Professional Development in Clinical Psychology
A defining feature of psychology and ethics is the element of “the unknown” within the field. From the diverse clientele, to the variety of issues psychologists are constantly exposed to, there is no concrete approach towards providing effective treatment for a client seeking counsel. It is undeniable that a large majority of psychologists’ work is dependent on their personal clinical judgment. What does exist, however, is a code of ethical guidelines that helps psychologist navigate through the obstacles in their career. While ethics is an extremely valuable tool to individuals in the field, it can also be a source of conflict (Fisher, 2013). With being a psychologist comes an immense amount of responsibility and pressure to offer the most effective care to those in need. As a result, it is inevitable for psychologists to struggle with this responsibility during some point in his or her professional career. The following fictional case captures this struggle, as well as identifies the crucial role of ethics in maintaining healthy yet professional client relationships. Ethical Case:
Dr. Teen is a female psychologist who received a part-time job at Lincoln Park High School. She recently graduated from Northwestern University’s Psy.D. program, where she had also attended undergraduate school. Dr. Teen was born and raised in the suburbs of Chicago, and feels strong ties to the city. Thus, after earning a license to practice, she decided to apply for a position as the school counselor of her formal high school. One perk that accompanies working at Lincoln Park High is that she is only required to work part time, allowing her to balance work with her secondary occupation. Additionally, she was excited to return to her high school in order to reestablish relationships with old teachers and administrators who were deeply supportive of her during her troubled past. Dr. Teen has been working at the school for nearly three months, and finds great satisfaction in her work. Lincoln Park High reports an all time high in the number of students currently signed up for counseling. Both male and female students are choosing to seek Dr. Teen’s counsel, in contrast to past years, in which faculty or parents were “forcing” students to meet with the school social worker. Dr. Teen is pleasantly surprised by the deep relationships she has established with many of her students. Additionally, she has found that she is even better able to relate to and form connections with her students, compared to her same-age co-workers. She enjoys bonding with her students so much that she is considering working full time at Lincoln High. Since Dr. Teen only works three days a week, her busy schedule often prevents her from meeting with students during the select days she comes into school. Though the school assures her that postponing her appointments is completely understandable, she feels too guilty turning away students. Unbeknown to the school, she occasionally meets with them outside of work on the weekends. Since she lives in the neighborhood directly behind school, she feels her home is the most convenient place for them to meet. Dr. Teen considers her work outside of school to be even more beneficial to students, as it is not in the formal setting, thus, she does not set a time limit on appointments. Plus, Dr. Teen benefits from meetings outside of school, as the students who come to her house often bring her coffee, food, gift certificates, and tokens of appreciation for the additional availability she offers on weekends. Recently, however, Dr. Teen has become very overwhelmed with her counseling duties. In order to foster the most effective therapy for students, she has decided to restrict the students she meets with to the students in which she feels she is able to connect with the most. Coincidentally, many of these select students are young females. Dr. Teen assures the male students that her choice is nothing personal; however, she would rather provide valuable counseling to a few students rather than mediocre counseling to many students. In attempt to alleviate the situation, she has given her personal cell phone number to the students whom she no longer meets with in person, and emphasizes her availability for them to call or text her at any time and for any reason. Dr. Teen has grown particularly close to her student, Anna, who she considers her “mini-me.” Dr. Teen and Anna share similar experiences, specifically, a car accident that resulted in symptoms of Posttraumatic Stress Disorder for the both of them. Although the car accident took place recently for Anna, it occurred over ten years ago for Dr. Teen. Aside from the car accident, Dr. Teen has bonded with Anna on a deeper, “friend-level.” Occasionally, Dr. Teen shares personal stories about her experiences and relationships during high school in order to make Anna feel comfortable reciprocating her experiences. Dr. Teen feels the only way for students to feel safe confiding in her is for her to confide in students, in return. Depending on the situation, she has elaborated on stories about her partying, drinking, and dating habits of the past. Dr. Teen feels it is justified for her to discuss even these provocative stories, since she does not behave as such anymore, and it is strictly for the purpose of building a therapeutic relationship with her clients. The details of Dr. Teen’s therapy are unknown to Lincoln Park High. However, based on the variety of gifts Dr. Teen has received from her students in appreciation of her services, the school is confident in her abilities and progress with the students. As far as the faculty is aware, Dr. Teen has been successful in maintaining student mental health. Students that have benefitted from counseling possess an overall more positive attitude towards school. Ethics Code Violations:
In therapy, there is a thin line between being an effective therapist, and being a professional therapist. Dr. Teen’s behavior represents a lack of professionalism that violates various ethical codes set out to prevent this type of relationship. A core code Dr. Teen violates is 3.04: Avoiding Harm. The code states, “Psychologists take reasonable steps to avoid harming their clients/patients, students, supervisees, research participants, organizational clients, and others with whom they work, and to minimize harm where it is foreseeable and unavoidable” (Fisher, 2013). Dr. Teen defies this code in various aspects of her practice. For example, she shares personal and provocative stories about herself, invites clients to her home, and offers her cell phone number for additional therapy benefits. In doing so, Dr. Teen is transforming what is supposed to be a professional relationship into a more personal connection. For the students who are seeking mental health care, this can prove more harmful than helpful to their overall well-being. In line with code 3.04, Avoiding Harm, is Principle A: Beneficence and Nonmaleficence of the General Principles of Psychology. This principle reflects “a psychologist’s dual obligation to strive to do good and avoid doing harm…by promoting the welfare of others, treating people and animals humanely, increasing scientific and professional knowledge of behavior an people’s understanding of themselves, and improving the condition of individuals…” (Fisher, 2013). By forming an unprofessional relationship with her students, Dr. Teen is neither striving to do good nor avoiding harm. Her closeness with these young and impressionable teens is not promoting their welfare. Instead, Dr. Teen appears to be too focused on bonding with students and forming a reciprocal relationship, when her true responsibility should be solely dedicated to the client. Dr. Teen’s relationship with Anna proves particularly harmful. By sharing intimate stories about her past, she is setting a poor example for Anna. It is clear Anna considers Dr. Teen a role model. Although Dr. Teen may have pure intentions by sharing provocative stories about her past, in turn, she is harming Anna by suggesting this behavior is acceptable, and even encouraged. While Dr. Teen’s ability to offer Anna a safe place to seek comfort and support is commended, the example she sets is not. Moreover, a multiple relationship is defined by “when a psychologist is in a professional relationship with a person and at the same time is in another role with the same person” (Fisher, 2013). The behaviors mentioned above, including providing students with her cell phone number and sharing personal stories about herself, signifies a friendship, not the role of a psychologist. Dr. Teen’s actions violate Code 3.04, Multiple Relationships. Perhaps one of the most difficult aspects in the role of a psychologist is maintaining the ability and restraint to separate one’s personal life from one’s professional endeavors. The fact that Dr. Teen and Anna share many of the same experiences, in particular the traumatic car accident, can serve as both a positive and a negative influence on both party’s mental health. On one hand, Dr. Teen possesses the proper empathy and understanding of Anna’s situation, and can foster the most effective coping strategies. In turn, Anna can take solace in knowing that Dr. Teen has endured a similar experience to her, and has been successful in overcoming such an obstacle. Yet, if Dr. Teen does not approach this sensitive issue properly, the outcome may prove detrimental to both hers and Anna’s health. Code 2.06: Personal Problems and Conflicts highlights the suggested course for a psychologist to take when dealing with this type of situation. The code states, “(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” (Fisher, 2013). According to professional ethics, research indicates that certain stressful life events can hinder a psychologist’s ability to use their skills competently and effectively. In addition to the violations of the various codes listed above, Dr. Teen’s relationship with Anna further violates standard 2.06, as she is required to refrain from activities in which her personal problems may impair her ability to perform. As a psychologist, it is Dr. Teen’s responsibility to respect the dignity and worth of all individuals appropriately. This includes offering equal services and availability to all students that seek her treatment. Code 3.01: Unfair Discrimination elucidates on this topic, stating, “In their work-related activities, psychologists do not engage in unfair discrimination based on age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, socioeconomic status, or any basis proscribed by law” (Fisher, 2013). Although standard 3.01 does not require psychologists to offer therapeutic assistance to all individuals requesting mental health services, Dr. Teen’s role as Lincoln High’s social worker does not offer her this luxury. As the school’s sole therapist, she is responsible for counseling each and every student that seeks her help, and providing all students with equal and just care. Selecting certain students and turning away others is a violation of standard 3.01, and exemplifies unfair discrimination. Furthermore, Dr. Teen is also in violation of Principle D, Justice, of the General Principles of Psychology. This principle encourages psychologists to “strive to provide to all people fair, equitable, and appropriate access to treatment and to the benefits of scientific knowledge” and warns psychologists to “be aware of and guard against their own biases and the prejudices of others that may condone or lead to unjust practices” (Fisher, 2013). Dr. Teen’s actions are in clear violation of this principle. Additionally, she is setting a poor example for her students by implying that discriminatory behaviors are indeed acceptable. By selecting certain students to counsel over other students seeking the same treatment, Dr. Teen defies Principle D. An exploitative relationship is defined as “taking unfair advantage of or manipulating for their own personal use or satisfaction” (Fisher, 2013). Meeting with students in her home on the basis that they bring her gifts as a show of gratitude represents an exploitative relationship. Standard 3.08 “prohibits psychologists from taking unfair advantage of or manipulating for their own personal use or satisfaction of students…” (Fisher, 2013). Dr. Teen is taking advantage of her students by offering additional services as an incentive to receive gifts. While gift giving and receiving is not considered a violation, exploiting clients as a means of receiving gifts is. Finally, because of Dr. Teen is a practicing psychologist within a school setting, she must be particularly careful with her responsibility to protect the privacy and confidentiality of her students. The Family Educational Rights and Privacy Act (FERPA) of 1974 outlines several laws in order to promise students’ privacy within school settings (Fisher, 2013). Specifically, FERPA provides certain rights to parents of students that are ultimately transferred to students when they reach 18 years. Such rights include the inability to disclose a student’s educational record without written permission from the parent or the eligible student (Fisher, 2013). In addition to the diverse guidelines Dr. Teen must adhere to under the ethics code, it is crucial that Dr. Teen is additionally aware of implications such as FERPA that impact her job and professional responsibilities. Celia Fisher’s, Decoding the Ethics Code, offers a quote by Nicholas Hobbs that captures the tough balance between being an effective psychologist, and adhering to the ethics that surround this task. Hobbs refers to psychology as, “a complex field where individual and social values are yet but ill defined…” (Fisher, 2013). He compares the field to a game, in which must be “played fairly” and “must be given direction and consistency by the rules of the game.” Though an individual’s values may be ill defined, it is a psychologist’s responsibility to use these ethical standards as a tool to navigate through the “game” of psychology. As the case of Dr. Teen demonstrates, this responsibility proves challenging in more ways than one. Yet, one theme remains prominent throughout every ethical guideline: the notion of beneficence and nonmaleficence. Above all, a psychologist’s greatest obligation is that of “striving to do good and doing no harm” when dealing with patients (Fisher, 2013).
Fisher, Celia B. (2013). Decoding the Ethics Code: A Practical Guide for Psychologists: Includes the 2010 APA Amendments to the Ethics Code. Los Angeles: SAGE, 2013. Print.