Not All Multiple Relationships are Created Equal

By Ofer Zur
Independent Practitioner, 34/1, 15-22. 2014.

Introduction

Most mental health professionals have attended risk management and ethics workshops where one of the central messages was the dire warning that multiple relationships are generally unethical, inherently harmful, mostly prohibited, and should be avoided.  While the term "unethical" is thrown about liberally when it comes to multiple relationships, the fact is that none of the major professional organizations' codes of ethics prohibit all forms of dual or multiple relationships.

The entire article is here.

Why Should We Behave Ethically?

Stephen A. Ragusea, PsyD, ABPP

Guest Blog

Every psychologist must read and know the basic tenets of the American Psychological Association’s Code of Ethics in order to get through graduate school and obtain a license to practice psychology.  We’ve all read it.  We’ve all learned it.  We’ve all tried to apply it.  How many of us have asked the question, “Why bother?”  Obviously, the entire concept of ethical behavior is rooted in our system of morality and, although the word “should” often has a negative connotation in our psychotherapeutic lexicon, any ethics code is all about what we should and should not do.  Codes attempt to answer the question, “What’s the right thing to do in this situation?”

It’s interesting to me that nowhere in the current Ethics Code is this question directly addressed.  The issue is addressed only obliquely.  The Preamble states,

“Psychologists are committed to increasing scientific and professional knowledge of behavior and people’s understanding of themselves and others and to the use of such knowledge to improve the condition of individuals, organizations, and society.  Psychologists respect and protect civil and human rights and the central importance of freedom of inquiry and expression in research, teaching, and publication.  They strive to help the public in developing informed judgments and choices concerning human behavior.  In doing so, they perform many roles, such as researcher, educator, diagnostician, therapist, supervisor, consultant, administrator, social interventionist, and expert witness.  This Ethics Code provides a common set of principles and standards upon which psychologists build their professional and scientific work.”

It seems to me, what the preamble does is one thing.  It advises us that this code of shoulds and should nots is intended to guide our behavior to facilitate our work as psychologists.  Essentially, the Ethics Code advises us that we’ll do a better job of being psychologists if we follow the principles articulated there in.  It helps us do our work.

What is our work?  The jobs that psychologists do could fill a book, in fact, they fill many books.  But for most of the membership of this state psychological association, our work consists largely of psychological assessment and psychotherapy.  It’s important work. 

This Christmas, I was reminded of the importance of the work we do via a Christmas card I received from one of my former patients.   Here’s the story.   Almost three decades ago, I was asked to evaluate a family because one of the parents had been found guilty of abusing a child.  In response to a child’s episode of enuresis, the parent placed the child in a bathtub full of ice cubes and cold water for half an hour.  The community’s response was to place all three children in foster care.  When I was asked to evaluate the family, I administered a variety of psychological tests to the entire family.

Through the assessment process, I uncovered important information as I worked with this very poor, rural family. The parents had graduated from high school as Special Education students, with Wechsler IQs near the bottom of the borderline range.  But they also had near perfect handwriting and spelling on the Rotter and WRAT and that told me they were capable of learning.  The father worked as a laborer and the mother, while somewhat disabled, worked as a homemaker caring for her family.  While talking with the parents during interviews, I found them to be loving, devoted people.  I learned that they had treated the enuresis problem using the same disciplinary technique used on them when they were children.  In their minds, they weren’t being abusive; they were being good parents.  I established a good relationship with them during the evaluation and ultimately worked with them in family therapy, which largely consisted of psycho-education – I had them read Dr. Spock’s Baby and Child Care and then we discussed it, section by section.  We worked hard.  These two parents eventually got their kids back and raised them as well as they could given the limits of their intellect, education, and finances.  What would you expect to be the outcome?  Here’s what was in their annual Christmas card to me this year.  Obviously, the information has been disguised to protect identities.  However, the original punctuation is maintained.

“Our son, Tim, is in Columbus going through college at Ohio State, business engineering, our daughter Martha is going through college at Indiana University in Indiana, criminal justice she wants to be a detective and she also works at the grocery store.  Our youngest moved to Erie, PA, in July she works at a Walgreen pharmacy.  John and I are just fine.  Hope all is fine and well where you are.  Take care….”

  

We all have cases like this in our files, don't we?  We do very important work out there and sometimes we forget that reality.

There were a number of significant ethical issues in this case.  For example, all the potential dangers regarding multiple relationships needed to be navigated.  Clarifying the identity of my client or clients at various points was a challenge.  I didn’t always adhere to the letter of the then current Ethics Code,  but I certainly tried to adhere to the spirit of the document.  It helped me to do what I think was good work.  I think our system of ethics helps us all to do good work.  And, I think that’s why we have an Ethics Code and why we should behave ethically.   Maybe you’ve got a better reason, but that’s the best answer I can come up with.  It helps us do good work. And that’s why we’re here, isn’t it? 

References

American Psychological Association. (2002). Ethical principles of psychologists and code of conduct. American Psychologist,Vol. 57, 1060-1073. 

If you have specific suggestions for topics to be covered in The Ethics Corner, please e-mail me with your suggestions.  My e-mail address is ragusea@aol.com. 

Update: APA/ASPPB/APAIT Telepsychology Guidelines for Psychologists

Telepsych_TF



A full page link can be found here.

The Menace Within: The Stanford Prison Experiment

What happened in the basement of the psych building 40 years ago shocked the world. How do the guards, prisoners and researchers in the Stanford Prison Experiment feel about it now?

By Romesh ratnesar

It began with an ad in the classifieds.

Male college students needed for psychological study of prison life. $15 per day for 1-2 weeks. More than 70 people volunteered to take part in the study, to be conducted in a fake prison housed inside Jordan Hall, on Stanford's Main Quad. The leader of the study was 38-year-old psychology professor Philip Zimbardo. He and his fellow researchers selected 24 applicants and randomly assigned each to be a prisoner or a guard.

Zimbardo encouraged the guards to think of themselves as actual guards in a real prison. He made clear that prisoners could not be physically harmed, but said the guards should try to create an atmosphere in which the prisoners felt "powerless."

The study began on Sunday, August 17, 1971. But no one knew what, exactly, they were getting into.

Forty years later, the Stanford Prison Experiment remains among the most notable—and notorious—research projects ever carried out at the University. For six days, half the study's participants endured cruel and dehumanizing abuse at the hands of their peers. At various times, they were taunted, stripped naked, deprived of sleep and forced to use plastic buckets as toilets. Some of them rebelled violently; others became hysterical or withdrew into despair. As the situation descended into chaos, the researchers stood by and watched—until one of their colleagues finally spoke out.

The public's fascination with the SPE and its implications—the notion, as Zimbardo says, "that these ordinary college students could do such terrible things when caught in that situation" —brought Zimbardo international renown. It also provoked criticism from other researchers, who questioned the ethics of subjecting student volunteers to such extreme emotional trauma. The study had been approved by Stanford's Human Subjects Research Committee, and Zimbardo says that "neither they nor we could have imagined" that the guards would treat the prisoners so inhumanely.

In 1973, an investigation by the American Psychological Association concluded that the prison study had satisfied the profession's existing ethical standards. But in subsequent years, those guidelines were revised to prohibit human-subject simulations modeled on the SPE. "No behavioral research that puts people in that kind of setting can ever be done again in America," Zimbardo says.

The Stanford Prison Experiment became the subject of numerous books and documentaries, a feature film and the name of at least one punk band. In the last decade, after the revelations of abuses committed by U.S. military and intelligence personnel at prisons in Iraq and Afghanistan, the SPE provided lessons in how good people placed in adverse conditions can act barbarically.

The experiment is still a source of controversy and contention—even among those who took part in it. Here, in their own words, some of the key players in the drama reflect on their roles and how those six days in August changed their lives.

     *          *          *          *          *

The entire article can be here.  The article brings up a host of ethical issues related to research.

The Dark Side of "Comprehensive Soldier Fitness"

opednews.com
By Roy Eidelson, Marc Pilisuk, and Stephen Soldz  

Why is the world's largest organization of psychologists so aggressively promoting a new, massive, and untested military program? The APA's enthusiasm for mandatory "resilience training" for all U.S. soldiers is troubling on many counts.

The January 2011 issue of the American Psychologist, the American Psychological Association's (APA) flagship journal, is devoted entirely to 13 articles that detail and celebrate the virtues of a new U.S. Army-APA collaboration. Built around positive psychology and with key contributions from former APA president Martin Seligman and his colleagues, Comprehensive Soldier Fitness (CSF) is a $125 million resilience training initiative designed to reduce and prevent the adverse psychological consequences of combat for our soldiers and veterans. While these are undoubtedly worthy aspirations, the special issue is nevertheless troubling in several important respects: the authors of the articles, all of whom are involved in the CSF program, offer very little discussion of conceptual and ethical considerations; the special issue does not provide a forum for any independent critical or cautionary voices whatsoever; and through this format, the APA itself has adopted a jingoistic cheerleading stance toward a research project about which many crucial questions should be posed. We discuss these and related concerns below.

At the outset, we want to be clear that we are not questioning the valuable role that talented and dedicated psychologists play in the military, nor certainly the importance of providing our soldiers and veterans with the best care possible. As long as our country has a military, our soldiers should be prepared to face the hazards and horrors they may experience. Military service is highly stressful, and psychological challenges and difficulties understandably arise frequently. These issues are created or exacerbated by a wide range of features characteristic of military life, such as separation from family, frequent relocations, and especially deployment to combat zones with ongoing threats of injury and death and exposure to acts of unspeakable violence. The stress of repeated tours of duty, including witnessing the loss of lives of comrades and civilians, can produce extensive emotional and behavioral consequences that persist long after soldiers return home. They include heightened risk of suicide, posttraumatic stress disorder (PTSD), substance abuse, and family violence.

(dropping to the ethical concerns)

Ethical Concerns

We also believe that other key aspects of Comprehensive Soldier Fitness should have received explicit discussion in this special issue. It is standard practice for an independent and unbiased ethics review committee (an "institutional review board" or "IRB") to evaluate the ethical issues arising from a research project prior to its implementation. This review and approval process may in fact have occurred for CSF, but the manner in which the principals blur "research" and "training" leads us to wish for much greater clarity here. This process is even more critical given that the soldiers apparently have no informed consent protections -- they are all required to participate in the CSF program. Such research violates the Nuremberg Code developed during the post-World War II trials of Nazi doctors. That code begins by stating:

The voluntary consent of the human subject is absolutely essential.

This means that the person involved should have legal capacity to give consent; should be so situated as to be able to exercise free power of choice, without the intervention of any element of force, fraud, deceit, duress, over-reaching, or other ulterior form of constraint or coercion; and should have sufficient knowledge and comprehension of the elements of the subject matter involved as to enable him to make an understanding and enlightened decision.

Disturbingly, however, this mandatory participation in a research study does not violate Section 8.05 of the APA's own Ethics Code, which allows for the suspension of informed consent "where otherwise permitted by law or federal or institutional regulations." Despite the APA's stance, we should never forget that the velvet glove of authoritarian planning, no matter how well intended, is no substitute for the protected freedoms of individuals to make their own choices, mistakes, and dissenting judgments. Respect for informed consent is more, not less, important in total environments like the military where individual dissent is often severely discouraged and often punished.

More broadly, the 13 articles fail to explore potential ethical concerns related to the uncertain effects of the CSF training itself. In fact, the only question of this sort raised in the special issue -- by Tedeschi and McNally in one article and by Lester, McBride, Bliese, and Adler in another -- is whether it might be unethical to withhold the CSF training from soldiers. Certainly, there are other ethical quandaries that require serious discussion if the CSF program's effectiveness is to be appropriately evaluated. For example, might the training actually cause harm? Might soldiers who have been trained to resiliently view combat as a growth opportunity be more likely to ignore or under-estimate real dangers, thereby placing themselves, their comrades, or civilians at heightened risk of harm?

The entire piece can be read here.

Blogging from the Convention

John Gavazzi & Rick Small

Today, Rick Small and John Gavazzi presented an advanced ethics workshop on ethical decision-making.  The workshop addressed relational ethics: a blend of positive ethics, psychological culture, and patient-focused care.  They used the Acculturation Model (Gottlieb, Handelsman, and Knapp) as a means to introduce how relationships with the community of psychologists is an important factor in understanding the ethical culture of psychology.  Bridging from that model, they highlighted how ethical decisions can be understood within that framework. 

Rick and John also described the differences between remedial ethics and positive ethics.  They also touched upon principle-based ethics as a means to identify competing ethical principles that are sometimes found in ethical conflicts.  Since there is no ethical decision-making strategy within APA's Code, they explained how knowledge of ethics, emotional factors, cognitive biases and situational factors combine to make the best decision possible.  Simultaneously, the outcomes of these decisions are ambiguous at the time the decisions are made, which can lead to anxiety and uncertainty.

Relational ethics accentuates that ethical decisions play out within the psychologist's relationship to the patient.  Relational ethics includes a commitment to both the relationship and high quality of care.  Relational ethics combines psychologist factors with the clinical features of the patient.

Rick and John finished the lecture portion of the presentation with quality enhancing strategies related to documentation and redundant protections.

Finally, Rick and John provided participants with several ethical dilemmas.  The workshop participants discussed the vignettes, focusing on the following questions.

What factors make the dilemma difficult for the psychologist?

What would his/her emotional reactions be to the content of the scenario?

What types of redundant protections and documentation issues would be helpful for the dilemma?

Feedback from workshop participants was uniformly positive.

For a copy of the slides, please email John.

APA calls for psychologists inclusion in ACOs

Part of a psychologist's aspirational ethic is to urge government agencies to help our patients access appropriate psychological care.  This form of advocacy also advances our profession.  Here is a press release from the American Psychological Association that illustrates an important part of our collective professional responsibility.

-------------------

June 9, 2011—This week, APA sent a comment letter (PDF, 265KB) to the Department of Health and Human Services (HHS) regarding a draft proposal to establish Accountable Care Organizations (ACOs) in Medicare. Section 3022 of the Affordable Care Act requires the establishment of the Medicare Shared Saving Program, which is intended to encourage the development of ACOs.

ACOs, one of the reforms included in the Affordable Care Act, will allow hospitals, physicians and other Medicare providers and suppliers of services to establish a network that emphasizes primary and coordinated care. Medicare beneficiaries will enroll in an ACO as an alternative to fee-for-service delivery, where the ACO will coordinate their care in an effort to improve quality and contain cost increases. Medicare beneficiaries may still see providers of their choice but their care will be more carefully coordinated by the ACO.

The letter from APA Chief Executive Officer Norman B. Anderson, PhD, and APA Executive Director for Professional Practice Katherine C. Nordal, PhD, to HHS Secretary Kathleen Sebelius, dated June 6, 2011, addresses a specific portion of the proposal regarding health care professionals who may participate in ACOs.

In the letter, Drs. Nordal and Anderson urge inclusion of clinical psychologists as participants in ACOs, therefore ensuring better access of Medicare beneficiaries to mental health, substance use disorder and behavioral health services. The letter is a recent example of APA’s ongoing advocacy to promote psychologists as key players in primary care as it develops.

Among Anderson and Nordal’s comments:

- APA agrees with Sebelius’ decision to expand the list of providers eligible to

  participate in ACOs to include clinical psychologists and other providers not

  specifically named in the statute. 

- Clinical psychologists should be incentivized to provide care as part of the ACO

  primary care team. 

- Including clinical psychologists in ACOs ensures the integration of mental,

  substance use disorder and behavioral health with physical health and a more

  comprehensive integrated care system.

APA is asking HHS to retain and implement this provision in the proposed rule in the final draft. We anticipate that HHS will finalize the rule in the coming months.

APA and the APA Practice Organization will continue to evaluate and provide input on proposed rules of interest to practicing psychologists. 

For more information, contact the Government Relations department by email or at (202) 336-5870.

Distance Therapy Comes of Age: Article Review

John D. Gavazzi, PsyD ABPP
Ethics Chair

A friend recommended that I read Distance Therapy Comes of Age by Robert Epstein in the magazine Scientific American Mind.  While the title seemed appealing, the article treats telehealth and e-therapy quite superficially.  There is little in the way of empirical support for conclusions made in the article.

The article indicates that there is an "avalanche of evidence" supporting the efficacy of e-therapy.  I reviewed one of the sources for this article, "Current Directions in Videoconferencing Tele-Mental Health Research" by Richardson and others.  Here is one important quote from the article that undermines the overall conclusion of the article:

"Compared to symptom reduction and cost effectiveness, satisfaction is a simple variable to measure, and it is perceived to be a necessary first step for the development of good therapist-client relationships (Rees & Haythornthwaite, 2004). However a common weakness of tele-mental health research, particularly in small studies and novel demonstrations, has been to overemphasize patient satisfaction as being the same as clinical effectiveness. Furthermore, the majority of studies examining satisfaction with tele-mental health have typically used study-specific measures of this outcome, and the psychometric properties of these instruments are largely unknown. Finally, we do not know whether patient satisfaction with tele-mental health would remain as high in the presence of alternative mental health services, or if ratings of high satisfaction are a by-product of simply being pleased to receive any service at all."

Additionally, one of the "Fast Facts" in the article states "brief therapeutic communiques using mobile phones can help combat eating disorder, alcohol abuse, cigarette smoking and anxiety, among other problems."  The author cites research from Kristin Heron and Joshua Smyth to support the point; however, there is no reference given as to who published this research or where to find it.

There were some positive components to the article.  The first is a quote from Gerry Koocher, which states "the important thing is that you're practicing competently, no matter how you are delivering the therapy."  Koocher also made the important points that e-therapy may not be appropriate for everyone as well as the potential for fraud exists.

Psychologists need more definitive information and guidelines about telepsychology and e-therapy to practice at the highest level.

Fortunately, there is positive movement for psychologists interested in telehealth, e-therapy, and telepsychology.  The Committee for the Advancement of Psychology recently announced the formation of a new Task Force on Telepsychology.

We are pleased to announce the members of the newly formed Task Force on Telepsychology.  The Task Force members represent the American Psychological Association (APA), the Association of State and Provincial Psychology Boards (ASPPB), and the American Psychological Association Insurance Trust (APAIT).  The purpose of the Task Force will be to develop telepsychology guidelines that will provide direction to psychologists as they navigate the numerous ethical, regulatory, legal and practice issues that arise in their use of technology in the delivery of psychological services.  We want to acknowledge and thank these new members for their leadership and commitment to participate in this multi-organizational Task Force.

Psychologists will need to rely on credible sources of information before embarking in e-therapy and telepsychology.  Some interesting issues include informed consent, practicing across state lines, and the overall efficacy of telepsychology. 

This blog will update our readers on recent research about the effectiveness of telepsychology as well as any outcomes from the Task Force on Telepsychology.  Psychologists need to be informed on the ethical, legal, and competent practice of telepsychology.

The Ethics of Leadership in Psychology

Stephen A. Ragusea, Psy D, ABPP

Guest Blog

It is often said that psychologists have the most complex and demanding set of ethics of all the professions.  Whether or not that is so, we are clearly obligated to behave ethically in our professional lives, and certainly providing leadership is part of that professional existence.

The essence of leadership may be examined in a variety of ways (Thompson 2008) and the ethics of leadership in the field of psychology may similarly be perceived from different perspectives.  Think about the problems caused by ethical mistakes made by leaders that are now significant parts of our collective history. For example, the words Nixon, Enron, and Madoff bring forth a flood of memories about ethical breaches of leadership that clearly impacted the recent past.  Within psychology, the name Abu Ghraib now has special meaning and the debate within psychology about our leadership role there is ongoing.  Of course, these are extreme examples provided to emphasize the importance of ethical leadership.

As psychologists, our Ethical Standards provide us with much general guidance.  We are advised by our Ethical Principles that in all our work as psychologists we should act with “Beneficence… Fidelity and Responsibility… Integrity… Justice… and…Respect for People’s Rights and Dignity….” That’s a significant list of demands. We’re just human beings, after all.  But, we psychologists tend to demand a lot from ourselves. 

It is noteworthy and perhaps surprising that nothing in the Ethical Principles of Psychologists and Code of Conduct (2002) specifically addresses our leadership roles. Yet, psychologists function in leadership positions wherever they work and that includes their efforts within psychological organizations.  So, we must look to other sources for guidance on leadership ethics.

A literature review quickly reveals that little psychological research has been done on ethics in leadership, despite its importance in our world. In fact, it seems that the subject of ethical leadership is more likely to be considered by business scholars than psychologists.  However, there has been some research and scholarly writing done by psychologists, which we can peruse.

On a fundamental level, we psychologists seem to agree that leadership may be described as a “basic tension between altruism and egoism.  That is, some leaders balance the development of themselves and their subordinates, raising the aspirations of both the leaders and the led in the process…. Other leaders wield power to satisfy their own needs and have little regard for either helping the development of their subordinates or behaving in socially constructive ways.” (Turner 2002). 

When considering ethical matters, both psychologists and business professionals tend to embrace models of leadership such as Transformational Leadership. Within that model, leaders provide a vision for change and then endeavor to inspire the other members of the group to pursue that transforming vision.  This model is seen as morally superior and stands in contrast to other models of leadership that involve the direct control of others through coercive transactions.   Such transactional models are tempting for a variety of reasons.  For example they have the advantage of being, at least temporarily, expedient.

Indeed, transactional leadership has been utilized in organizations and nations throughout history and is very often effective for a limited time.  Such was the case with Attila, who served as King of the Huns from 433-453 (Wess 1989).   However, as Gandhi pointed out, “all through history…there have been tyrants…and for a time they seem invincible but in the end, they always fall.  Think of it, always.” Therefore, from both ethical and effectiveness perspectives, it appears that more altruistic leadership based on inspiration is usually superior to self-centered intimidation in most realms.

For that reason alone, it is would be wise for all of us involved in leadership roles to remember that we are primarily there to serve our profession and our patients, not ourselves.  And, research suggests that we lead best by sharing a vision that inspires others to action.  In so doing, we embrace our core ethical principles of “Beneficence… Fidelity and Responsibility… Integrity… Justice… and…Respect for People’s Rights and Dignity….” And, that is our ethical obligation.

References

American Psychological Association. (2002). Ethical principles of psychologists and code of conduct. American Psychologist,Vol. 57, 1060-1073.

 

Roberts, Wess (1989). Leadership Secrets of Attila the Hun, New York, Warner Books.

Thompson, A.D., Grahek, M., and Ryan, E.P. (2008).  The Search for Worthy Leadership.  Consulting Psychology Journal: Practice and Research. Vol. 60, 4, 366-382.

Turner, N., Barling, J., Epitropaki, O., Butcher, V. and Milner, C. (2002). Transformational Leadership and Moral Reasoning.  Journal of Applied Psychology.  Vol. 87, 2, 304-311.

To Friend or Not to Friend: That is the Question

Anthony S. Ragusea, Psy.D.

Florida Psychological Association

Guest Blog 


Recently on the Florida Psychological Association (FPA) listserv there was a spirited debate about whether or not it is professionally appropriate to accept a “Friend” request on Facebook by a client.  The fact that the debate was happening at all speaks to the enormous change that the Internet and a private social media company, Facebook, is having on the practice of psychology.  For the uninitiated, Facebook provides a space, much like any personal web page, where one can post pictures, text, links to other sites, and share all that personal information with a select group of “Friends.” Friends are other users of Facebook who are invited by you to see everything you’ve posted on your page, engage in conversations with you, and otherwise interact with you.  One can also create professional pages, but most users prefer personal profiles.

Facebook has over 500 million users worldwide, so the chances are good that some of your clients have Facebook pages.  In fact, as the debate on the FPA listserv suggests, many psychologists who use Facebook have encountered situations where clients have asked to become Friends of their psychologist.  Whether or not to accept such a request is a complicated decision, depending on one’s level of comfort with dual relationships, whether the dual relationship is unethical, the theoretical orientation of the psychologist, the risk management practices of the psychologist, the unique circumstances of the request, and perhaps other factors as well. 

In other words, there are legal, ethical, professional, and personal factors to consider.  Each of these general factors is separate from the others.  For example, a psychologist may be personally comfortable with having a client as a Friend, but from a psychoanalytic orientation may have concerns about what that relationship may have on the development of transference in therapy.  Or, a humanistic psychologist may feel that to draw a relationship boundary with a client over Facebook would be a sign of disrespect, a way of creating a hierarchical relationship with the client that suggests “you must be self-disclosing with me, but I will not disclose myself with you,” yet may still choose not to accept a client as a Friend because of concerns that the relationship may increase the chances of the client filing a complaint against the psychologist or terminating therapy.  Several articles have been written recently about managing such concerns on Facebook, Google, and the Internet in general.  A very good one about Facebook was written by psychologist Ofer Zur (2011), and the full text is available on his website.  I will briefly address the ethical dilemma with current clients here. 

As always, when deciding whether a professional behavior is ethical or not, we look first to the APA’s Ethical Principles of Psychologists and Code of Conduct.  The most relevant standard relates to Multiple Relationships (3.05).  This standard reads in part:

“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.

 Multiple relationships that would not reasonably be expected to cause impairment or risk exploitation or harm are not unethical.

(b) 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.”

This standard informs us that to “friend” a client is not inherently unethical, because a Facebook relationship is not intrinsically harmful and may not impair the psychologist’s effectiveness in the professional relationship.  It is up to the psychologist to predict whether harm may come to the client or to the professional relationship.  Some conceivable harms could include: the client learns personal information about the psychologist which causes the client to dislike the psychologist; the client develops an unhealthy fantasy about the psychologist as a result of this window into the psychologist’s life; the psychologist comes to view the relationship as more casual than professional, resulting in impaired objectivity or failure to maintain professional standards of behavior; or, finally, the online relationship results in an accidental breach of confidentiality that offends or harms the client in some way. 

The risk of harm by “friending” must also be weighed against the harm, albeit unlikely, that could come to the client by not accepting the request.  For example, the client may be inappropriately offended by the refusal, resulting in damage to the professional relationship.  This harm could likely be avoided through a frank discussion with the client about why the client wants to be Friends, and why the psychologist does or does not wish to accept.  If the psychologist does accept the request, there is still an obligation to be vigilant so that if harm occurs it can be minimized as quickly as possible.
 

If the FPA listserv may be considered a crude survey of the prevailing attitudes of psychologists, most maintain a policy to not accept Friend requests, and maintain strict controls over privacy on Facebook to prevent possible clients from viewing their personal profiles.  To “friend” a client is not automatically unethical, but clearly there are many risks with few apparent benefits, so the answer to the question posed in the title according to emerging consensus appears to be, “Not.”

Reference

Zur, O. & Zur, A. (2011). The Facebook Dilemma: To Accept or Not to Accept? Responding to Clients' "Friend Requests" on Psychotherapists' Social Networking Sites. Independent Practitioner, 31(1), pp. 12-17.