What are the differences between traditional psychotherapy ethics (e.g. institutional ethics) and the relational approach to ethics, as you understand it? (Same as slide 14 prompt as per the deck on Relational Ethics)
CHAPTER 18: E T H I C S C O D E S, R E G U L AT I O N S, A N D E N F O RC E M E N T S
Presentation brought to you by: Cristie J. Caruso (& reviewed/adapted by Saliha Bava) 2023
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HOW TO PARTICIPATE IN THIS ONLINE CLASS/ DISCUSSION
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Slides with the following icon means: Pause and respond to the questions on Blackboard You might be asked to refer back to the text to respond but it is your critical view of the text that is of interest to me Engage other’s views with the respect you might show in person and with the intention to keep an open, learning,
dialogical space
There are two decks of slides based on this week’s readings. Post your reflections based on: This deck: professional Codes & laws on slide 34 (Same as on BB) The other deck has a discussion prompt on slide 14. (Same as on BB)
Feel free to share your ongoing questions & confusions, which I will respond to as we move forward.
Participation is REQUIRED. Lack of it will be reflected in your grade
DUE: 10/2 (noon). Suggestion: Start before the due date, so you can read the articles side-by- side
Communication: Email me if anything is unclear.
DR. BAVA, 2017
ETHICS CODES: PURPOSE
Instill public confidence in the profession Spell out which principles morally responsible members are expected to follow Used to help judge those whose ethical standards or practices have been questioned by ethic committees and other regulating bodies Give individuals protection if licensing boards, or other boards who are unable, unsuited to consider a complaint
(Koocher & Keith-Spiegel, 2016, p. 606)
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ON THE OTHER HAND…
It is to be noted that… mental health professionals can not prevent every potential for harm, or ethical dilemma Although not all harm can be avoided, or ethical issue extinguished, it is the purpose of
ethics codes to help provide guidelines for making good decisions There are no perfect solutions to every dilemma Thus, consider context and consultations! Codes do not speak to every context in which an incident occurs Thus, language of “attempt to” or “whenever feasible” but it might also lead to ambiguity & gray areas. Loose language DOES NOT EQUAL loose practices!
4 (Koocher & Keith-Spiegel, 2016, p. 606-607)
CODES OF ETHICS IN THE MENTAL HEALTH PROFESSION
– American Psychological Association
– American Association for Marriage and Family Therapy
– American Counseling Association – National Association of Social
Workers 5
AMERICAN PSYCHOLOGICAL ASSOCIATION: ETHICAL
PRINCIPLES AND CODE OF CONDUCT
1. Resolving Ethical Issues: How to deal with and report violations
2. Competence: Practicing within the field of one’s skills, and knowledge
3. Human Relations: Discrimination, harassment, multiple-role relationships, interruption of services, ect.
4. Privacy and Confidentiality
5. Advertising and Other Public Statements: What not to do during self-promoting, and how to conduct workshops, and other educational programs
For more information you can visit
http://www.apa.org/ethics/code/index.aspx
6. Recordkeeping and Fees: How to document, and disposal of confidential material. Bartering and making referrals
7. Education and Training: Teaching accurately, assessing students, and mandating therapy. Relationships between teachers, supervisors, and students, and what is appropriate, and what is not.
8. Research and Publication: Humane care of humans, and animals. Touches on plagiarism, and publication.
9. Assessment: Bases, uses, consent, scoring and interpretation
10. Therapy: Informed consent, Who are not acceptable clients, and unacceptable relationships
(Koocher & Keith-Spiegel, 2016, p. 609)
All information is paraphrased & can be found from the text above.
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THE AMERICAN ASSOCIATION FOR MARRIAGE AND FAMILY THERAPY 1. Responsibility to Clients: Nondiscrimination, multiple-role relationships, unethical conduct, referrals
2. Confidentiality: Written authorization before disclosing information with others, protecting records, client’s access to their records
3. Professional Competence and Integrity: Maintain and develop skills, avoid conflict of interest
4. Responsibility to Students and Supervisees: Avoid sexual intimacies, do not exploit students
5. Research and Publication: Institutional approval, respecting and protecting research, informed consent, confidentiality
For more information you can visit
http://www.aamft.org/iMIS15/AAMFT/Content/legal_ethics/code_o f_ethics.aspx
6. Technology-Assisted Professional Services: Competence to give services through electronical devices
7. Professional Evaluations: Performance of forensic services, legal proceedings, avoiding conflict, separation of custody
8. Financial Arrangements: Make sure agreements are understood by the clients, and others involved
9. Advertising: Do not misrepresent
(Koocher & Keith-Spiegel, 2016, p. 609-610)
All information is paraphrased & can be found from the text above.
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THE AMERICAN COUNSELING ASSOCIATION
1. The Counseling Relationship: Client welfare, informed consent, maintaining boundaries
2. Confidentiality and Privacy: Respect for privacy
3. Professional Responsibility: Improve the lives of who you come in contact with, continuing education, honesty, responsibilities to other professionals
4. Relationships with other Professionals
5. Evaluation, Assessment, and Interpretation: Competency to use assessments, informed consent, release of data, security, data
For more information you can visit
http://www.counseling.org/docs/ethics/2014-aca-code-of- ethics.pdf?sfvrsn=4
6. Supervision, Training, and Teaching: Education, and relationships
7. Research and Publication: Rights of participants, vulnerable individuals, reporting of results, publication
8. Distance Counseling, Technology, and Social Media: Web maintenance, how to maintain distant professional relationships
9. Resolving Ethical Issues: Knowing the law, suspected violations, conflicts between ethics and the law
(Koocher & Keith-Spiegel, 2016, p. 610-611)
All information is paraphrased & can be found from the text above.
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For Reference only
NATIONAL ASSOCIATION OF SOCIAL WORKERS
1. Ethical Responsibilities to Clients: Conflict of interest, privacy, sexual relationships, payment for services
2. Ethical Responsibilities to Colleagues: Respect, disputes, sexual relationships, harassment, incompetent and unethical colleagues
3. Ethical Responsibilities in Practice Settings: Education and training, client records and transfer, labor- management disputes
For more information you can visit
http://www.socialworkers.org/pubs/code/default.asp
4. Ethical Responsibilities as Professionals: Competence, discrimination, misrepresentation, client solicitation
5. Ethical Responsibilities to the Social Work Profession: “Promoting integrity, and ethical issues in evaluation research”
6. Ethical Responsibilities to the broader society: Improve social conditions, uphold human rights, social justice
(Koocher & Keith-Spiegel, 2016, p. 610-611)
All information is paraphrased, or can be found from the text above.
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For Reference only
ENFORCEMENT, COMMITTEES AND REPORTING
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COMPLAINTS
Most complainants have had direct and/or personal interactions with the accused Plagiarism is found by academics or by students Ethics committees can take on sua sponte (an act of authority taken without formal prompting from
another party.) Ex: Newspaper, local news, service advertisements, court records
Some complaints are questioned because of the mental state of the individual making the claim These complaints are not just swept under the rug, they are most likely still investigated
Power of Apologizing: Some charges are avoided by the therapist simply by apologizing to the client about the misunderstanding, or their behavior (e.g.
missing an appointment or running late)
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COMPLAINANT & ACCUSED
Individuals who make a complaint: Make sure the complaint is legit Must be willing to have their identities and the complaint shared with the accused subject Be prepared to possibly be countercharged
What if you, the professional, are being charged? It is advised that you do not try to “beat the system” and/or manipulate evidence in your favor Anger is common, but do not let it get out of control KNOW YOUR RIGHTS (See p. 621 for tips, photocopy it if you must and keep a record for yourself)
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CLIENTS’ PATHWAYS IN CASE OF MALPRACTICE
Complaints*
Legal
Criminal Civil
State Licensing Board
Professional Board
Review Committee
Supervisor/ Agency
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* Possible pathways depend on the potential malpractice, harm caused & relational ethics
ENFORCEMENT Formal Mechanisms
“Criminal law applicable to all citizens, including members of any profession”
“Profession-specific legal controls that emanate from state laws via licensing boards”
“Civil litigation to process claims of malpractice or other professional liability”
“Federal and state laws and regulations, such as policies issued on the protection of human participants in social and behavioral science, research, confidentiality of records, civil rights violations, or prescribing medication”
“Professional review committees to handle misunderstanding or complaints involving third-party payers, institutions, or employers. Professional review committees are rarely used now”
Relationship between Laws and Ethics General laws do not protect individuals from unethical
acts performed by mental health professionals
Morals and laws usually have similar purposes, but laws have been known to be unjust, immoral & been overturned.
“Some conduct specified as unethical in professional ethics codes can also qualify as civilly or criminally actionable (p. 613)
Professionals can lose their license to practice and be kicked out of their professional associations for being found guilty of a felony
Convictions on a misdemeanor are handled the same way if the offense was involved in the unethical act
Some therapists believe that defying the law is a matter of their own conscience (See case 18-3 on p. 614 for an example)
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LICENSING BOARDS VS PROFESSIONAL ASSOCIATIONS Licensing Boards:
Focus: Protecting the public from unqualified and unethical practitioners
“State licensing law establish practitioner’s scope of practice and the regulations detailing licensing board enforcement procedures.”
Comprise of members of profession and public members appointed by executive branch of the state
Can prevent a professional from practice by revoking their license in case of unscrupulous and harmful practice
E.g. NY’s State board for professions: https://www.op.nysed.gov/boards/state-boards- professions
For MFTs: https://www.op.nysed.gov/meeting- agendas/state-board-meetings-for-mental-health- practitioners
For Psychologists: https://www.op.nysed.gov/meeting- agendas/state-board-meetings-for-psychology
Professional Associations (State & National):
Focus: Prompting the best interest of its professional members via education, advocacy and public relations.
Lobby the state to make changes to state law and regulations enacted by state licensing boards.
Some offer hotline or consultation services for members.
Set up “Ethics Committees” that: (See next slide)
Might investigate complaints, reprimand, drop members who are in ethical violation (at times costing one’s practice)
E.g. AAMFT, APA
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ETHICS COMMITTEES
Members serve without pay, and usually without reimbursement for their expenses Ethics Committees: Investigate violations at all levels Help resolve cases which are too hard, or unable to be taken by others
Criticisms: Bias Lack of training Lack of experience Conflict of interests Excessive time taken to adjudicate cases Insufficient investigations Timid procedures from fear of lawsuits Possible harm to the public
(Koocher & Keith-Spiegel, 2016, p. 617)
All information is paraphrased, or can be found from the text above.
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CONSEQUENCES OF A HARMFUL ETHICAL VIOLATION
Impact of Ethical Violation
Professional Association Investigation
Legal Charges
Public Relations
Licensing Board
Adjudication
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In summary, there are many possible consequences of a major ethical (or legal) violation. Some or all are possible depending on the context.
This is meant to illustrate the landscape not just to scare you!
Ethical violation is costly! Thus, when in a dilemma or doubt, consult before you make a decision!
SANCTIONS, DIRECTIVES, AND LEVELS OF ETHICAL VIOLATIONS
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SANCTIONS Reprimand: Appropriate when there has been a violation, but the violation was not likely to cause harm to another person, or to the professional
Censure: Appropriate when there has been a violation, and the violation was likely to cause harm to the person, or profession, BUT was not likely to cause substantial harm
Expulsion: Appropriate if there has been a violation, and the violation was likely to cause substantial harm to the person, or professional
Stipulated Resignation: “May be offered after finding the respondent committed a violation of the ethics code or railed to show good cause why he or she should not be expelled, contingent on execution of an acceptable affidavit and approval by the board of directors” (p.626)
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DIRECTIVES
Cease-and-Desist: Immediately terminate the unethical behavior(s)
Supervision: Having work monitored
Education, Training, or Tutorial Required: Engage in learning appropriate to the unethical behavior
Evaluation: Determine the possibility of treatment, and obtain treatment if needed
Probation: Monitoring of the individual to make sure they are in compliance with the results
Other Corrective actions: Potential payment to the APA or the individual in order to protect the interests, and the individuals, or associations
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(Koocher & Keith-Spiegel, 2016) All information is paraphrased, or can be found from the text above.
LEVELS A
Level l: Behavior or practice was not clearly unethical,
but was done in insufficient caution
Level ll: Clearly unethical, but unlikely to harm the
public, or profession
Level lll: Continuing misconduct and producing a
genuine hazard to clients, the public, and the profession
B
Level l: Minor infraction occurred, but harm was
unlikely. May not have been intentional
Level ll: Deliberate or persistent behavior that could
lead to substantial harm to the client or public, although little harm may have happened
Level lll: Clients or others who have worked with the
are substantially injured, and there are serious thoughts on whether or not the therapist has potential for rehabilitation
21 (Koocher & Keith-Spiegel, 2016) All information is paraphrased & can be found from the text above.
RELATIONSHIP BETWEEN ETHICS & LAW
Saliha Bava, PhD
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QUESTIONS THAT WE’LL PONDER! How do we know if an issue is legal or ethical?
Can an issue be both legal and ethical?
In case of a conflict which one—ethics or law—supersedes?
The best answer is “it depends!”
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It depends on The situation The violation The law The jurisdiction The clinical/relational context The ethical codes The committee etc
UNDERSTANDING THE COURT SYSTEM
Statutory law: created by legislatures.
Constitutional law: results from court decisions regarding constitutional issues.
Common law: results from other court decisions. �
There are 51 U.S. court systems (the courts for the 50 states and the federal court). �
Both state and federal courts can enact decisions affecting therapists/psychologists. �
Decisions from state courts are binding only on persons living within that state but may serve as precedent for a similar case in another state (e.g Tarasoff case from CA guides laws on duty to protect in other states)
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Source: https://www.sulross.edu/sites/default/files/sites/default/files/users/docs/education/counseling-ethics_6.pdf
STATUTORY LAW
Statutory law is the body of mandates created through legislation passed by the U.S. Congress and state legislatures. (e.g our licensure requirements by states)
Much of the structure of health, mental health, and education, and many of the policies that govern their implementation are found within these mandates. This is why being engaged in the profession is key. Because we can shape our profession by lobbying
and asking our laws to be updated.
The majority of legislation influencing counselors/therapists is passed by state legislatures and concerns two types of legislation: creating state legislation to implement federal legislation, and enacting new, state-specific legislation.
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Source: https://www.sulross.edu/sites/default/files/sites/default/files/users/docs/education/counseling-ethics_6.pdf
STATE AND LOCAL AGENCIES
Most state departments of mental health, which ordinarily house licensing boards, can enact regulations that are binding upon the practice of counseling within the state.
Most state departments of education have the ability to enact regulations that are binding on the school districts within the state.
The regulations often encompass areas not addressed through other state legislation or add detail to state legislation.
State agencies also develop policies, which are often detailed explanations of how to implement a specific law.
State agencies may also issue guidelines, which are suggestions about how to address a specific issue.
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Source: https://www.sulross.edu/sites/default/files/sites/default/files/users/docs/education/counseling- ethics_6.pdf
MAKING DECISIONS Failure to understand the law, and by extension policies, procedures, and guidelines, is not an acceptable legal defense.
When making decisions: Use common sense, especially know what is common to your profession Also known as standard of practice
These might evolve & shift over time depending on the issues
Follow the logical course of action Document all actions Consult with manuals, supervisors, and other professionals Be aware of how personal beliefs and values impact the way you think about issues, the clients and
their needs, and the options that you perceive to be available Try to do what is in the best interest of the client
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Source: https://www.sulross.edu/sites/default/files/sites/default/files/users/docs/education/counseling- ethics_6.pdf
CONFLICTS BETWEEN ETHICS AND LAW
“many professionals will encounter routine differences between ethical and legal requirements” (p. 549)
“providers in many contexts occasionally encounter differences or tensions between laws and professional ethics, differences alone do not constitute conflicts.” (p. 549)
What constitutes a conflict? for an ethical–legal discrepancy to become a conflict, the provider’s obligations under the law and the
provider’s obligations under his or her professional code of ethics must be mutually exclusive. Genuine ethical–legal conflicts are not common in most contexts but when they occur, the provider perceives that fulfilling legal obligations will necessarily entail violating the code of ethics. (p. 549) Often the conflict arises because of the context which defines which rules need to be followed & can cost us
because we might be positioned to violate our ethical codes (threatening our license). An example: a clinician employed by the military who is required is interrogate a prisoner of war using techniques (eg. torture) that might
violate his/her professional codes.
28 (Johnson, Grasso, & Maslowski, 2010)
HOW PROFESSIONAL ETHICS CODES ADDRESS ETHICAL–LEGAL CONFLICTS “American Medical Association
E-1.02: The Relation of Law and Ethics
Ethical values and legal principles are usually closely related, but ethical obligations typically exceed legal duties. In some cases, the law mandates unethical conduct. In general, when physicians believe a law is unjust, they should work to change the law. In exceptional circumstances of unjust laws, ethical responsibilities should supersede legal obligations.
American Psychological Association
Standard 1.02: Conflicts Between Ethics and Law, Regulations, or Other Governing Legal Authority
If psychologists’ ethical responsibilities conflict with law, regulations, or other governing legal authority, psychologists make known their commitment to the ethics code and take steps to resolve the conflict. If the conflict is unresolvable via such means, psychologists may adhere to the requirements of the law, regulations, or other governing legal authority.” (p. 549)
29 Johnson, Grasso, & Maslowski, 2010)
HOW PROFESSIONAL ETHICS CODES ADDRESS ETHICAL–LEGAL CONFLICTS “American Psychiatric Association
Principles of Medical Ethics Specific to Psychiatry: Section 3
It would seem self-evident that a psychiatrist who is a law breaker might be ethically unsuited to practice his or her profession. When such illegal activities bear directly upon his or her practice, this would obviously be the case. However, in other instances, illegal activities such as those concerning the right to protest social injustices might not bear on either the image of the psychiatrist or the ability of the specific psychiatrist to treat his or her patient ethically and well…it is conceivable that an individual could violate a law without being guilty of professionally unethical behavior. Physicians lose no right of citizenship on entry into the profession of medicine.” (pp. 549-550)
30 (Johnson, Grasso, & Maslowski, 2010)
HOW PROFESSIONAL ETHICS CODES ADDRESS ETHICAL–LEGAL CONFLICTS: CONCLUSION All the codes give the practitioner flexibility on how to proceed
Always consult, both ethical & legal experts. Talk to fellow professionals who have been in similar predicaments
Develop a meta-perspective (a living philosophical stance). Check out this article that offers a meta position (a bit abstract but is an example of what
professionals read over time to develop their competence (w
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