Ethics in Psychotherapy and Counseling

The ethics book no psychology student or professional should be without

Thoroughly updated and expanded to include recent research findings, landmark legal decisions, the Hoffman Investigation Report, and changes in the ethical guidelines of the American Psychological Association and the Canadian Psychological Association, the new 5th edition of Ethics in Psychotherapy and Counseling covers the latest developments in ethical thinking, standards, and practice. You'll learn how to strengthen your ethical awareness, judgement, and decision-making.

Distinguished Emeritus Professor Don Meichenbaum described the 5th edition as 'a MUST READ book for both beginning and seasoned clinicians' and Professor David H. Barlow wrote, 'A stunningly good book. . . . If there is only one book you buy on ethics, this is the one.'

• Covers the many changes and challenges brought about by new technology, EHRs, videoconferencing, and texting, as well as practicing across state and provincial borders
• Discusses moral distress and moral courage
• Includes 5 chapters on different aspects of critical thinking about ethical challenges, including a chapter on 'Ethics Placebos, Cons, and Creative Cheating: A User's Guide'
• Deals with complex issue of culture, race, religion, sexual identity, sexual orientation, and politics
• Provides steps to strengthen ethics in organizations
• Offers guidance on responding to ethics, licensing, and malpractice complaints—not to imply that you'll need to after reading this book!

KENNETH S. POPE is in independent practice as a licensed psychologist. He has chaired the ethics committees of the American Psychological Association (APA) and the American Board of Professional Psychology (ABPP). He received the 2015 Canadian Psychological Association John C. Service Member of the Year Award.

MELBA J. T. VASQUEZ is a psychologist in independent practice in Austin, Texas. She has served on various ethics committees and task forces and served as the 2011 President of the American Psychological Association.

Acknowledgments xxiii

Preface xxv

Chapter 1 Strengthening Ethical Intelligence: What Do I Do Now? 1

Chapter 2 Ethics in Real Life: Grad School Didn’t Prepare Us for This 7

Computer Coincidences 8

Life in Chaos 10

Evaluating Children 11

The Fatal Disease 12

The Mechanic 13

The Postdoctoral Experience 14

Staying Sober 15

Chapter 3 The Human Therapist and the (Sometimes) Inhuman Relationship: Being Absent in the Present 17

Chapter 4 Avoiding Pseudoscience, Fads, and Academic Urban Legends 22

Chapter 5 Ethical Judgment Under Uncertainty and Pressure: Critical Thinking About Heuristics, Authorities, and Groups 26

Cognitive Commitments 27

Authorities 29

Groups 30

WYSIATI 31

Imaginative Illusions 32

Chapter 6 26 Logical Fallacies in Ethical Reasoning 36

1. Ad Hoc Rationalization 36

2. Ad Hominem or Ad Feminam 37

3. Affirming the Consequent 37

4. Appeal to Ignorance (Ad Ignorantium) 38

5. Argument to Logic (Argumentum ad Logicam) 38

6. Begging the Question (Petitio Principii) 38

7. Composition Fallacy 39

8. Denying the Antecedent 39

9. Disjunctive Fallacy 40

10. Division Fallacy 40

11. Existential Fallacy 40

12. False Analogy 41

13. False Continuum 41

14. False Dilemma 41

15. False Equivalence 41

16. Genetic Fallacy 42

17. Golden Mean Fallacy 42

18. Ignoratio Elenchi 42

19. Mistaking Deductive Validity for Truth 43

20. Naturalistic Fallacy 43

21. Nominal Fallacy 44

22. Post Hoc, Ergo Propter Hoc (After This, Therefore on Account of This) 44

23. Red Herring 44

24. Slippery Slope (Also Known as the Camel’s Nose Fallacy) 45

25. Straw Person 45

26. You Too! (Tu Quoque) 46

Chapter 7 Using and Misusing Words to Reveal and Conceal 47

Substitute the General for the Specific 49

Use a Conditional Frame for Consequences 49

Use Denied Motivation as Misdirection 50

Use the Abstract Language of Technicalities 50

Use the Passive Voice 50

Make Unimportant by Contrasting With What Did Not Occur 51

Replace Intentional Unethical Behavior With the Language of Accidents, Misfortune, and Mistakes 51

Smother the Events in the Language of Attack 52

Chapter 8 Ethics Placebos, Cons, and Creative Cheating: A User’s Guide 54

Chapter 9 Trust, Power, and Caring 58

Trust 58

Power 60

Caring 63

Chapter 10 Moral Distress and Moral Courage 66

Chapter 11 The Ethics of Teletherapy, Internet Therapy, and Other Digital Work: Challenges of the New Technologies 82

Risks, Downsides, and Disasters 85

Five Special Pitfalls 88

Questions to Assess Uses of Digital Media 94

Chapter 12 Competence and the Human Therapist 102

Competence as an Ethical and Legal Responsibility 104

Competence and Conflict 105

Intellectual Competence: Knowing About and Knowing How 106

Emotional Competence for Therapy: Knowing Yourself 107

Chapter 13 Creating—and Using—Strategies for Self-Care 114

Paying Attention to the Self 114

What Happens When Self-Care Is Neglected 115

Making Sure the Strategies Fit 117

The Need for Change 122

Chapter 14 Creating a Professional Will 123

Who Takes Charge? 124

Who Serves as Backup? 124

Coordinated Planning 124

Your Office, Its Key, and Its Security 125

Your Schedule 125

Client Records and Contact Information 125

Avenues of Communication for Clients and Colleagues 126

New Messages for Your Answering Machine, E-mail Account, and So On 126

Informed Consent 126

Client Notification 126

Colleague Notification 127

Professional Liability Coverage 127

Attorney for Professional Issues 128

Billing Records, Procedures, and Instructions 128

Expenses 128

Your Personal Will 128

Legal Review 129

Copies of the Professional Will 129

Review and Update 129

Chapter 15 Codes and Complaints in Context: Historical, Empirical, and Actuarial Foundations 130

Mechanisms of Accountability 133

Ethics Committees, Codes, and Complaints 135

Patterns of Ethics Complaints for CPA and APA 143

The Hoffman Report 145

Licensing Boards 146

Civil Statutes and Case Law 150

Criminal Statutes 152

Conclusion 152

Chapter 16 Responding to Ethics, Licensing, or Malpractice Complaints 154

Don’t Panic 155

Consult Your Attorney First—and Make Sure You Have a Good One! 155

Notify Your Professional Liability Carrier 156

Who Is Your Attorney’s Client? 156

Is the Complaint Valid? 157

Did You Make a Formal Complaint More Likely? 157

Apologize and Accept Responsibility? 158

What Are You Willing to Have Done? 158

Recognize How the Complaint Is Affecting You 159

Get the Help and Support You Need 160

What Can the Ordeal Teach? 160

Chapter 17 Steps in Ethical Decision Making 161

Step 1: State the Question, Dilemma, or Concern as Clearly as Possible 161

Step 2: Anticipate Who Will Be Affected by the Decision 162

Step 3: Figure Out Who, If Anyone, Is the Client 162

Step 4: Assess Whether Our Areas of Competence—and of Missing Knowledge, Skills, Experience, or Expertise—Fit the Situation 162

Step 5: Review Relevant Formal Ethical Standards 163

Step 6: Review Relevant Legal Standards 163

Step 7: Review the Relevant Research and Theory 163

Step 8: Consider Whether Personal Feelings, Biases, or Self-Interest Might Shade Our Ethical Judgment 163

Step 9: Consider Whether Social, Cultural, Religious, or Similar Factors Affect the Situation and the Search for the Best Response 164

Step 10: Consider Consultation 164

Step 11: Develop Alternative Courses of Action 164

Step 12: Think Through the Alternative Courses of Action 164

Step 13: Try to Adopt the Perspective of Each Person Who Will Be Affected 165

Step 14: Decide What to Do, Review or Reconsider It, and Take Action 165

Step 15: Document the Process and Assess the Results 165

Step 16: Assume Personal Responsibility for the Consequences 166

Step 17: Consider Implications for Preparation, Planning, and Prevention 166

Chapter 18 Beginnings and Endings, Absence and Access 167

Accessibility for People With Disabilities 168

Clarification 168

Therapist Availability Between Sessions 171

Vacations and Other Anticipated Absences 172

Serious Illness and Other Unanticipated Absences 173

Steps for Making Help Available in a Crisis 173

Endings 177

Conclusion 179

Scenarios for Discussion 181

Chapter 19 Informed Consent and Informed Refusal 185

Process of Informed Consent 186

The Foundation of Informed Consent 188

Adequate Information 194

Considerations in Providing Informed Consent 195

Failing to Provide Informed Consent 195

Benefits of Informed Consent 196

Limits of Consent 197

Consent for Families and Other Multiple Clients 197

Unequal Opportunity for Informed Consent 198

Cognitive Processes 198

Problems With Forms 199

Additional Resources 200

Scenarios for Discussion 201

Chapter 20 Assessment, Testing, and Diagnosis 204

Awareness of Standards and Guidelines 205

Staying Within Areas of Competence 206

Making Sure That Our Tests and Assessment Methods Stay Within Their Areas of Competence 207

Understanding Measurement, Validation, and Research 207

Ensuring That Patients Understand and Consent to Testing 208

Clarifying Access to the Test Report and Raw Data 209

Following Standard Procedures for Administering Tests 210

Knowing the Literature on Recordings and Third-Party Observers 212

Awareness of Basic Assumptions 213

Awareness of Personal Factors Leading to Misusing Diagnosis 214

Awareness of Financial Factors Leading to Misusing Diagnosis 214

Acknowledging Low Base Rates 215

Acknowledging Dual High Base Rates 216

Avoiding Confusion Between Retrospective and Predictive Accuracy 217

Awareness of Forensic Issues 217

High-Stakes Testing 219

Attention to Potential Medical Causes 219

Critically Examining Prior Records and History 219

Clearly State All Reservations About Reliability and Validity 220

Providing Adequate Feedback 221

Scenarios for Discussion 222

Chapter 21 Sexual Attraction to Patients, Therapist Vulnerabilities, and Sexual Relationships With Patients 225

HowModern Ethics Codes Address Therapist–Client Sex 226

How Therapist–Client Sex Can Injure Clients 228

Gender and Other Patterns of Perpetrators and Victims 228

Common Scenarios of Therapist–Client Sex 232

Therapist Risk Factors 232

Why Do Therapists Refrain When They Are Tempted? 233

Confronting Daily Issues 233

Physical Contact With Clients 234

Sexual Attraction to Clients 236

When the Therapist Is Unsure What to Do 238

Working With Clients Who Have Been Sexually Involved With a Therapist 242

Ethical Aspects of Rehabilitation 242

Hiring, Screening, and Supervising 246

Scenarios for Discussion 247

Chapter 22 Nonsexual Multiple Relationships and Other Boundary Crossings: The Therapeutic, the Harmful, the Risky, and the Inevitable 252

How the Field Changed Its View of Boundary Issues 254

What Makes This Area So Hard for Us? 256

Research Leading to a Call for Changes in the Ethics Code 258

Multiple Relationships as Defined by the APA and CPA Ethics Codes 261

Three Interesting Examples ofMultiple Relationships 262

Research Review 264

Self-Disclosure 267

Bartering 267

Multiple Relationships and Boundary Issues in Small Communities 269

Seven Common Therapist Errors and Mending Fences 270

Sources of Guidance 271

Additional Resources 272

Scenarios for Discussion 273

Chapter 23 Culture, Context, and Individual Differences 276

Context, Competence, and Personal Responsibility 279

Bringing It All Back Home 281

Context of Oppression, Exclusion, Discrimination, and Inequity 283

Overcoming Barriers to Ethical Services 284

Scenarios for Discussion 294

Chapter 24 Confidentiality 298

Referral Sources 300

Public Consultation 301

Gossip 301

Case Notes and Patient Files 302

Phones, Faxes, and Messages 303

Home Office 303

Sharing With Loved Ones 303

Communications in Group or Family Therapy 304

Written Consent 304

Managed Care Organizations 305

Disclosing Confidential Information for Mandated Reports Only to the Extent Required by Law 308

Publishing Case Studies 309

Distraction 310

Focusing on Legal Responsibilities to the Exclusion of Ethical Responsibilities 310

Scenarios for Discussion 311

Chapter 25 Recognizing, Assessing, and Responding to Suicidal Risk 314

Special Considerations 319

Avoiding Pitfalls: Advice From Experts 323

Scenarios for Discussion 332

Chapter 26 Steps to Strengthen Ethics in Organizations: Research Findings, Ethics Placebos, and What Works 335

Keep Codes in Context 337

Respect the True Costs of Betraying Ethics 338

Encourage Speaking Up, Listening Carefully, and Acting With Fairness 340

Conclusion: Only If We Act 342

Chapter 27 Supervision 344

Clear Tasks, Roles, and Responsibilities 344

Competence 347

Assessment and Evaluation 350

Informed Consent 351

Sexual Issues 353

Supervisee Perceptions of Supervisor’s Unethical Behavior 354

Beginnings and Endings, Absence and Availability 354

Scenarios for Discussion 355

Introduction to Appendices 360

Appendix A The Hoffman Report and the American Psychological Association: Meeting the Challenge of Change 361

What Does the Hoffman Report Have to Do With Each of Us as an Individual APA Leader, Member, or Outsider? 363

What Could Each of Us Have Done Differently? 364

What Do We Want Our Ethics and Our Ethics Enforcement to Be? 365

What Do We Do to Discover or Screen Out What Happens? 367

Where Do We Go From Here? 367

Appendix B The Hoffman Report: Resetting APA’s Moral Compass 370

Lessons Learned 372

Conclusion 376

References 380

About the Authors 436

Author Index 443

Subject Index 459