Finding the Right Psychologist
Ethical Psychological Pracice: Finding the Right Psychologist
Foundation for the Preservation of the American Family
2005
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Finding the Right Psychologist
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Abstract
Psychologists have duties and obligations imposed on them by many
individuals and organizations in their professional and private lives. These are
complex, variable and unique to the profession. State and Federal law, along
with the APA guidelines, provide psychologists with the limited information
necessary but insufficient to navigate the totality of the legal and ethical
landscape of the practice of psychology. Psychologists should try to make good
judgments by applying the law and guidelines in legal and ethical matters.
Throughout academic exploration and clinical practice psychologists should
make the best ethical choices they can, using as much information they can.
Usually these ethical decisions ignore personal ethical behavior which do not
enter the professional arena. It is critical, however, to set a boundary between
personal and professional roles. To the extent personal ethical breaches do enter
the professional arena, issues of whether harm, exploitation or impairment have
occurred exist and may fall under the APA Code. Though personal
transgressions deemed unethical most probably affect a psychologist’s
professional life the APA Code probably cannot reduce this phenomenon due to
the human factor involved.
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Ethical Psychological Pracice: Finding the Right Psychologist
There are several specific guidelines that should be consulted regarding
ethical considerations in the practice of psychology. These include the Ethics
Code1 of the American Psychological Association (2002a); applicable state
psychological association ethics codes; applicable Federal, state and local codes
and law; worksite policies and rules; and at times professional organization ethics
codes or rules of conduct. Beyond that there may be other professional
affiliations that may impose rules, including academic and religious institutions
that a psychologist may belong to. Even beyond these institutionalized policies
and laws there are ethical rules and morays that may be unwritten and even
unspoken, imposed by colleagues, friends and even family. This would appear to
exhaust the entire spectrum of guidelines. Yet there is one more consideration.
What about the personal behavior of the psychologist himself or herself? Does
the personal behavior of the individual, outside the arena of professional practice,
have any relevance to the ethical responsibilities of psychologists?
The Scope of The Issue
This question was adeptly explored by Pipes, Holstein and Aguirre (2005)
in this May-June Issue of American Psychologist. Citing the Ethics Code this
paper clearly identifies it scope and limit referring to the following excerpt from
the Code:
The Ethics Code applies only to psychologists’ activities that are part of their
scientific, educational, or professional roles as psychologists. . . . These
activities shall be distinguished from the purely private conduct of
psychologists, which is not within the purview of the Ethics Code. (p.1061)
1
The Ethics Code is itself a large topic for discussion given its many revisions and
controversies.
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The authors argue hypothetically that a psychologist can be as morally
and ethically reprehensible as the law will allow2 just as long as this behavior is
never exhibited in any aspect of their professional role as psychologists.
Conspicuously absent from the Ethics Code is any mention of personal behavior,
they point out (Pipes et al., 2005).
Psychology requires an ethics code in order to, among other things, set
some minimum standard of practice, essentially to protect the integrity of the
profession. To do this the Ethics Code in it current revision is made up of four
parts: aspirational ethics, enforceable standards, guidelines and policy
statements. As the name implies, aspirational ethics refers to the “general
principle” that psychologists should perform at their highest level of skill (Knapp &
VandeCreek, 2003). The enforceable standards portion or “Code of Conduct” is
equally self-explanatory in that it refers to disciplinary rules under which
psychologists are sanctioned for improper conduct. In what may appear to be a
confusing redundancy, typical of committee work, the guidelines actually attempt
to assist psychologists in navigating specific areas of practice. Guidelines provide
practical advice and certain recommendations for that particular practice area, for
example, forensic psychology. Finally the policy statements sweep up any issues
that may be on the horizon for psychologists.
The Ethics Code appears to be a work in progress3 and only provide a
skeletal framework for practicing psychologists. As with any set of rules or law it
is not a complete set of standards to cover every situation. Importantly, the APA
Code of Ethics attempts to shift the focus away from avoiding wrong to achieving
good. In this positive-ethics approach (Knapp & VandeCreek, 2003) the APA
2
As noted in the article, at the discretion of the APA members can be expelled for felony
convictions, but even this, for good reasons, is not mandatory.
3
Nine revisions have occurred since the creation in 1953 (Fisher, 2003).
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both encourages the integration of personal and professional ethics and seeks
alternative foundational principles to those found in the code. Here then we find a
source of the issue of personal and professional boundaries imbedded in the
Ethics Code itself. Indeed the APA has been criticized for failing to address
personal behavior in its Code (Knapp & VandeCreek, 2003). One can argue that
being a psychologist conveys an ethical duty to behave personally as one would
professionally. It is difficult to reconcile the proposition that within a single person
two separate moralities co-exist, professional and personal, as was frequently
pointed out by the Republicans and some Democrats in the Monica Lewinski
scandal. However, it is believed that a psychologist who is acting scandalously in
the community can also be a consummate professional. And yet common sense
leaves a nagging concern that perhaps this person is a violation waiting to
happen.
We should not lose sight of the fact that the Ethics Code does include
many sections in its attempt to address a wide range of issues. This includes the
Ethical Principles of Psychologists and Code of Conduct (American
Psychological Association, 2002a) wherein one finds specific reference to issues
of personal behavior:
2.06 Personal Problems and Conflicts
a) Psychologists refrain from initiating an activity when they know or
should know that there is substantial likelihood that their personal problems
will prevent them from performing their work-related activities in a competent
manner.
b) When psychologists become aware of personal problems that may
interfere with their performing work-related duties adequately, they take
appropriate measures, such as obtaining professional consultation or
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assistance, and determine whether they should limit, suspend, or terminate
their work-related duties. (See also Standard 10.10, Terminating Therapy.)
Is it safe to conclude then that personal behavior deemed unethical or
even illegal would not necessarily impair a psychologist’s capacity to perform
adequately? If impairment refers to psychological and physical disability, as
distinguished from incompetence and distress, studies indicate psychologists do
suffer from this condition to greater and lesser degrees (Knapp & VandeCreek,
2003; Thoreson et al., 1989). The question remains of whether such personal
ethical and legal violations beneath the enumerated APA Ethics Code threshold
cause impairment, thus triggering the application of the relevant yet
unenforceable Ethical Principles section 2.06. In reference to this specific section
Thomas F. Nagy in his latest book (2005) recommends that a psychologist:
Never undertake professional work when there is a good chance that your
personal problems and troubles will interfere with your ability to do a good
job. Psychologists, like everyone else, experience stress, illness, losses, and
life changes and have personal foibles and weaknesses. Be aware of these,
and avoid situations that would compromise your work.
Using a vignette Nagy (Nagy, 2005) described a psychologist who in the
fallout of a divorce demonstrated bias against female participants data in his
marital research . In addition he became sexually attracted to his student
research assistant. Seeking the advice and consult of a colleague the
psychologist veered away from two ethical violations through appropriate
measures to protect his research and his student. In this idealistic scenario the
problem is avoided due to the ethical actions of the psychologist to seek help and
advice in order to avoid causing harm to others. The remaining unanswered
question is whether this psychologist’s actions outside his professional behavior,
for example in his marriage, would also be relevant. Clearly the direct violations
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due to behavior in his professional role are addressed. What is left unanswered
is the possibility that this psychologist may have done things in his personal life,
which if done in his professional life would have placed him in the realm of ethical
violation. Assuming this were true we again must consider if two sets of ethics
can coexist within the same individual. The long history of role theory4 in
sociology coupled with traditions of self determination and freedom in our country
have prompted some to argue in favor of this seemingly paradoxical stance
(Pipes et al., 2005). However, this vignette supposes the psychologist recognized
his problem after consultation. When does it stretch credibility to assume that
one’s unreported, untreated severe personal problems are not affecting one’s
mental and physical state sufficiently to trigger at a minimum the Ethical
Principles of the Code, specifically 2.06, role theory not withstanding?
What Boundary Are We Talking About Then?
What the Ethics Code says and does not say about personal behavior
delineates what the boundary question might be. On one side we have specific
language that identifies issues pertaining to personal behavior and on the other
the Ethics Code is silent about many personal legal and ethical breaches. Given
the history of the importance of personal freedom in our society it seems likely
there is a limit to how much control over their personal behavior by the APA
psychologists would tolerate (Pipes et al., 2005). Still we can recognize that
common factors such as interpersonal chemistry, political and private advocacy,
and public controversies may evoke ethical dilemmas requiring oversight when
personal and professional roles are entwined. Revisions of the Code both in the
past and present reflect the evolution of this issue and reveal the process behind
the drafting of the Code itself (Knapp & VandeCreek, 2003; Pipes et al., 2005).
4
The idea that people can maintain conflicting roles (Getzels & Guba, 1955).
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The 2002 Code attempts to clarify the limit of the APA’s authority by
having language explicitly identifying the scope of behavior under its jurisdiction.
Simultaneously, the Code identifies a problem where personal issues begin to
affect a psychologist’s professional role in Section 2.06. The APA in recognizing
the limit of it’s control to the professional realm while warning psychologist to
prevent interference in that role from one’s personal life, seems to be drawing a
bright line. It can be argued that in some ways this implies a certain point of view
of the APA and it avoids the sticky choice of addressing the issue directly with
further language to describe and outline the ways in which private and
professional roles are intertwined. Standard 3.06 (Conflict of Interest) may be a
good example of how the two roles in sharing a common psychologist may be
closely linked. It states:
Psychologists refrain from taking on a professional role when personal,
scientific, professional, legal, financial, or other interests or relationships
could reasonably be expected to (1) impair their objectivity, competence or
effectiveness in performing their functions as psychologists or (2) expose the
person or organization with whom the professional relationship exists to harm
or exploitation (American Psychological Association, 2002a).
It should be noted that both Section 2.06 and 3.06 are enforceable as they
are part of the Code of conduct. As such, although the explicit language in the
Code limits the purview of the APA to the professional and not the private role
the section that does mention the overlap is one under which a psychologist can
be disciplined. This seeming paradox of limiting scope while placing the issue in
the enforcement section, may reflect a committee compromise. But it also
synthesizes an important policy, the attempt to focus the breach on its direct
negative affect on the client. Had the committee placed the issue in any of the
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other sections it would not have the same impact so it can be speculated that this
was done due to the importance the issue has.
Other sections of the code, specifically Section 3.05 (Multiple
Relationships) are relevant to the boundary issue since there are clear
connotations for a breach in personal ethical behavior causing a violation of this
standard. This Section states:
(a) A 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.
A psychologist refrains from entering into a multiple relationship if the
multiple relationship could reasonably be expected to impair the
psychologists’ objectivity, competence, or effectiveness in performing his or
her functions as a psychologist, or likewise risks exploitation or harm to the
person with whom the professional relationships exists.
(b) If a psychologist finds that, due to unforeseen factors, a potentially
harmful multiple relationship has arisen, the psychologist takes reasonable
steps to resolve it with due regard for the best interests of the affected
person and maximal compliance with the Ethics Code.
(c) When psychologists are required by law, institutional policy, or
extraordinary circumstances to serve in more than one role in judicial or
administrative proceedings, at the outset they clarify role expectations and
the extent of confidentiality and thereafter as changes occur (American
Psychological Association, 2002a).
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Given the extensive language of this section5 there appears to be clear
indication that the issue of roles outside those of the professional one created
with the client(s) are often difficult to navigate and require specific explicit
language to codify the precise parameters of admissible and inadmissible
behavior. Still this language must be broad enough to encompass a multitude of
scenarios over which the Code can apply. Since not all multiple relationships are
unethical one needs to determine whether harm, exploitation or impairment exist
(Fisher, 2003). It is possible to imagine a situation in which personal behavior
might breach this section of the Code. If, for example, a psychologists disclosure
of private information and derogatory personal views were discussed with a
student pertaining to a colleague with whom that student had a professional
relationship, which was subsequently undermined as a result, would that be a
breach of ethics pertaining to the multiple relationship and personal behavior?
One can alter the variables to see if and when such breaches are possible but
clearly what emerges is that the Code cannot possibly address all the possible
crosses of the boundary from the personal to the professional. It should be clear
then that looking for the issue within the Code merely reflects back all the myriad
ways in which personal ethical breaches can cross over to the professional. The
questions appear to always be whether there is harm, exploitation or impairment.
Strong criticism has been leveled at the APA for parsing issues perhaps
too finely or for the benefit of one group over another, as is always the case with
any institution made up of a wide range of groups. But some criticism has been
leveled at the Code’s failure to adhere to issues, such as human rights (Payton,
1994) as an indication of the APA’s focus away from clients welfare. Both from
5
As eluded to above the Code has been modified from the 1992 Ethics Code, in this case
for clarity.
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an aspect of this accusation and that of the Code being intentionally blind to the
ethical personal behavior of psychologists Payton (1994) has quite a bit to say:
Previous renditions of the American Psychological Association's (APA's)
code of ethics have clearly espoused psychologists' commitment to the ideal
of having respect for the dignity and worth of the individual human being. The
endorsement of the goal to protect fundamental human rights has always
been highlighted in the Preambles of each revision of the code. The current
code (APA, 1992) appears to have retreated from prioritizing this
humanitarian stance. Ethnic minorities, women, gay men, and lesbians have
reason to be apprehensive about the apparent downgrading in importance of
psychologists' declaration of respect for the dignity and worth of the
individual. All previous codes seemed to have been formulated from a
perspective of protecting consumers. The new code appears to be driven by
a need to protect psychologists. (abstract) . . . The distinction [between
personal and professional behavior] provokes rethinking of my role. Until
now, have always considered myself a psychologist regardless of my job
title. Social acquaintances view me as such. (p.319)
It may be that this criticism is part of why the APA draws such a bright line
and delimits its jurisdiction to the professional realm. While it seems impossible
to separate the personal from the professional at times it is quite another matter
to define a professional role, establish ethics codes pertaining to it and then
make strong enforceable language to impart a duty to avoid personal behavior
interfering with such a role. That seems a rather good way to measure the impact
of one’s personal life and by inference to measure the potential of harm done to
the client.
In my own clinical practice I have been faced with many ethical dilemmas.
Having been through a contentious divorce and being a single parent with
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children who require a lot of my personal attention I cannot guarantee that my
own personal feelings and opinions towards my clients have not ever been
negatively impacted by my personal life. What is difficult to determine is exactly
how and to what degree and to what extent was I aware of it requiring me to be
able to adjust or refer out. Does this preclude any divorced parents from clinical
practice? No more than it should preclude anyone whose life may have
negatively impacted their clinical practice to the same degree and in the same
manner. We are after all human and to that extent there is a limit to which we can
be expected to perform professionally with impunity from the effects of our own
personal lives. It seems it is this reality the Code tries to address.
The cross over from one sphere of influence to another is not one-way.
Sometimes it is the professional role that affects the personal and in so doing
also violates what some organizations codify as a violation of their ethical code,
though the APA does not (Pipes et al., 2005).
Other examples may appear more troubling and yet no less enforceable
by the Code. Take for example the issue of marijuana use. As we all know this
illegal drug has been used widely by a substantial number of people across the
country and continues to be a focus of controversy related to our national drug
policies. Does use of this drug by psychologists violate the Code if it is done only
during personal times? Clearly the question can only be addressed by the code
to the extent to which the usage would or could affect the psychologist’s
professional role. Even if the drugs’ effects do not diminish capacity after its
acute effect’s have subsided what would the effect be on one’s clients to discover
their psychologist had been arrested for illegal drug use? Is that an issue to be
considered especially if this Psychologist is treating drug abusers? If not is there
any effect on the ability of the psychologist caused by long-term use of the drug?
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Can we say similar things about the effects of alcohol? What about a
psychologist getting inebriated in front of students or clients?
Beyond the Boundary
Clearly the personal behavior of any professional from kindergarten
teachers to brain surgeons can and does have an effect on their professional life
and visa versa since the two roles co-exist in the same individual. The question is
to what extent and is there harm, exploitation or impairment caused as a result.
Hypocrisy aside, one could not refute this same logic used by the Republicans in
the impeachment of president Clinton. The fact the second half of the equation,
that is whether there was harm, exploitation or impairment, was not pursued was
perhaps purposeful. It would appear then, given the ubiquitous nature of the
influence of personal ethical transgressions into the professional realm that in
addition to clearly defining the boundary the APA should incorporate language to
make the issue more explicit and provide some guidance for psychologists.
Pipes, et al (2005) suggest several alterations to the current Code such as:
requiring psychologists to state whether their public statements are made as
simply individuals or as psychologists, to address harmful personal behavior to
clients and students occurring outside professional settings, to incorporate
language that encourages awareness of the professional impact of personal
identity, and to address hate speech. Pipes et al (2005) brings up the utility of
virtue ethics, character and fitness for duty determinations, and self-reflection
needs pointing out that psychologist seem to want a separate personal life while
acknowledging the inseparability of the two. Finally the paper makes specific
amendments to the Introduction and Applicability part of the Code, applying the
unenforceable General Principles to the personal lives of psychologists by
making two assumptions: (a) the Code should address personal behavior overtly
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and (b) the Code’s aspirational values should also apply to psychologists
personal life.
This may be well intentioned but it would appear the Code already
addresses these laudable goals by having an enforceable Code section to
identify and discipline psychologists who cause harm, exploit, or who treat clients
while impaired. The Code, in section 2.06 explicitly states there can be no
personal problems or conflicts that negatively impact their professional roles. In
addition there are other sections of the Code such as 3.05 and 3.06 that protect
against this breach, in part by determining whether the psychologist has or
potentially could cause any harm. Beyond this are the other portions of the Code,
which though unenforceable, are relevant to personal ethical behavior. In spite of
the specific language which explicitly limits the scope and authority of the APA
Code of Ethics to address personal behavior it maybe difficult for some to read
the Ethical Principles of Psychologists and Code of Conduct (American
Psychological Association, 2002a) in its entirety and imagine how a psychologist
could adhere to it and yet simultaneously breach it in his or her personal life, we
know, however, that it occurs with some regularity. This paradox may not be due
to the strength or weakness of the Code but the character of the psychologist,
which if corrupt, cannot be repaired by any document, no matter how well
drafted. The Code already seems clear as to what an ethical breach entails and
when personal behavior crosses the line. If psychologists fail to adhere to it the
problem is most likely not with the Code.
As mentioned, in addition to the APA Code there are Federal, State and
local laws that govern the practice of psychology that are indirectly relevant to the
personal/professional boundary issue. Under Federal law there is the U.S.
Constitution, the ultimate document of authority under our form of government. It
is probably not common for a psychology ethics case to rise to the level of a
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constitutional issue, though it can happen6. On top of that there is the U.S. Code,
which is created by the U.S. congress as well as the Code of Federal
Regulations along with rules, proposed rules and notices listed in the Federal
Register. Here there are specific references to psychologists and psychology
thereby establishing some very limited Federal regulations pertaining to the
practice of psychology. Due to space these laws are not listed or explained and
they cover a variety of issues, but as yet none cover psychology ethics per se.
Finally, there is Federal case law, which is contained in the published opinions of
the various courts starting at the Supreme Court on down to the Federal circuit or
appeals courts and finally the Federal district or trial courts. There are many
cases referring to and establishing legal precedent for the behavior of
psychologists. Some even refer to ethics. To the extent any of these involve
breaching the personal/professional boundary they could set forth a duty.
This potentially creates a legal liability for psychologists as an additional
guidance for behavior. But it is the states that have much more to say about the
regulation of psychologists. Again for brevity, and not to favor one state over
another, no comprehensive listing of State laws is being made here. Suffice it to
say the state constitutions, statutes, regulations, codes and case law, such as
those contained in California7 -- often a leader in jurisprudence for the rest of the
nation, are the most onerous burden a psychologist has. States can remove a
psychologist’s license. States can put psychologists in jail. Taken in totality for all
the many layers of government having some stake in the ethical behavior of
psychologists it would appear there is more written than could be honestly and
thoroughly digested by most psychologists. This would be a strong argument
6
A Westlaw® search revealed no such case.
Business and Professions Code Section 2900-2918 plus ten additional sections, 215
Statutes and hundreds of cases pertaining to or related to psychologists.
7
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against adding additional language to the APA Code, though clarification
certainly seems reasonable.
The Human Factor
Although APA ethics violation inquiries were up in 2002 they have
declined significantly since 1993 (American Psychological Association, 2002b).
Further examination of the data reveals the two most frequent categories are loss
of license and sexual misconduct, which, due to being the underlying factor for
the loss of license, accounts for 53% of the violations. And yet violations resulting
in discipline total only .09% of the membership, a fairly low number it seems.
What cannot be determined from the data is how many of these imbroglios were
actually started by a personal ethical violation that then became a professional
one. Perhaps this is the implicit issue at hand. If that turns out to be the case
should the APA attempt to manage personal ethical breaches as a prophylactic
measure to curtail professional ones? Again, when one looks at the enormous
amount of regulations, laws and guidelines imposed already it seems that at
some point there exists a limit after which the profession becomes too
encumbered to function adequately.
The history of the APA Ethics Code has been unique both in its inception
and revision process wherein it has striven to apply statistical data to unethical
behavior of its members. Studies of the experience of ethical dilemmas by
psychologists have revealed confidentiality as the most frequent area of trouble
(Pope & Vetter, 1992). This seems to be inextricably related to the
personal/professional boundary and the lack of data for this area of study leaves
many questions unanswered. Though impressive work is ongoing in this area
(Pope et al., 2006), studies of psychologists in ethical dilemmas would benefit
from further exploration of the personal/professional boundary and would most
likely yield a correlation between ethical breaches in personal behavior and
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professional ones. We know that when it comes to issues of the
personal/professional boundary and ethics violations much more has to do with
the psychologist than the Code.
Conclusion
Psychology exists under a large amount of law and guidance and codes of
conduct. The APA Code, or even the law cannot control unethical personal
behavior. Common sense and interpretation of the data would indicate a
correlation between personal and professional violations of ethical standards.
The existing APA Code and the large number of Federal and state laws seem
capable of covering almost all ethics violations in the professional area. But short
of all psychologists adopting virtue ethics8 there appears little one can
accomplish in revising the code to cover personal ethical breaches since it is
unlikely that those psychologists who ignore ethics in their personal lives will
reliably adhere to any ethics code whether published by the APA or not.
8
The philosophical concept that ethics is derived from personal virtue (O'Donohue &
Ferguson, 2003).
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