AVOIDING COMMON ETHICAL DIFFICULTIES: HOW TO ENHANCE ETHICAL AWARENESS WITH SOME PRACTICAL SUGGESTIONS: PART II
Below are ideas about how practitioners may avert common ethical dilemmas. Previously published in THE SPECIALIST (07/2018 - published by ABPP) and on the IPA Website BLOG (02/2019) were some thoughts about UNDERSTANDING WHAT CONSTITUTES A MULTIPLE RELATIONSHIP and IDENTIFY YOUR CLIENT AND YOUR ROLE.
1. RESPECT AUTONOMY
Psychologists need to provide clients with information needed to give informed consent at the beginning of treatment. When details are not given, difficult situations may arise. For example, when psychologists fail to explain their duty to report abuse and neglect to an adolescent client before psychotherapy begins, they may be unsure what to do if abuse is later revealed that the client does not want reported. Points to discuss with the client include: + Limits of confidentiality, such as mandatory reporting. + Nature and extent of the clinician’s record-keeping. + The clinician’s expertise, experience, education and training as well as areas where the psychotherapist lacks training. + Estimated length of psychotherapy. + Alternative treatment or service approaches. + Fees and billing practices. + Whom to contact in case of emergency. + Client’s right to terminate sessions and any financial obligations, if that occurs. + Services the psychologist will provide, and those not offered. If individuals are not competent to make decisions for themselves, then the person who is giving permission must have access to that same information. Moreover, a signed consent form does not substitute for the informing process, which should occur first, and that includes situations where informed consent is implied, such as in an employee evaluation.
2. KNOW THE DIFFERENCE BETWEEN ABANDONMENT AND TERMINATION
Psychologists may discontinue treatment when clients: + Are not benefiting from psychotherapy. + May be harmed by the treatment. + No longer need psychotherapy. + Threaten the psychotherapist, themselves or others. Psychologists should provide pre-termination treatment and suggest alternative providers. This may not be possible in all cases, such as if a client abruptly stops attending sessions. Such pre-termination discussion may include explaining the benefits of the new service and why the current treatment is no longer helpful, addressing feelings of separation by emphasizing the transfer is not a personal rejection and identifying practical issues in transferring the client, such as making financial arrangements with a new provider before ending treatment. Involve the client in the plan. Empower them to feel confident and competent. Help the client understand that the transition is a constructive step toward achieving their goals. By contrast, abandonment occurs when a psychologist inappropriately ends treatment, such as halting needed psychotherapy with no notice.
3. STAY WITH THE EVIDENCE
When you give an expert opinion, or conduct an assessment, base your evaluation only on the data available. For example, psychologists in child custody cases should be certain they are not biased in favor of the parent who is more financially secure. The best approach is to stay mindful about what one knows, what one does not know and what have been the sources of information. Some suggestions include: + Know the referral question(s) and choose assessment tools to validly answer question(s). This means psychologists need to read and understand test manuals. For example, personality tests appropriate for clinical use are not necessarily appropriate for employment selection. + Do not rely on third-party reports to formulate assessments and avoid giving an opinion of any person not directly evaluated. + Make certain the assessment is thorough. Do not give an expert opinion without consulting all sources available. For example, a psychologist conducting a custody evaluation fails to check with child protection services and therefore does not learn that one parent is being investigated for child neglect, a fact that may have changed the opinion of the psychologist. + Discuss the limitations of one’s work and make statements about the certainty of the findings. It is equally important to offer any plausible alternative hypothesis that would account for the data. In court cases, where the facts may be disputed, one may describe the contradictions between the two parties and then make a set of recommendations based on each party’s side of the story, leaving it to the court to decide the truth. + Ensure that tests were developed for the target population and that they are culturally appropriate. If not, make the proper adjustments and note the limitations of those adaptations in the findings.
4. SUPERVISORY RESPONSIBILITIES
Supervising psychologists should continually assess the competence of those they supervise and make certain they are doing what is appropriate. If a document is sent under the supervisor’s name, the supervisor is responsible. A client is not going to sue the receptionist/secretary, or the supervisee, but will sue the supervisor. Supervisors should also: + Establish timely and specific processes for providing feedback, and provide information about these processes at the beginning of supervision. + Outline the nature and structure of the supervisory relationship, in writing, before supervision begins. Include the responsibilities of both parties, the nature and frequency of the supervision and other key aspects of the supervisory relationship. + Document their experience with the supervisee, including supervision dates, discussions and other relevant facts. Such information will help if ethical dilemmas arise later. + Explain to clients that the psychotherapist is in training and give clients the name of the supervisor. Note that billing may be under a supervisor’s name, not the supervisee, so that clients do not accidentally report billing problems when there are none. + Avoid delegating work to people who have multiple relationships with the client that would likely lead to harm or the supervisee’s loss of objectivity. For example, avoid using a non-English speaking person’s spouse as a translator.