News and Views
Ethics Issues
THE NEW APA ETHICS CODE
After a five year review and debate, the American Psychological Association published its new 2002 APA Ethical Principles of Psychologists and Code of Conduct in the Dec. 2002 issue of the American Psychologist. This code is effective on June 1, 2003. A redline (point by point) comparison of the 1992 and 2002 codes can be found on the APA website by going to the website www.apa.org and then going to the ethics section where it can be found. The Jan 2003 issue of the APA MONITOR has an article examining the new code which can be found and downloaded: http://www.apa.org/monitor/jan03/newcode.html
Psychologist Bill Doverspike, author of Ethical Risk Management: Guidelines for Practice, has written The 2002 APA Ethics Code: An Overview for Division 42 (Independent Practice) of the APA. It can be accessed: ethics_code.html. If you use this address even a non-member can access it, even though it is in the "members" section of the site. [Please note that if you intend to try to print this, save it on your computer first and then have it printed in "landscape" orientation, otherwise the right hand side of the article will be cut off.]
Dr. Doverspike notes that the new code properly recognizes situations in which psychologists are asked to perform services in emergencies, and that forensic activities are addressed throughout the code rather than in a special section. It expands on informed consent issues, but without making substantive changes in the basic principles. The 2002 code adopts a "neutral stance" on multiple relationships and barter which the 1992 code "implied ….. are inherently unethical."
Dr. Doverspike notes a shift in the standards for release of psychological test data in that the 2002 code provides that it is an ethical requirement to release these to either the client or whomever they designate, unless they need to be withheld to protect the patient. There is also a provision that would allow for ethically withholding records for non-payment of fees in situations that do not involve emergency care. The 2002 code focuses on the client's release as being the major requirement -- not the determination that the person to receive these is qualified to use such information. I would agree with Dr. Doverspike that this is a major shift in the standards for handling requests for test data.
In the area of Education and Training, Dr. Doverspike notes that there are now more explicit limits put on pursuing personal information from students and for requiring them to be in a therapy group or receive individual therapy. As regards Terminating Therapy, the 2002 code provides a clear authorization to terminate therapy if threatened or endangered by the client or someone else connected to the client. It also allows for a psychologist to ethically terminate without pretermination counseling and referral "…where precluded by the actions of …. third party payors.
OVERVIEW
A major factor in the review process was a concern about the use of the code to prosecute psychologists in civil and licensing board actions. This version is approximately 20% shorter than its predecessor. In the Introduction and Applicability section a new paragraph was added:
The modifiers used in some of the standards of this Ethics Code (e.g., reasonably, appropriate, potentially) are included in the standards when they would (1) allow professional judgment on the part of psychologists, (2) eliminate injustice or inequality that would occur without the modifier, (3) ensure applicability across the broad range of activities conducted by psychologists, or (4) guard against a set of rigid rules that might be quickly outdated. As used in this Ethics Code, the term reasonable means the prevailing professional judgment of psychologists engaged in similar activities in similar circumstances, given the knowledge the psychologist had or should have had at the time.
The section on General Principles has shifted its major principles to terms more commonly found in traditional biomedical ethics. Principle E: "Concern for Other's Welfare" has become Principle A: Beneficence and Nonmaleficence. Principle C: "Professional and Scientific Responsibility" has become Principle B: Fidelity and Responsibility. Principle B, which is now C, remains Integrity. Principle D, which is now E, remains Respect for People's Rights and Dignity. The 2002 Code has added a new one:
PRINCIPLE D: JUSTICE
Psychologists recognize that fairness and justice entitle all persons to access to and benefit from the contributions of psychology and to equal quality in the processes, procedures, and services being conducted by psychologists. Psychologists exercise reasonable judgment and take precautions to ensure that their potential biases, the boundaries of their competence, and the limitations of their expertise do not lead to or condone unjust practices.
This principle does not directly deal with equitable use of resources or the competing rights of various persons such as with the duty to warn or protect type situation. Overall this section has shifted to more traditional ethical principles. Two General Principles in the prior code have been dropped: the former Principle A: Competence and former Principle F: Social Responsibility.
ETHICAL STANDARDS
Section 1.02 has been expanded beyond Conflicts between Ethics and Law to include conflicts with Regulations or Other Governing Legal Authority and now provides that if the conflict is unresolvable via such means, psychologists may adhere to the requirements of the law, regulations, or other governing legal authority
Section 1.05 Reporting Ethical Violations now states that it does not apply when an intervention would violate confidentiality rights or when psychologists have been retained to review the work of another psychologist whose professional conduct is in question. Section 1.06 Cooperating With Ethics Committees now states that making a request for deferment of adjudication of an ethics complaint pending the outcome of litigation does not alone constitute non-cooperation.
Several sections now recognize the fact that situations may require that a psychologist provide service even if not fully qualified. A new subsection (d) to 1.04 Boundaries of Competence allow those with closely related prior training or experience to provide services in order to ensure that services are not denied if they make a reasonable effort to obtain the competence required. A new standard 2.02 Providing Services in Emergencies allows essentially the same thing as 1.04, but additionally requires that the services are discontinued as soon as the emergency has ended or appropriate services are available.
Section 2.05 Delegation of Work to Others references use of the services of others, such as interpreters and requires the psychologist to take reasonable steps to (1) avoid delegating such work to persons who have a multiple relationship with those being served that would likely lead to exploitation or loss of objectivity. It is not clear what is intended in a common situation faced when interpreting is done by a family member, neighbor, or friend.
Section 3.05 Multiple Relationships has been substantially rewritten. It now more clearly warns about relationships with persons who are closely associated with someone with whom they have a professional relationship, and also about promises of future relationships with those associated with clients. It has a new statement of interest: Multiple relationships that would not reasonably be expected to cause impairment or risk exploitation or harm are not unethical.
Section 3.10 Informed Consent: Subsection (a) now allows an exception when conducting such activities without consent is mandated by law or government regulation or as otherwise provided in this Ethics Code. Subsection (b) now requires that with persons who are legally incapable of giving informed consent, besides obtaining permission from a legally authorized person, psychologists (1) provide an appropriate explanation, (2) seek the individual's assent, (3) consider such persons' preferences and best interests… A new subsection (c) states: When psychological services are court ordered or otherwise 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.
Section 3.11 Psychological Services Delivered To or Through Organizations requires disclosure beforehand of: (1) the nature and objectives of the services, (2) the intended recipients, (3) which of the individuals are clients, (4) the relationship the psychologist will have with each person and the organization, (5) the probable uses of services provided and information obtained, (6) who will have access to the information, and (7) limits of confidentiality.
In Section 4.05 Disclosures, Subsection (b) which allows for disclosure of confidential information without client consent now lists the psychologist along with the client/patient or others who might need to be protected from harm. Section 6.03 Withholding Records for Nonpayment (of fees) was changed to prohibit only the withholding of records needed for a client/patient's emergency treatment.
Section 6.05 Barter With Clients/Patients no longer begins with the sentence that Psychologists ordinarily refrain from…. but contains the same restrictions, with one clarification -- that the resulting arrangement (as opposed to "relationship") is not exploitative.
There is a new Section 7.04 Student Disclosure of Personal Information, which reads:
Psychologists do not requires students or supervisees to disclose personal information in course- or program-related activities, either orally or in writing, regarding sexual history, history of abuse and neglect, psychological treatment, and relationships with parents, peers, and spouses or significant others except if (1) the program or training facility has clearly identified this requirement in its admissions and program materials or (2) the information is necessary to evaluate or obtain assistance for students whose personal problems could reasonably be judged to be preventing them from performing their training- or professionally related activities in a competent manner or posing a threat to the students or others.
Two related new standards are found under 7.05 Mandatory Individual or Group Therapy:
- When individual or group therapy is a program our course requirement, psychologists responsible for that program allow students in undergraduate and graduate programs the option of selecting such therapy for practitioners unaffiliated with the program….
- Faculty who are or are likely to be responsible for evaluating students' academic performance do not themselves provide that therapy.
In Section 7.07 the prohibition against Sexual Relationships With Students and Supervisees is narrowed to include those who are in their department, agency, or training center or over whom psychologists have or are likely to have evaluative authority. [New wording is underlined.] Sections 8.02 and 8/05 which relate to informed consent to research have been significantly altered.
There is a new subsection (c) under 9.01 Bases for Assessments, which reads: When psychologists conduct a record review or provide consultation or supervision and an individual examination is not warranted or necessary for the opinion, psychologists explain this and the sources of information on which they have based their conclusions and recommendations.
Section 9.02 Use of Assessments has the significant addition of a single word -- adapt -- which allows for some creativity in the use of tests. It also has two new subsections:
(c) Psychologists use assessment instruments whose validity and reliability have been established for use with members of the population tested. When such validity or reliability has not been established, psychologists describe the strengths and limitations of test results and interpretation.
(d) Psychologists use assessment methods that are appropriate to an individual's language preference and competence, unless the use of an alternative language is relevant to the assessment issues.
There is a new standard 9.03 for Informed Consent in Assessments:
(a) Psychologists obtain informed consent for assessments, evaluations, or diagnostic services, as described in Standard 3.10 Informed Consent, except when (1) testing is mandated by law or governmental regulations; (2) informed consent is implied because testing is conducted as a routine educational, institutional, or organizational activity (e.g. when participants voluntarily agree to assessment when applying for a job); or (3) one purpose of the testing is to evaluate decisional capacity. Informed consent includes an explanation of the nature and purpose of the assessment, fees, involvement of third parties, and limits of confidentiality and sufficient opportunity for the client/patient to ask questions and receive answers.
(b) Psychologists inform persons with questionable capacity to consent or for whom testing is mandated by law or governmental regulations about the nature and purpose of the proposed assessment services, using language that is reasonably understandable to the person being assessed.
(c) Psychologists using the services of an interpreter obtain informed consent from the client/patient to use that interpreter, ensure that confidentiality of test results and test security are maintained, and include in their recommendations, reports, and diagnostic or evaluative statements, including forensic testimony, discussion of any limitations on the data obtained
There is a substantially changed Section 9.04 Release of Test Data, which now reads:
(a) The term test data refers to raw and scaled scores, client/patient responses to test questions or stimuli, and psychologists' notes and recordings concerning client/patient statements and behavior during examination. Those portions of test materials that include client/patient responses are included in the definition of test data. Pursuant to a client/'patient release, psychologists provide test data to the client/patient or other persons identified in the release Psychologists may refrain from releasing test data to protect a client/patient or others from substantial harm or misuse or misrepresentation of the data or the test recognizing that in many circumstances release of confidential information under these circumstances is regulated by law. (See also Standard 9.11 Maintaining Test Security.)
(b) In the absence of a client/patient release, psychologists provide test data only as required by law or court order.
The requirements in 9.06 Interpreting Assessment Results are broader and more explicit in the 2002 code, requiring that psychologists take into account the purpose of the assessment as well as test taking abilities and other characteristics of the person such as situational, personal, linguistic, and cultural differences. A related section, 9.10 Explaining Assessment Results, has been substantially rewritten:
Regardless of whether the scoring and interpretation are done by psychologists, by employees or assistants, or by automated or other outside services, psychologists take reasonable steps to ensure that explanations of results are given to the individual or designated representative unless the nature of the relationship precludes provision of an explanation of results (such as in some organizational consulting, preemployment or security screenings, and forensic evaluations), and this fact has been clearly explained to the person being assessed in advance.
There is one new subsection in 10.01 Informed Consent to Therapy:
(b) When obtaining informed consent for treatment for which generally recognized techniques and procedures have not been established, psychologists inform their clients/patients of the developing nature of the treatment, the potential risks involved, alternative treatments that may be available, and the voluntary nature of their participation
Far more significant than this addition is the fact that the previous subsection (b) which concerned the situation where "the psychologist's work with clients or patients will be supervised" and when the "supervisor has legal responsibility for the case" has been rewritten and narrowed so that the 2002 version addresses trainees under supervision:
(c) When the therapist is a trainee and the legal responsibility for the treatment provided resides with the supervisor, the client/patient, as part of the informed consent procedure is informed that the therapist is in training and is being supervised and is given the name of the supervisor.
This new language would appear to greatly limit the requirement of telling the client about the supervisor.
There is a new standard, 10.03 Group Therapy which states: When psychologists provide services to several persons in a group setting, they describe at the outset the roles and responsibilities of all parties and the limits of confidentiality.
The 2002 code contains another new standard, 10.06 Sexual Intimacies with Relatives or Significant Others of Current Therapy Clients/Patients which is quite similar to a standard in the code of the National Association of Social Workers: Psychologists do not engage in sexual intimacies with individuals they know to be close relatives, guardians, or significant others of current clients/patients. Psychologists do not terminate therapy to circumvent this standard.
In the 2002 code "Terminating the Professional Relationship" has become 10.10 Terminating Therapy. This section has a new subsection (b): Psychologists may terminate therapy when threatened or otherwise endangered by the client/patient or another person with whom the client/patient has a relationship. Subsection (c) has been rewritten significantly: Except where precluded by the actions of the clients/patients or third-party payors, prior to termination psychologists provide pretermination counseling and suggest alternative service providers as appropriate. The third party payor exception here is new.