Legal & Ethical Issues
in Psychopathology
Current Legal/Ethical Issues
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Legal Issues:
 Civil Commitment
 Criminal Commitment
 Duty to Warn
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Ethical Issues (in
Treatment):
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Confidentiality
Competence
Dual Relationships
Legal Issues
Legal Issues
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Rights of patients vs. rights of public
Few laws govern therapy
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Required to be competent
To have a license
Can use collection agencies if clients fail to pay
Several unique legal issues with therapy
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Complex questions
Burden therapist, state, others
Civil Commitment
Most hospitalizations are voluntary
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Voluntary is in best interest b/c can check out
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In some cases, patients are involuntarily
hospitalized
1.
2.
–
Danger to oneself (suicidality)
Danger to others (homocidality)
Majority of commitments are male
schizophrenics
Civil Commitment
Judge hears case & decides
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Hearing is requested by police, mental health
provider
Civil commitment must legally be lifted when
patient is no longer dangerous
Requirements protect patients - historically,
anyone could have someone committed
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But, goals are re: danger, not helping
The Right to Treatment
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Established 1972 by Wyatt v. Stickney
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Rationale for commitment = treatment
Thus, if hospital is unwilling or unable to provide,
patient can petition for commitment overruled
Why suspend a patient’s rights unless there is a
benefit?
First attempt to have minimum criteria for
mental health treatment
The Right to Treatment
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Staffing levels, # of bathrooms, size of facility,
variables that impact quality of life
Rulings required states to provide facilities
that met minimal requirements

State provides most treatment for the severely
and chronically mentally ill
The Insanity Defense
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Based up on premise that people cannot be
held responsible for crimes if they were
unaware of the nature of their actions or were
unable to control their actions
We have free will to commit or not commit
crime
Legal insanity is a very narrow definition

Psychological insanity: products of antecedents (a
disorder is not something we choose)
Insanity Defense Reform Act
(1984)
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Made it more difficult to prove insanity
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Unable to appreciate wrongfulness as result of
severe mental illness
Defense now has burden of proof
Previously, prosecution had to prove sanity
Reduced advantages of pleading insanity
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Fixed minimum periods of incarceration
Eliminated automatic release following reduction
of danger
Guilty But Mentally Ill
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Individual will be
incarcerated, but
acknowledges
presence of mental
illness
Suggests that
treatment is needed
during incarceration
Public Opinions of Insanity
Pleas
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90% of the public believes that:
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Public estimates of how many felony cases
involve insanity pleas: 33%
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The insanity defense is used too much
Lots of guilty people get to go free
Actual number: <1%
Public estimates of success: 50%

Actual number: 25%
Public Opinions of Insanity
Pleas
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Public estimate of how many “insane” people
are released: 50%
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Actual number: 15% (minor offenses that do not
result in incarceration anyway)
Public also tends to believe successful
insanity pleas = short time in hospital
They actually spend 50% longer in hospital
then they would have in prison if guilty
Competency to Stand Trial
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Is the person capable of understanding the
charges and helping attorney to prepare the
case?
This is independent from sanity at the time of
crime
Trial is postponed; defendant is held for
treatment
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Protects public from possible danger
The Right to Refuse Treatment
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Can usually refuse
treatment if desired
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Unless refusal is based
on psychosis or
delusions
Before all
commitments,
independent evaluation
is required (not
connected to the
hospital)
Therapist’s Duty to Warn

Tarasoff v. Regents of the U. of CA (1974, 1976)
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Therapists have a legal responsibility to warn potential
victims when they may be at risk from a client
1969 Tatiana Tarasoff is murdered by a grad student
who suggested, in therapy, that he was going to kill her
Therapist informed police, who told grad student they
were aware of his threats
Grad student assured police he had no intentions of
murder
Therapist’s Duty to Warn

Therapists are required to warn/protect
potential victims
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By telling the police
By committing the client
By informing the potential victim
Involves breaking a client’s confidentiality
Ethical Issues
Ethical Issues in Treatment
1.
2.
3.
4.
5.
6.
Competence
Integrity
Professional & Scientific Responsibility
Respect for People’s Rights & Dignity
Concern for Others’ Welfare
Social Responsibility
Confidentiality
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Therapy is a protected relationship information is not shared without explicit
permission
Exceptions:
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Knowledge of child abuse
Threats to others (Tarasoff)
Threat to self
Can consult with other therapists openly
Competence
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Maintain the highest standards of
competence
Recognize & respect the limits of
competence
Provide only those services we are qualified
to provide
Competence is a combination of: education,
training, experience
Competence
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E.g. Conducting a neuropsyc assessment
without training
Be familiar with culture, gender, other
differences & how those differences will effect
one’s work
Remain current in the field on research and
professional information
Record Keeping
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Maintain records of client contact to facilitate
& document treatment
Provide a basis for decisions
Covers the therapist in case of legal action
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E.g. decisions regarding suicidality
Records are often requested by insurance
companies to determine if more services are
needed
Who is the Client? (Esp.
Children)
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Psychologists may work with more than one
person
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Ethics do not offer a clear line in this case
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Especially with children, who have parents &
teachers, and other providers
Avoid multiple roles
Clarify roles if they are ambiguous
Often ask parents for child’s confidentiality
What if No Treatment Exists?
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Experimentation is required to further the field
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Clients should be informed of experimentation
Clients also should be informed of other options
that are established
Often try experimental tx if an EST has been
tried and failed (in clinical work)
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Design based on available science
Dual Relationships
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When therapist/client relationship exists at
the same time as another
E.g. friend/friend or boss/employee
Should therapists treat their friends?
Should therapists treat/listen to their
students?
Some Practical Issues
- Science vs.
Pseudoscience
The Widening Gap

Between academic psychology & popular
psychology
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Between research and general public
knowledge
Characteristics of
Pseudoscience
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Overuse of ad hoc hypotheses to escape refutation
Emphasis on confirmation, not refutation
Absence of self-correction
Reversed burden of proof
Overreliance on anecdotal evidence
Use of obscurantist language
Absence of “connectivity” with other disciplines
Pseudoscience in
Psychopathology
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Explosion of unvalidated tx for trauma
Use of demonstrably ineffective tx for autism
Continued use of inadequate assessments
Widespread use of herbal tx w/o testing
Subliminal self-help tapes
Explosion of self-help books and programs
Suggestive techniques for memory recovery
Why Should We Care?
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Why should we monitor the general public?
Can’t they use whatever they want to buy?
Techniques may be harmful to the public
Consumers waste time & $ they could use in
therapy
Damage to our reputation & integrity
Our ethical guidelines of social responsibility
What Should Psychologists
Do?
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Actively study & “debunk” pseudoscience
Evaluate self-help materials
Standardize training programs
Popularize our findings & methods to the general
public, convey our scientific excitement to outsiders
& show the successful applications of it
The general public is often unaware of what is
proven, and what is not
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Legal & Ethical Issues in Psychopathology