Ethics Rounds

One of the great privileges and pleasures of serving as director of APA's Ethics Office is occasionally having the opportunity to speak with colleagues from around the world about their work. I write this column from China, where I am a guest of the University of Hong Kong department of psychology. This week, I taught a class of 19 graduate students, met with practicing psychologists, discussed research ethics with the research and academic faculty, visited the university's counseling center and, overlooking Victoria Harbour, shared dinner with a group of psychologists revising the Hong Kong Psychological Society's Code of Conduct.

Teaching class

The official language of the University of Hong Kong is English, although walking the halls, one is more likely to hear Cantonese, a beautiful, lilting language. The 19 students in professor Tatia Lee's course on ethical and professional issues are in their second year of a two-year master's program in clinical psychology. The students expect to complete their degrees in August. At present, there is no licensure for psychologists in Hong Kong. Graduates with master's degrees can work independently, although many accept jobs in government settings for more experience once they have passed the civil service examination.

The students were bright and eager for our morning meeting-many had a cup of Starbucks coffee in their hands. I was struck by the similarities in the issues that psychology students in the United States address-child-abuse reporting, multiple relationships, self-disclosure-but what caught me most was the language with which the students captured central ethical issues. One student, Ms. Trista Chan, when discussing the importance of confidentiality in psychotherapy, said simply that confidentiality is important because "people speak to psychologists from deep within their hearts," an image that I found particularly compelling and that will stay with me for a very long time.

The university counseling center

Dr. Eugenie Leung, director of the university's counseling center, greeted me warmly as she welcomed me into her office and described the work she and her colleagues do with the university community. Dr. Leung explained that students come to the university with a variety of problems, many involving romantic relationships and difficulties adjusting to university life-challenges that would resonate with psychologists in U.S. college and university counseling centers. I noted with interest that alcohol is not considered a significant problem at the university-drinking is apparently not a large part of the school's culture. She has noticed a rise in depression, anxiety and psychoses in both the community and student populations. Also similar to the United States, student suicide is a serious concern.

Dr. Leung stressed the importance in her work of outreach to the university community, with a focus on promoting positive psychology and character strengths. She showed me a poster for a series of programs she and her colleagues had sponsored titled "The Diversity of Love." The program offered speakers on a variety of topics from difficulties with parents ("My Fussing Mom/Dad!") to same-sex relationships ("Love Beyond Boundaries"). What caught my eye about the poster was its design: Dr. Leung and her colleagues had used images from chess to illustrate specific topics, with a black and white background mimicking a chessboard. Next to the description of a talk about the relationship between love and sex, sat a bishop chess piece looking unmistakably like a condom (you'll see the similarity if you get out your chess set); next to the talk about parents was a queen towering over a pawn. The poster struck me as an exceedingly clever way to couple familiar images with language to invite the students into discussions about uncomfortable and important topics with which many would certainly be struggling.

In my discussion with Dr. Leung, she mentioned several other interesting aspects of her work. She explained that while there was not undue stigma attached to coming to the counseling center, she hoped that being part of the one-stop student service center-the Centre of Development and Resources for Students, or "CEDARS"-would help encourage students to use its services. Dr. Leung mentioned that there is no limit on the number of sessions the students may have. At present, a student can be seen within two weeks of contacting CEDARS, although the university plans to increase the number of students and she believes this will likely affect how quickly a student can be seen. In response to my questions about the "Diversity of Love" program, she explained that the situation regarding stigma against homosexuality and bisexuality "is getting better." There is an independent gay and lesbian student organization, and CEDARS and the student population are supportive of a diversity policy. I asked Dr. Leung whether she and her colleagues have any contact regarding mutual interests and concerns with colleagues in U.S. university and college counseling centers. Dr. Leung said that she is working on and welcomes international connections. (APA members interested in Dr. Leung's work may contact her at e-mail or browse the CEDARS Web site www.cedars.hku.hk).

Revising the Code of Conduct

I had the pleasure of having dinner at the Hong Kong Yacht Club with Mr. Helios Lau, chief clinical psychologist for the Hong Kong Social Welfare Department and chair of the group revising the Hong Kong Psychological Society's (HKPS) Code of Conduct, and two senior psychologist colleagues in his department. The Hong Kong Psychological Society, with about 500 members, has four divisions: educational, counseling, clinical and industrial/organizational. Mr. Lau has the challenging task of revising the code in a manner that speaks to the entire society membership.

I was struck during our dinner by the similarity of issues that confront APA and HKPS members. How to maintain the security of psychological tests, especially in the context of litigation, is the subject of intense discussion. Also, and very surprising to me, during my meeting with practicing psychologists the issue of multiple relationships (the population of Hong Kong is more than 7 million) was presented as being of considerable interest to the community of psychologists here.

As I reviewed their current code of conduct (www.hkps.org.hk/www/code.htm), many aspects caught my attention. One paragraph states, "Should Members have cause to disagree with colleagues on professional issues, they must nevertheless refrain from criticizing colleagues in public or in a manner which casts doubt on their professional competence." I could not but help wonder how this clause would apply to posts on psychology listservs that I have seen. (The clause provides an exception for evaluating published work.)

It was also interesting to see two issues-self-disclosure and touch-the ethical aspects of which psychologists in the United States frequently ponder, explicitly addressed in the HKPS Code of Conduct. The paragraph on self-disclosure reads "Psychologists should exercise reasonable restraint in self-disclosures to clients, which should be made only if they contribute to the client's understanding of an issue, as an appropriate means of establishing rapport or trust, or as part of a therapeutic dialogue." The paragraph addressing touch states "Any physical contact (e.g., hug or pat) made by the psychologist should be made as a gesture of support and only if the clients indicate that they feel comfortable with such contact." I will be eager to follow the progress of Mr. Lau and his colleagues as they work toward a final draft of the revised code.

Tomorrow I am off to Guam, for a workshop with the Guam Psychological Association. I've had a wonderful experience here in Hong Kong and now look forward to discussing ethics with a group of APA's own members, albeit far from home. It's an impressive experience to see psychology so vibrantly practiced throughout the world, and leaves me feeling that I'll return to APA headquarters in Washington, D.C., much richer and more educated than when I set out on my trip.


Stephen Behnke is director of APA's Ethics Office.