PSYC3082 Week 10: Ethics

Foundations of therapeutic interactions

• Content (WHAT): The explicit matter, words, facts, stories and specific topics discussed within a session (e.g. client recounting a workplace conflict).

• Process (HOW): The implicit dynamics, relational patterns, emotional tone and non-verbal exchanges that transpire between therapist and client as they interact.

Therapeutic modalities (varied based on weight on process)

• High-Process Modalities: Modalities such as psychodynamic group therapy focus almost entirely on the ‘‘here-and-now” process of interpersonal interaction.

• Lower-Process modalities: traditional Cognitive Behavioral Therapy (CBT) focuses primarily on the structured content (e.g. thought records, behavioral experiments) though process remains vital for alliance maintenance.

Importance of the Therapeutic Relationship

• Dodo Bird Verdict: different validated psychotherapy modalities often yield comparable client outcomes. This finding underscores that non-specific factors (chiefly the quality of the therapeutic relationship) account for major proportion of the outcome variance.

The effectiveness of the client-therapist relationship is determined by at least 5 core factors

1. Personal characteristics of the client: Personality, traits, core values, expectations of therapy, history of prior treatment and presenting symptom severity.

2. Personal characteristics of the therapist: interpersonal warmth, empathy, authenticity, emotional maturity and self-awareness.

3. Competence and expertise of the therapist: Technical mastery, clinical reasoning and execution of evidence-based interventions.

4. Relational Match (Fit): interpersonal compatibility, shared values and mutual understanding between client and therapist.

5. Extra-Therapeutic Factors: Factors outside the therapy room, including the client and the therapist.

Minimizing relational misunderstandings

• Listening carefully and actively to the client’s perspective.

• Explicitly inviting client feedback regrading the therapist’s actions during every session.

• Establishing mutually agreed-upon, consensual therapy goals at the outset of treatment.

• Remaining flexible, open and non-defensive throughout the therapeutic process.

Alliance Ruptures

• A negative therapeutic process indicates a rupture in the therapeutic alliance, it is the tensions or breakdowns in collaborative relationship between client and therapist.

• Inevitability: Ruptures occur in virtually all therapeutic relationships; they are a natural outcome of deep psychological work.

• Barriers vs. Opportunities: if ignored, ruptures pose a major barrier to progress and increase drop-out rates. However, if navigated constructively, they provide indispensable clinical information about the client’s core relational dynamic.

• Mutual contribution: Interpersonal theory asserts that strains reflect contributions from both parties, the client’s habitual patterns and the therapist’s complementary reactions.

Strategies for Repairing Ruptures

• Awareness of negative affect: Notice and utilize internal feelings of frustration, anxiety or defensiveness rather than denying or repressing them.

• Here-and-now exploration: Direct the client’s attention to their immediate experience in the room (‘‘ I notice you became quiet after I made that observation. What is happening between us right now ?”)

• Linking Patterns: Help the client connect the current therapeutic rupture to recurring maladaptive patterns in their external relationships.

• Collaboration and Compromise: Demonstrate flexibility by adjusting goals or intervention styles to rebuild trust.

• Empathy for resistance: validate the protective function of the client’s defensive behavior and show compassion for the underlying fears driving it.

• Speaking the Client’s language: Adapt communication styles and capitalize on the brief ‘‘flashes’’ of client cooperation.

Managing Client Resistance

• Defined as any client behavior that hinders the therapeutic progress, such as:

• Lack of engagement in therapeutic dialogue or emotional withdrawal

• Frequent lateness, missed appointments or sudden cancellations

• Persistent refusal to discuss specific topics or emotional triggers

• Non-completion of between-session assignments (homework)

• High levels of expressed emotion toward the therapist (ranging from overt hostility and intense flirtation)

• Subtle session avoidance (e.g. changing the subject, over-intellectualizing).

Homework Non-completion: Drivers and Clinical Solutions

Primary reason for non-completion - Targeted Remediation strategies

• Lack of Task Understanding - Explain the assignment clearly and complete a full example together in session

• Lack of rationale awareness - explicitly explain why the task matters and how it connects to therapy goals

• Lack of reinforcement - review and reinforce completed homework at the very start of the next session

• Practical barriers and stressors - identify environmental barriers, adjust task complexity and problem-solve logistics

• Unaddressed Resistance - Explore underlying fears (e.g. gear of failure, perfectionism) with empathy.

Managing communication extremes

• Clients who over-talk: may use speech as a defensive mechanism to avoid painful affection or retain control. Therapists must set compassionate limits, summarize key themes and redirect focus to immediate emotional experience.

• Client who under-talk: may experience intense anxiety, shame or fear of judgement. Therapists should slow the pace, utilize open-ended questions, offer gentle reflection and reduce pressure for immediate disclosure.

Therapists internal process

• anxiety and self-doubt regrading clinical competence.

• over-identification with clients or unrealistic expectations of self/client progress

• managing boundary setting while maintaining genuine empathy

• Difficulty handling challenging client queries (e.g. personal questions, requests for direct advice, questions with unknown answers or client romantic disclosures)

Group Therapy Process Management

• Participation selection: screening candidates to ensure group fit and prevent harm.

• setting context and rules: establishing clear expectations, confidentiality ground rules and member roles upfront.

• Managing dominating members: redirecting airtime gently to ensure equitable participation (‘‘ Thank you for sharing that perspective; let’s check with others who haven’t spoken yet”)

• Encouraging silent members: Creating low-pressure invitations for quiet participants.

• Handling unsuitable members: removing or transitioning members whose behaviors are destructive to group safety.

Morals vs. Ethics

• Morals: an individual’s personal principles, internal values and subjective ideals regarding right and wrong.

• Ethics: professional standards of conduct and moral principles formally adopted by a group or governing body to guide right conduct in professional relationships.

Mandatory vs Aspirational Ethics

• Mandatory ethics: the minimum mandatory standard of professional practice required to maintain registration and avoid disciplinary action (the ‘‘ floor’’)

• Aspirational ethics: the highest philosophical and clinical standards of conduct to which a professional continuously strives (‘‘ the ceiling”)

Functions of professional codes of ethics

1. Educate practitioners about their professional responsibilities.

2. provide a formal basis for public accountability and discipline.

3. serve as guide for critical self-reflection and quality improvement.

Primary Australian Governing and professional bodies:

• Psychology Board of Australia (PsyBA)/Ahpra: regulatory body enforcing legal and registration standards.

• Australian Psychological Society: Peak profession association providing ethical guidance.

• Australian Counselling Association (ACA) and PACFA: Professional bodies for counsellors and psychotherapists.

APS Code of Ethics (2007)

1. Principle A: Respect for the Rights and Dignity of people and peoples:
   - Focuses on how psychologists treat clients and community members
   - Encompasses legal rights, human rights, moral rights, self-determination, privacy, confidentiality and cultural respect.

2. Principle B: Propriety
   - Focuses on fitness to practice psychology
   - Mandates that psychologists practice within their level of competence, use evidence-based assessments/interventions, main proper client records and do no harm

3. Principle C: Integrity
   - Focuses on broader professional and personal conduct.
   - Demands honesty, objectivity, transparent communication, avoidance of conflicts of interest and proper boundary maintenance.

Psychology Board of Australia (PsyBA) Code of Conduct (2025)

1. Safe, Effective and Collaborative Services

2. Aboriginal and Torres Strait Islander Health and Cultural Safety

3. Respectful and Culturally Reflective Practice for All

4. Working with clients

5. Working with Other Practitioners and Colleagues

6. Working within systems

7. Minimizing Risk to and by Clients

8. Psychologists’ behavior

9. Proactive management of health, wellbeing and work-related risk factors

10. Teaching, Supervising and Assessing

11. Ethical Research

Key Professional and Clinical Ethical Domains

• Informed Consent: Informed consent is an ongoing clinical process, not a static form, that respects client autonomy and therapeutic trust.

• Essential components are:
  - Explaining exact nature, purpose and procedures of proposed psychological services
  - Outlining potential risks, discomforts, adverse effects and disadvantages of treatment
  - Clarifying how personal data will be collected, recorded, securely stored and accessed
  - Advising clients of their right to decline participation or withdraw at any time without penalty
  - Structuring financial agreements, fee schedules , and expected service duration upfront
  - Discussing termination conditions and sessions cancellation policies
  - Explicitly detailing the scope and statutory limits of confidentiality

Confidentiality and Legal Exceptions

• Confidentiality is fundamental to clinical safety but it is not absolute. Psychologists must inform clients of statutory exceptions at the commencement of therapy.

• mandatory exceptions to confidentiality:
  1. Imminent harm: Clear and imminent risk of severe harm to self or identifiable others.
  2. Child protection: Mandatory reporting obligations regrading child abuse, sexual exploitation or severe neglect.
  3. Legal Subpoena: Formal court orders mandating the release of clinical records.
  4. Client authorization: Explicit written request or consent by the client (or legal guardian)

Multiple Relationships and Boundary management

• Common examples of multiple relationships:
  - providing therapy to a friend, relative, student or employee
  - engaging in social, romantic or sexual relationships with current/former clients
  - entering into a business ventures or borrowing money from clients
  - bartering services
  - accepting expensive personal gifts from clients

• Clinical and Ethical Risk
  - impair professional objectivity, clinical judgement and impartiality
  - create exploitative dynamics due to inherent power imbalance between therapist and client
  - cause psychological harm or distress to the client

• Exception Protocol
  - If multiple relationship is unavoidable due to extreme circumstances (e..g isolated rural practice then: Consult with an experienced colleague or supervisor, formally documents why the arrangement is ethically reasonable and unavoidable, implement explicit safeguards to protect client welfare and maintain objectivity.

Risk Management, Duty to warn and Duty to protect

• The landmark US legal case established the mental health professional’s legal duty regrading client threats of violence. When Prosenjit Poddar a student at UC Berkely disclosed his intention to murder Tatiana Tarasoff to his therapist, he briefly got arrested but ended up going through with the plan. Her family sued the university.

• 1974 ruling (Duty to warn): The California Supreme Court ruled that therapists have legal duty to warn an intended victim when a client poses a serious danger of violence.

• 1976 Rehearsing (Duty to Protect): Expanded the standard to a Duty to Protect, therapists must take reasonable protective steps which may include notifying police, warning the intended victim or initiating involuntary hospitalization.

• Modern Risk Application: In 2012, Aurora Cinema shooting perpetrator James Holmes expressed homicidal fantasies to his treating psychiatrist. This case highlighted the complex legal and clinical challenges surrounding risk assessment, involuntary detention criteria and balancing public safety against client confidentiality.

Cultural Safety and Reflective Practice

• The Tripartite Model of Cultural Competence
  1. Cultural Awareness: developing