How should clinical psychologists behave?

The Ethics Code provides useful guidelines for psychologists as well as the public concerning the standards of professional conduct.

By: Thomas G. Plante

What are the rules and guidelines for professional behavior among clinical psychologists? Should a psychologist have lunch with his or her patient? Should a psychologist date a current or former patient? Should a psychologist tell his or her friends about a fascinating new patient he or she is treating in psychotherapy?

Whether a psychologist is a researcher, teacher, therapist, or administrator, he or she is expected to maintain the highest professional ethics in all professional activities at all times. In fact, psychology is one of the few fields that has adopted ethical guidelines that hold members to a much higher standard than the law.

Professional ethics form the cornerstone of professionalism in psychology. The APA formed an ethics committee in the 1930s, and developed its first set of ethical principles in 1953. It is especially important for the field of psychology to focus on professional ethics since psychologists generally have a high degree of responsibility that often significantly impacts the lives of others. For example, clinical psychologists who conduct psychotherapy are entrusted with the emotional and often physical vulnerabilities, confidences, and well-being of the people who seek their guidance. Clinical psychologists who are teachers or professors are called upon to provide objective, state-of-the-art, and unbiased information to their students. Clinical psychologists conducting research must design and conduct high-quality research, protect the rights of subjects, and carefully interpret and report their results in order to contribute meaningful information and knowledge about human behavior to the professional community.

Thus, clinical psychologists must closely and carefully follow ethical principles to ensure that they behave in an appropriate, responsible, and professional manner, protecting the public as well as the profession.

Curiously, the preponderance of media portrayals of clinical psychologists and other mental health professionals in films and on television depict these professionals as engaging in highly unethical, unprofessional, self-serving, and often, illegal behavior. Numerous feature length films such as The Prince of Tides, Final Analysis, Mumford, Anger Management, and Analyze This, as well as television shows such as Frazer, depict psychologists and other mental health professionals behaving inappropriately and unethically. Typically, the psychologists or psychiatrists portrayed in the media are involved in unethical dual relationships—rather than maintaining their professional relationships and boundaries, the psychologists fall in love with or befriend their patients. Using patients for personal gain or gratification, practicing outside of one’s area of competence, and breaking confidentiality are also typical depictions. In a review of 207 films that included psychiatrists, 35% suggested that the mental health professional was more troubled than his or her patients, and 22% were involved in manipulative behavior with their patients for the benefit of themselves (I. Schneider, 1987). However, some films, such as Ordinary People and Good Will Hunting, provide fairly realistic portrayals of psychologists behaving in an ethical and professional manner.

In real life, many of the mental health professionals depicted in the media would lose their license to practice and perhaps be prosecuted for engaging in the behaviors portrayed.

Psychologists in real life do commit ethical violations. Psychologists are human and suffer from the same vulnerabilities as the general public. They experience family conflicts, financial hardships, and stress and may behave in unbecoming and even illegal ways. It has been estimated that between 20% and 82% of psychologists experience relationship problems such as marital conflict, between 13% and 57% experience depression, and about 11% experience substance abuse problems (Deutsch, 1985; Norcross, Strausser-Kirtland, & Missar, 1988). It also has been suggested that between 5% and 15% of psychologists are impaired (Laliotis & Grayson, 1985). They might, for example, inappropriately break confidentiality, become sexually involved with their patient(s), falsify research data, engage in sexual harassment, encourage their patients to do favors for them such as babysit their child or paint their house, provide ineffective or questionable treatment, or engage in financial mismanagement and fraud. They also make honest mistakes due to ignorance, inattention, or vulnerability. For example, a psychologist who is lonely might be tempted to initiate a friendship or romantic relationship with a highly appealing client. A psychologist with significant financial problems might be tempted to invest in a business deal with a wealthy and successful client.

Between 1985 and 2002 an average of 337 ethical complaints were received per year (APA, 2003b) with about 275 received each year during the past several years (APA, 2002b). Many other ethical violations may not have been reported to the APA or to state ethics and licensing boards. Many of the ethical complaints filed are found to have little or no merit. Most of the complaints that result in action against the psychologist by the APA or local authorities involve breaking confidentiality, sexual misconduct (e.g., sexual relationship with a patient), nonsexual dual relationships (e.g., friendships or business partnerships with patients), and insurance/fee misbehavior (e.g., overbilling insurance, billing for services not rendered). Several authors have reported that the most common ethical violation involves patient confidentiality (Pope & Bajt, 1988; Pope & Vetter, 1992). While many of these violations involve breaking confidentiality without patient permission, a sizable number of cases involve psychologists refusing to break confidentiality when they are ethically and legally required, as in the case of reporting child abuse to the police or state child protective services. Sexual misconduct with adult patients was the most common ethical complaint against psychologists in most recent years (APA, 2003b). Fortunately, however, the vast majority of clinical psychologists do behave in an ethical and professional manner (Bersoff, 2003; Koocher & Keith-Spiegal, 1998; Layman & McNamara, 1997). The unethical psychologist is the exception rather than the rule.

What are the ethical guidelines for psychologists? How exactly should a psychologist behave? How can a psychologist be sure that he or she is behaving appropriately?

While certain behaviors seem easy to recognize as unethical, such as sexual contact with current patients, falsifying research data or records, breaking patient confidentiality, and overbilling, many other behaviors may not be so clear. The Ethics Code has been updated nine times by the APA since the original 1953 document was published; the current version was published in December 2002. The most recent version of the Canadian Code of Ethics for Psychologists was published in 2000 and is more similar than different to the American code (Canadian Psychological Association, 2000). Many of the principles outlined in these various versions were originally highlighted many centuries ago in the 2,500 year old Hippocratic Oath. These include competence, respect, confidentiality, informed consent, social justice, and avoiding both harm and exploitation. The fundamental principles outlined several thousand years ago are still in use today. In addition to the Ethics Code, more specific specialty guidelines have also been developed to provide further instructions and expectations for professional conduct. For example, the APA has published the following specialty guidelines:

Specialty Guidelines for the Delivery of Services by Clinical Psychologists (1981),

Guidelines for Computer Based Tests and Interpretations (1987a),

Standards for Educational and Psychological Testing (1985),

Guidelines for Providers of Psychological Services to Ethnic, Linguistic, and Culturally Diverse Populations (1990, 2003b).

Additional guidelines are provided for school psychologists, counseling psychologists, and others.

Koocher and Keith-Speigal (1998) outlined eight general principles for psychologists distilled from the Ethics Code, specialty guidelines, and additional sources. These include doing no harm, benefiting others, being just and faithful, according dignity, treating others with caring and compassion, pursuing excellence, respecting autonomy, and accepting accountability.

References    

Contemporary clinical psychology / Thomas G. Plante — 2nd ed. Copyright © 2005 by John Wiley & Sons, Inc. All rights reserved.

Web Resources

www.apa.org/ethics

Learn more about APA’s Ethics Code and other ethical matters related to psychology.

www.scu.edu/ethics

The Markkula Center for Applied Ethics at Santa Clara University offers a variety of articles, web links, and other information about applied ethics. commfaculty.fullerton.edu/lester/ethics/general. html

The School of Communications at California State University, Fullerton, offers this helpful web site with numerous links to ethics on the Web in many categories.

www.ethics.org.au

The St. James Ethics Center is a nonprofit organization that promotes ethics in daily life. It is not associated with any religious or political affiliations.

www.ethics.ubc.ca/resources

This site offers useful links to a variety of applied ethic topics.

www.globalethics.org

The Institute for Global Ethics is an independent, nonprofit, nonsectarian, and nonpartisan organization that promotes ethics in globally

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