Ethics for Psychologists _______________________________________________________________________
Case Study A psychologist decides to treat a family in therapy. The parents of two minor children decide at some point in treatment to get a divorce. Records are requested for a court hearing regarding custody of the children, and the therapist is asked to testify on behalf of the wife and to separately evaluate the children regarding custody. There are a number of issues regarding competence in this scenario. The psychologist has been acting as a therapist, and attempting to transition to the role of impartial evaluator in a forensic setting requires expertise above what is routine for a treating therapist. The blurring of roles and boundaries sug- gests the family may not understand what is appropriate in the situation and how the role of a forensic evaluator in a custody case differs from the role of a treating family therapist. Records of the family may have been kept on each person individually or on the family as a whole, making the release of records, if indicated, problematic. Knowing how to keep records appro- priately is an issue of competence. Finally, the therapist is being asked to testify on behalf of the wife in the divorce and custody proceeding. The relationship of the therapist at the start of the treatment clarifies to all parties the areas in which the therapist is competent. To enter into a separate relationship with just the wife will raise issues of boundaries and role clarification and may highlight areas that were not competently addressed at the outset of treatment. INFORMED CONSENT Informed consent in psychology has several aspects. The first part is that psychologists know what it is that they are antici- pating in providing services and can provide that information clearly to the client. The second part is that the person receiving services is able to understand and make use of the informa- tion the psychologist is providing. The third part is that the person receiving the services has the legal ability to consent to the services to be provided. Fourth, the person receiving the services must have the intellectual and psychological capacity to consent to the services being provided. The fifth part is the client’s ability to form rational decisions about the information being provided. Lastly, the documentation of the agreement to provide services and to consent to those services being provided is essential. Informed consent is described as having two goals: to promote individual autonomy and to encourage rational decision making. This presumes that the individual entering into the relationship has done so voluntarily and is capable of under- standing what the psychologist is disclosing.
Informed consent can be broken down into the following areas [13]: • Information: What is disclosed, how, when, and by whom? • Understanding: What did the client understand about what would happen? How did that understanding develop? • Competency: Did the client have the cognitive and emotional capacity to understand what was being commun-icated? Did they actually understand? • Voluntariness: Is the client free to choose or not? Are they subject to undue influence or coercion? Is some- one else responsible for ensuring that the client will decide or is someone else deciding for the client? • Decision: How are the decisions about treatment being made? What role does the disclosure play? The 2016 APA Ethics Code documents the need for informed consent in psychology in Standard 3.10 [8]. The following section has been reprinted with permission: 3.10 Informed Consent (a) When psychologists conduct research or provide assess- ment, therapy, counseling, or consulting services in person or via electronic transmission or other forms of communication, they obtain the informed consent of the individual or individuals using language that is reasonably understandable to that person or persons except when conducting such activities without consent is mandated by law or governmental regulation or as oth- erwise provided in this Ethics Code. (See also Standards 8.02, Informed Consent to Research; 9.03, Informed Consent in Assessments; and 10.01, Informed Consent to Therapy.) (b) For persons who are legally incapable of giving informed consent, psychologists nevertheless (1) provide an appro- priate explanation, (2) seek the individual’s assent, (3) consider such persons’ preferences and best interests, and (4) obtain appropriate permission from a legally authorized person, if such substitute consent is permitted or required by law. When consent by a legally authorized person is not permitted or required by law, psychologists take reasonable steps to protect the individual’s rights and welfare. (c) When psychological services are court ordered or other- wise mandated, psychologists inform the individual of the nature of the anticipated services, including whether the services are court ordered or mandated and any limits of confidentiality, before proceeding.
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