Ethics Rounds

Recently "Ethics Rounds" received two letters regarding titles. The first letter concerns titles that graduate students sometimes use:

Dear "Ethics Rounds,"

I am director of an organization of graduate students, and notice that some students sign their correspondence "PhD Candidate" or "PsyD Candidate." I have also seen "ABD" after names. What are the ethical implications of using such titles?

The second letter comes from the chair of a state psychological association ethics committee, who writes about a debate in his state:

Dear Ethics Rounds:

…Is it an unethical practice for psychologists in states…which do not license subspecialties in psychology to represent themselves in advertising and other ways (e.g., letterhead, signature lines, telephone communications with potential clients or referral sources) as a "licensed (fill in the blank) psychologist"? Some common examples include: Licensed Clinical Psychologist; Licensed Child Psychologist; Licensed Forensic Psychologist; Licensed Neuropsychologist; etc.

It is my understanding (although I do not know this to be a fact) that some states license subspecialties within psychology such that in those states it may be accurate to describe oneself as a "licensed clinical psychologist" and so on. In states such as [my own], however, which do not license subspecialties, many psychologists describe themselves a "licensed (fill in the blank) psychologist." While some argue that referring to oneself in this manner is acceptable because it merely conveys information relevant to the psychologist's area of specialized training and expertise, others argue that it constitutes misrepresentation of the psychologist's credentials....[A]t least one consumer has complained about the practice...

Recently I sat down for coffee with a journalist who writes for a newspaper distributed widely in the United States and abroad. I was expressing my dissatisfaction with how APA had been portrayed by him and others on a topic that had garnered national and international media attention. I was particularly annoyed by how APA had been compared-unfairly and inaccurately, in my opinion-with psychiatrists on this topic, a point that I impressed upon him at length. After listening carefully and patiently, the journalist replied, "Dr. Behnke, I understand what you're saying. But if you walked out onto the street and began asking people the difference between a psychologist and a psychiatrist, I would be surprised if more than half the people you stop could accurately describe that difference." While I believe this journalist overstated his point, I also believe that there was something important in what he was telling me.

The vast majority of us are highly engaged in our professional lives and have been so since the beginning of our graduate studies. Psychology is more a vocation than a job. By virtue of our being immersed in our work and in our field, it can be easy to lose our perspective and forget that others, sometimes those who come to seek our services, may understand very little about what we do and what training and credentials are necessary for our work. Often it falls upon us to educate them.

APA views the manner in which psychologists convey their training and credentials as having an explicitly ethical aspect. The ethical component stems from recognizing that the psychologist-client relationship is fiduciary in nature. Because the relationship is built upon trust, honesty and openness are integral parts of the relationship. Our honesty and openness also make important information available for our clients' consideration and thus enhance our clients' ability to make more fully informed and autonomous choices about their treatment. The Ethics Code therefore makes honesty and openness about our training and credentials part of our ethical obligations. As an example, the Ethics Code emphasizes the importance of informing clients whether an individual has completed training:

10.01 Informed Consent to Therapy

(c) When the therapist is a trainee and the legal responsibility for the treatment provided resides with the supervisor, the client/patient, as part of the informed consent procedure, is informed that the therapist is in training and is being supervised and is given the name of the supervisor.

As another example, the Ethics Code emphasizes the importance of accuracy and transparency in conveying our credentials:

5.01 Avoidance of False or Deceptive Statements

(a) Public statements include but are not limited to paid or unpaid advertising, product endorsements, grant applications, licensing applications, other credentialing applications, brochures, printed matter, directory listings, personal resumes or curricula vitae, or comments for use in media such as print or electronic transmission, statements in legal proceedings, lectures and public oral presentations, and published materials. Psychologists do not knowingly make public statements that are false, deceptive, or fraudulent concerning their research, practice, or other work activities or those of persons or organizations with which they are affiliated.

(b) Psychologists do not make false, deceptive, or fraudulent statements concerning (1) their training, experience, or competence; (2) their academic degrees; (3) their credentials; (4) their institutional or association affiliations; (5) their services; (6) the scientific or clinical basis for, or results or degree of success of, their services; (7) their fees; or (8) their publications or research findings.

The authors of these two letters to "Ethics Rounds" are struggling with how a particular practice fits with our sensibilities and obligations as ethical psychologists. A similarity between the two letters is that while the meanings and implications of the titles queried about in each are likely apparent to people in the field, they are very likely not apparent to those outside the field. Whether a particular title is misleading therefore requires asking "Misleading to whom?"

"PhD Candidate" is a recognized status within academic departments that indicates what degree requirements the student has completed and what remains to be done. "ABD" is not an official status, but is shorthand for where a student stands in an academic program. "PhD Candidate" and "ABD," because they convey information in a clear and succinct manner to those who are familiar with academic programs, can be useful when communicating with colleagues within academic communities. To people outside academic communities or who have never been in a doctoral program, however, these terms may be obscure at best in terms of what they are intended to convey. Many of the people who seek clinical services from psychologists in training will have little or no familiarity with academic culture or nomenclature. Like beauty, clarity is in the eyes of the beholder. The Ethics Code directs us to look through the eyes of the beholder.

The same analysis can be applied to the second letter. "Licensed psychologist" conveys in a straightforward manner that the state has granted an individual a psychology license. When a word such as "child" or "forensic" or a prefix such as "neuro" is placed between "licensed" and "psychologist," the implication is that the state recognizes a status in addition to the status of psychologist. If the state does not recognize any such status, the title can easily mislead someone unfamiliar with the state's licensing law. Note the difference between "licensed forensic psychologist," and "licensed psychologist, with a forensic practice." The latter does not imply that the state recognizes a special forensic expertise or that this psychologist has achieved a level of state recognition over and above that of being a psychologist. "Licensed psychologist, with a forensic practice" implies rather that the psychologist is licensed by the state and has a particular area of specialty.

The Ethics Code envisions a relationship of trust between psychologists and their clients. Providing relevant information in a straight-forward and transparent way can be essential to that trust and enhances our clients' autonomy by promoting more fully informed and autonomous choices. The Ethics Code explicitly recognizes the importance of how we present ourselves to our clients, and it is most in keeping with the Ethics Code when we present our credentials-often among the first pieces of information a client receives about us and the services we provide-in an ethically sensitive manner that paves the way for a clinically productive relationship.

Further Reading

Send questions, comments or suggestions regarding "Ethics Rounds"–or submit vignettes (without identifying information) for column discussion–via e-mail. "Ethics Rounds" welcomes your involvement and will confer with authors before publishing letters to discuss style and any confidentiality concerns.

Previous "Ethics Rounds" columns can be found at APA Ethics, in the "From the Director" section.