A thorough understanding of ethics and the ethical guidelines that govern the wo

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

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


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

Pages 113 – 115


Psychology: Science, Practice, and Culture

What Makes Multiple Relationships Unethical?

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

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. (American Psychological
Association, 2002, p. 1065)

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

As the last line of the standard above indicates, it is
possible to engage in a multiple relationship that is neither impairing to the
psychologist nor exploitive or harmful to the client. (And in some settings,
such as small communities, such multiple relationships may be difficult to avoid.
We discuss this in more detail later in this chapter.) However, multiple
relationships can be ethically treacherous territory, and clinical
psychologists owe it to their clients and themselves to ponder such
relationships with caution and foresight. Sometimes, major violations of the
ethical standard of multiple relationships are preceded by “a slow process of
boundary erosion” (Schank et al., 2003, p. 183). That is, a clinical
psychologist may engage in some seemingly harmless, innocuous behavior that doesn’t
exactly fall within the professional relationship—labeled by some as a
“boundary crossing” (Gabbard, 2009b; Zur, 2007)—and although this behavior is
not itself grossly unethical, it can set the stage for future behavior that is.
These harmful behaviors are often called “boundary violations” and can cause
serious harm to clients, regardless of their initial intentions (Gutheil &
Brodsky, 2008; Zur, 2009).

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


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

One specific ethical standard in the section on competence
(2.01a) addresses the boundaries of competence: “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”
(American Psychological Association, 2002, p. 1063).

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

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

Among the many aspects of competence that clinical
psychologists must demonstrate is cultural competence (as discussed extensively
in the previous chapter). Ethical Standard 2.01b (American Psychological
Association, 2002) states that when

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. (pp. 1063–1064)

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

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

The American Psychological Association’s (2002) code of
ethics also recognizes that psychologists’ own personal problems can lessen
their competence: “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” (Standard 2.06, p. 1064). Of course, personal
problems that impede psychologists’ performance can stem from any aspect of
their personal or professional lives (Barnett, 2008). On the professional side,
the phenomenon of burnout among clinical psychologists has been recognized in
recent decades (e.g., Grosch & Olsen, 1995; Morrissette, 2004). Burnout
refers to a state of exhaustion that relates to engaging continually in
emotionally demanding work that exceeds the normal stresses or psychological
“wear and tear” of the job (Pines & Aronson, 1988). Due to the nature of
the work they often perform, clinical psychologists can find themselves quite
vulnerable to burnout. In one study of more than 500 licensed psychologists
practicing therapy (Ackerley, Burnell, Holder, & Kurdek, 1988), more than
one third reported that they had experienced high levels of some aspects of
burnout, especially emotional exhaustion. In this study, the factors that
increased a psychologist’s susceptibility to burnout included feeling
overcommitted to clients, having a low sense of control over the therapy, and
earning a relatively low salary. A more recent study confirmed that over
involvement with clients correlates strongly with burnout, particularly in the
form of emotional exhaustion (Lee, Lim, Yang, & Lee, 2011).


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