AVOIDING COMMON ETHICAL DIFFICULTIES: HOW TO ENHANCE ETHICAL AWARENESS WITH SOME PRACTICAL SUGGESTIONS
By being aware of foreseeable potential conflicts, and discussing them frankly with colleagues and clients, practitioners may evade misunderstandings, hurt feelings and difficult situations that lead to hearings before licensing/ethics boards, lawsuits, suspension/revocation of license, loss of professional membership or other dire consequences.
Incorporate ethics by asking, “How may I be even better in my practice?” Good ethical practice is good professional practice, which is good risk management practice. When in ethical quandaries, it is often because one unwittingly slid too far down a slippery slope, a result of ignorance about ethical obligations or thinking one could deal with a situation that spiraled out-of-control.
Many problems are situations that develop gradually, moving step-by-step beyond what were once initially firm professional boundaries. Although each step seemed harmless at the time, many practitioners later realize that they have landed themselves in deep trouble.
Below are ways practitioners may avert two common ethical dilemmas.
UNDERSTAND WHAT CONSTITUTES A MULTIPLE RELATIONSHIP
Is it ethical to volunteer at your daughter’s softball team fund-raiser, if you know a client is going to be present? Should you purchase a vehicle from a client who owns the only dealership in your small, rural town? Should you ask an intern to drive you to the airport? A central question in any multiple relationship situation is, “Whose needs are being met?” Whenever the answer pertains to the needs of the psychologist, it is a time when the psychologist needs to take great care and obtain a consultation.
According to the APA Ethics Code, psychologists should avoid relationships that could reasonably impair, exploit or harm performance. Multiple relationships without such effects may not necessarily be unethical. When weighing the pros and cons in situations, think about three factors:
- POWER. How much of a power differential is there between the psychologist and the other person?
- DURATION. Will contact be brief, continuous or episodic over a long time? Before entering into a dual relationship psychologists should consider whether, for example, a client could return for additional services.
- TERMINATION. Has the therapeutic relationship been permanently terminated with mutual understanding by the client? If a psychologists treats clients with a chronic mental illness, treatment could stop and start for years, thus precluding some relationships that may be all right otherwise.
It is only an ethical problem when there is reason to predict a foreseeable risk and the psychologist fails to see it, ignores it and/or goes forth anyway. If psychologists find, despite their efforts, a potentially harmful multiple relationship has arisen, they are ethically mandated to take steps to resolve it in the best interest of the person or group while complying with the Ethics Code.
Never permissible are sexual relationships with current clients. While sexual relationships with previous clients are not automatic violations if they occur more than two years after termination of psychotherapy, psychologists need to be mindful of the harm that may come from a sexual involvement with a client no matter when it occurs.
IDENTIFY YOUR CLIENT AND YOUR ROLE
When practicing psychologists work with organizations or groups of individuals, they should understand from the beginning who they were hired to help and what is expected of them. Dilemmas arise in a variety of situations:
+ In couples psychotherapy when, for example, one partner wants a better marriage but the other wants a “painless” divorce. Psychologists should clarify, at the beginning, that they will not decide whether the couple should stay together or offer subsequent expert opinions during a divorce suit.
+ In court, when it is unclear whether the psychologist is serving as an expert witness or an advocate for one side. Court-appointed evaluators should express well-balanced, objective opinions, while advocates are often psychologists for one party and who have had little, if any, direct contact with the other party. Because they are unable to provide an objective evaluation, psychologists who are psychotherapists for one of the parties should not serve as expert witness.
+ When psychologists provide services to a person or entity at the request of a third party, such as a parent requesting psychotherapy for their child, or a Police Department requesting an evaluation of an Officer. A psychologist may have one legal client, but several ethical clients. In each case it is crucial to know who is being served and what is the role of the psychologist in providing that service.
How may psychologists avoid role-related dilemmas? Knowing who is the client, your role, being transparent about what it is that you do, and being mindful about the professional boundaries that arise, are good guideposts to effective practice. That means psychologists should, at the outset, have frank discussions with all parties involved about the relationship they will have with each person or organization. For example, are they hired by a business to enhance worker productivity or are they to help individual workers with mental health problems?
Other things to cover include confidentiality limits, what specific services will be provided to which people and how the psychologist and others could use the services or information obtained. If one is reasonable and straightforward with people, you will be in good stead most of the time Treat them the way you would want to be treated in a similar situation, find out what their expectations are and clarify those expectations.
The most effective strategy that a psychologist may take to minimize exposure to ethical and legal problems is to strive to be mindful, compassionate, wise, genuine and honest.
Barney Greenspan is a Diplomate in three specialties (Clinical Psychology; Clinical Child & Adolescent Psychology; & Psychoanalysis); Fellow in six divisions of APA (Clinical; Psychotherapy; Psychoanalysis; State, Provincial & Territorial Affairs; Independent Practice; & Clinical Child & Adolescent Psychology); Chair, ABPP Ethics Committee; Member, APA Ethics Committee; & President, Idaho Psychological Association.
This article was previously published in THE SPECIALIST by ABPP, 07/12/2018.