Standards 3 & 4

Question 1

psychologists may decide to refer individuals seeking services to other mental health professionals when they believe that an individual’s values, diagnosis, or other characteristic would negatively affect their ability to provide competent services. Knapp and VandeCreek (1993) note, for example, that it’s acceptable for psychologists to refuse to see clients whom they perceive to be unwilling or unable to pay their fees.

Question 2

Sexual Harassment: Standard 3.02 defines sexual harassment as “sexual solicitation, physical advances, or verbal or nonverbal conduct that is sexual in nature” and that (a) “is unwelcome, is offensive, or creates a hostile workplace or educational environment, and the psychologist knows or is told this” or (b) “is sufficiently severe or intense to be abusive to a reasonable person in the context.” It also states that sexual harassment can involve a single severe behavior or multiple persistent behaviors.

Question 3

it’s more difficult to determine if a person’s behavior constitutes sexual harassment when the person occasionally tells off-color jokes or makes suggestive comments. However, as noted in Standard 3.02, an ambiguous behavior becomes sexual harassment when the perpetrator continues to engage in the behavior after being told it’s unwelcome or offensive.

Question 4

Harm: Standard 3.04 requires psychologists to “take reasonable steps to avoid harming” clients, supervisees, students, and others with whom they work and to minimize the effects of any harm that’s foreseeable or unavoidable. As noted by Fisher (2017), this requirement does not apply to legitimate activities that may cause harm such as assigning a low grade to a failing student or assigning an accurate diagnosis to a client that disqualifies him from receiving disability insurance.

Question 5

Multiple Relationships
This Standard does not prohibit all multiple relationships but, instead, only those that “could reasonably be expected to impair the psychologist’s objectivity, competence, or effectiveness … or otherwise risks exploitation or harm to the person with whom the professional relationship exists.” Note that the Ethics Code does not explicitly prohibit nonsexual posttermination relationships. However, as noted by Fisher (2017), such relationships would be unethical “if the posttermination relationship was promised during the course of the original relationship or if the individual was exploited or harmed by the intent to have the posttermination relationship” (p. 131).

Question 6

Multiple Relationships
Guideline 12 of the Guidelines for Child Custody Evaluations in Family Law Proceedings (APA, 2022) states that psychologists “aspire to avoid conflicts of interests and multiple relationships.” It also identifies conducting custody evaluations with current or former psychotherapy clients and vice versa as multiple relationships. Similarly, Paragraph 4.02.01 of the Specialty Guidelines for Forensic Psychology (APA, 2013) states that “forensic and therapeutic psychological services to the same individual or closely related individuals … [is a multiple relationship] that may impair objectivity and/or cause exploitation or harm.” It also states that, when requested to provide concurrent or sequential forensic and therapeutic services, psychologists should refer the individual to another provider; but, when that’s not possible, “to minimize the potential negative effects of this circumstance.”

Question 7

Multiple Relationships
Gottlieb’s (1993) decision-making model proposes that psychologists consider three factors when considering whether or not to become involved in another professional relationship with a current client: (a) the power differential between the psychologist and the client, (b) the expected duration of each relationship, and (c) the clarity of termination of each relationship. The greater the power differential, the longer the duration of the two relationships, and the more likely that one or both relationships will resume in the future, the less acceptable it would be to become involved in the multiple relationship.

Question 8

Resolving Multiple Relationships
Reasonable steps include discussing the situation with the involved individual(s) and consulting with a colleague to determine the best course of action.

Question 9

Conflict of Interest
A psychologist may be violating this prohibition if he or she recommends that current clients buy a product or participate in an ancillary service when the psychologist has a financial interest in that product or service.

Question 10

Third-Party Requests for Services
psychologists attempt to clarify at the outset of the service the nature of the relationship with all individuals or organizations involved, … [including] 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 fact that there may be limits to confidentiality.”

Question 11

Guidelines for Forensic Psychology: Third-Party Requests for Services
“client” ordinarily refers “to a direct recipient of psychological health care services within the context of a professional relationship including a child, adolescent, adult, couple, family, group, organization, community, or other populations, or other entities receiving psychological services” (p. 2). However, it also states that, “in some circumstances (e.g., an evaluation that is court-ordered, requested by an attorney, an agency, or other administrative body), the client may be the individual or entity requesting the psychological services”

in the context of forensic practice, “client” refers to “the attorney, law firm, court, agency, entity, party, or other person who has retained, and who has a contractual relationship with, the forensic practitioner”

Question 12

Informed Consent
Exceptions to obtaining informed consent include conducting court-ordered evaluations and research that requires the use of deception.

Question 13

Informed Consent
consent is presumed when a parent or legal guardian is required to give consent for a minor’s treatment but is not available to do so and the circumstances are life-threatening for the minor (e.g., when the minor is at high risk for suicide). However, in this situation, consent should ordinarily be obtained for any resulting ongoing treatment (McNary, 2014). In the United States, providing emergency treatment to minors in an emergency department without the consent of a parent or legal guardian is permitted by the Emergency Medical Treatment and Labor Act (EMTALA) of 1986. It supersedes state law and is also known as the “doctrine of implied consent” because it assumes that, if the minor’s parent or guardian were present, he or she would consent to the treatment

Question 14

Forensic Psych & Informed Consent
Specialty Guidelines for Forensic Psychology which states that, when an evaluation is court-ordered, forensic psychologists must describe the nature and purpose of the examination but can conduct it without the examinee’s consent. It also states that, if the examinee refuses to be evaluated, a psychologist “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.” Standard 3.10(d) requires psychologists to “appropriately document written or oral consent, permission, and assent.”

Question 15

Informed Consent
circumstances may determine the required or appropriate type of informed consent. For example, laws or institutional regulations may require a signed written informed consent. And, in some situations, oral consent with documentation is preferable – for example, when providing services to members of certain cultures who object to written consents, when the individual has low literacy skills, or when it’s important to preserve the anonymity of research subjects.

Question 16

Interruption of Services
When an interruption in services is foreseeable, a good strategy is to discuss the situation with the client and, as appropriate, provide pretermination counseling and/or referrals. To adequately plan for an interruption in services due to death, the best strategy is for a psychologist to have a professional will that designates a professional executor who will assume responsibility for contacting clients and ensuring the security of client records. The ASPPB’s Guidelines for Closing a Psychology Practice states that the professional executor should be someone who understands relevant ethical obligations and legal requirements. It also notes that, ideally, “this individual should be a member of the profession or if this is not possible a member of another regulated health profession … [but] should not be a member of the psychologist’s own family due to the inherent conflict of interest that exists”

Question 17

Discussing Limits of Confidentiality
And Standard 4.02(b) states that, “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.” The following situations require special consideration:

(a) Couples and Families: clarify at the outset of therapy which individuals are the clients and “the probable uses of the services provided or the information obtained.” This includes informing all individuals how information shared separately with the therapist by one partner or family member will be handled – i.e., will all information disclosed by an individual be kept confidential or will some or all of the information be shared with the other partner or other family members?
(b) Group Therapy Members: psychologists can reduce the likelihood that confidential information will be disclosed by educating group members about the importance of maintaining confidentiality and the possible negative consequences of not doing so and by discussing confidentiality during the screening interview, the initial group therapy session, subsequent sessions as needed, and the final session
(c) Minors: The right to confidentiality does not extend to clients who are minors except in legally defined situations – e.g., when the minor is emancipated or legally able to consent to his/her own treatment. a good strategy is to discuss confidentiality with all parties and establish a confidentiality agreement at the beginning of therapy about what types of information will and will not be shared. For example, a psychologist would want to let the parties know that he/she will contact the parents or legal guardian of the minor client when the client is engaging in potentially harmful behavior and the psychologist believes that doing so will help ensure the client’s safety. As noted by Behnke and Warner, in this situation, “regardless of whether an adolescent assents to have information disclosed to a parent, it makes both clinical and ethical sense to tell the adolescent – beforehand, if possible – what information will be shared” and, when appropriate, to include the adolescent in conversations with the parent (2002, p. 4). Finally, psychologists should also inform minor clients and their parents or legal guardians about the circumstances in which psychologists are legally permitted or required to disclose information revealed by a minor client to medical personnel, members of law enforcement, and others – e.g., when the minor poses a severe risk of harm to him/herself or others and when the minor has been physically or sexually abused.
(d) Deceased Clients: The Ethics Code does not explicitly address the confidentiality of deceased clients, but most states have laws that allow disclosure of confidential information pertaining to a deceased client only with the authorization from the client’s executor, estate administrator, or other legal representative
(e) Members of the Military: Client confidentiality is not handled in exactly the same way in the military as it is elsewhere, and psychologists providing mental health services in military settings must adhere to Department of Defense rules that limit the confidentiality of mental health information. Johnson (2013) suggests that psychologists working in the military minimize the risk for ethical dilemmas by providing “detailed and exhaustive informed consent regarding the fact that confidentiality can never be guaranteed in the military … [and by maintaining] conservative documentation of the client’s history or private concerns”
(f) Correctional Facilities: Haag (2006) notes that psychologists working in correctional facilities often face ethical dilemmas related to confidentiality. According to Haag, “in correctional practice, confidentiality can range from essentially no confidentiality (i.e., court-ordered assessments) to levels of confidentiality present in general psychological practice … with the actual level of confidentiality [typically being] somewhere between these two extremes” (p. 97). He states that, for this reason, it’s important to describe the limits to confidentiality to all involved parties at the beginning of professional services.
(g) Employee Assistance Programs: Employee assistance programs (EAPs) “are designed to help employees address both work-related problems and personal problems outside of work that may be having an adverse effect on job performance” (Chernoff, 2020, p. 254). Client confidentiality is handled in EAPs in the same way it is handled in other therapy situations: This means that confidential information is not shared with an employee’s supervisor or employer without the employee’s signed written authorization, regardless of whether the employee’s participation in the EAP is the result of a self-referral or an informal or mandatory supervisor/employer referral. However, as in other circumstances, confidentiality may be breached without the employee’s authorization when doing so is legally required or permitted – e.g., to notify appropriate authorities when the employee is a danger to self or others or to report child abuse.
(h) Telepsychology: Methods for maintaining confidentiality and privacy include delivering telepsychology services from a private and soundproof room; discussing with clients the steps they can take to maintain confidentiality and privacy; having password protection on all devices that will be used to provide telepsychology; using encryption for emails, text messages, scanned documents, and other confidential data; ensuring that virus and malware protections are up-to-date and that methods for storing and disposing of confidential information are secure; and using videoconferencing platforms that provide adequate security and privacy.
* In the United States, videoconferencing platforms must comply with HIPAA and state security requirements. HIPAA-compliant platforms utilize appropriate encryption; have secure transmission, audit trails, and breach notification procedures; and will enter into a business associate agreement. HIPAA-compliant platforms includeDoxy.me, thera-LINK, Zoom for Healthcare, Webex for Healthcare, GoToMeeting, and Skype for Business (but not Consumer Skype).

Question 18

Forensic Psych & Discussing Limits for Confidentiality
* Pinta (2009) proposes that decisions about breaches of confidentiality made by psychologists providing therapy to prison inmates can be categorized as treatment- or security-driven: When making treatment-driven decisions, the therapeutic relationship ordinarily has priority and “principles of confidentiality and beneficence (i.e., acting in the best interests and welfare of patients) are given strict adherence”
* In contrast, when making security-driven decisions, “the confidential nature of the treatment relationship is respected, but the safety of staff and inmates is given greater importance when there are conflicting values”
* For example, with regard to the duty to protect Pinta (2010) notes that, when an incarcerated client reveals to a psychologist that he/she is planning to harm the correctional staff or another inmate and the psychologist believes the threat is serious, the psychologist would meet the duty to protect by breaching confidentiality and reporting the threat to the warden or other appropriate prison official.
* However, when an inmate reveals that he/she is planning to harm someone outside the prison, the duty to protect may not apply because the inmate does not have the ability to carry out his or her threat. In this situation, the inmate should receive treatment aimed at reducing the risk of violence if the threat is related to a serious mental disorder. Or, if there’s reason to believe that the intended victim is at risk (e.g., because the inmate is scheduled to be released from prison in the near future or the intended victim is on the inmate’s visitor list), it may be necessary to breach confidentiality by notifying the intended victim or prison officials.

Question 19

Disclosing Confidential Information

Standard 4.05 permits disclosure of confidential client information with (a) appropriate authorization to release information from the client or the client’s legal representative or (b) without authorization “only as mandated by law, or where permitted by law for a valid purpose.” For example, a psychologist is legally required to breach confidentiality to report child abuse to the appropriate authorities and is legally permitted to do so by contacting a collection agency when a client has failed to pay for the psychologist’s professional services (Fisher, 2017). The provisions of Standard 4.05 also apply to the following situations:

a) the client is a danger to him/herself
b) the client is a danger to others

Question 20

Disclosing Confidential Information when the client is a danger to him/herself

Answer 20

the psychologist must take appropriate action to protect the client’s safety. In some situations, this may require breaching client confidentiality – for example, when the psychologist determines that the best course of action is to have the client hospitalized. [Note that no-suicide contracts (also known as no-harm contracts or agreements) are sometimes employed in this situation, but there’s no evidence that they’re effective for preventing suicide or protecting psychologists from malpractice liability when a client commits suicide. Consequently, they should not be used as the sole intervention.]

Question 21

Disclosing Confidential Information when the client is a danger to others
Most jurisdictions have passed legislation that’s consistent with the Tarasoff decision, a California Supreme Court decision that established a psychologist’s duty to protect a third party who is at risk for physical harm by a therapy client. In most jurisdictions, the duty to protect applies only when the client communicates a clear and imminent threat of physical harm to an identifiable victim or victims and the client has the ability to carry out his or her threat. The appropriate action in this situation depends on the provisions of relevant legislation, but often includes warning the intended victim, notifying the police, or taking other reasonable steps such as hospitalizing the client.

Question 22

Disclosing Confidential Information
the Health Insurance Portability and Accountability Act (HIPAA) allows covered entities to disclose protected health information (PHI) without the client’s authorization when the information will be used for treatment, payment, or health care operations. However, disclosure of PHI without authorization may not be allowed in these situations by state law and, in that situation, state law takes precedence over HIPAA.
* Standard 4.04(a) requires psychologists to “include in written and oral reports and consultations only information germane to the purpose for which the communication was made.” This requirement echoes the requirements of HIPAA to limit disclosure of personal health to the minimum necessary to accomplish the purpose of the disclosure

Question 23

Forensic Psych & Disclosing Confidential Information

Answer 23

“forensic examiners seek to assist the trier of fact to understand evidence or determine a fact in issue, and they provide information that is most relevant to the psycholegal issue.” In other words, a forensic evaluation and the report based on its results should focus on information that’s relevant to the psycholegal questions addressed by the evaluation.

Question 24

Disclosing Confidential Information to Colleagues
* allows psychologists to consult with colleagues about clients but requires them not to disclose identifying information about a client to a consultant without the client’s authorization and to disclose only information that’s “necessary to achieve the purposes of the consultation.”
* psychologists must not use confidential client information in “writings, lectures, and other public media” unless they take reasonable steps to disguise the identity of the client, they have obtained written authorization from the client to do so, or there’s legal authorization to do so.
* Fisher (2017) notes that simply substituting a pseudonym for the client’s name is not likely to be sufficient, and she recommends that psychologists consider changing names, birthdates, and locations that are smaller than a state (which is required by HIPAA policy for de-identifying private health information) as well as “changing the season or year of an event or modifying details of family composition and other social networks that are not essential to the didactic goal”

Question 25

Confidentiality versus Privilege
maintaining client confidentiality is an ethical obligation and, in some circumstances, a legal requirement, while privilege (privileged communication) is a legal term that refers to a client’s right to confidentiality in legal proceedings. All 50 states have established laws that create some form of the psychotherapist-client privilege.
* The client or the client’s legal representative is the holder of the privilege, which means that the client or his/her legal representative decides whether to claim (assert) or waive the privilege. However, psychologists may claim the privilege on behalf of a client when asked to disclose confidential client information in a legal proceeding. In addition, there are legally defined exceptions to privilege, and the court determines whether an exception applies in a particular circumstance.
* Legal exceptions to privilege vary, but common exceptions include:
cases in which the court has ordered an examination of a person to determine his/her competence to stand trial
a person is suing his/her therapist for malpractice
a person is using his/her mental status as a claim or defense in a legal case.

Question 26

The Health Insurance Portability and Accountability Act (HIPAA) allows covered entities to disclose a patient’s personal health information (PHI):

A. only with an authorization signed by the patient or the patient’s legal representative.
B. without an authorization signed by the patient when it’s going to be used for the purpose of treatment, payment, or health care operations.
C. without an authorization signed by the patient only when it’s needed for the patient’s emergency treatment.
D. without an authorization signed by the patient when it meets the “minimum necessary” standard.

Answer 26

B. without an authorization signed by the patient when it’s going to be used for the purpose of treatment, payment, or health care operations.

Question 27

Dr. Horowitz learns that a current therapy client has started dating one of Dr. Horowitz’s close friends. To be consistent with ethical guidelines, Dr. Horowitz should:

A. reduce her interactions with her best friend.
B. discuss the situation with her client to help determine the best course of action.
C. do nothing unless she notices that the situation is affecting her effectiveness as a therapist.
D. say nothing to the client or friend but take special precautions to protect the client’s confidentiality.

Answer 27

B. discuss the situation with her client to help determine the best course of action.

This answer is most consistent with Standard 3.05(b) of APA’s Ethics Code. It states that when, “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.” Of the answers given, the most reasonable step would be to discuss the situation with the client to help determine the best course of action.

Question 28

____________ are the standards used in the APA’s Ethics Code to define sexual harassment.

A. Quid pro quo and reasonable woman
B. Hostile environment and reasonable person
C. Quid pro quo and hostile environment
D. Tangible detriment and reasonable person

Answer 28

B. Hostile environment and reasonable person

Standard 3.02 of APA’s Ethics Code distinguishes between two types of behavior that constitute sexual harassment: behaviors that create a hostile work environment and behaviors that are sufficiently severe or intense “to be abusive to a reasonable person.”

Question 29

Dr. Bharara, a licensed psychologist, saw Mr. and Mrs. D’Andrea and their two children in therapy for four months before the parents suddenly decided to get a divorce and stopped coming to therapy. One month later, Dr. Bharara receives a phone call from Mrs. D’Andrea who asks if he would be willing to conduct a custody evaluation of the children. As an ethical psychologist, Dr. Bharara:

A. should agree to do so only with the permission of both Mrs. and Mr. D’Andrea.
B. should agree to do so only if he believes his previous therapeutic relationship with the family will not interfere with his objectivity.
C. should agree to do so as long as he’s able to evaluate all family members.
D. should not agree to do so and provide Mrs. D’Andrea with an appropriate referral.

Answer 29

D. should not agree to do so and provide Mrs. D’Andrea with an appropriate referral.

Multiple relationships are addressed in Standard 3.05 of APA’s Ethics Code and Guideline 12 of APA’s Guidelines for Child Custody Evaluations in Family Law Proceedings. Both prohibit psychologists from becoming involved in a multiple relationship that might impair their objectivity, competence, or effectiveness, and the Guidelines identifies conducting a child custody evaluation with current or former therapy clients as a multiple relationship that should be avoided.

Question 30

Which of the following is true about privilege?

A. It can be claimed and waived only by the client.
B. It can be claimed by the client and the client’s legal representative but waived only by the court.
C. It can be claimed and waived by the client, the client’s legal representative, and the therapist.
D. It can be claimed and waived by the client and the client’s legal representative and claimed by the therapist on behalf of the client.

Answer 30

D. It can be claimed and waived by the client and the client’s legal representative and claimed by the therapist on behalf of the client.

The client or the client’s legal representative is the holder of the privilege, which means that the client or his/her representative decides when to claim or waive the privilege. However, psychologists may claim the privilege on behalf of a client when asked to disclose confidential client information in a legal proceeding.

Question 31

When consulting with a colleague about a client who’s not responding to treatment, you:

A. must get authorization from the client before doing so.
B. must get authorization from the client before doing so if you cannot disguise her identity while discussing the situation with the colleague.
C. do not need to get authorization from the client as long as you disclose only confidential information that’s pertinent to the purpose of the consultation.
D. do not need to get authorization from the client as long as the colleague is a licensed mental health professional.

Answer 31

B. must get authorization from the client before doing so if you cannot disguise her identity while discussing the situation with the colleague.

This answer is most consistent with Standard 4.06 of APA’s Ethics Code. It states that, when consulting with a colleague about a client, psychologists do not disclose confidential information “that reasonably could lead to the identification of a client/patient … unless they have obtained the prior consent of the person.”