’s problem.
DEVELOPMENT AND THEORY
Health has played a significant role throughout the history of psychology. In fact, many pioneers in the
field of psychology were originally trained in medicine. In the case of psychology, though, emphasis is
placed largely on mental rather than physical health.  
Since the 1950s, interest in the role psychological health plays in overall well-being has grown. The
development of the Health Belief Model (HBM) by a team of psychologists, including Irwin
Rosenstock, was a seminal event in the field of health psychology during the 1960s. The HBM,
which sought to explain why some people were not getting vaccinated against tuberculosis, proposes
that a person’s likelihood of engaging in a health-promoting behavior is affected by their beliefs about
the severity of an illness and their susceptibility to it, the costs and benefits of engaging in the behavior,
and the presence of cues to action.  neuropsychology, that qualify them to work constructively with clients with disabilities or other chronic
As more psychologists were employed by medical facilities, primary care clinics, and medical schools,
greater focus was placed on understanding how psychological and physical health intertwine. Health
psychology is now its own branch of psychology. Today, health psychologists focus on preventing and
treating illness, promoting overall health, and working to improve the health care system. Some health
psychologists are also interested in understanding how people handle and recover from physical illness.
Forensic Psychology is the interaction of the practice or study of psychology and the law.
Psychologists interested in this line of applied work may be found working in prisons, jails,
rehabilitation centers, police departments, law firms, schools, government agencies, or in private
practice, to name a few. They may work directly with attorneys, defendants, offenders, victims, pupils,
families, or with patients within the state's corrections or rehabilitation centers. Other psychologists
interested in forensic psychology focus on the study of psychology and the law. They may work in
colleges, universities, government agencies, or in other settings interested in researching and examining
the interaction of human behavior, criminology, and the legal system.
Clinical psychology is the psychological specialty that provides continuing and comprehensive mental
and behavioral health care for individuals and families; consultation to agencies and communities;
training, education and supervision; and research-based practice. It is a specialty in breadth — one that
is broadly inclusive of severe psychopathology — and marked by comprehensiveness and integration of
knowledge and skill from a broad array of disciplines within and outside of psychology proper. The
scope of clinical psychology encompasses all ages, multiple diversities and varied systems.
Neuropsychology aims at understanding the relationships between the brain, on the one hand, and the
‘mind’ and behavioral control, on the other. Although humankind has always been interested in this
issue, the science of neuropsychology is relatively young. Its traditional approach was the study of the
associations between focal brain lesions and psychological defects, but today neuropsychology is in
possession of refined methodologies and theoretical frameworks for understanding both how the mind
works and how the brain works. It is hoped that progress on both fronts will take neuropsychology
nearer the solution of the as yet intractable mind–brain problem, despite the feelings of some that
neuropsychological research in cognition should be restricted preferentially to inquiring how the mind
works, leaving the brain to cognitive neuroscience.
Gerontology is the psychological study of how the process of aging affects our mental, physical, and
even social lives during the stage of late adulthood. The field tends to specialize in treating those
typically 65 years and older and has grown over the years as the human lifespan continues to increase.
Alzheimer’s disease, dementia, Parkinson’s disease, glaucoma, arthritis, and diabetes are a few medical
issues that are more common in elderly patients and well known to the gerontology field. However,
many of these medical issues have a psychological as well as biological component and this is where
geriatric psychology becomes critical.
The Vital Role of Geriatric Psychology
Geriatric psychology plays a vital role in the health of the elderly population, helping older individuals
cope and understand illnesses that affect them emotionally and physically. For example, in Alzheimer’s
disease, the destruction and death of nerve cells causes both cognitive and emotional issues such as
memory failure, personality changes, and problems carrying out daily activities.
Rehabilitation Psychology is a subfield of psychology dedicated to developing therapeutic
interventions aimed at promoting the health and well-being of people with disabilities and chronic
health conditions or diseases. Rehabilitation psychologists apply and extend psychological knowledge
toward ameliorating psychological, social, mental, psychiatric, environmental, and other challenges that
prevent people with disabilities from leading meaningful, independent, and productive lives.
Rehabilitation psychologists are therapists, educators, counselors, administrators, consultants,
advocates, and researchers who possess a wide variety of training and skills, including knowledge of
health conditions, their caregivers, and their families. 
Lesson 2. Ethical Guidelines
ETHICAL STANDARDS
One yardstick by which to measure the maturity of a profession is its commitment to a set of ethical
standards. Psychology was a pioneer in the mental health field in establishing a formal code of ethics.
The APA published a tentative code as early as 1951; in 1953, it formally published the Ethical
Standards of Psychologists (American Psychological Association, 1953). Revisions of these standards
appeared in 1958, 1963, 1968, 1977, 1979, 1981, 1990, 1992, and most recently, 2002. The 2002
version of the Ethical Principles of Psychologists and Code of Conduct presents five general principles
as well as specific ethical standards relevant to various activities of clinical psychologists—assessment,
intervention, therapy, research, forensic activities, and so on (American Psychological Association,
2002). Web site 3-7 provides a link to the complete document online with 2010 amendments.
The general principles include the following:
■ Beneficence and non-maleficence: Psychologists strive to benefit those they serve and to do
no harm.
■ Fidelity and responsibility: Psychologists have professional and scientific responsibilities to society
and establish relationships characterized by trust.
■ Integrity: In all their activities, psychologists strive to be accurate, honest, and truthful.
■ Justice: All persons are entitled to access to and benefit from the profession of
psychology; psychologists should recognize their biases and boundaries of competence.
■ Respect for people’s rights and dignity: Psychologists respect the rights and dignity of all people
and enact safeguards to ensure protection of these rights.
Although these general principles are not technically enforceable rules, they serve to guide
psychologists’ actions. The specific ethical standards, however, are enforceable rules of conduct.
Acceptance of membership in the APA commits the member to adherence to these standards, several of
which are discussed in the following sections. Of course, actual clinical practice and its day-to-day
demands can generate ethical decisions and dilemmas that would tax the judgment of the wisest in the
field. Also, changes in our culture over time can provide a shifting ground that challenges a clinical
psychologist’s judgment.
Competence
Issues of competence have several important aspects. First, clinicians must always represent their
training accurately. Thus, master’s-level clinicians must never lead anyone to believe they possess the
Ph.D. Simply ignoring the fact that someone keeps referring to such a person as “Doctor” will not
suffice. If a clinician is trained as a counseling psychologist, that is how he or she must be presented—
not as a clinical psychologist. Clinicians have an obligation to “actively” present themselves correctly
with regard to training and all other aspects of competence. This also means that clinicians should not
attempt treatment or assessment procedures for which they lack specific training or supervised
experience. When there is any doubt about specific competencies, it is wise to seek out supervision
from more experienced clinicians.
It is equally important that clinicians be sensitive to treatment or assessment issues that could be
influenced by a patient’s gender, ethnic or racial background, age, sexual orientation, religion,
disability, or socioeconomic status. Finally, to the extent that clinicians have personal problems
or sensitive spots in their own personality that could affect performance, they must guard against
the adverse influence of these problems on their encounters with patients. Recently, “toolkits” have
been developed to allow for the assessment of competence in the practice of clinical psychology
(Kaslow, Grus, Campbell, Fouad, Hatcher, & Rodolfa, 2009). Such tools include: performance reviews,
case presentation reviews, client outcome data, consumer surveys, self-assessments, and both oral and
written examinations. By using tools such as these to assess competence to practice clinical psychology
in specific domains and with specific subpopulations, this will help ensure that clinicians are expert in
areas in which they are providing services.
Privacy and Confidentiality
Clinicians have a clear ethical duty to respect and protect the confidentiality of client information.
Confidentiality is central to the client–psychologist relationship. When information is released without
the client’s consent, the trusting relationship can be irreparably harmed. Clinicians should be clear and
open about matters of confidentiality and the conditions under which it could be breached. In today’s
climate, not all information is deemed“privileged.” For example, third parties (e.g., insurance
companies) may be paying for a client’s therapy. They may demand periodic access to records for
purposes of review. Sometimes school records that involve assessment data may be accessible to others
outside the school system under certain conditions (e.g., if they are subpoenaed by a court). More and
more, clinicians cannot promise absolute confidentiality.
Human Relations
Dual relationships pose many ethical questions regarding client welfare. Sexual activities with clients,
employing a client, selling a product to a client, or even becoming friends with a client after the
termination of therapy are all behaviors that can easily lead to exploitation of and harm to the client.
Although perhaps not very common, such events are clearly troublesome to the profession. Sexual
liaisons can be equally damaging in supervisory relationships. The worst of these dual relationships are
sexual harassment and sexual intimacies between psychologists and current clients. Make no mistake,
ethical principles condemn such behaviors in no uncertain terms.
The Psychological Association of the Philippines (PAP) adopted a Code of Ethics for
Clinical Psychologists in the 1980s, and this Code has remained unchanged since then. In 2007, the
Board of Directors of the PAP resolved to constitute a committee to revise the code of ethics, with the
goal of updating the code and making it more inclusive and applicable to all psychologists.
In 2008, the PAP Board of Directors appointed immediate past president, Dr. Allan B. I. Bernardo as
Chair of the Scientific and Professional Ethics Committee, in compliance with the PAP Charter. The
PAP Board also appointed Dr. Ma. Lourdes A. Carandang, Dr. Natividad A. Dayan, Dr. Rosalito De
Guzman, and Ms. Anna Guerrero as members of this committee.
Given a clear mandate from the PAP Board, the committee set out to accomplish its task with the
assistance of three graduate assistants: Mary Libertine Amor, Mary Grace M. Serranilla, and Sheri
Anne C. Zerna. The committee chair and the assistants undertook the preparatory work which involved
studying the old Code, and several documents related to ethical standards for psychologists (e.g., the
Universal Declaration of Ethical Principles for Psychologists, the ethics codes of the American
Psychological Association, the British Psychological Society, the Canadian Psychological Society,
among others).
The complete committee conducted a day-long workshop on February 27, 2009 to finalize the proposed
Code of Ethics for Philippine Psychologists. The committee was strongly influenced by existing codes
from other countries (which is reflected in the scope and structure of the Code), but worked hard to
ensure that the code was contextualized with the realities and constraints within the professional
environments that Philippine psychologists do their work.
The first draft of this Code was presented to the PAP Board of Directors on April 18, 2009. This draft
was further revised (with the editorial assistance of Reginal Bueno), and finally ratified by the PAP
Board of Directors on July 24, 2009.
The PAP shall take steps to ensure that all members of the PAP and the larger community of Philippine
psychologists will know, understand, and be properly guided by this Code. As such the PAP will
encourage continuous discussions on the Code and any of its specific provisions, with the goal of
making the Code a priority concern for all Philippine psychologists.
Mindful of the fact that the Code can never complete address all the possible emergent ethical concerns,
the PAP encourages all its members to study the code and make suggestions for its continuous
improvement. Members who have suggestions for new provisions or improvements and/or amendments
to the old provisions should submit these in writing, with supporting arguments and explanations, to the
PAP Board. The Board will regularly discuss such suggestions and adopt amendments to the Code.
Finally, any person who has a strong basis for asserting that a member of the PAP, especially a Certified
Psychology Specialist of the PAP, has violated any provision of this Code should inform the PAP in
writing, and provide supporting evidence for the assertion. This information should be addressed to the
PAP President and Board of Directors (ATTN: Scientific and Professional Ethics Committee). Upon
receipt of such information, the PAP shall take steps to investigate, make appropriate actions, and place
proper sanctions, if necessary.
DECLARATION OF PRINCIPLES
Psychologists in the Philippines adhere to the following Universal Declaration of Ethical Principles for
Psychologists that was adopted unanimously by the General Assembly of the International Union of
Psychological Science in Berlin on July 22, 2008 and by the Board of Directors of the International
Association of Applied Psychology in Berlin on July 26, 2008.
PREAMBLE
Ethics is at the core of every discipline. The Universal Declaration of Ethical Principles for
Psychologists speaks to the common moral framework that guides and inspires psychologists
worldwide toward the highest ethical ideals in their professional and scientific work.
Psychologists recognize that they carry out their activities within a larger social context. They recognize
that the lives and identities of human beings both individually and collectively are connected across
generations, and that there is a reciprocal relationship between human beings and their natural and
social environments. Psychologists are committed to placing the welfare of society and its members
above the self-interest of the discipline and its members. They recognize that adherence to ethical
principles in the context of their work contributes to a stable society that enhances the quality of life for
all human beings.
The objectives of the Universal Declaration are to provide a moral framework and generic set of ethical
principles for psychology organizations worldwide: (a) to evaluate the ethical and moral relevance of
their codes of ethics; (b) to use as a template to guide the development or evolution of their codes of
ethics; (c) to encourage global thinking about ethics, while also encouraging action that is sensitive and
responsive to local needs and values; and (d) to speak with a collective voice on matters of ethical
concern.
The Universal Declaration describes those ethical principles that are based on shared human values. It
reaffirms the commitment of the psychology community to help build a better world where peace,
freedom, responsibility, justice, humanity, and morality prevail. The description of each principle is
followed by the presentation of a list of values that are related to the principle. These lists of values
highlight ethical concepts that are valuable for promoting each ethical principle.
The Universal Declaration articulates principles and related values that are general and aspirational
rather than specific and prescriptive. Application of the principles and values to the development of
specific standards of conduct will vary across cultures, and must occur locally or regionally in order to
ensure their relevance to local or regional cultures, customs, beliefs, and laws.
The significance of the Universal Declaration depends on its recognition and promotion by psychology
organizations at national, regional and international levels. Every psychology organization is
encouraged to keep this Declaration in mind and, through teaching, education, and other measures to
promote respect for, and observance of, the Declaration’s principles and related values in the various
activities of its members.
PRINCIPLE I - Respect for the Dignity of Persons and Peoples
Respect for the dignity of persons is the most fundamental and universally found ethical principle
across geographical and cultural boundaries, and across professional disciplines. It provides the
philosophical foundation for many of the other ethical principles put forward by professions.
Respect for dignity recognizes the inherent worth of all human beings, regardless of perceived or real
differences in social status, ethnic origin, gender, capacities, or other such characteristics.
This inherent worth means that all human beings are worthy of equal moral consideration.
All human beings, as well as being individuals, are interdependent social beings that are born into, live
in, and are a part of the history and ongoing evolution of their peoples. The different cultures,
ethnicities, religions, histories, social structures and other such characteristics of peoples are integral to
the identity of their members and give meaning to their lives. The continuity of peoples and cultures
over time connects the peoples of today with the peoples of past generations and the need to nurture
future generations. As such, respect for the dignity of persons includes moral consideration of and
respect for the dignity of peoples.
Respect for the dignity of persons and peoples is expressed in different ways in different communities
and cultures. It is important to acknowledge and respect such differences. On the other hand, it also is
important that all communities and cultures adhere to moral values that respect and protect their
members both as individual persons and as collective peoples.
THEREFORE, psychologists accept as fundamental the Principle of Respect for the Dignity of Persons
and Peoples. In so doing, they accept the following related values:
a) respect for the unique worth and inherent dignity of all human beings;
b) respect for the diversity among persons and peoples;
c)respect for the customs and beliefs of cultures, to be limited only when a custom or a belief seriously
contravenes the principle of respect for the dignity of persons or peoples or causes serious harm to their
well-being;
d) free and informed consent, as culturally defined and relevant for individuals, families, groups, and
communities;
e) privacy for individuals, families, groups, and communities;
f) protection of confidentiality of personal information, as culturally defined and relevant
for individuals, families, groups, and communities;
g) fairness and justice in the treatment of persons and peoples.
PRINCIPLE II - Competent Caring for the Well-Being of Persons and Peoples
Competent caring for the well-being of persons and peoples involves working for their benefit and,
above all, doing no harm. It includes maximizing benefits, minimizing potential harm, and offsetting or
correcting harm. Competent caring requires the application of knowledge and skills that are appropriate
for the nature of a situation as well as the social and cultural context. It also requires the ability to
establish interpersonal relationships that enhance potential benefits and reduce potential harm. Another
requirement is adequate self-knowledge of how one's values, experiences, culture, and social context
might influence one's actions and interpretations.
THEREFORE, psychologists accept as fundamental the Principle of Competent Caring for the Well-
Being of Persons and Peoples. In so doing, they accept the following related values:
a) active concern for the well-being of individuals, families, groups, and communities;
b) taking care to do no harm to individuals, families, groups, and communities;
c)maximizing benefits and minimizing potential harm to individuals, families, groups, and
communities;
d) correcting or offsetting harmful effects that have occurred as a result of their activities;
e) developing and maintaining competence;
f) self-knowledge regarding how their own values, attitudes, experiences, and social contexts influence
their actions, interpretations, choices, and recommendations;
g) respect for the ability of individuals, families, groups, and communities to make decisions for
themselves and to care for themselves and each other.
PRINCIPLE III - Integrity
Integrity is vital to the advancement of scientific knowledge and to the maintenance of public
confidence in the discipline of psychology. Integrity is based on honesty, and on truthful, open and
accurate communications. It includes recognizing, monitoring, and managing potential biases, multiple
relationships, and other conflicts of interest that could result in harm and exploitation of persons or
peoples.
Complete openness and disclosure of information must be balanced with other ethical considerations,
including the need to protect the safety or confidentiality of persons and peoples, and the need to
respect cultural expectations.
Cultural differences exist regarding appropriate professional boundaries, multiple relationships, and
conflicts of interest. However, regardless of such differences, monitoring and management are needed
to ensure that self-interest does not interfere with acting in the best interests of persons and peoples.
THEREFORE, psychologists accept as fundamental the Principle of Integrity. In so doing, they accept
the following related values:
a) honesty, and truthful, open and accurate communications;
b) avoiding incomplete disclosure of information unless complete disclosure is culturally inappropriate,
or violates confidentiality, or carries the potential to do serious harm to individuals, families, groups, or
communities;
c) maximizing impartiality and minimizing biases;
d) not exploiting persons or peoples for personal, professional, or financial gain;
e) avoiding conflicts of interest and declaring them when they cannot be avoided or are inappropriate to
avoid.
PRINCIPLE IV - Professional and Scientific Responsibilities to Society
Psychology functions as a discipline within the context of human society. As a science and a profession,
it has responsibilities to society. These responsibilities include contributing to the knowledge about
human behavior and to persons’ understanding of themselves and others, and using such knowledge to
improve the condition of individuals, families, groups, communities, and society. They also include
conducting its affairs within society in accordance with the highest ethical standards, and encouraging
the development of social structures and policies that benefit all persons and peoples.
Differences exist in the way these responsibilities are interpreted by psychologists in different cultures.
However, they need to be considered in a way that is culturally appropriate and consistent with the
ethical principles and related values of this Declaration.
THEREFORE, psychologists accept as fundamental the Principle of Professional and Scientific
Responsibilities to Society. In so doing, they accept the following related values:
a) the discipline’s responsibility to increase scientific and professional knowledge in
ways that allow the promotion of the well-being of society and all its members;
b) the discipline’s responsibility to use psychological knowledge for beneficial purposes
and to protect such knowledge from being misused, used incompetently, or made
useless;
c) the discipline’s responsibility to conduct its affairs in ways that are ethical and
consistent with the promotion of the well-being of society and all its members;
d) the discipline’s responsibility to promote the highest ethical ideals in the scientific,
professional and educational activities of its members;
e) the discipline’s responsibility to adequately train its members in their
ethical responsibilities and required competencies;
f) the discipline’s responsibility to develop its ethical awareness and sensitivity, and
to be as self-correcting as possible.
Lesson 3: Mental Health Law
IMPLEMENTING RULES AND REGULATIONS OF REPUBLIC ACT NO. 11036
AN ACT ESTABLISHING A NATIONAL MENTAL HEALTH POLICY FOR THE PURPOSE OF
ENHANCING THE DELIVERY OF INTEGRATED MENTAL HEALTH SERVICES, PROMOTING
AND PROTECTING THE RIGHTS OF PERSONS UTILIZING PSYCHIATRIC, NEUROLOGIC
AND PSYCHOSOCIAL HEALTH SERVICES, APPROPRIATING FUNDS THEREFOR, AND FOR
OTHER PURPOSES.
Proposed more than 3 years ago, the Philippine Mental Health Act was passed in the congress and
senate in 2017 (Senate Bill No. 1354, 2017) and signed into law on 21 June 2018. Prior to this bill, the
Philippines were one of a minority of countries with no mental health legislation. Clinicians lacked
guidance on legal and ethical aspects of their practice, and patients' rights were not clearly defined – for
example, the usual practice was for patients who lacked capacity to be ‘signed in’ by a next of kin. The
passing of this bill is a major milestone in the history of psychiatry in the Philippines. The bill, the first
in the country's history, provides a rights-based mental health legislation. It mandates for the provision
of psychiatric, psychosocial and neurological services in all hospitals, and basic mental health services
in community settings. Compulsory treatment is limited to hospital settings, and the Act does not
provide for compulsory community treatment.
Under its provisions, the Philippine Mental Health Act protects the rights of patients as follows: ‘a right
to freedom from discrimination, right to protection from torture, cruel, inhumane, and degrading
treatment; right to aftercare and rehabilitation; right to be adequately informed about psychosocial and
clinical assessments; right to participate in the treatment plan to be implemented; right to evidence-
based or informed consent; right to confidentiality; and right to counsel, among others’.
The Act also incorporates rights for ‘concerned individuals’, incorporating patient relatives and mental
health professionals. In this context, a mental health professional refers to a medical doctor,
psychologist, nurse, social worker or any other appropriately-trained and qualified person with specific
skills relevant to the provision of mental health services (section 4 of the Act). The Act highlights the
need to provide psychosocial support to family members of the patient if required and, with informed
patient consent, to include them in the planning of treatment for the patient.
It further recognizes the role of mental health professionals, protecting their right to participate in
mental health planning and development of services, and ensuring that they have a safe working
environment, access to continuing education and autonomy in their own practice. Additionally, and
with some foresight, the Act seeks to integrate mental health into the educational system by promoting
mental health programmes in schools and other organisations.
Principles of the Mental Health Act
In keeping with the United Nations (UN) resolution, the Principles for the Protection of Persons with
Mental Illness and for the Improvement of Mental Health Care, to which the Philippines is a signatory,
the Philippines Mental Health Act of 2017 has several core principles including those covering the
following areas:
Definition of mental illness
According to the Act, ‘“Mental Health Condition” refers to a neurologic or psychiatric condition
characterized by the existence of a recognizable, clinically-significant disturbance in an individual's
cognition, emotional regulation, or behaviour that reflects a genetic or acquired dysfunction in the
neurobiological, psychosocial, or developmental processes underlying mental functioning. The
determination of whether a mental health condition exists shall be based on the best available scientific
and medical evidence’. The new bill covers all mental disorders, inclusive of substance-related
disorders, and involves active treatment of substance-related issues and preventive measures such as
incorporation of psychoeducational topics in the education system, from elementary school onwards.
Informed consent
The Act provides for ‘Free Prior Informed Consent’ or ‘Informed Consent’, referring to consent
voluntarily given by a service user to a plan for treatment. A patient must ‘give prior informed consent
before receiving treatment or care, including the right to withdraw such consent’. ‘All persons … shall
be presumed to possess legal capacity for the purposes of this Act or any other applicable law,
irrespective of the nature or effects of their mental health condition or disability’.
The Act makes provision to treatment without informed consent, ‘during psychiatric or neurologic
emergencies, or when there is impairment or temporary loss of capacity on the part of a service user’. In
such instances, ‘treatment, restraint or confinement, whether physical or chemical, may be administered
or implemented pursuant to the following safeguards and conditions:’ service user's advance directives;
only to the extent that such treatment or restraint is necessary; and only while a psychiatric or
neurologic emergency, or impairment or temporary loss of capacity, exists or persists.
Legal representatives and supported decision-making
Under the Act, any person subject to the Act may designate a person of legal age to act as his or her
legal representative through a notarised document. This legal representative shall ‘provide the service
user with support and help represent his or her interests; receive medical information about the service
user in accordance with this Act; assist the service user vis-á-vis the exercise of any right provided
under this Act; and be consulted with respect to any treatment or therapy received by the service user’.
If a legal representative is not chosen, other persons can act as the legal representative, including the
spouse, non-minor children and either parent by mutual consent, if the service user is a minor. A person
subject to the Act may also designate up to three persons or ‘supporters’, including the service user's
legal representative, for the purposes of supported decision-making.

Other considerations
The Act also addresses protection of the rights of persons with mental disorders in mental health
facilities, protection of minors, provision of resources for mental health facilities, role of community
and culture, review mechanisms providing for the protection of the rights of offenders with mental
disorders, procedural safeguards protecting the rights of persons with mental disorders, protection of
confidentiality, and standards of care and treatment including involuntary admission and consent to
treatment. The Act does not mention specific types of treatment, such as electroconvulsive therapy, but
its section on ‘Quality of Mental Health Services’ states that treatments must be based on medical and
scientific research findings, responsive to individual and cultural needs, provided in the least restrictive
setting and provided by mental health professionals and workers in a manner that ensures
accountability.

A pertinent issue facing many jurisdictions is whether their mental health legislation is compatible with
the UN Convention on the Rights of Persons with Disabilities, including those with ‘mental
impairments’. The UN regional authorities were involved in the process of drafting and further
revisions of the Act, along with other important stakeholders such as patients and their families, the
Commission on Human Rights and the World Association for Psychosocial Rehabilitation.

A further consideration is the practical implementation and impact of the new Act, and how this will be
monitored. The PPA is currently in the process of implementing a set of rules and regulations, which
are due to be completed within 90 days from the signing of the Act. A ‘Healthy Mind’ summit in
October 2018 involved all of the stakeholders in a joined review of the law, with the aim of identifying
practical challenges and providing a critical perspective.

Conclusion
Mental healthcare remains an under-resourced and neglected aspect of healthcare in the Philippines.
Until now, the country has lacked a formal structure in which to enshrine the rights of those people with
mental illness, their families, and the rights and responsibilities of mental health professionals and
government in relation to mental health. The Philippine Mental Health Act of 2017 has created an
environment for the organisation and provision of hospital- and community-based mental healthcare in
the Philippines, while providing specific legislative checks to ensure the rights of patients receiving
mental healthcare and treatment are protected.

The Philippine Mental Health Act of 2017 is therefore a major step forward for mental health in the
Philippines and a milestone for psychiatry in the country. Under the direction of the PPA, willing
governmental support along with the driving enthusiasm of mental health professionals, patient groups
and family members have led to the first comprehensive Mental Health Act legislation in the
Philippines. Significant logistical challenges remain in the successful implementation of this legislation,
but the Act is a significant step with the provision to comprehensively address, at a national and local
level, the mental health needs of the population.