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A Thorough Understanding Of Ethics And The Ethical Guidelines That Govern The Wo

A thorough understanding of ethics and the ethical guidelines that govern the world of clinical psychology is very important for both the professionals who work in the field, as well as those they seek to treat. The ability to effectively deliver informed consent is a big part of that understanding, in particular with regard to the application of all forms of psychotherapy.

Through the use of Chapter Five (pp. 113-115) in the text, as well as the APA Ethical Principles of Psychologists and Code of Conduct (2010), in at least 250 words, provide a set of guidelines that detail the necessary elements of an effective informed consent form, as it relates to providers of psychotherapy and clinical psychology. You are not required to develop an informed consent form, simply provide an outline of what constitutes effective informed consent.


American Psychological Association. Ethical Principles of Psychologists and Code of Conduct (2010). Retrieved fromhttp://www.apa.org/ethics/code/index.aspx?item=1

Pages 113 – 115


ClinicalPsychology: Science, Practice, and Culture

What Makes Multiple Relationships Unethical?

Not every multiple relationship is, by definition,unethical. To help identify the specific elements of multiple relationshipsthat characterize them as unethical, we again turn to Ethical Standard 3.05a:

A psychologist refrains from entering into a multiplerelationship if the multiple relationship could reasonably be expected toimpair the psychologist’s objectivity, competence, or effectiveness inperforming his or her functions as a psychologist, or otherwise risksexploitation or harm to the person with whom the professional relationshipexists. Multiple relationships that would not reasonably be expected to causeimpairment or risk exploitation or harm are not unethical. (American PsychologicalAssociation, 2002, p. 1065)

As this standard indicates, there are essentially twocriteria for impropriety in a multiple relationship. The first involvesimpairment in the psychologist; if the dual role with the client makes itdifficult for the psychologist to remain objective, competent, or effective,then it should be avoided. The second involves exploitation or harm to theclient. Psychologists must always remember that the therapist–clientrelationship is characterized by unequal power, such that the therapist’s roleinvolves more authority and the client’s role involves more vulnerability,especially as a consequence of some clients’ presenting problems (Pope, 1994;Schank et al., 2003). Thus, ethical psychologists remain vigilant about exploitingor harming clients by clouding or crossing the boundary between professionaland nonprofessional relationships. Above all, the client’s well-being, not thepsychologist’s own needs, must remain the overriding concern.

As the last line of the standard above indicates, it ispossible to engage in a multiple relationship that is neither impairing to thepsychologist nor exploitive or harmful to the client. (And in some settings,such as small communities, such multiple relationships may be difficult to avoid.We discuss this in more detail later in this chapter.) However, multiple relationships can be ethically treacherous territory, and clinicalpsychologists owe it to their clients and themselves to ponder suchrelationships with caution and foresight. Sometimes, major violations of theethical standard of multiple relationships are preceded by “a slow process ofboundary erosion” (Schank et al., 2003, p. 183). That is, a clinicalpsychologist may engage in some seemingly harmless, innocuous behavior that doesn’texactly fall within the professional relationship—labeled by some as a“boundary crossing” (Gabbard, 2009b; Zur, 2007)—and although this behavior isnot itself grossly unethical, it can set the stage for future behavior that is.These harmful behaviors are often called “boundary violations” and can causeserious harm to clients, regardless of their initial intentions (Gutheil &Brodsky, 2008; Zur, 2009).

As an example of an ethical “slippery slope” of this type,consider Dr. Greene, a clinical psychologist in private practice. Dr. Greenefinishes a therapy session with Annie, a 20-year-old college student, and soonafter the session, Dr. Greene walks to his car in the parking lot. On the way,he sees Annie unsuccessfully trying to start her car. He offers her a ride toclass, and she accepts. As they drive and chat, Annie realizes that she lefther backpack in her car, so Dr. Greene lends her some paper and pens from hisbriefcase so she will be able to take notes in class. Dr. Greene drops offAnnie and doesn’t give his actions a second thought; after all, he was merelybeing helpful. However, his actions set a precedent with Annie that a certainamount of nonprofessional interaction is acceptable. Soon, their out-of-therapyrelationship may involve socializing or dating, which would undoubtedlyconstitute an unethical circumstance in which Annie could eventually beexploited or harmed. Although such “boundary erosion” is not inevitable(Gottlieb & Younggren, 2009), minor boundary infractions can foster theprocess. As such, clinical psychologists should give careful thought to certainactions—receiving or giving gifts, sharing food or drink, self-disclosing one’sown thoughts and feelings, borrowing or lending objects, hugging—that may beexpected and normal within most interpersonal relationships but may provedetrimental in the clinical relationship (Gabbard, 2009b; Gutheil &Brodsky, 2008; Zur, 2009).


The American Psychological Association’s (2002) code ofethics devotes an entire section of ethical standards to the topic ofcompetence. In general, competent clinical psychologists are those who aresufficiently capable, skilled, experienced, and expert to adequately completethe professional tasks they undertake (Nagy, 2012).

One specific ethical standard in the section on competence(2.01a) addresses the boundaries of competence: “Psychologists provideservices, teach, and conduct research with populations and in areas only withinthe boundaries of their competence, based on their education, training,supervised experience, consultation, study, or professional experience”(American Psychological Association, 2002, p. 1063).

An important implication of this standard is that having adoctoral degree or a license in psychology does not automatically make apsychologist competent for all professional activities. Instead, thepsychologist must be specifically competent for the task at hand. As anexample, consider Dr. Kumar, a clinical psychologist who attended a doctoraltraining program in which she specialized in child clinical psychology. All hergraduate coursework in psychological testing focused on tests appropriate forchildren, and in her practice, she commonly uses such tests. Dr. Kumar receivesa call from Rick, an adult seeking an intelligence test for himself. AlthoughDr. Kumar has extensive training and experience with children’s intelligencetests, she lacks training and experience with the adult versions of thesetests. Rather than reasoning, “I’m a licensed clinical psychologist, andclinical psychologists give these kinds of tests, so this is within the scopeof my practice,” Dr. Kumar takes a more responsible, ethical approach. Sheunderstands that she has two options: become adequately competent (throughcourses, readings, supervision, etc.) before testing adults such as Rick, orrefer adults to another clinical psychologist with more suitable competence.

Psychologists not only need to become competent, but theymust also remain competent: “Psychologists undertake ongoing efforts to developand maintain their competence” (Standard 2.03, American PsychologicalAssociation, 2002, p. 1064). This standard is consistent with the continuingeducation regulations of many state licensing boards. That is, to be eligibleto renew their licenses, psychologists in many states must attend lectures,participate in workshops, complete readings, or demonstrate in some other waythat they are sharpening their professional skills and keeping their knowledgeof the field current.

Among the many aspects of competence that clinicalpsychologists must demonstrate is cultural competence (as discussed extensivelyin the previous chapter). Ethical Standard 2.01b (American PsychologicalAssociation, 2002) states that when

an understanding of factors associated with age, gender,gender identity, race, ethnicity, culture, national origin, religion, sexualorientation, disability, language, or socioeconomic status is essential foreffective implementation of their services or research, psychologists have orobtain the training, experience, consultation, or supervision necessary toensure the competence of their services. (pp. 1063–1064)

Ethical psychologists do not assume a “one-size-fits-all”approach to their professional work. Instead, they realize that clients differin important ways, and they ensure that they have the competence to choose orcustomize services to suit culturally and demographically diverse clients(Salter & Salter, 2012). Such competence can be obtained in many ways,including through coursework, direct experience, and efforts to increase one’sown self-awareness. Readings sponsored by the American PsychologicalAssociation, such as the “Guidelines for Psychotherapy With Lesbian, Gay, andBisexual Clients” (Division 44, 2000) and “Guidelines for Providers ofPsychological Services to Ethnic, Linguistic, and Culturally DiversePopulations” (American Psychological Association, 1993) can also be importantcontributors to cultural competence for clinical psychologists.

It is important to note that ethical violations involvingcultural incompetence (e.g., actions reflecting racism or sexism) are viewedjust as negatively by nonprofessionals as other kinds of ethical violations,such as confidentiality violations and multiple relationships (Brown & Pomerantz,2011). In other words, cultural competence is not only a wise clinicalstrategy; it is an essential component of the ethical practice of clinicalpsychology that can lead to detrimental consequences for clients when violated(Gallardo, Johnson, Parham, & Carter, 2009).

The American Psychological Association’s (2002) code ofethics also recognizes that psychologists’ own personal problems can lessentheir competence: “When psychologists become aware of personal problems thatmay interfere with their performing work-related duties adequately, they takeappropriate measures, such as obtaining professional consultation orassistance, and determine whether they should limit, suspend, or terminatetheir work-related duties” (Standard 2.06, p. 1064). Of course, personalproblems that impede psychologists’ performance can stem from any aspect oftheir personal or professional lives (Barnett, 2008). On the professional side,the phenomenon of burnout among clinical psychologists has been recognized inrecent decades (e.g., Grosch & Olsen, 1995; Morrissette, 2004). Burnoutrefers to a state of exhaustion that relates to engaging continually inemotionally demanding work that exceeds the normal stresses or psychological“wear and tear” of the job (Pines & Aronson, 1988). Due to the nature ofthe work they often perform, clinical psychologists can find themselves quitevulnerable to burnout. In one study of more than 500 licensed psychologistspracticing therapy (Ackerley, Burnell, Holder, & Kurdek, 1988), more thanone third reported that they had experienced high levels of some aspects ofburnout, especially emotional exhaustion. In this study, the factors thatincreased a psychologist’s susceptibility to burnout included feelingovercommitted to clients, having a low sense of control over the therapy, andearning a relatively low salary. A more recent study confirmed that overinvolvement with clients correlates strongly with burnout, particularly in theform of emotional exhaustion (Lee, Lim, Yang, & Lee, 2011).

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