After 5 years, seven drafts and a series of public comment periods, psychologists now have a newly revised Ethics Code to guide their work. The 2002 Ethical Principles of Psychologists and Code of Conduct will become effective on June 1 this year.
While perhaps the most notable change pertains to whether psychologists can release raw test data to clients, there were modifications to numerous other portions of the code, such as student publication, informed consent and therapy termination.
"We wanted to make sure the 2002 code was conducive to growth in the field," says Celia Fisher, PhD, director of the Fordham University Center for Ethics Education and chair of APA's Ethics Code Task Force, which had the arduous task of redrafting the code. "We wanted to be sure it reflects the values of the profession, that it's educative for psychologists and consumers of psychological services, and that it is able to guide licensing boards in the many states" that draw upon the code.
To achieve those goals, the task force solicited comments from the public, APA divisions and governance, consumer groups, and others on how the code might be revised. The task force reviewed more than 1,300 comments, and obtained several legal reviews before the Council of Representatives approved the code in August.
Here are some of the most significant changes.
Release of test data
Standards 9.04 and 9.11
The 2002 code eliminates a prohibition in the 1992 code that prevents psychologists from releasing raw test data to individuals who are not qualified to use them. Beginning June 1, psychologists must release test data to clients and their designees when clients provide a written release. The code also stipulates that, in the absence of a client release, psychologists provide test data only as required by law or court order.
The Ethics Code Task Force made the change to clarify the amount of discretion psychologists had in refraining from releasing test data under the Health Insurance Portability and Accountability Act (HIPAA), which directs providers to release certain health information to clients upon request. "What this represents is a shift from a kind of paternalistic, beneficence stance to a more autonomy-based stance that stresses the client/patients' rights to make decisions for themselves about health care," says Fisher.
The 2002 code does permit psychologists to withhold test data to protect the client from "substantial harm or misuse or misinterpretation of the data or the test." However, Fisher cautions that HIPAA does not recognize the misuse or misinterpretation of tests as a legitimate reason to withhold health records, so psychologists should take caution in such situations.
"We understand in 9.04 that all psychologists will not come under HIPAA, and therefore their ethical decision to protect the misuse of tests can certainly be appropriate," she adds.
One other noteworthy change is that the code now includes definitions of "test data" and "test materials." Test data are "raw and scaled scores, client/patient responses to test questions or stimuli, and psychologists' notes and recordings concerning client/patient statements and behavior during examination" as well as "portions of test materials that include client/patient responses." Test materials, as defined in standard 9.11, are "manuals, instruments, protocols, and test questions or stimuli," and do not include test data.
Protections for graduate students in therapy
Standards 7.02, 7.04 and 7.05
In response to concerns voiced by graduate students, the 2002 code includes several revised and new standards to protect the privacy of psychology students who attend graduate programs that require psychotherapy as part of training:
7.02 requires that such programs clearly note on their applications that psychotherapy is a program requirement.
7.04 states that students and supervisees are not required to discuss personal information regarding sexual history, history of abuse and neglect, psychological treatment, and relationships with parents, peers and spouses or significant others. There are two exceptions: if the program has clearly stipulated this preference in its admissions and program materials or if students' personal problems appear to be affecting their performance or are a threat to themselves or others.
7.05 specifies that, if therapy is required as part of a program, the program must allow students to select a therapist from outside the program. "However, it does not prohibit programs from approving the credentials of the outside therapist," adds Fisher.
Informed-consent requirements for experimental research Standard 8.02b
For the first time, the Ethics Code lays out the parameters of informed consent explicitly for psychologists conducting intervention research on experimental treatments. Researchers are now required to inform participants of the following:
The experimental nature of the treatment.
The services that will or will not be available to the control group(s).
The means by which assignment to treatment and control groups will be made.
Available treatment alternatives if an individual does not wish to participate in the research or wishes to withdraw once a study has begun.
Compensation for or monetary costs of participating, including whether reimbursement from the participant or a third-party payor will be sought.
"This was something we were asked a lot of questions about," says Fisher. "Treatment research is different from nonclinical research in that many times one is working with individuals who need or are seeking help....It's important for [these] individuals who may be more vulnerable to understand the experimental nature of what they're being involved in."
There are also new subsections in the assessment section, including:
9.02, which emphasizes that psychologists should only use assessment instruments that are valid and reliable for the population being tested. If validity or reliability haven't been established, they should describe the strengths and limitations of their results and interpretation. It also directs psychologists to use assessment methods appropriate for an individual's language preference and competence, unless the use of another language is relevant to the assessment.
9.03, which stipulates that informed consent in assessments includes the nature and purpose of the assessment, fees, involvement of third parties, confidentiality limits and a chance for clients to have their questions answered. Moreover, in instances when informed consent may be waived--when testing is mandated by law or government regulation, when informed consent is implied or when evaluating decisional capacity--psychologists should still provide information about the assessment in understandable language.
Publication credit for students
While both the 1992 and 2002 codes assert that publication credit should be based solely on an individual's contributions, the 2002 standard on student publication is somewhat different from the 1992 standard:
The standard includes new language mandating that faculty advisers discuss publication credit with students as early as feasible and throughout the research and publication process. This provision applies to students at all levels of higher education.
The standard now reads that, except under exceptional circumstances, doctoral students should be listed as first author on any article substantially based on their dissertation. This language differs from the 1992 code in that it no longer applies to master's theses. Like the 1992 code, it includes an exemption for extenuating dissertation circumstances, such as when several students are writing dissertations on a large research project published as a whole.
During the revision process, the Ethics Code Task Force received many comments expressing concerns over the 1992 requirement that master's students be listed as the primary author on work substantially based on their theses. Because many students write theses on work to which they are not the chief contributors, making them the first author on such work could conflict with other standards that stipulate that authorship reflect contribution.
"There are many instances where the student should be the first author," says Fisher, "Standards 8.12a and b cover that. But there are instances where it would not be appropriate, and therefore we didn't want to make it a rule."
Moreover, says Fisher, the added language about student-faculty discussions of publication credit mean master's students will be able to discuss with their advisers the different research and publications options before beginning their theses.
Informed consent in therapy
A new subsection in the 2002 code directs psychologists to tell their patients when they would like to use a new treatment for which "generally recognized techniques and procedures" haven't been established. This informed consent process should include discussions of the developing nature of the treatment, the potential risks, alternative treatments and the voluntary nature of the client's participation.
While psychologists are now required to tell patients if a treatment is experimental, the Ethics Code does not prohibit the use of new treatments, notes Fisher, as long as they are based on scientific or professional knowledge.
When to terminate therapy
New to the 2002 code, this subsection specifies that psychologists can terminate therapy when threatened or endangered by clients or another person with whom the client has a relationship. There is no similar language in the 1992 code.
The addition was made, Fisher explains, to address psychologists' concerns that by halting treatment of a threatening client they could be accused of abandonment.
"You're not required to endanger yourself," she says.
Several other provisions will carry over from the 1992 code, including that psychologists may terminate therapy when the client no longer needs the service, is not likely to benefit or is being harmed by continued service. Also, except when precluded by clients or third-party payors, psychologists must provide pretermination counseling and suggest alternative service providers prior to termination.
The 2002 code explicitly defines multiple relationships for the first time, and points out that not all multiple relationships are unethical. Specifically, it says:
"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 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."
"We've become more informative by defining multiple relationships and underscoring the fact that multiple relationships that are not harmful or going to impair your judgment or limit your effectiveness are not unethical," says Fisher.
Specifically, the standard says that multiple relationships that "would not reasonably be expected to cause impairment or risk exploitation or harm" are not unethical. However, the code says psychologists refrain from multiple relationships if they could reasonably be expected to impair the psychologists' professional performance or could exploit or harm the other individual.
The 2002 code also includes:
Specific language that states that the code's General Principles are aspirational in nature, and--in contrast to the Ethical Standards--"do not represent obligations and should not form the basis for imposing sanctions."
Definitions of modifying words in the code, such as "reasonably," "appropriate" and "potentially."
Separate standards for education and training, and research and publication. Under the 1992 code, section 6 covers teaching, training supervision, research and publishing. The 2002 code's section 7 specifically addresses education and training, while section 8 focuses on research and publication.
Language in Standard 1.08 that prohibits any unfair discrimination against people filing or responding to an ethics complaint. The 1992 code's equivalent, Standard 1.11, only applies to sexual harassment. Fisher notes that the 2002 standard does not preclude organizations or individuals from taking appropriate action after the complaint is adjudicated.
Additions to address the use of interpreters. Standard 2.05 says that psychologists should take reasonable steps to avoid interpreters who have multiple relationships with clients, and that the translator should be competent. Standard 9.03c requires psychologists who use an interpreter to obtain informed consent from the client to use that interpreter, ensure the confidentiality of test results and include the limitations of the data when giving recommendations, reports, evaluations or forensic testimony.
A new standard, 10.03, which explicitly stipulates that psychologists who provide group therapy describe at the outset the roles and responsibilities of all parties and the limits of confidentiality.
Language throughout the code that addresses the Internet and electronic transmission. For example, Standard 4.02c stipulates that psychologists who offer services, products or information via electronic transmission inform their clients of the risks to privacy and limits of confidentiality.
While these are some of the most significant changes, psychologists should read the entire new code to see what other provisions may affect their work. The new code was published in the December American Psychologist (Vol. 57, No. 12) and is on the APA Ethics Office Web site: www.apa.org/ethics. It takes effect on June 1.