EPPP (Nicky's Qs) - Ethics

Question 1

What sections comprise the APA’s Ethical Principles of Psychologists and Code of Conduct (i.e. the Ethics Code)?

Answer 1

1. Introduction
2. Preamble
3. General Principles (A-E)
4. Ethical Standards

Question 2

What is the role of the Ethics Code Introduction?

Answer 2

It discusses the intent, organization, procedural considerations, and scope of application of the Ethics Code.

Question 3

An important distinction between the Preamble and General Principles and the Ethical Standards of the Ethics Code.

Answer 3

The Preamble and General Principles are aspirational goals. They are intended to guide psychologists toward the highest ideals of psychology. They are not themselves enforceable rules, and thus will not be used as the basis of disciplinary action against a psychologist. However, they should be considered when trying to determine an ethical course of action.

The Ethical Standards delineate enforceable rules for how psychologists should act. These are mandatory and are usually cited in a charge of ethical misconduct by the Ethics Committee.

Question 4

The Ethics Code does no apply to…

Answer 4

… the purely private conduct of psychologists.

Question 5

The Ethics Code applies to…

Answer 5

All psychologists’ activities that are part of their scientific, educational, or professional roles as psychologists only.

Caveat: “APA may take action against a member after his/her conviction of a felony, expulsion or suspension from an affiliated state psychological association, or suspension or loss of licensure.”

Note that according to Fisher (2009), in the case of a felony, APA may take action whether or not it resulted directly from activities performed by the member in his/her professional role. (Vol. I, p. 8)

Question 6

The Ethics Code is not intended to…

Answer 6

… serve as a basis of civil liability.

Question 7

The Preamble

Answer 7

States the primary goal of the Ethics Code:

To provide a common set of principles and specific standards to cover most situations encountered by psychologists in their professional and scientific work.

To ensure the welfare and protection of the individuals and groups with whom psychologists work and the education of members, students, and the public regarding ethical standards of the discipline.

Question 8

The General Principles

Answer 8

Principle A: Beneficence and Nonmaleficence.
Principle B: Fidelity and Responsibility.
Principle C: Integrity.
Principle D: Justice.
Principle E: Respect for People’s Rights and Dignity.

Question 9

Principle A

Answer 9

Beneficence and Nonmaleficence

Question 10

Principle B

Answer 10

Fidelity and Responsibility

Question 11

Principle C

Answer 11

Integrity

Question 12

Principle D

Answer 12

Justice

Question 13

Principle E

Answer 13

Respect for People’s Rights and Dignity

Question 14

Principle A: Beneficence and Nonmaleficence

Answer 14

Psychologists…

1. strive to benefit those with whom they work.
2. take care to do no harm.
3. seek to safeguard the welfare and rights of those with whom they interact professionally and other affected persons.
4. seek to safeguard the welfare of animal subjects of research.
5. attempt to resolve conflicts in a responsible manner that avoids or minimizes harm.
6. are alert to and guard against personal, financial, social, organizational, or political factors that might lead to misuse of their influence.
7. strive to be aware of the possible effect of their own physical and mental health on their ability to help those with whom they work.

Question 15

Principle B: Fidelity and Responsibility

Answer 15

Psychologists…

1. establish relationships of trust with those with whom they work.
2. are aware of their professional and scientific responsibility to society and to the specific communities in which they work.
3. uphold professional standards of conduct, clarify their professional roles and obligations, accept appropriate responsibility for their behavior, and seek to manage conflicts of interest that could lead to exploitation or harm.
4. consult with, refer to, or cooperate with other professionals and institutions to the extent needed to serve the best interests of those with whom they work.
5. are concerned about the ethical compliance of their colleagues’ scientific and professional conduct.
6. strive to contribute a portion of their professional time for little or no compensation or personal advantage.

Question 16

Principle C: Integrity

Answer 16

Psychologists…

1. seek to promote accuracy, honesty, and truthfulness in the science, teaching, and practice of psychology.
2. do not steal, cheat, or engage in fraud, subterfuge, or intentional misrepresentation of fact.
3. strive to keep their promises and to avoid unwise or unclear commitments.
4. have a serious obligation to consider the need for, the possible consequences of, and their responsibility to correct any resulting mistrust or other harmful effects that arise from the use of deception when such techniques may be ethically justifiable to maximize benefits and minimize harm.

Question 17

Principle D: Justice

Answer 17

Psychologists…

1. recognize that fairness and justice entitle all persons to access to and benefit from the contributions of psychology and to equal quality in the processes, procedures and services being conducted by psychologists.
2. exercise reasonable judgment and take precautions to ensure that their potential biases, the boundaries of their competence, and the limitations of their expertise do not lead to or condone unjust practices.

Question 18

Principle E: Respect for People’s Rights and Dignity

Answer 18

Psychologists…

1. respect the dignity and worth of all people, and the rights of individuals to privacy, confidentiality, and self-determination.
2. are aware that special safeguards may be necessary to protect the rights and welfare of persons or communities whose vulnerabilities impair autonomous decision making.
3. are aware of and respect cultural, individual, and role differences, including those based on age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, and socioeconomic status and consider theses factors when working with members of such groups.
4. try to eliminate the effect of their work of biases based on those factors, and they do not knowingly participate in or condone activities of others based upon such prejudices.

Question 19

The Ethics Code attempt to protect client welfare.

Answer 19

Provides mandatory, enforceable Ethical Standards that govern a psychologist’s behavior in consultations, therapy, research, forensic settings, and other contexts.

Question 20

A psychologists primary consideration.

Answer 20

Client Welfare.

While the welfare of non-clients, colleagues, and the profession of psychology and other issues are certainly important, a psychologist’s first consideration when choosing a course of action in the context of his/her professional activities is ALWAYS the welfare of the client.

Question 21

Ethical vs Legal Requirements

Answer 21

When a conflict between ethical and legal requirements occurs, psychologists must resolve it in a way that is “in keeping with basic principles of human rights.”

The appropriate action to take depends on the nature of the situation, some of which are addressed by APA in fairly clear guidelines (e.g. Specialty Guidelines for Forensic Psychology 6.03.02, addressing how to approach limits on confidentiality when conducting evaluations for the court).

Further, if “the Ethics Code establishes a higher standard of conduct than is required by law, psychologists must meet the higher ethical standard.” Examples: misrepresenting research results, accepting a past sexual partner as client, providing a diagnosis of a caller to a ration or TV talk show. p. 9

Question 22

Pro Bono Services

Answer 22

Professional services provided without charge or other personal advantage.

These are recommended (by the aspirational General Principle B), but are not required (i.e. not mentioned in the mandatory Ethical Standards).

Question 23

As described in the Preamble, a primary goal of the Ethics Code is ensuring the “________ of the individuals and groups with whom psychologists work.”

Answer 23

welfare and protection

Question 24

Although APA is able to enforce adherence to the Ethics Code for APA members only, violation of its provisions may result in action by the state ________, court or other authority.

Answer 24

licensing board

Question 25

The Introduction states that the Ethics Code applies only to activities that are relevant to a psychologist’s professional roles but also states that “APA may take action against a member after his or her conviction of a ________.

Answer 25

felony

Question 26

The Introduction notes that, when there is a conflict between ethical and legal requirements, psychologists must resolve it in a way that is “in keeping with basic principles of ________.”

Answer 26

human rights

Question 27

General Principle B states that “psychologists strive to contribute a portion of their professional time for little or no compensation or personal advantage,” which implies that providing pro bono services is ________ by the Code.

Answer 27

recommended

Question 28

While the Ethical Standards provide mandatory and enforceable provisions, the Preamble and General Principles are ________ and nonenforceable, which means that they provide general guidelines for ethical decision-making but will not serve as the basis for disciplinary action against a psychologist.

Answer 28

aspirational

Question 29

The Ethical Standards

Answer 29

E.S.  1:  Resolving Ethical Issues
E.S.  2:  Competence
E.S.  3:  Human Relations
E.S.  4:  Privacy and Confidentiality
E.S.  5:  Advertising and Other Public Statements
E.S.  6:  Record Keeping and Fees
E.S.  7:  Education and Training
E.S.  8:  Research and Publication
E.S.  9:  Assessment
E.S. 10:  Therapy

Question 30

Ethical Standard 1

Answer 30

Resolving Ethical Issues

Question 31

Ethical Standard 2

Answer 31

Competence

Question 32

Ethical Standard 3

Answer 32

Human Relations

Question 33

Ethical Standard 4

Answer 33

Privacy and Confidentiality

Question 34

Ethical Standard 5

Answer 34

Advertising and Other Public Statements

Question 35

Ethical Standard 6

Answer 35

Record Keeping and Fees

Question 36

Ethical Standard 7

Answer 36

Education and Training

Question 37

Ethical Standard 8

Answer 37

Research and Publication

Question 38

Ethical Standard 9

Answer 38

Assessment

Question 39

Ethical Standard 10

Answer 39

Therapy

Question 40

E.S. 1.01: Misuse of Psychologists’ Work

Answer 40

Psychologists take reasonable steps to correct or minimize the misuse or misrepresentation of their work.

Discussion: It is up to the psychologist to decide what should be done when this happens. However, the appropriate action is usually to contact the involved party and request that a corrective measure be taken. One should then document the action taken to correct the misuse or misrepresentation.

Question 41

E.S. 1.02: Conflicts Between Ethics and Law, Regulations, or Other Governing Legal Authority

Answer 41

Pertaining to when a psychologist’s ethical responsibilities conflict with the law, regulations, or other governing legal authorities.

Psychologists clarify the nature of the conflict, make known their commitment to the Ethics Code, and take reasonable steps to resolve the conflict in a manner that is consistent with the General Principles and Ethical Standards.

Note: under no circumstances may this standard be used to justify or defend violating human rights!

Question 42

E.S. 1.03: Conflicts Between Ethics and Organizational Demands

Answer 42

Pertaining to when demands of an organization with which the psychologist is affiliated or for whom they are working are in conflict with the Ethics Code.

Psychologists clarify the nature of the conflict, make known their commitment to the Ethics Code, and take reasonable steps to resolve the conflict in a manner that is consistent with the General Principles and Ethical Standards.

Note: under no circumstances may this standard be used to justify or defend violating human rights!

Question 43

E.S. 1.04: Informal Resolution of Ethical Violations

Answer 43

Involves bringing up the concerns of an ethical violation directly to the offending psychologist.

When? Should be pursued when this appears to be an appropriate course of action and when the intervention does not violate any confidentiality rights that may be involved.

When not? If a violation has substantially harmed or is likely to substantially harm a person or organization and is not appropriate for an informal resolution.

Question 44

E.S. 1.05: Reporting Ethical Violations

Answer 44

Involve taking further action than an informal approach, such as making a referral to state or national committees on professional ethics, to state licensing boards, or to the appropriate institutional authorities.

When? If a violation has substantially harmed or is likely to substantially harm a person or organization and is not appropriate for an informal resolution or when an informal resolution has not succeeded in resolving the matter satisfactorily.

When not? This standard does not apply when an intervention would violate confidentiality rights or when psychologists have been retained to review the work of another psychologist whose professional conduct is in question.

Question 45

E.S. 1.06: Cooperating with Ethics Committees

Answer 45

Psychologists cooperate in ethics investigations, proceedings, and resulting requirements of the APA of any affiliated state psychological association to which they belong. In doing so, they address any confidentiality issues. Failure to cooperate is itself an ethics violation.

Note: Making a request for deferment of adjudication (judgment, ruling) of an ethics complaint pending the outcome of litigation does not alone constitute noncooperation.

Question 46

E.S. 1.07: Improper Complaints

Answer 46

Psychologists do not file or encourage the filing of ethics complaints that are made with reckless disregard for or willful ignorance of facts that would disprove the allegation.

Question 47

E.S. 1.08: Unfair Discrimination Against Complainants and Respondents

Answer 47

Psychologists do not deny persons employment, advancement, admissions to academic or other programs, tenure, or promotion, based solely upon their having made or their being the subject of an ethics complaint.

Note: This does not preclude taking action based upon the outcome of such proceedings or considering other appropriate information.

Question 48

How should a psychologist proceed when s/he becomes aware of misuse or misrepresentation of their work?

Answer 48

It is up to the psychologist to decide what should be done when this happens. However, the appropriate action is usually to contact the involved party and request that a corrective measure be taken. One should then document the action taken to correct the misuse or misrepresentation.

(E.S. 1.01)

Question 49

Standard 1.05 requires psychologists to file a formal complaint when a violation involves substantial harm.

What constitutes “substantial harm?”

Answer 49

The standard does not specify. However, sexual misconduct, insurance fraud, and plagiarism have been identified as examples in APA’s (2002) Rules and Procedures.

Question 50

Both standards 1.04 and 1.05 require psychologists to take some action, informal or formal, to address ethical violations by colleagues.

What is the first and most important thing psychologists should do in such a case?

Answer 50

First and foremost, psychologists should consider client confidentiality, which always takes precedence over the need to educate or punish an offending psychologist.

Note: Any action, informal or formal, that could jeopardize the confidentiality of a client is strictly prohibited!

Example: You have been seeing a client, who recently reveals s/he had sexual conduct with a previous therapist who seduced the client. If the client wants to file a complaint, you can assist the client in whatever way is needed. However, if the client does not want to do anything about it and doesn’t want the matter known for whatever reason, you must respect the client’s right to confidentiality and defer any action.

Question 51

Standard 1.06 requires psychologists to cooperate with APA’s investigations of ethical complaints and establishes that failure to do so is itself an ethical violation.

What is an important step to take before responding to an inquiry from the Ethics Committee with regard to a complaint filed against you by a client?

Answer 51

Again, first and foremost, psychologists should consider client confidentiality. Thus, a psychologist should confirm that the client has signed a release before disclosing any information about the client, even to the Ethics Committee.

Note: This does not mean one should ignore or delay in responding to an inquiry from the Committee as doing so could result in additional charges for failure to respond. One could respond, without acknowledging a professional relationship with the complainant, by requesting a release before further discussion.

Question 52

An employee is up for review and his/her evaluation qualifies him/her for a raise and/or promotion. You find out that said employee has been the subject of an ethical violation complaint and has been accused of sexual misconduct by a previous client.

How would you proceed, taking into consideration Standard 1.08?

Answer 52

The standard specifically prohibits psychologists from acting in discriminatory ways toward people who are either complainants or respondents to a charge of ethical misconduct solely on the basis of being the subject of an ethics complaint.

Thus, if the complaint is unresolved, the employee psychologist should be granted his/her raise or promotion according to the positive review received because the charges could be ruled unfounded or could be dismissed. The promotion or raise can be rescinded if the outcome of the complaint is unfavorable to the psychologist.

Same would go with hiring someone. If you would hire them was it not for the complaint, they should be hired if it is not yet resolved. They can always be let go if there is a ruling against the psychologist. Past rulings can be used in decision-making about employee hiring or advancement.

Question 53

Standard 1.04 encourages psychologists to handle ethical violations by a colleague informally when “an informal resolution appears appropriate,” while Standard 1.05 states that psychologists make a formal report to the appropriate authority when the violation involves ________ and is not appropriate for informal resolution.

Answer 53

substantial harm

Question 54

It is important to note that Standards 1.04 and 1.05 require psychologists to take action only when the action does not violate ________.

Answer 54

the client’s confidentiality rights

Question 55

Standard 1.06 states that failing to cooperate with APA’s investigation of an ethical complaint constitutes an ________.

Answer 55

ethical violation

Question 56

Standard 1.08 states that it is unethical to discriminate against a person (e.g., deny a person a promotion) solely on the basis of being a ________ to a charge of ethical misconduct.

Answer 56

complainant or respondent

Question 57

The prohibition of not discriminating against a psychologist solely on the basis of being a complainant or respondent to a charge of ethical misconduct applies only to _______ and not to ________.

Answer 57

a pending case; its outcome.

Question 58

E.S. 2.01: Boundaries of Competence

Answer 58

(a) Psychologists provide services, teach, and conduct research with populations and in areas only within the boundaries of their competence, based on their education, training, supervised experience, consultation, study, or professional experience.
(b) Where scientific or professional knowledge in the discipline of psychology establishes that an understanding of factors associated with age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, or socioeconomic status is essential for effective implementation of their services or research, psychologists have or obtain the training, experience, consultation, or supervision necessary to ensure the competence of their services, or they make appropriate referrals, except as provided in Standard 2.02, Providing Services in Emergencies.
(c) Psychologists planning to provide services, teach, or conduct research involving populations, areas, techniques, or technologies new to them undertake relevant education, training, supervised experience, consultation, or study.
(d) When psychologists are asked to provide services to individuals for whom appropriate mental health services are not available and for which psychologists have not obtained the competence necessary, psychologists with closely related prior training or experience may provide such services in order to ensure that services are not denied if they make a reasonable effort to obtain the competence required by using relevant research, training, consultation, or study.
(e) In those emerging areas in which generally recognized standards for preparatory training do not yet exist, psychologists nevertheless take reasonable steps to ensure the competence of their work and to protect client/patients, students, supervisees, research participants, organizational clients, and others from harm.
(f) When assuming forensic roles, psychologists are or become reasonably familiar with the judicial or administrative rules governing their roles.

Question 59

E.S. 2.02 Providing Services in Emergencies

Answer 59

In emergencies, when psychologists provide services to individuals for whom other mental health services are not available and for which psychologists have not obtained the necessary training, psychologists may provide such services in order to ensure that services are not denied. The services are discontinued as soon as the emergency has ended or appropriate services are available.

Question 60

E.S. 2.03 Maintaining Competence

Answer 60

Psychologists undertake ongoing efforts to develop and maintain their competence.

Question 61

E.S. 2.04 Bases for Scientific and Professional Judgments

Answer 61

Psychologists’ work is based upon established scientific and professional knowledge of the discipline

(See also Standards
• 2.01e, Boundaries of Competence, and
• 10.01b, Informed Consent to Therapy.)

Question 62

E.S. 2.05 Delegation of Work to Others

Answer 62

Psychologists who delegate work to employees, supervisees, or research or teaching assistants or who use the services of others, such as interpreters, take steps to…

(1) avoid delegating such work to persons who have a multiple relationship with those being served that would likely lead to exploitation or loss of objectivity;
(2) authorize only those responsibilities that such persons can be expected to perform competently on the basis of their education, training, or experience, either independently or with the level of supervision being provided; and
(3) see that such persons perform these services competently.

(See also Standards
• 2.02, Providing Services in Emergencies;
• 3.05, Multiple Relationships;
• 4.01, Maintaining Confidentiality;
• 9.01, Bases for Assessments;
• 9.02, Use of Assessments;
• 9.03, Informed Consent in Assessments; and
• 9.07, Assessment by Unqualified Persons.)

Question 63

E.S. 2.06 Personal Problems and Conflicts

Answer 63

(a) Psychologists refrain from initiating an activity when they know or should know that there is a substantial likelihood that their personal problems will prevent them from performing their work-related activities in a competent manner.
(b) When Psychologists become aware of personal problems that may interfere with their performing work-related duties adequately, they take appropriate measures, such as obtaining professional consultation or assistance, and determine whether they should limit, suspend, or terminate their work-related duties.

(See also E.S. 10.10, Terminating Therapy.)

Question 64

You have been practicing for several years and have significant experience with trauma treatment. A new technique has been developed over the last few years and studies show it is very effective to treat certain forms of trauma. You happen to be seeing a client that has been struggling and may greatly benefit from this technique.

How would you approach this situation?

Answer 64

There are several ethical options available:

(1) I could refer the client to someone who is experienced with the new technique (E.S. 2.05). This would have to be a mutual decision with the client and his/her level of comfort transferring to a new provider or seeing the new provider as an added component to the work we are doing, such as one might do with EMDR.
(2) If I am versed in other techniques that are fairly similar, I could conduct research on the new technique and seek consultation with someone certified or otherwise equipped to supervise work with this technique (E.S. 2.01c, d, e; 2.03).
(3) If I am not versed in any techniques similar to this one, I could pursue coursework and supervision in the use of this technique (E.S. 2.01c, d, e; 2.03).

These are all options that ensure the client is receiving services by a provider who is competent in the skill.

Question 65

You are a child psychologist with limited experience working with adults. You live in a relatively small town where there was a school shooting at the local community college a few hours ago. Mental health providers are being asked to help offer support to members of the community.

How would you approach this situation?

Answer 65

If providers are desperately needed, I would answer the call and try to provide as much support as possible until such time as additional experienced providers arrive or until the emergency passes (E.S. 2.02 Providing Services in Emergencies).

Unless, the incident is some sort of trigger for me that would prevent me from doing the work needed (E.S. 2.06 Personal Problems and Conflicts).

Question 66

You live and have a private practice in a very conservative rural area. You have been working with fairly new client on marital concerns and stressors associated with coworkers at the factory he works. You have developed a very strong therapeutic relationship. Last session he discloses he believes he was born in the wrong body and should have been born a woman. He identifies this new concern as the primary goal for therapy. You have never worked with this presentation before nor received any training.

How do you proceed?

Answer 66

During the time between sessions I look for other providers in the area with expertise in trans concerns. When I meet with the client next, I would discuss my current lack of competence in working with trans issues and explore possible avenues, including transferring care to another provider if one is available and the client is willing (E.S. 2.05 Delegation of Work to Others).

If a more experienced provider is not available, I offer to do the necessary research and seek consultation with a more experienced provider in this area (E.S. 2.01b, c, d, e Boundaries of Competence; 2.03 Maintaining Competence; 10.01b Informed Consent to Therapy).

I would only provide ongoing services if my own biases would not cause harm to the client (i.e. I don’t have a prejudice against trans folk and/or I explore my feelings about this population with a consultant).

Question 67

Your training and experience are solely with adults. Recently you realize you have a passion for working with children.

In order to develop the needed competence, should you go back to graduate school to obtain a second doctoral degree with an emphasis in child psychology?

Answer 67

No, I would not be required to obtain a second doctorate in psychology, but I would need to complete the necessary relevant coursework and obtain supervise training in that area.

** Section 1.7 of the General Guidelines for Providers of Psychological Services (APA, 1987): “psychologists who change or add a specialty meet the same requirements with respect to subject matter and professional skills that apply to doctoral education, training, and experience in the new specialty.”

Question 68

E.S. 2.05 requires psychologists to ensure that individuals to whom they delegate work are competent to perform their responsibilities competently. How do we ensure that?

Answer 68

No specific criteria are provided, but a critical element in ensuring the competence of supervises and employees is providing hem with regular performance feedback.

Question 69

You are working with a new client who has been referred to you because of your expertise in the concerns the client wishes to address. The client is polish and has limited English skills. She arrives to session with her bilingual daughter so she can serve as interpreter.

How do you proceed?

Answer 69

I explain my concerns with having her daughter serve as interpreter and the fact that doing so would constitute an ethical violation in my profession. I offer, instead, to make the necessary arrangements to secure a trained interpreter who is bound to confidentiality.

** E.S. 2.05 prohibits psychologists from delegating work to others when doing so will create a multiple relationship with the individual being served that is likely to limit their objectivity or lead to exploitation.

Question 70

What is vicarious liability?

Answer 70

A term that refers to how under certain circumstances, supervisors and employers may be legally responsible for the actions of their supervises and employees (respondent superior).

** Its legal determination ordinarily rests on the disparity in training and experience between the supervisor/employer and supervisee/employee and the right, ability, or responsibility of the supervisor/employer to control the actions of the supervisee/employee. (p. 18)

Question 71

You recently experienced the loss of someone very close to you. You have several clients on your caseload coping with losses as well.

Should you discontinue therapy with them immediately?

Answer 71

No, not necessarily. However, I should try to determine whether my own loss is interfering with my work with them. Appropriate measures I could take include seeking therapy for myself and seeking consultation to determine my readiness to continue providing services to those clients.

If we determine my work is being affected by my loss, the right course of action would be to provide referrals to other professionals competent in the areas of need. (E.S. 2.06 Personal Problems; 2.05 Delegation of Work to Others).

Question 72

When expanding his/her services, a psychologist must do so in a way that minimizes potential harm to clients. For example, Standard 2.01 states that, in emerging areas where standards of training do not exist, psychologists take ________ to protect the welfare of their clients.

Answer 72

reasonable steps

Question 73

Standard 2.02 permits psychologists to provide emergency services when they do not have adequate training as long as alternatives are unavailable and they discontinue those services when the ________ or appropriate services become available.

Answer 73

emergency passes

Question 74

Standard 2.05 requires psychologists to take reasonable steps to avoid delegating work to others when doing so will create a _______ with those being served that is likely to limit their objectivity or lead to exploitation.

Answer 74

multiple relationship

Question 75

Under certain circumstances, supervisors and employers may be legally responsible for the actions of their supervisees and employees, which is referred to as ________.

Answer 75

vicarious liability

Question 76

Standard 2.06 requires psychologists to avoid starting a work-related activity when there is a significant likelihood that a personal problem will interfere with their ability to perform their work competently and to take ________ when they become aware that a personal problem is adversely affecting their work.

Answer 76

“appropriate measures”

Question 77

E.S. 3.01 Unfair Discrimination

Answer 77

In their work-related activities, psychologists do not engage in unfair discrimination based on age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, socioeconomic status, or any basis proscribed by law.

Question 78

E.S. 3.02 Sexual Harassment

Answer 78

Psychologists do not engage in sexual harassment.

Sexual harassment is sexual solicitation, physical advances, or verbal or nonverbal conduct that is sexual in nature, that occurs in connection with the psychologist’s activities or roles as a psychologist, and that either

(1) is unwelcome, is offensive, or creates a hostile workplace or educational environment, and the psychologist knows or is told this or
(2) is sufficiently severe or intense to be abusive to a reasonable person in the context.

Sexual harassment can consists of a single intense or severe act or of multiple persistent or pervasive acts.

(See also E.S. 1.08, Unfair Discrimination Against Complainants and Respondents.)

Question 79

E.S. 3.03 Other Harassment

Answer 79

Psychologists do not knowingly engage in behavior that is harassing or demeaning to persons with whom they interact in their work based on factors such as those persons’ age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, or socioeconomic status.

Question 80

E.S. 3.04 Avoiding Harm

Answer 80

Psychologists take reasonable steps to avoid harming their clients/patients, students, supervisees, research participants, organizational clients, and others with whom they work, and to minimize harm where it is foreseeable and unavoidable.

Question 81

E.S. 3.05 Multiple Relationships

Answer 81

(a) A multiple relationship occurs when a psychologist is in a professional role with a person and
(1) at the same time is in another role with the same person,
(2) at the same time is in a relationship with a person closely associated with or related to the person with whom the psychologist has the professional relationship, or
(3) promises to enter into another relationship in the future with the person or a person closely associated with or related to the person.

A psychologist refrains from entering into a multiple relationship if the multiple relationship could reasonably be expected to impair the psychologist’s objectivity, competence, or effectiveness in performing his or her functions as a psychologist, or otherwise risks exploitation or harm to the person with whom the professional relationships exits.

Multiple relationships that would not reasonably be expected to cause impairment or risk exploitation or harm are not unethical.

(b) If a psychologist finds that, due to unforeseen factors, a potentially harmful multiple relationship has arisen, the psychologist takes reasonable steps to resolve it with due regard for the best interests of the affected person and maximal compliance with the Ethics Code.
(c) When psychologists are required by law, institutional policy, or extraordinary circumstances to serve in more than one role in judicial or administrative proceedings, at the outset they clarify role expectations and the extent of confidentiality and thereafter as changes occur.

(See also Standards
• 3.04, Avoiding Harm, and
• 3.07, Third-Party Requests for Services.)

Question 82

E.S. 3.06 Conflict of Interest

Answer 82

Psychologists refrain from taking on a professional role when personal, scientific, professional, legal, financial, or other interests or relationships could reasonably be expected to

(1) impair their objectivity, competence, or effectiveness in performing their functions as psychologists or
(2) expose the person or organization with whom the professional relationship exists to harm or exploitation.

Question 83

E.S. 3.07 Third-Party Requests for Services

Answer 83

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 probable uses of the services provided or the information obtained, and the fact that there may be limits to confidentiality.

(See also Standards
• 3.05, Multiple Relationships, and
• 4.02, Discussing the Limits of Confidentiality.)

Question 84

E.S. 3.08 Exploitative Relationships

Answer 84

Psychologists do not exploit persons over whom they have supervisory, evaluative, or other authority such as clients/patients, students, supervisees, research participants, and employees.

(See also Standards
• 3.05, Multiple Relationships;
• 6.04, Fees and Financial Arrangements;
• 6.05, Barter With Clients/Patients;
• 7.07, Sexual Relationships With Students and Supervisees;
• 10.05, Sexual Intimacies With Current Therapy Clients/Patients;
• 10.06, Sexual Intimacies With Relatives or Significant Others of Current Therapy Clients/Patients;
• 10.07, Therapy With Former Sexual Partners; and
• 10.08, Sexual Intimacies With Former Therapy Clients/Patients.)

Question 85

E.S. 3.09 Cooperation With Other Professionals

Answer 85

When indicated and professionally appropriate, psychologists cooperate with other professionals in order to serve their clients/patients effectively and appropriately.

(See also E.S. 4.05, Disclosures.)

Question 86

E.S. 3.10 Informed Consent

Answer 86

(a) When psychologists conduct research or provide assessment, therapy, counseling, or consulting services in person or via electronic transmission or other forms of communication, they obtain the informed consent of the individual or individuals using language that is reasonably understandable to that person or persons except when conducting such activities without consent is mandated by law or governmental regulation or as otherwise provided in this Ethics Code. (See also Standards 8.02, Informed Consent to Research; 9.03, Informed Consent in Assessments; and 10.01, Informed Consent to Therapy.)

(b) For persons who are legally incapable of giving informed consent, psychologists nevertheless
(1) provide an appropriate explanation,
(2) seek the individual’s assent,
(3) consider such persons’ preferences & best interests, &
(4) obtain appropriate permission from a legally authorized person, if such substitute consent is permitted or required by law. When consent by a legally authorized person is not permitted or required by law, psychologists take reasonable steps to protect the individual’s rights and welfare.

(c) When psychological services are court ordered or otherwise mandated, psychologists inform the individual of the nature of the anticipated services, including whether the services are court ordered or mandated and any limits of confidentiality, before proceeding.
(d) Psychologists appropriately document written or oral consent, permission, and assent. (See also Standards 8.02, Informed Consent to Research; 9.03, Informed Consent in Assessments; and 10.01, Informed Consent to Therapy.)

Question 87

E.S. 3.11 Psychological Services Delivered To or Through Organizations

Answer 87

(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.

(b) If psychologists will be precluded by law or by organizational roles from providing such information to particular individuals or groups, they so inform those individuals or groups at the outset of the service.

Question 88

E.S. 3.12 Interruption of Psychological Services

Answer 88

Unless otherwise covered by contract, psychologists make reasonable efforts to plan for facilitating services in the event that psychological services are interrupted by factors such as the psychologist’s illness, death, unavailability, relocation, or retirement or by the client’s/patient’s relocation or financial limitations.

(See also Standard 6.02c, Maintenance, Dissemination, and Disposal of Confidential Records of Professional and Scientific Work.)

Question 89

Standards 3.01 and 3.03 prohibit psychologists from harassing and unfairly discriminating against people on the basis of age, gender, gender identity, race, ethnicity, sexual orientation, and other factors prohibited by law.

Are there situations where a psychologist can refuse services?

Answer 89

The prohibition does not preclude psychologists from refusing to provide services to individuals they do not feel competent to serve or to “difficult” individuals.

Koocher and Keith-Spiegel note that it is probably more appropriate for a psychologist to refer an individual who “stirs up troubling feelings or anger in the therapist” (1998, p. 90) than to treat that individual him/herself. (p. 23)

Also E.S. 10.10b states that psychologists “may terminate therapy when threatened or otherwise endangered by the client/patient or another person with whom the client/patient has a relationship.”

Question 90

What constitutes sexual harassment?

Answer 90

Behaviors that are sexual in nature and are unwelcome, offensive, or create a hostile work or educational environment or would be recognized by a reasonable person as being abusive. It may consist of a “single intense or severe act or of multiple persistent or pervasive acts.”

The standard of “unreasonable” is often used by the courts to determine if a behavior constitutes sexual harassment.

Question 91

What is Quid pro quo?

Answer 91

“This for that”

Refers to an explicit or implicit requirement to trade sexual favors for a promotion, raise, or other tangible job benefit.

Question 92

What constitutes a “hostile environment”?

Answer 92

One that involves sexually offensive behaviors that make it difficult for an employee to perform his/her job. It includes sexual gestures, jokes, remarks, and pictures.

Question 93

In your spare time, you make and sell delicious truffles. A cafe owner in your town wants to sell your truffles at her coffee shop and the two of you have been discussing terms. During your last session with a client, you realize that the cafe owner is the cousin of your client.

How do you proceed?

Answer 93

According to E.S. 3.05a, I would not be allowed to enter into a business relationship with the relative of a client nor promise to do so in the future after termination of therapy because such a multiple relationship could potentially have the effect of impairing my objectivity, competence, or effectiveness or might risk exploitation or harm to my client or the client’s relative.

The standard also accounts for unforeseen factors (3.05b) such as those in this scenario and calls for one to take reasonable steps to resolve the situation with due regard for the best interests of the affected person (client and relative?) and maximal compliance with the Ethics Code. This may involve discussing the potential conflicts with my client or seeking consultation to identify the most appropriate course of action.

Question 94

The Ethics Code strictly prohibits all multiple relationships.

True or False

Answer 94

False. The Ethics Code does not have an absolute prohibition against multiple relationships. In fact, these are allowed in certain situations where they may be unavoidable or non harmful. E.S. 3.05a specifically states that “multiple relationships that would not reasonably be expected to cause impairment or risk exploitation or harm are not unethical.” This may be especially unavoidable in small towns.

Question 95

You are asked to appear in court as an expert witness in a child protection case involving a child you saw as a client last year.

Are you able to testify in court?

Answer 95

This situation is addressed in E.S. 3.05c, which deals with multiple relationships in forensic settings.

This is a case were a multiple relationship would be acceptable. Although according to the Guidelines for Psychological Evaluations in Child Protection Matters (APA, 2011) a psychologist should ordinarily avoid conducting evaluations in child protection cases when they have previously served as a therapist to the child or the child’s immediate family, this does not preclude them from “testifying in cases as fact or expert witnesses concerning therapeutic treatment of the children, parents, or families” (pp. 20-21).

Question 96

What are three factors that a psychologist should consider when determining the acceptability of a multiple relationship?

Answer 96

• Power Differential: The more influence the psychologist has over the individual, the less likely that the relationship is ethical.
• Duration of the Relationship: The longer the duration of either relationship, the more dubious the acceptability of the multiple relationship.
• Clarity of Termination: If there is a chance that either relationship will continue (e.g., that the individual will want to return for additional therapy later), the less acceptable the multiple relationship.

Gottlieb (1993) recommendations.

Question 97

What is a major problem a psychologist will face in third-party requests for services?

Answer 97

Defining “who is the client.”

Question 98

What are some examples of third-party requests for services?

Answer 98

Court-ordered evaluations and/or treatments.

A parent or legal guardian brings a minor for therapy.

An employer requests to have an employee evaluated for promotability.

Question 99

What is a very important step to take in third-party requests for services?

Answer 99

In addition to identifying who the client is, the psychologist should clarify the relevant issues with all involved parties, the most important of which is the limits of confidentiality.

Question 100

How many conditions must be met for a consent to be truly “informed” and what are they?

Answer 100

Three.

• Capacity: The individual is able to make rational decisions.
• Comprehension: The individual is given adequate information and understand the information sufficiently to make an informed decision.
• Voluntariness: The individual has given consent freely (without coercion).

Question 101

Describe a few obstacles or challenges in meeting the three conditions required for consent to be truly informed.

Answer 101

In terms of capacity, a psychologist may have a difficult time accurately determining if an individual is able to make rational decisions.

In terms of comprehension, consent forms have been found to often contain language that is beyond the reading level of many adults.

For instance, an individual with mild mental retardation may not have the capacity and/or the comprehension to understand certain issues, such as the limits of confidentiality. Also, members of other cultural backgrounds may have a different perception of health and illness and may not fully understand the content discussed during the informed consent process. Members of certain cultures are also likely to defer to individuals they perceive as an authority in the field and thus their agreement may not be fully voluntary despite a psychologists best efforts to eliminate coercion.

Question 102

When seeking an informed consent for therapy, what is some of the information that must be provided to the client/patient?

Answer 102

“the nature and anticipated course of therapy, fees, involvement of third parties, and limits of confidentiality.”

(E.S. 10.0a)

Question 103

When seeking an informed consent for an experimental or emerging procedure, what is some of the information that must be provided to the client/patient?

Answer 103

“the developing nature of the treatment, the potential risks involved, alternative treatments that may be available, and the voluntary nature of their participation.”

(E.S. 10.0b)

Question 104

According to the Ethics Code, when should one obtain the informed consent of a client/patient?

Answer 104

“as early as feasible in the therapeutic relationship.”

E.S. 10.01

Question 105

The informed consent process takes place at the beginning of the relationship.

Answer 105

Yes, as early as possible, but not exclusively. Informed consent is an ongoing process with discussions along the way as needed with regard to the progress and other relevant factors. (p. 26)

Question 106

What is an essential step of the informed consent process?

Answer 106

Documentation of the informed consent given by the client/patient.

Question 107

How does one document that one has received the informed consent from a client/patient?

Answer 107

There are several acceptable formats:

• Signed written form
• Audio- or videotape
• Assent + signed permission of legally authorized person
• Note in client’s record *
• Some cultural groups may regard signed written consents as offensive and prefer verbal agreements. However, a signed written consent may be required by law or institutional regulation.

Question 108

How does one obtain the informed consent of a person that is not legally capable of doing so due to age or cognitive deficits?

Answer 108

The psychologist provides the individual with as clear an explanation as possible, seeks the individual’s assent (agreement), and obtains the permission from a legally authorized person (parent or legal guardian).

Question 109

How does one obtain the informed consent of a person that has not been declared legally incompetent when the psychologist suspects cognitive deficits or is otherwise uncertain about the client’s ability to provide informed consent?

Answer 109

Proceed with caution.

Seek consultation and/or engage in a shared decision-making process with the individual’s parents or other caregivers/legal guardians.

Question 110

Standard 3.02 defines sexual harassment as behaviors that are sexual in nature and are unwelcome, offensive, or create a hostile work or educational environment or would be recognized by a ________ as being abusive.

Answer 110

reasonable person

Question 111

In the context of sexual harassment, ________ refers to an explicit or implicit requirement to trade sexual favors for a tangible job benefit.

Answer 111

Quid pro quo

Question 112

Standard 3.05a prohibits psychologists from entering into a multiple relationship with a person when that relationship could be reasonably expected to impair their objectivity or competence or risks ________ to that person.

Answer 112

exploitation or harm

Question 113

Standard 3.05c states that, when psychologists accept multiple roles in forensic settings, they must clarify ________ and issues related to confidentiality.

Answer 113

role expectations

Question 114

Gottlieb (1993) proposes that psychologists consider three factors when assessing the acceptability of a multiple relationship – the ________, the duration of the relationship, and the clarity of termination.

Answer 114

power differential

Question 115

Legally, three conditions must be met for a consent to be truly informed – i.e., capacity, comprehension, and ________.

Answer 115

voluntariness

Question 116

Standard 3.10 requires that psychologists obtain consents using language that is ________ and that consents be ________.

Answer 116

reasonably understandable; documented

Question 117

It also states that, when the individual is a minor or other person not legally capable of giving consent, a psychologist should provide the individual with an explanation, seek the individual’s ________, and obtain permission from a legally authorized person.

Answer 117

assent

Question 118

E.S. 4.01 Maintaining Confidentiality

Answer 118

Psychologists have a primary obligation and take reasonable precautions to protect confidential information obtained through or stored in any medium, recognizing that the extent and limits of confidentiality may be regulated by law or established by institutional rules or professional or scientific relationship.

(See also E.S. 2.05, Delegation of Work to others.)

Question 119

E.S. 4.02 Discussing the Limits of Confidentiality

Answer 119

(a) Psychologists discuss with persons (including, to the extent feasible, persons who are legally incapable of giving informed consent and their legal representatives) and organizations with whom they establish a scientific or professional relationship
(1) the relevant limits of confidentiality and
(2) the foreseeable uses of the information generated through their psychological activities.

(See also E.S. 3.10, Informed Consent.)

(b) Unless it is not feasible or is contraindicated, the discussion of confidentiality occurs at the outset of the relationship and thereafter as new circumstances may warrant.
(c) Psychologists who offer services, products, or information via electronic transmission inform clients/patients of the risks to privacy and limits of confidentiality.

Question 120

E.S. 4.03 Recording

Answer 120

Before recording the voices or images of individuals to whom they provide services, psychologists obtain permission from all such persons or their legal representatives.

(See also Standards
• 8.03, Informed Consent for Recording Voices and Images in Research;
• 8.05, Dispensing With Informed Consent for Research; and
• 8.07, Deception in Research.)

Question 121

E.S. 4.04 Minimizing Intrusions of Privacy

Answer 121

(a) Psychologists include in written and oral reports and consultations, only information germane to the purpose for which the communication is made.
(b) Psychologists discuss confidential information obtained in their work only for appropriate scientific or professional purposes and only with persons clearly concerned with such matters.

Question 122

E.S. 4.05 Disclosures

Answer 122

(a) Psychologists may disclose confidential information with the appropriate consent of the organizational client, the individual client/patient, or another legally authorized person on behalf of the client/patient unless prohibited by law.
(b) Psychologists disclose confidential information without the consent of the individual only as mandated by law, or where permitted by law for a valid purpose such as to

(1) provide needed professional services;
(2) obtain appropriate professional consultations;
(3) protect the client/patient, psychologist, or others from harm; or
(4) obtain payment for services from a client/patient, in which instance disclosure is limited to the minimum that is necessary to achieve the purpose.

(See also E.S. 6.04e, Fees and Financial Arrangements.)

Question 123

E.S. 4.06 Consultations

Answer 123

When consulting with colleagues,

(1) psychologists do not disclose confidential information that reasonably could lead to the identification of a client/patient, research participant, or other person or organization with whom they have a confidential relationship unless they have obtained the prior consent of the person or organization or the disclosure cannot be avoided, and
(2) they disclose information only to the extent necessary to achieve the purposes of the consultation.

(See also E.S. Standard 4.01, Maintaining Confidentiality.)

Question 124

E.S. 4.07 Use of Confidential Information for Didactic or Other Purposes

Answer 124

Psychologists do not disclose in their writings, lectures, or other public media, confidential, personally identifiable information concerning their clients/patients, students, research participants, organizational clients, or other recipients of their services that they obtained during the course of their work, unless

(1) they take reasonable steps to disguise the person or organization,
(2) the person or organization has consented in writing, or
(3) there is legal authorization for doing so.

Question 125

Privacy

Answer 125

“the freedom of individuals to choose for themselves the time and the circumstances under which and the extent to which their beliefs, behaviors, and opinions are to be shared [with] or withheld from others” (Siegal, 1979, p. 251).

Question 126

Confidentiality

Answer 126

The obligation of psychologists to protect clients from unauthorized disclosure of information revealed in the context of a professional relationship.

Confidentiality is an ethical principle and, in some situations, a legal requirement.

Question 127

Privilege

Answer 127

A legal concept that protects a client’s confidentiality in the context of legal proceedings.

Psychotherapist-patient privilege was recognized at the federal level in 1996 by the U.S. Supreme Court decision in Jaffee v. Redmond, and most jurisdictions now have laws that establish privilege for communications between licensed mental health professionals and their clients.

Question 128

Privacy, confidentiality, and privilege are interchangeable terms.

Answer 128

No, they are related, but have distinct meanings.

Privacy refers to the freedom people have to decide when and how their personal information is shared or not.

Confidentiality is an ethical principle (sometimes a legal requirement too) that requires psychologists to protect their clients’ information from unauthorized access.

Privilege is a legal concept that protects a client’s confidentiality in the context of legal proceedings.

Question 129

Who is the holder of the privilege?

Answer 129

The client or the client’s legal guardian or representative.

However, a psychologist may claim the privilege on behalf of the client when the psychologist is asked to disclose confidential information in a legal proceeding.

Question 130

Is there ever a time when the holder of the privilege is someone other than the client or the client’s legal guardian or representative?

Answer 130

Yes! A psychologist may claim the privilege on behalf of the client when the psychologist is asked to disclose confidential information in a legal proceeding.

In other words, the psychologist should claim the privilege on the client’s behalf when the therapist is first asked to disclose confidential information about a client when providing testimony in court. The therapist would then release the information only when ordered to do so by the court or when the client or the client’s representative consents to the release.

Question 131

Claim, assert, and invoke are interchangeable terms.

Answer 131

Yes.

With regard to privilege then, one can “claim the privilege,” “assert the privilege,” and “invoke the privilege.”

Question 132

Is privilege absolute or are there exceptions?

Answer 132

There are numerous exceptions legally defined and which vary between jurisdictions but often include:

Waivers: The client authorizes the release of information.

Mandatory Reporting: The therapist knows or suspects that a client is involved in child, elder, or dependent adult abuse.

Danger to Self or Others: The therapist believes the client is a danger to him/herself or others.

Legal/Regulatory Actions: The client …
• is suing the therapist for malpractice;
• has filed a complaint against a psychologist with the Ethics Committee or licensing board;
• is a party in a custody dispute; or
• is the subject of a court-ordered evaluation.

Note: Exceptions to privilege are not automatic, but rather determined by a judge after review of relevant material. The judge then issues an order to release the info.

Question 133

Confidentiality and privilege are a frequent source of concern for psychologists, particularly when the ethical obligation to maintain a client’s confidentiality is pitted against a legal requirement to breach confidentiality.

How does one resolve such a dilemma?

Answer 133

The Ethics Code provides the guidelines for this situation in E.S. 4.05b, which states that psychologists may disclose confidential information without a client’s consent when to do so is “mandated by law or permitted by law for a valid purpose.”

Remember: legal exceptions to privilege and other legal mandates for the release of confidential information ordinarily take precedence over ethical obligations.

Question 134

The parent of a child you have been seeing asks about what is being discussed in session.

Are you required to withhold or disclose the information requested?

Answer 134

Ordinarily I would have to disclose the information, unless a legal exception applies.

A minor’s parent or legal guardian has a legal right to be informed of information revealed by the minor during the course of his or her treatment unless a legal exception in this general rule applies, such as when the minor is emancipated or is legally able to consent to his/her own treatment.

Remember: a minor’s parent or legal guardian is ordinarily the holder of the privilege for a minor, but there are legal exceptions to this rule, such as when a judge determines it so (e.g. case of father accused of molesting minor son – judge determined privilege to belonged to son). p. 31

Question 135

Standard 4.02 requires psychologists to discuss the limits of confidentiality with people and organizations to whom they provide services and to do so when feasible “at the outset of the relationship and thereafter as new circumstances may warrant.”

What are some situations that create special problems related to confidentiality?

Answer 135

• Group therapy
• Couple and family therapy
• Minor clients
• Deceased clients
• Services delivered or stored electronically
• Services provided by military psychologists to military personnel
• Employee assistance programs (EAPs)

Question 136

How should psychologists approach the issue of confidentiality in group therapy?

Answer 136

Group members must be informed of the limits of confidentiality (E.S. 10.03).

The discussion should include …
• how confidentiality will be handled when the therapist also sees group members in individual therapy.
• legal limits to confidentiality (i.e., in some states, info revealed in presence of a third party is exempt from privilege statues).

Question 137

What are some things group therapists can do to help protect members’ confidentiality?

Answer 137

To help protect members’ confidentiality, it is recommended that …

(a) the need for confidentiality be discussed in both prescreening interviews and initial therapy sessions and that group members be periodically reminded of the importance of confidentiality in later sessions;
(b) group members be encouraged to confront each other in therapy about possible violations of confidentiality; and
(c) group members be reminded to continue to maintain confidentiality when the group ends.

Hummel, Talbutt, and Alexander (1985).

Question 138

How might issues of confidentiality arise in the context of couple and family therapy?

Answer 138

The problem of “secrets” can arise, especially when it is the therapist’s policy to also see partners or family members in individual therapy.

A member of the couple of family could also reveal a “secret” over the phone or some other medium.

Question 139

How might a therapist approach concerns about “secrets” in the context of couple and family therapy before these problems arise?

Answer 139

This is not directly addressed by the Ethics Code, but Corey, Corey, and Callahan (1988, p. 307) suggest that

… the best policy is for the psychologist to let partners or family members know at the outset of treatment that information disclosed in private sessions “will be divulged as … [he/she sees] fit in accordance with the greatest benefit for the couple or the family.”

Question 140

How might issues of confidentiality arise in the context of therapy with minor clients?

Answer 140

Except in legally defined situations, the parent or legal guardian of a minor client has the right to information that the minor reveals during the course of treatment. Such a disclosure may undermine the effectiveness of treatment.

Question 141

How might a therapist approach concerns about confidentiality in the context of therapy with minor clients?

Answer 141

A good practice is to have all parties agree at the outset of treatment what kinds of information will and will not be disclosed (even though the agreement may not be legally binding).

Question 142

How might issues of confidentiality arise in the context of deceased clients?

Answer 142

The confidentiality of client information following a client’s death is not explicitly covered by the Ethics Code, but some jurisdictions have laws that apply to this situation.

Example: Massachusetts statute states that “all communications… shall be deemed to be treated as confidential in perpetuity” (251 CMR 1.11).
• In such situations, the records of a deceased client cannot be released to a family member or other person without a release from the executor or administrator of the client’s estate.

Question 143

How might a therapist approach concerns about confidentiality in the context of services delivered or stored electronically?

Answer 143

• E.S. 4.02a: requires psychologists to inform clients of the possible limits on privacy and confidentiality when they deliver services electronically;
• E.S. 6.02b: states that, when psychologists store information in databases or other systems that can be accessed by others, they must use coding or other techniques that restrict access to identifying information.

Question 144

What are some methods one can use to protect the confidentiality of clients when storing information electronically?

Answer 144

• passwords
• de-identifying confidential information
• establishing and monitoring procedures for maintaining client confidentiality.

Question 145

How might issues of confidentiality arise in the context of services provided by military psychologists to military personnel?

Answer 145

Military psychologists must strive to protect the confidentiality of their clients while also adhering to Department of Defense rules that pertain to this issue (Ford, 2006).

(I would say that is a conflict of interests.)

Question 146

How might a military psychologist approach concerns about confidentiality in the context of services provided to military personnel?

Answer 146

The military psychologist must …

• clearly explain the limits on confidentiality (e.g., the need to violate confidentiality when the psychologist believes the client is unfit for duty or poses a threat to national security)
• discuss concerns related to who the client is in the situation (e.g., the Department of Defense versus the individual)

Question 147

How might issues of confidentiality arise in the context of an Employee Assistance Program?

Answer 147

As with other situations, this can happen when …

• a client signs an authorization for release of confidential information and when
• disclosing confidential information without an authorization is permitted or required by law (e.g., when the client is believed to be a danger to him/herself or others).

Question 148

E.S. 4.05 states that psychologists may discuss confidential information with others with the consent of the client of his/her legal representative or when to do so is mandated by law or permitted by law for a valid purpose.

What are some situations where the latter provision might apply?

Answer 148

• The client is a danger to him/herself: When a psychologist believes a client is at risk for suicide, the psychologist must take action to protect the client, such as establishing a no-suicide contract, contacting the client’s family, or having the client hospitalized.

Note: These intended actions should ideally be discussed the the client first and information disclosed to others should be limited to relevant situation.

• The client is a danger to another person: In some jurisdictions, psychologists are required or authorized to warn or protect identifiable third parties at risk of harm from therapy clients. In most cases, the duty to warn/protect applies only when a client poses a clear and imminent danger to an identifiable victim or victims (although, in some jurisdictions, the duty has been expanded to include an identifiable “class of victims”).

However, this does NOT apply to when a client

(a) reveals he/she killed a person ten years ago but was never questioned by the police.
(b) says that his/her brother-in-law has been talking about killing his boss; or
(c) says he/she is “mad enough to kill someone” but further questioning reveals no specific intended victim.

Note: other actions by the psychologist might be needed, such as encouraging the client to contact the police in scenarios a and b.

• The client is the perpetrator or victim of child abuse: although the exact provisions of reporting laws vary, all jurisdictions …

(a) require psychologists to make a report to an appropriate authority whenever they know or suspect that child abuse has occurred and
(b) grant reporters immunity from civil or criminal liability when a report has been made in good faith.

• There are no time limits on child abuse reporting. Therefore, a psychologist has an obligation to file a report as long as the victim is still a minor. There is also an obligation to file a report if an adult client tells a psychologist he/she was abused by someone who could be still victimizing a minor (e.g., a sibling; a teacher or other role where the abuser has responsibility for children). Best to include the client in the reporting process.

Note: In most jurisdictions, a psychologist has the option to make or not make a report if they learn about a case of child abuse outside their professional capacity. p. 34

Question 149

What is the Tarasoff decision?

Answer 149

A 1974 court ruling that established a “duty to warn” an intended victim; but, in the 1976 rehearing of the case, this was changed to a “duty to protect” the intended victim by warning him/her, notifying the police, or taking other steps.

Question 150

How does the Tarasoff decision of “duty to warn” (1974), which was later amended to “duty to protect” (1976), apply to a case where a psychologist has a client who is HIV-positive and reveals that he/she is engaging in unsafe sexual practices?

Answer 150

The laws around this controversial issue vary. The laws in some jurisdictions require or allow psychologists to warn identifiable at-risk individuals while others prohibit them from doing so.

APA recommendation (1991):

1. A legal duty to protect third parties from HIV infection should not be imposed.
2. If, however, specific legislation is considered, then it should permit disclosure only when
   (a) the provider knows of an identifiable third party who the provider has compelling reason to believe is at significant risk for infection;
   (b) the provider has a reasonable belief that the third party has no reason to suspect that he or she is at risk; and
   (c) the client has been urged to inform the third party and has either refused or is considered unreliable in his/her willingness to notify the third party.

Question 151

What are some important considerations around consultation and confidentiality?

Answer 151

While E.S. 3.09 requires psychologists to cooperate with other professionals (e.g. colleague, physician, attorney) to best serve their clients, E.S. 4.06 states that one must only discuss information relevant to the consultation and only with the client’s prior consent unless the client’s identity can be disguised.

Question 152

A psychologist has prepared a case presentation for an upcoming job interview and is using a pseudonym for the client.

Has the psychologist met the requirements set forth by E.S. 4.07 to protect the confidentiality of his/her client? Why or why not?

Answer 152

No. Although using pseudonyms are an appropriate step, other “reasonable steps” to be taken include removing all personally identifiable information that could compromise the client’s confidentiality.

Question 153

________ refers to a psychologist’s obligation to protect clients from unauthorized disclosure of information revealed in the context of a professional relationship, while ________ is a legal concept that protects a client’s confidentiality in the context of a legal proceeding.

Answer 153

Confidentiality; privilege

Question 154

The client is usually the ________, but a psychologist may ________ on behalf of the client.

Answer 154

holder of the privilege; claim the privilege

Question 155

In their survey of APA members, Pope and Vetter (1992) found that ________ was identified by respondents as the most frequently occurring “ethically troubling issue.”

Answer 155

confidentiality

Question 156

Standard 4.02 requires psychologists to discuss the limits of confidentiality with clients, unless not feasible, at the ________ and thereafter as new circumstances warrant.

Answer 156

outset of the relationship

Question 157

Psychologists may discuss confidential information with others with the consent of the client or his/her legal representative or when to do so is ________ or permitted by law for a valid reason.

Answer 157

mandated

Question 158

Psychologists may breach client confidentiality when the client is the perpetrator or minor victim of child abuse or is a danger to self or others. With regard to the latter, the ________ established a duty to warn/protect the intended victim of a client when the client poses a clear and imminent danger to that individual.

Answer 158

Tarasoff decision

Question 159

Standard 4.06 states that, when consulting with others about a client, psychologists discuss only information that is relevant to the purpose of the consultation and must obtain ________ from the client before doing so unless the client’s identity can be disguised.

Answer 159

prior consent

Question 160

Standard 4.07 states that psychologists do not reveal personally identifiable client information in their writings, lectures, etc. unless they take reasonable steps to disguise the person’s identity or have obtained ________ from the client to do so.

Answer 160

written consent

Question 161

E.S. 5.01 Avoidance of False or Deceptive Statements

Answer 161

(a) Public statements include but are not limited to paid or unpaid advertising, product endorsements, grant applications, licensing applications, other credentialing applications, brochures, printed matter, directory listings, personal resumes or curricula vitae, or comments for use in media such as print or electronic transmission, statements in legal proceedings, lectures and public oral presentations, and published materials. Psychologists do not knowingly make public statements that are false, deceptive, or fraudulent concerning their research, practice, or other work activities or those of persons or organizations with which they are affiliated.

(b) Psychologists do not make false, deceptive, or fraudulent statements concerning
(1) their training, experience, or competence;
(2) their academic degrees;
(3) their credentials;
(4) their institutional or association affiliations;
(5) their services;
(6) the scientific or clinical basis for, or results or degree of success of, their services;
(7) their fees; or
(8) their publications or research findings.

(c) Psychologists claim degrees as credentials for their health services only if those degrees
(1) were earned from a regionally accredited educational institution or
(2) were the basis for psychology licensure by the state in which they practice.

Question 162

E.S. 5.02 Statements by Others

Answer 162

(a) Psychologists who engage others to create or place public statements that promote their professional practice, products, or activities retain professional responsibility for such statements.
(b) Psychologists do not compensate employees of press, radio, television, or other communication media in return for publicity in a news item. (See also E.S. 1.01, Misuse of Psychologists’ Work.)
(c) A paid advertisement relating to psychologists’ activities must be identified or clearly recognizable as such.

Question 163

E.S. 5.03 Descriptions of Workshops and Non-Degree-Granting Educational Programs

Answer 163

To the degree to which they exercise control, psychologists responsible for announcements, catalogs, brochures, or advertisements describing workshops, seminars, or other non-degree-granting educational programs ensure that they accurately describe the audience for which the program is intended, the educational objectives, the presenters, and the fees involved.

Question 164

E.S. 5.04 Media Presentations

Answer 164

When psychologists provide public advice or comment via print, internet, or other electronic transmission, they take precautions to ensure that statements …

(1) are based on their professional knowledge, training, or experience in accord with appropriate psychological literature and practice;
(2) are otherwise consistent with this Ethics Code; and
(3) do not indicate that a professional relationship has been established with the recipient.

(See also E.S. 2.04, Bases for Scientific and Professional Judgments.)

Question 165

E.S. 5.05 Testimonials

Answer 165

Psychologists do not solicit testimonials from current therapy clients/patients or other persons who because of their particular circumstances are vulnerable to undue influence.

Question 166

E.S. 5.06 In-Person Solicitation

Answer 166

Psychologists do not engage, directly or through agents, in uninvited in-person solicitation of business from actual or potential therapy clients/patients or other persons who because of their particular circumstances are vulnerable to undue influence.

However, this prohibition does not preclude …

(1) attempting to implement appropriate collateral contacts for the purpose of benefiting an already engaged therapy client/patient or
(2) providing disaster or community outreach services.

Question 167

E.S. 5.01 requires psychologists to claim as credentials for their health services only academic degrees that are from regionally accredited educational institutions or were the basis for their ________, while E.S. 5.02 prohibits psychologists from compensating employees of the press, television, etc. in return for ________.

Answer 167

psychology licensure; publicity

Question 168

Providing professional advice to the public via the Internet, radio, television, or other media is addressed in E.S. 5.04, which requires psychologists to ensure that they do not imply that a ________ has been established.

Answer 168

professional relationship

Question 169

E.S. 5.05 prohibits psychologists from ________ testimonials from current clients or others who are vulnerable to undue influence; while E.S. 5.06 prohibits psychologists from engaging in ________ in-person solicitation of business from people who are vulnerable to undue influence.

Answer 169

soliciting; uninvited

Question 170

There are exceptions to the prohibition of engaging in uninvited in-person solicitation of business from actual or potential therapy clients or from other people who are vulnerable to undue influence: Psychologists may invite a current client’s family members to participate in therapy to benefit the client or offer ________ or community outreach services to individuals.

Answer 170

disaster

Question 171

E.S. 6.01 Documentation of Professional and Scientific Work and Maintenance of Records

Answer 171

Psychologists create, and to the extent the records are under their control, maintain, disseminate, store, retain, and dispose of records and data relating to their professional and scientific work in order to …

(1) facilitate provision of services later by them or by other professionals,
(2) allow for replication of research design and analyses,
(3) meet institutional requirements,
(4) ensure accuracy of billing and payments, and
(5) ensure compliance with law.

(See also E.S. 4.01, Maintaining Confidentiality.)

Question 172

E.S. 6.02 Maintenance, Dissemination, and Disposal of Confidential Records of Professional and Scientific Work

Answer 172

(a) Psychologists maintain confidentiality in creating, storing, accessing, transferring, and disposing of records under their control, whether these are written, automated, or in any other medium. (See Also Standards 4.01, Maintaining Confidentiality, and 6.01, Documentation of Professional and Scientific Work and Maintenance of Records.)
(b) If confidential information concerning recipients of psychological services is entered into databases or systems of records available to persons whose access has not been consented to by the recipient, psychologists use coding or other techniques to avoid the inclusion of personal identifiers.
(c) Psychologists make plans in advance to facilitate the appropriate transfer and to protect the confidentiality of records and data in the event of psychologists’ withdrawal from positions or practice. (See also Standards 3.12, Interruption of Psychological Services, and 10.09, Interruption of Therapy.)

Question 173

E.S. 6.03 Withholding Records for Nonpayment

Answer 173

Psychologists may not withhold records under their control that are requested and needed for a client’s/patient’s emergency treatment solely because payment has not been received.

Question 174

E.S. 6.04 Fees and Financial Arrangements

Answer 174

(a) As early as is feasible in a professional or scientific relationship, psychologists and recipients of psychological services reach an agreement specifying compensation and billing arrangements.
(b) Psychologists’ fee practices are consisted with law.
(c) Psychologists do not misrepresent their fees.
(d) If limitations to services can be anticipated because of limitations in financing, this is discussed with the recipient of services as early as is feasible. (See also Standards 10.09, Interruption of Therapy, and 10.10, Terminating Therapy.)
(e) If the recipient of services does not pay for services as agreed, and if psychologists intend to use collection agencies or legal measures to collect the fees, psychologists first inform the person that such measures will be taken and provide that person an opportunity to make prompt payment. (See also Standards 4.05, Disclosures; 6.03, Withholding Records for Nonpayment; and 10.01, Informed Consent to Therapy.)

Question 175

E.S. 6.05 Barter With Clients/Patients

Answer 175

Barter is the acceptance of goods, services, or other non monetary remuneration from clients/patients in return for psychological services. Psychologists may barter only if …

(1) it is not clinically contraindicated, and
(2) the resulting arrangement is not exploitative.

(See also Standards 3.05, Multiple Relationships, and 6.04, Fees and Financial Arrangements.)

Question 176

E.S. 6.06 Accuracy in Reports to Payors and Funding Sources

Answer 176

In their reports to payors for services or sources of research funding, psychologists take reasonable steps to ensure the accurate reporting of the nature of the services provided or research conducted, the fees, charges, or payments, and where applicable, the identity of the provider, the findings, and the diagnosis.

(See also Standards 4.01, Maintaining Confidentiality; 4.04, Minimizing Intrusions on Privacy; and 4.05, Disclosures.)

Question 177

E.S. 6.07 Referrals and Fees

Answer 177

When psychologists pay, receive payment from, or divide fees with another professional, other than in an employer-employee relationship, the payment to each is based on the services provided (clinical, consultative, administrative, or other) and is not based on the referral itself.

(See also E.S. 3.09, Cooperation With Other Professionals.)

Question 178

Although E.S. 6.01 addresses the maintenance of records, more specific information about record maintenance and retention is provided in APA’s (2007) Record Keeping Guidelines.

According to Guideline 2, what type of information should a psychologist record for each substantive contact with a client?

Answer 178

• Date of session
• Duration of session
• Type of service provided (e.g., assessment, treatment)
• Nature of intervention or contact (e.g., tx modality)
• Summary of client’s status

Question 179

Guideline 7 of APA’s (2007) Record Keeping Guidelines specifies that a “psychologist strives to be aware of applicable laws and regulations and to retain records for the period required by legal, regulatory, institutional, and ethical requirements” (p. 997).

What should one do in the absence of superseding laws or institutional regulations?

Answer 179

The recommendation is that psychologists may consider retaining full records…

• until 7 years after the last date of service delivery for adults or
• until 3 years after a minor reaches the age of majority,

whichever is later.

Note: in some circumstances, the psychologist may wish to keep records for a longer period, weighing the risks associated with obsolete or outdated information, or privacy loss, versus the potential benefits associated with preserving the records. (p. 999)

Question 180

E.S. 6.02a states that psychologists must “maintain confidentiality in creating, storing, accessing, transferring, and disposing of records under their control.”

What are some measures a psychologist can take to preserve the confidentiality of clients with regard to record-keeping?

Answer 180

The measures may depend on the specific circumstances, but they include…

• ensuring that all staff members understand the importance of keeping information contained in files confidential,
• keeping records in a locked filing cabinet or room, and
• making sure that access to records stored in electronic databases is limited.

Question 181

E.S. 6.02b requires psychologists to have a plan for protecting the confidentiality of records in the event of their death, illness, or withdrawal from practice for other reasons.

What are some ways that a psychologist can protect the confidentiality of records in such situations?

Answer 181

One can…

• specify in one’s professional will or elsewhere how client records should be handled;
• have an agreement with a responsible colleague about the management of records,
• one can instruct one’s spouse or executor to seek advice on record keeping,
• ask a professional association to assist in managing or maintaining the records

(Koocher & Keith-Spiegel, 1998)

Question 182

Ethical Standard 6 deals with record keeping and fees. Based on this knowledge, how should a psychologist approach a client’s request for his/her records?

Answer 182

Client access to records is not covered by the Ethics Code, but rather it is addressed by federal, state, and provincial laws and institutional regulations and by HIPAA. Thus, I would have to be familiar with my local laws regarding this issue. I would also consult with colleagues.

Question 183

What does the Ethics Code state about ownership of client records?

Answer 183

The Ethics Code does not address this. The laws vary between jurisdictions, with some laws granting ownership of physical records to the practitioner or institution but giving clients the right to inspect and amend the information.

Also, some laws recognize that complete access to psychological records may have a detrimental impact on clients and provide exceptions to the general rule.

Question 184

Client access to records is Addressed by the Health Insurance Portability and Accountability Act (HIPAA). Its Privacy Rule distinguishes between protected health information (PHI) and psychotherapy notes.

How are these two types of documents defined and how are they distinguished with regard to client record access?

Answer 184

• PHI: includes information used by health care professionals or entities that relates to the patient’s physical or mental health care, that could be used to identify the patient, and that has been transmitted or maintained in any form or medium.
• Psychotherapy notes: notes in any medium used by the mental health practitioner for the purpose of documenting or analyzing the content of a therapy session and that are maintained separately from the patient’s medical record.
• HIPAA’s Privacy Rule allows patients to inspect and obtain a copy of PHI contained in a “designated record set,” which is defined as the medical and billing records maintained by a psychologists and used to make decisions about the patient. It does not, however, require psychologists to release their psychotherapy notes, unless required to do so by state law.

Question 185

What does the Family Education Rights and Privacy Act (FERPA) apply to?

Answer 185

It applies to the records maintained by educational institutions receiving federal funds.

Question 186

FERPA prohibits schools from disclosing personally identifying information from student records without the consent of the parents of students or of eligible students (those aged 18 and older or those who are attending postsecondary institutions.

In what circumstances is there an exception to this rule?

Answer 186

Exceptions include:

• providing records to education professionals who have a legitimate educational interest in the student,
• to appropriate individuals for the purpose of financial aid decisions, and
• to another school to which the student is transferring.

Question 187

FERPA grants parents and eligible students the right to inspect the student’s educational records and to challenge their content except in what cases?

Answer 187

This does not apply to

• personal notes that are in the sole possession of educational personnel and
• health records that are used in conjunction with the treatment of a student and are available only to the individuals providing the treatment.

Question 188

E.S. 6.03 prohibits psychologists from withholding a client’s records because of nonpayment of fees “when such records are needed for a client’s/patient’s emergency treatment.”

This would imply that it would be acceptable to withhold records in non-emergency situations when a client owes money. Would that be ethical, then?

Answer 188

Not really. E.S. 3.04 requires psychologists to “take reasonable steps to avoid harming their clients/patients” and withholding records for nonpayment may violate this provision.

Also, state, federal, and provincial laws or institutional regulations may not recognize nonpayment of fees as a legitimate reason for withholding records under any circumstance.

Question 189

A psychologist has been seeing a client for several years and billing the insurance company. The client was recently hit hard economically and is not sure ongoing therapy is possible. To help alleviate the client’s financial burden temporarily and to avoid a break in the client’s treatment, the psychologist agrees to not collect the client’s co-payment.

What are the ethical and/or legal implications of this decision?

Answer 189

This basically constitutes insurance fraud (if the insurance company has not agreed to this arrangement) because now they are essentially paying 100% of the client’s fee rather than the smaller percentage they agreed to.

Better alternatives might include…
• Temporarily going pro bono
• temporarily spacing out visit

Question 190

What are some examples of insurance fraud?

Answer 190

• signing insurance forms as the provider of services that were actually provided by a supervisee;
• billing an insurance company for missed appointments (unless the company agreed to this arrangement);
• billing for individual sessions when group, couple, or family therapy has actually been provided;
• changing the date of the beginning of therapy or the onset of a disorder to circumvent insurance restrictions;
• assigning an inaccurate DSM dx to a client to qualify for insurance payments; or
• billing an insurance company in a way that waives a client’s co-payment without the company being aware of this arrangement.

Question 191

A new potential client comes to see you and indicates they do not have the financial means to pay your fee and asks if you would be willing to accept housekeeping services in exchange for your fee. You have actually considered hiring a housekeeper.

Do you accept the proposal? Why or why not? If not, what action would you take?

Answer 191

No, this is not an appropriate form of barter or one that I would be comfortable with. This could lead to friction between the client and I if there are disagreements as to the quality of services provided by either. I also see issues with confidentiality (e.g., my spouse would sooner or later know of the dual relationship). Rather, I would consider pro bono services, a sliding scale, or a referral.

Note: Canter et al. (1994) conclude that the exchange of certain services for therapy – e.g., housekeeping or childcare – would be clearly clinically contraindicated because of the potential negative consequences if those services are not performed satisfactorily. They also note that, when considering the potential for exploitation, the client and the psychologist should both be considered.

Remember E.S. 6.05 states that barter may be acceptable when it is not clinically contraindicated and not exploitative.

Question 192

Taking into consideration that E.S. 6.07 states that referral fees are not prohibited and that they must be based on the actual cost of the services provided.

You recently referred a client to a colleague, who will be seeing the client in your office space at times you do not use it. Would it be okay to accept a fee?

Answer 192

A fee for using the office, yes; a fee for the referral itself, no.

Question 193

Are there ethical problems associated with the use of a sliding fee scale?

Answer 193

The Ethics Code does not address sliding fee scales, but they are generally considered acceptable as long as their use is fair and serves the best interests of the client.

Koocher and Keith-Spiegel conclude that “the actual fee charged for services rendered is not as important from an ethical standpoint as the manner in which it is set, communicated, managed, and collected” (2008, p. 162).

Question 194

APA’s Record Keeping Guidelines specify that, in the absence of superseding laws or regulations, a psychologist may consider retaining a client’s full record until ________ years after termination of services for adults or ________ years after a minor reaches the age of majority.

Answer 194

seven; three

Question 195

In many jurisdictions, laws grant ownership of a client’s physical record to the ________ and give clients the right to inspect and amend the information contained in the record.

Answer 195

practitioner or institution

Question 196

HIPAA’s ________ distinguishes between protected health information (PHI) and psychotherapy notes and allows patients to inspect and obtain a copy of PHI contained in a ________.

Answer 196

Privacy Rule; designated record set

Question 197

________ is also known as the Buckley Amendment and prohibits schools from disclosing personally identifying information from student records without the consent of the parents of student or of eligible students.

Answer 197

FERPA (Family Education Rights and Privacy Act)

Question 198

E.S. 6.03 prohibits psychologists from withholding a client’s record because of nonpayment of fees when those records are needed for the client’s ________; and E.S. 6.04 requires psychologists to discuss fees and other financial matter with clients ________.

Answer 198

emergency treatment; as early as feasible

Question 199

It is acceptable for psychologists to use a ________ to obtain outstanding fees from a client, but they must do so only after notifying the client of that intent and giving him/her the opportunity to pay the fees.

Answer 199

collection agency;

Question 200

According to E.S. 6.05, barter may be acceptable when it is not ________ and not exploitative.

Answer 200

clinically contraindicated;

Question 201

Referral fees are covered in E.S. 6.07, which states that they are not prohibited but must be based on the ________ of the services provided and not the referral itself.

Answer 201

actual costs

Question 202

Sliding fee scales are not addressed in the Ethics Code but are generally considered acceptable as long as they are ________ and serve the best interests of the client.

Answer 202

fair

Question 203

E.S. 7.01 Design of Education and Training Programs

Answer 203

Psychologists responsible for education and training programs take reasonable steps to ensure that the programs are designed to provide the appropriate knowledge and proper experiences, and to meet the requirements for licensure, certification, or other goals for which claims are made by the program.

(See also E.S. 5.03, Descriptions of Workshops and Non-Degree-Granting Educational Programs.)

Question 204

E.S. 7.02 Descriptions of Education and Training Programs

Answer 204

Psychologists responsible for education and training programs take reasonable steps to ensure that there is a current and accurate description of the program content (including participation in required course- or program-related counseling, psychotherapy, experiential groups, consulting projects, or community service), training goals and objectives, stipends and benefits, and requirements that must be met for satisfactory completion of the program. This information must be made readily available to all interested parties.

Question 205

E.S. 7.03 Accuracy in Teaching

Answer 205

(a) Psychologists take reasonable steps to ensure that course syllabi are accurate regarding the subject matter to be covered, bases for evaluating progress, and the nature of course experiences. This standard does not preclude an instructor from modifying course content or requirements when the instructor considers it pedagogically necessary or desirable, so long as students are made aware of these modifications in a manner that enables them to fulfill course requirements. (See also E.S. 5.01, Avoidance of False or Deceptive Statements.)
(b) When engaged in teaching or training, psychologists present psychological information accurately. (See also E.S. 2.03, Maintaining Competence.)

Question 206

E.S. 7.04 Student Disclosure of Personal Information

Answer 206

Psychologists do not require students or supervisees to disclose personal information in course- or program-related activities, either orally or in writing, regarding sexual history, history of abuse and neglect, psychological treatment, and relationships with parents, peers, and spouses or significant others except if

(1) the program or training facility has clearly identified this requirement in its admissions and program materials or
(2) the information is necessary to evaluate or obtain assistance for students whose personal problems could reasonably be judged to be preventing them from performing their training- or professionally related activities in a competent manner or posing a threat to the students or others.

Question 207

E.S. 7.05 Mandatory Individual or Group Therapy

Answer 207

(a) when individual or group therapy is a program or course requirement, psychologists responsible for that program allow students in undergraduate and graduate programs the option of selecting such therapy from practitioners unaffiliated with the program. (See also E.S. 7.02, Descriptions of Education and Training Programs.)
(b) Faculty who are or are likely to be responsible for evaluating students’ academic performance do not themselves provide that therapy. (See also E.S. 3.05, Multiple Relationships.)

Question 208

E.S. 7.06 Assessing Student and Supervisee Performance

Answer 208

(a) In academic and supervisory relationships, psychologists establish a timely and specific process for providing feedback to students and supervisees. Information regarding the process is provided to the student at the beginning of supervision.
(b) Psychologists evaluate students and supervisees on the basis of their actual performance on relevant and established program requirements.

Question 209

E.S. 7.07 Sexual Relationships With Students and Supervisees

Answer 209

Psychologists do not engage in sexual relationships with students or supervisees who are in their department, agency, or training center or over whom psychologists have or are likely to have evaluative authority. (See also E.S. 3.05, Multiple Relationships.)

Question 210

Standards 7.01 through 7.06 require psychologists to take ________ to ensure they do not misrepresent themselves or their work when teaching, supervising, or designing education or training programs.

Answer 210

reasonable steps

Question 211

Although course syllabi should be accurate, this does not preclude psychologists from modifying course requirements when to do so is ________ necessary or desirable.

Answer 211

pedagogically

Question 212

Psychologists are generally prohibited from requiring students and supervisees to disclose personal information in a course or program, but doing so may be acceptable when the requirement is clearly stated in admissions or program materials or the information is needed to evaluate or obtain assistance for a student or supervisee whose personal problems may be interfering with his/her education or training or ________ to others.

Answer 212

pose a threat

Question 213

E.S. 7.07 prohibits psychologists from engaging in sexual relationships with students and supervisees over whom they have or are likely to have ________.

Answer 213

evaluative authority

Question 214

E.S. 8.01 Institutional Approval

Answer 214

When institutional approval is required, psychologists provide accurate information about their research proposals and obtain approval prior to conducting the research. They conduct the research in accordance with the approved research protocol.

Question 215

E.S. 8.02 Informed Consent to Research

Answer 215

(a) When obtaining informed consent as required in E.S. 3.10, Informed Consent, psychologists inform participants about …
(1) the purpose of the research, expected duration, and procedures;
(2) their right to decline to participate and to withdraw from the research once participation has begun;
(3) the foreseeable consequences of declining or withdrawing;
(4) reasonably foreseeable factors that may be expected to influence their willingness to participate such as potential risks, discomfort, or adverse effects;
(5) any prospective research benefits;
(6) limits of confidentiality;
(7) incentives for participation; and
(8) whom to contact for questions about the research and research participants’ rights.

They provide opportunity for the prospective participants to ask questions and receive answers. (See also Standards 8.03, Informed Consent for Recording Voices and Images in Research; 8.05, Dispensing With Informed Consent for Research; and 8.07, Deception in Research.)

(b) Psychologists conducting intervention research involving the use of experimental treatments clarify to participants at the outset of the research
(1) the experimental nature of the treatment;
(2) the services that will or will not be available to the control group(s) if appropriate;
(3) the means by which assignment to treatment and control groups will be made;
(4) available treatment alternatives if an individual does not wish to participate in the research or wishes to withdraw once a study has begun; and
(5) compensation for or monetary costs of participating including, if appropriate, whether reimbursement from the participant or a third-party payor will be sought.

(See also E.S. 8.02a, Informed Consent to Research.)

Question 216

E.S. 8.03 Informed Consent for Recording Voices and Images in Research

Answer 216

Psychologists obtain informed consent from research participants prior to recording their voices or images for data collection unless

(1) the research consists solely of naturalistic observations in public places, and it is not anticipated that the recording will be used in a manner that could cause personal identification or harm, or
(2) the research design includes deception, and consent for the use of the recording is obtained during debriefing.

(See also E.S. 8.07, Deception in Research.)

Question 217

E.S. 8.04 Client/Patient, Student, and Subordinate Research Participants

Answer 217

(a) When psychologists conduct research with clients/patients, students, or subordinates as participants, psychologists take steps to protect the prospective participants from adverse consequences of declining or withdrawing from participation.
(b) When research participation is a course requirement or an opportunity for extra credit, the prospective participant is given the choice of equitable alternative activities.

Question 218

E.S. 8.05 Dispensing With Informed Consent for Research

Answer 218

Psychologists may dispense with informed consent only

(1) where research would not reasonably be assumed to create distress or harm and involves
(a) the study of normal educational practices, curricula, or classroom management methods conducted in educational settings;
(b) only anonymous questionnaires, naturalistic observations, or archival research for which disclosure of responses would not place participants at risk of criminal or civil liability or damage their financial standing, employability, or reputation, and confidentiality is protected; or
(c) the study of factors related to job or organization effectiveness conducted in organizational settings for which there is no risk to participants’ employability, and confidentiality is protected or

(2) where otherwise permitted by law or federal or institutional regulations.

Question 219

E.S. 8.06 Offering Inducements for Research Participation

Answer 219

(a) Psychologists make reasonable efforts to avoid offering excessive or inappropriate financial or other inducements for research participation when such inducements are likely to coerce participation.
(b) When offering professional services as an inducement for research participation, psychologists clarify the nature of the services, as well as the risks, obligations, and limitations.

(See also E.S. 6.05, Barter With Client/Patients.)

Question 220

E.S. 8.07 Deception in Research

Answer 220

(a) Psychologists do not conduct a study involving deception unless they have determined that the use of deceptive techniques is justified by the study’s significant prospective scientific, educational, or applied value and that effective non deceptive alternative procedures are not feasible.
(b) Psychologists do not deceive prospective participants about research that is reasonably expected to cause physical pain or severe emotional distress.
(c) Psychologists explain any deception that is an integral feature of the design and conduct of an experiment to participants as early as is feasible, preferably at the conclusion of their participation, but no later than at the conclusion of the data collection, and permit participants to withdraw their data.

(See also E.S. 8.08, Debriefing.)

Question 221

E.S. 8.08 Debriefing

Answer 221

(a) Psychologists provide a prompt opportunity for participants to obtain appropriate information about the nature, results, and conclusions of the research, and they take reasonable steps to correct any misconceptions that participants may have of which the psychologists are aware.
(b) If scientific or humane values justify delaying or withholding this information, psychologists take reasonable measures to reduce the risk of harm.
(c) When psychologists become aware that research procedures have harmed a participant, they take reasonable steps to minimize the harm.

Question 222

E.S. 8.09 Humane Care and Use of Animals in Research

Answer 222

(a) Psychologists acquire, care for, use, and dispose of animals in compliance with current federal, state, and local laws and regulations, and with professional standards.
(b) Psychologists trained in research methods and experienced in the care of laboratory animals supervise all procedures involving animals and are responsible for ensuring appropriate consideration of their comfort, health, and humane treatment.
(c) Psychologists ensure that all individuals under their supervision who are using animals have received instruction in research methods and in the care, maintenance, and handling of the species being used, to the extent appropriate to their role. (See also E.S. 2.05, Delegation of Work to Others.)
(d) Psychologists make reasonable efforts to minimize the discomfort, infection, illness, and pain of animal subjects.
(e) Psychologists use a procedure subjecting animals to pain, stress, or privation only when an alternative procedure is unavailable and the goal is justified by its prospective scientific, educational, or applied value.
(f) Psychologists perform surgical procedures under appropriate anesthesia and follow techniques to avoid infection and minimize pain during and after surgery.
(g) When it is appropriate that an animal’s life be terminated, psychologists proceed rapidly, with an effort to minimize pain and in accordance with accepted procedures.

Question 223

E.S. 8.10 Reporting Research Results

Answer 223

(a) Psychologists do not fabricate data. (See also E.S. 5.01a, Avoidance of False or Deceptive Statements.)
(b) If psychologists discover significant errors in their published data, they take reasonable steps to correct such errors in a correction, retraction, erratum, or other appropriate publication means.

Question 224

E.S. 8.11 Plagiarism

Answer 224

Psychologists do not present portions of another’s work or data as their own, even if the other work or data source is cited occasionally.

Question 225

E.S. 8.12 Publication Credit

Answer 225

(a) Psychologists take responsibility and credit, including authorship credit, only for work they have actually performed or to which they have substantially contributed. (See also E.S. 8.12b, Publication Credit.)
(b) Principal authorship and other publication credits accurately reflect the relative scientific or professional contributions of the individuals involved, regardless of their relative status. Mere possession of an institutional position, such as department chair, does not justify authorship credit. Minor contributions to the research or to the writing for publications are acknowledged appropriately, such as in the footnotes or in an introductory statement.
(c) Except under exceptional circumstances, a student is listed as principal author on any multiple-authored article that is substantially based on the student’s doctoral dissertation. Faculty advisors discuss publication credit with students as early as feasible and throughout the research and publication process as appropriate. (See also E.S. 8.12b, Publication Credit.)

Question 226

E.S. 8.13 Duplicate Publication of Data

Answer 226

Psychologists do not publish, as original data, data that have been previously published. This does not preclude republishing data when they are accompanied by proper acknowledgment.

Question 227

E.s. 8.14 Sharing Research Data for Verification

Answer 227

(a) After research results are published, psychologists do not withhold the data on which their conclusions are based from other competent professionals who seek to verify the substantive claims through reanalysis and who intend to use such data only for that purpose, provided that the confidentiality of the participants can be protected and unless legal rights concerning proprietary data preclude their release. This does not preclude psychologists from requiring that such individuals or groups be responsible for costs associated with the provision of such information.
(b) Psychologists who request data from other psychologists to verify the substantive claims through reanalysis may use shared data only for the declared purpose. Requesting psychologists obtain prior written agreement for all other uses of the data.

Question 228

E.S. 8.15 Reviewers

Answer 228

Psychologists who review material submitted for presentation, publication, grant, or research proposal review respect the confidentiality of and the proprietary rights in such information of those who submitted it.

Question 229

In a research study proposal, the investigators discuss offering prisoners extra time outside and additional visits from loved ones over the course of the next year as an inducement for research participation.

As a member of the review board, what would your feedback be on this aspect of the proposal? Why?

Answer 229

I would ask the investigators to rethink their inducements because offering prisoners excessive special privileges in return for participation may be coercive, which violates E.S. 8.06.

Question 230

E.S. 8.02 states that research participants must be informed about the purpose, expected duration, and procedures of the research; their right to decline and to ________ from the study once it has begun; any reasonably foreseeable factors that might affect their willingness to participate; the limits of ________; and whom to contact for questions about the research.

Answer 230

withdraw; confidentiality

Question 231

E.S. 8.05 notes that it may be unnecessary to obtain an informed consent when the study is not likely to cause ________, is part of a normal educational or occupational practice, or only involves administering an anonymous survey or questionnaire.

Answer 231

harm or distress

Question 232

E.S. 8.04 states that, when participation in research is a part of course requirements, students must be offered ________; and Standard 8.06 permits offering participants inducements as long as they are not ________.

Answer 232

alternative activities; coercive

Question 233

As defined in E.S. 8.07, the use of deception is acceptable as long as it is justified by the prospective value of the study, alternative procedures are unavailable, participants are not deceived about conditions that may cause physical pain or severe ________, and participants will be debriefed preferably at the end of the study but no later than at the conclusion of ________.

Answer 233

emotional distress; data collection

Question 234

E.S. 8.09 applies to the use of animals as research subjects and states that procedures that produce pain, stress, or privation are acceptable only when justified by the potential findings of the study and when ________ are unavailable.

Answer 234

alternative procedures

Question 235

If an animal’s life must be terminated, it must be done as ________ as possible.

Answer 235

rapidly and painlessly

Question 236

E.S. 8.14 requires psychologists to share their research data with colleagues for the purposes of independent interpretation, verification, or re-analysis once the research results have been ________.

Answer 236

published

Question 237

Finally, E.S. 8.12 provides guidelines for publication credit and requires credit to be based on each person’s ________ and for a student to be listed as the ________ on multiple-authored articles based substantially on the student’s dissertation except “under exceptional circumstances.”

Answer 237

contribution; principal author

Question 238

E.S. 9.01 Bases for Assessments

Answer 238

(a) Psychologists base the opinions contained in their recommendations, reports, and diagnostic or evaluative statements, including forensic testimony, on information and techniques sufficient to substantiate their findings. (See also E.S. 2.04, Bases for Scientific and Professional Judgments.)
(b) Except as noted in 9.01c, psychologists provide opinions of the psychological characteristics of individuals only after they have conducted an examination of the individuals adequate to support their statements or conclusions. When, despite reasonable efforts, such an examination is not practical, psychologists document the efforts they made and the result of those efforts, clarify the probable impact of their limited information on the reliability and validity of their opinions, and appropriately limit the nature and extent of their conclusions or recommendations. (See also Standards 2.01, Boundaries of Competence, and 9.06, Interpreting Assessment Results.)
(c) When psychologists conduct a record review or provide consultation or supervision and an individual examination is not warranted or necessary for the opinion, psychologists explain this and the sources of information on which they based their conclusions and recommendations.

Question 239

E.S. 9.02 Use of Assessments

Answer 239

(a) Psychologists administer, adapt, score, interpret, or use assessment techniques, interviews, tests, or instruments in a manner and for purposes that are appropriate in light of the research on or evidence of the usefulness and proper application of the techniques.
(b) Psychologists use assessment instruments whose validity and reliability have been established for use with members of the population tested. When such validity or reliability has not been established, psychologists describe the strengths and limitations of test results and interpretation.
(c) Psychologists use assessment methods that are appropriate to an individual’s language preference and competence, unless the use of an alternative language is relevant to the assessment issues.

Question 240

E.S. 9.03 Informed Consent in Assessments

Answer 240

(a) Psychologists obtain informed consent for assessments, evaluations, or diagnostic services, as described in E.S. 3.10, Informed Consent, except when

(1) testing is mandated by law or governmental regulations;
(2) informed consent is implied because testing is conducted as a routine educational, institutional, or organizational activity (e.g., when participants voluntarily agree to assessment when applying for a job); or
(3) one purpose of the testing is to evaluate decisional capacity.

Informed consent includes an explanation of the nature and purpose of the assessment, fees, involvement of third parties, and limits of confidentiality and sufficient opportunity for the client/patient to ask questions and receive answers.

(b) Psychologists inform persons with questionable capacity to consent or for whom testing is mandated by law or governmental regulations about the nature and purpose of the proposed assessment services, using language that is reasonably understandably to the person being assessed.
(c) Psychologists using the services of an interpreter obtain informed consent from the client/patient to use that interpreter, ensure that confidentiality of test results and test security are maintained, and include in their recommendations, reports, and diagnostic or evaluative statements, including forensic testimony, discussion of any limitations on the data obtained. (See also Standards, 2.05, Delegation of Work to Others; 4.01, Maintaining Confidentiality; 9.01, Bases for Assessments; 9.06, Interpreting Assessment Results; and 9.07, Assessment by Unqualified Persons.)

Question 241

E.S. 9.04 Release of Test Data

Answer 241

(a) The term test data refers to raw and scaled scores, client/patient responses to test questions or stimuli, and psychologists’ notes and recordings concerning client/patient statements and behavior during an examination. Those portions of test materials that include client/patient responses are included in the definition of test data. Pursuant to a client/patient release, psychologists provide test data to the client/patient or other persons identified in the release. Psychologists may refrain from releasing test data to protect a client/patient or others from substantial harm or misuse or misrepresentation of the data or the test, recognizing that in many instances release of confidential information under these circumstances is regulated by law. (See also E.S. 9.11, Maintaining Test Security.)
(b) In the absence of a client/patient release, psychologists provide test data only as required by law or court order.

Question 242

E.S. 9.05 Test Construction

Answer 242

Psychologists who develop tests and other assessment techniques use appropriate psychometric procedures and current scientific or professional knowledge for test design, standardization, validation, reduction or elimination of bias, and recommendations for use.

Question 243

E.S. 9.06 Interpreting Assessment Results

Answer 243

When interpreting assessment results, including automated interpretations, psychologists take into account the purpose of the assessment as well as the various test factors, test-taking abilities, and other characteristics of the person being assessed, such as situational, personal, linguistic, and cultural differences, that might affect psychologists’ judgments or reduce the accuracy of their interpretations. They indicate any significant limitations of their interpretations. (See also Standards 2.01b and c, Boundaries of Competence, and 3.01, Unfair Discrimination.)

Question 244

E.S. 9.07 Assessment by Unqualified Persons

Answer 244

Psychologists do not promote the use of psychological assessment techniques by unqualified persons, except when such use is conducted for training purposes with appropriate supervision. (See also E.S. 2.05, Delegation of Work to Others.)

Question 245

E.S. 9.08 Obsolete Tests and Outdated Test Results

Answer 245

(a) Psychologists do not base their assessment or intervention decisions or recommendations on data or test results that are outdated for the current purpose.
(b) Psychologists do not base such decisions or recommendations on tests and measures that are obsolete and not useful for the current purpose.

Question 246

E.S. 9.09 Test Scoring and Interpretation Services

Answer 246

(a) Psychologists who offer assessment or scoring services to other professionals accurately describe the purpose, norms, validity, reliability, and applications of the procedures and any special qualifications applicable to their use.
(b) Psychologists select scoring and interpretation services (including automated services) on the basis of evidence of the validity of the program and procedures as well as on other appropriate considerations. (See also E.S. 2.01b and c, Boundaries of Competence.)
(c) Psychologists retain responsibility for the appropriate application, interpretation, and use of assessment instruments, whether they score and interpret such tests themselves or use automated or other services.

Question 247

E.S. 9.10 Explaining Assessment Results

Answer 247

Regardless of whether the scoring and interpretation are done by psychologists, by employees or assistants, or by automated or other outside services, psychologists take reasonable steps to ensure that explanations of results are given to the individual or designated representative unless the nature of the relationship precludes provision of an explanation of results (such as in some organizational consulting, preemployment or security screenings, and forensic evaluations), and this fact has been clearly explained to the person being assessed in advance.

Question 248

E.S. 9.11 Maintaining Test Security

Answer 248

The term test materials refers to manuals, instruments, protocols, and test questions or stimuli and does not include test data as defined in E.S. 9.04, Release of Test Data.

Psychologists make reasonable efforts to maintain the integrity and security of test materials and other assessment techniques consistent with law and contractual obligations, and in a manner that permits adherence to this Ethics Code.

Question 249

When you meet with a client for a forensic evaluation, the client refuses to participate. Can you conduct an examination if the client is not willing to be tested? What do you do in such a situation?

Answer 249

This issues is not directly addressed by the Ethics Code, but rather by Paragraph 6.03.02 of APA’s Specialty Guidelines for Forensic Psychology (2011), which reads..

“If the examinee is ordered by the court to participate, the forensic practitioner can conduct the examination over the objection, and without the consent, of the examinee… If the examinee declines to proceed after being notified of the nature and purpose of the forensic examination, the forensic practitioner may consider a variety of options including postponing the examination, advising the examinee to contact his or her attorney, and notifying the retaining party about the examinee’s unwillingness to proceed.”

Question 250

Can certain instruments, such as the MMPI, be completed at home by clients?

Answer 250

No. To do so would jeopardize the integrity of the test materials, i.e., the instrument itself.

(This would violate E.S. 9.11, Maintaining Test Security.)

Question 251

When might the use of an obsolete instrument be warranted?

Answer 251

If a client was tested with said instrument in the past and one wants to assess changes in the client’s performance, it would make sense to use the same instrument. This may help evaluate the changes better or the long-term effects of a treatment or the level of deterioration (e.g., long-term effect of AIDS diagnosis and treatment).

Question 252

In the absence of direct guidelines, what should be the guiding principle to determine how long assessment results should be kept?

Answer 252

The client’s welfare.

Question 253

E.S. 9.03 states that an informed consent for assessment includes providing the client with an explanation of the nature and purpose of the assessment, fees, any limits on confidentiality, and any involvement of ________.

Answer 253

third parties

Question 254

It also notes that it is not always necessary to obtain an informed consent - e.g., when testing is part of a ________ educational, institutional, or organizational activity or mandated by law.

Answer 254

routine;

Question 255

E.S. 9.04 describes ________ as raw and scaled scores, the examinee’s responses to test questions, and the psychologist’s notes concerning the examinee’s responses and behaviors during testing; while E.S. 9.11 defines ________ as manuals, instruments, protocols, and test questions or stimuli.

Answer 255

test data; test materials

Question 256

E.S. 9.09 requires psychologists to select test scoring and interpretation services on the basis of their ________ and other appropriate considerations and states that they are responsible for applying and interpreting the information in an appropriate manner.

Answer 256

validity

Question 257

To avoid misusing tests and other assessment techniques, psychologists must ensure that they are administered, scored, and interpreted by ________ and that recommendations and conclusions are not based on the results of ________.

Answer 257

qualified people; obsolete data

Question 258

E.S. 10.01 Informed Consent to Therapy

Answer 258

(a) When obtaining informed consent to therapy as required in Standard 3.10, Informed Consent, psychologists inform clients/patients as early as is feasible in the therapeutic relationship about the nature and anticipated course of therapy, fees, involvement of third parties, and limits of confidentiality and provide sufficient opportunity for the client/patient to ask questions and receive answers. (See also Standards 4.02, Discussing the Limits of Confidentiality, and 6.04, Fees and Financial Arrangements.)
(b) When obtaining informed consent for treatment for which generally recognized techniques and procedures have not been established, psychologists inform their clients/patients of the developing nature of the treatment, the potential risks involved, alternative treatments that may be available, and the voluntary nature of their participation. (See also Standards 2.01e, Boundaries of Competence, and 3.10, Informed Consent.)
(c) When the therapist is a trainee and the legal responsibility for the treatment provided resides with the supervisor, the client/patient, as part of the informed consent procedure, is informed that the therapist is in training and is being supervised and is given the name of the supervisor.

Question 259

E.S. 10.02 Therapy Involving Couples of Families

Answer 259

(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 client/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. (See also E.S. 4.02, Discussing the Limits of Confidentiality.)

(b) If it becomes apparent that psychologists may be called on to perform potentially conflicting roles (such as family therapist and then witness for one party in divorce proceedings), psychologists take reasonable steps to clarify and modify, or withdraw from, roles appropriately. (See also E.S. 3.05c, Multiple Relationships.)

Question 260

E.S. 10.03 Group Therapy

Answer 260

When psychologists provide services to several persons in a group setting, they describe at the outset the roles and responsibilities of all parties and the limits of confidentiality.

Question 261

E.S. 10.04 Providing Therapy to Those Served by Others

Answer 261

In deciding whether to offer or provide services to those already receiving mental health services elsewhere, psychologists carefully consider the treatment issues and the potential client’s/patient’s welfare. Psychologists discuss theses issues with the client/patient or another legally authorized person on behalf of the client/patient in order to minimize the risk of confusion and conflict, consult with the other service providers when appropriate, and proceed with caution and sensitivity to the therapeutic issues.

Question 262

E.S. 10.05 Sexual Intimacies With Current Therapy Clients/Patients

Answer 262

Psychologists do not engage in sexual intimacies with current therapy clients/patients.

Question 263

E.S. 10.06 Sexual Intimacies With Relatives or Significant Others of Current Therapy Clients/Patients

Answer 263

Psychologists do not engage in sexual intimacies with individuals they know to be close relatives, guardians, or significant others of current clients/patients.

Psychologists do not terminate therapy to circumvent this standard.

Question 264

E.S. 10.07 Therapy With Former Sexual Partners

Answer 264

Psychologists do not accept as therapy clients/patients persons with whom they have engaged in sexual intimacies.

Question 265

E.S. 10.08 Sexual Intimacies With Former Therapy Clients/Patients

Answer 265

(a) Psychologists do not engage in sexual intimacies with former clients/patients for at least two years after cessation or termination of therapy.
(b) Psychologists do not engage in sexual intimacies with former clients/patients even after a two-year interval except in the most unusual circumstances. Psychologists who engage in such activity after the two years following cessation or termination of therapy and of having no sexual contact with the former client/patient bear the burden of demonstrating that there has been no exploitation, in light of all relevant factors, including…

(1) the amount of time that has passed since therapy terminated;
(2) the nature, duration, and intensity of the therapy;
(3) the circumstances of termination;
(4) the client’s/patient’s personal history;
(5) the client’s/patient’s current mental status;
(6) the likelihood of adverse impact on the client/patient; &
(7) any statements or actions made by the therapist during the course of therapy suggesting or inviting the possibility of a posttermination sexual or romantic relationship with the client/patient.

(See also E.S. 3.05, Multiple Relationships.)

Question 266

E.S. 10.09 Interruption of Therapy

Answer 266

When entering into employment or contractual relationships, psychologists make reasonable efforts to provide for orderly and appropriate resolution of responsibility for client/patient care in the event that the employment or contractional relationship ends, with paramount consideration given to the welfare of the client/patient.

(See also E.S. 3.12, Interruption of Psychological Services.)

Question 267

E.S. 10.10 Terminating Therapy

Answer 267

(a) Psychologists terminate therapy when it becomes reasonably clear that the client/patient no longer needs the service, is not likely to benefit, or is being harmed by continued service.
(b) Psychologists may terminate therapy when threatened or otherwise endangered by the client/patient or another person with whom the client/patient has a relationship.
(c) Except where precluded by the actions of clients/patients or third-party payors, prior to termination psychologists provide pretermination counseling and suggest alternative service providers as appropriate.

Question 268

Several years after terminating therapy with a couple, which together was identified as “the client,” the husband calls the psychologist and asks that the psychologist testify on his behalf in a custody hearing.

What would be the best course of action for the psychologist?

Answer 268

The psychologist’s best course of action would be to refuse to do so because the “client” was the couple, not just the husband.

(E.S. 10.02)

Question 269

The client of a psychodynamic therapist contacts a behavioral therapist to request treatment for nicotine dependence.

Should the behavioral therapist accept or refuse to treat the client?

Answer 269

In this situation, assuming this is not the main issue being worked on in the other therapeutic relationship, it would be appropriate to provide the services needed and to try to coordinate care with the psychodynamic provider.

(E.S. 10.04)

Question 270

E.S. 10.01 identifies the information that should be included in the informed consent process and states that this information should be provided to a client ________.

Answer 270

as early as feasible

Question 271

It also states that, when a supervisor has legal responsibility for the treatment provided by a trainee, the client must be informed that the trainee is being supervised and be given ________.

Answer 271

the supervisor’s name

Question 272

E.S. 10.04 states that, when a client or prospective client is receiving similar services from another professional, a psychologist must ________ and sensitivity to the therapeutic issues.

Answer 272

proceed with caution

Question 273

Sexual intimacies are addressed in several Standards:

E.S. 10.08 prohibits psychologists from having sexual relationships with former clients for at least ________ years after cessation of therapy and then only in the “most unusual circumstances.”

Answer 273

two

Question 274

E.S. 10.06 prohibits psychologists from becoming sexually involved with individuals they know to be ________, guardians, or significant others of current clients, while E.S. 10.07 states that psychologists must not provide therapy to people with whom they have had a sexual relationship ________.

Answer 274

close relatives; in the past

Question 275

Interruption and termination of therapy are addressed in Standards 10.09 and 10.10, which require psychologists to discontinue a therapeutic relationship when the client is not benefiting from it and to avoid abandonment of the client by providing him/her with ________ and/or appropriate referrals.

Answer 275

pretermination counseling

Question 276

The General Guidelines for Providers of Psychological Services present ________ guidelines for all providers of psychological services except for those engaged in teaching psychology, conducting research, or writing and editing scientific manuscripts.

Answer 276

aspirational

Question 277

As defined in the General Guidelines for Providers of Psychological Services, “professional psychologists” have a ________ degree from an organized, sequential program in a regionally accredited university or professional school, while a “________” can take one of several forms - e.g., one or more psychologists providing professional services in a multidisciplinary setting or one or more psychologists in a private practice.

Answer 277

doctoral; psychological service unit

Question 278

“Users” include direct recipients of psychological services as well as ________ institutions, facilities, or organizations that receive those services.

Answer 278

public and private

Question 279

When psychologists want to change their area of specialty, they must meet the education and training requirements for a ________ in that specialty.

Answer 279

doctoral degree

Question 280

Finally, the General Guidelines for Providers of Psychological Services state that the advancement of ________ is “the primary principle guiding the professional activities of all members of the psychological service unit.”

Answer 280

human welfare

Question 281

Paragraph 4.02 of the Specialty Guidelines for Forensic Psychology states that forensic psychologists seek to minimize any detrimental effects of multiple relationships by avoiding involvement in them whenever ________,

while Paragraph 4.02.01 required psychologists who are requested or ordered to provide concurrent or sequential forensic therapeutic services to disclose any potential risks and make ________ to refer the request to another qualified provider.

Answer 281

feasible; reasonable efforts

Question 282

Paragraph 5.02 of the Specialty Guidelines for Forensic Psychology requires psychologists to avoid providing professional services on the basis of ________ fees.

Answer 282

contingent

Question 283

Paragraph 6.03.01 of the Specialty Guidelines for Forensic Psychology requires forensic psychologists to obtain ________ from an examinee unless the examination is court-ordered.

Paragraph 6.03.02 states that when an examination has been ordered by the court, a psychologist may conduct the exam over the examinee’s objection.

In either case, if the examinee is unwilling to proceed after being told about the _______ of the exam, the psychologist may consider postponing the examination, advising the examinee to contact ________, or notifying the retaining party about the examinee’s objection.

Answer 283

informed consent; nature and process; his/her attorney

Question 284

Paragraph 8.04 of the Specialty Guidelines for Forensic Psychology addresses the confidentiality of case materials and states that psychologists attempt to protect a person’s privacy by disguising personally identifying information, using only information that is in the ________, or obtaining the consent of the person or other relevant parties or organizations.

Answer 284

public domain

Question 285

Insanity

Answer 285

A legal concept that serves as the basis for a criminal defense in many jurisdiction.

Its definition varies between jurisdictions, but most reflect the rule set forth by the American Law Institute:

a person is not guilty by reason of insanity if, because of a mental disease or defect, “that person lacks substantial capacity to appreciate the wrongfulness of the act or … behave according to the requirements of the law” (Gutheil, 1995, p. 2764).

Note: some jurisdictions have replaced the not guilty by reason of insanity defense with alternatives such as guilty but insane or guilty but mentally ill.

Question 286

Competence to Stand Trial

Answer 286

A legal concept. It’s related laws vary, but all were derived from the standard set forth in Dusky v. United States (1960), which defines a defendant as incompetent if,

as the result of mental defect or illness, the defendant lacks “sufficient present ability to consult with his lawyer with a reasonable degree of rational understanding, and … a rational as well as a factual understanding of the proceedings against him” (p. 171).

When evaluating a defendant’s competence to stand trial, the focus is on the defendant’s psycholegal abilities and impairments, including his/her capacity to comprehend the charges or allegations, disclose pertinent facts and events to counsel, and testify.

Question 287

Fact Witness

Answer 287

A person “who testifies as to what he/she has seen, heard, or otherwise observed regarding a circumstance, event or occurrence as it actually took place…. Fact witnesses are generally not allowed to offer opinions, address issues that they do not have personal knowledge of or respond to hypothetical situations” (APA, 1998, p. 7).

A fact witness may provide information about a client in a legal proceeding only with the consent of the client or a court order.

Question 288

Expert Witness

Answer 288

A person “who by reason of education or specialized experience possesses superior knowledge respecting a subject about which persons having no particular training are incapable of forming an accurate opinion or deducing correct conclusions” (Nolan & Nolan-Haley, 1990, p. 578).

A person who has been qualified as an expert witness by the court is allowed to offer opinions and provide testimony based on hypothetical scenarios.

Question 289

Guardianship

Answer 289

A “legal right given to a person to be responsible for the necessities (e.g., food, health care) of another person legally deemed incapable of providing these necessities him/herself” (APA, 1998, p. 7).

A guardian ad litem is “an adult appointed by the court to represent and make decisions for someone (such a a minor) legally incapable of doing so on his/her own in a civil legal proceeding” (APA, 1998, p. 7).

Question 290

A psychologist is asked to predict a person’s risk for committing violent acts in the future based on their relatively brief work with them.

How accurate is the psychologist’s predictions likely to be?

Answer 290

According to the research, such predictions are not particularly accurate (especially their long-term predictions) and often produce a high rate of false positives (e.g., Appelbaum & Gutheil, 2006).

Question 291

What does the research indicate is the single-most accurate predictor of future violent behavior?

Answer 291

past history of violent behavior

Klassen & O’Connor, 1988; Mossman, 1994

Question 292

What type of information might be useful in helping predict a person’s risk for future violence?

Answer 292

criminal and court records tell us about a person’s past incidents of violent behavior.

The greater the number of incidents, the greater the risk that a person will commit future acts of violence.

(Scott, Quanbeck, and Resnick, 2008)

Question 293

Some studies suggest that combining past history of violence with what two types of factors improves the accuracy of predicting someone’s risk for future violence?

Answer 293

Static factors (age at first violent offense, hx of parental criminality, comorbid psychiatric conditions, and other fixed and historical events) 
                                          &
Dynamic risk factors (impulse control, substance abuse, social support, and other changeable factors)

(Douglas & Kropp, 2002; Mills, 2005)

Question 294

Malpractice

Answer 294

• Civil suits
• require the plaintiff to prove his/her claim by a “preponderance of the evidence” (establish that there is a standard of care and that the psychologist deviated from it).
• often involves testimony from expert witnesses

Question 295

What four conditions must be met for a client or other person to successfully bring a claim of malpractice against a psychologist?

Answer 295

(1) The psychologist must have had a professional relationship with the person that established a legal duty of care.
(2) There must be a demonstrable standard of care that the psychologist has breached.
(3) The person suffered harm or injury.
(4) The psychologist’s breach of duty within the context of the standard of care was the proximate cause of the person’s harm or injury.

Question 296

What do experts generally agree is the best defense in cases of litigation against psychologists?

Answer 296

adequate (well-organized) records

Question 297

How can a psychologist reduce the risk for a charge of malpractice?

Answer 297

• being familiar with the applicable legal and ethical standards and relevant research
• providing only services that are compatible with one’s education, training, and experience
• maintaining careful, well-organized records.