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Chapter#04
Ethical and Professional Issues in Clinical Psychology
Content Overview of American Psychological Association’s Code of ethics Ethics in Clinical Assessment Ethics in Clinical Research Professional Issues (Professional Ethics) Overview of American Psychological Association’s Code of ethics Ethics: Ethics refers to the correct rules of conduct necessary when carrying out research. We have a moral responsibility to protect research participants from harm. According to Collins Dictionary (1979:502), ethical means in accordance with principles of conduct that are considered correct, especially those of a given profession or group. The American Psychological Association (APA) publishes the Ethical Principles of Psychologists and Code of Conduct which outlines aspirational principles as well as enforceable standards that psychologists should use when making decisions. The APA first published their ethics code in 1953 and has been continuously evolving the code ever since. The current version of the ethics code, which introduced the distinction between principles and standards, was developed in 2002 and later amended in 2010 and 2016. Difference Between Principle and Standards: The APA code of ethics is composed of key principles and ethical standards. The principles are intended as a guide to help inspire psychologists as they work in their profession, whether they are working in mental health, in research, or in business. The standards, on the other hand, are expectations of conduct that can lead to professional and legal ramifications when violated. Five Ethical Principles: Principle A: Beneficence and Non-maleficence The first principle of the APA ethics code states that psychologists should strive to protect the rights and welfare of those with whom they work professionally. This includes the clients they see in clinical practice, animals that are involved in research and experiments, and anyone else with whom they engage in professional interaction. This principle encourages psychologists to strive to eliminate biases, affiliations, and prejudices that might influence their work. This includes acting independently in research and not allowing affiliations or sponsorships to influence results. Principle B: Fidelity and Responsibility The APA also suggests that psychologists have a moral responsibility to help ensure that others working in their profession also uphold high ethical standards. This principle suggests that psychologists should participate in activities that enhance the ethical compliance and conduct of their colleagues. Serving as a mentor, taking part in peer-review, and pointing out ethical concerns or misconduct are examples of how this principle might be put into action. Psychologists are also encouraged to donate some of their time to the betterment of the community. Principle C: Integrity In research and practice, psychologists should never attempt to deceive or misrepresent. In research, deception can involve fabricating or manipulating results in some way to achieve desired outcomes. Psychologists should also strive for transparency and honesty in their practice. When deception is used in research (which may involve the use of confederates or not fully revealing the true nature of the research), psychologists must make efforts to mitigate the effects. This type of research deception must be justified and the possible gains must outweigh potential drawbacks. The use of deception should be minimal, not result in distress, and be disclosed at the earliest possible opportunity. Principle D: Justice In its broadest sense, justice relates to a responsibility to be fair and impartial. This principle states that people have a right to access and benefit from advances that have been made in the field of psychology. It is important for psychologists to treat people equally. Psychologists should also always practice within their area of expertise and also be aware of their level of competence and limitations. Principle E: Respect for People's Rights and Dignity Psychologists should respect the right to dignity, privacy, and confidentiality of those they work with professionally. They should also strive to minimize their own biases as well as be aware of issues related to diversity and the concerns of particular populations. For example, people may have specific concerns related to their age, socioeconomic status, race, gender, religion, ethnicity, or disability. Ethical Standards The 10 standards found in the APA ethics code are enforceable rules of conduct for psychologists working in clinical practice and academia. These standards tend to be broad in order to help guide the behavior of psychologists across a wide variety of domains and situations. They apply to areas such as education, therapy, advertising, privacy, research, and publication. .1. Resolving Ethical Issues This standard of the APA ethics code provides information about what psychologists should do to resolve ethical situations they may encounter in their work. This includes advice for what researchers should do when their work is misrepresented and when to report ethical violations 2. Competence It is important that psychologists practice within their area of expertise. When treating clients or working with the public, psychologists must make it clear what they are trained to do as well as what they are not trained to do. This standard stipulates that in an emergency situation, professionals may provide services even if it falls outside the scope of their practice in order to ensure that access to services is provided. 3. Human Relations Psychologists frequently work with a team of other mental health professionals. This standard of the ethics code is designed to guide psychologists in their interactions with others in the field. This includes guidelines for dealing with sexual harassment, discrimination, avoiding harm during treatment, and avoiding exploitative relationships (such as a sexual relationship with a student or subordinate). 4. Privacy and Confidentiality This standard outlines psychologists’ responsibilities with regards to maintaining patient confidentiality. Psychologists are obligated to take reasonable precautions to keep client information private. However, the APA also notes that there are limitations to confidentiality. Sometimes psychologists need to disclose information about their patients in order to consult with other mental health professionals, for example. 5. Advertising and Other Public Statements Psychologists who advertise their services must ensure that they accurately depict their training, experience, and expertise. They also need to avoid marketing statements that are deceptive or false. This also applies to how psychologists are portrayed by the media when providing their expertise or opinion in articles, blogs, books, or television programs. When presenting at conferences or giving workshops, psychologists should also ensure that the brochures and other marketing materials for the event accurately depict what the event will cover. 6. Record Keeping and Fees Maintaining accurate records is an important part of a psychologist’s work, whether the individual is working in research or with patients. Patient records include case notes and other diagnostic assessments used in the course of treatment. In terms of research, record keeping involves detailing how studies were performed and the procedures that were used. This allows other researchers to assess the research and ensures that the study can be replicated. 7. Education and Training This standard focuses on expectations for behaviour when psychologists are teaching or training students. When creating courses and programs to train other psychologists and mental health professionals, current and accurate evidence-based research should be used. This standard also states that faculty members are not allowed to provide psychotherapy services to their students. 8. Research and Publication This standard focuses on ethical considerations when conducting research and publishing results. For example, the APA states that psychologists must obtain approval from the institution that is carrying out the research, present information about the purpose of the study to participants, and inform participants about the potential risks of taking part in the research. 9. Assessment Psychologists should obtain informed consent before administering assessments. Assessments should be used to support a psychologist’s professional opinion, but psychologists should also understand the limitations of these tools. They should also take steps to ensure the privacy of those who have taken assessments. 10. Therapy This standard outlines professional expectations within the context of providing therapy. Areas that are addressed include the importance of obtaining informed consent and explaining the treatment process to clients. Confidentiality is addressed, as well as some of the limitations to confidentiality, such as when a client poses an immediate danger to himself or others. Minimizing harm, avoiding sexual relationships with clients, and continuation of care are other areas that are addressed by this standard. For example, if a psychologist must stop providing services to a client for some reason, psychologists are expected to prepare clients for the change and help locate alternative services. Ethical Considerations Because psychologists often deal with extremely sensitive or volatile situations, ethical concerns can play a big role in professional life. Key Ethical Issues The most significant ethical issues include the following: Client Welfare Informed Consent Confidentiality o Competence Client Welfare Due to the role they serve, psychologists often work with individuals who are vulnerable due to their age, disability, intellectual ability, and other concerns. When working with these individuals, psychologists must always strive to protect the welfare of their clients. Informed Consent Psychologists are responsible for providing a wide range of services in their roles as therapists, researchers, educators, and consultants. When people are acting as consumers of psychological services, they have a right to know what to expect. In therapy, obtaining informed consent involves explaining what services are offered, what the possible risks might be, and the patient’s right to leave treatment. When conducting research, informed consent involves letting participants know about any possible risks of taking part in the research. Confidentiality Therapy requires providing a safe place for clients to discuss highly personal issues without fear of having this information shared with others or made public. However, sometimes a psychologist might need to share some details such as when consulting with other professionals or when they are publishing research. Ethical guidelines dictate when and how some information might be shared, as well as some of the steps that psychologists should take to protect client privacy. Competence The training, education, and experience of psychologists is also an important ethical concern. Psychologists must possess the skill and knowledge to properly provide the services that clients need. For example, if a psychologist needs to administer a particular assessment in the course of treatment, they should have an understanding of both the administration and interpretation of that specific test. Ethics in Clinical Assessment Psychologists are obliged to select tests that are appropriate for the purpose of assessment and the population being tested. Test selection should entail the number of factors including the psychologist’s competence, client’s culture, language, and age and the test’s reliability and validity Psychologists must not select the tests that have become obsolete or have been replaced by revised editions that are better suited to assessment questions being addressed. Sometimes, psychologists find themselves in a position of constructing a new test rather than selecting from existing tests. Psychologists involved in test construction should do their best to establish adequate reliability and validity, minimize test bias, and accompany the test with coherent, user-friendly test manual. Test Security represents another specific area of focus of the American Psychological Association’s ethical code. Psychologists should make efforts to protect the security and integrity of test materials they use. In other words, psychologists should prevent the questions, items, and other stimuli included in psychological tests from entering the public domain. When psychologists allow the test material to be taken home by the clients, photocopied or posted on internet sites, not only might they be violating copyright laws, but they might also be allowing prospective test takers inappropriate access to tests. This could lead to the preparation or coaching for psychological tests, which could, in turn, produce invalid test results. Psychologists should keep test materials secure. The American Psychological Association’s Ethical Code explains that they are generally obligated to release test data to clients on request. Test data refers to raw data that client provided during the assessment_ responses, answers and other notes the psychologist may have made. Although previous editions of the ethical code instructed psychologists not to release test data to clients, the current edition instructs psychologists to release test data unless there is a reason to believe that the data will be misused or will harm the client. It reflects more global shift towards patient’s autonomy in the health care. Ethics in Clinical Research The American Psychological Association’s code of ethics include numerous standards that apply to research of all kinds, including clinical research. So, just like psychologists from other specialty areas, clinical psychologists who conduct research are ethically obliged to minimize harm to participants, steer clear of plagiarism, and avoid fabrication of data, among other things. Here, we will focus our discussion on one issue particularly relevant to an essential area of clinical research: Efficacy of psychotherapy. When clinical psychologists conduct empirical studies to measure how well a particular therapy works, they typically conduct the therapy in question with one group of participants, whereas second group does not receive this therapy. What should the second group receive? This is a question with important ethical implications. Although studies of this type may ultimately benefit many clients via the identification of evidence-based treatment, psychologists should be careful not to mistreat or harm some of their clients or research participants in process. Most commonly, the participants in therapy efficacy studies are placed in one of three conditions: no treatment (often called a wait-list control group), a placebo treatment (some kind of interpersonal interaction with a professional but with presumably therapeutic techniques deliberately omitted), or an alternate treatment (the efficacy of which may be unknown). Is it ethical to provide any of these options to people who have psychological problems and have chosen, presumably with the hope of improvement, to participate in a study on its treatment? Of course, it is essential to inform participants before they consent to the study that some of them may not receive the treatment being studied or any treatment at all. Even if the participants agree to this agreement, the ethicality of the treatment they received throughout the study of this type has been questioned. Professional Issues in Clinical Psychology Professional Ethics: Following are professional ethics in clinical psychology: 1. Informed consent to therapy: When obtaining informed consent to therapy, psychologists inform clients/patients as early as feasible in the therapeutic relationship about the nature and anticipated course of therapy, fees, involvement of third parties and limits of confidentiality and provide sufficient opportunity for the client/patient to ask questions and receive answers. When obtaining informed consent for treatment for which generally recognized techniques and procedures have not been established, psychologists inform their client/patients of the developing nature of treatment, the potential risks involved, alternative treatments that may be available, and the voluntary nature of their participation. When therapist is a trainee and the legal responsibility for the treatment provided resides with supervisor, the client/patient, as a part of the informed consent procedure, is informed that the therapist is in training and is being supervised and is given the name of supervisor. 2. Therapy involving couples or families: When psychologists agree to provide services to several persons who have a relationship (such as spouses, significant others, or parents and children), they take reasonable steps to clarify at the outset. 1. Which of the individuals are clients/patients and 2. The relationship the psychologist will have with each person This clarification includes the psychologist’s role and the probable uses of the services provided or the information obtained. If it becomes apparent that psychologists may be called on to perform potentially conflicting roles (such as family therapist and then witness for one party in divorce proceedings), psychologists take reasonable steps to clarify and modify, or withdraw from, roles appropriately. 3. Group therapy: When psychologists provide services to several persons in a group setting, they describe at the onset the roles and responsibilities of all parties and the limits of confidentiality. 4. Providing therapy to those served by others: In deciding whether to offer or provide services to those already receiving mental health services elsewhere, psychologists carefully consider the treatment issues and potential client’s/patient’s welfare. Psychologists discuss these issues with the client/patient or another legally authorized person on behalf of the client/patient in order to minimize the risk of confusion and conflict, consult with the other service provider when appropriate and proceed with caution and sensitivity to the therapeutic issues. 5. Sexual intimacies with current therapy clients/patients: Psychologists do not engage in sexual intimacies with current therapy clients/patients. 6. Sexual intimacies with relatives or significant others of current therapy clients/patients: Psychologists do not engage in sexual intimacies with individuals they know to be close relatives, guardians or significant others of current clients/patients. Psychologists do not terminate the therapy to overcome this standard. 7. Therapy with former sexual partners: Psychologists do not accept as a clients/patients persons with whom they have engaged in sexual intimacies. 8. Sexual intimacies with former therapy clients/patients: Psychologists do not engage in sexual intimacies with former clients/patients for at least two years after cessation or termination of therapy Psychologists do not engage in sexual intimacies with former clients/patients even after a two years interval except in the most unusual circumstances. 9. Interruption of therapy: When entering into employment or contractual relationships, psychologists make reasonable efforts to provide for orderly and appropriate resolution of responsibility for client/patient care in the event that the employment or contractual relationship ends, with paramount consideration given to the welfare of the client/patient. 10. Terminating therapy: Psychologists terminate the therapy when it becomes reasonably clear that the client/patient no longer needs the service, is not likely to benefit, or is being harmed by continued service. Psychologists may terminate therapy when threatened or otherwise endangered by the client/patient or another person with whom the client/patient has a relationship. Except where impossible by the actions of clients/patients or third party payors, prior to termination psychologists provide pretermination counseling and suggest alternative service providers as appropriate.