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Chapter 12

ETHICS AND PROFESSIONAL ISSUES

Just as there are multiple defi nitions for forensic psychology (as dis- cussed in Chapter 1 ), the term forensic psychologist may mean different things to different people. There are many and varied roles that a foren- sic psychologist may play and in this chapter we examine some of those roles in more detail. In addition, we discuss the forensic psychologist ’ s professional responsibilities as well as some relevant ethical issues that are often faced.

ROLES AND RESPONSIBILITIES OF THE FORENSIC PSYCHOLOGIST

Forensic psychologists may take on many roles. Examination of the Student Section/Careers portion of the website for the American Psychology - Law Society (AP - LS; Division 41 of the American Psychological Association, www.ap - ls.org ) indicates that there is no one particular path to becoming a forensic psychologist and that forensic psychologists may be employed in a wide variety of settings. In addition, the roles and responsibilities of the forensic psychologist are many and varied. In general, a forensic

In this chapter, you will become familiar with:

The roles and responsibilities of the forensic psychologist Issues of licensure and certifi cation for psychologists The core ethical principles for psychologists Procedures for resolving ethical issues The general principles and ethical standards of the American Psychological Association’s Ethics Code Common ethical issues that arise in each of the roles of a forensic psychologist

• • • • •

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CHAPTER OBJECTIVES

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C o p y r i g h t 2 0 1 0 . W i l e y .

A l l r i g h t s r e s e r v e d . M a y n o t b e r e p r o d u c e d i n a n y f o r m w i t h o u t p e r m i s s i o n f r o m t h e p u b l i s h e r , e x c e p t f a i r u s e s p e r m i t t e d u n d e r U . S . o r a p p l i c a b l e c o p y r i g h t l a w .

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324 Ethics and Professional Issues

psychologist will take on one primary role but may engage in additional roles depending on his or her interests and training. The various roles that may be played by a forensic psychologist include, but are not limited to: trial consultant, expert witness, evaluator, treatment provider, researcher, academic, and correctional psychologist. Of course, it is possible (in fact, common) for an individual to take on more than one of these roles or to take on additional roles not mentioned here.

The Trial Consultant

A trial consultant (or jury consultant) is someone who works with legal pro- fessionals, mainly attorneys, to assist in various aspects of case preparation including jury selection, development of case strategy, and witness prepara- tion. Many trial consultants rely on their research training to develop and execute research that will assist attorneys in preparing a case. Research and data collection strategies might include community surveys, focus groups, jury simulations, shadow juries, and mock trials. Trial consultants (or jury consultants) may be involved in both civil and criminal cases and may assist at any (or all) stage(s) of the proceedings — in preparation for trial, during trial, or after trial. There is no one avenue to becoming a trial consultant; however, trial consultants usually have advanced degrees in one of the behavioral sciences, such as psychology or criminology. There are many trial consulting fi rms across the United States that employ individuals in this role; however, it is also possible to maintain a private practice as a trial consultant without working for a trial consulting fi rm.

The Expert Witness

An expert witness is someone who testifi es in court about specialized knowledge that he or she possesses. Forensic psychologists are often called upon to testify regarding matters of mental health (in the case of a clini- cal forensic psychologist) or general theory and research in psychology and law. Generally, clinical forensic psychologists are involved as expert witnesses after having evaluated a defendant and thus are called to testify regarding that defendant ’ s mental state and how it relates to the legal issue at hand (such as insanity, competency, dangerousness, civil commitment, etc.). It is possible, however, for forensic psychologists to serve as gen- eral expert witnesses where, instead of testifying regarding specialized knowledge about a particular defendant/complainant, they may be called to testify regarding broader psychological principles in which they have specialized knowledge or expertise. This role is usually performed in con- junction with another role, such as that of researcher, academic, or evalua- tor and thus is not generally the only (or even the primary) role in which a

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forensic psychologist engages. Forensic psychologists in the expert witness role may participate in both criminal and civil proceedings and are usu- ally trained either in general psychology or in a particular psychological specialty such as clinical psychology.

The Evaluator

Many forensic psychologists take the role of evaluators. In general, this refers to the evaluation of criminal defendants or parties to civil litiga- tion with respect to mental health issues that relate to the legal issue at hand; however, this may also refer to the evaluation of service delivery or treatment programs. In the criminal realm, forensic psychologists may be called upon to evaluate defendants with respect to their competency to stand trial, their mental state at the time of the offense (insanity), their risk for future dangerousness, or other such issues. In the civil realm, foren- sic psychologists may be called upon to evaluate an individual ’ s psycho- logical state after having been injured or in an accident or may evaluate families involved in custody and access disputes. The evaluator role usu- ally goes hand in hand with the expert witness role as many evaluators are called into court to testify about the opinions they formed during their evaluations. Forensic psychologists who take on the role of an evaluator are employed in a wide variety of settings, including forensic hospitals, state psychiatric hospitals, community mental health centers, and private practice. Forensic psychologists who evaluate defendants or parties to civil litigation usually have been trained as clinical psychologists and have some specialization in forensic psychology and are usually required to be licensed as psychologists.

The Treatment Provider

Treatment providers offer psychological treatment to individuals requiring or desiring these services. Forensic psychologists who take on the role of the treatment provider work in a wide variety of settings, similar to those who take on the evaluator role, including forensic hospitals, state psychi- atric hospitals, community mental health centers, and private practices. In addition, similar to the evaluator, treatment providers may work with indi- viduals (or groups) involved in both criminal and civil proceedings. In the criminal realm, treatment providers may be called upon to offer psycho- logical interventions to individuals who have been deemed by the courts as incompetent to stand trial (and thus require treatment for the restoration of competency), insane at the time of the crime (and thus require treatment for their mental illness), or at a high risk to commit a violent offense (and thus require treatment to minimize the likelihood of acting violently in the

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326 Ethics and Professional Issues

future), as well as a number of other criminal law - related issues. Within the civil realm, forensic psychologists may be called upon to provide treat- ment to families who are going through divorce proceedings or to individ- uals who sustained psychological injuries as a result of some trauma that they endured or a host of other civil law - related issues. The roles of treat- ment provider and evaluator may both be performed by the same forensic psychologist, although ethical guidelines (discussed later in this chapter) attempt to limit the chances that both of these roles will be fulfi lled with the same client or patient.

The Researcher

Forensic psychologists who take on the role of researcher design and implement research on various issues relevant to forensic psychology or psychology and the law, both criminal and civil. In addition, these profes- sionals may conduct research on mental health law and policy or program evaluation. These professionals may be employed in a number of settings including universities and colleges, but also at research institutes, govern- ment or private agencies, and psychiatric hospitals or other mental health agencies.

The Academic

Forensic psychologists who take on the role of the academic are involved in teaching, research, and a host of other education - related activities such as training and supervision of students. Psychologists who take on this role can be trained either generally in psychology or in one of the specialties such as clinical psychology. In addition, these pro- fessionals usually have an advanced degree in psychology, typically a PhD. It is often the case that academics will also take on one or more of the aforementioned roles in addition to the role of academic. In general, academics are employed by institutions of higher learning — colleges or universities.

The Correctional Psychologist

A correctional psychologist is a forensic psychologist who works in a cor- rectional setting with inmates and offenders. These psychologists often engage in direct service delivery — both evaluation and treatment — of individuals who have been incarcerated or who are out on probation or parole. Thus, in addition to the roles of evaluator and treatment provider, correctional psychologists may also take on the role of researcher or expert witness.

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PROFESSIONAL ISSUES

Licensure and Certifi cation

Every state has developed statutory provisions for the practice of psychol- ogy and in every state an individual must be licensed as a psychologist in order to practice psychology independently (without supervision). In most every state, a doctoral - level degree is required to become licensed as a psy- chologist; however, some states have provisions for becoming licensed as a psychological technician (or some other similar title) with a master ’ s degree. Although not licensed as a psychologist and therefore unable to practice psy- chology independently, being licensed as a psychological technician allows for the practice of many aspects of psychology under the supervision of a doctoral - level licensed psychologist. Depending on the state, licensed psy- chological technicians may be able to conduct assessments and provide treatment as long as they are supervised by a licensed psychologist.

An individual need not be licensed to participate in many of the roles described earlier. It is necessary to be licensed to engage in the role of eval- uator, treatment provider, or expert witness (unless the testimony is to be general and not specifi cally in regard to an individual that the psychologist has evaluated or treated); however, it is possible to engage in the role of trial consultant, researcher, academic, correctional psychologist, and expert witness (for general testimony about psychological theory and research) without being licensed to practice as a psychologist or psychological tech- nician. As a general statement, it is necessary to be licensed as a psycholo- gist whenever one engages in the practice of psychology with an individual or a group of people. The one exception to this is when one engages in the practice of psychology within a correctional setting. In this case, it is possi- ble to practice psychology without a license and it is the correctional insti- tution that retains responsibility for its psychological personnel.

Psychology is a self - regulating profession, thus decisions regarding com- petence to practice psychology and the conduct expected of psychologists are made by members of the profession as well as members of the public who sit on a self - regulating board. The primary purpose of the self - regulating board is the protection of the public. Each state has a regulatory board that controls the profession of psychology. Practitioners apply to this regulatory board to become licensed (which usually requires that the individual have completed a series of specifi c courses in psychology, have completed a certain number of hours of supervised clinical contact, and have passed a national licensing exam) and this board is responsible for implementing and administering the relevant Act or statutes pertaining to the practice of psychology. In each state, the regulatory board is usually responsible for: protecting the public from incompetent or unethical psychologists; determining the requirements for

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328 Ethics and Professional Issues

becoming licensed as a psychologist; periodic review of licensed psycholo- gists ’ competence to practice psychology; developing and enforcing codes of ethical and professional conduct to be followed by licensed psychologists; educating and informing the public about the regulation of psychology; and developing and enforcing complaint and disciplinary procedures brought against psychologists.

Resolving Ethical Issues

When a client, patient, member of the public, or another psychologist has a complaint about the professional behavior of a psychologist, there are a couple courses of action that may be taken. The fi rst action to be consid- ered is to bring the complaint to the attention of the offending psycholo- gist. This informal mechanism may not be appropriate for every complaint but, for those in which it is appropriate, it represents an effi cient way of resolving the issue. For example, this may be an appropriate course of action when a psychologist has taken on a multiple role relationship with a client; simply bringing this to the attention of the psychologist may be enough to remediate the concern. If an informal means of resolving the issue is ineffective or inappropriate, the complainant may fi le a complaint with the licensing board of the state in which the psychologist practices. In addition, if the offending psychologist is a member of the American Psychological Association (APA) a complaint may also be registered with the APA, which has an ethics offi ce to hear and deal with complaints about a psychologist ’ s behavior. The state licensing boards and the APA have formal mechanisms for resolving complaints about a psychologist ’ s behav- ior. This can be a stressful and time - consuming process, but it is generally considered to be a fair means of adjudicating complaints.

ETHICAL AND LEGAL ISSUES

As discussed in the previous section, psychology is a self - regulating profession that uses ethical principles and standards as one means of regulation. Although there is no set number of ethical principles and numerous authors and commen- tators have used various terms to describe these principles, Koocher and Keith - Spiegel (1998) have compiled a list of nine core ethical principles relevant to the profession of psychology that appear to capture the essence of the values to which the profession of psychology subscribes (see Table 12.1 ).

The American Psychological Association ’ s Ethics Code

While numerous ethics codes pertaining to the conduct of psychologi- cal services exist, the most relevant code, and therefore the one on

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Table 12.1 Core Ethical Principles for Psychologists

1. Doing no harm (nonmalefi cence). Through commission or omission, psychologists strive to benefi t those with whom they work, at the same time taking care to ensure that the potential for damage is eliminated or minimized to the greatest extent possible.

2. Respecting autonomy. The rights of individuals to decide how to live their lives as long as their actions do not interfere with the welfare of others is accepted by psychologists as an ultimate goal for clients, students, research participants, and others with whom psychologists work.

3. Benefi ting others. All decisions that psychologists make should have the potential for a posi- tive effect on others. Often, this principle must be balanced against doing no harm, respect for autonomy, available resources, and utility.

4. Being just. Actions should be fair and equitable. Others should be treated as psychologists would want to be treated under similar circumstances.

5. Being faithful. Issues of fi delity, loyalty, trustfulness, trust, promise keeping, and respect for those with whom psychologists work converge to form the delicate standards necessary in fi du- ciary relationships. When psychologists are straightforward, sincere, candid, and without intent to mislead or deceive anyone, ethical action is more likely.

6. According dignity. Psychologists view others as worthy of respect. This enhances the probabil- ity that decisions will be ethical.

7. Treating others with care and compassion. Psychologists should be considerate and kind to those with whom they work, yet maintain professional boundaries.

8. Pursuit of excellence. Maintaining competence, doing one’s best, and taking pride in one’s work are important in ensuring high-quality professional services, as well as providing hedges against unprofessional and unethical actions.

9. Accepting accountability. Psychologists who act with a consideration of possible consequences, who accept responsibility for actions and inactions, and who avoid shifting blame or making excuses are acting with integrity. Putting principles over expediency is sometimes the longer and more arduous route, but in the long run it is the one that ensures self-respect.

Source: Koocher & Keith-Spiegel (1998, p. 4–5).

which we will focus this discussion, is the American Psychological Association ’ s Ethical Principles of Psychologists and Code of Conduct (also called the Ethics Code). The most recent version of the Ethics Code was published in 2002 and represents a revision and update of the 1992 Ethics Code.

The APA fi rst developed and published a code of ethics for psycholo- gists in 1953 and, since that time, has continually worked to revise and update this code. The current APA Ethics Code consists of two parts: gen- eral principles and ethical standards.

General Principles The general principles section of the Code contains fi ve principles, which represent aspirational goals meant to guide psychologists to the highest ideals of psychology. These fi ve general principles are not enforceable rules (it is the Ethical Standards section of the Code that sets out enforceable rules), but rather, are principles to be considered by psychologists when attempting to determine an ethical course of action. (Note that the nine core principles outlined earlier by Koocher and

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330 Ethics and Professional Issues

Keith - Spiegel are represented in these fi ve principles.) The fi ve general principles are as follows:

1. Benefi cence and Nonmalefi cence . “ Psychologists strive to benefi t those with whom they work and take care to do no harm. In their profes- sional actions, psychologists seek to safeguard the welfare and rights of those with whom they interact professionally and other affected persons, and the welfare of animal subjects of research ” (APA Ethics Code, p. 1062).

2. Fidelity and Responsibility . “ Psychologists establish relationships of trust with those with whom they work. They are aware of their profes- sional and scientifi c responsibilities to society and to the specifi c com- munities in which they work ” (p. 1062).

3. Integrity . “ Psychologists seek to promote accuracy, honesty, and truth- fulness in the science, teaching, and practice of psychology ” (p. 1062).

4. Justice . “ Psychologists recognize that fairness and justice entitle all per- sons to access to and benefi t from the contributions of psychology and to equal quality in the processes, procedures, and services being con- ducted by psychologists ” (p. 1062).

5. Respect for People ’ s Rights and Dignity . “ Psychologists respect the dig- nity and worth of all people, and the rights of individuals to privacy, confi dentiality, and self - determination ” (p. 1063).

Ethical Standards The ethical standards section of the Ethics Code consists of enforceable ethical standards that fall into the following 10 different content areas: resolving ethical issues, competence, human relations, privacy and con- fi dentiality, advertising and other public statements, record keeping and fees, education and training, research and publication, assessment, and therapy.

Within each of these 10 content areas are standards that serve to provide more detailed information regarding ethical courses of action and guide- lines for behavior. The underlying basis of each of these ethical standards is a concern for the welfare of those individuals with whom psychologists interact on a professional basis.

Discussion of the ethical standards within each of these 10 content areas is beyond the scope of this chapter but Table 12.2 provides a sample of some of the guidelines within each of these areas.

Forensic psychologists, like psychologists who do not interact with the legal system, are bound by these ethical guidelines; however, there

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Ethical and Legal Issues 331

Table 12.2 Sample of Ethical Standards within each of Ten Content Areas

Content Area Sample of Ethical Standards

Resolving Ethical Issues 1.04 Informal Resolution of Ethical Violations When psychologists believe that there may have been an ethical violation by another psychologist, they attempt to resolve the issue by bringing it to the attention of that individual, if an informal resolution appears appropriate and the intervention does not violate any confi dentiality rights that may be involved.

Competence 2.01 Boundaries of Competence Psychologists provide services, teach, and conduct research with populations and in areas only within the boundaries of their compe- tence, based on their education, training, supervised expe- rience, consultation, study, or professional experience.

Human Relations 3.05 Multiple Relationships 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 a professional relationship, or (3) promises to enter into another rela- tionship 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 psychologist’s objectivity, competence, or effectiveness in performing his or her functions as a psychologist, or otherwise risks exploitation or harm to the person with whom the professional relationship exists. Multiple relationships that would not reasonably be expected to cause impairment or risk exploitation or harm are not unethical.

Privacy and Confi dentiality 4.01 Maintaining Confi dentiality Psychologists have a primary obligation and take reasonable precautions to protect confi dential information obtained through or stored in any medium, recognizing that the extent and limits of confi dentiality may be regulated by law or estab- lished by institutional rules or professional or scientifi c relationship.

4.04 Minimizing Intrusions on Privacy Psychologists include in written and oral reports and consultations, only information germane to the purpose for which the commu- nication is made.

Advertising and Other Public Statements

5.01 Avoidance of False or Deceptive Statements Psychologists do not knowingly make public state- ments that are false, deceptive, or fraudulent concern- ing their research, practice, or other work activities or those of persons or organizations with which they are affi liated.

(continued)

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332 Ethics and Professional Issues

Table 12.2 (Continued)

Content Area Sample of Ethical Standards

Record Keeping and Fees 6.04 Fees and Financial Arrangements As early as is feasible in a professional or scientifi c relationship, psychologists and recipients of psychological services reach an agreement specifying compensation and billing arrangements.

Education and Training 7.03 Accuracy in Teaching Psychologists take reasona- ble steps to ensure that course syllabi are accurate regard- ing the subject matter to be covered, bases for evaluating progress, and the nature of course experiences. This standard does not preclude an instructor from modifying the course content or requirements when the instructor considers it pedagogically necessary or desirable, so long as students are made aware of these modifi cations in a manner that enables when to fulfi ll course requirements.

Research and Publication 8.07 Deception in Research Psychologists do not conduct a study involving deception unless they have determined that the use of deceptive techniques is justi- fi ed by the study’s signifi cant prospective scientifi c, edu- cational, or applied value and that effective nondeceptive alternative procedures are not feasible. Psychologists do not deceive prospective participants about research that is reasonably expected to cause physical pain or severe emotional distress.

Assessment 9.06 Interpreting Assessment Results When interpret- ing assessment results, including automated interpreta- tions, psychologists take into account the purpose of the assessment as well as the various test factors, test-taking abilities, and other characteristics of the person being assessed, such as situational, personal, linguistic, and cultural differences, that might affect psychologists’ judgments or reduce the accuracy of their interpreta- tions. They indicate any signifi cant limitations of their interpretations.

Therapy 10.01 Informed Consent to Therapy When obtaining informed consent to therapy as required in Standard 3.10, Informed Consent, psychologists inform clients/patients as early as is feasible in the therapeutic relationship about the nature and anticipated course of therapy, fees, involvement of third parties, and limits of confi dentiality and provide suffi cient opportunity for the client/patient to ask questions and receive answers.

Source: APA Ethical Principles of Psychologists and Code of Conduct (2002).

also exist Specialty Guidelines for Forensic Psychologists (Committee on Ethical Guidelines for Forensic Psychologists, 1991), which focus on issues specifi c to working in conjunction with the legal system.

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The Specialty Guidelines for Forensic Psychology

The Specialty Guidelines for Forensic Psychology were fi rst published in 1991 and are currently undergoing an update and revision (most recent draft available at www.ap - ls.org ). These guidelines represent joint endorse- ment by the American Psychology - Law Society (AP - LS; Division 41 of the American Psychological Association) and the American Academy of Forensic Psychology but are not an offi cial statement of the American Psychological Association. That is, these Specialty Guidelines are not enforceable by the APA but they were developed to provide further guid- ance than that offered by the APA ’ s Ethical Code for those professionals who engage in the practice of psychology within the forensic arena.

The Guidelines provide guidance and information to be considered in attempting to determine the most ethical course of action in 12 different areas, including: responsibilities; competence; diligence; relationships; fees; notifi cation, assent, consent, and informed consent; confl icts in prac- tice; privacy, confi dentiality, and privilege; methods and procedures; assess- ment; documentation; and professional and other public communications.

There are a number of ethical issues that psychologists and forensic psychologists deal with on a regular basis. Some of the most common issues include taking on multiple roles and confi dentiality, privacy, and privilege.

Ethical Issues in the Various Roles of the Forensic Psychologist

Many of the ethical issues that psychologists deal with cut across the vari- ous roles that they take on. For example, when psychologists interact with students, they may take on the role of researcher, academic, or supervi- sor. When they interact with clients, they may be involved as a treatment provider or evaluator. Each role carries with it ethical issues and we will discuss the most common role confl icts next.

Among other ethical issues, such as taking on multiple roles with the patient or client, psychologists acting in the roles of evaluators and treat- ment providers must often think about issues related to informed consent, confi dentiality, and whether they are practicing within the bounds of their competence. When the evaluator or treatment provider is working within the forensic context, he or she must also grapple with the issue of who is the client. In many situations, the client or patient is the person being evaluated or receiving treatment services; however, in the forensic context, it is the attorney or the court who is the client, rather than the person being evaluated or treated. Recall also that working within the forensic context

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334 Ethics and Professional Issues

means that there is often no confi dentiality for the person being evaluated or treated. In addition, there is an assumption that the evaluator or treat- ment provider will be objective and neutral — not favoring one side over the other and thus not concealing information that may be favorable to one party to the proceedings but not the other (for example, not concealing how the offender ’ s previous violent history may increase his or her risk for future violence, even when being retained by the defense to present miti- gating testimony at a sentencing hearing). The same issue regarding being objective and neutral is of concern to psychologists taking on the role of the expert witness. In the expert witness role, psychologists are expected to maintain their objectivity and to provide information that will assist the court in making a legal decision; thus, it would be unethical for expert wit- nesses to agree to be paid on a contingency basis (the expert would get paid for his/her services only if the desired outcome is reached in a case).

When psychologists take on the role of a researcher, they need to adhere to ethical guidelines regarding the design and implementation of research. Issues of concern in this role include the honest reporting of data, obtain- ing informed consent from research participants, being honest about the risk of harm that may occur as a result of research participation (for example, some research designs may require that the participants are ini- tially deceived, which may cause them to feel duped and perhaps mistrust- ful), ensuring that research participation is voluntary and not coerced, and ensuring that participants are able to withdraw from participation without any undue consequences. In addition, when the research involves treat- ment for a psychological problem or condition, the psychologist - researcher must also consider the right of everyone to treatment when designing the research. The role of researcher is often inherent in the role of academic but a few additional ethical issues arise in this role including being aware of multiple roles with students, respecting the power differential between the academic and the student, and ensuring that proper credit is given to stu- dents and other individuals involved in academic work and publication.

In the role of trial consultant, psychologists must be sure to practice within the bounds of their competence, guard against guaranteeing the out- come of a case, ensure that research is performed on sample sizes large enough to demonstrate any desired effects, honestly report research results or data, and be careful not to taint witnesses during preparation.

Finally, psychologists working within the correctional system also deal with numerous ethical issues on a daily basis, such as confi dentiality, informed consent, competence, and who is the client (the person being treated or evaluated or the correctional institution for whom the psychol- ogist works). In addition, correctional psychologists are often put in the awkward position of performing multiple roles on a daily basis — consider

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the psychologist who works with inmates on a daily basis but who is also expected to be able to discipline an inmate or even turn a fi rearm on an inmate in a time of institutional crisis (psychologists working in the fed- eral correctional system receive fi rearms training and are expected to take arms during institutional upheaval).

These are just some of the ethical issues that arise for psychologists in each of the various roles they may assume. Of course, this list is neither comprehensive nor exhaustive. We now turn to a discussion of two of the most common ethical issues for psychologists in almost any role: multiple roles and confi dentiality.

Multiple Roles Although psychologists may take on many different professional roles, it is important that a psychologist use caution when taking on multiple pro- fessional roles with the same client/student/patient. For example, although a psychologist may be a researcher, a clinical supervisor, and a treatment provider, it would be important that the psychologist not engage in each of these roles with the same student. Thus, a student may act as a research assistant as well as a clinical supervisee for the psychologist but should not also receive treatment for his or her own psychological issues from the same psychologist. The responsibility for ensuring that the student not engage with the psychologist in too many roles rests on the psychologist, not on the student. Psychologists must maintain an awareness of the power differential that occurs in certain situations and use caution so as not to exert undue power over the actions of others with whom they interact. See Box 12.1 for a case study of multiple roles.

Of course, nothing is ever as simple as it seems. What would happen if Dr. Smart were the only forensic psychologist in the small town where the McDonalds live and thus referring the McDonalds to another psychologist is not an option? The Ethics Code warns against psychologists engaging in multiple roles but sometimes this is impossible to avoid. The main purpose of the Ethics Code is to protect the public and to ensure that psychologists carefully consider the various ways in which their behavior may affect others. Of course, that is not to say that there are easy resolutions for every situation. What is important, however, is that psychologists use the Ethics Code to guide their actions and to assist them in thinking through all the possible issues involved in a particular situation.

Confi dentiality and Privilege One of the main issues that psychologists deal with on a daily basis is that of confi dentiality . That is, psychologists are ethically bound to keep infor- mation about their clients confi dential. But what happens when the client

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336 Ethics and Professional Issues

tells the psychologist something that may end up harming someone else? Or, what happens when the psychologist believes that the client is going to hurt him - or herself or even someone else? These are not easy issues to deal with by any means. Fortunately, one way of attempting to guard against these situations is for psychologists to tell their clients up front what information might require them to break the client ’ s confi dentiality. Psychologists are

Situation: Dr. Smart, a forensic psychologist, has been seeing Mrs. McDonald in therapy for almost a year at the request of the court. Mrs. McDonald pled guilty to shoplifting and, as a condition of receiving probation, agreed to attend coun- seling sessions with Dr. Smart for one year. Over the last year, Dr. Smart and Mrs. McDonald have worked on Mrs. McDonald’s various personal issues and the increasing tension in Mrs. McDonald’s marriage. Mrs. McDonald has recently made the decision to divorce her husband and things have escalated to the point where she and her husband are no longer speaking to each other. In addi- tion, he has decided to sue Mrs. McDonald for full custody of their 6-year-old daughter. The Judge who is to hear Mr. McDonald’s petition in family court has requested a custody evaluation of the family to assist in his determination regard- ing the best interests of Mr. and Mrs. McDonald’s daughter. Mrs. McDonald has asked Dr. Smart to conduct this custody evaluation since she will have completed her required one-year of counseling with Dr. Smart and thus Dr. Smart will no longer be her therapist. Mrs. McDonald believes that Dr. Smart will be an objec- tive evaluator and will make the process somewhat easier since Dr. Smart already has a good understanding of Mrs. McDonald’s background and functioning. Should Dr. Smart participate in this evaluation?

Issues: Dr. Smart is being asked to perform a custody evaluation, which would entail an assessment of all relevant parties—Mr. McDonald, Mrs. MacDonald, and their 6-year-old daughter—in order to make a recommendation to the Court regarding which parent should receive custody. Although Mrs. McDonald has completed her counseling with Dr. Smart, and is thus no longer a patient of Dr. Smart, this is a somewhat tricky situation. Dr. Smart is being asked to par- ticipate as an evaluator in a custody suit; however, Dr. Smart has already engaged with Mrs. McDonald as a treatment provider for a year.

Resolution: In this situation, it would be unwise for Dr. Smart to engage in the role of evaluator since she has already engaged with Mrs. McDonald as a treatment provider. The concern is that it may be diffi cult for Dr. Smart to remain objective and neutral in the custody evaluation. This may work in either of two ways— Dr. Smart may be swayed in favor of Mrs. McDonald since she has come to know her and is familiar with the struggles in the McDonald’s marriage; or Dr. Smart may be swayed in favor of Mr. McDonald since she has knowledge of Mrs. McDonald’s troubles with the law and is familiar with the struggles in the McDonald’s mar- riage. The best course of action may be for Dr. Smart to refer the McDonald’s to a colleague for the custody evaluation.

Box 12.1 Case Study: Multiple Roles

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legally bound to report certain types of information — such as learning about known or suspected child abuse (or, in some states, elder abuse). It is impor- tant that the client know ahead of time the limits on confi dentiality.

What about the specifi c case of the forensic psychologist? Is a forensic psychologist who is retained by the courts to evaluate a defendant ’ s men- tal state required to keep this information confi dential? The short answer is no. In the case of the forensic psychologist, the purpose of the evaluation is to assist the courts in making a decision about a particular legal issue (e.g., competency to stand trial, or mental state at the time of the offense) and, thus, the psychologist is unable to maintain confi dentiality of the informa- tion obtained from the defendant. It is, however, important that the defendant understand that there is no confi dentiality in this situation. In addition, sim- ply because confi dentiality does not apply in the forensic context, does not mean that the forensic psychologist is free to divulge the details of the case to other people not involved in the case. The forensic psychologist must still respect the defendant ’ s right to privacy and must still act ethically by divulg- ing information about the defendant to only those relevant parties — usually the judge, the defense, and the prosecution.

Confusion often exists regarding confi dentiality and privilege . Confi dentiality is an ethical principle prohibiting psychologists from divulging information about their clients to third parties except under certain circumstances that have been agreed to by both parties. Privilege , on the other hand, is a legal protection belonging to the client that ensures protection of communications from disclosure in legal proceed- ings. Every state recognizes attorney - client, physician - patient, husband - wife, and priest - penitent privilege; however, some, but not all, states also recognize a psychotherapist - patient privilege. In those states where a psychotherapist - patient privilege exists, communications between psychotherapist and patient are protected from disclosure in legal pro- ceedings, unless the patient waives that privilege. (Read the sample case study on confi dentiality in Box 12.2 .)

Again, however, nothing is as simple as it seems. What if the crimes were violent and people were getting hurt? What if Mr. Schneider were to identify a specifi c target of his crimes? What if Mr. Schneider were a forensic examinee sent to Dr. Blake by the courts for an evaluation and he divulged this information to Dr. Blake?

In the case of violent crimes wherein innocent people are getting hurt, Dr. Blake ’ s course of action might depend on whether the potential vic- tims of future crimes committed by Mr. Schneider were identifi able. If they were clearly identifi able and could be harmed, Dr. Blake might need to con- sider breaking Mr. Schneider ’ s confi dence and warning either the intended victim, or the authorities, or both. If the potential victims were not clearly

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338 Ethics and Professional Issues

identifi able, Dr. Blake would most likely need to maintain Mr. Schneider ’ s confi dence. If, however, Mr. Schneider was a forensic examinee and divulged this information to Dr. Blake during the course of an evaluation for the courts, Dr. Blake could then include this information in the report to court. Recall that in forensic evaluations, confi dentiality does not apply and the authority requesting the evaluation has a right to any of the information obtained from the examinee.

With issues of confi dentiality, as well as with any other ethical issue, there are rarely easy answers — the situation is rarely black or white. The ethical

Situation: Dr. Blake is a clinical psychologist whose private practice mainly involves treating adults who are suffering from depression. He has recently begun to conduct some forensic evaluations for the courts, but this comprises only about 10% of his practice. Dr. Blake has been seeing Mr. Schneider, a general therapy client, for his depression for the last three months. Before beginning therapy with Mr. Schneider, Dr. Blake informed him about the limits of confi dentiality—that Dr. Blake would keep everything Mr. Schneider told him confi dential unless Mr. Schneider divulged information to Dr. Blake regarding known or suspected child or elder abuse or an intention to hurt himself or someone else. During the last therapy session, Mr. Schneider told Dr. Blake that he had been involved in a series of crimes over the last six months. As Mr. Schneider elaborated on his behaviors, it became clear to Dr. Blake that these were highly publicized crimes that the city police were actively attempting to solve. What should Dr. Blake do in this situation? Can Dr. Blake inform the police of the information he learned from Mr. Schneider?

Issues: Dr. Blake has entered into an agreement with Mr. Schneider wherein he promised confi dentiality within certain limits. Mr. Schneider has divulged infor- mation to Dr. Blake that implicates himself in a number of well-known crimes that the city police are actively attempting to solve; in fact, the police have posted a reward for the arrest and conviction of the person or persons involved in these crimes. The crimes have nothing to do with child or elder abuse and Mr. Schneider has not voiced an intention to hurt himself or anyone else; although there is a pos- sibility that someone could get hurt if the crimes were to continue to happen.

Resolution: Dr. Blake clearly laid out the limits on confi dentiality with Mr. Schneider before commencing treatment. The information provided does not suggest that there are any child/elder abuse concerns nor does it suggest that Mr. Schneider intends to hurt himself or someone else. In this situation, the most appropriate course of action for Dr. Blake is to maintain Mr. Schneider’s confi - dence and not divulge the details of his crimes to the authorities or anyone else. Of course, this does not prohibit Dr. Blake from making this a focus of treatment or from attempting to convince Mr. Schneider to turn himself in to the police.

Box 12.2 Case Study: Confi dentiality

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guidelines to which psychologists must adhere provide useful information to assist psychologists think through these dilemmas; however, the deci- sions that psychologists make about these dilemmas are often the product of lengthy discussion with colleagues and painstaking weighing of options. In this respect, the ethical guidelines are invaluable, both to psychologists as well as to the people and groups with whom psychologists work.

SUMMARY

One of the most intriguing things about becoming a psychologist is the abil- ity to participate in many different roles and activities. While we have only touched on some of the various roles that psychologists play in this chapter, one thing is clear: psychologists perform a wide variety of activities and par- ticipate in a large variation of professional roles, sometimes on a daily basis.

The fact that psychology is a self - regulating profession means that it is up to psychologists to ensure that their own behavior, as well as the behavior of their colleagues, is ethical and will not lead to harm for those people with whom psychologists interact. Psychologists are guided by a number of core ethical principles including: doing no harm, respecting autonomy, benefi t- ing others, being just, being faithful, according dignity, treating others with care and compassion, pursuing excellence, and accepting accountability.

Professional licensing boards in each state are responsible for regulat- ing the practice of psychology and for protecting the public through the adjudication of any complaints against a practicing psychologist. In addi- tion, the American Psychological Association has an ethics committee that is responsible for hearing complaints against any of its members. For the most part, psychologists are careful and conscientious about their interac- tions and often painstakingly engage in consultation and deliberation with colleagues regarding ethical issues that they may face.