Letters

More ethical dilemmas

WHILE MONITOR staff writer Deborah Smith did an absolutely wonderful job of pulling together readably and accurately the complexities and breadth of APA's new ethical code in her "10 ways practitioners can avoid ethical pitfalls" (January Monitor), I found two of her examples under "Understand what constitutes a multiple relationship" (page 50) problematic and perhaps even (unintentionally) misleading. This weakness is not of Ms. Smith's doing, but is rather to be laid at the doorstep of the ethical code's drafters.

Since examples in media reports are critical in conveying the gist of a report's meaning, I believe it will be instructive to parse two examples and, in so doing, reveal a glaring weakness in the ethical code. To put it simply, this is to urge APA to lighten up a bit, not to take itself and human behavior all that seriously, and to accept the truism that we are not perfect, that we will make mistakes, and that probably most of these mistakes are neither malicious nor committed in reckless disregard for conducting ourselves ethically, morally and properly.

* "Is it ethical to volunteer at your daughter's softball team fund-raiser if you know a client is going to be there?" The implication in the text is that, yes, it is unethical. And why, pray tell, is it unethical? It is unethical because in some remote and convoluted manner that might occur once in a million times, according to our ethics sleuths, the client might be harmed, might not receive the best therapy that the softball daughter's parent might otherwise have been enabled to deliver. What nonsense! Suppose that I, as a therapist, live in a small town and it turns out that a large percentage of the town's residents will attend this fund-raiser where not surprisingly my client, public-spirited person that he or she might be in his or her commitment to see that softball thrives munificently, will also be cavorting with fruit punch in one hand and an hors d'oeuvre in the other. This will threaten the outcome of this person's therapy?

* "Can you buy a car from a client who owns the only dealership in your small, rural town?" Later in that same section the reason why it might be unethical to buy a car not from the client but from a dealership in another town is as follows: "...the psychologist in a rural town may decide to buy a car from his client because going elsewhere could signal that the car dealer was in therapy." First of all, I'm not convinced that most people in this small town would know that the therapist did not buy his or her car from the car dealer who is a client. There are many reasons for not buying the car from your client: The client may be a shyster; the client might be pricing his cars outrageously; the client may be known for having poor post-purchase car service; the client may have a Buick dealership, while the therapist wants to purchase a Mercury or a Chrysler Town Car.

The upshot of all this is that we shouldn't take ourselves all that seriously or arrogate unto ourselves the capacity to forecast and circumvent each little incident that might, alas, lead to the dastardly act of behaving unethically. Get a life, my fellow psychologists. Lighten up. It's a vast big world out there, and we're not the only ones with the wisdom on how to live and behave with decorum.

ROBERT PERLOFF, PHD
University of Pittsburgh

RESPONSE FROM APA's ETHICS OFFICE:

Dr. Perloff states that raising the question of whether it is ethical to volunteer at a softball fund-raiser implies that it is not. No such implication should be drawn for either vignette Dr. Perloff discusses. Rather, these questions were given as examples of what psychologists contact APA's Ethics Office about regarding multiple relationships. The article sought to provide a helpful way for psychologists to approach such situations.

STEPHEN BEHNKE, JD, PHD
Director of APA's Ethics Office

IN THE JANUARY APA MONITOR, you printed an article on "10 ways practitioners can avoid frequent ethical pitfalls." In our view, your reports on multiple relationships do not concur with APA's own ethical principles and its overall code of ethics. These principles and codes emphasize integrity, responsibility and the commitment to present unbiased, complete and updated information. You boldly elect to neglect the most comprehensive and most updated texts and articles on the topic of multiple or dual relationships. While you cite a 1993 article by Gottlieb, you fail to mention that there is a growing body of knowledge that asserts that multiple relationships can increase therapeutic effectiveness. You also failed to mention in your Web resources section the most comprehensive Web site on dual relationships in psychotherapy: www.drzur.com/dualrelationships.html.

OFER ZUR, PHD
Sonoma, Calif.

ARNOLD A. LAZARUS, PHD
Princeton, N.J.

THE ARTICLE ON ETHICS WAS disappointing. While the Monitor cover was captivating, the text was simplistic, blurring ethics with legal obligations. It was as if we were once more hearing how child abuse has to be reported. Reporting it is the law--a nondiscretionary edict.

Particularly related to this was your section on billing. Of course 90806 is individual therapy. Do we refuse care when the mother of a 6-year-old has obtained preapproval for you to see her child regarding questions of attention-deficit disorder? The precertified service is 90806--does this mean we can't talk to the mother, we can't do behavior checklists and we can't see them because ADHD is not a covered diagnosis under the plan? When family therapy is not covered under a plan's mental health policy, should we not treat the encopretic 4-year-old because it's inadequate to see only the child? Would the right thing to do be to see the child alone and the mother alone back-to-back, giving a diagnosis to the mother as well? That's going by the rules. Is it sufficient to just document why we broke the law--seeing the child with the mother and billing individual therapy?

All of these questions need addressing through APA's advocacy efforts with insurance carriers and managed-care companies. In the meantime, those on the front lines face these ethical dilemmas every day and to minimize the struggle by announcing that 90806 only covers individual therapy is taking us nowhere.

GORDON C. SAUER JR, PHD
Plano, Texas

Profiling perils

WHILE THE ETHICAL POINTERS were all well taken in your January 2003 piece "The perils of profiling for the media," the overall thrust was one-sided and critical--likely due to the edition's special theme, "Ethical pitfalls."

A more comprehensive discussion on profiling could include two or more points:

* The value of media psychology in "giving psychology away" to the public to broaden understanding or address concerns.

* Not all profiling was wrong. As with science's 'law of parsimony,' a profile's accuracy could improve if one stays closer to the evidence and makes fewer assumptions.

After the Washington sniper's tarot card, this profiler surmised a) we are not seeking a deranged or despairing avenger aimed at a specific target, b) we are seeking a sharpshooter/sniper with possibly military training in "one shot, one kill," concealment and evasion, possibly traveling as a pair, c) the motive may entail criminal thrill, power and gamesmanship, a beef with authority, possibly laced with vengeance for failures, d) "Dear policeman..." had a juvenile ring. On target? Or bull's-eye?

TONY FARRENKOPF, PHD
Portland, Ore.

Tolerance and diversity

I APPRECIATED ROBERT Sternberg's acknowledgment that APA is a "diamond in the rough" (January Monitor ) and is making an attempt to represent all of its constituents. My sense, however, is that the latter is simply not true. Many Members are unhappy with APA for the political positions that it has taken over the years. Activism, it seems, has replaced science. The terms "tolerance" and "diversity" appear limited to one worldview.

Maybe it's time that the "diamond in the rough" take a real stand for tolerance and diversity and provide a clear message: APA will not tolerate the suppression of views it disfavors and will take any steps necessary to sanction those Members who engage in such behavior.

A. DEAN BYRD, PHD
Highland, Utah

On motivational interviewing

I WAS SURPRISED AND PLEASED to see in the January Monitor that 42 percent of American psychologists report using motivational interviewing (MI) strategies to help substance abusing clients. The definition offered for MI, however, bears no resemblance to my understanding of this clinical method. MI was described on page 34 as involving "a detailed behavioral assessment of a client's substance abuse problem, an assessment of motives and disincentives to positive change, as well as advice on how to change." None of these is part of MI. Rather, we define MI as a "client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence" [in "Motivational Interviewing: Preparing People for Change" (Guilford Press, 2002)]. Structured assessment was included in one adaptation of MI, motivational enhancement therapy, that should not be confused with MI itself. Furthermore, advice-giving, while not proscribed, is used sparingly in MI, which focuses much more on eliciting the client's own motivation and solutions.

MI is a clinical method useful when client motivation for change is an issue. It is no panacea, but combines well with other clinical methods, including cognitive-behavior therapy. Originally developed to address substance use disorders, MI has now been applied and tested more broadly in health behavior change, with problems including asthma, cardiovascular rehabilitation, diabetes, gambling and health promotion. Further information and a bibliography regarding MI can be found at www.motivationalinterview.org. I hope this clarifies for readers the nature of MI.

WILLIAM R. MILLER, PHD
University of New Mexico

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