Dealing with moral problems and judgements can traditionally be termed as ethics. The Committee of Scientific and Professional ethics was created in 1938 and sought on an informal basis to deal with and investigate any ethical issues that had been challenged (Hobbs, 1948). The American Psychological Association (APA) developed an Ethics Code in 1947 and the British Psychological Association (BPS) in 1985 respectively (Bersoff, 2008). These codes were produced so that formal guidelines could be used if an ethical dilemma arose. These codes have been revised over many years so that they would ‘encourage the highest endeavours of psychologists, ensure public welfare, promote sound relationships with allied professions, and promote the professional standing of the discipline’ (Hobbs, 1948).
There will always be occasions, however, when a psychologist feels that they have no other option than to break an ethical code, regardless of how well trained and respected a psychologist may be. There are a number of ethical dilemmas that I will be presenting that could be expected from a sample of contemporary clinical psychologists.
Confidentiality refers to a general standard of professional conduct that obliges a professional not to discuss information about a client with anyone (Keith- Spiegel & Koocher, 1998), except under certain circumstances agreed to by both source and subject. A clinical psychologist may need to be cautious of several different types of topic that may arise when treating a client such as the use of the internet, audio recordings, electronic media etc. (2009, PRBD (Vic)2). This broad range of topics that confidentiality crosses over into makes confidentiality one of the most frequently experienced ethical issue.
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However, in some circumstances a clinical psychologist may feel that they are in a position where in order to act legally they must break the Ethics Code. This can put the clinical psychologist in a testing situation where they do not know what the legally right or morally right thing to do and vice versa. A psychologist is legally required to ‘warn a potential victim of a client’s intent to harm him or her’ (APA 4.01).There are some situations when an individual could be in danger due to the content of the conversations that a therapist has had with a client (Keith- Spiegel & Koocher, 1998), case 3.4; Mental Disability Law Reporter (1979), p64). The APA code clearly states that confidentiality should be broken in such cases.
Another circumstance when confidentiality may need to be broken is when a client has disclosed confidential information that is illegal APA 4.05 (Pope & Vetter, 1999). This is shown again in case 8.9 p 197(Keith-Spiegel and Koocher, 2008) where confidentiality has to be broken because the patient has taken part in an illegal act (BPS 1.2v).
These cases illustrate the difficulty of therapists in such situations and may be another reason why psychologists listed confidentiality as the most frequently describe ethical dilemma (Pope & Vetter, 1999), as the consequences of some ethical dilemmas where confidentiality is not broken can lead to very serious implications to clients, individuals and their families resulting in catastrophic effects (BPS 1.2vi) (Fisher, 2009).
Clinical psychologists often work in the context of relationships where they can hold an advantage of power over the people and clients with whom they work and can inadvertently lose sight of the unequal power levels which can cause very serious issues. (Keith- Spiegel & Koocher, 1998). This is a very important ethical issue to acknowledge because frequently, clinical psychologists are harmed as well as the client when this ethical dilemma occurs (Pope and Vetter, 1999).
As clearly stated by APA guidelines ‘a psychologists refrains from entering into a multiple relationshipsâ€¦..’ (APA 3.05 (a)).When a blurred, dual or multiple relationship takes place between therapist and client the relationship becomes superimposed, and the potential for adverse consequences to all concerned is heightened as shown in case 10.20, p269 (Keith-Spiegel and Koocher, 1998) (BPS 4.2 i). This case showed the difficulties in the separation of work and family relationships where a clinical psychologist has been placed in an ethical dilemma due to a family member (Keith-Spiegel and Koocher, 1998).
However, there are some situations where the opportunity to not have blurred, dual or multiple relationships is unavoidable such as clinical psychologists working in rural communities, small towns or other isolated communities and cultures. These situations show circumstances where alternative psychological services are not available and where this would not be a violation of the Ethics Code (APA 3.05 (a)) if the psychologist took reasonable steps to protect harm to themselves and the client (Fisher, 2009). Sobel (1984) posited that, ‘to be competent, psychologists in rural areas have a responsibility for educating the community through involvement in such groups, and professional or social organizations’.
Another circumstance when the ethical dilemma of blurred, dual or conflicting relationships may occur can be when clients of a psychologist over express their gratitude (BPS 4.2 iv). This issue demonstrates how a gift given to a psychologist for their services can potentially become manipulated (Keith- Spiegel & Koocher, 1998), case 10.44, p281), illustrates how a psychologist needs to be aware that naiveté and inexperience can be harmful (Keith-Spiegel & Koocher, 2008, case 11.5, p285) (BPS 3.1 iv).
It is important that clinical psychologists exercise reasonable judgement and precautions to ensure that their work does not reflect personal, organizational biases or prejudices that can lead to injustice (Fisher, 2009).
Sexual engagement between therapist and client is always a difficult topic and attempts have been made to define these boundaries effectively (APA 3.08). This ethical issue occurs quite frequently due to the opportunist nature of the therapist-client relationship . Little or no understanding is accepted when a therapist attempts to rationalise their actions (Keith-Spiegel & Koocher, 1998), case 10.3, p256).
Rationalizations are difficult to accept when one considers the fact that the targets for such ‘therapy’ are not randomly spread across the whole range of therapist clients (Kardener et al, 1974). The therapist -client relationship exposes a client to exploitation when this unequal power relationship is used as an advantage. As stated by the BPS guidelines psychologists should ‘refrain from engaging in any form of sexual or romantic relationshipâ€¦.’ (BPS 4.3 i).
Another circumstance when sexual issues may present an ethical dilemma between a therapist and client (Keith-Spiegel & Koocher, 1998), case 10.13, p261) is when sexual involvement is used as a form of revenge or coercion. These situations can create a huge risk to the clinical psychologist and can cause substantial psychological harm to the client (2009, PRBD, (Vic) 3).
These cases illustrate the difficulties of therapists in such situations and may be another reason why psychologists find difficulty in dealing with the ethical dilemma involving sexual issues.
A substantial percentage of complaints to ethics committees about clinical psychologists derive from their colleagues or their employees (Pope and Vetter, 1999). This is understandable as other therapists and colleagues are also knowledgeable on their rights as a clinical psychologist and when something is ethically wrong. In cases where the conduct of colleagues is questioned brings an unpleasant amount of intensity and vindictiveness of which a claim can be pursued (Keith- Spiegel & Koocher, 1998).
There have been cases when a therapist may become angry at a patient who has decided to change therapist unexpectedly, even after an appropriate termination and may refuse to cooperate with another therapist (Keith- Spiegel & Koocher, 1998, case 11.2, p292) (APA 3.09). As stated by the APA code regarding third party requests for services (APA3.07), it is unethical if there is any potential harm to the client if information is not shared with a new therapist(Keith- Spiegel & Koocher, 2008 case 13.7, p 347).
The most common types of concern raised involve pirating clients or seeing clients who are involved in a relationship with another professional at the time (case 11.4, p293). One could argue that a clinical psychologist should not deny treatment to a client in need but it is difficult to treat adequately a client who wishes to conceal something about a prior psychotherapy experience. A potential exception to this strategy could be discovering ethical miss conduct on the part of colleagues.
These cases illustrate the difficulties and harm a client can be exposed to if clinical psychologists prevent a client from getting the best treatment that the client feels comfortable with, however negative this can be to the therapist.
Clinical psychologists use psychological assessments as a tool to help them understand the study of human behaviour and capabilities. An assessment is any form of psychological test that is used for the purpose of describing, classifying, diagnosing, evaluating, or predicting behaviour (Keith- Spiegel & Koocher, 1998). The ethical topic of assessment is important to help provide decisions and direction in supporting the wellbeing of individuals, families, groups, organizations and institutions (Fisher, 2009) (APA 9.02). The most typical ethical dilemmas involving assessments tend to involve one of two themes: ‘(a) The availability of tests to those who may not be adequately trained in testing, and (b) Basing conclusions on inadequate data or ignoring important sources of data’ (Pope and Vetter,1992).
When psychological assessments are abused, ethical codes can be broken (APA 9.01) and sometimes ethical dilemmas can arise (Keith- Spiegel & Koocher, 1998), case 4.25, p108). A clinical psychologist may have not been informed that test data would be used in a certain manner (APA 9.03). However, ethical dilemmas causing a life and death consequence are rare.
Another circumstance when this code is broken is when a psychologist is asked to interpret an assessment when no contact has taken place between the therapist and the client (Pope & Vetter, 1999). Only in some cases such as a disability claim or relocation would it be accepted that a personal examination may not be possible.
These cases illustrate the difficulties that can arise if psychological tests are not carried out appropriately. By presenting ethical codes that all clinical psychologists should obey, there is less risk that an assessment can cause harm to a client and other individuals.
The media is a very important part of our society and is best used in psychology as a constructive source that can provide a strong education about psychology to a large audience of different cultures, for free. However, as most psychologists know, what the media tell the public about psychology can quite often be inaccurate, misrepresented, distorted, trivialized, and sensationalised when presented to the public (Fisher, 2009). As stated by the BPS, psychologists should ‘be honest and accurate in advertising their professional services and products, in order to avoid encouraging unrealistic expectations or otherwise misleading the public’ (BPS 4.1 vii).
Clinical psychologists may be interviewed on the radio or on a television show relating to an area of psychology. Quite often in this process psychologists can be asked inappropriate questions or can be referred to as a psychiatrist which can produce frustration and distortion to the public about what psychology is as a profession.
In some cases, the psychologist bears full responsibility when breaking this ethical issue (case 8.4, p203). This case shows how statements about a psychologist ‘research’ were highly misleading, irresponsible and could have possibly caused psychological, emotional and mental harm to radio listeners. In another case a psychologist is accused of miss representing their knowledge to a listener, causing the listener harm (case 8.13, p214).
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Psychologists have proposed alongside with the critics of the miss representation of psychology in the media, that a set of specific guidelines be created that can assist psychologists in the media to clarify and support them before any ethical issues and dilemmas arise. This is an important ethical issue because the way that a piece of psychological information is portrayed to the public can be both beneficial but can also be very damaging if the information is incorrect, miss leading and can cause psychological harm (Hodgson, 2007).
Professional competence and incompetence has been an ill-defined category in relation of a general presumption of competence (Keith- Spiegel & Koocher, 1998). It is very important that the knowledge and experience developed as a clinical psychologist should benefit all individuals that the psychologist works with and cause them no harm (Field, 2009).
When boundaries are not recognised by a clinical psychologist an ethical dilemma may arise (Keith- Spiegel & Koocher, 1998), case 9.1, p225), and therefore a psychologist could subsequently either cause more harm to a client which required therapy from a more experienced psychologist (2009, PRBD (Vic)5).
Another situation when a psychologists competence can create an ethical issue is when a psychologist begins working in an area of psychology on the basis that they have read some books within the relevant area (Keith-Spiegel & Koocher, 1998), case 9.3, p229). It would not be questioned that the psychologist is well trained and an expert within their field of therapy, however, their trained competency is certainly exceeded. Often a psychologist is unaware that they are breaking an ethical guideline, as positive thought and career progression seems to be something that we would expect a psychologist to work towards. However, although this guideline (APA 2.01) has been broken, this is not necessary unethical. If a psychologist is able to limit their practices to the areas in which they are well trained, then their behaviour would not be inappropriate.
These cases illustrate the difficulty of therapists in such situations and without careful thought and exploration some areas of a psychologist competence may be deemed as unethical even when the psychologist is completely unaware of any wrong doing.
Clinical psychologists are guided to reach an agreement specifying financial arrangements between the client and themselves as early as possible (APA 6.04) where they will need to determine the financial arrangement between themselves and their prospective client before any kind of therapy begins (Keith- Spiegel & Koocher, 1998).
However, in some circumstances an ethical dilemma can result from failure to commit, procedural ignorance or naiveté. Psychologists can often become concerned about addressing those particular clients who are poor, unemployed or homeless, and feel that these clients need the therapy from the psychologist, rather than just want it (2006, PRBD (Vic)2). This ethical guideline may sometimes need to be broken (APA 6.04), especially when a psychologist becomes unable or is prevented from treating an individual who needs psychological therapy, and is restricted because of the individual’s financial situation (Pope & Vetter, 1999).
This point is also illustrated when a client is referred to a local community psychologist at a reduced fee after the client’s financial situation unfortunately prevents them from continuing with their current psychologist, who is unable to reduce their fees because of the ethical guidelines (Keith- Spiegel & Koocher, 1998), case 6.2, p156). One could argue that it would be better for the client to stay with their current therapist and that less attention should be paid to trivial areas such as money.
This case raises the issue of abandonment due to financial restrictions, where the abandonment of the client may subsequently worsen their mental and psychological condition .However, the financial agreement between the psychologist and the patient should have been agreed at the start of the patient’s therapy, and therefore honoured.
These cases illustrate the difficulty that clinical psychologist have concerning the issues about helping the more financially stricken clients. To help psychologists on this ethical issue, more attention and focus should be given to address the ethics of interventions which can help the more vulnerable individuals of society (Pope & Vetter, 1999).
To conclude, there are occasions when inevitably ethical dilemmas will arise. To effectively approach an ethical dilemma clinical psychologists must importantly be responsible, sensible and aware of the situations that could potentially cause harm to a client or other individuals. To maintain and enforce these ethical codes, revisions of the guidelines will be essential and beneficial in presenting formal guidelines that all psychologists can refer to if such an ethical dilemma arises in their professional career.
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