Anticipation of ethical pitfalls and consultation with colleagues are key to preventing practitioners' most common ethical dilemmas, noted speakers from APA's Ethics Committee and Committee on Legal Issues (COLI) at APA's 2003 Annual Convention. Some of the top hot spots included:
Think of informed consent--helping your patients understand the limits of confidentiality, what services you do and do not provide, expectations for the length of treatment, possible alternative treatments or approaches, and your fees and billing practices--as a process, not a once-and-done obligation, advised Ethics Committee member Michael Gottlieb, PhD. This means you should address informed consent issues as they arise throughout the course of treatment, he explained, even though it may feel like a therapeutic detour.
Other tips Gottlieb offered:
Tailor consent forms to your practice. One size doesn't fit all, he said.
Don't overwhelm your clients. Give clients the information they need to make good decisions, but don't inundate them just to cover every confidentiality situation you can think of, said Gottlieb.
It's more than paperwork. Don't let the fact that you have those forms on file lull you into a false sense of security, he said. For example, said Ethics Committee member Katherine DiFrancesca, PhD, in couples therapy, think ahead about the possibility of divorce and address your role in legal proceedings as needed.
"Make informed consent a part of your routine practice, but don't make it routine," Gottlieb advised.
When selecting any assessment tool and interpreting its results, stick to the tool's intended purposes, advised APA Ethics Committee member Linda Campbell, PhD. Other tips she and DiFrancesca offered:
Choose assessment tools that can answer the question. While you may be tempted to use a more familiar tool, it may not be the best instrument. "How do you know the scope of practice for any instrument?" Campbell asked. "Read the manual."
Cite the limitations. Explain why you chose the instrument and note caveats to your findings.
Only include relevant information. Watch for content that is not germane to the purpose of your report or evaluation, such as facts that may just be embarrassing to someone, said DiFrancesca. In fact, Ethics Code Standard 4.04(a) mandates this.
Don't overstep your boundaries. As you reach your findings, attorneys and clients may try to persuade you to go beyond your own competency or the scope of information gathered from the assessment. Stick to the data, said Campbell.
Multiple relations in rural practice
Psychologists in rural areas face multiple relationship dilemmas their city and suburban colleagues often do not, said Michael D. Roberts, PhD, chair of APA's Ethics Committee. For example, he said, their children may be friends with a client's children, or they may serve with clients in community groups, such as the Rotary Club.
"The concept here is to best help the patient," said Roberts, who noted that APA's Ethics Code says that not all multiple relationships are unethical--only those that could reasonably be expected to impair a therapist's objectivity, competence or effectiveness, or risk exploitation of or harm to the client.
Rural psychologists must use that test, he said, when facing multiple relationship dilemmas, such as bartering with a client, treating a client's relative or securing a mortgage through a client who's a loan officer. When weighing your decision, he said, keep the patient's interests first and consult with a colleague. In fact, he urged rural practitioners to develop a working relationship with a fellow rural psychologist--whether across the county or in another state--so that consultation is readily available.
When you provide services at the request of a third party--such as assessing a lawyer's client for a child-custody case or conducting a fitness-for-duty evaluation--the rule of thumb is clarify, clarify, clarify, said presenters. Some of the issues to consider, said APA Board of Directors member Katherine Nordal, PhD:
Identify who is the client. In third-party situations, the individual is often not the client, which has ramifications for confidentiality. For example, a lawyer for whom you've conducted a client assessment typically has access to that person's test data.
Inform all parties involved. Be sure everyone is aware of the confidentiality implications of the situation, said Nordal. For example, make sure a police officer reporting for a fitness-for-duty evaluation understands that your meeting is not treatment, and that what is said is not confidential.
Who pays the bill? Understand who is financially responsible. If the lawyer is the client, then the lawyer pays the bill, not the person's insurance company, said Nordal.
Section 2 of APA's new Ethics Code pulls together previously scattered information on competence that can serve as guiding framework for psychologists who may be crossing into an area where they aren't qualified--whether unknowingly or purposefully, said Campbell.
"A psychologist is not always expected to make the 'right' decision," Campbell noted. Rather, she said, he or she is expected to have done what would be reasonably expected of any other psychologist in the same situation.
"How do you know that you are performing psychological activities competently?" asked Campbell. Look to the section in the Ethics Code on competence, she said, which, among other things, requires psychologists to be versed in diversity issues when applicable, prepare before practicing in a new area and become familiar with the forensic role before assuming it.