● Is the multiple relationship necessary, or can it be avoided? ● What are the motivations of the psychologist and client related to the relationship?
Questions to consider when reflecting on whether a nonsexual multiple relationship is ethical include: ● Is the relationship likely to cause harm? ● Would the relationship be beneficial to the client? Privacy and confidentiality The Ethics Code states that psychologists have a primary responsibility to protect confidential information obtained through, or stored in, any medium. The scope and limits of confidentiality should be discussed at the onset of treatment, as confidentiality is central to developing a trusting therapeutic relationship. Confidentiality is an issue that spans ethical, therapeutic, and legal areas, and ethical considerations within the realm of confidentiality are numerous. There are situations where a client’s confidential disclosure must be broken, for example, when suicidal intent is expressed. Although the Health Insurance Portability and Accountability Act (HIPAA) specifies that therapy process notes are to be kept separate in the client’s record, third-party payors typically have access to client diagnosis and therapy visit notes. With advances in Competence Achieving competence and being aware of one’s boundaries of competence are crucial to the ethical treatment of clients. Despite the importance of being competent to provide a service, it is not always easy to define what it means. Rule 2.01 states that psychologists obtain the training, experience, consultation, and/or supervision necessary to provide competent services, or they make an appropriate referral. Rule 2.02 recognizes that there may be emergency situations that, for the safety of the client, require the psychologist to practice outside of their scope.
technology and the recent pandemic, telehealth has become common. Frittgen and Haltaufderheide (2022) discuss the challenges to privacy and confidentiality that are inherent to video-based services. Many clients are not aware of the limits of confidentiality, particularly in situations of mandated reporting. It is generally good practice to have a written statement about its scope and limits signed by the client at the onset of treatment as part of the initial paperwork in order to avoid any later complaint of an ethical violation. In addition, HIPAA requires that clients sign the more general Notice of Privacy Practices, which details the routine use and disclosure of protected health information and client rights with respect to that information. This signed notice should be placed in the client’s records. But there is the expectation that services will be discontinued as soon as the emergency resolves or appropriate services become available. In addition to competent psychology knowledge and skills, the psychologist must have emotional competence. Per Rule 2.06, the psychologist must be aware of personal problems that could prevent them from providing services in a competent manner. If that situation occurs, they must take appropriate steps to limit or suspend their work duties.
ETHICAL DECISION MAKING
Understanding the laws, regulations, General Principles, and Ethical Standards provide the foundation for navigating the complexities involved in the ethical practice of psychology. Psychology professionals will face many situations during their careers that require them to make a judgment about the best course of action. An ethical dilemma occurs when a decision must be made about a course of action when two or more ethical standards are in conflict and the standards do not provide a clear solution to the situation. It is then left up to the psychologist to determine the best course of action that would produce the best outcome for the client. The General Principles and Ethics Code provide invaluable guidance, but they cannot address every specific situation or decision that may arise. Psychologists should then rely on models or frameworks for making ethical decisions. These models are designed to help guide the professional in a standardized manner when determining the best course of action to address a dilemma. There are numerous models for ethical decision making, and psychologists must find one that fits with their own professional identity, theoretical orientation, personality, and risk tolerance. They fall into three general categories. Standards-based models are based on the assumption that laws, rules, and organizational polices provide the best guidance for making a decision. Once the dilemma is identified, a determination is made as to whether there is a reason to deviate from those rules or policies. Principles-based models focus on the key ethical principles involved. The provider questions whether an ethical principle will be violated, facts are distinguished from theories and opinions, alternatives and consequences are reviewed, and an action is implemented that maximizes benefit while reducing risk. Ethical principles are prioritized. Finally, virtue-based models evaluate the potential action in terms of virtues. Above all, the psychologist asks if the proposed action is consistent with their personal values. Johnson et al. (2022) reviewed the current literature on the use of ethical decision-making models by mental health professionals. They note that although professionals do not always use a model when analyzing a dilemma, doing so
has many benefits, including improved decision quality and better preparation for dealing with difficult situations. They identified 38 unique models for ethical decision making, reviewed the individual steps in the models, and categorized them into common themes. Based on this, they identified core components of ethical decision-making models. These core characteristics can be used by the professional to evaluate decision-making models and select one that fits them best. ● Action : Taking an action toward resolving the dilemma and accepting consequences. Select a course of action, implement the action, modify practices based on the action, and accept responsibility for the action. ● Review : Gathering information, including review of professional standards. Define the dilemma based on standards or principles, review ethical and legal standards, and review literature. ● Intrapersonal : Considering personal values and professional competencies. Self-reflect on personal values and beliefs, and assess boundaries of competence. ● Interpersonal : Discussing with those involved in the decision and consult with colleagues. Discuss with the client, consult with a colleague, and/or seek out additional training or supervision. ● Prediction : Thinking about the potential consequences of the action. Consider possible outcomes, estimate the probability of consequences for each option, and determine if the solution is feasible. ● Deliberation : Defining and judging all aspects of the situation. Identify and interpret the problem, consider possible courses of action, identify the ideal desired outcome, assess values, and determine if the action is acceptable. ● Self-monitoring : Monitoring the process, decision, and consequences. Monitor the outcome, review the process, and document the process. ● Perspective thinking : Reviewing the perspectives of all involved parties. Consider all parties affected, consider cultural factors, identify competing values, and adopt the perspective of each party involved.
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Book Code: PYFL2024
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