Lecture 2 - Ethics in Psychotherapy

Question 1

Canadian Psychological Association (CPA) Code of Ethics

Answer 1

➢Ethical principles, values, and standards for psychologists operating across various contexts
-For psychotherapists, psychologists in research… all sorts
➢Ethical Principles (in order of priority):
▫I: Respect for the dignity of persons and peoples
▫II: Responsible caring
▫III: Integrity in relationships
▫IV: Responsibility to society

I: Respect for the dignity of persons and peoples
➢Informed consent
▫Ensure client understands nature of therapy and has opportunity to ask questions
➢Privacy
▫Collect minimal information necessary and keep all records secure
➢Confidentiality
▫Do not share client information with anyone unless required by law

II: Responsible Caring
➢Competence and self-knowledge
▫Practice within areas of competence or seek consultation/supervision
▫Engage in self-care and seek help if needed
➢Maximize benefit
▫Provide the best service possible (stay up to date on literature and requirements…))
➢Minimize harm
▫Be aware of power differential in therapy
▫Do not encourage or engage in sexual intimacy with clients

III: Integrity in Relationships
➢Accuracy/honesty
▫Accurately represent your credentials and qualifications
➢Straightforwardness/openness
▫Be clear about fees, policies, limits of confidentiality
➢Avoidance of conflict of interest
▫Avoid multiple relationships (ex: knowing client in other context, relationship with someone the client knows…)

IV: Responsibility to Society
➢Respect for society
▫Familiarize self with laws and regulations in one’s jurisdiction
➢Development of society
▫Act to change aspects of the discipline that detract from beneficial societal change (ex: apologies from the field for conversion therapy)

Question 2

Common Ethical Issues

Answer 2

➢Confidentiality and its limits
▫(Almost) everything in psychotherapy remains confidential
Necessary for client to feel safe and be honest
Exceptions are threats of harm to self (not necessarily thoughts of suicide… depends on degree of risk) or someone else or harm/neglect of vulnerable person
▫Tarasoff vs. Board of Regents of University of California (1976)
Doctor was found liable because he didn’t warn the young woman, only the police
Should’ve told the police and contacted the young woman to warn her of the danger of that student
*Duty to warn AND protect

➢Confidentiality and treating adolescents
▫When adolescents expect confidentiality, disclosure increases
▫Most times, guardians hold rights to records
-Often the adult is providing the informed consent on the part of the adolescent and is able to request information from the therapist
In Québec, 14 is the age of medical consent
▫When to disclose information to parents?
➢When to disclose? ▫Considerations:
Immediate as well as future harm
Parental reaction and client-parent relationship
Best interest of client and therapeutic relationship
▫If disclosure is needed:
Partner with adolescent and provide them some autonomy (wanna be in the room together? Want the teen or the therapist to tell the parent?)
Everyone needs to know and agree on what kind of information will be shared

➢Multiple relationships
▫Multiple roles with same person or someone closely associated with person with whom psychologist has a professional relationship
-definitely not allowed relationship with the current client (other than patient-therapist relationship)
Either with same person or somebody closely associated with
▫Not all multiple relationships are necessarily unethical; sometimes cannot be avoided
Ex: very rural area with only one psychologist
▫Can create conflicts of interest
Clear violation:
▫Violations like having a sexual relationship with a current client are clear
▫What about lessclear examples?
Dating your former client’s cousin
Treating one of your child’s classmates
Going to the same gym as your client
➢Guiding questions for evaluating multiple relationships
▫Is the multiple relationship necessary?
▫Is the multiple relationship exploitative?
▫Who does the multiple relationship benefit?
▫Is there a risk that the multiple relationship could damage the client?
▫Is there a risk that the multiple relationship could disrupt the therapeutic relationship?

Question 3

Contemporary Ethical Issues

Answer 3

Telepsychology: Stoll et al., 2020; Frontiers in Psychiatry

➢Benefits
▫Increased access, availability, and flexibility
e.g., patients in rural communities; specialist care (lots of therapists don’t treat certain topics (eg: eating disorders), so way more options with telepsychology)
▫Convenience, satisfaction, and increased demand
Clients like this!
▫Anonymity and privacy
Disclosure may increase

➢Ethical concerns
▫Privacy, confidentiality, and security issues (tech issues for safety of info)
Unencrypted tools
▫Therapist competence and training
Technology AND therapeutic competence
-some are older and not as good as using tools
-can u form a good relationship with the patient online?
▫Informed consent and emergency issues
Verify patient identity (is this the right person?) and location (address in case of emergency need to send authorities)
▫Practicing across borders
PSYPACT in US15 (recognize license across states)

➢Recommendations
▫Comprehensive informed consent procedure
▫Know emergency care options in client’s local area
▫Ensure both clinical and technological competence in services offered
▫Develop set of procedures for verifying client identity
▫Ensure client and presenting problem is appropriate for telepsychology (ex: maybe over time, only online for agoraphobia won’t help)