Ethics Rounds

BY DR. STEPHEN BEHNKE APA Ethics Director

According to its preamble, the new APA Ethics Code "has as its goals the welfare and protection of the individuals and groups with whom psychologists work and the education of members, students and the public regarding ethical standards of the discipline." Standard 3.05, on multiple relationships, is an excellent example of how the code achieves these goals. To illustrate how it both protects and educates, Standard 3.05 can be broken down into five parts.

The first paragraph of the standard offers a definition that is new to the code. The definition states that a multiple relationship arises when a psychologist is in a professional role with an individual, and that, in addition to this professional role, one of three other conditions is met. Note the future aspect to the third condition--that the psychologist indicates that another relationship will occur at some later point in time.

STANDARD 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.

The first paragraph of Standard 3.05 thus informs psychologists and the public what constitutes a multiple relationship.

One of the most frequent misconceptions I encounter in consulting with psychologists is that multiple relationships are, by definition, unethical. The second paragraph of Standard 3.05 makes it clear that simply meeting the definition does not speak to the ethics of the multiple relationship. In order to assess the ethical appropriateness of the relationship, the second paragraph sets forth a test:

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.


Note several things about this test. First, the test sets out criteria: an impairment in objectivity, competence or effectiveness, and a risk of exploitation or harm. In assessing whether the test is met, the psychologist will therefore consider the likelihood of impairment or the risk of exploitation or harm. Second, the phrase "reasonably expected" is central in determining what level of likelihood must be present: what a reasonable psychologist would expect to occur. Would a reasonable psychologist expect that the multiple relationship will cause impairment or risks exploitation or harm? If a reasonable psychologist would not, the test is not met.

Third, there must be a causal connection between the multiple relationship and the impairment or risk. In other words, something about the relationship must reasonably lead a psychologist to expect that the relationship will cause impairment or risks exploitation or harm. Thus, that a multiple relationship exists, in and of itself, does not meet the test--a reasonable psychologist must expect that the multiple relationship will lead somewhere problematic. The third paragraph in Standard 3.05 emphasizes this point:

Multiple relationships that would not reasonably be expected to cause impairment or risk exploitation or harm are not unethical.


The definition in Standard 3.05 educates psychologists and the public about when a multiple relationship is present. The test that follows protects those with whom psychologists work, and thereby promotes their welfare, by making a safe space available for the psychologist and client to proceed.

One of the very enjoyable aspects of my position directing the APA Ethics Office is that I have the opportunity to listen to psychologists discuss ethical aspects of their work. Discussions about Standard 3.05 are especially interesting because of the wide variety of multiple relationships that arise in our profession. Often, though, I find myself thinking that a discussion ostensibly about the ethics of multiple relationships is not really about ethics at all.

What I mean is that often such discussions pose a specific question: whether a multiple relationship will lead to impairment or risks exploitation or harm. All the participants agree that if the multiple relationship were likely to lead to impairment or such risks, the relationship should be avoided. Thus, the debate is not about values--protecting from harm and promoting welfare--but is rather about what effect a particular multiple relationship will have on a particular client. While the answer to this clinical question has profound ethical implications, the disagreement remains on clinical and technical grounds. As psychologists, we can agree upon and share the underlying values.

The APA Ethics Code recognizes that because of the many roles psychologists assume in their work, family, community and social lives, multiple relationships arise in unexpected ways. Some of these multiple relationships are potentially harmful. The fourth paragraph in Standard 3.05 addresses potentially harmful, unanticipated multiple relationships:

(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.
Note that the touchstone is again what a reasonable psychologist would do. The psychologist's focus will be on the affected person's best interests and on complying with the Ethics Code, which has as its focus the individual's welfare and protection. Thus, the Ethics Code continues to return to and emphasize its central values of doing good and not doing harm, found in Principle A of the code's General Principles, Beneficence and Nonmaleficence.

In its fifth and final paragraph, Standard 3.05 recognizes that psychologists are sometimes required to serve in more than one role in judicial or administrative proceedings, and so cannot always avoid or fully resolve a potentially harmful multiple relationship. When a psychologist encounters such a situation, the Ethics Code focuses the psychologist on informing those affected about the change in expectations. The reasoning behind the code's language is that if a psychologist must take on a potentially harmful multiple role, the best way to help protect those affected is to inform them of the change in circumstances:

(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.)
Thus, Standard 3.05:

* Defines a multiple relationship.

* Provides a test for when psychologists refrain from entering into a multiple relationship.

* Indicates what psychologists do when an unanticipated and/or unavoidable multiple relationship arises in their professional lives.

The goal of Standard 3.05, like the goal of the code as a whole, set forth in the preamble, is "the welfare and protection of the individuals and groups with whom psychologists work and the education of members, students and the public regarding ethical standards of the discipline."

Standard 3.05 illustrates that an excellent way to protect our clients and promote their welfare is to educate the public about our profession's core values and to inform psychologists about how these values can be implemented in their everyday practice.

For the full text of APA's Ethics Code, visit the Ethics page.

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