Thought Paper #5 - Ethical Issues in Clinical Psychology Max Gilles - Intro to Clinical Psychology
Ethical issues are arguably the most important principle in clinical psychology. No matter how effective a treatment, it cannot be used if it does not follow a certain ethical guideline. The American Psychological Association first published ethical guidelines in 1953, as a code of ethics . This code
has since been updated many times, and the most current code of ethics focuses on two distinct sections. General principles , the first section, are aspirational , that means they are a description of an ideal way that psychologists should conduct themselves. The second section, ethical standards , includes enforceable rules of conduct. These are standards, not principles, and so they are more clearly violated, as opposed to not living up to a principle. Even with these guidelines, standards, and principles, sometimes the right ethical choice isn’t completely clear. Celia Fisher made an eight step model for ethical decision making , that simplified making these decisions and helps guide psychologists into making the right ethical choice. A more specific ethical issue is that of confidentiality , the process of providing professional services without sharing the personal or private details learned from providing the service. However, confidentiality is not absolute, and herein lies a majority of the issues. A perfect example of a confidentiality issue was in the Tarasoff case , where a psychologists failed to do enough in warning a victim when told about the intent to murder her by his patient. The decision in this case, lead the the legal precedent of duty to warn, where a psychologist has a duty to warn those who could be put into danger by their patient. Child abuse, is another example of when confidentiality must be broken, all mental health professionals must report any evidence of known or suspected child abuse. This issue of confidentiality is very convoluted and complicated since each case is unique.
Another specific ethical issue is that of informed consent , this issue is pretty well summed up by APA: “psychologists inform clients/patients as early as is feasible in the therapeutic relationship about the nature and anticipated course of therapy, fees, involvement of third parties, and limits of confidentiality and provided sufficient opportunity for the client/patient to ask questions and receive answers.” Multiple relationships is the issue of having more than one relationship with a client or
student, so not just as a therapist or teacher, but also as a friend, business partner or romantic partner. Arguably the most damaging are sexual multiple relationships where the clinical psychologist becomes a sexual partner of the client. This is directly forbidden by the APA as it often results in significant psychological issues for the client. Nonsexual multiple relationships (friendships, business relationships, etc.) These are less directly forbidden and it is up to the psychologist to determine when they overlap and can become potentially harmful for the client. Competence in general has to do with capabilities of psychologists and being adequately skilled
and experienced in performing their duties. Boundaries of competence are defined as “Psychologists provide services, teach, and conduct research with populations and in areas only within the boundaries of their competence, based on their education, training, supervised experience, consultation, study, or professional experience.” A way to keep competence high is by using continuing education regulations in regard to licensure, by constantly testing and educating psychologists we can help maintain the level of competence throughout their career. As discussed last chapter, cultural competence is very important now and has been receiving more and more attention justifiably. Sometimes competence is affected by life stressors or other factors, not just lack of education or experience, burnout is a perfect example of this. Too much work can cause negative psychological effects and this can dramatically hurt the
effectiveness of the therapists work. There are ethical issues in clinical assessment as well as clinical treatment. Test selection for instance can be very important, due to the biases or outdatedness that may appear in assessment tests, the psychologist must consider a multitude of factors when considering which test to use to asses their client. Keeping these tests confidential, known as test security, is also a very important and controversial topic. The release of test data, raw data the clients provided during assessment, even to the clients themselves comes into issue as well. When conducting treatment research, it is always important to focus on the efficacy of the research itself, in other words, how well does the treatment produce the desired results and how honest are the researchers in disclosing this information. In my opinion I think there should be no end to ethical and competency training in a psychologist career. As we have seen from this chapter, not only are the ethical issues vast and complicated, often relying on individual judgment, but they are also constantly changing and adapting to the modern condition. I see no reason why ethical and competency training should not be mandatory for licensure renewal, nor why this renewal should not occur as frequently as practical. Reporting dangerous subjects can save lives, but the boundaries are not very clear regarding this, and I would urge all psychologists to seek advice when not sure, since it is better to be safe than sorry. While reporting on dangerous subjects may save other lives, maintaining a level of ethical competency regarding multiple relationships and proficiency in duties can greatly impact clients both negatively and positively, so they are of almost equal importance. Overall, ethical issues are almost the most important issue in psychology, because it is the guidelines that all psychological work should be driven by.
