Ethical Standards in Clinical Psychology

Learning Objectives

  • Describe ethical standards and expectations for psychologists including competence, informed consent, confidentiality, relationships with clients and others, and record keeping

Ethical Standards

In addition to the five ethical principles previously mentioned, the Ethics Code also describes ethical standards related to situations many psychologists may encounter in their professional roles. There are 10 standards contained within the Ethics Code, which we briefly summarize below—those related to resolving ethical issues, competence, human relations, privacy and confidentiality, advertising and public statements, record keeping and fees, education and training, research and publication, assessment, and therapy. The ethical standards are enforced for the benefit of the psychologists, clients, students, and other individuals that work with psychologists. Any psychologist that is a member of the APA is expected to adhere to the ethical standards. Any violation of an ethical standard may result in sanctions ranging from termination of APA membership to loss of licensure.

Resolving Ethical Issues

This section of the code explains how psychologists should resolve ethical conflicts between professional organizations, how to cooperate with professional ethics committees, and how to report ethical violations.

Competence

This ethical standard establishes the fact that psychologists must work within the boundaries of their own competence, based on their training, experience, consultation, and supervision. The different types of mental health–related problems and potential treatments are highly varied. It is impossible for psychologists to be competent in all areas, and in fact, unethical to attempt to portray themselves as such. If a psychologist feels that he/she has not been trained to ensure competence in a specific area to treat a client, they should make an appropriate referral, which is the act of directing a patient to a therapist, physician, agency, or institution for evaluation, consultation, or treatment. This ethical standard also provides psychologists with guidelines on providing services in emergency situations.

WAtch It

In addition to maintaining general competence in the field, psychologists also need to demonstrate cultural competence, showing respect and understanding when working with people from varied cultural backgrounds.

In this video, Lilian Comas-Díaz discusses why this is so important as she talks about her book “Multicultural Care: A Clinician’s Guide to Cultural Competence.”

You can view the transcript for “Interview with APA author Lillian Comas-Díaz” here (opens in new window).

Human Relations

The human relations section of the Ethics Code provides criteria for psychologists on how to approach situations related to the process of working with people in a helping field; how to identify and avoid unfair discrimination, sexual harassment, and other types of verbal and nonverbal harassment. These types of behavior have strong adverse influences on mental health. As such, psychologists must be particularly vigilant in identifying and avoiding these kinds of behavior.

Some treatments have been shown to cause harm, and as such, should be avoided. Situations where a clinician has more than one relationship with the client, beyond just being a client, can be difficult to navigate and should be avoided as multiple relationships can also lead to conflicts of interest. A psychologist refrains from entering into a multiple relationship if the multiple relationship could reasonably be expected to impair the psychologist’s objectivity, competence, or effectiveness in performing their functions as a psychologist, or otherwise risks exploitation or harm to the person with whom the professional relationship exists. The APA Ethics Code definition states that a multiple relationship arises when a psychologist is in a professional role with an individual, and (1) at the same time is in another role with the same person, (2) at the same time is in a relationship with a person closely associated with or related to the person with whom the psychologist has the professional relationship, or (3) promises to enter into another relationship in the future with the person or a person closely associated with or related to the person.[1]

This section also provides guidance for cooperating with other professionals, which is often a situation faced in multidisciplinary treatment teams. Guidance is provided for providing and obtaining informed consent for treatment. Another section outlines how to provide psychological services to or through organizations. And lastly, guidance is provided for how to navigate situations in which there is an interruption of psychological services for various reasons.

Therapist-client Relationships

What is it like to open up and reveal your most vulnerable and painful feelings to another person when you are struggling with depression, anxiety, or any mental disorder? The initial step to seeking therapy can be the hardest to take. And once the step is taken, how do clients experience the relationship with their therapist? The therapeutic relationship is considered by many leading clinicians and theorists to be the main vehicle for client change and it is the means by which a therapist and a client hope to engage with each other. Some may argue that the nature and quality of the therapeutic relationship is the most significant curative factor in psychotherapy.

In the humanistic approach, Carl Rogers identified a number of necessary and sufficient conditions that are required for therapeutic change to take place. These include the three core conditions: congruence (a state in which a person’s ideal self and actual experience are consistent), unconditional positive regard, and empathy.

In psychoanalysis, the therapeutic relationship, described by Freud (1912) as a friendly affectionate feeling, has been theorized to consist of three parts: the working alliance, transference/countertransference, and the real relationship. The working alliance may be defined as the relationship between the client and counselor, aimed at improving outcomes for the patient. Transference can be described as the client’s distorted perceptions of the therapist, caused when a client redirects feelings they have about someone else, like a significant other or parent, toward the therapist. Countertransference is defined as redirection of a therapist’s feelings toward a client—or, more generally, as a therapist’s emotional entanglement with a client. All of these feelings can have a great effect on the therapeutic relationship. In contrast to a social relationship, the focus of the therapeutic relationship is on the client’s needs and goals. Goals are what the client hopes to gain from therapy, based on their presenting concerns. The bond forms from trust and confidence that what the therapist and client agree need to be done to reach the client’s goals will bring the client closer to their goals. 

Client characteristics like social attitudes toward psychological disorders and attachment style have been found to be related to client use of counseling as well as expectations and outcome. Stigma against mental illness can keep people from acknowledging problems and seeking help. In terms of attachment style, clients with avoidance styles have been found to perceive greater risks and fewer benefits to counseling, and are less likely to seek professional help, than securely attached clients. Those with anxious attachment styles perceive greater benefits as well as risks to counseling. Educating clients about expectations of counseling can improve client satisfaction, treatment duration, and outcomes, and is an efficient and cost-effective intervention.

Psychologists are also interested in how culture relates to help-seeking, counseling process, and outcome. Recent research suggests that clients who are Black are at risk for experiencing racial micro-aggression from counselors who are White.[2] Efficacy for working with clients who are lesbians, gay, or bisexual might be related to therapist demographics, gender, sexual identity development, sexual orientation, and professional experience. Clients who have multiple oppressed identities might be especially at risk for experiencing unhelpful situations with counselors, so counselors might need help with gaining expertise for working with clients who are transgender, lesbian, gay, bisexual, or transgender people of color, and other oppressed populations. The Guidelines for Psychological Practice with Lesbian, Gay and Bisexual Clients provide assistance to psychologists in areas such as religion and spirituality, the differentiation of gender identity and sexual orientation, socioeconomic and workplace issues, and the use and dissemination of research on LGBT issues.

With so many potential forces driving an individual away from seeking therapy, the initial step can indeed be hard to take. Thus, the therapeutic relationship requires the client to be willing to work with the therapist in a partnership, break old patterns, and take the opportunity to talk, think, relate, and grow.

Privacy and Confidentiality

The privacy and confidentiality section is written to help provide psychologists with guidelines for maintaining appropriate confidentiality and respecting the privacy of the clients and patients under their care. Specific guidelines are provided for maintaining confidentiality for the psychologist’s patients as well as discussing the limits of confidentiality with them. In certain situations where the safety of the patient or others is at risk, confidentiality must be broken as law enforcement needs to be notified. Sections on disclosures and consultations provide guidance on how and when psychologists should disclose information and how to ethically consult with other professionals while maintaining appropriate levels of confidentiality.

HipAa

Most of us feel that our health information is private and should be protected. That is why there is a federal law that sets rules for health care providers and health insurance companies about who can look at and receive our health information. This law, called the Health Insurance Portability and Accountability Act of 1996 (HIPAA), gives you rights over your health information, including the right to get a copy of your information, make sure it is correct, and know who has seen it.

By law, your health information can be used and shared for specific reasons not directly related to your care, like making sure doctors give good care, making sure nursing homes are clean and safe, reporting when the flu is in your area, or reporting as required by state or federal law. In many of these cases, you can find out who has seen your health information. You can do the following:

  • Learn how your health information is used and shared by your doctor or health insurer. Generally, your health information cannot be used for purposes not directly related to your care without your permission. For example, your doctor cannot give it to your employer, or share it for things like marketing and advertising, without your written authorization. You probably received a notice telling you how your health information may be used on your first visit to a new health care provider or when you got new health insurance, but you can ask for another copy anytime.
  • Let your providers or health insurance companies know if there is information you do not want to share. You can ask that your health information not be shared with certain people, groups, or companies. If you go to a clinic, for example, you can ask the doctor not to share your medical records with other doctors or nurses at the clinic. You can ask for other kinds of restrictions, but they do not always have to agree to do what you ask, particularly if it could affect your care. Finally, you can also ask your health care provider or pharmacy not to tell your health insurance company about care you receive or drugs you take, if you pay for the care or drugs in full and the provider or pharmacy does not need to get paid by your insurance company.
  • Ask to be reached somewhere other than home. You can make reasonable requests to be contacted at different places or in a different way. For example, you can ask to have a nurse call you at your office instead of your home or to send mail to you in an envelope instead of on a postcard.

Advertising and Other Public Statements

The advertising and other public statements section is designed to guide psychologists through the process of advertising their practice and making other types of public statements.

Record Keeping and Fees

The record-keeping and fees standard is developed to guide psychologists in maintaining records of professional and scientific work in confidentiality. This standard states that maintaining records allow professionals to share information with other professionals if needed, help replicate research findings, and abide by the requirements of the institution and the law.

Education and Training

The education and training standard is designed to help psychologists create high-quality programs that train future psychologists with appropriate knowledge and practice.

Research and Publication

The research and publication standard is developed to highlight research and publication ethics that psychologists are expected to adhere to. This standard emphasizes the necessity of approval by the institute prior to carrying out the research, providing accurate information about the research study, and carrying out the research in accordance with the approval. When obtaining informed consent, details of the study should be presented to the participants, including but not limited to, the objective of the study, the procedures, benefits, and potential risks associated with the study, and the participants’ right to decline to participate and withdraw from the study without any penalty. However, for studies that are not expected to cause any harm, such as observing in a naturalistic environment, using anonymous questionnaires, or if permitted by the law, it may not be necessary to obtain informed consent.

Compensation for participation should not be used to persuade an unwilling participant. At the conclusion of the study, each participant should be presented with a summary of the study and the participant should be provided with an opportunity to ask any questions they have. Further, if there has been some harm caused to the participant due to participation in the study, necessary steps should be followed to minimize the harm.

This standard also provides guidelines and instructions on animal research. Psychologists are responsible for reporting accurate findings and taking the necessary steps to correct any errors in research and publication. Psychologists are also required to only present original data as their work and share publication credits based on the contributions rather than authority. Psychologists are also expected to be willing to share research data when required for verification and maintain the confidentiality of the participants during the review process.

Assessment

The assessment standard is developed to broadly address guidelines on assessments. This standard states that the psychologist’s views should be supported by findings from assessments while reporting the limitations of assessments. Psychologists are responsible for using valid and reliable assessments that are administered in a preferred language by the client. Informed consent is expected to be obtained in accordance to the guidelines on the “Informed Consent” standard, unless the assessment is required by the law, a routine practice, or required to test for the ability to make decisions. Psychologists are required to be appropriately trained in order to administer assessments and are responsible for using current tests.

Therapy

The therapy section is broadly written to guide psychologists through various aspects of providing psychological services. Psychologists are required to obtain informed consent from clients prior to treatment by presenting sufficient details about the therapy technique, including how established the treatment is and whether a psychologist in training will be assisting the client. It is necessary to communicate with the client about the potential risks and benefits of therapy, confidentiality and its limits, and the expected length of therapy. When psychologists are required to provide services in a group setting, psychologists are required to identify the role of the psychologist and notify the clients of the limitations of confidentiality. If a psychologist is required to provide services for a client already receiving mental health services from another professional, the psychologist is required to discuss with the client or other identified persons to minimize conflict and harm. Psychologists should not engage in sexual relationships with current clients or with those closely related to clients. Psychologists should not be sexually engaged with past clients within two years of termination, and even after two years of termination, psychologists will have to provide enough details to ensure that this ethical standard is not violated by being involved with a past client. In the event of a termination of employment, necessary steps should be taken in order to ensure client care. Termination of therapy should occur when the client shows significant improvements, does not benefit further from treatment, is being harmed by the treatment, or the clinician is threatened by the client or a person related to the client. Psychologists are expected to prepare clients for termination and provide sources for alternative services.

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glossary

countertransference: redirection of a therapist’s feelings toward a client or a therapist’s emotional entanglement with a client

informed consent: details provided prior to treatment about the therapy technique, the potential risks and benefits of therapy, confidentiality and its limits, and the expected length of therapy

multiple relationship: occurs when a psychologist is in a professional role with a person and (1) at the same time is in another role with the same person, (2) at the same time is in a relationship with a person closely associated with or related to the person with whom the psychologist has the professional relationship, or (3) promises to enter into another relationship in the future with the person or a person closely associated with or related to the person.

referral: the act of directing a patient to a therapist, physician, agency, or institution for evaluation, consultation, or treatment

transference: a client’s distorted perceptions of a therapist

working alliance: the relationship between the client and counselor, aimed at improving outcomes for the client

  1. Behnke, S. (2004, January). Ethics rounds--Multiple relationships and APA's new Ethics Code: Values and applications. Monitor on Psychology, 35(1). http://www.apa.org/monitor/jan04/ethics ↵
  2. Constantine, M. (2007). Racial micro-aggression against African American clients in cross-racial counseling relationships. Journal of Counseling Psychology, 54(1), 1–16. ↵