Ethics Rounds

APA's Ethical Principles of Psychologists and Code of Conduct sets forth the core values of our profession. The title of the document conveys that the Ethics Code consists of two central aspects: a set of principles and a code of conduct. While the code tells us that the principles are aspirational in nature and that the ethical standards are enforceable rules for conduct, much more can be said about this subtle and rich relationship.

Principle E of the code's General Principles, "Respect for People's Rights and Dignity," begins by stating "Psychologists respect the dignity and worth of all people, and the rights of individuals to privacy, confidentiality and self-determination." Throughout the code are examples of how psychologists respect their clients' right to self-determination. Respecting a client's right to self-determination both manifests a core value of our profession and plays a helpful and important role in providing services that will benefit clients.

Perhaps the most apparent way in which the new code supports a client's right to self-determination is found in four ethical standards with "informed consent" in their title: Standard 3.10, "Informed Consent"; Standard 8.02, "Informed Consent to Research"; Standard 9.03, "Informed Consent in Assessments"; and Standard 10.01, "Informed Consent to Therapy." Obtaining informed consent respects a client's right to self-determination by informing the client about central aspects of the relationship and obtaining from the client consent to proceed. Through the process of becoming informed, the client receives information on which to base a considered decision; through the process of obtaining consent, the psychologist ensures that the decision to proceed belongs to the client and is not the product of coercion.

The process of obtaining informed consent also holds important clinical meanings. Through informed consent, the client is made a collaborator in the work. Research has shown that when clients experience themselves to be true partners in the therapeutic process, the likelihood of a beneficial outcome increases. Here is an excellent example of how good ethics can promote good clinical care.

The Ethics Code emphasizes and elaborates the centrality of informed consent in a variety of ways. Standard 3.10, in the "Human Relations" section, provides that psychologists obtain informed consent when they "conduct research or provide assessment, therapy, counseling or consulting services," while other standards take this general language and apply it to specific circumstances: Standard 8.02 to research, Standard 9.03 to assessments, and Standard 10.01 to therapy. Numerous other standards that do not make explicit mention of "informed consent" nonetheless promote self-determination and autonomy, as well as excellent client care.

An example of a standard containing the concept, but not the term "informed consent," is Standard 3.07, "Third-Party Requests for Services." Standard 3.07 contains language from the 1992 Ethics Code with an interesting and helpful addition:

3.07 THIRD-PARTY REQUESTS FOR SERVICES

When psychologists agree to provide services to a person or entity at the request of a third party, psychologists attempt to clarify at the outset of the service the nature of the relationship with all individuals or organizations involved. This clarification includes the role of the psychologist (e.g., therapist, consultant, diagnostician, or expert witness), an identification of who is the client...



The new language is the phrase, "an identification of who is the client." The APA Ethics Office receives numerous requests for consultation, a significant portion of which involve third-party requests for services. Often a problem arises in this context because the psychologist has not identified the client and, following provision of a service, must decide who controls the release of a report or who may receive other confidential information. Not having identified the client (perhaps not knowing exactly who the client is) can cause major complications for all of the parties involved, including and especially the psychologist. By virtue of the new language in Standard 3.07, psychologists will think through--in order to clarify--"at the outset of the service" who their client is, and thereby minimize the likelihood that problems will arise later that interfere with the efficient and effective provision of psychological services.

Ethical Standard 3.11, "Psychological Services Delivered To or Through Organizations," is a second such example:

3.11 PSYCHOLOGICAL SERVICES DELIVERED TO OR THROUGH ORGANIZATIONS

(a) Psychologists delivering services to or through organizations provide information beforehand to clients and when appropriate those directly affected by the services about (1) the nature and objectives of the services, (2) the intended recipients, (3) which of the individuals are clients, (4) the relationship the psychologist will have with each person and the organization, (5) the probable uses of services provided and information obtained, (6) who will have access to the information, and (7) limits of confidentiality. As soon as feasible, they provide information about the results and conclusions of such services to appropriate persons.



While perhaps tempting, I believe it would be unfortunate for psychologists to read Standard 3.11 primarily as a "laundry list" of items about which organizations and individuals must be informed. Rather, Standard 3.11 can be used as a tool to help psychologists think through what questions they will need to answer when working with or in organizations. The seven items in this standard, which are new to the Ethics Code, can help structure a psychologist's thinking about essential aspects of their services. Informing clients and others about these issues is simply the last step in the process of the psychologist's having thought carefully through how, to whom, for whom and what services will be provided.

Standard 10.02 is a third example of a standard that, while not using the term "informed consent," nonetheless promotes the value of making central aspects of the professional relationship clear:

10.02 THERAPY INVOLVING COUPLES OR FAMILIES

(a) When psychologists agree to provide services to several persons who have a relationship (such as spouses, significant others, or parents and children), they take reasonable steps to clarify at the outset (1) which of the individuals are clients/patients and (2) the relationship the psychologist will have with each person. This clarification includes the psychologist's role and the probable uses of the services provided or the information obtained.



Psychologists who work with children, adolescents, couples and families often include various configurations of individuals in their work. Even in individual therapies, psychologists will sometimes include a significant person from their client's life in a very limited way. Including additional individuals in a therapy is a clinical decision that can be appropriate and helpful. Such determinations become problematic when individuals are not clear whether they are clients and do not understand the psychologist's role. By virtue of Standard 10.02, psychologists will carefully think through their relationship with each of the people whom they involve in the work. As with Standard 3.11, clarification of these issues follows from the psychologist first having considered how to organize and structure the services in the most clinically helpful manner.

The Ethical Principles of Psychologists and Code of Conduct--our Ethics Code--consists of general principles and ethical standards. General Principle E, "Respect for People's Rights and Dignity," exhorts psychologists to respect the right of individuals to self-determination. The many examples throughout the ethical standards of how respecting the right to self-determination can improve client care show the important relationship between our ethics and our clinical work: Good ethics and good care go hand-in-hand.

Further Reading

APA's Ethics Code is at APA's ethics. Send questions or comments about this column or suggestions for future "Ethics Rounds" columns to ethicsrounds@apa.org.

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