Assessment Log

Ethics in Practice

Overview

What are ethics?

Dimensions of Ethical Reasoning

British Psychology Society

Health & Care Professions Council

Areas of Unethical Practice

Professional Values

Boundaries in Practice

Ethical Decision Making

What comes to mind when you think about unethical therapy practice?

Group Activity 1 Close the notes and/or your notebook

In groups : 1. Please write down anything that you

could remember about Ethics in the last module?

2. Why there should be ethics for professionals?

Professional Ethics

• Obligations and ideal behaviours expected of practitioners within a profession e.g. codes of practice/ ethical frameworks

Clinical ethics

• The practical, ethical decisions made with respect to individual cases by practitioners usually around therapeutic practice and goals ie: timing of sessions, referring on to others

Virtue ethics

• The values, characteristics and ways of being above and beyond a specific situation. Values may include prudence and integrity, respectfulness and benevolence. Ie: is it the right thing to do

Social ethics

• Emphasising the relationship between individuals and their communities, professional institutions and society. Ie: power plays out here

Dimensions of Ethical Reasoning (Tjeltveit 1999)

Benefits of Ethics

• Protects you as a practitioner as well as others

• Can establish a strong reputation – individual

transactions may be lost, but clients will return to a

reputable practice.

• An ethical stance is considered honourable & integral

British Psychology

society

• Code of Ethics

• Code of Ethics and Conduct | BPS - British Psychological Society

• BPS Practice Guidelines • to define good psychological practice for all

psychologists • to strengthen the identity of psychologists • to benefit the public • to benefit members • to provide guidance on legal and regulatory issues

• Practice Guidelines - Nicola Gale

Health & Care Professions

Council

• Set out, in general terms, how we expect our registrants to behave

• Outline what the public should expect from their health and care professional

• Help make decisions about the character of professionals who apply to our Register

• Used if someone raises a concern about a registrant’s practice

HCPC cont….

HCPC cont….

HCPC cont….

HCPC Standards of

Conduct Performance

and Ethics

Standards of conduct, performance and ethics | The HCPC

3 forms of unethical

action (Palmer Barnes 1998)

• Poor Practice • Misrepresenting skills or training. • Failing to contract effectively • Being unreliable/cancelling sessions for no reason • Weak/lack of boundaries

• Negligence • Failing to ensure that no harm comes to clients • Failing to act to prevent serious situations from

occurring • Failing to ensure confidentiality

• Malpractice • Active misdemeanours such as entering into

exploitative relationships with clients (sexual or financial)

Poor Practice

• Misrepresenting skills or training - exaggerating the titles of projects or by inflating the level of involvement in a certain project to make it sound more important – or omitting details which would make a fundamental difference

• Failing to contract effectively – omitting details/consequences from the contract

• Cancelling sessions for no reason

• Weak/Lack of boundaries

Group Activity 2 Based on HKPS Code of Ethics

Which code of ethics that the counselor had violated?

Professional Values

• Ethical practice will be fed from your personal values

• “the moral principles and beliefs or accepted standards of a person or social group” (Collins Dictionary)

• ‘Values can be thought of as priorities, internal compasses or springboards for action—moral imperatives.

• Defined as the best way of doing something

• Examples of values: • Integrity • Respect • Responsibility • Honesty • Others?

• Refined values and based on ethical principles and legal frameworks

• Rule of abstinence • ‘am I doing this in the service of the client or my own needs?’ • Personal gratification should only be found in helping the

client and from payment for professional services • Therapists should not air their personal views on social,

political or religious issues or make choices for the patient about work, money or friendships

• Support for the patient's autonomy and self-determination – including informed consent and allowing the client to determine the content of the session

Boundaries

• Respect for human dignity. Patient's vulnerability and dependence mean the therapist must act only in the best interests of the patient

• Only the therapist has the power to violate the boundary although clients will/might try and cross it – this provides material to discuss in the session

• Stable, private and quiet setting for the sessions with clear agreement on timing and length from the outset

• Many boundary violations occur at the end of session when therapist and client might ‘brush off their roles’ therapist should remember that session doesn’t end until the client has left

Boundaries

Boundary examples

Telling a client where you are going on holiday

Lending a client your scarf in a session when they say they are cold

Hugging a client

Shaking a client’s hand when they extend it

Visiting a client in hospital

Taking calls outside of business hours from a client

Therapist has pictures of their family in their therapy office

Not answering any personal questions, rather enquiring as to the client’s motivation for asking

Boundary examples

Seeing a client in public and starting up a conversation

Seeing a client in public and avoiding eye contact

Therapist drinks coffee in therapy session

Therapist wears slippers in the therapy session

Therapist plays tennis with the client

Therapist accepts an expensive gift from a client

Therapist accepts an inexpensive gift from a client

Therapist does not let client in when they arrive early to the session

Therapist allows session to go on beyond the 50 minutes

According to recent research (Vessentini et al, 2022)

Over _____ of mental health professionals report emotional feelings and sexual attraction to their clients

A. 70%

B. 50%

C. 40%

According to recent research (Vessentini et al, 2022)

Over _____ of mental health professionals acted on such impulses.

A. 3%

B. 5%

C. 10%

Therapist in jail for sexual

relationship with a client

• Therapist Jailed

What is Ethical Decision Making

What is Ethical Decision Making?

• A cognitive process where people consider ethical rules, principles or guidelines when making decisions

• We all have ethical or “morally right” values which we live and abide by and how we conduct ourselves

• Ethical decision making arises in all areas of life, work places & personal lives

• Becoming aware of ourselves as practitioners and as psychological professionals is a fundamental duty and obligation

• Usually when we think of ethical decision making, we think of difficult decisions but it is not necessarily so!

• Ethical decision making refers to a structured approach that helps professionals navigate complex moral dilemmas by balancing personal values, professional codes, and contextual factors. At its core, it is about acting in a way that upholds professional integrity, respects human dignity, and minimizes harm.

• Recent research has highlighted several key principles and processes that shape ethical decision making in psychology.

Ethical Decision Making

Ethical Sensitivity as a Foundation

• Narvaez & Lapsley (2009) explain that ethical sensitivity includes empathy, perspective-taking, and awareness of how one’s actions affect others.

• Rest’s Four-Component Model (1986), still foundational and widely cited, describes ethical behavior as involving:

1. Moral sensitivity

2. Moral judgment

3. Moral motivation

4. Moral character.

Essences of Ethical Decision Making

Meta-Cognition and Self-Awareness

• Self-reflection and humility are critical.

• Professionals must examine:

• Their own biases

• Their emotional reactions

• Power differentials in relationships

This aligns with research by Knapp et al. (2017), who advocate for ethical mindfulness—a continuous awareness of ethical implications in practice.

Essences of Ethical Decision Making

Contextual and Cultural Considerations

• Ethical decisions are shaped by culture, context, and power dynamics.

• Gottlieb et al. (2016) emphasize the importance of relational ethics—accounting for real-world relationships and multicultural realities.

• Fisher (2022) recommends a practical-ethical approach where context is deeply embedded in each decision step.

Essences of Ethical Decision Making

Use of Structured Decision-Making Models • Professionals often follow structured frameworks such as:Kitchener’s (1984) Five Moral

Principles: • Autonomy • Beneficence • Non-maleficence • Justice • Fidelity

• These principles serve as ethical anchors when evaluating options. • The Canadian Code of Ethics for Psychologists (CPA, 2017) promotes a hierarchical model: • First consider respect for the dignity of persons, then responsible caring, followed by

integrity in relationships, and lastly responsibility to society. This helps prioritize when values conflict.

Essences of Ethical Decision Making

Ethical Decision- Making Model Based on Pope & Vasquez (2016)

1. Clarify Whether the Problem is Ethical

2. Identify Relevant Ethical Guideline and Laws

3. Consider the Consequences

4. Consult with Colleagues or Ethics Board

5. Evaluate Alternatives

6. Choose the most ethical action

7. Implement the Action

8. Document the Process

Ethical Decision Making Model

Dual Relationship Ethical Dilemma

Ethical Decision-Making Case Study

Managing Dual Relationships and Conflict of Interest

1. Identify the Problem

Client: 30-year-old female, recently broke up with your son.

Ethical issue: Potential multiple relationship.

Timing: Discovered before second session.

2. Identify Relevant Ethical Guideline and Laws

• 3.05: Avoid multiple relationships. • 3.06: Avoid conflicts of interest. • 10.10: Terminate therapy appropriately. • Principles: A (Do no harm), B (Fidelity and Responsibility).

Reference: APA (2017). Ethical Principles of Psychologists and Code of Conduct.

3. Consider the Consequences

• Client: Emotional distress, loss of trust. • Therapist: Compromised objectivity, ethical risk. • Son: Privacy issues, family tension. • Therapeutic relationship: Trust compromised.

Reference: Pope, K. S., & Vasquez, M. J. T. (2016). Ethics in Psychotherapy and Counseling.

4. Consult with Colleagues or Ethics Board

• Seek supervision or peer consultation or institutional ethics board. • Document advice and steps taken. • Ensure a neutral perspective.

Reference: Koocher, G. P., & Keith-Spiegel, P. (2016). Ethics in Psychology and the Mental Health Professions.

5. Evaluate Alternatives

• Option 1: Continue therapy with disclosure – not advised. • Option 2: Terminate and refer – most ethical choice. • Option 3: Explore with the client the possibility of referral in a sensitive and

supportive way.

6. Choose the most ethical action

• Terminate the therapeutic relationship, as continuing poses a significant risk to objectivity and client welfare.

• Provide a referral to ensure continuity of care. • Handle the conversation with empathy and professionalism.

Reference: APA Ethics Code 10.10 (Terminating Therapy)

7. Implement the Action

• Discuss the situation with the client in a non-judgmental and supportive manner.

• Explain your ethical obligation to avoid dual relationships and protect her wellbeing.

• Offer assistance in connecting her with another qualified professiona

8. Document the Process

• Keep clear and confidential documentation of: • Discovery of the conflict. • Ethical reasoning and guidelines consulted. • Colleague consultations. • The decision and referral process. • Any client communication regarding the decision.

References

• APA (2017). Ethical Principles of Psychologists and Code of Conduct. • Pope & Vasquez (2016). Ethics in Psychotherapy and Counseling. • Koocher & Keith-Spiegel (2016). Ethics in Psychology.

A case study: Ethical Considerations in Flu Vaccination Compliance

• You are the Associate Director of Human Resources in a large healthcare organization. Amid growing concern over patient safety, workforce health, and infection control, the Chief Executive Officer (CEO) has asked your department for input on a new proposal to increase staff uptake of the annual influenza vaccine.

• The proposal originates from the Quality and Safety Department, who argue that low vaccination rates pose an unacceptable risk to both patients and staff. To drive compliance, they recommend that each staff member’s flu vaccination status be made visible to all senior management. Through the organization’s internal management app, supervisors would be able to see which of their team members have or have not received the flu shot, and would be encouraged to proactively follow up with unvaccinated staff.

• Your HR Director has asked for your professional view before responding to the CEO.

Group Activity 3

Based on the case background, please propose your view using the ethical decision-making model

Questions for today?