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Kenneth S. Pope. Ethics in Psychotherapy and Counseling
CRITICAL PRAISE FOR ETHICS IN PSYCHOTHERAPY AND COUNSELING
Ethics in Psychotherapy and Counseling. A Practical Guide, Sixth Edition
CONTENTS
List of Illustrations
List of Tables
Guide
Pages
THE AUTHORS
PREFACE
A NOTE ON TERMINOLOGY
ACKNOWLEDGEMENTS
Chapter 1 HELPING WITHOUT HURTING
WHAT DO I DO NOW?
Notes
Chapter 2 ETHICS IN REAL LIFE
RECORDS
LUNCH
THE MECHANIC
EVALUATING CHILDREN
STAYING SOBER
THE INTERNSHIP
THE FATAL DISEASE
LIFE IN CHAOS
LANGUAGE: THE INTERPRETER
COMPUTER COINCIDENCES
Chapter 3 ETHICS THEORIES AND CODES
THEORIES OF ETHICS
Utilitarianism
Kantian Ethics
Feminist Ethics
American Indian Ethics
CODES, ACCOUNTABILITY, AND CONFLICTS
AMERICAN PSYCHOLOGICAL ASSOCIATION APPROACH TO AN ETHICS CODE
The First APA Code
The Empirical Approach to a Code Half a Century Later
Confidentiality
Blurred, Dual, or Conflictual Relationships
Payment Sources, Plans, Settings, and Methods
Academic Settings, Teaching Dilemmas, and Concerns About Training
Forensic Psychology
Research
Conduct of Colleagues
Sexual Issues
The Current APA Ethics Code
CANADIAN PSYCHOLOGICAL ASSOCIATION’S APPROACH TO AN ETHICS CODE
ADJUDICATION OF ETHICS COMPLAINTS FOR CPA AND APA
Notes
Chapter 4 DIGNITY AND RESPECT
DIAGNOSTIC CATEGORIES
FINANCIAL CONCERNS
FATIGUE
PERSONAL PREDISPOSITIONS, BIASES, AND PREJUDICES
Chapter 5 TRUST, POWER, CARING, AND HEALING
TRUST
POWER
1. Power Conferred by the State
2. Power to Name and Define
3. Power of Testimony
4. Power of Knowledge
5. Power of Expectation
6. Therapist-Created Power
7. Inherent Power Differential
CARING AND HEALING
Chapter 6 COMPETENCE, HUMILITY, AND THE HUMAN THERAPIST
COMPETENCE AS AN ETHICAL AND LEGAL RESPONSIBILITY
COMPETENCE AND CONFLICT
INTELLECTUAL COMPETENCE: KNOWING ABOUT AND KNOWING HOW
EMOTIONAL COMPETENCE FOR THERAPY: KNOWING YOURSELF
Chapter 7 CULTURE, CONTEXT, AND ETHICS IN PSYCHOTHERAPY AND COUNSELING
CULTURE HAS ALWAYS BEEN A PART OF HEALING
CULTURAL COMPETENCE
The Impact of Cultural Competence on Treatment
CULTURAL COMPETENCE AND PROFESSIONAL GUIDELINES
BUILDING CULTURAL COMPETENCE
Looking Inward
Looking Outward
SCENARIOS FOR DISCUSSION
Chapter 8 STEPS IN ETHICAL DECISION-MAKING
STEP 1: STATE THE QUESTION, DILEMMA, OR CONCERN AS CLEARLY AS POSSIBLE
STEP 2: *ANTICIPATE WHO WILL BE AFFECTED BY THE DECISION
STEP 3: FIGURE OUT WHO, IF ANYONE, IS THE CLIENT
STEP 4: ASSESS WHETHER OUR AREAS OF COMPETENCE—AND OF MISSING KNOWLEDGE, SKILLS, EXPERIENCE, OR EXPERTISE—FIT THE SITUATION
STEP 5: REVIEW RELEVANT FORMAL ETHICS CODES AND STANDARDS
STEP 6: REVIEW RELEVANT LEGAL STANDARDS
STEP 7: REVIEW THE RELEVANT RESEARCH AND THEORY
STEP 8: *CONSIDER WHETHER PERSONAL FEELINGS, BIASES, OR SELF-INTEREST MIGHT SHADE OUR ETHICAL JUDGMENT
STEP 9: CONSIDER WHETHER SOCIAL, CULTURAL, RELIGIOUS, OR SIMILAR FACTORS AFFECT THE SITUATION AND THE SEARCH FOR THE BEST RESPONSE
STEP 10: CONSIDER CONSULTATION
STEP 11: *DEVELOP ALTERNATIVE COURSES OF ACTION
STEP 12: *THINK THROUGH THE ALTERNATIVE COURSES OF ACTION
STEP 13: TRY TO ADOPT THE PERSPECTIVE OF EACH PERSON WHO WILL BE AFFECTED
STEP 14: *DECIDE WHAT TO DO, REVIEW OR RECONSIDER IT, AND TAKE ACTION
STEP 15: *DOCUMENT THE PROCESS AND ASSESS THE RESULTS
STEP 16: *ASSUME PERSONAL RESPONSIBILITY FOR THE CONSEQUENCES
STEP 17: *CONSIDER IMPLICATIONS FOR PREPARATION, PLANNING, AND PREVENTION
Chapter 9 MORAL DISTRESS AND MORAL COURAGE
*THE PSYCHOLOGIST AS WHISTLE BLOWER: A CASE STUDY
BACKGROUND
BUREAUCRATIC-PROFESSIONAL CONFLICT
THE TRANSFER
LEGAL MANEUVERS
THE PROFESSION’S RESPONSE
THE LONELINESS OF WHISTLE BLOWING
Notes
Chapter 10 ETHICS, SCIENCE, AND PSEUDOSCIENCE
Chapter 11 ETHICAL FALLACIES1
1. AD HOC RATIONALIZATION
Example
2. Ad Hominem or Ad Feminam
Example
3. AFFIRMING THE CONSEQUENT
Example
4. APPEAL TO IGNORANCE (AD IGNORANTIUM)
Example
5. ARGUMENT TO LOGIC (ARGUMENTUM AD LOGICAM)
Example
6. BEGGING THE QUESTION (PETITIO PRINCIPII)
Examples
7. COMPOSITION FALLACY
Example
8. DENYING THE ANTECEDENT
Example
9. DISJUNCTIVE FALLACY
Example
10. DIVISION FALLACY OR DECOMPOSITION FALLACY
Example
11. EXISTENTIAL FALLACY
Example
12. FALSE ANALOGY
Example
13. FALSE CONTINUUM
Example
14. FALSE DILEMMA
Example
15. FALSE EQUIVALENCE
Example
16. GENETIC FALLACY
Examples
17. GOLDEN MEAN FALLACY
Example
18. IGNORATIO ELENCHI
Examples
19. MISTAKING DEDUCTIVE VALIDITY FOR TRUTH
Example
20. NATURALISTIC FALLACY
Example
21. NOMINAL FALLACY
Example
22. POST HOC, ERGO PROPTER HOC (AFTER THIS, THEREFORE ON ACCOUNT OF THIS)
Example
23. RED HERRING
Example
24. SLIPPERY SLOPE (ALSO KNOWN AS “THE CAMEL’S NOSE FALLACY”)
Examples
25. STRAW PERSON
Example
26. YOU TOO! (TU QUOQUE)
Example
Chapter 12 PITFALLS IN ETHICAL JUDGMENT
COGNITIVE COMMITMENTS
AUTHORITIES
GROUPS
WYSIATI
HINDSIGHT BIAS
CORRESPONDENCE BIAS
FALSE CONSENSUS
STATUS QUO BIAS
OMISSION BIAS
OPTIMISTIC BIAS
NARRATIVE BIAS
EQUALITY BIAS
Chapter 13 LANGUAGE AND ETHICS
SUBSTITUTE THE GENERAL FOR THE SPECIFIC
USE A CONDITIONAL FRAME FOR CONSEQUENCES
USE DENIED MOTIVATION AS MISDIRECTION
USE THE ABSTRACT LANGUAGE OF TECHNICALITIES
USE THE PASSIVE VOICE
MAKE UNIMPORTANT BY DESCRIBING WHAT DID NOT OCCUR
REPLACE INTENTIONAL UNETHICAL BEHAVIOR WITH THE LANGUAGE OF ACCIDENTS, MISFORTUNE, AND MISTAKES
SMOTHER THE EVENTS IN THE LANGUAGE OF ATTACK
USING LANGUAGE TO GENERATE EMPATHY
Chapter 14 ETHICS PLACEBOS, RATIONALIZATIONS, AND EXCUSES
Chapter 15 BEGINNINGS AND ENDINGS, ABSENCE AND ACCESS
ACCESSIBILITY FOR PEOPLE WITH DISABILITIES
CLARIFICATION
THERAPIST AVAILABILITY BETWEEN SESSIONS
VACATIONS AND OTHER ANTICIPATED ABSENCES
SERIOUS ILLNESS AND OTHER UNANTICIPATED ABSENCES
STEPS FOR MAKING HELP AVAILABLE IN A CRISIS
ENDINGS
CONCLUSION
SCENARIOS FOR DISCUSSION
Chapter 16 INFORMED CONSENT AND INFORMED REFUSAL
FRIGHTENING FORMS, EMPTY FORMALITIES, AND NEEDLESS BURDENS
PROCESS OF INFORMED CONSENT
THE FOUNDATION OF INFORMED CONSENT
ADEQUATE INFORMATION
CONSIDERATIONS IN PROVIDING INFORMED CONSENT
Failing to Provide Informed Consent
Benefits of Informed Consent
Limits of Consent
Consent for Families and Other Multiple Clients
Unequal Opportunity for Informed Consent
Cognitive Processes
Problems with Forms
SCENARIOS FOR DISCUSSION
Chapter 17 CREATING AND USING STRATEGIES FOR SELF-CARE
PAYING ATTENTION TO THE SELF
WHAT HAPPENS WHEN SELF-CARE IS NEGLECTED
Disrespecting Clients
Disrespecting Work
Making More Mistakes
Lacking Energy
Becoming Anxious and Afraid
Using Work to Block Out Unhappiness, Pain, and Discontent
Losing Interest
MAKING SURE THE STRATEGIES FIT
Isolation vs. Connection
Monotony vs. Variety
Fatigue vs. Limits, Rest, and Renewal
The Sedentary Life vs. Physical Activity and Exercise
The Dispirited Life vs. Nurturing the Spirit
The Unsupported Life vs. Support Networks
1) Supervision, Consultation, and Additional Training
2) Accountant
3) Billing/Bookkeeper
4) Psychopharmacology Resources
5) Emergency, Hospital, Safety, Legal, and Other Resources
6) Mandatory and Discretionary Reporting Resources
7) Attorney
8) Personal Relationships
9) Maintaining Health
10) Managing Stress
11) Self-Care Strategies for BIPOC1
THE NEED FOR CHANGE
Notes
Chapter 18 CREATING A PROFESSIONAL WILL
WHO TAKES CHARGE?
WHO SERVES AS BACKUP?
COORDINATED PLANNING
YOUR OFFICE, ITS KEY, AND ITS SECURITY
YOUR SCHEDULE
CLIENT RECORDS AND CONTACT INFORMATION
AVENUES OF COMMUNICATION FOR CLIENTS AND COLLEAGUES
NEW MESSAGES FOR YOUR ANSWERING MACHINE, EMAIL ACCOUNT, ETC
INFORMED CONSENT
CLIENT NOTIFICATION
COLLEAGUE NOTIFICATION
PROFESSIONAL LIABILITY COVERAGE
ATTORNEY FOR PROFESSIONAL ISSUES
BILLING RECORDS, PROCEDURES, AND INSTRUCTIONS
EXPENSES
YOUR PERSONAL WILL
LEGAL REVIEW
COPIES OF THE PROFESSIONAL WILL
REVIEW AND UPDATE
Chapter 19 RESPONDING TO ETHICS, LICENSING, OR MALPRACTICE COMPLAINTS
DON’T PANIC
CONSULT YOUR ATTORNEY FIRST —AND MAKE SURE YOU HAVE A GOOD ONE!
NOTIFY YOUR PROFESSIONAL LIABILITY CARRIER
WHO IS YOUR ATTORNEY’S CLIENT?
IS THE COMPLAINT VALID?
DID YOU MAKE A FORMAL COMPLAINT MORE LIKELY?
APOLOGIZE AND ACCEPT RESPONSIBILITY?
WHAT ARE YOU WILLING TO HAVE DONE?
RECOGNIZE HOW THE COMPLAINT IS AFFECTING YOU
GET THE HELP AND SUPPORT YOU NEED
WHAT CAN THE ORDEAL TEACH?
Chapter 20 ASSESSMENT, TESTING, AND DIAGNOSIS
AWARENESS OF STANDARDS AND GUIDELINES
STAYING WITHIN AREAS OF COMPETENCE
ENSURING THAT OUR TESTS AND ASSESSMENT METHODS STAY WITHIN THEIR AREAS OF COMPETENCE
UNDERSTANDING MEASUREMENT, VALIDATION, AND RESEARCH
ENSURING THAT PATIENTS UNDERSTAND AND CONSENT TO TESTING
CLARIFYING ACCESS TO THE TEST REPORT AND RAW DATA
FOLLOWING STANDARD PROCEDURES FOR ADMINISTERING TESTS
KNOWING THE LITERATURE ON RECORDINGS AND THIRD-PARTY OBSERVERS
AWARENESS OF BASIC ASSUMPTIONS
AWARENESS OF PERSONAL FACTORS LEADING TO MISUSING DIAGNOSIS
AWARENESS OF FINANCIAL FACTORS LEADING TO MISUSING DIAGNOSIS
ACKNOWLEDGING LOW BASE RATES
ACKNOWLEDGING DUAL HIGH BASE RATES
AVOIDING CONFUSION BETWEEN RETROSPECTIVE AND PREDICTIVE ACCURACY
AWARENESS OF FORENSIC ISSUES
HIGH STAKES TESTING
ATTENTION TO POTENTIAL MEDICAL CAUSES
CRITICALLY EXAMINING PRIOR RECORDS AND HISTORY
CLEARLY STATE ALL RESERVATIONS ABOUT RELIABILITY AND VALIDITY
AVOIDING THE CULTURAL EQUIVALENCY FALLACY IN ASSESSMENT
PROVIDING ADEQUATE FEEDBACK
SCENARIOS FOR DISCUSSION
Notes
Chapter 21 CONFIDENTIALITY
NOTE TO READERS
REFERRAL SOURCES
PUBLIC CONSULTATION
GOSSIP
CASE NOTES AND PATIENT FILES
PHONES, FAXES, AND MESSAGES
HOME OFFICE
SHARING WITH LOVED ONES
POST-DEATH CONFIDENTIALITY
COMMUNICATIONS IN GROUP OR FAMILY THERAPY
WRITTEN CONSENT
MANAGED CARE AND OTHER ORGANIZATIONS
DISCLOSING CONFIDENTIAL INFORMATION FOR MANDATED REPORTS ONLY TO THE EXTENT REQUIRED BY LAW
PUBLISHING CASE STUDIES
DISTRACTION
FOCUSING ON LEGAL RESPONSIBILITIES TO THE EXCLUSION OF ETHICAL RESPONSIBILITIES
SCENARIOS FOR DISCUSSION
Chapter 22 RECOGNIZING, ASSESSING, AND RESPONDING TO SUICIDAL RISK
ASSESSING SUICIDAL RISK
SPECIAL CONSIDERATIONS
AVOIDING PITFALLS: ADVICE FROM EXPERTS
ASSISTED DYING—ASSISTED SUICIDE
SCENARIOS FOR DISCUSSION
Chapter 23 SUPPORTING HUMAN RIGHTS AND ADDRESSING OPPRESSION IN PSYCHOTHERAPY
ADDRESSING OPPRESSION IN PSYCHOTHERAPY
THE SOCIALIZATION AND OPPRESSION IN PSYCHOTHERAPY FRAMEWORK
Part I: Historical Context and Socialization
Part II: Overlapping Forms of Oppression
Part III: The Therapeutic Context
Navigating Oppressive Encounters in Therapy
1. Pause and Pay Attention to Your Emotional Reactions
2. Contextualize the Exchange
3. Decide How Best to Proceed
4. Take Care of Your Wellness
5. Consider Consultation
Therapists Can Also Perpetrate Oppression
ENGAGING IN SOCIAL JUSTICE ACTIONS
SCENARIOS FOR DISCUSSION
Chapter 24 THERAPISTS IN A VIRTUAL WORLD Teletherapy, Electronic Records, and Social Media
EMPIRICAL SUPPORT AND VARIED VALIDITY
BENEFITS OF DIGITAL CLINICAL WORK
RISKS, DOWNSIDES, AND DISASTERS
SOCIAL MEDIA CHALLENGES
Social Media Attacks1
TEST SECURITY IN THE DIGITAL WORLD
FIVE SPECIAL PITFALLS
Pitfall 1
Pitfall 2
Pitfall 3
Pitfall 4
Pitfall 5
QUESTIONS TO ASSESS USES OF DIGITAL MEDIA
Where Is the Computer?
Is the Computer Protected from Hackers?
Is the Computer Protected from Malicious Code That Can Access Confidential Information?
Is Your Computer Protected from Viruses and Other Malware?
Is the Computer Protected Using a Strong Password?
Is Confidential Information Encrypted?
How Are Confidential Files Deleted?
How Are Computer Disks Discarded?
How Do You Guard Against Human Error in Handling Confidential Information?
How Do You Make Sure that Only the Intended Recipient Receives Your Confidential Information?
Do Your Clients Clearly Understand the Ways in Which They Can or Can’t Communicate with You via E-Mail, Text Message, or Other Digital Means?
Is Your Professional Website or the Website of the Clinic, Hospital, or Group Practice at Which You Work Accessible to People with Disabilities?
If Your Website Includes a Function That Enables Patients to Communicate with You (e.g., By Signing On with a Username and Password), Has It Been Adequately Secured)?
If You Use Social Networking Media, Such as Facebook, Twitter, Instagram, And So On, Does the Medium Form a Link Between You and Any of Your Patients or Your Patients’ Family Members? If So, How, If at All, Does It Affect the Therapy or Your Relationships with Your Patients?
Are You Aware of the Relevant Laws, Regulations, and Guidelines Governing the Use of Digital Media in Providing Clinical Services?
Are You Aware of Emerging Research on Clinical Services Offered Through Digital Media?
Notes
Chapter 25 SEXUAL ATTRACTION TO PATIENTS, THERAPIST VULNERABILITIES, AND SEXUAL RELATIONSHIPS WITH PATIENTS
HOW MODERN ETHICS CODES ADDRESS THERAPIST-CLIENT SEX
HOW THERAPIST-CLIENT SEX CAN INJURE CLIENTS
GENDER AND OTHER PATTERNS OF PERPETRATORS AND VICTIMS
COMMON SCENARIOS OF THERAPIST-CLIENT SEX
THERAPIST RISK FACTORS
WHY DO THERAPISTS REFRAIN WHEN THEY ARE TEMPTED?
CONFRONTING DAILY ISSUES
PHYSICAL CONTACT WITH CLIENTS
SEXUAL ATTRACTION TO CLIENTS
WHEN THE THERAPIST IS UNSURE OF WHAT TO DO
1.Fundamental Prohibition
2.Slippery Slope
3.Consistency of Communication
4.Clarification
5.Client’s Welfare
6.Consent
7.Adopting the Client’s View
8.Competence
9.Uncharacteristic Behaviors
10.Consultation
WORKING WITH CLIENTS WHO HAVE BEEN SEXUALLY INVOLVED WITH A THERAPIST
ETHICAL ASPECTS OF REHABILITATION
1.Competence
2.Informed Consent
3.Assessment
4.Power and Trust
HIRING, SCREENING, AND SUPERVISING
SCENARIOS FOR DISCUSSION
Chapter 26 NONSEXUAL MULTIPLE RELATIONSHIPS AND OTHER BOUNDARY CROSSINGS The Therapeutic, the Harmful, the Risky,and the Inevitable
HOW THE FIELD CHANGED ITS VIEW OF BOUNDARY ISSUES
WHAT MAKES THIS AREA SO HARD FOR US?
1. Being Caught Unprepared
2. Self-Interest vs. The Client’s Needs
3. The Allure of Rigidity
4. Emotions and Risk Management
RESEARCH LEADING TO A CALL FOR A CHANGE IN THE ETHICS CODE
BLURRED, DUAL, OR CONFLICTUAL RELATIONSHIPS
MULTIPLE RELATIONSHIPS AS DEFINED BY THE APA AND CPA ETHICS CODES
THREE INTERESTING EXAMPLES OF MULTIPLE RELATIONSHIPS
1. Opportunity
2. Employee Benefits
3. Helping as a Friend
RESEARCH REVIEW
SELF-DISCLOSURE
BARTERING
MULTIPLE RELATIONSHIPS AND BOUNDARY ISSUES IN SMALL COMMUNITIES
SEVEN COMMON THERAPIST ERRORS AND MENDING FENCES
SOURCES OF GUIDANCE
SCENARIOS FOR DISCUSSION
Chapter 27 STEPS TO STRENGTHEN ETHICS IN ORGANIZATIONS Research Findings, Ethics Placebos, and What Works1
STEP 1: KEEP CODES IN CONTEXT
STEP 2: RESPECT THE TRUE COSTS OF BETRAYING ETHICS
STEP 3: ENCOURAGE SPEAKING UP, LISTENING CAREFULLY, AND ACTING WITH FAIRNESS
CONCLUSION: ONLY IF WE ACT
Notes
REFERENCES
ABOUT THE AUTHORS. KENNETH S. POPE, PHD, ABPP
MELBA J. T. VASQUEZ, PHD, ABPP
NAYELI Y. CHAVEZ-DUEÑAS, PHD
HECTOR Y. ADAMES, PSYD
AUTHOR INDEX
SUBJECT INDEX
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