The results of research presented at APA's 2016 Annual Convention suggest that today's practitioners are less likely to commit such ethical violations as kissing a client, altering diagnoses to meet insurance criteria and treating homosexuality as pathological than their counterparts 30 years ago.
The research, conducted by psychologists Rebecca Schwartz-Mette, PhD, of the University of Maine at Orono and David S. Shen-Miller, PhD, of Bastyr University, replicated a 1987 study by Kenneth Pope, PhD, and colleagues published in the American Psychologist. Schwartz-Mette and Shen-Miller asked 453 practicing psychologists the same 83 questions posed to practitioners three decades ago.
The items included clear ethical violations, such as having sex with a client or supervisee. But they also included behaviors that could reasonably be construed as ethical, such as breaking confidentiality to report child abuse; behaviors that are ambiguous or not specifically prohibited, such as lending money to a client; and even some that don't seem controversial, such as shaking hands with a client. "Interestingly, 75 percent of the items from the Pope study were rated as less ethical in our study, suggesting a more general trend toward conservativism in multiple areas," says Schwartz-Mette.
Participants were especially likely to rate what Schwartz-Mette calls "gray area issues" as less ethical than their counterparts from the 1987 study. Examples of these areas now deemed less ethical include becoming friends with a former client, accepting goods or services in lieu of fees, providing therapy to students or supervisees, hugging clients and charging for missed appointments.
There were generational differences within the new study, too, adds Schwartz-Mette. Practitioners within 10 years of receiving their professional degrees were more likely to rate items as unethical than practitioners who received their degrees more than 21 years earlier when it came to such areas as managing practice-related finances and managing boundaries with clients. The early-career psychologists were more likely to think that allowing a client to run up a large unpaid bill or attending a client's social event was unethical, for example. "It could be that these participants were fresh out of training and so more careful," says Schwartz-Mette.
Meanwhile, APA's Ethics Code has evolved since Pope's original survey and now explicitly addresses some of the unethical behaviors in the survey, such as terminating therapy if a client can't pay and limiting treatment notes to name, date and fee.
The good news is that even though some psychologists may overstep ethical boundaries, it's not often. The percentage of members with complaints filed against them has stayed steady at less than 1 percent per year over the last two decades, according to Lindsay Childress-Beatty, JD, PhD, of APA's Ethics Office. —Rebecca A. Clay
