Decoding The Ethics Code, Ch. 6

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CHAPTER 6

Standards on

Human Relations

3. Human Relations

3.01 Unfair Discrimination

In their work-related activities, psychologists do not engage in unfair discrimination based on age,

gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability,

socioeconomic status, or any basis proscribed by law.

Psychologists respect the dignity and worth of all people and appropriately consider

the relevance of personal characteristics based on factors such as age, gender,

gender identity, race, ethnicity, culture, national origin, religion, sexual orientation,

disability, or socioeconomic status (Principle E: Respect for People’s Rights and

Dignity). Much of the work of psychologists entails making valid discriminating

judgments that best serve the people and organizations they work with and fulfilling

their ethical obligations as teachers, researchers, organizational consultants, and

practitioners. Standard 3.01 of the APA Ethics Code (APA, 2002b) does not prohibit

such discriminations.

􀀵 The graduate psychology faculty of a university used differences in standardized test

scores, undergraduate grades, and professionally related experience as selection criteria

for program admission.

􀀵 A research psychologist sampled individuals from specific age, gender, and cultural

groups to test a specific hypothesis relevant to these groups.

􀀵 An organizational psychologist working for a software company designed assessments

for employee screening and promotion to distinguish individuals with the

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92——PART II ENFORCEABLE STANDARDS

Standard 3.01 does not require psychologists offering therapeutic assistance to

accept as clients/patients all individuals who request mental health services. Discerning

and prudent psychologists know the limitations of their competence and accept to

treat only those whom they can reasonably expect to help based on their education,

training, and experience (Striefel, 2007). Psychologists may also refuse to accept

clients/patients on the basis of individuals’ lack of commitment to the therapeutic

process, problems they have that fall outside the therapists’ area of competence, or their

perceived inability or unwillingness to pay for services (Knapp & VandeCreek, 2003).

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). For example, the American

Psychological Association’s (APA’s) Resolution on Religious, Religion-Based, and/or

Religion-Derived Prejudice (APA, 2007d) condemns prejudice and discrimination

against individuals or groups based on their religious or spiritual beliefs, practices,

adherence, or background.

Standard 3.01 prohibits psychologists from making unfair discriminations based

on the factors listed in the standard.

requisite information technology skills to perform tasks essential to the positions from

individuals not possessing these skills.

􀀵 A school psychologist considers factors such as age, English language proficiency, and

hearing or vision impairment when making educational placement recommendations.

􀀵 A family bereavement counselor working in an elder care unit of a hospital regularly

considered the extent to which factors associated with the families’ culture or religious

values should be considered in the treatment plan.

􀀵 A psychologist conducting couples therapy with gay partners worked with clients to

explore the potential effects of homophobia, relational ambiguity, and family support

on their relationship (Green & Mitchell, 2002).

􀀴 The director of a graduate program in psychology rejected a candidate for program

admission because the candidate indicated that he was a Muslim.

􀀴 A consulting psychologist agreed to a company’s request to develop pre-employment

procedures that would screen out applicants from Spanish-speaking cultures based on

the company’s presumption that the majority of such candidates would be undocumented

residents.

􀀴 A psychologist working in a Medicaid clinic decided not to include a cognitive component

in a behavioral treatment based solely on the psychologist’s belief that lowerincome

patients were incapable of responding to “talk therapies.”

􀀴 One partner of a gay couple who recently entered couple counseling called their psychologist

when he learned that he tested positive for the HIV virus. Although when

working with heterosexual couples the psychologist strongly encouraged clients to

inform their partners if they had a sexually transmitted disease, she did not believe such

an approach was necessary in this situation based on her erroneous assumption that

all gay men engaged in reckless and risky sexual behavior (see Palma & Iannelli, 2002).

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Chapter 6 Standards on Human Relations——93

Discrimination Proscribed by Law

Standard 3.01 prohibits psychologists from discriminating among individuals on

any basis proscribed by law. For example, industrial–organizational psychologists

need to be aware of nondiscrimination laws relevant to race, religion, and disability

that apply to companies for which they work (e.g., ADA, www.ada.gov; Title VII of

the Civil Rights Act of 1964, www.eeoc.gov/laws/statutes/titlevii.cfm, archive.eeoc

.gov/types/religion.html; Workforce Investment Act of 1998, www.doleta.gov/

usworkforce/wia/wialaw.txt). Psychologists conducting personnel performance

evaluations should avoid selecting tests developed to assess psychopathology (see

Karraker v. Rent-a-Center, 2005). In addition, under ADA (1990), disability-relevant

questions can only be asked of prospective employees after the employer has made

a conditional offer. In some instances, ADA laws for small businesses also apply to

psychologists in private practice, such as wheelchair accessibility. In addition,

HIPAA prohibits covered entities from discriminating against an individual for filing

a complaint, participating in a compliance review or hearing, or opposing an act or

practice that is unlawful under the regulation (45 CFR 164.530[g]).

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.)

It is always wise for psychologists to be familiar with and comply with applicable

laws and institutional policies regarding sexual harassment. Laws on sexual

harassment vary across jurisdictions, are often complex, and change over time.

Standard 3.02 provides a clear definition of behaviors that are prohibited and considered

sexual harassment under the Ethics Code. When this definition establishes

a higher standard of conduct than required by law, psychologists must comply

with Standard 3.02.

According to Standard 3.02, sexual harassment can be verbal or nonverbal

solicitation, advances, or sexual conduct that occurs in connection with the psychologist’s

activities or role as a psychologist. The wording of the definition was

carefully crafted to prohibit sexual harassment without encouraging complaints

against psychologists whose poor judgments or behaviors do not rise to the level of

harassment. Thus, to meet the standard’s threshold for sexual harassment, behaviors

have to be either so severe or intense 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 are unwelcome, offensive, or creating a hostile

workplace or educational environment.

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94——PART II ENFORCEABLE STANDARDS

For example, a senior faculty member who places an arm around a student’s

shoulder during a discussion or who tells an off-color sexual joke that offends a

number of junior faculty may not be in violation of this standard if such behavior

is uncharacteristic of the faculty member’s usual conduct, if a reasonable

person might interpret the behavior as inoffensive, and if there is reason to

assume the psychologist neither is aware of nor has been told the behavior is

offensive.

A hostile workplace or educational environment is one in which the sexual

language or behaviors of the psychologist impairs the ability of those who are the

target of the sexual harassment to conduct their work or participate in classroom

and educational experiences. The actions of the senior faculty member described

above might be considered sexual harassment if the psychologist’s behaviors

reflected a consistent pattern of sexual conduct during class or office hours, if

such behaviors had led students to withdraw from the psychologist’s class, or if

students or other faculty had repeatedly told the psychologist about the discomfort

produced.

􀀴 A senior psychologist at a test company sexually fondled a junior colleague during an

office party.

􀀴 During clinical supervision, a trainee had an emotional discussion with her female

supervisor about how her own experiences recognizing her lesbian sexual orientation

during adolescence were helping her counsel the gay and lesbian youths

she was working with. At the end of the session, the supervisor kissed the trainee

on the lips.

According to this standard, sexual harassment can also consist of a single intense

or severe act that would be considered abusive to a reasonable person.

A violation of this standard applies to all psychologists irrespective of the status,

sex, or sexual orientation of the psychologist or individual harassed.

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 persons’ age, gender, gender

identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language,

or socioeconomic status.

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Chapter 6 Standards on Human Relations——95

According to Principle E: Respect for People’s Rights and Dignity, psychologists

should eliminate from their work the effect of bias and prejudice based on factors

such as age, gender, gender identity, race, ethnicity, national origin, religion, sexual

orientation, disability, language, and socioeconomic status. Standard 3.03 prohibits

behaviors that draw on these categories to harass or demean individuals with

whom psychologists work, such as colleagues, students, research participants, or

employees. Behaviors in violation of this standard include ethnic slurs and negative

generalizations based on gender, sexual orientation, disability, or socioeconomic

status whose intention or outcome is lowering status or reputation.

The term knowingly reflects the fact that evolving societal sensitivity to language

and behaviors demeaning to different groups may result in psychologists unknowingly

acting in a pejorative manner. The term knowingly also reflects awareness that

interpretations of behaviors that are harassing or demeaning can often be subjective.

Thus, 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.

This standard does not prohibit psychologists from critical comments about

the work of students, colleagues, or others based on legitimate criteria. For

example, professors can inform, and often have a duty to inform, students that

their writing or clinical skills are below program standards or indicate when a

student’s classroom comment is incorrect or inappropriate. It is the responsibility

of employers or chairs of academic departments to critically review, report on,

and discuss both positive and negative evaluations of employees or faculty.

Similarly, the standard does not prohibit psychologists conducting assessment or

therapy from applying valid diagnostic classifications that a client/patient may

find offensive.

3.04 Avoiding Harm

Psychologists take reasonable steps to avoid harming their clients/patients, students, supervisees,

research participants, organizational clients, and others with whom they work, and to minimize

harm where it is foreseeable and unavoidable.

As articulated in Principle A: Beneficence and Nonmaleficence, psychologists

seek to safeguard the welfare of those with whom they work and avoid or minimize

harm when conflicts occur among professional obligations. In the rightly practiced

profession and science of psychology, harm is not always unethical or avoidable.

Legitimate activities that may lead to harm include (a) giving low grades to students

who perform poorly on exams; (b) providing a valid diagnosis that prevents a

client/patient from receiving disability insurance; (c) conducting personnel reviews

that lead to an individual’s termination of employment; (d) conducting a custody

evaluation in a case in which the judge determines one of the parents must relinquish

custodial rights; or (e) disclosing confidential information to protect the

physical welfare of a third party.

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96——PART II ENFORCEABLE STANDARDS

Steps for Avoiding Harm

Recognizing that such harms are not always avoidable or inappropriate,

Standard 3.04 requires psychologists to take reasonable steps to avoid harming

those with whom they interact in their professional and scientific roles and to

minimize harm where it is foreseeable and unavoidable.

These steps often include complying with other standards in the Ethics Code,

such as the following:

􀀵 Parents of a fourth-grade student wanted their child placed in a special education

class. After administering a complete battery of tests, the school psychologist’s

report indicated that the child’s responses did not meet established definitions for

learning disabilities and therefore did not meet the district’s criteria for such

placement.

􀀵 A forensic psychologist was asked to evaluate the mental status of a criminal

defendant who was asserting volitional insanity as a defense against liability in

his trial for manslaughter. The psychologist conducted a thorough evaluation

based on definitions of volitional insanity and irresistible impulse established by

the profession of psychology and by law. While the psychologist’s report noted

that the inmate had some problems with impulse control and emotional instability,

it also noted that these deficiencies did not meet the legal definition of volitional

that would bar prosecution (see also Hot Topic “Human Rights and

Psychologists’ Involvement in Assessments Related to Death Penalty Cases” in

Chapter 4).

􀀴 A psychologist conducted therapy over the Internet for clients/patients in a rural area

120 miles from her office. The psychologist had not developed a plan with each client/

patient for handling mental health crises. During a live video Internet session, a client

who had been struggling with bouts of depression showed the psychologist his gun

and said he was going outside to “blow his head off.” The psychologist did not have

the contact information of any local hospital, relative, or friend to send prompt emergency

assistance.

􀀴 A psychologist with prescription privileges prescribed a Food and Drug Administration

(FDA)-approved neuroenhancer to help a young adult patient suffering from performance

anxiety associated with his responsibilities as quarterback for his college varsity

football team. The psychologist failed to discuss the importance of gradual reduction in

dosage, and she was dismayed to learn that her patient had been hospitalized after he

abruptly discontinued the medication when the football season ended (APA, 2011a;

McCrickerd, 2010; I. Singh & Kelleher, 2010).

􀀴 Consistent with Standard 10.10a, Terminating Treatment, a psychologist treating a

client/patient with a diagnosis of borderline disorder terminated therapy when she

realized the client/patient had formed an iatrogenic attachment to her that was clearly

interfering with any benefits that could be derived from the treatment. However, her

failure to provide appropriate pretermination counseling and referrals contributed to

the client’s/patient’s emergency hospitalization for suicidal risk (Standard 10.10c,

Terminating Treatment).

HMO

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Chapter 6 Standards on Human Relations——97

Is Use of Aversion Therapies Unethical?

Aversion therapy involves the repeated association of a maladaptive behavior or

cognition with an aversive stimulus (e.g., electric shock, unpleasant images, nausea)

to eliminate pleasant associations or introduce negative associations with the undesirable

behavior. Aversion therapies have proved promising in treatments of drug

cravings, alcoholism, and pica (Bordnick, Elkins, Orr, Walters, & Thyer, 2004;

Ferreri, Tamm, & Wier, 2006; Thurber, 1985) and have been used with questionable

effectiveness for pedophilia (Hall & Hall, 2007). It is beyond the purview of this

volume to review literature evaluating the clinical efficacy of aversion therapies for

different disorders. However, even with evidence of clinical efficacy, aversion therapies

have and will continue to require ethical deliberation because they purposely

subject clients/patients to physical and emotional discomfort and distress. In so

doing, they raise the fundamental moral issue of balancing doing good against

doing no harm (Principle A: Beneficence and Nonmaleficence).

Psychologists should consider the following questions before engaging in aversion

therapy:

Have all empirically and clinically validated alternative therapeutic approaches

been attempted?

Is there empirical evidence that the aversive therapeutic approach has demonstrated

effectiveness with individuals who are similar to the client/patient in

mental health disorder, age, physical health, and other relevant factors?

(Standard 2.04, Bases for Scientific and Professional Judgments)

􀀵 Clarifying course requirements and establishing a timely and specific process for providing

feedback to students (Standard 7.06, Assessing Student and Supervisee Performance)

􀀵 Selecting and using valid and reliable assessment techniques appropriate to the nature

of the problem and characteristics of the testee to avoid misdiagnosis and inappropriate

services (Standards 9.01, Bases for Assessments, and 9.02, Use of Assessments)

􀀵 When appropriate, providing information beforehand to employees and others who

may be directly affected by a psychologist’s services to an organization (Standard 3.11,

Psychological Services Delivered To or Through Organizations)

􀀵 Acquiring adequate knowledge of relevant judicial or administrative rules prior to

performing forensic roles to avoid violating the legal rights of individuals involved in

litigation (Standard 2.01f, Boundaries of Competence)

􀀵 Taking steps to minimize harm when, during debriefing, a psychologist becomes aware

of participant distress created by the research procedure (Standard 8.08c, Debriefing)

􀀵 Becoming familiar with local social service, medical, and legal resources for clients/

patients and third parties who will be affected if a psychologist is ethically or legally

compelled to report child abuse, suicide risk, elder abuse, or intent to do physical harm

to another individual (Standard 4.05b, Disclosures)

􀀵 Monitoring patient’s physiological status when prescribing medications (with legal

prescribing authority), particularly when there is a physical condition that might complicate

the response to psychotropic medication or predispose a patient to experience

an adverse reaction (APA, 2011a).

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98——PART II ENFORCEABLE STANDARDS

To what extent is the behavior endangering the life or seriously compromising

the well-being of the client/patient?

For this particular patient, will the discomfort and distress of the aversive

treatment outweigh its potential positive effects?

To what extent is the urgency defined by the needs of third parties rather than

the client/patient? (Standards 3.05, Multiple Relationships; 3.07, Third-Party

Requests for Services; and 3.08, Exploitative Relationships)

Am I competent to administer the aversive treatment? (Standards 2.01a,

Boundaries of Competence, and 2.05, Delegation of Work to Others)

If aversive treatment is the only remaining option to best serve the needs of

the client/patient, how can harm be minimized?

Have I established appropriate monitoring procedures and termination criteria?

􀀵 Prescribing psychologists trained in addiction treatments opened a group practice to

provide assessment and individual and group therapy for substance abuse and comorbid

disorders. Occasionally, some clients who were long-term cocaine users could not

overcome their cravings despite positive responses to therapy. In such cases, the team

would offer the client a chemical aversion therapy with empirical evidence of treatment

efficacy. The therapy was supervised by a member of the team who was a prescribing

psychologist and who had acquired additional training in this technique (see

also Standard 2.01, Competence).

􀀵 Prior to initiating the aversion therapy, clients/patients were required to undergo a

physical examination by a physician to rule out those for whom the treatment posed

a potential medical risk. The treatment consisted of drinking a saltwater solution

containing a chemical that would induce nausea. Saltwater was used to avoid creating

a negative association with water. As soon as the client began to feel nauseated,

he or she was instructed to ingest a placebo form of crack cocaine using drug paraphernalia.

A bucket was available for vomiting. Patients were monitored by a physician

assistant and the prescribing psychologist during the process and recovery for

any medical or iatrogenic psychological side effects (Standard 3.09, Cooperation With

Other Professionals). Following the recommended minimum number of sessions,

patients continued in individual psychotherapy, and positive and negative reactions to

the aversion therapy continued to be monitored (see Bordnick et al., 2004).

Need to Know: When HMOs

Refuse to Extend Coverage

When health maintenance organizations refuse psychologists’ request to extend coverage for

clients/patients whose reimbursement quotas have been reached, psychologists may be in

violation of Standard 3.04 if they (a) did not take reasonable steps at the outset of therapy to

estimate and communicate to patients and their insurance company the number of sessions

anticipated, (b) did not familiarize themselves with the insurers’ policy, (c) recognized a need

for continuing treatment but did not communicate with insurers in an adequate or timely

fashion, or (d) were unprepared to handle client/patient response to termination of services.

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Chapter 6 Standards on Human Relations——99

Often, violation of Standard 3.04 will occur in connection with the violation of

other standards in this code that detail the actions required to perform psychological

activities in an ethically responsible manner. For example:

􀀴 Providing testimony on the poor parenting skills of an individual whom the psychologist

has never personally examined that contributed to that individual’s loss of child

custody (Standard 9.01b, Bases for Assessments)

􀀴 Engaging in a sexual relationship with a current therapy client/patient that was a

factor leading to the breakup of the client’s/patient’s marriage (Standard 10.05,

Sexual Intimacies With Current Therapy Clients/Patients)

􀀴 Asking students to relate their personal experience in psychotherapy to past and current

theories on mental health treatment when this requirement was not stipulated in

admissions or program materials, causing some students to drop out of the program

(Standard 7.04, Student Disclosure of Personal Information)

􀀴 Deceiving a research participant about procedures that the investigator expected

would cause some physical pain (Standard 8.07b, Deception in Research)

􀀴 Invalidating the life experience of clients from diverse cultural backgrounds by defining

their cultural values or behaviors as deviant or pathological and denying them culturally

appropriate care (D. W. Sue & Sue, 2003; Standard 2.01b, Boundaries of Competence).

Some contexts require more stringent protections against harm. For example,

psychologists working within institutions that use seclusion or physical restraint

techniques to treat violent episodes or other potentially injurious patient behaviors

must ensure that these extreme methods are employed only upon evidence of their

effectiveness, when other treatment alternatives have failed, and when the use of

such techniques is in the best interest of the patient and not for punishment, for

staff convenience or anxiety, or to reduce costs (Jerome, 1998).

􀀴 The director of psychological services for a children’s state psychiatric inpatient ward

approved the employment of time-out procedures to discipline patients who were disruptive

during educational classes. A special room was set up for this purpose. The director

did not, however, set guidelines for how the time-out procedure should be implemented.

For example, he failed to set limits on the length of time a child could be kept in the room

and not require staff monitoring, did not ensure the room was protected against fire

hazard, and did not develop policies that would permit patients to leave the room for

appropriate reasons. The director was appalled to learn that staff had not monitored

a 7-year-old who was kept in the room for over an hour and was discovered crying and

self-soiled (see, e.g., Dickens v. Johnson County Board of Education, 1987; Goss v. Lopez,

1975; Hayes v. Unified School District, 1989; Yell, 1994).

Psychotherapy and Counseling Harms

Psychologists should also be aware of psychotherapies or counseling techniques

that may cause harm (Barlow, 2010). If psychological interventions are powerful

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100——PART II ENFORCEABLE STANDARDS

enough to improve mental health, it follows that they can be equally effective in worsening

it. In the normative practice of mental health treatment, the diversity of patient/

client mental health needs and the fluid nature of differential diagnosis will mean that

some therapeutic approaches will fail to help alleviate a mental health problem. In such

circumstances, psychologists will turn to other techniques, seek consultation, or offer

an appropriate referral. In other circumstances, negative symptoms are expected to

increase then subside during the natural course of evidence-based treatment (e.g.,

exposure therapy). When treating naturally deteriorating conditions (e.g., Alzheimer’s

disease), a worsening of symptoms does not necessarily indicate treatment harms

(Dimidjian & Hollon, 2010). By contrast, harmful psychotherapies are defined as those

that produce outcomes worse than what would have occurred without treatment

(Dimidjian & Hollon, 2010; Lilienfeld, 2007). Such harmful effects are easiest to detect

for mental health problems whose natural course is constant. In all these circumstances,

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.

Need to Know: How to Detect Harm

in Psychotherapy and Counseling

Psychologists should be aware of the evolving body of knowledge on potential contributors

to the harmful effects of psychotherapy and keep in mind the following suggestions

drawn from Beutler, Blatt, Alimohamed, Levy, and Angtuaco (2006), Castonguay, Boswell,

Constantino, Goldfried, and Hill (2010), and Lilienfeld (2007):

Obtain training in and keep up to date on the flexible use of interventions and

treatment alternatives to avoid premature use of clinical interpretations, rigid theoretical

frameworks, and singular treatment modalities.

Be familiar with the degree to which each client/patient and treatment setting match

those reported for a specific EBP and look for multiple knowledge sources as support

for different approaches (readers may also want to refer to the Need to Know section

on “Navigating the Online Search for Evidence-Based Practices” in Chapter 5).

Monitor change suggesting client/patient deterioration or lack of improvement;

continuously evaluate what works and what interferes with positive change.

Attend to treatment-relevant characteristics such as culture, sexual orientation,

religious beliefs, and disabilities and be aware of the possibility of over- or underdiagnosing

these clients’/patients’ mental health needs.

Carefully attend to client’s/patient’s disclosures of frustration with treatment and

use the information self-critically to evaluate the need to modify diagnosis, adjust

treatment strategy, or strengthen relational factors that may be jeopardizing the

therapeutic alliance.

Equipoise and Randomized Clinical Trials

Important questions of treatment efficacy and effectiveness driving the conduct

of randomized clinical trials (RCTs) for mental health treatments raise, by their very

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Chapter 6 Standards on Human Relations——101

nature, the possibility that some participants will fail to respond to experimental

treatment conditions or experience a decline in mental health during the trial. To

comply with Standard 3.04, research psychologists should develop procedures to

identify and address such possibilities. Such steps can include (a) scientifically and

clinically informed inclusion and exclusion criteria for patient participation, (b) the

establishment of a data safety monitoring board to evaluate unanticipated risks that

may emerge during a clinical trial, and (c) prior to the initiation of the research,

establishing criteria based on anticipated risks for when a trial should be stopped to

protect the welfare of participants. For additional information on guidance from the

Office of Human Research Protections, readers can refer to http://www.hhs.gov/

ohrp/policy/advevntguid.html.

􀀵 There is professional and scientific disagreement over the risks and benefits of

prescribing methylphenidate (e.g., brand name Ritalin) for treatment of attentiondeficit/

hyperactivity disorder (ADHD) in children less than 6 years of age. An interdisciplinary

team of behavioral and prescribing psychologists sought to empirically

test the advantage of adding psychopharmaceutical treatment to CBT for 3- to

5-year-old children previously diagnosed with ADHD. To avoid unnecessarily exposing

children to the potential side effects of medication, the team decided that preschoolers

would first participate in a multi-week parent training and behavioral

treatment program and that only those children whose symptoms did not significantly

improve with the behavioral intervention would continue on to the medication

clinical trial.

3.05 Multiple Relationships

(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.

Individual psychologists may perform a variety of roles. For example, during

the course of a year, a psychologist might see clients/patients in private practice,

teach at a university, provide consultation services to an organization, and conduct

research. In some instances, these multiple roles will involve the same person or

persons who have a close relationship with one another and may be concurrent or

sequential.

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102——PART II ENFORCEABLE STANDARDS

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. For example, it is not unethical

for psychologists to serve as clinical supervisors or dissertation mentors for students

enrolled in one of their graduate classes because supervision, mentoring, and

teaching are all educational roles.

Standard 3.05 does not prohibit attendance at a client’s/patient’s, student’s,

employee’s, or employer’s family funeral, wedding, or graduation; the participation

of a psychologist’s child in an athletic team coached by a client/patient; gift giving

or receiving with those with whom one has a professional role; or entering into a

social relationship with a colleague as long as these relationships would not reasonably

be expected to lead to role impairment, exploitation, or harm. Incidental

encounters with clients/patients at religious services, school events, restaurants,

health clubs, or similar places are also not unethical as long as psychologists react

to these encounters in a professional manner. Nonetheless, psychologists should

always consider whether the particular nature of a professional relationship might

lead to a client’s/patient’s misperceptions regarding an encounter. If so, it is advisable

to keep a record of such encounters. For example:

􀀵 A client with a fluctuating sense of reality coupled with strong romantic transference

feelings for a treating psychologist misinterpreted two incidental encounters with his

psychologist as planned romantic meetings. The client subsequently raised these incidents

in a sexual misconduct complaint against the psychologist. The psychologist’s

recorded notes, made immediately following each encounter, were effective evidence

against the invalid accusations.

Posttermination Nonsexual Relationships

The standard does not have an absolute prohibition against posttermination

nonsexual relationships with persons with whom psychologists have had a previous

professional relationship. However, such relationships are prohibited if the

posttermination relationship was promised during the course of the original

relationship or if the individual was exploited or harmed by the intent to have the

posttermination relationship. Psychologists should be aware that posttermination

relationships can become problematic when personal knowledge acquired

during the professional relationship becomes relevant to the new relationship

(see S. K. Anderson & Kitchener, 1996; Sommers-Flanagan, 2012).

􀀵 A psychologist in independent practice abruptly terminated therapy with a patient

who was an editor at a large publishing company so that the patient could review a

book manuscript that the psychologist had submitted to the company.

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Chapter 6 Standards on Human Relations——103

Clients in Individual and Group Therapy

In most instances, treating clients/patients concurrently in individual and

group therapy does not represent a multiple relationship because the practitioner

is working in a therapeutic role in both contexts (R. E. Taylor & Gazda, 1991), and

Standard 3.05 does not prohibit such practice. Psychologists providing individual

and group therapy to the same clients/patients should consider instituting special

protections against inadvertently revealing to a therapy group information shared

by a client/patient in individual sessions. As in all types of professional practice,

psychologists should avoid recommending an additional form of therapy based on

the psychologist’s financial interests rather than the client’s/patient’s mental health

needs (Knauss & Knauss, 2012; Standard 3.06, Conflict of Interest).

Need to Know: Ethical “Hot Spots”

of Combined Therapy

Brabender and Fallon (2009) have identified ethical “hot spots” of combined therapy that

should be addressed at the outset of plans to engage clients/patients in individual and

group therapy. First, clients/patients should know that they have a choice in being offered

an additional therapy beyond what they expected, and their concerns about costs in time

and money should be respected and discussed (Standard 10.01, Informed Consent to

Therapy; 10.03, Group Therapy). Second, the psychologists should describe how private

information disclosed in individual therapy will be protected from transfer during group

sessions (Standard 4.02, Discussing the Limits of Confidentiality). Finally, psychologists

should explain their policies on client/patient decisions to choose to terminate one of the

treatment modalities (Standard 10.10a, Terminating Therapy).

Judging the Ethicality of Multiple Roles

Several authors have provided helpful decision-making models for judging

whether a multiple relationship may place the psychologist in violation of Standard

3.04 (Brownlee, 1996; Gottlieb, 1993; Oberlander & Barnett, 2005; Younggren &

Gottlieb, 2004). The majority looks at multiple relationships in terms of a continuum

of risk. From these models, the ethical appropriateness of a multiple relationship

becomes increasingly questionable with

increased incompatibility in role functions and objectives;

the greater power or prestige the psychologist has over the person with whom

there is a multiple role;

the greater the intimacy called for in the roles;

the longer the role relationships are anticipated to last;

the more vulnerable the client/patient, student, supervisee, or other subordinate

is to harm; and

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104——PART II ENFORCEABLE STANDARDS

the extent to which engaging in the multiple relationship meets the needs of

the psychologist rather than the needs of the client/patient.

Potentially Unethical Multiple Relationships

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. The following examples illustrate multiple relationships that,

with rare exception, would be prohibited by Standard 3.05a because each situation

could reasonably be expected to impair psychologists’ ability to competently and

objectively perform their roles or lead to exploitation or harm.

􀀴 A psychologist agreed to see a student in the psychologist’s introductory psychology

course for brief private counseling for test anxiety. At the end of the semester, to avoid

jeopardizing the student’s growing academic self-confidence, the psychologist refrained

from giving the student a legitimate low grade for poor class performance. The psychologist

should have anticipated that the multiple relationship could impair her objectivity and

effectiveness as a teacher and create an unfair grading environment for the rest of the class.

􀀴 A company hired a psychologist for consultation on how to prepare employees for a

shift in management anticipated by the failing mental health of the chief executive

officer (CEO). A few months later, the psychologist agreed to a request by the board

of directors to counsel the CEO about retiring. The CEO did not want to retire and told

the psychologist about the coercive tactics used by the board. The psychologist realized

too late that this second role undermined both treatment and consultation

effectiveness because the counseling role played by the psychologist would be viewed

as either exploitative by the CEO or as disloyal by the board of directors.

􀀴 A school psychologist whose responsibilities in the school district included discussing

with parents the results of their children’s psychoeducational assessments regularly

recommended to parents that they bring their children to his private practice for

consultation and possible therapy.

􀀴 As part of their final class assignment, a psychologist required all students in her

undergraduate psychology class to participate in a federally funded research study

that she was conducting on college student drinking behaviors.

􀀴 A psychologist treating an inmate for anxiety disorder in a correctional facility agreed

with a request by the prison administrator to serve on a panel determining the

inmate’s parole eligibility (Anno, 2001).

􀀴 A graduate student interning at an inpatient psychiatric hospital asked her patients if

they would agree to participate in her dissertation research.

􀀴 An applied developmental psychologist conducting interview research on moral

development and adolescent health risk behaviors, often found herself giving advice

to adolescent female participants who asked for her help during the interviews.

Forensic Roles

Forensic psychologists may be called upon for a variety of assessment roles that

differ in their goals and responsibilities from those of treating psychologists.

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Chapter 6 Standards on Human Relations——105

Whereas the responsibility of the treating psychologist is to help clients/patients

achieve mental health, the responsibility of forensic psychologists serving as experts

for the court, the defense, or plaintiff is to provide objective information to assist

the finder of facts in legal determinations. In most instances, psychologists who take

on both roles concurrently or sequentially will be in violation of Standard 3.05a.

For example, in the treatment context, the format, information sought, and

psychologist–client/patient relationship are guided by the psychologist’s professional

evaluation of client/patient needs. Information obtained in a standardized or

unstructured manner or in response to practitioner empathy and other elements of

the therapeutic alliance is a legitimate means of meeting treatment goals.

However, when mixed with the forensic role, the subjective nature of such inquiries

and the selectivity of information obtained impair the psychologist’s objectivity

and thus ability to fulfill forensic responsibilities. Moreover, the conflicting objectives

of the treating and forensic roles will be confusing and potentially intimidating to

clients/patients, thereby undermining the psychologist’s effectiveness in functioning

under either role. Gottlieb and Coleman (2012) advise forensic psychologists to play

only one role in legal matters and to notify parties if a role change is contemplated.

􀀴 A forensic psychologist was hired by the court to conduct a psychological evaluation

for a probation hearing of a man serving a jail sentence for spousal abuse. At the end

of the evaluation, the psychologist suggested that if the inmate were released, he and

his wife should consider seeing her for couple’s therapy.

Bush et al. (2006) suggest that one potential exception to multiple relationships

in forensic contexts may be seen in psychologists who transition from the role of

forensic evaluator to trial consultant. For example, in some contexts it might be

ethically permissible for a psychologist originally retained by a defense attorney to

evaluate a client to also perform consultative services to the attorney regarding the

testimony of other psychologists during a trial if (a) the psychologist provided

only an oral report on his or her diagnostic impressions and (b) the psychologist

would not be called on to provide court testimony. Psychologists should, however,

approach such a multiple relationship with caution if, by ingratiating themselves

with the attorney, they intentionally or unintentionally bias their evaluation or

otherwise violate Standard 3.05a, Multiple Relationships, or 3.06, Conflict of Interest.

(For additional discussion of the role of forensic experts, see the Hot Topics in

Chapters 8 and 12 on psychologists providing testimony in courts.)

Personal–Professional Boundary Crossings

Involving Clients/Patients, Students,

Research Participants, and Subordinates

Boundaries serve to support the effectiveness of psychologists’ work and create

a safe place for clients/patients, students, employees, and other subordinates to

benefit from the psychologists’ services (Burian & Slimp, 2000; Russell & Peterson,

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106——PART II ENFORCEABLE STANDARDS

1998). Boundaries protect against a blurring of personal and professional domains

that could jeopardize psychologists’ objectivity and confidence of those with whom

they work that psychologists will act in their best interests. 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”

(Oberlander & Barnett, 2005, p. 51). Boundary crossings can thus place psychologists

on a slippery slope leading to ethical misconduct (Gutheil & Gabbard, 1993;

Norris, Gutheil, & Strasburger, 2003; Sommers-Flanagan, 2012).

Clients/patients, students, research participants, and supervisees have less experience,

knowledge, and power compared with psychologists providing assessment, treatment,

teaching, mentoring, or supervision. Consequently, they are unlikely to recognize

inappropriate boundary crossings or to express their concerns. It is the psychologist’s

responsibility to monitor and ensure appropriate boundaries between professional and

personal communications and relationships (Gottlieb, Robinson, & Younggren, 2007).

Sharing aspects of their personal history or current reactions to a situation with

those they work with is not unethical if psychologists limit these communications

to meet the therapeutic, educational, or supervisory needs of those they serve.

􀀵 A graduate student expressed to his dissertation mentor his feelings of inadequacy

and frustration upon learning that a manuscript he had submitted for publication was

rejected. The mentor described how she often reacted similarly when first receiving

such information but framed this disclosure within a “lesson” for the student on rising

above the initial emotion to objectively reflect on the review and improve his chances

of having a revised manuscript accepted.

􀀵 A psychologist in private practice was providing CBT to help a client conquer feelings

of inadequacy and panic attacks that were interfering with her desired career

advancement. After several sessions, the psychologist realized that the client’s distorted

belief regarding the ease with which other people and the psychologist, in

particular, attained their career goals was interfering with the effectiveness of the

treatment. The psychologist shared with the client a brief personal story regarding

how he experienced and reacted to a career obstacle, limiting the disclosure to elements

the client could use in framing her own career difficulties.

Boundary crossings can become boundary violations when psychologists share personal

information with clients/patients, students, or employees to satisfy their own needs.

􀀴 A psychologist repeatedly confided to his graduate research assistant about the economic

strains his marriage was placing on his personal and professional life. After

several weeks, the graduate student began to pay for the psychologist’s lunches when

they were delivered to the office.

􀀴 A psychologist providing services at a college counseling center was having difficulties

with her own college-aged son’s drinking habits. She began to share her concerns

about her son with her clients and sometimes asked their advice.

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Chapter 6 Standards on Human Relations——107

Research

Boundary crossings can also lead to bidirectional coercion, exploitation, or

harm. For example, the intimacy between researchers and study participants inherent

in ethnographic and participant observation research can create ambiguous or

blurred personal–professional boundaries that can threaten the validity of data

collected (Fisher, 2004, 2011). Study participants may feel bound by a personal

relationship with an investigator to continue in a research project they find distressing,

or investigators may feel pressured to yield to participant demands for involvement

in illegal behaviors or for money or other resources above those allocated for

participation in the research (Singer et al., 1999).

􀀴 A psychologist was conducting ethnographic research on the lives of female sex workers

who were also raising young children. In an effort to establish a sense of trust with

the sex workers, she spent many months in the five-block radius where they worked,

sharing stories with them about her own parenting experiences. One day, when the

police were conducting a drug raid in the area, a participant the psychologist had

interviewed numerous times begged the psychologist to hold her marijuana before

the police searched her, crying that she would lose her child if the drugs were discovered.

The psychologist felt she had no choice but to agree to hide the drugs because

of the personal worries about the safety of her own children that she had shared with

the participant (adapted from Fisher, 2011).

Nonsexual Physical Contact

Nonsexual physical contact with clients/patients, students, or others over whom

the psychologist has professional authority can also lead to role misperceptions that

interfere with the psychologist’s professional functions. While Standard 3.05 does

not prohibit psychologists from hugging, handholding, or putting an arm around

those with whom they work in response to a special event (e.g., graduation, termination

of therapy, promotion), or showing empathy for emotional crises (e.g.,

death in the family, recounting of an intense emotional event), such actions can be

the first step toward an easing of boundaries that could lead to an unethical multiple

relationship.

Whenever such circumstances arise, psychologists should evaluate, before

they act, the appropriateness of the physical contact by asking the following

questions:

Is the initiation of physical contact consistent with the professional goals of

the relationship?

How might the contact serve to strengthen or jeopardize the future functioning

of the psychologist’s role?

How will the contact be perceived by the recipient?

Does the act serve the immediate needs of the psychologist rather than the

immediate or long-term needs of the client/patient, student, or supervisee?

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108——PART II ENFORCEABLE STANDARDS

Is the physical contact a substitute for more professionally appropriate

behaviors?

Is the physical contact part of a continuing pattern of behavior that may

reflect the psychologists’ personal problems or conflicts?

Need to Know: Professional Boundaries

and Self-Disclosure Over the Internet

The Internet has complicated psychologists’ control over access to personal information.

Psychologists can control some information disclosed on the Internet through

carefully crafted professional blogs, participation on professional or scientific listservs,

and credentials or course curricula posted on individual or institutional websites.

However, accidental self-disclosure (Zur, Williams, Lehavot, & Knapp, 2009) can occur

when clients/patients, students, employees, or others (a) pay for legal online background

checks that may include information on divorce or credit ratings, (b) conduct

illegal searches of cell phone records, or (c) use search engines to find information that

the psychologist may not be aware is posted online. Even when psychologists refuse

“friending” requests, it is increasingly easy for individuals to find information on social

networks such as Facebook through the millions of interconnected links and “mutual

friends” who may have personal postings from and photos of the psychologist on their

websites (Luo, 2009; L. Taylor, McMinn, Bufford, & Change, 2010; Zur et al., 2009).

Given the risks of accidental self-disclosure, psychologists should consider the following

to limit access to personal information (Barnett, 2008; Lehavot, Barnett, & Powers,

2010; Nicholson, 2011):

Set one’s social network settings to restrict access to specifically authorized

visitors only.

Consider whether posted personal information, if accessed, would cause harm to

those with whom you work; undermine your therapeutic, teaching, consultation, or

research effectiveness; or compromise the public’s trust in the discipline.

Periodically search one’s name online using different combinations (e.g., Dr. Jones,

Edward Jones, Jones family).

Consult with experts on how to remove personal or inaccurate information from

the Internet.

When appropriate discuss your Internet policies during informed consent or the

beginning of other professional relationships (see “Need to Know: Setting an Internet

Search and Social Media Policy During Informed Consent” in Chapter 13).

Relationships With Others

Psychologists also encounter situations in which a person closely associated with

someone with whom they have a professional role seeks to enter into a similar professional

relationship. For example, the roommate of a current psychotherapy client/

patient might ask the psychologist for an appointment to begin psychotherapy. A

CEO of a company that hires a psychologist to conduct personnel evaluations might

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Chapter 6 Standards on Human Relations——109

ask the psychologist to administer psychological tests to the CEO’s child to determine

whether the child has a learning disability. With few exceptions, entering into

such relationships would risk a violation of Standard 3.05a because it could reasonably

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.

Receiving referrals from current or recent clients/patients should raise ethical

red flags. In many instances, accepting into treatment a friend, relative, or others

referred by a current client can create a real or perceived intrusion on the psychologist–

patient relationship. For example, a current client/patient may question whether the

psychologist has information about him or her gained from the person he or she

referred or whether the psychologist is siding with one person or the other if there

is a social conflict. Psychologists must also guard against exploiting clients/patients

by explicitly or implicitly encouraging referrals to expand their practice (see also

Standard 3.06, Conflict of Interest).

Some have suggested that treating psychologists should consider a referral from

a current client/patient in the same way they would evaluate the therapeutic meaning

of a “gift” (E. Shapiro & Ginzberg, 2003). In all circumstances, psychologists

must evaluate the extent to which accepting a referral can 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 and, if a situation arises requiring an immediate need for

treatment, to provide a professional referral to another psychologist (see also

Standard 2.02, Providing Services in Emergencies).

When practicing psychologists receive referrals from former clients/patients, it is

prudent to consider (a) whether the former client/patient may need the psychologist’s

services in the future, (b) whether information obtained about the new referral

during the former client’s/patient’s therapy is likely to impair the psychologist’s

objectivity, and (c) the extent to which the new referral’s beliefs about the former

client’s/patient’s relationship with the psychologist is likely to interfere with treatment

effectiveness.

Preexisting Personal Relationships

Psychologists may also encounter situations in which they are asked to take on a

professional role with someone with whom they have had a preexisting personal

relationship. Such multiple relationships are often unethical because the preexisting

relationship would reasonably be expected to impair the psychologist’s objectivity

and effectiveness.

􀀴 A psychologist agrees to spend a few sessions helping his nephew overcome anxiety

about going to school.

􀀴 At a colleague’s request, a psychologist agrees to administer a battery of tests to

assess whether the colleague has adult attention deficit disorder.

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110——PART II ENFORCEABLE STANDARDS

Sexual Multiple Relationships

Sexual relationships with individuals with whom psychologists have a current

professional relationship are always unethical. Because of the strong potential for

harm involved in such multiple relationships, they are specifically addressed in

several standards of the Ethics Code that will be covered in greater detail in

Chapters 10 and 13 (Standards 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).

“Reasonably Expected”

It is important to note that the phrase “could reasonably be expected” indicates

that violations of Standard 3.05a may be judged not only by whether actual impairment,

harm, or exploitation has occurred but also 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.

􀀵 A judge asked a psychologist who had conducted a custody evaluation to provide

6-month mandated family counseling for the couple involved followed by a reevaluation

for custody. The psychologist explained to the judge that providing family counseling

to individuals whose parenting skills the psychologist would later have to

evaluate could reasonably be expected to impair her ability to form an objective

opinion independent of knowledge gained and the professional investment made in

the counseling sessions. She also explained that such a multiple relationship could

impair her effectiveness as a counselor if the parents refrained from honest engagement

in the counseling sessions for fear that comments made would be used against

them during the custody assessment. The judge agreed to assign the family to another

psychologist for counseling.

Unavoidable Multiple Relationships

In some situations, it may not be possible or reasonable to avoid multiple relationships.

Psychologists working in rural communities, small towns, American

Indian reservations, or small insulated religious communities or who are qualified

to provide services to members of unique ethnic or language groups for which

alternative psychological services are not available would not be in violation of this

standard if they took reasonable steps to protect their objectivity and effectiveness

and the possibility of exploitation and harm (Werth et al., 2010).

Such steps might include seeking consultation by phone from a colleague to

help ensure objectivity and taking extra precautions to protect the confidentiality

of each individual with whom the psychologist works. Psychologists can also

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Chapter 6 Standards on Human Relations——111

explain to individuals involved the ethical challenges of the multiple relationships,

describe the steps the psychologist will take to mitigate these risks, and

encourage individuals to alert the psychologist to multiple relational situations of

which the psychologist might not be aware and that might place his or her effectiveness

at risk.

􀀵 A rabbi in a small orthodox Jewish community also served as the community’s sole

licensed clinical psychologist. The psychologist was careful to clearly articulate to his

clients the separation of his role as a psychologist and his role as their rabbi. His work

benefited from his ability to apply his understanding of the orthodox faith and community

culture to help clients/patients with some of the unique psychological issues

raised. He had been treating a young woman in the community for depression when

it became clear that a primary contributor to her distress was her deep questioning of

her faith. The psychologist knew from his years in the community that abandoning

orthodox tenets would most likely result in the woman being ostracized by her family

and community. As a rabbi, the psychologist had experience helping individuals

grapple with doubts about their faith. However, despite the woman’s requests, he was

unwilling to engage in this rabbinical role as a part of the therapy, believing that helping

the woman maintain her faith would be incompatible with his responsibility as a

psychologist to help her examine the psychological facets of her conflicted feelings.

The rabbi contacted the director of an orthodox rabbinical school who helped him

identify an advanced student with experience in Jewish communal service who was

willing to come to the community once a week to provide a seminar on Jewish studies

and meet individually with congregants about issues of faith. The psychologist

explained the role conflict to his patient. They agreed that she would continue to see

the psychologist for psychotherapy and meet with the visiting rabbinical student to

discuss specific issues of faith. Readers may also wish to refer to the Hot Topic in

Chapter 13 on the role of religion and spirituality in psychotherapy.

Correctional and Military Psychologists

Psychologists working in correctional settings and those enlisted in the military

often face unique multiple relationship challenges. In some prisons, correctional

administrators believe that all employees should provide services as officers. As

detailed by Weinberger and Sreenivasan (2003), psychologists in such settings may

be asked to search for contraband, use a firearm, patrol to prevent escapes, coordinate

inmate movement, and deal with crises unrelated to their role as a psychologist.

Any one of these roles has the potential to undermine the therapeutic

relationship a psychologist establishes with individual inmates by blurring the roles

of care provider and security officer. Such potentially harmful multiple relationships

are also inconsistent with the Standards for Psychological Services in Jails,

Prisons, Correctional Facilities, and Agencies (Althouse, 2000).

As required by Standard 1.03, Conflicts Between Ethics and Organizational

Demands, prior to taking a position as a treating psychologist or whenever correctional

psychologists are asked to engage in a role that will compromise their health

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112——PART II ENFORCEABLE STANDARDS

provider responsibilities, they should clarify the nature of the conflict to the administrator,

make known their commitment to the Ethics Code, and attempt to resolve

the conflict by taking steps to ensure that they do not engage in multiple roles that

will interfere with the provision of psychological services.

􀀵 A psychologist working in a correctional facility had successfully established his primary

role as that of mental health treatment provider with both prison officials and

inmates. He was not required to search his patients for contraband or to perform any

other security-related activities. As required of all facility staff, he received training in

the use of firearms and techniques to disarm prisoners who had weapons. On one

occasion, several newly admitted inmates suddenly began to attack some of the older

prisoners with homemade knives. As one of the few correctional staff members present

at the scene, the psychologist assisted the security staff in disarming the inmates.

Although none of the attacking inmates were in treatment with him, he did discuss

the incident with his current patients to address any concerns they might have about

the therapeutic relationship.

Psychologists in the military face additional challenges (Kennedy & Johnson,

2009). W. B. Johnson, Bacho, Heim, and Ralph (2006) highlight multiple role obligations

that may create a conflict between responsibilities to individual military

clients/patients and to their military organization: (a) as commissioned officers,

psychologists’ primary obligation is to the military mission; (b) embedded psychologists

must promote the fighting power and combat readiness of individual

military personnel and the combat unit as a whole; (c) since many military psychologists

are the sole mental health providers for their unit, there is less room for

choice of alternative treatment providers; (d) there is less control and choice

regarding shifts between therapeutic and administrative role relationships (e.g.,

seeing as a patient a member about whom the psychologist previously had to render

an administrative decision); and (e) like rural communities, military communities

are often small, with military psychologists having social relationships with

individuals who may at some point become patients.

To minimize the potential harm that could emerge from such multiple relationships,

Johnson et al. (2006) suggest that military psychologists (a) strive for a neutral

position in the community, avoiding high-profile social positions; (b) assume

that every member of the community is a potential client/patient and attempt to

establish appropriate boundaries accordingly, for example, limiting self-disclosures

that would be expected in common social circumstances; (c) provide informed

consent immediately if a nontherapeutic role relationship transitions into a therapeutic

one; (d) be conservative in the information one “needs to know” in the

therapeutic role to avoid to the extent feasible threats to confidentiality that may

emerge when an administrative role is required; (e) collaborate with clients/

patients on how best to handle role transitions when possible and appropriate; and

(f) carefully document multiple role conflicts, how they were handled, and the

rationale for such decisions.

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Chapter 6 Standards on Human Relations——113

(b) 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.

There will be instances when psychologists discover that they are involved in a

potentially harmful multiple relationship of which they had been unaware. Standard

3.05b requires that psychologists take reasonable steps to resolve the potential harms

that might arise from such relationships, recognizing that the best interests of the

affected person and maximal compliance with other standards in the Ethics Code

may sometimes require psychologists to remain in the multiple roles.

􀀵 A military psychologist provided therapy to an enlisted officer who was ordered to enter

treatment for difficulties in job-related performance. During treatment, the client and

psychologist were assigned to a field exercise in which the client would be under

the psychologist’s command. To reassign the client to a different officer for the exercise,

the psychologist would need to speak with a superior who was not a mental health

worker. Recognizing that the client’s involvement in therapy would have to be revealed

in such a discussion, the psychologist explained the situation to the enlisted member

and asked permission to discuss the situation with her superiors. The client refused to

give permission. The psychologist was the only mental health professional on the base,

so transferring the client to another provider was not an option. The psychologist therefore

developed a specific plan with the client for how they would relate to each other

during the field exercise and how they would discuss in therapy issues that arose. (This

case is adapted from one of four military cases provided by Staal & King, 2000.)

􀀵 A psychologist responsible for conducting individual assessments of candidates for an

executive-level position discovered that one of the candidates was a close friend’s

husband. Because information about this prior relationship was neither confidential

nor harmful to the candidate, the psychologist explained the situation to company

executives and worked with the organization to assign that particular promotion

evaluation to another qualified professional.

􀀵 A psychologist working at a university counseling center discovered that a counseling

client had enrolled in a large undergraduate class the psychologist was going to teach.

The psychologist discussed the potential conflict with the client and attempted to help

him enroll in a different class. However, the client was a senior and needed the class

to complete his major requirements. In addition, there were no appropriate referrals

for the student at the counseling center. Without revealing the student’s identity, the

psychologist discussed her options with the department chair. They concluded that

because the class was very large, the psychologist could take the following steps to

protect her objectivity and effectiveness as both a teacher and a counselor: (a) a

graduate teaching assistant would be responsible for grading exams and for calculating

the final course grade based on the average of scores on the exams and (b) the

psychologist would monitor the situation during counseling sessions and seek consultation

if problems arose.

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114——PART II ENFORCEABLE STANDARDS

(c) 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.)

Standard 3.05c applies to instances when psychologists are required to serve in

more than one role in judicial or administrative proceedings because of institutional

policy or extraordinary circumstances. This standard does not permit psychologists

to take on these multiple roles if such a situation can be avoided. When

such multiple roles cannot be avoided, Standard 3.05c requires, as soon as possible

and thereafter as changes occur, that psychologists clarify to all parties involved the

roles that the psychologist is expected to perform and the extent and limits of confidentiality

that can be anticipated by taking on these multiple roles.

In most situations, psychologists are expected to avoid multiple relationships

in forensically relevant situations or to resolve such relationships when they

unexpectedly occur (Standard 3.05a and b). When such circumstances arise (e.g.,

performing a custody evaluation and then providing court-mandated family

therapy for the couple involved), the conflict can often be resolved by explaining

to a judge or institutional administrator the ethically problematic nature of the

multiple relationship (Standards 1.02, Conflicts Between Ethics and Law,

Regulations, and Other Governing Legal Authority; 1.03, Conflicts Between

Ethics and Organizational Demands).

􀀵 A psychologist in independent practice became aware that his neighbor had begun dating

one of the psychologist’s psychotherapy patients. Although telling the patient about

the social relationship could cause distress, it was likely that the patient would find out

about the relationship during conversations with the neighbor. The psychologist considered

reducing his social exchanges with the neighbor, but this proved infeasible. After

seeking consultation from a colleague, the psychologist decided that he could not ensure

therapeutic objectivity or effectiveness if the situation continued. He decided to explain

the situation to the patient, provide a referral, and assist the transition to a new therapist

during pretermination counseling (see also Standard 10.10, Terminating Therapy).

􀀵 A consulting psychologist developed a company’s sexual harassment policy. After the

policy was approved and implemented, the psychologist took on the position of counseling

employees experiencing sexual harassment. One of the psychologist’s clients

then filed a sexual harassment suit against the company. The psychologist was called

on by the defense to testify as an expert witness for the company’s sexual harassment

policy and by the plaintiff as a fact witness about the stress and anxiety observed during

counseling sessions. The psychologist (a) immediately disclosed to the company and

the employee the nature of the multiple relationship; (b) described to both the problems

that testifying might raise, including the limits of maintaining the confidentiality

of information acquired from either the consulting or counseling roles; and (c) ceased

providing sexual harassment counseling services for employees. Neither party agreed

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Chapter 6 Standards on Human Relations——115

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.

Psychologists strive to benefit from and establish relationships of trust with those with

whom they work through the exercise of professional and scientific judgments based on

their training and experience and established knowledge of the discipline (Principle A:

Beneficence and Nonmaleficence and Principle B: Fidelity and Responsibility).

Standard 3.06 prohibits psychologists from taking on a professional role when competing

professional, personal, financial, legal, or other interests or relationships could reasonably

be expected to impair their objectivity, competence, or ability to effectively

perform this role. Psychologists, especially those with prescription privileges, should

also be sensitive to the effect of gifts from pharmaceutical or others who might exert

influence on professional decisions (Gold & Applebaum, 2011). Examples of conflicts

of interest sufficient to compromise the psychologist’s judgments include the following:

􀀴 Irrespective of patients’ treatment needs, to save money, a psychologist reduced the

number of sessions for certain patients after he had exceeded his yearly compensation

under a capitated contract with an HMO (see the Hot Topic in Chapter 9, “Managing

the Ethics of Managed Care”).

􀀴 A member of a faculty-hiring committee refused to recuse herself from voting when a

friend applied for the position under the committee’s consideration.

􀀴 A psychologist in private practice agreed to be paid $1,000 for each patient he

referred for participation in a psychopharmaceutical treatment study.

􀀴 A research psychologist agreed to provide expert testimony on a contingent fee basis,

thereby compromising her role as advocate for the scientific data.

􀀴 A psychologist who had just purchased biofeedback equipment for his practice began

to overstate the effectiveness of biofeedback to his clients.

􀀴 A prescribing psychologist failed to disclose to patients her substantial financial

investment in the company that manufactured the medication the psychologist frequently

recommended.

􀀴 A psychologist used his professional website to recommend Internet mental health

services in which he had an undisclosed financial interest.

􀀴 A school psychologist agreed to conduct a record review for the educational placement

of the child of the president of a foundation that contributed heavily to the

private school that employed the psychologist.

to withdraw its request to the judge for the psychologist’s testimony. The psychologist

wrote a letter to the judge explaining the conflicting roles and asked to be recused from

testifying (see Hellkamp & Lewis, 1995, for further discussion of this type of dilemma).

 
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