Condensed Midterm StudyGuide

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Carlos Albizu University *

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PSYD705

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Psychology

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Dec 6, 2023

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Condensed Midterm Study Guide Based on WK2, Ethical Principles of Psychologists and Code of Conduct; Decoding Ethics Code Ch. 1-2 Ch. 1 A Code of Ethics for Psychology: How Did We Get Here? The Purpose of an Ethics Code ● Ethics Code first published in 1953 ● Goal of Ethics Code = welfare and protection of who psychologists work with and the education of members, students, and the public regarding ethical standards of the discipline *Practice Question* A core value of the discipline of psychology is the ____________ and ____________ of the individuals and groups with whom psychologists work. A: welfare, protection *Practice Question* Why was the ethics code created? A: gain public trust, ensure public welfare APA Ethics Code revisions have been guided by the following objectives: ● Establishing the integrity of a profession ○ Having a code reinforces core value of psychology: the welfare and protection of the individuals and groups with whom psychologists work ● Education and professional socialization ○ Guide to what psychologists should reasonably expect of themselves and one another ● Public trust ○ Contract with society to act in the consumers’ best interest—can be held accountable by the public ● Enforcement value ○ Means of avoiding capricious standards set by non psychologists—less vulnerable to external regulation General Principles Principle A = Beneficence and Nonmaleficence ● Reflects psychologists’ dual obligation to strive to do good and avoid doing harm ● Represents the joint influences of beneficence and nonmaleficence in recognition that in rightly practiced psychology, individuals may be harmed without being
wronged Principle B = Fidelity and Responsibility ● Fidelity = faithfulness of one human being to another ○ In psychology, this includes promise keeping; discharge and acceptance of fiduciary responsibilities; and appropriate maintenance of scientific, professional, and teaching relationships ● Psychologists seek to meet their responsibilities by avoiding conflicts of interest that would jeopardize trust or lead to exploitation or harm ○ They also consult with other professionals when necessary (see Standards 3.05, 3.06, and 3.09) Principle C = Integrity ● Maintaining integrity in psychological activities requires honest communication; truth telling; promise keeping; and accuracy in the science, teaching, and practice of psychology ● In some scientific and professional relationships, deception may be justified to maximize knowledge gained or the welfare of individuals served (see Standard 8.07) Principle D = Justice ● Calls for psychologists to strive to provide all people with fair, equitable, and appropriate access to treatment and the benefits of scientific knowledge. ● Also calls for psychologists to select procedures and services that meet the needs of those with whom they work, recognizing that existing social and economic inequities may require different but comparable scientific and professional techniques Principle E = Respect for People’s Rights and Dignity ● Calls for psychologists to “respect the dignity and worth of all people, and the rights of individuals to privacy, confidentiality, and self-determination.” ● Reflected in standards requiring informed consent (Standards 3.10, 8.02, 9.03, and 10.01), respect for individual differences (Standards 2.01, 3.01, and 9.01), and privacy and confidentiality (Standards 6.02, 7.04, and 10.03), amongst others *Practice Question* How many principles are included in the ethics code? List them all A: Five principles: Beneficence and nonmaleficence; Fidelity and responsibility; Integrity; Justice; and Respect for People's Rights and Dignity Changes to APA Ethics Code
1992 Revision = made clear distinction between aspirational principles and specific ethical standards ● Aspirational : statements of broadly worded ideals and principles ● Educational : combines ethical principles with explicit interpretations ● Enforceable : specifically describe behaviors required and proscribed by the profession & serves as basis for adjudicating grievances General Principles vs Enforceable Standards ● Principles = impart core moral values reflecting the highest ideals of the profession → 5 PRINCIPLES ● Standards = cast in behaviorally specific language, and can therefore be enforced by the APA Ethics Committee and other organizations that adopt the Code → 10 STANDARDS (151 total) *Practice Question* The Ethics Code strives to reflect both the ________________ and __________________ of ethical decisions made by members of the profession. A: aspirations, practical aspects *Practice Question* An Ethics Code should reflect: A: the moral principles underlying values of the profession 2010 Amendment = prohibited psychologists from “engaging in activities that would justify or defend violating human rights” ● Controversy regarding psychologists in consultative roles to interrogation and information-gathering processes for national security-related purposes ○ Response to reports that some psychologists were actively involved in harsh interrogations of post-9/11detainees ● Amended the language of code to make clear that psychologists’ ethical duties supersede their legal obligations when their activities contributed in any way to a violation of human rights ● Amended Standards 1.02 and 1.03 2016/17 Amendment = prohibited psychologists from participating in or facilitating in torture Distinction Between APA Ethics Code and Specific APA Guidelines ● Guidelines endorsed by scientific and professional psychological organizations may be
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useful in applying the Ethics Code to everyday activities ● Specific APA guidelines are not listed in the current Code Ch. 2 The Ethics Code Introduction and Preamble, and Relationship to Enforcement and Law: How is The Ethics Code Applied? Who Does Ethics Code Apply To? ● APA members and student affiliates ● Adopted by many psychology programs and integrated into state laws, rules, and regulations governing the licensed practice of psychology Professional vs. Personal Activities ● The Code does not apply to the purely private conduct of psychologists (unless a psychologist is convicted of a felony) *Practice Question* You are driving under the influence and you get arrested and someone reports that to the Ethics Committee. What do you think the Ethics Committee is going to do? A: APA Ethics Committee will not do anything because incident is not related to relationship with client. If the incident is a felony, the APA Ethics Committee will take that into account. Who Enforces Ethics Code? APA Ethics Committee enforces the Ethics Code Ethics Complaints ● Complaints to the Ethics Committee may be brought by APA members or nonmembers or initiated by members of the Ethics Committee ● A complaint may be dismissed prior to review by the Ethics Committee ● If a case is opened, the psychologist against whom the complaint is made receives a charge letter and is given an opportunity to provide the committee with comment and materials regarding the allegations Sanctions ● The Ethics Committee reviews the materials and resolves to either dismiss the case or recommend one of the following actions: ○ Reprimand = if violation not likely to cause harm to another person or cause substantial harm to profession ○ Censure = if violation is likely to cause harm to another person but not likely to cause substantial harm to another person or to profession
○ Expulsion = if violation is likely to cause substantial harm to another person or profession ○ Stipulated resignation = if committee finds that member committed a violation of code or failed to show cause why they shouldn’t be expelled ● The Ethics Committee may also issue directives requiring the respondent to ○ Cease and desist from an activity ○ Obtain supervision or additional training or education ○ Be evaluated for and obtain treatment if ○ Appropriate agree to probationary monitoring Relation to Sanction by Other Bodies ● Other bodies include: state psychological associations, psychology boards, payors for health services (insurance) ● The Ethics Code is adopted in its entirety or in part in statute by more than half the state-licensing boards ● Insurance companies regularly require psychologists applying or reapplying for professional liability policies to reveal whether they have been the recipient of an ethics complaint ○ Many insurance companies retain the right to raise rates or cancel policies depending on the nature of an ethical violation Notification Following a Decision, Director of Ethics Office: ● Informs the respondent and the complainant of the final disposition in a matter ● Provides to the APA membership on an annual basis the names of individuals who have been expelled and those who have resigned from membership while under investigation ● Informs the APA Council of Representatives in confidence who received a stipulated resignation and who resigned from membership while under investigation Show Cause Procedure ● The Ethics Committee can also take action against a member if a criminal court, licensing board, or state psychological association has already taken adverse action against the member Conflicts Between Ethics and Law ● Introduction and Applicability section → notes that psychologists must comply with the Ethics Code if it establishes a higher standard of conduct than is required by law ● When an Ethical Standard is in direct conflict with a governing legal authority, psychologists must make known their commitment to the Ethics Code and take steps to resolve the conflict ○ If the conflict is unresolvable, psychologists are permitted to adhere to the legal
requirements, but only if such adherence cannot be used to justify or defend violation of human rights (see Standard 1.02) Based on WK3, Decoding Ethics Code Ch. 4-5 Ch. 4 Ethical Theories and Ethical Decision Making Openness to Others = characterized by a personal and professional commitment to applying a multicultural lens to our work motivated by a genuine interest in understanding others rather than reacting to a new wave of multicultural “shoulds” ● Core virtue for practice of multiculturalism *Practice Question* Dr. Stevens has a new client from a county in South America of which he is not familiar with the culture or values. Dr. Stevens decides he needs to do some research related to the county so that he may understand any cultural differences and that he may creatively apply ethical principles and standards to this new culture. Dr. Stevens is said to have: A: openness to others Types of Ethical Approaches ● Deontology or Kantian Ethics [described as “absolutist,” “universal,” and “impersonal”] ○ Ethical decision-making as rational act of applying universal principles to all situations irrespective of specific relationships, contexts, or consequences ○ Reflects Immanuel Kant’s conviction: ethical decisions cannot vary or be influenced by special circumstances or relationships ○ Application to Deception Study: ■ From a Kantian perspective, deception in research is not ethically permissible ● Utilitarianism or Consequentialism = prioritizes consequences of an act over the application of universal principles ○ Ethical-making must be governed by a risk-benefit calculus ○ Act utilitarian vs. rule utilitarian ○ Application to Deception Study: ■ From Utilitarianism perspective, deception in research may be deemed ethically permissible or impermissible ● Communitarianism = right actions derive from community values, goals, traditions, and cooperative virtues ○ Compared with Utilitarianism → “Whereas utilitarianism asks whether a policy will produce the greatest good for all individuals in society, communitarianism asks whether a policy will promote the kind of community we want to live in ○ Challenge to this perspective → question of which community values should
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be represented in ethical decision-making ■ Decisions made in response to majority values may result in or perpetuate health disparities and other inequalities suffered by marginal groups ○ Application to Deception Study: ■ Possible that views of the scientific and those of the “community of research participants” differ regarding the ethics of deception ● Relational Ethics = commitment to act on behalf of persons with whom one has a significant relationship as central to ethical decision-making ○ Attention on power imbalances and supports efforts to promote equality of power and opportunity for women and other marginalized groups ○ Psychologists’ ethical decision-making is not isolated from the interpersonal, contextual, and political contexts that shape ethical obligations ○ Application to Deception Study: ■ Would view deception as a violation of interpersonal trust that gives participants false impression that investigators have honestly provided them with all the information that might affect their decision to participate ■ Deception research conducted in college → exploits the power asymmetry present Approaches to Dilemmas Involving Cultural Differences ● Ethical Universali sm [also called Ethical Absolutism] = rejects the influence of culture on the identification and resolution of ethical problems ○ Adopts universal perspective of deontic position ○ Flaw → runs risk of failing to understand or ignore critical value differences held by clients or research populations essential to effective treatment or scientific results ● Ethical Relativism = how ethical problems are identified and resolved is unique to each particular culture or community ○ Denies existence of universal or common moral values characterizing whole of human relationships ○ Aligned with some forms of Communitarian and Utilitarianism theoretical perspective ○ Flaws: ■ Fails to consider alternative solutions to an ethical problem when there is a disconnect between profession’s values and different or opposing values articulated by those with whom psychologists work ■ Risk of condoning attitudes that reflect systemic cultural injustices or cultural values such as racism, heterosexism or misogyny ● Multicultural Ethics [also known as “Ethical Contextualism”] = arriving at an ethical decision as a psychologist requires a recognition of one’s professional values in relationship to the values of those with whom the psychologist works ○ Assumes that moral principles should be universally valued across diverse contexts
and cultures, but the expression of an ethical problem and the actions to resolve it can be unique to the cultural context ○ Also referred to as “cross-cultural ethics” or “moral realism” ○ Aligned with Relational Ethics and Social Justice, and Liberation psychology theories ○ Flaw: can also fall victim to ethical relativism when psychologist does not have tools to find common ground in resolving differences in the cultural values embedded within profession and those by a client Steps in Ethical Decision-Making ● Step 1: Identification of ethical problem = develop the skills to identify when a situation raises ethical issues ○ Recognizing when a situation calls for ethical decision-making includes the following: ➢ Familiarity with ethical theories and moral dispositions ➢ Reflection on the personal vs. professional values, biases, and potential conflicts of interest ➢ Professional humility that enables one to seek consultation ➢ Implementing self-care strategies to guard against influence of occupational and moral distress ● Step 2: Ethical principles, standards, and guidelines = Consider relevant APA Ethics Code General Principles and Ethical Standards & other professional guidelines and organizational policies → identify relevant guidelines for resolving dilemma ○ Applying ethical principles, standards, and guidelines to an ethical dilemma requires psychologists to do the following: ➢ Identify ethical principles, standards, and guidelines most relevant ➢ Consider whether there are general principles and ethical standards that appear to be in conflict ➢ Draw on professional or scientific guidelines ➢ Identify other resources relevant to fair and right actions ● Step 3: Laws, regulations, and policies = determine which local, state, and federal laws and institutional policies are relevant to ethical situation ○ Only a handful of Ethical Standards require psychologists to adhere to laws or institutional rules ○ Laws and policies should not dictate ethics, but familiarity with legal and organizational rules is essential for informed ethical decision-making ➢ Be familiar with procedures to be in compliance ➢ Understand consequences of compliance with relevant laws ➢ Consider whether compliance advances or violates human rights ➢ When conflicts between ethics and laws, consider the consequences ● Step 4: Stakeholder perspectives = understand the perspective of different stakeholders who will be affected by and who will affect the outcome of the decision ○ Discussion with stakeholders can clarify the multifaceted nature of an ethical
problem, illuminate ethical principles that are in jeopardy of being violated or ignored, and alert psychologists to potential unintended consequences of specific action choices ➢ Understand worldviews of those with whom you work ➢ Include stakeholders who will be directly affected by your work ➢ Develop procedures for contacting hard-to-reach or vulnerable persons ➢ Consult with community stakeholders ➢ Develop procedures for engaging stakeholders ● Step 5: Considering alternatives and developing and implementing a plan = apply Steps 1-4 to generate ethical alternatives and select alternative that best fulfills one’s obligations under Ethics Code and has greatest likelihood of protecting welfare of stakeholders ○ Ethical decision-making must draw on critical thinking → including intuitive and affective components of ethical reflection, to prioritize those principles, standards, and theoretical approaches that will result in fair and right actions ● Step 6: Monitoring and evaluating = monitor and evaluate effectiveness of course of action; and modify and continue to evaluate plan if necessary ○ Continued monitoring and evaluation of an ethics action plan is intrinsic to the responsible conduct of science and practice in psychology Ch. 5 Standards for Resolving Ethical Issues Under the Ethics Code, are Psychologists Obligated to Report Ethics Code Violations of Others? ● An informal resolution may be appropriate (see Standard 1.04) ● First, attempt to resolve informally if appropriate and confidentiality of patients are not violated ● Formal reporting is required if an ethical violation has or is likely to result in substantial harm, informal resolution is not appropriate, and the reporting would not violate confidentiality rights (see Standard 1.05) ● Also refer to Standards 1.07 and 1.08 regarding reporting complaints *Practice Question - SHORT ANSWER* Describe when an ethical violation committed by a psychologist should be reported: A: When an attempt to resolve informally is inappropriate and/or fails, confidentiality of patients are not violated, and when ethical violation has or is likely to result in substantial harm *Practice Question - TRUE OR FALSE* An ethical violation that has substantially harmed a client may be handled informally A: False
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*Practice Question - TRUE OR FALSE* An informal resolution may be attempted when an ethical violation can be addressed in discussion A: True Standard 1. Resolving Ethical Issues 1.01 Misuse of Psychologist’s Work = “If psychologists learn of misuse or misrepresentation of their work, they take reasonable steps to correct or minimize the misuse or misrepresentation” ● Focuses on corrective action that must be taken when psychologists learn that others have misused or misrepresented their work ○ Rely on existing corrective mechanism (i.e. asking judge to permit clarification) ○ Could refrain from corrective action if attempt to remedy would violate rules of court or APA code ○ Psychologists should always document the corrective efforts made to remedy known misuse or misrepresentations ● Phrase of “reasonable steps” → in some instances, psychologists may not be in a position to ensure that their requests to correct misuse are followed ● Frequently, psychologists will not be aware that their work has been misrepresented; in such cases → inaction on their part would not be an ethical violation *Practice Question* According to Standard 1.01, if psychologists learn of the misuse of their work, they must: A: take reasonable steps to correct the misuse *Practice Question* If a psychologist is not aware that their work has been misrepresented or misused, are they still liable? A: No—inaction on their part would not be an ethical violation (of Standard 1.01) *Practice Question* If a psychologist learns of _________, they take reasonable steps to correct or minimize the ________. A: misuse or misrepresentation 1.02 Conflicts Between Ethics and Law, Regulations, or Other Governing Legal Authority = If psychologists’ ethical responsibilities conflict with law, regulations or other governing legal authority, psychologists clarify the nature of the conflict, make known their commitment to the Ethics Code, and take
reasonable steps to resolve the conflict consistent with the General Principles and Ethical Standards of the Ethics Code. Under no circumstances may this standard be used to justify or defend violating human rights ” ● Standard does not require compliance with law When Conflict Cannot Be Resolved ● When reasonable actions taken by psychologists do not resolve the conflict → they are permitted to make a conscientious decision to comply with the legal or regulatory authority under circumstances in which their actions cannot be used to justify or defend violating human rights Psychology and International Declarations on Human Rights ● Critical intersections between ethical responsibilities of psychologists and the international human rights movement *Practice Question* If psychologists’ ethical responsibilities conflict law, regulations, or other legal authority, psychologists should do all of the following, except: A: must follow the law [must do: clarify the nature of the conflict, make known commitment to Ethics Code, take reasonable steps to resolve the conflict] *Practice Question - SHORT ANSWER* Discuss the steps a psychologist must take when dealing with conflict between ethics and law. A: Clarify the nature of conflict, make known commitment to ethics code, take reasonable steps to resolve conflict 1.03 Conflicts Between Ethics and Organizational Demands = “If the demands of an organization with which psychologists are affiliated or for whom they are working are in conflict with this Ethics Code, psychologists clarify the nature of the conflict, make known their commitment to the Ethics Code, and take reasonable steps to resolve the conflict consistent with the General Principles and Ethical Standards of the Ethics Code. Under no circumstances may this standard be used to justify or defend violating human rights” ● Psychologists working in or with organizations may encounter company policies that conflict with the Ethics Code ● The standard specifically requires psychologists to make known their commitment to the Ethics Code in communications with the organization ● Psychologists should not assume that Standard 1.03 waives their obligation to adhere to other standards in this Ethics Code
Human Rights and Organizational Consulting ● Psychologists working in or consulting to organizations must evaluate how their work may unintentionally condone organizational practices that justify violation of human rights ● Psychologists working in and consulting to organizations must address the needs of multiple stakeholders who differ in terms of power and privilege Commercially Funded Research ● Conflicts can occur when research sponsors attempts to control the dissemination of research findings ● Standard 1.03 requires that psychologists explain to the sponsor their ethical obligations under the Ethics Code, including their commitment to participant protection and the responsible conduct of research 1.04 Informal Resolution of Ethical Violations = “When psychologists believe that there may have been an ethical violation by another psychologist, they attempt to resolve the issue by bringing it to the attention of that individual, if an informal resolution appears appropriate and the intervention does not violate any confidentiality rights that may be involved” ● In instances which an informal resolution seems appropriate → should discuss violation with the offending psychologist to confirm whether misconduct has actually occurred and, if appropriate → recommend corrective steps and ways to prevent future ethical violations Informal Resolutions in Interprofessional Settings ● In integrated care setting, psychologists may be approached by other providers seeking assistance for emotional distress or personal problems ○ These requests raise ethical questions regarding whether the impairment is jeopardizing the welfare of patients ● At the beginning of their employment, psychologists should become familiar with site rules and procedures for reporting impaired practitioners and ask how such incidents are handled Implications of HIPPA ● HIPPA requires that healthcare professionals take reasonable steps to mitigate any harmful effects of unlawful disclosure of PHI by an employee or business associate Instances when Informal Resolution is Not Feasible ● Previous attempts to discuss the violation with the offending psychologist were ineffective ● Offending psychologist is inaccessible ● An informal resolution would violate an individual’s confidentiality rights
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Peer Review ● Journal editors or psychologists reviewing manuscripts or grant proposals may come across information in the submitted materials that suggests a potential ethical violation ● When an informal resolution is appropriate → reviewer should alert the editor ○ If informal resolution is not appropriate → formal complaint may be made after having consulted the confidentiality and proprietary rights of the submitted materials within the context of the specific review process 1.05 Reporting Ethical Violations = “If an apparent ethical violation has substantially harmed or is likely to substantially harm a person or organization and is not appropriate for informal resolution under Standard 1.04, Informal Resolution of Ethical Violations, or is not resolved properly in that fashion, psychologists take further action appropriate to the situation. Such action might include referral to state or national committees on professional ethics, to state licensing board, or to the appropriate institutional authorities. This standard does not apply when an intervention would violate confidentiality rights or when psychologists have been retained to review the work of another psychologist whose professional conduct is in question” ● Behaviors likely to cause substantial harm → sexual misconduct, insurance fraud, plagiarism, and blatant intentional misrepresentation 1.06 Cooperating With Ethics Committees = “Psychologists cooperate in ethics investigations, proceedings, and resulting requirements of the APA or any affiliated state psychological association to which they belong. In doing so, they address any confidentiality issues. Failure to cooperate is itself an ethics violation. However, making a request for deferment of adjudication of an ethics complaint pending the outcome of litigation does not alone constitute noncooperation” ● To ensure the validity and viability of APA ethics adjudication, Standard 1.06 requires that psychologists cooperate with APA and state-affiliated ethics investigations, proceedings, and resulting requirements ● Requiring cooperation with an ethics committee when a complaint has been brought against a psychologist does NOT violate the Fifth Amendment right against self-incrimination ○ Professional organizations are not bound by the Fifth Amendment *Practice Question* If you’re reviewing an applicant who is applying for a position and they have a pending ethical complaint against them—can you use that pending complainant to make a decision on their application? A: No, must wait for it to resolve 1.07 Improper Complaints = “Psychologists do not file or encourage the filing of ethics complaints that
are made with reckless disregard or willful ignorance of facts that would disprove the allegation” ● Common improper complaints to the APA Ethics Committee involve: ○ Academic colleagues ○ Business rivals ○ Psychologists with opposing forensic roles ● Violated if psychologists making a complaint had access to information refuting the accusation – whether or not they availed themselves of such information 1.08 Unfair Discrimination Against Complainants and Respondents = “Psychologists do not deny persons employment, advancement, admissions to academic or other programs, tenure, or promotion, based solely upon their having made or their being the subject of an ethics complaint. This does not preclude taking action based upon the outcome of such proceedings or considering other appropriate information” ● Protects unfair discrimination against those who make ethics complaints ● Protects rights of those accused of unethical behaviors to pursue their career paths pending resolution of a complaint Based on WK4, Decoding Ethics Code Ch. 6 Ch. 6 Standards of Competence Standard 2. Competence 2.01 Boundaries of Competence 2.01 (a) “Psychologists provide services, teach, and conduct research with populations and in areas only within the boundaries of their competence, based on their education, training, supervised experience, consultation, study, or professional experience” *Practice Question* Psychologists provide services within the boundaries of their __________________. A: competence *Practice Question* Dr. Jones who has a private practice working with children has been asked to provide assessment services for child custody evaluations. Dr. Jones has never performed a custody evaluation before. If he accepts this position, he will be: A: practicing outside the boundaries of his competence 2.01 (b) “Where scientific or professional knowledge in the discipline of psychology establishes
that an understanding of factors associated with age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, or socioeconomic status is essential for effective implementation of their services or research, psychologists have or obtain the training, experience, consultation, or supervision necessary to ensure the competence of their services, or they make appropriate referrals, except as provided in Standard 2.02, Providing Services in Emergencies” Three Sequentially Related Obligations (Under 2.01b) ● Familiarity with Professional and Scientific Knowledge ○ Be sufficiently familiar with current scientific and professional knowledge to determine whether an understanding of factors associated with the individual characteristics listed in Standard 2.01b is necessary for effective implementation of their services or research ● Appropriate Skills ○ If current knowledge in the field indicates that an understanding of one or more of the factors cited in Standard 2.01b is essential to conduct activities competently, psychologists must have or obtain the training, experience, consultation, or supervision necessary ● Knowledge of When to Refrain and Refer ○ Psychologists who have not had or cannot obtain the knowledge or experience required must refrain from engaging in such activities, and make referrals when appropriate (except in emergencies) *Practice Question* Under Standard 2.01b, psychologists have related obligations: A: familiarity with professional and scientific knowledge, appropriate skills, knowledge when to refrain and refer 2.01 (c ) “Psychologists planning to provide services, teach, or conduct research involving populations, areas, techniques, or technologies new to them undertake relevant education, training, supervised experience, consultation, or study” 2.01 (d) “When psychologists are asked to provide services to individuals for whom appropriate mental health services are not available and for which psychologists have not obtained the competence necessary, psychologists with closely related prior training or experience may provide such services in order to ensure that services are not denied if they make a reasonable effort to obtain the competence required by using relevant research, training, consultation, or study” ● Such situations often arise in rural settings or small ethnocultural communities where a single psychologist serves a diverse-needs population ● Standard reflects the balance, articulated in Principle A: Beneficence and
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Nonmaleficence, between the obligation to do good and the responsibility to do no harm 2.01 (e) “In those emerging areas in which generally recognized standards for preparatory training do not yet exist, psychologists nevertheless take reasonable steps to ensure the competence of their work and to protect clients/patients, students, supervisees, research participants, organizational clients, and others from harm” ● Applies when psychologists wish to develop or implement new practice, teaching, or research techniques for which there are no generally agreed upon training qualifications ● Psychologists working in emerging areas are required to take reasonable steps to protect those with whom they work from harm ● Adherence to this standard requires that psychologists have the foundational knowledge in psychology necessary to implement and evaluate novel approaches Digital Ethics: Competence in Basic Knowledge of Electronic Modalities ● Psychologists utilizing the internet, mobile phone, and other technologies for research, practice, consulting, and other professional activities → ○ Need to obtain appropriate knowledge or training in the technical requirements necessary to ensure adequate provision of services, test administration, or data collection and analysis ● eHealth → must be attentive to harm that may be inflicted on clients/patients when the use of electronic media results in misdiagnosis, failure to identify suicidal or homicidal ideation, or inadvertent reinforcement of maladaptive behavior (e.g. social phobia) Digital Ethics: Competence in the Use of Telepsychology ● Stay abreast of advances in the field ● Identify local agencies for crisis situations ● Clear written plan for what to do in an emergency ● Document rationale for selecting specific telepsychology modality ● Use scanning techniques for delivering/receiving questionnaires ● Consider termination when telepsychology services are no longer needed, ineffective, or harmful *Practice Question - SHORT ANSWER* When using telehealth services, what steps should you take to fulfill requirements of competency? A: stay updated on advances in telehealth field; identify local agencies for crisis situations; have a clear written plan for emergencies; document
rationale for selecting specify telepsychology modality; use scanning techniques for delivering/receiving questionnaires Also, understand risks of using telehealth: conduct an initial review to determine the risks and benefits of the service for each client and whether they can adequately manage client emergencies if they arise ● Misdiagnosis ● Failure to identify suicidal or homicidal ideation ● Inadvertent reinforcement of maladaptive behavior (e.g. social phobia) 2.01 (f) “When assuming forensic roles, psychologists are or become reasonably familiar with the judicial or administrative rules governing their roles” ● Forensic Role = engaging in activities intended to provide scientific, technical, or specialized knowledge of psychology to the legal system to assist in addressing legal, contractual, and administrative matters ○ Relevant standards to forensic psychologists: 2.01f, 3.05c, 3.10c, 9.01a, 9.03a, 9.04b, 9.10, 9.11, 10.02b Familiarity with Law, Regulations, and Governing Authorities ● Provision of competent forensic services requires knowledge of the judicial or administrative rules governing various forensic roles *Practice Question - TRUE OR FALSE* A forensic psychologist should be familiar with the legal and judicial system. A: True *Practice Question* What kind of roles can a forensic psychologist have? A: assessment, research, consultation, teaching, public statements Distinguishing Forensic from Clinical Assessments ● Clinical, goal is = to help the client adjust positively to life circumstances ● Forensic = assist the “trier of facts” (judge, jury, etc) with determining a legal question Evolving Law and School Psychologists ● School or educational psychologists who serve as expert witnesses in due process hearings for educational services need to be familiar with the legal
foundations of special education law ● School psychologists also have a legal duty to protect all students attending the school from reasonably foreseeable risk of harm *Practice Question* The Individuals with Disabilities Education Improvement Act of 2004 is required legal information for which psychologists: A: school psychologists 2.02 Providing Services in Emergencies = “In emergencies, when psychologists provide services to individuals for whom other mental health services are not available and for which psychologists have not obtained the necessary training, psychologists may provide such services in order to ensure that services are not denied. The services are discontinued as soon as the emergency has ended or appropriate services are available” Emergency Care Suicidality ● In emergency situations, psychologists without the necessary competencies are permitted to try to reduce the immediate risk of suicide ● In such cases, psychologists should call for emergency services or attempt to obtain appropriate services for the individual or refer the person to such services as soon as feasible Emergencies and Public Health Ethics ● In disaster situations, providers must make difficult decisions about whom to treat among survivors with different and competing needs ● Prioritizing whom to treat must be decided on evidence-based differences in the mental health needs of individuals or of particular groups essential to promoting health of others (first responders 2.03 Maintaining Competence = “Psychologists undertake ongoing efforts to develop and maintain their competence” ● Requirements of this standard can be met through: independent study, continuing education courses, supervision, consultation, or formal postdoctoral study Competencies for Collaborative Group Practices and Primary and Integrated Care Settings ● With the passing of the Affordable Care Act, psychologists will need to acquire competencies in collaborative practice ● To deliver collaborative care requires competencies Consulting and Professional Competencies for Collaborative Care in Global health
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● Psychologists working in international settings need to understand the large differences in healthcare and educational systems, water and food security, and exposure to violence that exists across countries and regions 2.04 Bases for Scientific and Professional Judgments = “Psychologists’ work is based on established scientific and professional knowledge of the discipline (see also Standards 2.01e, Boundaries of Competence, and 10.01b, Informal Consent to therapy)” ● Scientific knowledge = information generated according to accepted principles of research practice ● Professional knowledge = widely accepted and reliable clinical reports, case studies, or observations Evidence-Based Practice ● Evidence-Based Practice in Psychology (EBPP) = integration of the best available research with clinical expertise in the context of patient characteristics, culture and preferences, and relevance to the patient’s treatment and assessment needs ○ When patient characteristics and treatment context meet EBP criteria, psychologists implement the evidence-based treatments as designed, a practice known as “ treatment integrity” I mplications of the ACA ● To meet criteria for services coverage within ACA, psychologists working in group practices and primary care patient-centered health systems must be able to utilize evidence-based practices that enhance the cost-effective quality of care 2.05 Delegation of Work to Others = “Psychologists who delegate work to employees, supervisees, or research or teaching assistants or who use the services of others, such as interpreters, take reasonable steps to (1) avoid delegating such work to persons who have a multiple relationship with those being served that would likely lead to exploitation or loss of objectivity; (2) authorize only those responsibilities that such persons can be expected to perform competently on the basis of their education, training, or experience, either independently or with the level of supervision being provided; and (3) see that such persons perform these services competently.” ● Implications of HIPPA → train, document, and appropriately sanction employees regarding HIPPA ● “Reasonable steps” → recognizes that despite their best efforts, persons to to whom work is delegated may fail to perform their duties appropriately ○ Also recognizes that sometimes psychologists working in organizations, in the military and other public service positions, or at the bequest of the legal system may be assigned assistants, employees, or interpreters insufficiently qualified to perform their duties
Psychologists Should ● Evaluate whether those whose services are used have the skills to implement the task independently or under appropriate supervision ● Assign such individuals only those tasks for which they are qualified ● Monitor the activities to ensure competent implementation Use of Interpreters ● Psychologists must ensure that interpreters have adequate translation skills and sufficient understanding of the psychological nature and ethical responsibilities of the duties to be performed 2.06 Personal Problems and Conflict 2.06 (a) “Psychologists refrain from initiating an activity when they know or should know that there is a substantial likelihood that their personal problems will prevent them from performing their work-related activities in a competent manner” ● Intent of this standard is preemptive (indicated by “refrain from beginning” and “substantial likelihood”) ● “Or should know” → will not avoid a finding of violation of this standard by claiming they did not know that their problems could interfere with their work *Practice Question - TRUE OR FALSE* Emotional, social, and other personal problems cannot interfer with psychologists ability to effectively practice A: false 2.06 (b) “When psychologists become aware of personal problems that may interfere with their performing work-related duties adequately, they take appropriate measures, such as obtaining professional consultation or assistance, and determine whether they should limit, suspend, or terminate their work-related duties (see also Standard 10.10 Terminating Therapy) ● To comply, psychologists can turn to state licensing boards/state psychological associations that provide colleague assistance programs to help psychologists deal proactively with and remediate impairment ○ If not adequate to ensure competence → appropriately limit, suspend, or terminate work-related duties Based on WK5/WK6, Multicultural Guidelines Multicultural Guidelines
Why Cultural Competence? ● Cultural competence = incorporates role of cultural humility whereby cultural competence is considered a lifelong process of reflection and commitment ● All benefit from “an appreciation for, understanding of, and willingness to learn about the multicultural backgrounds of individuals, families, couples, groups, research participants, organizations, and communities” ○ Multicultural guidelines seek to demonstrate this benefit How Multicultural Guidelines are Re-envisioned ● New guidelines → regard the term multicultural more fully ● Broader understanding reflects current trends focused on contextual factors and intersectionality Layered Ecological Model of the Multicultural Guidelines ● Based on Bronfenbrenner's (1977, 1979) ecological model, which proposes five concentric circles where outer layers affect inner layers and vice a versa Layers (Bronfenbrenner’s Ecological Model) ● Microsystem = immediate family, friends, teachers, and institutions that have direct influence on the individual ○ Psychologists address microsystems that affect an individual’s resilience, such as interactions with schools, family, peers, place of worship, and clinics ● Mesosystem = interrelations of various social entities found in the microsystem that affect a person’s life (e.g. home, school, community) ● Exosystem = societal and cultural forces acting upon the individual without necessarily having a direct link to individual experience ○ In consulting role, psychologists may engage more directly with exosystems and macrosystems ● Macrosystem = corresponds with cultural context in which individual lives, such as cultural values and norms, and laws and governmental influences ● Chronosystem = influence of the passage of time, historical trends and transitions, and historical context that surrounds individual experience *Practice Question - SHORT ANSWER* What are the multicultural guidelines and levels based on? and how many levels are there? A: The multicultural guidelines and levels are based on Bronfenbrenner's (1977, 1979) ecological model, which proposes five concentric circles, each representing: ● Microsystem ● Mesosystem
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● Exosystem ● Macrosystem ● Chronosystem There are five levels within the Layered Ecological Model of the Multicultural Guidelines: ● Level 1, Bidirectional Model of Self-definition and Relationships ● Level 2: Community, School, and Family Context ● Level 3: Institutional Impact on Engagement ● Level 4: Domestic and International Climate ● Level 5: Outcomes Parameters to Consider for Multiculturally Responsive Service ● Practice → consider work with individuals from diverse sociocultural backgrounds who are seeking mental and behavioral health services, as well as training and supervision with students ● Research → consider scientific inquiry and generation of knowledge from within a multicultural biopsychosocial framwork ● Consultation → being responsive to considerations regarding diversity within organizations ● Education → inclusion of multicultural curricula in psychology programs, modeling cultural competence for students, and providing training and supervisory experiences in diverse community contexts *Practice Question* In what context can the APA Multicultural guidelines be applied? A: clinical work, research, consultation, teaching/education Levels of Layered Ecological Model of Multicultural Guidelines Level 1: Bidirectional Model of Self-Definition and Relationships Guideline 1: “Psychologists seek to recognize and understand that identity and self-definition are fluid and complex and that the intersection between the two is dynamic. To this end, psychologists appreciate that intersectionality is shaped by the multiplicity of the individual’s social contexts” Guideline 2: “Psychologists aspire to recognize and understand that as cultural beings, they hold attitudes and beliefs that can influence their perceptions of and interactions with others as well as their clinical and empirical conceptualizations. As such, psychologists strive to move beyond conceptualizations rooted in categorical assumptions, biases, and/or formulations based on limited knowledge about individuals and communities” Application Examples For Level 1:
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● Importance of avoiding ethnic gloss ● Attunement to self-definition ● Attend to how intersectionality contributes to a diverse identity ● Supervisors consult with colleagues to work through painful emotions ● Self-examination and deliberate attention to privilege ● Attend to structural dynamics through intersectional research ● Scholar activism ● Importance of researcher self-reflection for culturally informed empirical studies ● Consultation to address structural factors related to organizational issues Level 2: Community, School, and Family Context Guideline 3: “Psychologists strive to recognize and understand the role of language and communication through engagement that is sensitive to the lived experience of the individual, couple, family, group, community, and/or organizations with whom they interact. Psychologists also seek to understand how they bring their own language and communication to these interactions” (pg. 34) Guideline 4: “Psychologists endeavor to be aware of the role of the social and physical environment in the lives of clients, students, research participants, and/or consultees” Application Examples For Level 2: ● Awareness and sensitivity to language ● Recognize that individuals living in low-resource environments may have greater barriers to access and lower quality care ● Consider interventions for health problems that result from social trajectories ● Understand limitations and potential lack of applicability when using standardized tests both in practice and research ● Incorporate local terms in research protocol ● Research to explore feasible intervention in low resourced neighborhoods ● Need for research focused on life span issues ● Be attentive to patterns of communication in the organization ● Promote communication across organizational constituencies to promote understanding Level 3: Institutional Impact on Engagement
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Guideline 5: “Psychologists aspire to recognize and understand historical and contemporary experiences with power, privilege, and oppression. As such, they seek to address institutional barriers and related inequities, disproportionalities, and disparities of law enforcement, administration of criminal justice, educational, mental health, and other systems as they seek to promote justice, human rights, and access to quality and equitable mental and behavioral health services” Guideline 6: “Psychologists seek to promote culturally adaptive interventions and advocacy within and across systems, including prevention, early intervention, and recovery” (pg. 60) Application Examples For Level 3: ● Incorporate a critical understanding of contextual factors ● Be mindful of the concept of cultural mistrust ● Be aware of how diagnoses and assessment are culturally tailored and ecologically relevant ● Be aware of the terminology that a particular culture uses ● Be aware of cultural differences in perceptions of mental health, stigma, and help-seeking behavior ● Engage in relationship-centered advocacy ● Participate in a “cooperative community” through advocacy ● Encourage the development of a science of culture-centered interventions Level 4: Domestic and International Climate
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Guideline 7: “Psychologists endeavor to examine the profession’s assumptions and practices within an international context, whether domestically or internationally based, and consider how this globalization has an impact on the psychologist’s self-definition, purpose, role, and function” (pg. 65) Guideline 8: “Psychologists seek awareness and understanding of how developmental stages and life transitions intersect with the larger biosociocultural context, how identity evolves as a function of such intersections, and how these different socialization and maturation experiences influence worldview and identity” Application Examples For Level 4: ● Strive to learn to integrate Western and indigenous interventions ● It is anticipated that “psychologists of the future will be asked to interact with clients from a potentially limitless range of immigrant backgrounds” (APA, 2017) ● “Research on the nature and status of the mental health professions in different countries can ask a series of questions with respect to the nature of a possible global helping paradigm that would link psychology, psychotherapy, and indigenous healing across national boundaries” ● Awareness of literature on mental health practices and treatment in different cultures ● Explore the developmental trajectory of intersectional identities including “factors that may have acted as barriers or those that promoted identity achievement” (APA, 2017) ● Understand aspects of intersectional identity when working with clients from the deaf community ● Consult about accessible, equitable, and effective global mental and behavioral health care Level 5: Outcomes Guideline 9: “Psychologists strive to conduct culturally appropriate and informed research, teaching, supervision, consultation, assessment, interpretation, diagnosis, dissemination, and evaluation of efficacy as they address the first four levels of the Layered Ecological Model of Multicultural Guidelines” (pg. 83) Guideline 10: “Psychologists actively strive to take a strength-based approach when working with individuals, families, groups, communities, and organizations that seeks to build resilience and decrease trauma within the sociocultural context” Application Examples For Level 5: ● Awareness that members of diverse groups are “less likely to seek help from mental health providers, just as they are less likely to participate in research
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and interventions” ○ Reasons for this include: “problems with the development of a therapeutic or research alliance, distrust, or a feeling that the intervention or research lacks relevance to the individual’s life and circumstances” ○ Fear of unequal treatment or mistreatment is a related concern ● Culturally informed clinical and community-based interventions consider the role of historical and ongoing experiences of trauma and social injustice ● Attending to trauma and resilience involves “consideration of traumatic exposure not currently recognized as a precipitant to PTSD in existing psychiatric diagnostic manuals” (APA, 2017) ● Strength-based approach ● Foster resilience through an understanding of impact of social injustice and trauma on mental health ● Recognize that the often-limited generalizability of randomized controlled trials (RCTs) may reduce the effectiveness of resulting evidence-based treatments (EBTs) with diverse groups ○ One strategy to deal with the potential misfit of RCTs and EBTs is to adapt them to the needs of the target population ● Culturally adapted interventions have had demonstrated efficacy ● Consultation across research, practice, and educational settings can integrate existing knowledge concerning the role of sociocultural issues in resilience and trauma Based on WK6, Decoding Ethics Code Ch. 7 Ch. 7 Standards on Human Relations Standard 3. Human Relations 3.01 Unfair Discrimination “In their work-related activities, psychologists do not engage in unfair discrimination based on age, gender, identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, socioeconomic status, or any basis proscribed by law” ● Standard 3.01 does not require psychologists offering therapeutic assistance to accept as clients all individuals who requested mental health services ● Psychologists must, however, exercise reasonable judgment and precautions to ensure that their work does not reflect personal or organizational biases or prejudices that can lead to injustice (Principle D: Justice) Refusing or Referring Clients/Patients Based on Religious Beliefs ● When practitioners encounter a situation in which their own values appear to conflict with those of a patient/client, a decision regarding treatment can be facilitated by
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considering their motivations and potential outcomes of their decision ● Prior to making this decision, practitioners should consider: ○ Is there a scientific/professional knowledge basis for not treating the client/patient? (Standard 2.04) ○ Are practitioners engaging in financial exploitation if they agree to see a patient with the knowledge that a referral may soon follow? (Standards 3.08, 6.04) ○ Will explaining the reason for referral prior to or during treatment harm the patient? (Standard 3.04) Discrimination Proscribed by Law ● Standard 3.01 prohibits psychologists from discriminating among individuals on any basis proscribed by law *Practice Question* Standard 3.01 prohibits psychologists from unfair discrimination. Which General Principle most closely underlies this standard? A: Principle E: Respect for People’s Rights and Dignity 3.02 Sexual Harassment = “Psychologists do not engage in sexual harassment. Sexual harassment is sexual solicitation, physical advances, or verbal or nonverbal conduct that is sexual in nature, that occurs in connection with the psychologist’s activities or role as a psychologist, and that either (1) is unwelcome, is offensive, or creates a hostile workplace or educational environment, and the psychologist knows or is told this; or (2) is sufficiently severe or intense to be abusive to a reasonable person in the context. Sexual harassment can consist of a single intense or severe act or of multiple persistent or pervasive acts (See also Standard 1.08, Unfair Discrimination Against Complainants and Respondents)” ● When this definition establishes a higher standard of conduct than required by law, psychologists must comply with Standard 3.02 ● To meet the standard’s threshold for sexual harassment: ○ Behaviors must be either so severe that a reasonable person would deem them abusive in that context OR ○ Regardless of intensity, the psychologist was aware or had been told that the behaviors were unwelcome or offensive or that they created a hostile workplace or educational environment *Practice Question* Sexual harassment may be ____________ or __________ conduct that is sexual in nature A: verbal, nonverbal
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*Practice Question* Many states contain laws prohibiting sexual harassment. When the Ethics Code establishes a higher standard than the state law, psychologist must comply with: A: Standard 3.02 Sexual Harassment 3.03 Other Harassment = “Psychologists do not knowingly engage in behavior that is harassing or demeaning to persons with whom they interact in their work based on factors such as those person’s age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, or socioeconomic status” ● Examples of violations: ethnic slurs and negative generalizations based on gender, sexual orientation, disability, or socioeconomic status whose intention or outcome is lowering status or reputation ● A violation of this standard rests on an objective evaluation that a psychologist would have or should have been aware that his or her behavior would be perceived as harassing or demeaning 3.04 Avoiding Harm 3.04(a) “Psychologists take reasonable steps to avoid harming their clients, students, supervisees, research participants, organizational clients, and others with whom they work, and to minimize harm where it is foreseeable and unavoidable.” Steps for Avoiding Harm ● Steps for avoiding harm often include complying with other standards in the Ethics Code, such as the following: Standard 7.06, Assessing Student and Supervisee Performance; Standards 9.01, Bases for Assessments; 9.02, Use of Assessments; Standard 3.11, Psychological Services Delivered To or Through Organizations; Standard 2.01f, Boundaries of Competence; Standard 8.08c, Debriefing; Standard 4.05b, Disclosures *Practice Question* Psychologists take _____ to avoid harming clients, patients, students, and others with whom they work. A: reasonable steps Is Use of Aversion Therapies Unethical? ● Aversion Therapy = involves the repeated association of a maladaptive behavior or cognition with an aversive stimulus to eliminate pleasant associations or introduce negative associations with the undesirable behavior
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● Proved promising in treatments of drug cravings, alcoholism, and pica ○ Even with evidence of clinical efficacy, aversion therapies require ethical deliberation because they purposely subject clients/patients to physical and emotional discomfort and distress Standard 3.04 and Violation of Other Standards ● Often, violation of Standard 3.04 will occur in connection with the violation of other standards in the Code ● Some contexts require more stringent protections against harm (e.g. psychologists working within institutions that use seclusion or physical restraint techniques to treat potentially injurious patient behaviors) Psychotherapy and Counseling Harms ○ Be aware of psychotherapies or counseling techniques that may cause harm ○ Failure to terminate treatment when it becomes clear that continuation would be harmful is a violation of Standard 3.04 and Standard 10.10a, Terminating Therapy *Practice Question - SHORT ANSWER* If a client is not benefitting from treatment, should you continue? A: No not ethical. Violation of standard 3.04 Avoid harm and Standard 10.10a Terminating Therapy Conversion Therapy Involving Sexual and Gender Minority (SGM) Children and Adolescents ● 2015 joint report by APA and SAMHSA concluded: conversion therapy perpetuates outdated gender roles and negative stereotypes that being a sexual or gender minority or identifying as LGBTQ is an abnormal aspect of human development ● Appropriate therapeutic approaches to providing services to children and adolescents distressed by their sexual orientation or gender: ○ Provide accurate information on development of sexual orientation and gender identity and expression ○ Focus on identity development and exploration ○ Identify and work to ameliorate sources of distress ○ Client-centered and developmentally appropriate treatments ○ Consider recommending school and community interventions Research Risks ● IRBs must determine that risks to subjects are reasonable in relation to
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anticipated benefits, if any, to participants and the importance of the knowledge that may reasonable be expected to result ● Minimal Risk = procedures for which the probability and magnitude of harm or discomfort anticipated in the research are not greater in and of themselves than those ordinarily encountered in daily life or during the performance of routine physical or psychological examination or tests 3.04(b) Prohibition Against Torture = “Psychologists do not participate in, facilitate, assist, or otherwise engage in torture, defined as any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person, or in any other cruel, inhuman, or degrading behavior that violates 3.04a” 3.05 Multiple Relationships 3.05(a) “A multiple relationship occurs when a psychologist is in a professional role with a person and (1) at the same time is in another role with the same person, (2) at the same time is in a relationship with a person closely associated with or related to the person with whom the psychologist has the professional relationship, or (3) promises to enter into another relationship in the future with the person or a person closely associated with or related to the person. 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. Multiple relationships that would not reasonably be expected to cause impairment or risk exploitation or harm are not unethical.” Not All Multiple Relationships Are Unethical ● Multiple relationships that would not reasonably be expected to cause impairment or risk exploitation or harm are not unethical Posttermination Nonsexual Relationships ● Not all post-termination nonsexual relationships are prohibited Clients in Individual and Group Therapy ● Standard 3.05 does not prohibit treating clients/patients concurrently in individual and group therapy Risks of Ethical Appropriateness of a Multiple Relationship ● Increased incompatibility in role functions and objectives ● Greater power or prestige the psychologists has over the person with whom there is a multiple role ● Greater intimacy called for in the role ● Longer the role relationships are anticipated to last
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● More vulnerable the client is to harm ● Extent to which engaging in multiple relationship meets needs of psychologist rather than patient Entering into Another Role ● Psychologists may encounter situations in which the opportunity to enter a new relationship emerges with a person with whom they already have an established professional role ● This type of multiple relationship may be prohibited by Standard 3.05a if the situation could reasonably be expected to impair psychologists’ ability to competently and objectively perform their roles or lead to exploitation or harm Forensic Roles ● Responsibility of forensic psychologists = provide objective information to assist the finder of acts in legal determination ● In most instances, psychologists who take on both roles concurrently or sequentially will be in violation of Standard 3.05a Personal-Professional Boundary Crossings Involving Clients ● Unethical multiple relationships often emerge after psychologists have engaged in a pattern that progresses from apparently benign and perhaps well-intended boundary crossings to increasingly intrusive and harmful boundary violations and multiple relationships ● Clients/patients, students, research participants, and supervisees are less likely than psychologists to recognize inappropriate boundary crossings or to express their concerns Self-Disclosure ● Boundary crossings can become violations when psychologists share personal information with clients to satisfy their own needs Research ● Boundary crossings in research can also lead to bidirectional coercion, exploitation, or harm ● Intimacy between researchers and study participants can create ambiguous or blurred personal-professional boundaries that can threaten the validity of data collected Nonsexual Physical Contact ● Standard 3.05 does not prohibit psychologists from hugging, handholding, or
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putting an arm around those with whom they work in response to a special event or showing empathy for emotional crises ○ However, such actions can be the first step toward an easing of boundaries that could lead to an unethical multiple relationship Relationship with Others ● Psychologists also encounter situations in which a person closely associated with someone with whom they have a profession role seeks to enter into a similar professional relationship ● With few exceptions, entering into such relationships → would risk a violation of Standard 3.05a because: ○ It could reasonable be expected that the psychologist’s ability to make appropriate and objective judgments would be impaired, which in turn would jeopardize the effectiveness of services provided and result in harm Referrals From Clients ● Must evaluate the extent to which accepting a referral could impair their objectivity and conduct of their work or lead to exploitation or harm ○ One way of addressing this issue is to clearly state to current patients the psychologist’s policy of not accepting patient referrals Preexisting Personal Relationships ● Psychologists may encounter situations where they are asked to take on a professional role with someone with whom they have had a preexisting personal relationship ○ Often unethical because the preexisting relationship would reasonably be expected to impair the psychologist’s objectivity and effectiveness Multiple Sexual Relationships ● Sexual relationships with individuals with whom psychologists have a current professional relationship are always unethical “Reasonably Expected” ● “Could be reasonable expected” → violations of Standard 3.05a may be judged by whether most psychologists engaged in similar activities in similar circumstances would determine that entering into such a multiple relationship would be expected to lead to such harms
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3.05(b) Unforeseen Multiple Relationships = “If a psychologist finds that, due to unforeseen factors, a potentially harmful multiple relationship has arisen, the psychologist takes reasonable steps to resolve it with due regard for the best interests of the affected person and maximal compliance with the Ethics Code.” 3.05(c) When Multiple Roles Are Unavoidable = “When psychologists are required by law, institutional policy, or extraordinary circumstances to serve in more than one role in judicial or administrative proceedings, at the outset they clarify role expectations and the extent of confidentiality and thereafter as changes occur. (See also Standards 3.04, Avoiding Harm, and 3.07, Third-Party Requests for Services.)” Unavoidable Multiple Relationships ● When alternative psychological services are not available, providing such services is not be in violation of Standard 3.05 if psychologists take reasonable steps to safeguard their objectivity and effectiveness and protect against the possibility of exploitation and harm Correctional and Military Psychologists ● Psychologists in these correctional settings or in military must be particularly vigilant to ensure that they do not engage in multiple roles that will interfere with the provision of psychological services 3.06 Conflict of Interest = “Psychologists refrain from taking on a professional role when personal, scientific, professional, legal, financial, or other interests or relationships could reasonably be expected to (1) impair their objectivity, competence, or effectiveness in performing their functions as psychologists or (2) expose the person or organization with whom the professional relationship exists to harm or exploitation.” Conflicts of Interest in Forensic Practice ● Forensic psychologists hired to provide expert testimony need to be aware of potential conflicts of interests that may impair their objectivity or lead them to distort their testimony Recommendations on How to Avoid Conflicts of Interest in Research, Teaching, and Practice ● Many federal agencies, professional and scientific organizations, and academic and other institutions have conflict-of-interest policies of which psychologists should be aware ○ The APA Task Force on External Funding provides a detailed history of conflicts of interest in related fields and provides specific recommendations for psychology
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3.07 Third-Party Requests for Services = “When psychologists agree to provide services to a person or entity at the request of a third party, psychologists attempt to clarify at the outset of the service the nature of the relationship with all individuals or organizations involved. This clarification includes the role of the psychologist (e.g., therapist, consultant, diagnostician, or expert witness), an identification of who is the client, the probable uses of the services provided or the information obtained, and the fact that there may be limits to confidentiality. (See also Standards 3.05, Multiple relationships, and 4.02, Discussing the Limits of Confidentiality.)” Legal Representatives Seeking to Retain a Forensic Psychologist ● During the initial consultation with a legal representative seeking the psychologist’s forensic services, psychologists should consider providing the following information: ○ Fee structure for anticipated services ○ Previous or current activities or relationships that might be perceived as conflicts of interests ○ Level and limitations of competence to provide forensic services requested ○ Any other information that might reasonably be expected to influence the decision to contract with the psychologist Implications of HIPPA ● Psychologists planning to share information with third parties → consider whether information is included under HIPPA + whether prior patient authorization is required for release 3.08 Exploitative Relationships = “Psychologists do not exploit persons over whom they have supervisory, evaluative or other authority such as clients/patients, students, supervisees, research participants, and employees. (See also Standards 3.05, Multiple Relationships; 6.04, Fees and Financial Arrangements; 6.05, Barter with Clients/Patients; 7.07, Sexual Relationships with Students and Supervisees; 10.05, Sexual Intimacies with Current Therapy Clients/Patients; 10.06, Sexual Intimacies with Relatives or Significant Others of Current Therapy Clients/Patients; 10.07, Therapy with Former Sexual Partners; and 10.08, Sexual Intimacies with Former Therapy Clients/Patients.)” Recruitment for Research Participation Involving Institutionalized Populations ● Institutionalized populations are particularly susceptible to research exploitations and exploitative recruitment practices ○ Investigators should ensure that research participation is not coerced 3.09 Cooperating with Other Professionals = “When indicated and professionally appropriate, psychologists cooperate with other professionals in order to serve their clients/patients effectively and appropriately. (See also Standard 4.05, Disclosures.)” ● Collaboration and consultation with, and referral to, other professionals are thus often necessary to serve the best interests of clients/patients Implications of HIPAA ● Be familiar with situations in which regulations requiring patients’ written
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authorization for release of PHI apply to communications with other professionals ● Develop clear agreement with other professionals regarding overlapping and distinct role responsibilities and how confidential information should be handled in the best interests of the students or clients 3.10 Informed Consent 3.10(a) “When psychologists conduct research or provide assessment, therapy, counseling, or consulting services in person or via electronic transmission or other forms of communication, they obtain the informed consent of the individual or individuals using language that is reasonably understandable to that person or persons except when conducting such activities without consent is mandated by law or governmental regulation or as otherwise provided in this Ethics Code. (See also Standards 8.02, Informed Consent to Research; 9.03, Informed Consent in Assessments; and 10.01, Informed Consent to Therapy.)” ● Obligations described in Standard 3.10 apply to these other consent standards Language ● Using language reasonable understandable by the person asked to consent Culture ● 3.10(a) requires sensitivity to cultural dimensions of individuals’ understanding of and anticipated responses to consent information + the tailoring of informed consent language to such dimensions 3.10(b) Persons Legally Incapable of Consent = “For persons who are legally incapable of giving informed consent, psychologists nevertheless (1) provide an appropriate explanation, (2) seek the individual’s assent, (3) consider such persons’ preferences and best interests, and (4) obtain appropriate permission from a legally authorized person, if such substitute consent is permitted or required by law. When consent by a legally authorized person is not permitted or required by law, psychologists take reasonable steps to protect the individual’s rights and welfare.” Informed Consent in Research and Practice Involving Children and Adolescents ● APA Ethics Code and federal regulations governing research require the informed assent of children capable of providing assent Emancipated and Mature Minors ● Emancipated Minor = legal status conferred on persons who have not yet attained the age of legal competency but are entitled to treatment as if they have such status by virtue of assuming adult responsibilities ● Mature Minor = someone who has not reached adulthood but who, according to state law, may be treated as an adult for certain purposes
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Best Interests of the Child ● Requirement for a guardian’s permission may be inappropriate if there is serious doubt as to whether the guardian’s interests adequately reflect the child’s interests or the permission can reasonably be obtained Guardian Authority Under HIPAA ● HIPAA requires that if a person has authority to act on behalf of an individual who is an adult or minor in making decisions related to health care, a covered entity must treat such a person as the individual 3.10(c) Court-Ordered or Mandated Services = “When psychological services are court ordered or otherwise mandated, psychologists inform the individual of the nature of the anticipated services, including whether the services are court ordered or mandated and any limits of confidentiality, before proceeding.” ● Standard applies to military psychologists and psychologists conducting court- ordered forensic assessment *Practice Question* Situations exempt from requiring informed consent? A: Court ordered or mandated psychological services 3.10(d) Documentation of Informed Consent = “Psychologists appropriately document written or oral consent, permission, and assent. (See also Standards 8.02, Informed Consent to Research; 9.03, Informed Consent in Assessments; and 10.01, Informed Consent to Therapy.)” ● HIPAA requires that all valid client authorizations for the use and disclosure of PHI be signed and dated by the individual or the individual’s personal representative 3.11 Psychological Services Delivered To or Through Organizations 3.11(a) “Psychologists delivering services to or through organizations provide information beforehand to clients and when appropriate those directly affected by the services about (1) the nature and objectives of the services, (2) the intended recipients, (3) which of the individuals are clients, (4) the relationship the psychologist will have with each person and the organization, (5) the probable uses of services provided and information obtained, (6) who will have access to the information, and (7) limits of confidentiality. As soon as feasible, they provide information about the results and conclusions of such services to appropriate persons.” 3.11(b) When Information is Precluded by Law = “If psychologists will be precluded by law or by organizational roles from providing such information to particular individuals or groups, they so inform those individuals or groups at the outset of the service.”
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3.12 Interruption of Psychological Services = “Unless otherwise covered by contract, psychologists make reasonable efforts to plan for facilitating services in the event that psychological services are interrupted by factors such as the psychologist’s illness, death, unavailability, relocation, or retirement or by the client’s/patient’s relocation or financial limitations. (See also Standard 6.02c, Maintenance, Dissemination, and Disposal of Confidential Records of Professional and Scientific Work.)” ● Make reasonable efforts to ensure that needed services are continued by: ○ Discussing interruption of services with client and responding to their concerns ○ Conducting termination counseling ○ Referring client to another practitioner ○ Working with professional who will be responsible for client’s case ● Prepare for unplanned interruptions such as sudden illness or death ○ In most cases, it would suffice to have a trusted professional colleague prepared to contact clients/patients if such a situation arose
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