Decoding the Ethics Code, Ch. 5

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CHAPTER 5

Standards on Competence

2. Competence

2.01 Boundaries of Competence

(a) Psychologists provide services, teach, and conduct research with populations and in areas

only within the boundaries of their competence, based on their education, training, supervised

experience, consultation, study, or professional experience.

Psychologists benefit those with whom they work and avoid harm through the

application of knowledge and techniques gained through education, training, supervised

experience, consultation, study, or professional experience in the field

(Principle A: Beneficence and Nonmaleficence). Competence is the linchpin

enabling psychologists to fulfill other ethical obligations required by the APA Ethics

Code (APA, 2010c). Under Standard 2.01a, psychologists must refrain from providing

services, teaching, or conducting research in areas in which they have not had the

education, training, supervised experience, consultation, study, or professional experience

recognized by the discipline as necessary to conduct their work competently.

􀀴 Psychologists with doctoral degrees from programs solely devoted to research would

be in violation of this standard if they provided therapy to individuals without obtaining

additional education or training in practice fields of psychology.

􀀴 Graduates of counseling, clinical, or school psychology programs should not conduct

neuropsychological assessments unless their programs, internships, or postdoctoral

experiences provided specialized training in those techniques.

􀀴 Psychologists should not offer courses or professional workshops if their graduate

education, training, or continued study is insufficient to provide students with fundamental

knowledge and concepts of the topics or areas to be taught.

􀀴 Psychologists without applicable training in job-related counseling and assessment

should not offer executive coaching services (S. K. Anderson, Williams, & Kramer, 2012).

HMO

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68——PART II ENFORCEABLE STANDARDS

Specialties, Certifications,

and Professional and Scientific Guidelines

Determinations of whether psychologists are engaged in activities outside the

boundaries of their competence will vary with current and evolving criteria in the

relevant field. For example, the Council of Specialties in Professional Psychology

(COSPP) and the ABPP recognize 13 “specialty areas” defined in terms of competence

in providing distinctive configurations of services for specified problems and

populations. The COSPP website provides descriptions of the education, training,

and experience required to attain competencies in each specialty (http://cospp.org).

Advanced training for specific problems across specialties may also be required.

As noted in the Introduction and Applicability section of the Ethics Code and

discussed in Chapters 1 and 3 of this book, psychologists are encouraged to refer to

materials and guidelines endorsed by scientific and professional psychological organizations

to help identify competencies necessary for adherence to Standard 2.01a.

For example:

􀀴 Forensic psychologists should not offer opinions on children’s ability to testify if they

have not obtained requisite knowledge of developmental processes related to recollection

of facts, susceptibility to leading questions, understanding of court procedures, and

emotional and behavioral reactions to legal proceedings.

􀀴 Psychologists should not suggest to clients/patients that they alter their psychotropic

medication regimen unless they have specialized training as a prescribing psychologist.

􀀵 According to the Specialty Guidelines for Forensic Psychology (SGFP) (Committee on

Ethical Guidelines for Forensic Psychologists, 1991), forensic practitioners refrain from

offering legal opinions, explain to parties that legal information is not the same as legal

advice, and encourage parties to consult with an attorney for guidance regarding relevant

legal issues. (Readers may also wish to refer to the American Psychology-Law

Society (AP-LS) Committee on the Revision of the Specialty Guidelines for Forensic

Psychology, 2010.)

􀀵 According to the Guidelines for Child Custody Evaluation in Divorce Proceedings

(APA, 1994), custody evaluation requires specialized knowledge of psychological

assessments for children, adults, and families; child and family development and

psychopathology; the impact of divorce on children; applicable legal standards; and,

in some instances, expertise on child abuse and neglect, domestic violence, or parental

mental or physical illness (see also Guidelines for the Practice of Parenting

Coordination [APA, 2012a]).

􀀵 According to the Guidelines for the Evaluation of Dementia and Age-Related Cognitive

Decline (APA, 2012b), psychologists who provide evaluations for dementia and agerelated

cognitive decline must have education, training, experience, or supervision in

clinical interviews and neuropsychological testing, and training in the areas of gerontology,

neuropsychology, rehabilitation psychology, neuropathology, psychopharmacology,

and psychopathology in older adults.

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Chapter 5 Standards on Competence——69

(b) Where scientific or professional knowledge in the discipline of psychology establishes that an

understanding of factors associated with age, gender, gender identity, race, ethnicity, culture,

national origin, religion, sexual orientation, disability, language, or socioeconomic status is essential

for effective implementation of their services or research, psychologists have or obtain the

training, experience, consultation, or supervision necessary to ensure the competence of their services,

or they make appropriate referrals, except as provided in Standard 2.02, Providing Services

in Emergencies.

Understanding the ways individual differences relate to psychological phenomena

is essential to ensure the competent implementation of services and

research. Insensitivity to factors associated with age, gender, gender identity,

race, ethnicity, culture, national origin, religion, sexual orientation, disability,

language, or socioeconomic status can result in underutilization of services,

misdiagnosis, iatrogenic treatments, impairments in leadership effectiveness

and member cohesion in group therapy, and methodologically unsound

research designs (APA, 2000, 2003, 2012a, 2012d; Ridley, Liddle, Hill, & Li,

2001; Trimble & Fisher, 2006).

Standard 2.01b requires that psychologists have or obtain special understanding

and skills when the scientific and professional knowledge of the discipline establishes

that an understanding of factors associated with these individual differences

is essential to competent work. According to this standard, the competencies

required to work with such populations are determined by the knowledge and skills

􀀵 The Guidelines for Ethical Conduct in the Care and Use of Animals (APA Committee

on Animal Research and Ethics [CARE], 1996; http://www.apa.org/science/anguide.

html) state that psychologists conducting research with animals must be knowledgeable

about the normal and species-specific behavior characteristics of their animal

subjects and unusual behaviors that could forewarn of health problems.

􀀵 According to the task force on Ethical Practice in Organized Systems of Care, convened

by the APA Committee for the Advancement of Professional Practice (CAPP), psychologists

who are contracted providers for HMOs should only accept clients/patients

whom they have the expertise to benefit (Acuff et al., 1999).

􀀵 The APA Guidelines for Education and Training at the Doctoral and Postdoctoral Levels

in Consulting Psychology/Organizational Consulting Psychology (APA, 2007a) details

three domains of competencies required for organizational consulting psychology:

(1) individual (i.e., career and vocational planning, employee selection and promotion,

employee job analysis, executive and employee coaching), (2) group (i.e., assessment

and development of teams and functional and dysfunctional group behavior, work

flow, technology, and stress management), and (3) organization/systemwide/intersystem

(i.e., organizational assessment and diagnosis, corporate-wide job analysis, centralizing

and decentralizing decision making, strategic planning).

􀀵 The American Statistical Association’s (ASA) Ethical Guidelines for Statistical Practice

(1999) warns that selecting one “significant” result from multiple analyses on the

same data set poses a risk of incorrect conclusions and that failing to disclose the

limits of conclusions drawn is highly misleading.

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70——PART II ENFORCEABLE STANDARDS

identified by the scientific and professional knowledge base—not by personal

differences or similarities between psychologists and those to whom they provide

services or involve in research.

Under Standard 2.01b, psychologists have three sequentially related obligations:

Familiarity With Professional and Scientific Knowledge

For each activity in which they engage, psychologists must be sufficiently

familiar with current scientific and professional knowledge to determine

whether an understanding of factors associated with the individual characteristics

listed above is necessary for effective implementation of their services or

research. For example:

􀀵 Research and professional guidelines suggest that familiarity with the concept of cultural

paranoia and culturally equivalent norms on certain scales of psychopathology is

required for competent clinical assessment of African American clients/patients with

presenting symptoms of subclinical paranoia (APA, 1993, 2003; Combs, Penn, &

Fenigstein, 2002).

􀀵 Professional guidelines require knowledge of the mental health risks of social stigmatization

and individual differences in the developmental trajectories of lesbian, gay,

bisexual, and transgender (LGBT) youths, as well as cohort and age differences when

treating LGBT clients/patients (APA, 2012d).

􀀵 Psychologists providing treatment must be alert to how religious ideals and internalized

religious norms may positively or negatively influence clients’/patients’

reactions to life events such as the death of a loved one or their attitudes

and behaviors regarding sexual relationships, child rearing, and self-evaluation

(APA, 2007d).

􀀵 There is growing awareness that research, assessment, and treatments involving girls

and women need to be informed by biological, psychological, social, and political influences

that may uniquely affect the development and well-being of this population. The

APA “Guidelines for Psychological Practice With Girls and Women” (APA, 2007b) provides

a historical overview as well as guidance for identifying and addressing areas in

which a special understanding of factors associated with women’s issues is required

for competent provision of mental health services.

Appropriate Skills

If current knowledge in the field indicates that an understanding of one or

more of the factors cited in Standard 2.01b is essential to conduct activities competently,

psychologists must have or obtain the training, experience, consultation,

or supervision necessary. The type of knowledge and training required

depends on the extent to which the individual difference factor is central or

peripheral to the service required as well as the psychologist’s prior training or

experience.

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Chapter 5 Standards on Competence——71

􀀵 A psychologist providing bereavement counseling to a recently widowed 70-year-old

woman noticed that the client was reporting difficulties shopping for groceries and

finding it frustrating to be among friends. While these difficulties might be attributed

to depression following the loss of her husband, given the client’s age, the psychologist

advised the client to get a full medical checkup and sought additional consultation

with a geropsychologist on changes associated with and techniques for

enhancing functional capacities related to age-related declines in vision, hearing, and

activities of daily living (APA, 2012b).

􀀵 A rehabilitation psychologist who began to receive referrals for work with hearingimpaired

clients sought training in sign language and other appropriate communication

techniques (Hanson & Kerkoff, 2011).

􀀵 A psychologist with prescribing authority was treating a woman for depression who

was also under the care of a medical doctor for diabetes. The psychologist made sure

he was up-to-date on research on potential drug–drug interactions between insulin

and antidepressants (APA, 2011a).

􀀴 A counseling psychologist working at a college counseling center typically provided

either behavioral or interpersonal psychotherapy for non-Hispanic white students who

met diagnostic criteria for anxiety disorder. However, he limited the treatment plan to

behavioral therapy for students of Chinese and Korean heritage based on his erroneous

assumption that members of this cultural group were not comfortable with treatments

that involved insight-oriented techniques (Wang & Kim, 2010).

Need to Know: Critical Self-Reflection

and Personal and Professional Bias

Familiarity with professional and psychological knowledge may also require critical selfreflection

and the courage and vigilance to continually confront biases, prejudices, and

privileges held by oneself, one’s profession, and one’s society (Allen, Cherry, & Palmore, 2009;

Dovidio & Gaertner, 2004; L. Smith, Constantine, Graham, & Dize, 2008; Spanierman, Poteat,

Wang, & Oh, 2008; D. W. Sue et al., 2007; Vasquez, 2009). This includes (a) acquiring the skills

to identify and resist simplistic and monolithic stereotypes of clients/patients, research participants,

and students in terms of their race, ethnicity, gender, social class, sexual orientation,

or other socially constructed categories; and (b) openness to see how an individual’s

strengths or vulnerabilities are or are not related to cultural issues (APA, 2012d; Fisher, in

press; Fisher, Busch-Rossnagel, Jopp, & Brown, 2012; Fisher et al., 2002; Hayes & Erkis, 2000;

Hoop, DiPasquale, Hernandez, & Roberts, 2008; J. Johnson, 2009; Stuart, 2004; S. Sue, 1999).

Knowing When to Refrain and Refer

Under Standard 2.01b, psychologists who have not had or cannot obtain the

knowledge or experience required must refrain from engaging in such activities and

make referrals when appropriate, except in emergencies when such services are

immediately needed but unavailable (Standard 2.02, Providing Services in

Emergencies; see also Standard 2.01d).

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72——PART II ENFORCEABLE STANDARDS

HMO

􀀵 A psychologist trained only in adult assessment was asked to assess a child for learning

difficulties. The psychologist referred the family to another psychologist with the specialized

knowledge and experience necessary to conduct child assessments in general

and developmental disabilities assessments in particular (Childs & Eyde, 2002).

􀀴 A counseling psychologist agreed to provide career services to a client with mild

bilateral deafness. The psychologist had no education or training in career skills and

opportunities available to people who are hearing impaired, employment-relevant

disability law, hearing loss–appropriate counseling techniques, the use of American

Sign Language and other modes of communication, and the appropriate use of

interpreters (Leigh, 2010).

􀀵 Prior to offering psychological rehabilitation services, a clinical psychologist without

previous training in this area obtained knowledge and supervised experience with

individuals with sensory impairments; burns; spinal cord, brain, and orthopedic injuries;

catastrophic injury and illness; and chronically disabling conditions (Patterson &

Hanson, 1995; Scherer, 2010).

􀀵 A psychologist trained solely in individual psychotherapy obtained appropriate

advanced education and training prior to extending his practice to group and family

therapy work (Stanton & Welsh, 2011; Wilcoxon, Remley, & Gladding, 2012).

􀀵 To deliver the short-term treatment required under the practice guidelines of the

HMO for which she worked, a psychologist acquired additional supervised experience

in the delivery of time-limited services (Haas & Cummings, 1991; Parry, Roth, &

Kerr, 2005).

􀀵 A developmental psychologist who wished to test a theory of genetic and environmental

influences on cognitive aging using an animal population obtained knowledge and

supervised experience in animal models, animal care, and animal experimental techniques

prior to conducting the research (APA CARE, 1996).

􀀵 Prior to implementing an executive coaching program in a South Asian country, a

consulting psychologist obtained knowledge about the culture’s orientation toward

collective versus independent goals, receptivity to authoritative versus collegial coaching

approaches, and preferences for launching quickly into a task versus spending time

getting to know the coach personally (Peterson, 2007).

􀀵 A teaching psychologist who planned to offer an interactive Internet course consulted

with a specialist to ensure the information would be presented accurately (e.g.,

Graham, 2001; Randsdell, 2002).

areas, techniques, or technologies new to them undertake relevant education, training, supervised

experience, consultation, or study.

Standard 2.01c applies when psychologists wish to expand the scope of their

practice, teaching, or research to populations, areas, techniques, or technologies for

which they have not obtained the necessary qualifications established by the field.

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Chapter 5 Standards on Competence——73

(d) When psychologists are asked to provide services to individuals for whom appropriate mental

health services are not available and for which psychologists have not obtained the competence

necessary, psychologists with closely related prior training or experience may provide such services

in order to ensure that services are not denied if they make a reasonable effort to obtain the

competence required by using relevant research, training, consultation, or study.

Standard 2.01d applies to situations in which a psychologist without the appropriate

training or experience is the only professional available to provide necessary

mental health services. Such situations often arise in rural settings or small ethnocultural

communities where a single psychologist serves a diverse-needs population

(Werth, Hastings, & Riding-Malon, 2010). The standard reflects the balance, articulated

in Principle A: Beneficence and Nonmaleficence, between the obligation to do

good (to provide needed services) and the responsibility to do no harm (to avoid

poor services provided by unqualified professionals). The standard also reflects the

importance of providing fair access to services (Principle D: Justice).

Standard 2.01d stipulates two conditions in which psychologists may provide services

for which they do not have the required education or experience: (1) psychologists

must have prior training or experience closely related to the service needed and

(2) having agreed to provide the service, psychologists must make reasonable efforts to

obtain the knowledge and skills necessary to conduct their work effectively.

􀀵 A psychologist with expertise in culturally sensitive assessment of childhood personality

and educational disorders was the only Spanish-speaking mental health professional

with regularly scheduled appointments to a Mexican–migrant worker

community. A social worker serving the community asked the psychologist to evaluate

a Spanish-speaking 80-year-old man for evidence of depression. The nearest mental

health clinic was 500 miles away, and the elder was too feeble to travel. The psychologist’s

expertise in multicultural assessment of mental disorders in children was

related though not equivalent to the knowledge and expertise necessary for a culturally

sensitive geropsychological diagnosis. The psychologist agreed to conduct the

evaluation. Prior to evaluating the elder, she consulted by phone with a geropsychologist

in another state. She also informed the elder, the elder’s family, and the social

worker that because she did not have sufficient training or experience in treating

depression in elderly persons, if treatment was necessary, it would have to be

obtained from another provider.

(e) In those emerging areas in which generally recognized standards for preparatory training do

not yet exist, psychologists nevertheless take reasonable steps to ensure the competence of their

work and to protect clients/patients, students, supervisees, research participants, organizational

clients, and others from harm.

Standard 2.01e applies when psychologists wish to develop or implement new

practice, teaching, or research techniques for which there are no generally agreed

upon scientific or professional training qualifications. The standard recognizes the

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74——PART II ENFORCEABLE STANDARDS

value of innovative techniques as well as the added risks such innovations may

place on those with whom psychologists work.

Psychologists must take reasonable steps to ensure the competence and safety of

their work in new areas. In using the term competence, the standard assumes that all

work conducted by psychologists in their role as a psychologist draws upon established

scientific or professional knowledge of the discipline (see Standard 2.04,

Bases for Scientific and Professional Judgments). Adherence to this standard

requires that psychologists have the foundational knowledge and skills in psychology

necessary to construct or implement novel approaches and to evaluate their

effectiveness. For example:

􀀵 The growing literature in the field of executive coaching indicates that psychologists

planning to offer new forms of these services must demonstrate a knowledge and

expertise in (a) techniques for fostering and measuring change within business, government,

nonprofit, or educational organizations; (b) the nature of executive

responsibility and leadership; (c) targeted goal setting within organizational cultures;

(d) succession planning; and (e) relevant factors associated with executive challenges

such as information technology and globalization (Brotman, Liberi, & Wasylyshyn,

1998; Diedrich, 2008; Kampa-Kokesch & Anderson, 2001).

􀀵 As states begin to grant psychologists prescriptive authority, psychologists proposing

to practice in this area will need the education and training outlined in the evolving

practice guidelines for this field (Fox et al., 2009). Psychologists who do not have

prescription privileges but are knowledgeable about pharmacotherapy must continue

to be cautious when discussing medications with clients/patients to ensure that they

are not working outside evolving professional and legal boundaries of competence

(Bennett et al., 2006; Sechrest & Coan, 2002).

Standard 2.01e also requires that psychologists working in emerging areas take

reasonable steps to protect those with whom they work from harm, recognizing that

novel approaches may require greater vigilance in consumer or research protections.

􀀵 The application of neurocognitive enhancement techniques to healthy individuals and

those displaying no signs of neurocognitive degeneration or dysfunction is an emerging

field. To date, there is little research documenting positive effects of neurocognitive

pharmacological treatments, cognitive exercises, neuroimaging, neurosurgery,

and noninvasive cerebral manipulation such as transcranial magnetic stimulation

(Bush, 2006). Psychologists investigating these techniques and practitioners who wish

to incorporate them into current modes of counseling or treatment must ensure they

have the knowledge and skills to not only administer, assess, and monitor participant

or patient reactions to these new methods but also remedy negative reactions if they

arise (Standards 3.04, Avoiding Harm, and 8.08, Debriefing). Psychologists must also

inform prospective research participants and patients of the experimental nature of

the techniques (see Standards 8.02b, Informed Consent to Research, and 10.01b,

Informed Consent to Therapy).

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Chapter 5 Standards on Competence——75

(f) When assuming forensic roles, psychologists are or become reasonably familiar with the judicial

or administrative rules governing their roles.

Psychologists assume forensic roles when they engage in activities intended to

provide psychological expertise to the legal system. According to the SGFP (AP-LS

Committee on the Revision of the Specialty Guidelines for Forensic Psychology,

2010; Committee on Ethical Guidelines for Forensic Psychologists, 1991), forensic

roles include clinical forensic examiners, psychologists employed by correctional

mental health systems, researchers who provide expert testimony on the relevance

of psychological data to a psycholegal issue, trial behavior consultants, practitioners

who are called to appear before the court as fact witnesses, forensic experts, or psychologists

who otherwise consult with or testify before judicial, legislative, or

administrative agencies acting in an adjudicative capacity.

Familiarity With Law, Regulations,

and Governing Authority

The provision of competent forensic services requires not only education and

training in a psychologist’s specific area of expertise but also knowledge of the

judicial or administrative rules governing various forensic roles.

􀀵 Continuous advances in electronic and computer technology present new opportunities

and ethical challenges for psychologists. At present, there are no generally

accepted theories or comprehensive models for e-therapy, and research on the applicability

of traditional therapies is still in its infancy (Heinlen, Welfel, Richmond, &

O’Donnell, 2003; Yuen, Goetter, Herbert, & Forman, 2012). Traditional psychotherapy

techniques based on oral and nonverbal cues may not transfer to Internet communications

through written text (Nickelson, 1998). Additional harm to Internet clients/

patients may be inflicted when psychologists misdiagnose a disorder, fail to identify

suicidal or homicidal ideation, or inadvertently reinforce maladaptive behavior (e.g.,

social phobia) through the use of the Internet medium. Steps that psychologists using

Internet-mediated assessment or therapeutic services might take to ensure the competence

of their work and to protect clients/patients from harm include (a) staying abreast

of advances in the field, (b) requiring in-person initial consultation, and (c) identifying

professionals and health and social service agencies in the locality in which the client/

patient lives who can be enlisted in crisis situations (Fried & Fisher, 2008; Maheu,

2001; Maheu, Pulier, Wilhelm, McMenamin, & Brown-Connolly, 2005).

􀀵 Scientific psychologists serving as expert witnesses should be familiar with federal

rules of evidence regarding case law and expert testimony (e.g., Daubert v. Merrell

Dow Pharmaceuticals, Inc., 1993; Kumho Tire Co., Ltd. v. Carmichael, 1999; see also

the Hot Topic on “The Use of Assessments in Expert Testimony: Implications of Case

Law and the Federal Rules of Evidence” in Chapter 12).

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76——PART II ENFORCEABLE STANDARDS

Evolving Law and School Psychologists

School or educational psychologists who serve as expert witnesses in due process

hearings for educational services need to be familiar with the legal foundations for

special education law such as Brown v. Board of Education (1954) and federal regulations,

including Section 504 of the Rehabilitation Act of 1973 (1993), Education

for All Handicapped Children Act of 1975, the Americans with Disabilities Act of

1990 (ADA), and the Individuals with Disabilities Education Improvement Act

of 2004 (IDEA).

As district employees, school psychologists also have a legal duty to protect all

students attending the school from reasonably foreseeable risk of harm such as

student-on-student violence or harassment or student suicide (Marachi, Astor, &

Benbenishty, 2007). The most common tort against school personnel is the claim

of negligence in this duty. Jacob and Hartshorne (2007) identify four questions

school psychologists may be called upon to address when testifying in a negligence

suit: Was a wrong or damage done to the student’s person, rights, reputation, or

property? Did the school owe a duty in law to the student? Did the school breach

that duty? Was there a proximate cause (causal) relationship between the injury and

the breach of duty?

Forensic Assessments

Knowing the difference between clinical and forensic evaluations is also

important. The clinician’s goal is to help the client/patient adjust positively to life

􀀵 Psychologists offering trial consultation services to organizations may need to have

an understanding of change in venue motions and sexual harassment or retaliation

work policies and laws (Weiner & Bornstein, 2011).

􀀵 Psychologists conducting custody evaluations should have sufficient understanding of

the hearsay rule and what the term “best interests of the child” means in legal proceedings.

They should also understand the distinction between criminal and civil law.

The purpose of criminal law is to determine a person’s guilt or innocence as it relates

to violation of law and to determine appropriate sanctions if the defendant is found

guilty. On the other hand, the purpose of civil law is to determine the best interests of

minors or others who are under guardianship (e.g., child custody disputes, adoption,

capacity determinations), assign responsibility for claims of harm (e.g., workers’ compensation,

personal injury litigation), and provide legal remedies (Bush, Connell, &

Denney, 2006).

􀀵 Psychologists administering psychological services in correctional facilities should be

familiar with guidelines and regulations governing the ratio of psychology staff to

inmates as well as regulations governing access to confidential information by nonpsychologist

correctional staff (American Association of Correctional Psychology, 2000).

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Chapter 5 Standards on Competence——77

circumstances (Bush et al., 2006). The purpose of a forensic evaluation is to

assist the “trier of facts” (a judge, jury, or administrative hearing officer) determine

the legal question. While the forensic evaluator must respect the legal

rights and welfare of defendants or litigants who they assess, techniques aimed

at promoting the testee’s mental health or therapeutic alliance, for example, are

not necessary and, in fact, may be inappropriate (Greenberg & Shuman, 1997).

In addition, legal definitions of mental disorders may differ from those ordinarily

applied for diagnosis and treatment. For example, psychologists conducting

competency assessments should know that the term insanity has different meanings

in different jurisdictions (Denney, 2012). Readers may also wish to refer to

the Hot Topic in Chapter 4 on forensic assessment of intellectual capacity in

death penalty cases.

According to the SGFP (AP-LS Committee on the Revision of the Specialty

Guidelines for Forensic Psychology, 2010; Committee on Ethical Guidelines for

Forensic Psychologists, 1991), psychologists who conduct psychological evaluations

of those accused of a crime must know how to acquire and report details about the

defendant’s intent, motivation, planning, thought processes, and general mental

state at the time of the crime, without divulging information not previously known

by the court that could aid prosecutorial investigation. Such “fruits of the statements”

cannot be admitted into evidence except on an issue relevant to the defendant’s

mental condition already introduced by the defense into testimony.

Fact Witnesses

Sometimes psychologists who do not offer forensic services are asked to provide

legal testimony as a fact witness. Fact witnesses are called on by the court to

provide records or testify on knowledge they have about a patient’s psychological

functioning or treatment not originally obtained for legal purposes (Gottlieb &

Coleman, 2012). For example, an independent practitioner seeing a client for

anxiety-related disorders might be called as a fact witness in a workers’ compensation

case for mental distress involving the client. Under Standard 2.01f, even when

psychologists have no advance knowledge that their work will be used in a legal or

administrative setting, when called on to provide such a service, they are nonetheless

responsible for becoming reasonably familiar with the rules governing their

forensic role.

􀀵 A licensed practitioner was called to testify as a fact witness regarding the diagnosis,

treatment, and treatment progress of a child he was seeing in group therapy.

Prior to going to court, the psychologist obtained consultation on rules governing

privileged communications for children and for patients in group therapy in the

state in which the psychologist practiced (Glosoff, Herlihy, Herlihy, & Spence, 1997;

Knapp & VandeCreek, 1997).

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78——PART II ENFORCEABLE STANDARDS

2.02 Providing Services in Emergencies

In emergencies, when psychologists provide services to individuals for whom other mental

health services are not available and for which psychologists have not obtained the necessary

training, psychologists may provide such services in order to ensure that services are not

denied. The services are discontinued as soon as the emergency has ended or appropriate

services are available.

The Oklahoma City bombing; the September 11, 2001, attacks on the United

States; and the aftermath of Hurricane Katrina illustrate the important public role

of psychological expertise during disasters. Standard 2.02 recognizes that when

adequate mental health services are not available during emergencies, psychologists

without training in therapeutic services or crisis intervention may still have

knowledge and expertise that can benefit the public. The standard permits psychologists,

who do not have the necessary training, to offer such services but

requires that they limit services to the immediate timeframe and to cease as soon

as the emergency has passed or appropriate services become available. When a

city- or statewide disaster erupts unexpectedly, psychologists wishing to offer their

immediate services should have some knowledge of the efficacy of different intervention

techniques to ensure that their services do not exacerbate psychological

trauma.

In rare instances, psychologists who do not have education or training related

to suicidality assessment or intervention may come in contact with an individual

who appears imminently suicidal and for whom no mental health or other

health services are immediately available. Under Standard 2.02, psychologists

without the necessary competencies would be permitted to try to reduce the

immediate risk of suicide. However, the psychologist should call for emergency

services or attempt to obtain or refer the individual for appropriate services as

soon as feasible. Unqualified psychologists should be wary of providing such

services, recognizing the potentially harmful nature of uninformed interventions

and the ethical inappropriateness of providing unqualified treatment if

medical or other suicide crisis services are available (American Psychiatric

Association, 2003).

􀀵 A second-year clinical psychology doctoral student was leaving her social services

externship site when she received an emergency call from a guard who told her a

member of the custodial staff was threatening to commit suicide. The student had

never treated a suicidal patient but knew she was the only mental health provider

still in the building. She immediately called her supervisor, who gave her instructions

on how to provide limited support to the individual while the supervisor

called the nearby hospital emergency services to send a treatment team to the

building.

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Chapter 5 Standards on Competence——79

2.03 Maintaining Competence

Psychologists undertake ongoing efforts to develop and maintain their competence.

The scientific and professional knowledge base of psychology is continually

evolving, spawning new research methodologies, assessment procedures, and forms

of service delivery. Information and techniques constituting the core curricula of

psychologists’ doctoral education and training are often outdated and are replaced

by new information and more effective practices as decades pass. Lifelong learning

is fundamental to ensure that teaching, research, and practice provide an ongoing

positive effect for those with whom psychologists work. Standard 2.03 requires that

psychologists undertake ongoing efforts to ensure continued competence. This

standard is consistent with mandatory requirements for continuing education of

many Psychology Licensing Boards (E. H. Wise et al., 2010). The foundational competencies

developed through graduate education and training (e.g., reflective

practice/self-assessment, scientific knowledge/methods, ethical/legal standards,

individual/cultural diversity) provide psychologists with the basic knowledge and

skills to maintain and foster postgraduate developmental progressions in functional

competence in specific work domains, for example, research evaluation,

intervention, assessment, and consulting (Rodolfa et al., 2005). The requirements

of this standard can be met through independent study, continuing education

courses, supervision, consultation, or formal postdoctoral study.

􀀵 School psychologists are faced with a continuously evolving knowledge base and laws

relevant to effective teacher and school consultation. They must be aware of requirements

for statewide reading and mathematics tests and state and local Board of

Education criteria for attaining academic proficiency for all students, availability of

public school choice, supplemental tutoring, and criteria for evaluating teacher proficiencies

(Jacob & Hartshorne, 2007). They must also understand the requirements of

and fiscal implications to schools of federal laws such as the No Child Left Behind Act

(2001) and keep abreast of future changes to the Act (S. Dillon, 2010).

􀀵 Industrial–organizational psychologists developing personnel screening and employment

practices must stay abreast of continually changing equal employment legislation

(e.g., Title VII of the Civil Rights Act of 1964, ADA, the Uniformed Services

Employment and Reemployment Rights Act of 1994, and the Age Discrimination in

Employment Amendments of 1996), administrative laws (e.g., Equal Employment

Opportunity Act of 1972, Family and Medical Leave Act of 1993, Pregnancy

Discrimination Act of 1978), executive orders (e.g., Executive Order No. 11246,

1964–1965), and court decisions (e.g., Griggs v. Duke Power, 1971; Wards Cove

Packing Company v. Antonio, 1989; see also Cornell University Law School, 2007;

Lowman, 2006; McAllister, 1991; Sireci & Parker, 2006).

􀀵 Forensic psychologists are often asked to assess the validity of an examinee’s symptoms

and presentation to determine if the examinee is attempting to manage impressions

of his or her psychological status. Impression management is highly variable

both between- and within-individual examinees, and as a consequence, accepted

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80——PART II ENFORCEABLE STANDARDS

2.04 Bases for Scientific and Professional Judgments

Psychologists’ work is based on established scientific and professional knowledge of the discipline

(see also Standards 2.01e, Boundaries of Competence, and 10.01b, Informed Consent to

Therapy).

Standard 2.04 requires psychologists to select methods and provide professional

opinions firmly grounded in the knowledge base of scientific and professional psychology.

Scientific knowledge refers to information generated according to accepted

principles of research practice. Professional knowledge refers to widely accepted and

reliable clinical reports, case studies, or observations. Standard 2.04 is firmly rooted

in psychology’s historic recognition of the importance of the reciprocal relationship

between science and practice (APA, 1947). This relationship is bidirectional in that

practitioners must be able to apply scientific knowledge to their applied work and

applied scientists must be able to draw upon practice-based evidence to design and

evaluate real-world interventions (Fisher et al., 2012; J. L. Jones & Mehr, 2007).

Psychologists engaged in innovative activities, who do not draw on established

knowledge of the field may fail to anticipate or detect aspects of such procedures

that could lead to substantial misrepresentation or harm. The standard permits the

use of novel approaches, recognizing that new theories, concepts, and techniques

are critical to the continued development of the field. It does, however, prohibit

psychologists from applying idiosyncratic ideas and techniques that are not

grounded in either accepted principles or the field’s cumulative knowledge of psychological

research or practice.

measures and techniques for assessing symptom validity are continuously evolving.

Failing to detect malingering or failing to recognize symptoms as indicators of a valid

mental health disorder results in harm to all stakeholders in the legal process. Forensic

psychologists need to keep abreast of evolving research on the assessment of facetious

disorders (Larrabee, 2007; see also sections on malingering in Chapter 12).

􀀵 Investigators and statistical consultants should remain current in dynamically evolving

statistical methodology and avoid the use of antiquated statistical methods (ASA,

1999; Panter & Sterba, 2011).

􀀴 Several families who believed that their children had been the victims of sexual abuse

in the day care center they attended retained the services of a clinical psychologist to

evaluate and testify in court that the children had been abused. During her years in

practice, the psychologist had created for her own use a set of criteria for determining

abuse based on her clinical observations and the writings of two leading practitioners

who observed what they determined were universal syndromes of child sexual abuse.

The psychologist’s testimony played an important role in convicting the day care staff

members. On appeal, however, the conviction was overturned based on the appellate

court’s finding that the psychologist’s evaluation methods were invalid, unreliable,

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Chapter 5 Standards on Competence——81

Psychologists trained in more traditional techniques also have a responsibility to

keep up with evolving knowledge of the field to know under which conditions and

for which disorders treatments do and do not work and which have iatrogenic risks

(Pope & Vasquez, 2007; see also Standard 2.03, Maintaining Competence).

Evidence-Based Practice

The APA Presidential Task Force report on evidence-based practice in psychology

(EBPP) (adopted as policy in 2005, see APA, 2006) emphasized both the importance

of scientific knowledge to treatment decisions and the importance of clinical judgment

in determining the applicability of research findings to individual cases. The

task force defined EBPP as the integration of the best available research with clinical

expertise in the context of client/patient characteristics, culture and preferences, and

relevance to the client’s/patient’s treatment and assessment needs. Clinical expertise

was defined as competence attained by psychologists through education, training,

and experience resulting in effective practice and the ability to identify and integrate

the best research evidence with clinical data (e.g., patient information obtained over

the course of treatment or assessment; see also APA, 2002a).

Other professional groups have endorsed the integration of research and practice

knowledge as an ethical obligation. For example:

and not probative of sexual abuse. For additional discussion of these issues, see Fisher

(1995), Fisher and Whiting (1998), and Kuehnle and Sparta (2006).

􀀴 On the day of and immediately following the attacks on September 11, 2001, psychologists

from across the country who were not trained in trauma treatment rushed

to provide services to victims, rescuers, and their families. An immediate controversy

arose regarding their application of the popular but unvalidated Critical Incident

Stress Debriefing (CISD) technique. The CISD encourages individuals to discuss their

emotional reactions to a traumatic event immediately following exposure, with proponents

claiming that it reduces immediate distress, prevents later adverse psychological

reactions, and helps screen for individuals who are at risk for developing more

serious disorders (Everly, Flannery, & Mitchell, 2000). Adversaries claimed the debriefing

treatment had no efficacy or was potentially harmful to victims of the terrorist

attacks (van Emmerick, Kamphuis, Hulsbosch, & Emmelkamp, 2002). By the second

day, there was a public call to stop untrained “trauma tourists” from using the technique

based on concerns they might have actually compounded the effects of trauma

on those they “treated” (Bongar et al., 2002).

􀀵 The National Association of School Psychologists’ Principles for Professional Ethics

(NASP, 2010) requires that “school psychologists use assessment techniques, counseling

and therapy procedures, consultation techniques, and other direct and indirect

service methods that the profession considers to be responsible, research-based

practice” (Standard II.3.2).

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82——PART II ENFORCEABLE STANDARDS

􀀵 The draft revision of the SGFP includes a provision that “forensic practitioners typically

provide opinions and testimony that are (a) sufficiently based upon facts or data

and on adequate scientific foundation; (b) the product of reliable principles and

methods; and (c) based on principles and methods that have been applied reliably to

the facts of the case” (Provision 4.05, AP-LS, 2010).

􀀵 The Journal of Clinical Psychology: In Session, recently published a series of articles

describing the convergence of evidence-based practice (EBP) and multiculturalism

with illustrations of EBP that have successfully addressed the clinical needs of cultural

minority populations (Morales & Norcross, 2010).

Need to Know: Navigating the

Online Search for EBPs

The ability to use online searches to quickly identify evolving best practices may become

an essential competence required by health insurance organizations (Standard 2.03,

Maintaining Competence; Berke, Rozell, Hogan, Norcross, & Karpiak, 2011; Guyatt, Rennie,

Meade, & Cook, 2008; Weinfeld & Finkelstein, 2005). New research on EBP for diverse

disorders, populations, and treatment modalities is constantly emerging. Primary databases

such as PubMed Clinical Queries (http://www.ncbi.nlm.nih.gov/pubmed/clinical) and

psycINFO (APA, 2010b) have begun to contain references to individual studies that clinicians

must individually evaluate with respect to their validity and relevance to the current

treatment question. Other EBP databases are designed to facilitate practitioner searches

by including summaries of new empirical studies on clinical efficacy that have been evaluated

for scientific validity and applicability (e.g., the National Registry of Evidence-Based

Programs and Practices website, http://www.nrepp.samhsa.gov; see also Hennessy &

Green-Hennessy, 2011).

Falzon, Davidson, and Bruns (2010) have developed a formula to guide practitioner

online searches for the EBP most applicable to a particular client/patient. Their PICO formula

includes finding appropriate search terms for four components: (P) patient disorder,

for example, depression with suicidal ideation; (I) type of intervention the clinician is

considering, for example, dialectical behavior therapy (DBT); (C) the comparison intervention

the clinician is considering, for example, cognitive–behavioral therapy; and (O) the

outcome measure of interest, for example, reduction in symptoms or need for hospitalization.

Once the research has been collected, psychologists need to draw on previous scientific

and professional training to critically evaluate which studies best meet criteria for

ecological validity, relevance, and utility for the individual clinical case.

In many instances, the EBPs reviewed may not provide a perfect match to all aspects

of the clinical question. Appropriate application of the EBP thus requires clinical judgment

in determining how best to integrate or adapt the EBP in ways that are best fitted to the

psychologist’s clinical expertise, treatment context, and patient’s clinically relevant needs

and characteristics (see also Standard 2.04, Bases for Scientific and Professional

Judgments). Final steps in the process include monitoring and evaluating the effectiveness

of the EBP-informed treatment for the specific client, making clinically informed modifications

and, if needed, conducting a new database search.

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Chapter 5 Standards on Competence——83

2.05 Delegation of Work to Others

Psychologists who delegate work to employees, supervisees, research or teaching assistants, or

who use the services of others, such as interpreters, must take reasonable steps to: (1) avoid

delegating such work to persons who have a multiple relationship with those being served that

would likely lead to exploitation or loss of objectivity; (2) authorize only those responsibilities that

such persons can be expected to perform competently on the basis of their education, training, or

experience, either independently or with the level of supervision being provided; and (3) see that

such persons perform these services competently. (See also Standards 2.02, Providing Services in

Emergencies; 3.05, Multiple Relationships; 4.01, Maintaining Confidentiality; 9.01, Bases for

Assessments; 9.02, Use of Assessments; 9.03, Informed Consent in Assessments; and 9.07, Assessment

by Unqualified Persons.)

In their obligation to protect the rights and welfare of those with whom they

work, psychologists who delegate or use the services of others are responsible for

ensuring that such work is performed competently. To be in compliance with

Standard 2.05, psychologists should (a) evaluate whether employees, supervisees,

assistants, or others whose services are used have the skills to implement the task

independently or under appropriate supervision, (b) assign such individuals only

those tasks for which they are qualified, and (c) monitor the activities to ensure

competent implementation.

􀀵 Consulting and industrial–organizational psychologists who delegate employee

assessments or organizational research responsibilities to others must ensure to the

extent feasible that such individuals have adequate training in the testing or data

collection skills necessary to implement the work proficiently.

􀀵 Psychologists in academia must take reasonable measures to ensure that research

and teaching assistants have the knowledge and skills required to implement valid

and ethical research procedures, teach or advise students, or grade exams.

􀀵 Psychologists in mental health settings who supervise psychologist and nonpsychologist

staff (e.g., lay leaders for group work; see Glass, 1998) must take steps to determine

that these individuals have the necessary training to perform or assist in

therapeutic procedures (Stratton & Smith, 2006).

􀀵 School psychologists must read and approve before signing assessments administered

and scored by or pupil reports prepared by graduate students, externs, or others under

the psychologists’ supervision.

Implications of HIPAA

Psychologists who are covered entities under HIPAA should be aware that the

act requires covered entities to train, document, and appropriately sanction

employees regarding federal policies and procedures involving Protected Health

Information (PHI) (DHHS 45 CFR 164.530[b][1]; see “A Word About HIPAA” in

the Preface of this book).

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84——PART II ENFORCEABLE STANDARDS

Use of Interpreters

Standard 2.05 specifically draws attention to the appropriate delegation of work

to interpreters who assist psychologists in providing services for or conducting

research involving individuals who use American Sign Language or who do not

speak the same language as the psychologist. Psychologists must ensure that interpreters

have adequate translation skills and sufficient understanding of the psychological

nature and ethical responsibilities of the duties to be performed. Some

clients/patients who are hearing impaired or do not speak English live, work, or

socialize in close-knit communities in which those who serve as interpreters are

known personally. In such settings, psychologists should avoid delegating work to

such individuals when it will create a multiple relationship between the interpreter

and the research participant or person receiving services that could reasonably be

expected to lead to breaches in confidentiality, exploitation, or loss of objectivity.

􀀴 At the beginning of the fall academic year, a public school experienced an influx of

new pupils who had recently emigrated from Russia and who did not speak English.

In the rush to ensure adequate academic placement for the students, the school psychologist

asked a member of the custodial staff who was fluent in Russian and English

to serve as an interpreter for administration of tests to determine if any of the pupils

had learning disabilities.

􀀵 A research psychologist received IRB approval to conduct a study concerning health

knowledge and behaviors of illegal immigrants. All informed consent and interview

scripts were translated into the participants’ language. The psychologist realized that

legal residents of the community trusted by prospective participants would be more

effective participant recruiters than university staff. He placed an ad in the local

papers and spent a week training newly hired community-based recruiters in methods

to protect prospective participants from coercion, ensure confidentiality of information

collected, and avoid exploitative or otherwise harmful multiple relationships.

Reasonable Steps

The phrase “take reasonable steps” recognizes that despite their best efforts,

persons to whom work is delegated may fail to perform their duties appropriately.

The phrase also recognizes that sometimes psychologists working in organizations,

in the military and other public service positions, or at the bequest of the

legal system may be assigned assistants, employees, or interpreters insufficiently

qualified to perform their duties. Psychologists must at minimum discuss their

concerns and ethical obligations with those responsible for such assignments,

provide appropriate training when feasible, and closely supervise and monitor

performance (see Standards 1.02, Conflicts Between Ethics and Law, Regulations,

or Other Governing Legal Authority, and 1.03, Conflicts Between Ethics and

Organizational Demands).

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Chapter 5 Standards on Competence——85

2.06 Personal Problems and Conflicts

(a) Psychologists refrain from initiating an activity when they know or should know that there is

a substantial likelihood that their personal problems will prevent them from performing their

work-related activities in a competent manner.

There is a growing body of research indicating that emotional, social, healthrelated,

and other personal problems can interfere with psychologists’ ability to use

their skills effectively. Substance abuse problems, acute depression or other mental

disorders, chronic or life-threatening diseases, and other stressful life events such as

divorce or the death of a loved one are situations that sometimes prevent psychologists

from performing their work in a competent manner (W. B. Johnson & Barnett,

2011; O’Connor, 2001; Sherman & Thelen, 1998). Work-related stressors, such as

social isolation in private practice, burnout, and vicarious traumatization encountered

by some psychologists working with survivors of trauma, can lead to boundary

violations and otherwise compromise effective job performance (Pearlman &

Saakvitne, 1995; Skorupa & Agresti, 1993). Clients/patients, students, employers,

and employees suffer when personal problems prevent psychologists from competently

implementing their work, and the misconduct that is often a product of these

circumstances harms public perceptions of psychology.

Standard 2.06a requires psychologists to refrain from beginning an activity

when there is a substantial likelihood their personal problems may impair their

ability to perform their work competently. The phrases “refrain from beginning”

and “substantial likelihood” indicate that the intent of this standard is preemptive:

It prohibits psychologists from taking on a professional or scientific role when their

personal problems have the potential to impair their work. As signified by the

phrase “or should know,” psychologists suffering from problems that would reasonably

be expected by members of the profession to cause work-related impairment

􀀵 A consulting psychologist was hired to conduct a job analysis to determine hiring

needs for an organization. The company agreed to provide the psychologist with one

of their administrative assistants to help schedule meetings and provide other clerical

assistance. The consulting psychologist discovered that the assistant was discussing

with other employees her misimpression of the goals and preliminary findings of the

job analysis in a manner that compromised the validity of future assessments. The

psychologist immediately brought this matter to the assistant’s attention and began

to have biweekly monitoring meetings with the assistant to ensure her understanding

of her role responsibilities.

􀀵 A prescribing psychologist worked in a hospital that employed nurse practitioners to

conduct patient medical histories at intake. The psychologist noticed that while the

nurses’ reports contained detailed information regarding physical health, the histories

were incomplete in terms of information relevant to mental health. The psychologist

requested and received approval from the medical director to run a brief training session

on mental health intake procedures for the nurses.

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86——PART II ENFORCEABLE STANDARDS

will not avoid a finding of violation of this standard by claiming they did not know

that their problems could interfere with their work. Pope and Brown (1996) note

that competence in the conduct of psychotherapy requires knowledge of selfmonitoring

techniques to identify one’s own emotional strengths and weaknesses,

needs and resources, and abilities and limits. Signs may include intense emotional

reactions during therapy.

􀀵 A psychologist had just returned to independent practice following chemotherapy for

a cancer that was now in remission. The psychologist believed that she had recovered

from the fatigue and mental stress of the chemotherapy but recognized that such

symptoms may persist. She set up a weekly consultation meeting with a colleague to

help monitor her work until she was confident that the symptoms had fully abated.

􀀴 An industrial–organizational psychologist responsible for preemployment screening

for an organization had begun to drink heavily and found that he needed to have

several beers before seeing candidates in the morning and several more drinks periodically

throughout the workday. In response to a complaint to the APA Ethics

Committee filed by an applicant who was appalled by the psychologist’s slurring of

words during a screening, the psychologist claimed that his alcoholism prevented him

from acknowledging he had a problem.

Strategies for Preventing Work-Related Stress

Involving High-Risk Clients/Patients

Kristen Webb (2011) addressed the ethical dilemma of providing consistent and

reliable care to a patient with suicidal urges, self-harming behaviors, and significant

abandonment issues with the need to ensure competent provision of services in formal

sessions and telephone contact. She scheduled brief (8-minute) regular telephone

check-ins between sessions to assure the patient of her availability to assist with lifethreatening

urges, but she limited these phone calls to skills coaching. She adhered to

firm boundaries for beginning and ending sessions. Webb carefully used self-disclosure

to provide the patient with examples of how she had weathered storms in her life,

consistently monitoring the effect of the disclosures on her patient and the therapeutic

(vs. countertransferential) motivation for the disclosures, and sought regular peer

consultation. She was alert to feelings of professional discouragement, physical

exhaustion, and stress related to fears of a poor outcome for her patient. She monitored

her sleep and eating, created transitional activities between work and home, and

made time to set aside her worries and counter the self-isolation that therapists can

experience through self-nourishing exercise and socializing. Readers may also wish to

refer to the Hot Topic in Chapter 3 on the ethics of self-care.

(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 assistance, and determine whether they should limit, suspend, or

terminate their work-related duties. (See also Standard 10.10, Terminating Therapy.)

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Chapter 5 Standards on Competence——87

Standard 2.06b applies to situations in which psychologists who are already

providing services, teaching, or conducting research become aware that their personal

problems are interfering with their work. The standard calls for psychologists

to take appropriate steps to remedy the problem and to determine whether such

remedies are sufficient for them to continue work-related activities.

􀀵 A teaching psychologist who was undergoing outpatient treatment for a life-threatening

medical disorder found it increasingly difficult to prepare lectures, grade papers, and

mentor students effectively. The psychologist consulted with the chair of the department,

who agreed to assign an experienced graduate teaching assistant for the lectures.

The psychologist also asked a colleague to serve as a consultant on the two

dissertations he was currently mentoring.

􀀵 A counseling psychologist returned to her position at a college counseling center after

sick leave for physical injuries incurred during a car accident. Within a week at the

counseling center, the psychologist realized the pain medication she was frequently

taking during the day was interfering with her ability to focus on clients’ problems.

She contacted a psychologist assistance program in her state that helped her taper off

the medications, provided ongoing supervision to help her self-monitor her ability to

perform her tasks, and provided support for the psychologist to approach the director

of the counseling center to cut back on her hours.

Distinguishing between personal and professional impairment is not always easy,

nor is there consensus among members of the profession on how to identify workrelated

impairment (P. L. Smith & Burton Moss, 2009; Williams, Pomerantz, Segrist,

& Pettibone, 2010). Fear of losing highly valued abilities in the face of serious,

chronic, or life-threatening diseases or being judged by colleagues as incompetent

can create denial and professional blind spots (Barnett, 2008). Health problems and

personal distress become professional deficits when they make services ineffective or

compromise functioning in ways that harm students, research participants, organizational

clients, and patients (Munsey, 2006). Signs of impairment may include

intense emotional reactions (e.g., anger or uncontrolled sexual attraction), disrespectful

comments to clients/patients or students, lack of energy or interest in work,

or using work to block out negative personal feelings to the detriment of those with

whom one works (Pope & Vasquez, 2007; P. L. Smith & Burton Moss, 2009).

To comply with this standard, psychologists can turn to the increasing number

of state licensing boards and state psychological associations that provide colleague

assistance programs to help psychologists deal proactively with and remediate

impairment (APA Committee on Colleague Assistance, 2006; Barnett &

Hillard, 2001). If such steps are not adequate to ensure competence, Standard

2.06a requires that psychologists appropriately limit, suspend, or terminate workrelated

duties.

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􀀴 A psychologist working in a correctional facility was violently attacked by a new

prisoner during a psychological assessment interview. The psychologist did not seek

psychological counseling for his reaction to the assault. A month later, the psychologist

was conducting an intake of a prisoner who reminded him of his attacker.

Although the psychological assessment did not provide evidence of extreme dangerousness,

the psychologist’s report indicated the prisoner was highly dangerous and

should be assigned to the most restrictive environment (adapted from Weinberger &

Sreenivasan, 2003).

Need to Know: Education

and Training Stressors

Graduate students are also vulnerable to stressful life experiences, physical or mental

illness, and substance use problems. In addition, graduate schools and postdoctoral

internships or research can create distress related to financial concerns, relocation, lack of

social support, and academic and related time pressures (APA, Committee on Colleague

Assistance, 2006; Tamura, 2012). Education and training programs can increase the

competent conduct of practice and research by providing (a) materials on how personal

problems can diminish professional competence; (b) strategies for assessing and

monitoring when these problems may compromise effectiveness and harm those with

whom they work; (c) opportunities to openly discuss these issues with faculty and

supervisors; and (d) fair and effective approaches to remediation and, if necessary,

termination, when a student exhibits signs of impairment (N. J. Kaslow, et al., 2007;

Tamura, 2012; see also Hot Topic “The Ethical Component of Self-Care” in Chapter 3).

HOT TOPIC

Multicultural Ethical Competence

Ethical decision making for psychological research and practice in diverse cultural venues must be sensitive to

cultural attitudes toward individual autonomy and communal responsibility, historical and contemporary discrimination

within society and psychology as a discipline, sociopolitical factors influencing definitions of race

and ethnicity, and variations in immigration history, acculturation, cultural/ethnic identity, language, and mixed

race/ethnic heritage (Arrendo & Toporek, 2004; Fisher et al., 2002; Fisher et al., 2012; Fisher, in press; Lyon &

Cotler, 2007; Ponterotto, Casas, Suzuki, & Alexander, 2001; D. W. Sue & Sue, 2003; Trimble & Fisher, 2006).

Multicultural responsibility requires “a fusion of personal and professional commitments to consider culture

during ethical encounters” (Ridley et al., 2001, p. 176). This Hot Topic section applies the ethical decisionmaking

model introduced in Chapter 3 to help psychologists identify key questions to consider as a means of

acquiring the attitudes and knowledge essential to multicultural ethical competence.

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Chapter 5 Standards on Competence——89

Multicultural Ethical Commitment

Multicultural ethical commitment requires a strong desire to understand how culture is relevant to the identification

and resolution of ethical problems. It demands a moral disposition and emotional responsiveness that

moves psychologists to explore cultural differences and creatively apply the APA Ethics Code to each cultural

context. Cultivation of these competencies thus includes motivation to consider the influence of culture in

psychologists’ work conscientiously, prudently, and with caring discernment.

The desire to ensure that cultural sensitivity is integrated into ethical decision making requires a willingness

to reflect on how one’s own cultural values and cultural identity influence the way ethics is conceived in one’s

activities as a psychologist (Arredondo, 1999; Helms, 1993; Trimble, Trickett, Fisher, & Goodyear, 2012). Furthermore,

multicultural ethical competence entails recognition of harms that psychology can exert on culturally

diverse groups by invalidating their life experiences, defining their cultural values or differences as deviant, and

imposing the values of dominant culture upon them (Fisher, 1999; Fisher et al., 2002; Fowers & Davidov, 2006;

Prilleltensky, 1997; Trimble & Fisher, 2006; Vasquez, 2012).

In psychological research and practice, multicultural ethical commitment involves motivation to do the

following:

Critically examine moral premises in the discipline that may largely reflect Eurocentric conceptions of

the good

Question “deficit” and “ethnic group comparative” approaches to understanding cultural differences

Address the reality and impact of racial discrimination in the lives of cultural minorities

Recognize that socially constructed racial/ethnic labels can strip participants of their personal identity by

responding to them only in terms of racial or ethnic categorizations

Avoid conceptually grouping members of ethnic minority groups into categories that may not reflect how

individuals see themselves

Engage in self-examination of how institutional racism may have influenced each psychologist’s own

role, status, and motivation to develop professional identities free from these influences

Develop the flexibility required to respond to rapid cultural diversification and fluid definitions of culture,

ethnicity, and race

Multicultural Ethical Awareness

Multicultural ethical commitment is just the first step toward multicultural ethical competence. Good intentions

are insufficient if psychologists fail to acquire relevant knowledge about cultural differences and how they may

affect the expression of and solutions for ethical problems. To ethically work with diverse populations, psychologists

must remain up-to-date on advances in multicultural research, theory, and practice guidelines relevant

to their work (Salter & Salter, 2012). This may include an understanding of the following:

The history of ethical abuses of cultural minorities in the United States, and how this may exacerbate

disparities in mental health care, employment, criminal justice, and involvement in psychological

research

The impact on mental health of historical and contemporary discrimination in employment, education,

housing, and other areas

Cultural and contextual factors that may facilitate or interfere with psychological well-being or responsiveness

to treatment

Scientific, social, and political factors influencing the definitions of race, ethnicity, and culture, and how

these may serve as barriers to conducting psychological activities that protect individuals’ rights and

welfare

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90——PART II ENFORCEABLE STANDARDS

Within-group as well as between-group differences that may be obscured by cultural stereotypes in

society and within the discipline of psychology

Knowledge and skills in constructing and implementing culturally valid and language-appropriate

assessments, treatments, research procedures, teaching strategies, and consulting and organizational

evaluation techniques

Knowledge of relevant ethical standards in the APA Ethics Code and organizational guidelines relevant

to multicultural ethical competence in research and practice

Knowledge of antidiscrimination federal and state laws relevant to the contexts in which psychologists

work

Goodness-of-Fit Ethics and Multicultural Ethical Decision Making

Multicultural ethical commitment and ethical awareness are essential but not sufficient to ensure ethical resolution

of multicultural challenges. Given the dynamic nature of individual, institutional, and sociopolitical concepts

of race, culture, and ethnicity, ethical decision making across different cultural contexts can be informed but may

not be resolved by previous approaches to ethical problems. Many multicultural ethical challenges are unique

to the culture, the salience of the culture for a particular individual in a particular context, other within-culture

individual differences, the environment in which the psychological activity occurs, and the goals of that activity

(Nicolaidis et al., 2010). In applying the steps for ethical decision making described in Chapter 3, multicultural

ethical competence includes (a) creating a goodness of fit between the cultural context and the psychologist’s

work setting and goals and (b) engaging in a process of co-learning that ensures this fit (Fisher, 1999, 2002a,

in press; Fisher & Goodman, 2009; Fisher & Masty, 2006; Fisher & Ragsdale, 2006; Fisher et al., 2012; Trimble,

Trickett, Fisher, & Goodyear, 2012).

Applying goodness-of-fit ethics to multicultural contexts requires reflection on the following questions:

What are the cultural circumstances that might render individuals more susceptible to the benefits or

risks of the intended psychological assessment, treatment, or research?

Are cultural factors under- or overestimated in the assessment, treatment, organizational evaluation, or

research plan?

Do psychologists and members of cultural groups with whom they work have different conceptions of

practice goals or research benefits?

Are traditional approaches to informed consent and confidentiality protections compatible with the

values of spirit, collectivity, and harmony characteristic of different ethnocultural populations?

Are there aspects of the psychological work setting that are “misfitted” to the competencies, values,

fears, and hopes of recipients of psychological services, examinees, employees, or research participants?

How can the setting (including the aims and procedures to accomplish these aims) be modified to fit the

requirements of culturally sensitive and responsibly conducted psychology?

How can psychologists engage organizations and employees, clients/patients and practitioners, students

and school personnel, research participants, and investigators in discussions that will help illuminate the

cultural lens through which each views the psychologist’s work?

Culture is a dynamic construct influenced by an ever-changing sociopolitical landscape. Ethical decision

making that includes multicultural commitment and awareness can help psychologists correct cultural misimpressions

and biases in their work. An openness to learning from and collaborating with stakeholders can help

psychologists implement and monitor the cultural adequacy of ethical decisions and make appropriate adjustments

when necessary. Multicultural ethical competence requires a process of lifelong learning that enables

psychologists to make ethical decisions that reflect and respect the values of the discipline of psychology and

the values of cultural communities.