If you saw another psychologist do something that appeared unethical, would you know how to respond?
Many psychologists don't, says Beth Kaplan Westbrook, PsyD, co-chair of APA's Advisory Committee on Colleague Assistance (ACCA) and a private practitioner in Portland, Ore. They may be unsure about laws in their state and how those laws interact with APA's Ethics Code. They may lack the information they need. Or they may be nervous about the liability issues that could arise, either from reporting a colleague or failing to do so.
ACCA is working to make sure psychologists are clear about how to react when a colleague needs help. In addition to creating a series of online resources, the group is urging state, provincial and territorial psychological associations (SPTAs) to create colleague assistance programs that can stop problems before they become crises.
"Health professionals aren't immune from the same problems that affect the general public," says Westbrook, citing as examples substance abuse and mental health disorders. "ACCA's main purpose is not only to help people get the treatment they need, but also to focus on prevention—to have programs in place so that psychologists can seek help or refer colleagues as problems arise."
A state-by-state basis
According to APA's Ethics Code, psychologists who believe another psychologist may have committed an ethical violation should first try an informal resolution. As long as it seems appropriate and intervening doesn't violate confidentiality rights, they should bring the issue to the other psychologist's attention and try to resolve the matter one-on-one.
If that doesn't work or the apparent violation is serious, says the Ethics Code, the psychologist should take further action appropriate to the situation. That might mean reporting the individual to a state or national committee on professional ethics, the state licensing board or institutional authorities. One caveat: The standard doesn't apply if intervening would violate confidentiality rights or if you've been retained to review the psychologist's conduct.
According to Stephen Behnke, JD, PhD, director of APA's Ethics Office, state laws governing confidentiality, privilege and mandatory reporting vary considerably. Psychologists, he says, should be familiar with the rules in their own jurisdiction governing the disclosure of confidential information.
"Consulting an expert on your jurisdiction's mental health law can be enormously helpful," says Behnke.
But many psychologists don't know the law in their states, says Westbrook.
Oregon, for example, has a law requiring psychologists to report unethical behavior. But when the Oregon Colleague Assistance Committee surveyed Oregon Psychological Association members, the group found that nearly three-quarters erroneously thought that they were required to report unethical behavior revealed in the context of a therapeutic relationship, whether psychotherapy or a peer review group. Instead, says Westbrook, privilege trumps the duty to report unethical behavior. Plus, many psychologists weren't aware that Oregon has a law protecting people from civil actions if they report health professionals to regulatory boards in good faith.
Because the issues are so tricky, ACCA suggests that every SPTA create a colleague assistance program or at the very least appoint an individual or task force to review state laws related to the duty to report unethical behavior, privilege and peer review issues, and consult with a mental health attorney familiar with the state's laws. Only 26 of the 60 SPTAs have colleague assistance programs or more informal services, according to ACCA's latest research.
To help SPTAs, ACCA has created several resources on such topics as how to create colleague assistance programs, confidentiality and liability issues, and prevention strategies. (To access the materials, visit PsycLINLK and log in under the upper right log in, then select PsycLINK. Or log on to MyAPA and click on the link at left.)
A colleague assistance program doesn't have to be elaborate, says ACCA member Wendy A. Plante, PhD, a member of the Rhode Island Psychological Association's new colleague assistance committee.
"We're a small state so one of the challenges is that there are only so many resources to go around," says Plante, a clinical associate professor of psychiatry and human behavior at Brown University's Alpert Medical School. "We've learned that you can start a colleague assistance program on a really small scale and get a good response."
Established in 2011, Rhode Island's program focuses on prevention and education, offering workshops on wellness and similar topics plus a consultation line. Psychologists can call for help if they have a problem or think someone else does, whether it's coping with the impact of personal illness on practice or addressing such direct ethical concerns as practicing within one's competence or preventing boundary violations.
In larger states, says Plante, colleague assistance programs may do much more. In addition to prevention-oriented workshops and consultation lines, they may run diversion programs that provide treatment so psychologists who have had infractions—or who are at risk of doing so—get the help they need rather than simply punishing them. These larger programs may also go beyond educating psychologists about laws to engaging in advocacy designed to improve those laws. "But don't feel intimidated by feeling that you have to do it all," says Plante.
For colleagues who have observed unethical behavior, says Plante, a colleague assistance program can help you work through what to do.
"We try not to provide advice," she says. "Our goal is just to be educational."
Psychologists handling such calls might review APA's Ethics Code or relevant clinical issues with callers. They might review legal and risk management issues. They might suggest resources, such as expert consultation with a mental health attorney, university or hospital ethics committee or treatment resources for psychologists in need.
Confronting a colleague can be difficult, says ACCA member Glen A. Martin, PhD, chair of the North Carolina Psychological Association's colleague assistance program. And graduate programs typically explain psychologists' obligations but not the mechanics of confronting someone and dealing with the aftermath.
"It's a difficult thing to do, but important," says Martin. "My advice is to try to look at it as a win/win situation: You are helping a colleague avoid a potentially difficult and embarrassing situation and helping the profession maintain its reputation."
Rebecca A. Clay is a writer in Washington, D.C.