临床与咨询心理学导论 5 - Ethics 伦理

L5 Ethics in Research & Practice

5.1 APA Code of Ethics

“Ethical Principles of Psychologists and Code of Conduct”

- First ethics code published in 1953

- Most recent version updated in 2016

General Principles

- “Aspirational”

- Values of Psychologists

Five general principles:

- Beneficence & Nonmaleficence: benefit those you work with; do not harm

- Fidelity & Responsibility: establish trust; aware of responsibilities

- Integrity: promote accuracy, honesty, and truthfulness

- Justice: everyone entitled to access and benefit from psychology

- Respect for People’s Rights & Dignity: respect the dignity and worth of all people and rights to privacy, confidentiality, and self-determination

Ethical Standards

- Enforceable Rules of Conduct

- Cover a wide range of topics

1. Resolving Ethical Issues;

2. Competence

3. Human Relations;

4. Privacy and Confidentiality;

5. Advertising and Other Public Statements;

6. Record Keeping and Fees;

7. Education and Training;

8. Research and Publication;

9. Assessment;

10. Therapy.

5.2 Special Topics in Psychotherapy

5.2.1 Confidentiality & Privilege

- Confidentiality is an ethical obligation

- Obligation to protect information

- In general, nothing disclosed in therapy is revealed to third party

- Privilege is a legal right granted to clients

- Protects clients from having therapists disclose info without their consent

- Privileged communication = Communication within a relationship

(e.g., spouses, attorney-client, psychologistclient)

- Importance of confidentiality (considered the most important)

Topic appears in General Principles

Topic appears in many specific Ethical Standards

- Need for trust within a clinical relationship

Tarasoff Case & Duty to Warn

- Case involving two students at UC Berkeley

- One student disclosed intention to kill another student during a therapy session at the University’s counseling center

- Psychologist contacted campus police who interviewed and released the student

- Two months later he killed Tarasoff

- Tarasoff vs Regents of the University of CA (1974/1976)

- Court ruled that psychologist did not take adequate actions

- Duty to Warn (psychologist not inform the student directly) - 1974

- Duty to Protect (psychologist has the duty to protect, which could involve something rather than the direct warning) - 1976

“The protection privilege ends where the public peril begins.”

Duty to Warn/Protect - different in different states.

5.2.2 Limits to Confidentiality

• Client is at risk of harming themself or others

• Known or suspected abuse or neglect (of a child)

• Court-ordered evaluation of psychological condition

• Client raises the issue of their mental condition in a trial and consents for the therapist to testify on their behalf

• Client claims malpractice against therapist

5.2.3 Informed Consent for Psychotherapy

• Consent needed for research, assessment, and therapy

• For therapy, consent must include:

- Nature and anticipated course of therapy

- Fee arrangement

- Involvement of third parties

- Limits of confidentiality

- Opportunity for questions and answers

• Usually an ongoing process

5.2.4 Multiple Relationships

Being in both professional and nonprofessional relationships with a client

- Being in a relationship with someone closely associated with a client

- Promising a future relationship with a client or someone close to the client

Multiple Relationships in Psychotherapy

Sexual Multiple Relationships - Never acceptable to have a sexual relationship with a current client or associate of a current client

Nonsexual Multiple Relationships May be ethical unless:

- Interfere with psychologist’s objectivity or competence

- Have the potential for exploitation/harm to the client

5.2.5 Competence

Psychologists must be capable, skilled, and experienced to complete their tasks

- Must operate within “boundaries of their competence”

- Work within areas of expertise

- Having a doctoral degree/license ≠ Competence

Continuing education required

- Efforts to maintain competence

- Part of renewing license in many states

Importance of preventing and minimizing these problems:

Psychologists need to recognize that their personal problems may lessen their competence

Burnout - State of exhaustion / Engaging in excessively demanding and stressful work

5.3 Ethics in Clinical Assessment

- Informed Consent for Assessment

Must include information on:

- Nature and purpose of the assessment

- Fee arrangement

- Involvement of third parties

- Limits to confidentiality

- Opportunity for questions and answers

- Test

Test Selection

- Should be appropriate to the assessment goal

- Should be appropriate for the population being tested

Factors influencing selection include:

- Psychologist competence

- Client culture, language, and age

- Reliability and validity

- Up-to-date forms

Test Security

- Ethical obligation to protect security of test materials

- Violation could invalidate future assessments

Test Data

- Raw scores on an assessment

- Should release test data unless reason to believe that it will be misused or harm the client

5.4 Ethics in Clinical Research

Informed Consent for Research

Must inform participants about:

- Purpose of the study

- Study procedures

- Length of the study

- Any predictable risks

- Any anticipated benefits

- Compensation

- Right to decline to participate and/or withdraw

- Limits to confidentiality

- Who to contact about questions about the study or their rights as a research participant

Additional information for treatment studies:

- Experimental nature of the treatment

- Use of “no treatment” or control groups

- Alternatives

Institutional Review Boards (IRB)

Required for all institutions with federal funding

Include scientists and members of the community

Must review all research involving human subjects

Risk-Benefit Ratio

Academic Integrity

Scientific Misconduct: Fabrication; Falsification; Plagiarism

Credit: Authorship; Contributions to work

5.5 Ethical Decision Making

- Model for making decisions with ethical issues arise (Celia B. Fisher)

- Make a commitment to doing what is ethical

- Know the APA’s ethical code

- Consult legal and professional guidelines

- Try to understand the perspectives of all involved parties

- Generate and evaluate alternatives

- Select and implement the most ethically appropriate actions

- Monitor and evaluation your actions

- Modify as needed