Ethics in Psychotherapy and Counseling. Kenneth S. Pope

First APA Code

      The emerging standards, along with the illustrative critical incidents, were published in the American Psychologist (APA Committee, 1951a, 1951b, 1951c). The standards were grouped into six major sections:

      1 Ethical standards and public responsibility

      2 Ethical standards in professional relationships

      3 Ethical standards in client relationships

      4 Ethical standards in research

      5 Ethical standards in writing and publishing

      6 Ethical standards in teaching

      The draft sparked much discussion and several revisions. Finally, in 1952, it was formally adopted as the Ethical Standards of Psychologists, and it was published in 1953.

      In 1954, information on the complaints that the committee had handled for the past 12 years, during most of which there had been no formal code of ethics, was published in the American Psychologist (“Cases and Inquiries,” 1954). During this period, the ethical principles most frequently violated were:

       Invalid presentation of professional qualifications (cited 44 times).

       Immature and inconsiderate professional relations (cited 23 times).

       Unprofessional advertisement or announcement (cited 22 times).

       Unwarranted claims for tests or service offered usually by mail (cited 22 times).

       Irresponsible public communication (cited 6 times).

      The Empirical Approach to a Code Half a Century Later

      APA pioneers provided an array of reasons to use an empirical approach to create the code of ethics for psychologists. But a critical incident survey of APA members could also serve other purposes. For instance, the actuarial data of ethics committees, licensing boards, and civil and criminal courts can reveal trends in ethical or legal violations as established by review agencies, empirical critical incident studies. They can also reveal ethical dilemmas and concerns that are encountered in day-to-day practice by a diverse range of psychologists and not just those who are subject to formal complaint.

The APA critical incident study undertaken in the 1940s was replicated in the 1990s and published in the American Psychologist (Pope & Vetter, 1992). In this study, 1,319 randomly sampled APA members were asked to describe incidents that they found ethically challenging or troubling. Table 3.1 describes 703 incidents in 23 categories provided by 679 psychologists.

Table 3.1. Ethical Problems Reported by a National Sample of APA Members.

Category	Number	Percentage
Confidentiality	128	18
Blurred, dual, or conflictual relationships	116	17
Payment sources, plans, settings, and methods	97	14
Academic settings, teaching dilemmas, and concerns about training	57	8
Forensic psychology	35	5
Research	29	4
Conduct of colleagues	29	4
Sexual issues	28	4
Assessment	25	4
Questionable or harmful interventions	20	3
Competence	20	3
Ethics and related codes and committees	17	2
School psychology	15	2
Publishing	14	2
Helping the financially stricken	13	2
Supervision	13	2
Advertising and (mis)representation	13	2
Industrial-organizational psychology	9	1
Medical issues	5	1
Termination	5	1
Ethnicity	4	1
Treatment records	4	1
Miscellaneous	7	1
Source: Adapted with permission from “Ethical Dilemmas Encountered by Members of the American Psychological Association: A National Survey,” by K. S. Pope and V. A. Vetter, 1992, American Psychologist, 47, 397–411, p. 399. Available at http://kspope.com. Copyright 1992 by the American Psychological Association.

      Here is a sample of the ethical concerns that the psychologists described in this anonymous survey:

      Confidentiality

       “The executive director of the mental health clinic with which I’m employed used his position to obtain and review clinical patient files of clients who were members of his church. He was [clerical title] in a … church and indicated his knowledge of this clinical (confidential) information would be of help to him in his role as [clerical title].”

       “Having a psychologist as a client who tells me she has committed an ethical violation and because of confidentiality I can’t report it.”

       “One of my clients claimed she was raped; the police did not believe her and refused to follow up (because of her mental history). Another of my clients described how he raped a woman (the same woman).”

      Blurred, Dual, or Conflictual Relationships

       “I live and maintain