Approaching ethical dilemmas

Can psychologists accept gifts from their clients? Is it ethical to be the mediator in the divorce case of former marital therapy clients?

At a session at APA's 2004 Annual Convention, members of APA's Ethics Committee discussed these questions and other common ethical dilemmas of practicing psychologists. They emphasized that psychologists who thoroughly consider the consequences of their actions are better able to effectively weigh competing ethical principles, avoid conflicts of interest and put clients' best interests first.

The presenters illustrated such ethical decision-making by discussing how psychologists might think about the ethical quandaries posed by several vignettes, including:

My laptop containing confidential client records was stolen. Should I tell my clients about it?

Ethics Committee member Anne Hess, PhD, suggested that psychologists in such a situation first consider their record-keeping and confidentiality practices more broadly. For example, are they treating electronic records with the same level of security as paper records? Are their electronic files encrypted or password protected--and are they stored on a removable drive that can be locked away? Do they include that they store information on a laptop in their informed consent forms? Do they back up their electronic records? Section 6 of APA's Ethics Code offers guidance on such issues, noted Hess.

Other considerations, she said, include how the disclosure would affect clients' course of treatment and whether nondisclosure would affect the psychologist's effectiveness.

Should I rent an apartment to a current client?

Psychologists considering entering into a multiple relationship should use the two-prong evaluation test laid out in Standard 3.05 of APA's Ethics Code, said former committee member Elizabeth Swenson, PhD: Could the relationship impair the psychologist's objectivity, competence or effectiveness, and does the relationship risk harm or exploitation to the client? When considering those questions, added Swenson, psychologists should not fail to think of the worst. They should also consult a colleague and document the decision-making processes in case they must later defend their decision, she added.

This particular vignette, Swenson said, may well fail the two-prong test. For example, the psychologist might have to evict his client for failing to pay rent--or he might be a poor landlord.

I provided marital counseling to a couple, and they have asked me to serve as the mediator in their divorce. Should I agree to the request?

Several ethical standards apply to this situation, said Linda Campbell, PhD, the Ethics Committee chair. For example, does the psychologist have adequate training to be a competent mediator, as Standard 2.01 requires? Familiarity with his clients doesn't override the need for training, Campbell noted.

Another consideration is Standard 3.05 on whether the multiple relationship would be harmful to the couple or impair the psychologist: For example, would knowledge gained from the previous therapy influence his judgment in this new role? Will the couple understand that his role has changed? And does the psychologist understand who the client is? Taking on multiple roles that have the potential for so much confusion is probably unadvisable, Campbell suggested.

Should I accept a gift from a client?

Ethics Committee member Neil Massoth, PhD, noted that while there's no specific ethical standard that addresses client gifts, there is some guidance in the code. For example, Principle A says psychologists strive to benefit their clients and do no harm--would accepting or refusing the gift cause harm? Would accepting the gift create a harmful or exploitative relationship, as in Standards 3.06 and 3.08? Other factors include whether it's personal in nature, a one-time occurrence or a pattern, for a special occasion or no apparent reason, and expensive or reasonable in cost.

For example, he recounted at first feeling uncomfortable accepting a large chocolate and peanut butter Christmas candy from a client. However, he changed his mind when she told him that she made 60 to 70 every holiday, and humorously added that he "shouldn't feel too terribly important."

When weighing their decision, psychologists should also consider cultural factors, he added--pointing to Principle E on respecting the dignity of others. Depending on a person's background, he said, psychologists may do more harm than good if they refuse a reasonable gift. That said, he also noted that many psychologists have a flat no-acceptance policy.

A company has released a new edition of an assessment tool I use. Can I still use the older version that I prefer?

While Standard 9.08 says psychologists shouldn't use tests that are obsolete or "not useful for the current purpose," Hess noted that doesn't mean that older tests are automatically off the table. Psychologists, she said, should note the norm groups for each version and from that determine which test is more appropriate for the client. For example, the norms of newer versions tend to include more diverse populations, but the content of an older intelligence test might be more appropriate for older adults or a specific population, she said.

However, Hess said, "Being too lazy to learn the new test is not defensible." You should be comfortable justifying your test choice to a third party or a judge, she noted.