What If

Ethics in Clinical Psychology
Six “what-if” scenarios for the undergraduate

Abnormal Psychology course
Richard Alexander
Muskegon Community College
Based on:
Ethical Principles of Psychologists and Code of Conduct
American Psychological Association
Latest revision: June 1, 2010
http://www.apa.org/ethics/code/index.aspx
General Principles
Principle A: Beneficence and Nonmaleficence

Psychologists strive to benefit those with whom they work and
take care to do no harm.
Principle B: Fidelity and Responsibility

Psychologists establish relationships of trust with those with
whom they work. They are aware of their professional and
scientific responsibilities to society and to the specific
communities in which they work.
Principle C: Integrity
Psychologists seek to promote accuracy, honesty, and
truthfulness in the science, teaching, and practice of
psychology.
Principle D: Justice
Psychologists recognize that fairness and justice entitle all
persons to access to and benefit from the contributions of
psychology and to equal quality in the processes, procedures,
and services being conducted by psychologists.
Principle E: Respect for People's Rights and Dignity

Psychologists respect the dignity and worth of all people, and
the rights of individuals to privacy, confidentiality, and self-
determination.
As a way of marketing my licensed
outpatient substance abuse clinic, I
leave business cards with the
bartenders and managers at the busiest
upscale bars and lounges in the area. I
ask them to hand my card to any
customer they think might be in need
of my assessment or treatment
services. No “finder’s fee” or other
quid pro quo is involved.
Ethical or unethical?
Ethical Principles of Psychologists and Code
of Conduct Section 5.06 says,
“Psychologists do not engage, either
directly or through agents, in
uninvited in-person solicitation of
business from actual or potential
clients/patients, or other persons who
because of their particular
circumstances are vulnerable to undue
influence.”
A person made an appointment to see me in my
private practice about an anxiety problem she had
been struggling with for several years. She said
she might not be able to afford my fee, but I was
highly recommended to her and so she’d like to
at least discuss the financial issue before starting
therapy. Through some mutual friends I’ve had a
passing acquaintance with this person, a local
artist, although we’ve never socialized together.
At our first meeting, she said that after working

through the numbers, she decided she could not
afford to pay even a discounted fee if she had a
therapy session every week, or even every other
week. She proposed that we barter some of her
artwork, valued at a local gallery’s price, for
weekly therapy sessions at my regular fee. I liked
what I saw of her work, so I agreed.
“Psychologists may barter only if it is
not clinically contraindicated and the
resulting arrangement is not
exploitative.”
In my capacity as a psychologist, I’m asked to
appear on a local TV news show in a feature
about mental health awareness, especially bipolar
disorder. I had limited clinical experience with
this disorder but had studied it extensively, and I
believed that such awareness was important, so I
agreed.
I illustrated my talk using video clips and articles

about persons in the news—specifically,
examples of behavior by Ozzy Osbourne and
Mike Tyson that I said were typical for persons
with bipolar disorder.
Section 5.02 says, “When psychologists provide public
advice or comment via print, Internet, or other electronic
transmission, they take precautions to ensure that
statements…are based on their professional knowledge,
training, or experience in accord with appropriate
psychological literature and practice…”
Also, Section 9.01 says, “Psychologists base their

opinions contained in their recommendations, reports,
and diagnostic or evaluative statements…on information
and techniques sufficient to substantiate their findings.
“…psychologists provide opinions of the psychological

characteristics of individuals only after they have
conducted an examination of the individuals adequate to
support their statements or conclusions.”
However…
“When, despite reasonable efforts, such an
examination is not practical, psychologists
document the efforts they made and the result of
those efforts, clarify the probable impact of their
limited information on the reliability and validity
of their opinions, and appropriately limit the
nature and extent of their conclusions or
recommendations.”
I’d been working in therapy with a 23-year-old
polysubstance dependent man for several months.
He attended faithfully but made minimal progress.
One day, I got a phone call from his 38-year-old
sister, who said she would like to meet with me to
discuss some concerns she had about her brother and
about their family in general. This was welcome
news, as both her brother and I were feeling stuck.
To maintain confidentiality and good clinical
practice, I mentioned the call to her brother. He
agreed to the discussion and signed a release-of-
information form.
The following week, his sister and I had a long and

productive meeting in my office. Toward the end of
the meeting, our conversation strayed onto other
topics. We looked familiar to each other, and we
finally realized we had mutual friends and interests,
and that we met at a party a couple of summers ago.
To be continued…
Two days later she called me again, said she enjoyed
our conversation, and asked if I’d like to get together
for coffee. I also enjoyed the conversation, and she
was not my client, so I said yes. Long story short,
over the next few weeks we discovered a mutual
attraction that appeared likely to develop into an
intimate emotional and sexual relationship.
Concerned that this potential relationship would

almost certainly affect my therapeutic relationship
with her brother, and noting that in any event he had
made minimal progress with me as his therapist, I
decided it was in the best interest of all concerned to
refer him to my clinic partner. My partner had even
greater skills and experience than I in the treatment
of polysubstance dependent clients.
“Psychologists do not engage in sexual
intimacies with individuals they know
to be close relatives, guardians, or
significant others of current
clients/patients. Psychologists do not
terminate therapy to circumvent this
standard.”
Three years ago, I saw a 38-year-old woman for
therapy related to some grieving and life adjustment
issues. We met for eight sessions over three months
and concluded the therapy with productive results.
Two years later, we ran into each other at a coffee

house. She asked me to join her, so I did. (This did
not violate confidentiality or privacy rules.) She told
me that her life was back on track and that she would
be starting graduate school next fall in, of all things,
clinical psychology. She asked me if we could get
together again so she could pick my brain about
graduate school, career options, etc. I agreed, and so
we met at the same coffee house the following week.
Again, long story short, we found we shared a lot of

interests and basic values, and developed a friendship
that progressed over the next year into a close and
monogamous sexual and emotional relationship.
Section 10.08 says, “Psychologists do not engage
in sexual intimacies with former clients/patients
for at least two years after cessation of
termination of therapy.
“Psychologists do not engage in sexual intimacies

with former clients/patients even after a two-year
interval except in the most unusual circumstances.
Psychologists who engage in such activity after
the two years…and having had no [prior] sexual
contact with the former client/patient, bear the
burden of demonstrating that there has been no
exploitation, in light of all relevant factors…”
Relevant factors are: “(1) the amount of time that has passed
since therapy terminated; (2) the nature, duration, and intensity
of the therapy; (3) the circumstances of termination; (4) the
client's/patient's personal history; (5) the client's/patient's
current mental status; (6) the likelihood of adverse impact on
the client/patient; and (7) any statements or actions made by
the therapist during the course of therapy suggesting or
inviting the possibility of a posttermination sexual or romantic
relationship with the client/patient.”
Part one: I started seeing a 18-year-old high school senior for
therapy related to academic underperformance, conflict with
his parents, and marijuana use. He was mildly depressed and
perceived his 17-year-old girlfriend as the only positive thing in
his life. He said they were sexually active, often got high
together, and went for high-speed drives in his car just for fun.
In our eighth session, some additional information he

mentioned about his girlfriend led me to the inescapable
conclusion that it was my daughter he was talking about. I
brought this up immediately, told him that it would be
impossible for me to continue to be objective in our work
together, and that I would need to discontinue therapy with
him and refer him to another therapist as soon as possible.
Part two: That evening, I told my daughter I knew she often

had been with her boyfriend when she said she was hanging
out with her girlfriends. I told her the stoned high-speed drives
were putting her life in danger, and so I was confiscating her
driver’s license and phone and grounding her indefinitely,
unless she was at school or with a responsible adult.
Section 3.05 says, “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.
“If a psychologist finds that, due to unforeseen

factors, a potentially harmful multiple
relationship has arisen, the psychologist takes
reasonable steps to resolve it with due regard for
the best interests of the affected person and
maximal compliance with the Ethics Code.”
Section 4.05 says, “Psychologists disclose
confidential information without the consent of
the individual only as mandated by law, or
where permitted by law for a valid purpose
such as to:
(1) provide needed professional services;
(2) obtain appropriate professional consultations;
(3) protect the client/patient, psychologist, or
others from harm; or
(4) obtain payment for services from a
client/patient, in which instance disclosure is
limited to the minimum that is necessary to
achieve the purpose.”

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Ethics in Clinical Psychology

Six “what-if” scenarios for the undergraduate

Principle A: Beneficence and Nonmaleficence

Principle B: Fidelity and Responsibility

Principle E: Respect for People's Rights and Dignity

At our first meeting, she said that after working

I illustrated my talk using video clips and articles

Also, Section 9.01 says, “Psychologists base their

“…psychologists provide opinions of the psychological

The following week, his sister and I had a long and

Concerned that this potential relationship would

Two years later, we ran into each other at a coffee

Again, long story short, we found we shared a lot of

“Psychologists do not engage in sexual intimacies

In our eighth session, some additional information he

Part two: That evening, I told my daughter I knew she often

“If a psychologist finds that, due to unforeseen

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