APA task force considers changes to proposed ethics code

Revisions to APA's 1992 Ethical Principles of Psychologists and Code of Conduct is now in full swing. Since its first call for comments in 1998, the APA task force charged with the revision has received almost 600 comments. Guided by those members' responses, the 13-member task force is tweaking its proposals and suggesting new ones.

"This is how the process is supposed to work," says Celia B. Fisher, PhD, chair of the APA Ethics Code Task Force (ECTF). "We are welcoming input from members, reacting to their suggestions and looking forward to more comments from them during APA's August convention."

The task force hopes to publish a first draft of the revised code in early 2001. The group will then use the feedback that draft elicits to produce a second draft, which it will submit to APA's Council of Representatives for a final decision.

Changes in thinking

An article about the task force's proposed code revisions in the July/August 1999 Monitor prompted a wave of responses, says Fisher.

For example, feedback from some members persuaded the task force to change its thinking on its proposal to ban in perpetuity all sexual relationships with former clients. The current code bans all sexual relationships with former clients for two years after the termination of professional services and in all but the most unusual circumstances after that. Even then, the psychologist bears the burden of demonstrating that no exploitation has occurred.

"Since we have no evidence that the current standard isn't working, we decided to leave it alone," says Fisher. "One of the guiding principles of the task force is, 'If it ain't broke, don't fix it.'"

A recent court decision against the Florida Board of Psychology's life-time ban on sexual relationships with former clients--although not a basis for the ECTF's decision--underscores the fact that courts look carefully at restrictions on fundamental rights, that they want to see objective bases for any such restrictions, and that they prefer a standard that allows flexibility and the ability to take into consideration the facts and circumstances of a given case.

In the case, Glenn R. Caddy v. State of Florida, Department of Health, Board of Psychology, the court found that there was no clear evidence that such a restriction on privacy rights and rights of association was necessary. The court also noted that the state's psychiatrists were not subject to the same restriction, since their sexual relationships were evaluated on a case-by-case basis to determine whether former patients had been harmed.

Other changes

Another proposed revision that generated feedback was one that urged psychologists who see clients in both group and individual settings to guard against possible "multiple relationship" violations. Members objected to the implication that seeing patients in both situations was therapeutically unsound and left them more vulnerable to such violations than other types of therapy. The task force agreed with members' concerns and has since eliminated that proposal.

Feedback has also helped convince the task force it needs to reduce the code's length. In the current code, Fisher explains, some standards are repeated in various places. The revised code will eliminate those redundancies, using a general section to explainstandards applicable to all psychologists and highlighting issues specificto certain settings in the appropriate sections.

For example, the general section will contain a standard requiring psychologists to obtain informed consent for most activities. The sections on psychotherapy, research and other settings will contain standards alerting these psychologists to special issues they need to watch out for.

Since last year's Monitor article, the task force has proposed several additional changes:

• Prohibiting sexual relationships with relatives of current psychotherapy clients.

• Protecting graduate students in programs requiring individual or group therapy. The task force's recommendations include requiring programs to inform applicants of such requirements in advance, prohibiting faculty responsible for evaluating students' performance from providing their therapy, allowing students to fulfill therapy requirements outside their programs and not requiring students to reveal embarrassing or upsetting information.

• Giving psychologists more latitude to provide services to individuals for whom appropriate mental health services are not available and for which the psychologist has not had the time to obtain the competence necessary. The standard would require psychologists to advise clients of their limitations and either refer them to appropriately trained providers as soon as possible or make reasonable efforts to obtain the necessary training themselves.

• Adding new rules governing informed consent for psychologists providing individual and forensic assessments, providing treatments for which standards don't yet exist and conducting clinical research involving experimental treatments. The task force may also develop a more specific standard providing guidelines for waiving informed consent in research.

• Requiring psychologists who provide information, services or products electronically to inform users of the medium's limitations on privacy and confidentiality.

• Modifying a current standard related to withholding records for nonpayment. The current standard prohibits psychologists in this situation from withholding records that are "imminently needed." The task force recommends a substitution that would prohibit psychologists from withholding records needed for clients' emergency treatment solely because payment hasn't been received.

• Clarifying a standard that allows psychologists to terminate professional relationships when clients or their families threaten or otherwise endanger them.

"Our job is far from finished," says Fisher. "Comments and concerns will continue to play a critical role in the construction of a revised ethics code that reflects the values and merits the trust of the membership."

To submit a comment or critical incident to the Ethics Code Task Force, send it to APA's Office of Ethics at 750 First St., N.E., Washington, DC, 20002-4242; fax to (202) 336-5997; or e-mail to Ethics Office.

Rebecca A. Clay is a writer in Washington, D.C.