of confidentiality. The informed consent process must also provide an opportunity for the client to ask questions. Test data, including raw and scaled scores, client responses to questions, and psychologist notes and recordings, may be released to the client with appropriate client consent. Psychologists strive to maintain the security and integrity of test materials, including manuals, protocols, test questions, and test stimuli. Interpretation of results takes into account all the various test factors that may affect results. Use of outdated or obsolete tests should be avoided, and psychologists retain responsibility for the assessment when using scoring and interpretation services. Results are explained to the client unless clinically contraindicated. 10. Therapy: Rules 10.01–10.10 discuss informed consent to engage in therapy, which includes the anticipated course of therapy, fees, involvement of third parties, limits of confidentiality, and the opportunity for the client to ask questions. Roles and responsibilities of all parties are discussed with all parties in couples, family, and group therapy. Sexual relationships with current clients or close relatives, guardians, or significant others of current clients is prohibited. Therapy may not be terminated to circumvent this standard. Psychologists do not accept former sexual partners as clients. Psychologists do not have sexual intimacy with a former client for at least two years after termination of therapy and even then, the psychologist bears the burden of demonstrating that there has been no exploitation. Relevant Boundary crossings and violations Professional boundaries are addressed in multiple sections of the Ethics Code. They help guide the psychologist in choosing appropriate behaviors to prevent harm to clients. Boundary crossings are deviations from practice that are harmless to the client and may also be therapeutic. Limited self-disclosure on the part of the therapist as a way of establishing rapport or normalizing a client behavior would be in this category. A boundary violation, however, is a deviation from practice that is clearly harmful or exploitive of the client (Jain & Roberts 2009). The boundary violation usually takes the psychologist out of the professional role, it benefits the psychologist more than the client, there is significant risk in harming the client, and it transgresses an ethical standard. Sexual relationships are an example of a boundary violation, are extremely harmful to clients, and are specifically prohibited (Rule 10.05), as are such relationships with relatives and significant others of current clients (Rule 10.06). Exerting undue influence and taking advantage of a client are other examples of boundary violations. Boundary crossings, on the other hand, are a more common occurrence in daily practice. Consider these situations: ● Allowing a former client to friend you on social media. ● Having a client who recently lost their job ask you to temporarily waive your fee. All deviate from classical practice but are not necessarily harmful. However, self-reflection by the psychologist is necessary to ensure that the client’s needs and well-being are not at risk. Dual/multiple relationships A psychologist refrains from entering into a multiple relationship if it could impair the psychologist’s effectiveness or if could cause harm to the client (Rule 3.05). Entering into a business relationship with a former client, providing therapy to more than one family member, seeing a friend in therapy, and having a social relationship with a former client all constitute a multiple relationship. It may not be possible to avoid some multiple relationships; therefore, it is important to note that the standard also states that if the multiple relationship would not reasonably be expected to cause harm or exploitation, then it is not unethical. Questions to consider when reflecting on whether a nonsexual multiple relationship is ethical include: ● Running into a client at the store. ● Accepting a minor gift from a client. ● Extending the length of a session.
factors to be considered include the amount of time since therapy terminated, the nature and intensity of the therapy, the circumstances of termination, the patient’s personal history and mental state, the likelihood of an adverse impact on the patient, and any statements or actions by the psychologist during therapy that suggested the possibility of a posttermination sexual relationship. Psychologists terminate therapy when the client no longer needs the service, is not benefitting from the service, or is being harmed by the service, or if the psychologist is threatened by the client or someone on behalf of the client. Of these broad areas, the most common reasons for licensing board complaints include sexual misconduct and other boundary violations; multiple relationship violations; breaches of confidentiality; and child custody disputes, especially when they are outside the provider’s competence (Novotney, 2016). Self-Assessment Quiz Question #4 Which ethical standard addresses when services can be provided in an emergency? a. Privacy and confidentiality. b. Competence. c. Human relations. d. Assessment. Pope and Keith-Spiegel (2008) discuss nine guidelines to consider when making decisions involving boundary crossings and whether they will be helpful or harmful to the client: ● Imagine the best and worst possible outcomes from crossing the boundary and not crossing the boundary. Will doing so involve risk of negative consequences, or risk of serious harm in the short or long term? ● Consider any available research regarding the boundary crossing. ● Consider guidance offered by professional guidelines, ethics codes, legislation, case law, and other resources. ● Have at least one colleague you can trust to give honest feedback about boundary crossing issues. ● Pay attention to any uneasy feelings, doubts, or confusion and try to identify what is causing them and what implications they may have for your decision. ● When starting therapy as part of the informed consent discussion, describe to the client exactly what type of therapy you do. If warranted, refer them to a colleague who may be better suited for the client. ● Refer to a colleague any client that you feel incompetent to treat or that you do not feel you could work effectively with. ● Pay attention to informed consent for any planned or obvious boundary crossing. ● Keep notes on any planned boundary crossing describing why, in your clinical judgment, you feel it is necessary or helpful to the client. ● Is the relationship likely to cause harm? ● Would the relationship be beneficial to the client? ● Is the multiple relationship necessary, or can it be avoided? ● What are the motivations of the psychologist and client for the relationship? In the age of social media, it has become increasingly difficult to avoid inadvertently entering into a social relationship with a client. Accepting a client’s friend request and a client following you on your social media account are potentially problematic. Loss of psychologist privacy, loss of psychologist objectivity in treatment, or issues with power differentials may come into
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