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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.
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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 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).
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.
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 lower-income 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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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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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.
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.
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.
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.
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
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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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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).
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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:
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).
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:
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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)
To what extent is the behavior endangering the life or seriously compromising the wellbeing 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.
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:
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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 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
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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):
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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 under-diagnosing these clients’/patients’ mental health
needs.
Carefully attend to client’s/patient’s disclosures of frustration with treatment and use the information selfcritically 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 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 attention-deficit/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
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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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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.
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
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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
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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
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.
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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. 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
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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, 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
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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.
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:
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•
•
•
•
•
•
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?
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 selfdisclosure, 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 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
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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.
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).
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“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 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
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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 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,
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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.
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.)
(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 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
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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.
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).
(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 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
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acquired from either the consulting or counseling roles; and (c) ceased providing sexual harassment
counseling services for employees. Neither party agreed 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).
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 3.06prohibits
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
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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.
Conflicts of interest can extend to financial or other gains that accrue to psychologists
indirectly through the effect of their decisions on the interests of their family members:
An educational psychologist encouraged a school system she was consulting to purchase learning
software from a company that employed her husband.
An organizational psychologist was hired by a company to provide confidential support and referral
services for employees with substance abuse problems. The psychologist would refer employees he
counseled to a private mental health group practice in which his wife was a member.
Psychologists also have a fiduciary responsibility to avoid actions that would create public
distrust in the integrity of psychological science and practice (Principle B: Fidelity and
Responsibility). Accordingly, Standard 3.06 also prohibits taking on a role that would expose a
person or organization with whom a psychologist already works to harm or exploitation. For
example:
A research psychologist on the board of a private foundation encouraged the foundation to fund a
colleague’s proposal from which he would be paid as a statistical consultant.
A psychologist accepted a position on the board of directors from a company for which she was
currently conducting an independent evaluation of employee productivity.
A psychologist took on a psychotherapy client who was a financial analyst at the brokerage company
the psychologist used for his personal investments.
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Psychologists in administrative positions have a responsibility to resist explicit or implicit
pressure to bias decisions regarding the adequacy of research participant or patient protections to
meet the needs of the institution’s financial interests.
A psychologist serving on her university’s IRB gave in to pressure to approve a study with ethically
questionable procedures because it would bring a substantial amount of funding dollars to the
university.
A school psychologist refused the district superintendent’s request that she conduct training sessions
for teachers at an overcrowded school that would result in the misapplication of behavioral principles
to keep students docile and quiet.
Organizational and consulting psychologists should be wary of situations in which an employer
may request the psychologist to assist with managerial directives that may be ethically
inappropriate and harmful to the wellbeing of employees (Lefkowitz, 2012).
Conflicts of Interest in Forensic Practice
Psychologists seek to promote accuracy and truthfulness in their work (Principle C: Integrity).
Forensic psychologists hired to provide expert testimony based on forensic assessment or research
relevant to the legal decision need to be aware of potential conflicts of interest that may impair
their objectivity or lead them to distort their testimony. For example, psychologists providing
expert testimony should not provide such services on the basis of contingent fees (fees adjusted to
whether a case is won or lost) since this can exert pressure on psychologists to intentionally or
unintentionally modify their reports or testimony in favor of the retaining party. However, if a
psychologist is serving as a consultant to a legal team and will not be testifying in court, a
contingency fee may not be unethical as long as it does not lead psychologists to distort facts in
giving their advice (Heilbrun, 2001). Psychologists should also avoid charging higher fees for
testimony since this may motivate writing a report that is more likely to lead to a request to testify
(Heilbrun, 2001). Bush et al. (2006) suggest psychologists set fixed rates (which may be required
in some states) and bill an hourly rate consistent for all activities.
Forensic psychologists hired by the defense team must also avoid explicit or subtle pressure to
use more or less sensitive symptom validation measures to assess the mental status of the
defendant. Psychologists should not submit to pressure by a legal team to modify a submitted
report. Amendments to the original report may be added to correct factual errors, and if a report is
rewritten, the rationale for the changes should be given within the report (Bush et al., 2006;
Martelli, Bush, & Sasler, 2003). Interested readers may also refer to the Chapter 8 Hot Topic on
“Avoiding False and Deceptive Statements in Scientific and Clinical Expert Testimony.”
Corporate Funding and Conflicts of Interest in Research, Teaching, and Practice
The APA Task Force on External Funding (http://www.apa.org/pubs/info/reports/externalfunding.aspx) provides a detailed history of conflicts of interest in related fields and provides
specific recommendations for psychology (see also Pachter, Fox, Zimbardo, & Antonuccio, 2007).
Recommendations include the following:
•
When research is industry sponsored, psychologists should ensure that they have input into
study design, independent access to raw data, and a role in manuscript submission.
Standard 3 Human relation
Pages 91-134
•
•
•
Full public disclosure regarding financial conflicts of interest should be included in all
public statements.
Psychologists should be aware and guard against potential biases inherent in accepting
sponsor-provided inducements that might affect their selection of textbooks or assessment
instruments.
Practitioners should be alert to the influence on clients/patients of sponsor-provided
materials (e.g., mugs, pens, notepads) that might suggest endorsement of the sponsor’s
products.
Many federal agencies, professional and scientific organizations, and academic and other
institutions have conflict of interest policies of which psychologists should be aware.
•
•
•
•
The National Institutes of Health (NIH) Office of Extramural Research requires every
institution receiving Public Health Service (PHS) research grants to have written guidelines
for the avoidance and institutional review of conflict of interest. These guidelines must
reflect state and local laws and cover financial interests, gifts, gratuities and favors,
nepotism, political participation, and bribery. In addition, employees accepting grants or
contracts are expected to be knowledgeable of the granting and contracting organization’s
conflict-of-interest policy and to abide by it (http://grants.nih.gov/grants/policy/coi/). In
addition, the PHS Regulations 42 CFR Part 50 (Subpart F) and 45 CFR Part 94 provide
conflict-of-interest
guidelines
for
individual
investigators
(http://grants.nih.gov/grants/guide/notice-files/not95-179.html).
The APA Editor’s Handbook: Operating Procedures and Policies for APA
Publications (APA, 2006, Policy 1.03) requires that journal reviewers and editors avoid
either real or apparent conflict of interest by declining to review submitted manuscripts
from recent collaborators, students, or members of their institutions or work from which
they might obtain financial gain. When such potential conflicts of interest arise or when
editors or associate editors submit their own work to the journal they edit,
the Handbook recommends that the editor (a) request a well-qualified individual to serve
as ad hoc Action Editor, (b) set up a process that ensures the Action Editor’s independence,
and (c) identify the Action Editor in the publication of the article. APA also requires all
authors to submit a Full Disclosure of Interests Form that certifies whether the psychologist
or his or her immediate family members have significant financial or product interests
related to information provided in the manuscript or other sources of negative or positive
bias (www.apa.org/pubs/authors/disclosure_of_interests.pdf).
The APA Committee on Accreditation’s Conflict of Interest Policy for Site Visitors
includes prohibitions against even the appearance of a conflict of interest for committee
members and faculty in the program being visited. Possible conflicts include former
employment or enrollment in the program or a family connection or close friend or
professional
colleague
in
the
program
(http://www.apa.org/ed/accreditation/visits/conflict.aspx).
The NASP’s Professional Conduct Manual requires psychologists to avoid conflicts of
interest by recognizing the importance of ethical standards and the separation of roles and
by taking full responsibility for protecting and informing the consumer of all potential
concerns (NASP, 2010, V.A.1).
Standard 3 Human relation
Pages 91-134
•
According to the SGFP (AP-LS Committee on the Revision of the Specialty Guidelines for
Forensic Psychologists, 2010), psychologists should not provide services to parties to a
legal proceeding on the basis of a contingent fee (SGFP, IV.B).
3.07 Third-Party Requests for Services
When psychologists agree to provide services to a person or entity at the request of a third party,
psychologists attempt to clarify at the outset of the service the nature of the relationship with all individuals
or organizations involved. This clarification includes the role of the psychologist (e.g., therapist, consultant,
diagnostician, or expert witness), an identification of who is the client, the probable uses of the services
provided or the information obtained, and the fact that there may be limits to confidentiality. (See
also Standards 3.05, Multiple Relationships, and 4.02, Discussing the Limits of Confidentiality.)
Psychologists are often asked to conduct an assessment, provide psychotherapy, or testify in
court by third parties who themselves will not be directly involved in the evaluation, treatment, or
testimony.
In all these cases, Standard 3.07 requires psychologists at the outset of services to explain to
both the third party and those individuals who will receive psychological services the nature of the
psychologist’s relationship with all individuals or organizations involved. This includes providing
information about the role of the psychologist (i.e., therapist, consultant, diagnostician, expert
witness), identifying whether the third party or the individual receiving the services is the client,
who will receive information about the services, and probable uses of information gained or
services provided.
Standard 3 Human relation
Pages 91-134
A company asked a psychologist to conduct preemployment evaluations of potential employees. The
psychologist informed each applicant evaluated that she was working for the company, that the
company would receive the test results, and that the information would be used in hiring decisions.
A school district hired a psychologist to evaluate students for educational placement. The psychologist
first clarified state and federal laws on parental rights regarding educational assessments,
communicated this information to the school superintendent and the child’s guardian(s), and explained
the nature and use of the assessments and the confidentiality and reporting procedures the psychologist
would use.
A legal guardian requested behavioral treatment for her 30-year-old developmentally disabled adult
child because of difficulties he was experiencing at the sheltered workshop where he worked. At the
outset of services, using language compatible with the client’s/patient’s intellectual level, the
psychologist informed the client/patient that the guardian had requested the treatment, explained the
purpose of the treatment, and indicated the extent to which the guardian would have access to
confidential information and how such information might be used.
A defense attorney hired a psychologist to conduct an independent evaluation of a plaintiff who claimed
that the attorney’s client had caused her emotional harm. The plaintiff agreed to be evaluated. The
psychologist first explained to the plaintiff that the defense attorney was the client and that all
information would be shared with the attorney and possibly used by the attorney to refute the plaintiff’s
allegations in court. Once the evaluation commenced, the psychologist avoided using techniques that
would encourage the plaintiff to respond to the psychologist as a psychotherapist (Hess, 1998).
A judge ordered a convicted sex offender to receive therapy as a condition of parole. The psychologist
assigned to provide the therapy explained to the parolee that all information revealed during therapy
would be provided to the court and might be used to rescind parole.
Legal Representatives Seeking to Retain a Forensic Psychologist
In many instances, forensic psychologists will be retained by the attorney representing the legal
party’s interests. In such instances, the attorney is the psychologist’s client. During the initial
consultation with a legal representative seeking the psychologist’s forensic services, psychologists
should consider providing the following information: (a) the fee structure for anticipated services;
(b) previous or current obligations, activities, or relationships that might be perceived as conflicts
of interest; (c) level and limitations of competence to provide forensic services requested; and (d)
any other information that might reasonably be expected to influence the decision to contract with
the psychologist (see AP-LS Committee on the Revision of the Specialty Guidelines for Forensic
Psychologists, 2010; Standard 6.04a, Fees and Financial Arrangements).
Implications of HIPAA
Psychologists planning to share information with third parties should also carefully consider
whether such information is included under the HIPAA definition of Protected Health Information
(PHI), whether HIPAA regulations require prior patient authorization for such release, or whether
the authorization requirement can be waived by the legal prerogatives of the third party (45 CFR
164.508 and 164.512). Psychologists should then clarify beforehand to both the third party and
recipient of services the HIPAA requirements for the release of PHI (see also “A Word About
HIPAA” in the Preface of this book).
Standard 3 Human relation
Pages 91-134
3.08 Exploitative Relationships
Psychologists do not exploit persons over whom they have supervisory, evaluative, or other authority such
as clients/patients, students, supervisees, research participants, and employees. (See also Standards 3.05,
Multiple Relationships; 6.04, Fees and Financial Arrangements; 6.05, Barter With Clients/Patients; 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.)
Standard 3.08 prohibits psychologists from taking unfair advantage of or manipulating for their
own personal use or satisfaction students, supervisees, clients/patients, research participants,
employees, or others over whom they have authority. The following are examples of actions that
would violate this standard:
Repeatedly requiring graduate assistants to work overtime without additional compensation
Requiring employees to run a psychologist’s personal errands
Taking advantage of company billing loopholes to inflate rates for consulting services
Encouraging expensive gifts from psychotherapy clients/patients
Using “bait-and-switch” tactics to lure clients/patients into therapy with initial low rates that are hiked
after a few sessions
Violations of Standard 3.08 often occur in connection with other violations of the Ethics Code.
For example:
Psychologists exploit the trust and vulnerability of individuals with whom they work when they have
sexual relationships with current clients/patients or students (Standards 10.05, Sexual Intimacies With
Current Therapy Clients/Patients, and 7.07, Sexual Relationships With Students and Supervisees).
Exploitation occurs when a psychologist accepts nonmonetary remuneration from clients/patients, the
value of which is substantially higher than the psychological services rendered (Standard 6.05, Barter
With Clients/Patients).
Standard 3 Human relation
Pages 91-134
Psychologists exploit patients with limited resources who they know will require long-term treatment
plans when they provide services until the patients’ money or insurance runs out and then refer them to
low-cost or free alternative treatments.
It is exploitative to charge clients/patients for psychological assessments for which the client/patient
had not initially agreed to and that are unnecessary for the agreed on goals of the psychological
evaluation (Standard 6.04a, Fees and Financial Arrangements).
School psychologists exploit their students when, in their private practice, they provide fee-for-service
psychological testing to students who could receive these services free of charge from the psychologist
in the school district in which they work (Standard 3.05a, Multiple Relationships; see also the
Professional Conduct Manual for School Psychology, National Association of School Psychologists,
2010, http://www.nasponline.org/standards/ProfessionalCond.pdf).
Standard 3.08 does not prohibit psychologists from having a sliding-fee scale or different
payment plans for different types or amount of services, as long as the fee practices are fairly and
consistently applied.
Recruitment for Research Participation
Institutional populations are particularly susceptible to research exploitation. Prisoners and
youth held for brief periods in detention centers, for example, are highly vulnerable because of
their restricted autonomy and liberty, often compounded by their low socioeconomic status, poor
education, and poor health (Gostin, 2007). Incarcerated persons have few expectations regarding
privacy protections and may view research participation as a means of seeking favor with or
avoiding punishment from prison guards or detention officials. Inpatients in psychiatric centers or
nursing homes are also vulnerable to exploitive recruitment practices that touch upon their fears
that a participation refusal will result in denial of other needed services. Investigators should ensure
through adequate informed consent procedures and discussion with institutional staff that research
participation is not coerced (Fisher, 2004; Fisher et al., 2002; Fisher & Vacanti-Shova, 2012; see
also Standards 8.02, Informed Consent to Research, and 8.06, Offering Inducements for Research
Participation).
3.09 Cooperation With Other Professionals
When indicated and professionally appropriate, psychologists cooperate with other professionals
in order to serve their clients/patients effectively and appropriately. (See also Standard 4.05,
Disclosures.)
Standard 3 Human relation
Pages 91-134
Individuals who come to psychologists for assessment, counseling, or therapy are often either
receiving or in need of collateral medical, legal, educational, or social services. Collaboration and
consultation with, and referral to, other professionals are thus often necessary to serve the best
interests of clients/patients. Standard 3.09 requires psychologists to cooperate with other
professionals when it is appropriate and will help serve the client/patient most effectively. For
example:
With permission and written authorization of the parent, a clinical child psychologist spoke with a
child’s teacher to help determine if behaviors suggestive of attention deficit disorder exhibited at home
and in the psychologist’s office were consistent with the child’s classroom behavior.
With consent from the parent, a school psychologist contacted a social worker who was helping a
student’s family apply for public assistance to help determine the availability of collateral services (e.g.,
substance abuse counseling).
A psychologist with prescribing privileges referred a patient to a physician for diagnosis of physical
symptoms thought by the patient to be the result of a psychological disorder that was more suggestive
of a medical condition.
In schools, hospitals, social service agencies, and other multidisciplinary settings, a
psychologist may have joint responsibilities with other professionals for the assessment or
treatment of those with whom they work. In such settings, psychologists should develop a clear
agreement with the other professionals regarding overlapping and distinct role responsibilities and
how confidential information should be handled in the best interests of the students or
clients/patients. The nature of these collaborative arrangements should be shared with the
recipients of the services or their legal guardians.
Implications of HIPAA
Psychologists who are covered entities under HIPAA should be familiar with situations in
which regulations requiring patients’ written authorization for release of PHI apply to
communications with other professionals (45 CFR 164.510, 164.512). They should also be aware
of rules governing patients’ rights to know when such disclosures have been made (45 CFR
164.520, Notice of Privacy Practices, and 45 CFR 164.528, Accounting of Disclosures of Protected
Health Information).
Standard 3 Human relation
Pages 91-134
3.10 Informed Consent
(a) When psychologists conduct research or provide assessment, therapy, counseling, or consulting services
in person or via electronic transmission or other forms of communication, they obtain the informed consent
of the individual or individuals using language that is reasonably understandable to that person or persons
except when conducting such activities without consent is mandated by law or governmental regulation or
as otherwise provided in this Ethics Code. (See also Standards 8.02, Informed Consent to Research; 9.03,
Informed Consent in Assessments; and 10.01, Informed Consent to Therapy.)
Informed consent is seen by many as the primary means of protecting the self- governing and
privacy rights of those with whom psychologists work (Principle E: Respect for People’s Rights
and Dignity). Required elements of informed consent for specific areas of psychology are detailed
in Standards 8.02, Informed Consent to Research; 9.03, Informed Consent in Assessments; and
10.01, Informed Consent to Therapy. The obligations described in Standard 3.10 apply to these
other consent standards.
Language
In research, assessment, and therapy, psychologists must obtain informed consent using
language reasonably understandable by the person asked to consent. For example, psychologists
must use appropriate translations of consent information for individuals for whom English is not
a preferred language or who use sign language or Braille. Psychologists should also adjust reading
and language comprehension levels of consent procedures to an individual’s developmental or
educational level or reading or learning disability.
Culture
Individuals from recently immigrated or disadvantaged cultural communities may lack
familiarity with assessment, treatment or research procedures, and terminology typically used in
informed consent documents (Fisher, in press). These individuals may also be unfamiliar with or
distrust statements associated with voluntary choice and other client/patient or research participant
rights described during informed consent. Standard 3.10 requires sensitivity to the cultural
dimensions of individuals’ understanding of and anticipated responses to consent information and
tailor informed consent language to such dimensions. This may also require psychologists to
Standard 3 Human relation
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