Another popular model is the ETHICS model, which was introduced by Ling and Hauck (2016). It serves to simplify the ethical decision-making process into six steps that can be applied to a broad range of ethical dilemmas: 1. E—Evaluate the dilemma . This is the most critical aspect of the model. Identifying and understanding the dilemma provides the framework for the decision-making process. The psychologist applies the Ethics Code and any applicable laws to help define the dilemma. Possible courses of action and the ethical codes that support or violate each option are evaluated, since by definition a dilemma cannot be resolved without potentially violating an ethical code. 2. T—Think ahead . Once the dilemma is defined, the psychologist must think ahead to the possible consequences, positive and negative, of each potential action. Consideration of all who are potentially affected by the action is necessary and may include the psychologist, client, colleagues, or the profession. Psychologists have a duty to do no harm, so this step aligns with the General Principle of Beneficence and Nonmaleficence. 3. H—Help . It is important to receive help from others in the form of consulting with others. Receiving help is different from receiving a decision. Receiving help Case example Regardless of the specific decision-making model the psychologist chooses as a best fit for their practice, most models simplify down to the following steps: 1. Identify the problem. 2. Gather information: Review laws, rules, and code of ethics; get consultation. 3. Identify potential courses of action. 4. Consider the potential consequences of all options, determine a course of action, and implement it. 5. Review the outcome. Apply the steps for ethical decision-making to the following fictitious case example. Dr. Smith has a private practice in the small town where she lives. Jane has recently moved to the town and has been seeing Dr. Smith for weekly psychotherapy sessions over the past two months for symptoms of anxiety with panic episodes. They have a mutually agreed upon goal of reducing the frequency of panic attacks to one per week. Jane is making good progress in her ability to recognize symptoms and utilize cognitive and behavioral strategies, and the frequency of her panic attacks has decreased from multiple times daily to an average of three per week. As she has been feeling more in control, she has begun to reengage in activities that have provided her with support and comfort. One of these activities is church attendance. Dr. Smith was surprised when she saw Jane arrive alone at Dr. Smith’s church one Sunday morning, the only church of that denomination in the town. Jane came up to Dr. Smith and asked to sit next to her during the service. Although somewhat startled, Dr. Smith agreed. At their next therapy session, Jane stated that she had become a full member of their mutual church and has volunteered to work on the same outreach committee as Dr. Smith but hasn’t attended a meeting yet. How should Dr. Smith proceed? ○ Is there an ethical dilemma? ○ What about the situation requires decision making? ○ If a decision is needed, what is the best course of action for resolution? 1. Identify the problem. This may be a multiple relationship. In addition to seeing Jane in therapy, Dr. Smith will also see
involves discussion of relevant factors to help determine a course of action, which keeps the responsibility for the action with the psychologist. Help can be sought from different sources, for example, legal clarification from an attorney, risk-management clarification from a liability company, or clinical clarification from a supervisor or colleague. The help received is then applied to each potential action and analyzed in conjunction with the information from other steps. 4. I—Information . Information should be sought from all available sources, including literature, laws, regulations, and agency policies. The information is then applied to each possible action to highlight its pros and cons. 5. C—Calculate risk . Assessing risk involves calculating how each potential action could expose the psychologist to liability or otherwise compromise each of the stakeholders involved in the situation. Decreasing risk for one party may increase risk for another. By considering risk for each participant separately, the psychologist can get a better understanding of the overall risk of each possible action. 6. S—Select an action . This is the final step, when the psychologist determines the most ethical/least unethical course of action. her on a consistent basis in social and volunteer situations. Incidental contact outside of therapy is not a dilemma (boundary crossing), but this situation will have ongoing close contact in a nontherapy setting (boundary violation?). Standard 3 states that the psychologist does not engage in a multiple relationship if it could reasonably be expected to impair the psychologist’s objectivity and effectiveness. Can objectivity in therapy be maintained? Can confidentiality outside of therapy be maintained? 2. Gather information: Review laws, rules, and code of ethics; get consultation. There are no laws that address this situation. Per Ethics Standard 3, Dr. Smith has a primary obligation to Jane as her client and must resolve the situation in Jane’s best interest and minimize or do no harm. Standard 4 states that she has an obligation to protect Jane’s confidentiality, which would be difficult in this situation. Consistent social interaction may prevent her from staying objective in her treatment with Jane. Jane is still an active client and though she has made progress in therapy, she has not yet reached their agreed upon goal. Standard 10 states that therapy should be terminated if the client could be harmed by continued services. Is that the case here? Is this an avoidable multiple relationship? What is the potential for inappropriate therapist transparency and self-disclosure in social settings? 3. Identify potential courses of action. a. Smith could do nothing and continue as is professionally and socially. b. Smith or Jane could find a new church. c. Smith and /or Jane could resign from the committee but continue church attendance. d. Therapy could be terminated, and Jane could be referred to another therapist. e. Therapy could be terminated. 4. Consider the potential consequences of actions, determine a course of action, and implement it. Dr. Smith discussed the ethical issue and her concerns with Jane at their next therapy session, since the client should be actively engaged in
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