ETHICAL ISSUES IN CLINICAL PSYCHOLOGY

APA Code of Ethics

• 1953 APA published the first code of ethics; it's appearance corresponded with the rise of professional psychology around that time period.

• Since then, 9 addition to the ethical code has been published.

• Two amendments were made in 2012.

1980s

PAP adapted Code of Ethics for clinical psychologists, it has remained unchanged since then.

2007

The board of directors of the PAP resolve to constitute a committee to revise the code of ethics, with the goal of updating the COE and making it more inclusive and applicable to all psychologists.

February 27, 2009

The complete committee conducted a day-long workshop to finalize the proposed COE for Philippine psychologists. The committee was strongly influence by existing codes from other countries, but worked hard to ensure that the COE is contextualized with the realities and constraints of working as a Filipino psychologists.

April 28, 2009

The draft of COE was presented to the PAP board of directors.

True

T OR F: Mindful that the code can never completely address all the possible emergent ethical concerns, the PAP encourages all each member to study the code and makes suggestions for its continuous improvement.

True

T OR F: Members with sugestions for a new probations or improvements and or amendments to the old provisions should submit this in writing, with supporting arguments and explanation, to the PAP board.

July 24, 2009

It was further revised and finally signed by the PAP board of directors.

2020

A committee was tasked to revised the COE in view of recent technological developments, as well as the implications of covid-19 on the practice of psychology .

August 26, 2022

The final version was approved by the board of trustees.

General Principles

• Are aspirational

• They describe an ideal level of ethical functioning or how psychologist should strive to conduct themselves.

• They don't include specific definitions of ethical violations; instead they offer more broad descriptions of exemplary ethical behavior.

• General principles should not be the basis for imposing sanctions on psychologist as they are broad.

APA General Principles

• Beneficence and nonmaleficence

• Fidelity and responsibility

• Integrity

• Justice

• Respect for People's Rights and Dignity

PAP General Principles

• Respect for the Dignity of Persons and Peoples

• Competent Caring for the Well-being of Persons and People

• Integrity

• Professional and Scientific Responsibilities to Society

Ethical Standards

• Includes enforceable rules of conduct

• If a psychologist is found guilty of an ethical violation, it is the ethical standard they violate, not a principle.

• More specific than general principles

• The PAP code of ethics is grouped into 10 categories, with 89 individual standards.

Ethical Decision Making

• When any ethical issue arises, a clinical psychologist should be equipped with a process to make the most ethical decision possible.

• The APA’s ethical code does not offer any such decision making models per se, but many experts in the field have recommended such models.

• Psychologists best prepare themselves to deal with ethical dilemmas by becoming generally ethical people with sound values.

• Functioning as an ethical psychologist should not be a rote exercise.

• The model for decision making works best when utilized by a person who has already examined his or her values and align them with the ethics of the profession.

Celia Fisher

Served as the chair of APA's ethical code task force; in her book ‘Decoding the Ethics Code’, she proposes an eight step model for ethical decision making.

Eight Step Model for Ethical Decision Making

1. Before the ethical dilemma arises, commit to doing what is ethically appropriate.

2. Become familiar with the APA/PAP 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.

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

• The APA Code of Ethics provides rules, but psychologists actual beliefs about what is ethical can vary.

• A major survey asked over 450 APA members to rate the ethicality of 83 different therapist behaviors.

• Most behaviors fell into a gray area (between unethical and ethical), showing how complex ethical decision making can be.

Blatantly unethical behaviors

1. Sex with clients or former clients

2. Socializing with former clients

3. Sharing confidential information without cause or permission.

Clearly ethical behaviors

1. Shaking hands with clients

2. Using clients’ first names

3. Breaking confidentiality if clients are suicidal or homicidal.

Confidentiality

• Psychologists’ have a primary obligation and take reasonable precaution to protect confidential information.

• The public entrust the profession to provide professional services without sharing the private personal details offered however confidentiality is not absolute.

Issues in Confidentiality

• Tarasoff Case

• Clinical Psychologist has a duty to warn people toward whom their clients make credible serious threats

• Confidentiality with minors

Tarasoff Case

Set legal precedent for the understanding of clinical psychologists on the limits of confidentiality agreements with client.

Takeaways from Tarasoff Case

• Confidentiality has limits - therapists must act if a client makes a credible, serious threat.

• Duty to warn/protect - therapists must take reasonable steps to prevent harm to potential victims.

• Legal Precedent - this case established that protecting others can outweigh client confidentiality.

• The Tarasoff case reshaped psychology and law by showing that therapists must sometimes break confidentiality to protect others. But applying this principle in real world situations remains complex, with no easy answers

Trust vs. Parental Rights

• Children may not open up if they know everything will be shared with parents.

• Parents, as legal guardians, are entitled to know about their child's progress.

• Effective therapy often requires keeping parents engaged while balancing the child's privacy.

Negotiated Agreements

• Psychologists sometimes set ground rules with both childs and parents: (1) parents agree not to expect full disclosure of sessions. (2) Exceptions: when the child is at risk of harm (self harm, danger from others) or for general updates on progress.

• Cultural differences can affect whether parents accept this agreement.

Informed Consent

• A process for psychologists to inform clients, participants, or patients about what they will experience.

• Ensures people can make an educated decision to participate or refuse.

• Assessment and therapy also require informed consent according to the ethical code.

• Applies to all professional activities: research, assessment, and therapy.

IC in Research

• Purpose, procedures, and duration of the study

• Risks and possible negative effects

• Incentives for participation

• Right to decline or withdraw at any time

• If experimental: explain control groups and alternative treatments

IC in Assessment

• Nature and purpose of the assessment

• Fees involved

• Who else may be involved (third parties)

• Limits of confidentiality (e.g., duty to warn, child abuse reporting)

Child Abuse

• Mental health professionals break confidentiality to report known or suspected child abuse.

• Some situations demand the clinical psychologists primary responsibility shift to immediate prevention of harm.

• Child abuse situations often require the clinical psychologist to make difficult judgement calls.

IC in Therapy

• Nature and expected course of therapy

• Fees and financial policies and involvement of third parties (e.g., insurance/managed care)

• Limits to confidentiality

• Provide opportunities for clients to ask questions

Why informed consent matters

• Builds trust and transparency

• Protects client’s rights and autonomy

• Strengthens the therapeutic alliance, which is central to successful outcomes.

• Helps clients actively participate in decisions about their treatment.

Boundaries and Multiple Relationships

• Multiple relationships happens when a license professional involve themselves in a “incident of blurred boundaries“. Weather with a client or a student.

• Can also occur if the psychologist has a relationship with someone closely associated with the client (e.g., their partner, sibling, or close friend).

Sexual Multiple Relationships

• Strictly prohibited: psychologists cannot have sexual relationship with current therapy clients.

• Such behavior is considered a serious ethical violation and can cause significant harm to clients.

• Attraction may occur, but psychologists must not act on it instead, they should seek supervision or consultation.

Boundary Crossing

• Minor, seemingly harmless actions (e.g., giving a ride, accepting a gift, sharing personal information).

• Small crossings can lead to a “slippery slope” towards violation.

Boundary Violation

Serious harm caused when boundaries are eroded (e.g., socializing, dating, financial entanglements)

What makes multiple relationship unethical?

• Impairment in the psychologist

• Exploitation or harm to the client

Impairment in the psychologist

If the role with client makes it difficult for the psychologist to remain objective, competent, or effective then it should be avoided.

Exploitation or harm to the client

The therapist-client relationship is characterized by unequal power; the therapist is the authority.

Competence

• Competent clinical psychologists are those who are sufficiently capable, skilled, experienced, and expert to adequately complete the professional tasks they undertake.

• A license or doctoral degree alone does not guarantee competence in all areas.

• Psychologists must only practice within the boundaries of their training and expertise.

Continuing Education Regulations

• Psychologists must not only need to become competent, but they must also remain competent.

• This standard is consistent with continuing education regulations of many state licensing boards.

• To be eligible to renew their licenses, psychologists in many states must attend lectures, participate in workshops, complete readings, or demonstrate in some other way that they are sharpening their professional skills and keeping their knowledge of field current.

Cultural Competence

• Psychologists must understand factors like age, gender, race, culture, religion, sexual orientation, disability, language, socio-economic status when relevant.

• No “one-size-fits-all” approach — services should be adaptable to diverse clients. APA guidelines (e.g., for multicultural, LGBTQ+ clients, ethnic/cultural diversity) support this.

• Violation of cultural competence are seen as serious ethical breaches.

Personal Problems and Burnout

• Psychologists must address personal issues that impair competence.

• Common among therapists; link to over commitment, low control, low pay, perfectionism, or lack of support. Can reduce therapy effectiveness (e.g., disengagement, poorer outcomes for clients)

Ethics in Clinical Assessment

• Test Selection

• Test Security

• Test Data

Test Selection

• Entail several factors including the psychologists competence; the client’s culture language and age and test reliability and validity.

• Psychologist must not select tests that have become obsolete or have been replaced by revised addition better suited to the assessment questions being addressed.

Test Security

• Psychologists should make efforts to protect the security and integrity of the test materials they used.

• Psychologist should prevent the question items and other stimuli included in psychological tests from entering the public domain.

Test Data

• Refer to the raw data that the client provided during testing responses and other notes that the psychologist made;

• The current edition instructs the psychologist to release test data unless there is a reason to believe that the data will be misused or will harm the client.

• This revision reflects the global shift toward patient autonomy.

Ethics in Clinical Research

• Psychologists must minimize harm to participants

• Avoid plagiarism, never fabricate data

• This rules apply across all areas of psychology, including clinical research.

Psychotherapy Efficacy

The participants and therapy efficacy studies who don't receive the treatment being studied are placed in one of these conditions:

• No treatment (wait list control)

• Placebo treatment (personal interaction with a professional, but the therapeutic techniques were deliberately omitted)

• Alternate treatment

Psychotherapy Efficacy Studies

• Goal: test how well a therapy works

• Method: compare a group receiving the therapy with a group that does not

• Ethical Dilemma: what should the control group receive?

Ethical Concerns in the Efficacy

• Participants join studies hoping for improvement, but somewhat receive no real help.

• Even with informed consent, questions remain:

  • Is it ethical to withhold treatment from people with psychological problems?

  • Does the pursuit of scientific evidence justify potential harm or lack of benefit to some participants?

Issues in Psychotherapy Efficacy

Balancing the need for empirical evidence with the duty to protect and help clients.

Psychotherapy Efficacy Takeaway

Psychotherapy research is vital, but it raises tough ethical questions about fairness and harm, especially for participants who don't receive the tested treatment.

Contemporary Ethical Issues

• Manage care and ethics

• Technology and ethics

• Ethics in a small community

Manage Care and Ethics

Confidentiality, diagnosis

Technology and Ethics

test security

Ethics in a Small Community

multiple relationships