The ethics of multiple relationships: a clinical perspective

By Stephen Behnke
The Monitor on Psychology
July/August 2015, Vol 46, No. 7
Print version: page 84

APA members contact the Ethics Office on a daily basis to discuss the ethical aspects of their work. Receiving these calls is both interesting and gratifying, and educates the office about how psychologists across the country frame the ethical questions they encounter. One of the most frequent topics is multiple relationships. During the Ethics Code revision process that ended in 2002, the Ethics Code revision task force made clear that not all multiple relationships are unethical. The task force wrote a test for determining when a psychologist should refrain from entering a multiple relationship:

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.

The language of ethical standard 3.05 requires the psychologist to determine when a particular relationship would impair the psychologist's objectivity, competence, or effectiveness in doing the work of a psychologist, or would otherwise risk exploitation or harm. The standard thus illustrates clinically driven ethics.

The entire article is here.

University of Oregon Employees Under Investigation for Misconduct in Rape Case

By Richard Read
The Oregonian
Originally posted May 8, 2015

Six University of Oregon employees, including a vice president and the school's interim top lawyer, are under investigation for alleged misconduct in the handling of therapy records of a student who says she was gang-raped by three Ducks basketball players.

The Oregon State Bar is investigating complaints against interim general counsel Douglas Park and associate general counsel Samantha Hill. The Oregon Board of Psychologist Examiners is investigating complaints against four people, including Robin Holmes, the university's vice president for student life, who is a licensed psychologist.

Jennifer Morlok, a senior staff therapist identified in legal correspondence as the clinician who counseled the woman, filed all the complaints.

The entire article is here.

Do You Google Your Shrink?

By Ana Fels
The New York Times - Opinionator
Originally published April 4, 2015

Here are two excerpts:

Patients’ access to huge amounts of information about therapists’ lives can’t help but change both members of the therapeutic dyad. It can have, for instance, a chilling effect on the therapist’s work outside the office. As a psychiatrist who occasionally writes and speaks, I now have to think about the impact of these activities on prospective patients. If I write a feminist article, will I end up with only female patients?

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The blurring of boundaries between the personal and professional can get quite creepy. A patient told me, in greater detail than I wished to know, about her Match.com date with a psychoanalyst with whom I’ve had professional dealings. It was an encounter that almost certainly would not have occurred in the pre-Internet-dating era, and it will be hard ever to think of him in quite the same way.

The entire article is here.

Online Ethics for Professionals

By The Social Network Show
Originally published March 16, 2015

Part of the Show Recap

The Social Network Show welcomes Dr. John Gavazzi to the March 16, 2015 episode.

If you are a healthcare professional or a professional in any other field, one thing you have to pay attention to is your online reputation. Something to remember, there is no difference in your professional and your personal online presence and patients, clients and customers can find you.

Dr. Gavazzi, a clinical psychologist and named Ethics Educator of the Year by the Pennsylvania Psychological Association in 2013, talks about the issues to consider when building an online presence. In this episode you will hear about what ethical issues to consider; the importance of setting boundaries; what is included in informed consent; the limitations of technology; what constitutes a violation of privacy; and what are the advantages of being online for professionals.

(I was also named Ethics Educator of the Year by the American Psychological Association in 2014.)

The podcast is here.

Physician guidelines for Googling patients need revision

By Jennifer Abbasi
Penn State News
Originally posted February 2, 2015

With the Internet and social media becoming woven into the modern medical practice, Penn State College of Medicine researchers contend that professional medical societies must update or amend their Internet guidelines to address when it is ethical to "Google" a patient.

"As time goes on, Googling patients is going to become more and more common, especially with doctors who grew up with the Internet," says Maria J. Baker, associate professor of medicine.

Baker has dealt with the question first hand in her role as a genetic counselor and medical geneticist. In a case that inspired her recent paper in the Journal of General Internal Medicine, a patient consulted her regarding prophylactic mastectomies. The patient's family history of cancer could not be verified and then a pathology report revealed that a melanoma the patient listed had actually been a non-cancerous, shape-changing mole.

The entire article is here.

How To Spot A Bad Therapist: 10 Major Signs

By Tamara Hill
PsychCentral Blog

Here is an excerpt:

It is often much easier to spot a good therapist than it is to spot a bad therapist. We all look for kind, loving, compassionate, and caring people to connect with. Yet, we are hardly able to pinpoint when we are being taken advantage of for a variety of reasons. It’s who we are and how we have been molded in society and even in our families to think about “professionals.” The first few nonverbal signs we look for when we meet someone new is genuine smiling, eye contact, and maybe touch (a touch on the arm or hand) to convey friendliness, and a positive tone of voice. When we do not see these things, we often do one of two things:

1. Ignore the behavior: Because the therapist may offer cheap rates, may be close to home, or offers other incentives, you may be more willing to ignore any signs of incompetence.
2. Make excuses: “Maybe she/he is having a bad day,” or “maybe he/she just doesn’t like me.” “Maybe he/she needs time to warm up to me!” Does this sound familiar?

The entire article is here.

Editor's Note: While a psychologist may not do any of the 10 signs, there are probably other activities that we do during therapy that may be countertherapeutic or unhelpful.  Asking for honest feedback from patients about what we are doing well and not doing well may help your overall skill level and competence.  Many times, psychologists ask patients to self-reflect.  Maybe it is important for psychologists to take the time to self-reflect.

Therapist and Patient Share a Theater of Hurt

By Corey Kilgannon
The New York Times
Originally published November 5, 2014

Here is an excerpt:

Dr. Dintino said that her behavioral approach to Ms. Powell’s condition allows for a more personal relationship with the patient than conventional psychotherapy, and for looser guidelines when it comes to patient-therapist relations.

Ms. Powell was willing to bare all as a patient, and both women felt the risks were outweighed by the potential therapeutic value, as well as the attention that the show could bring to the disorder.

As for the notion that the decision constitutes a breach of ethics, Dr. Landy said, “With certain forms of mental illness that do not respond to conventional treatment, we need a more radical approach, which therapeutic theater can provide.”

The entire article is here.

When Mental Health Professionals are on Facebook

By Steven Petrow
The Washington Post
Originally posted on August 25, 2014

For the past two weeks, whenever I’ve scrolled through my Facebook newsfeed I’ve come to the section “People You May Know.” The suggestions offered have included relatives, co-workers, some people I don’t even like in “real” life — and my current psychologist. “OMG!” I’ve winced repeatedly at the profile photo of my shrink, who for the sake of his privacy I’ll just call Dr. E.

Still, being the curious sort, I clicked to view his page, which isn’t very well protected from eyes like mine. For starters, there are 12 photos of him available for all the world to enjoy, several of them shirtless and one that had a “friend” of his posting “Woof!” underneath it. I also discovered pictures of Dr. E from high school with two nice-looking young ladies. Although I’ve known he was gay, I started to wonder: Was he bisexual then? When did he come out? I found myself thinking much more about his personal life than any patient should.

Among Dr. E’s Facebook friends was another psychologist, one who seemed to deploy no privacy safeguards whatsoever. Any patient clicking on his Facebook page could see tons of photos, including those of his wedding and honeymoon, and even his attendance at a celebration of “Bush 43’s” last night in office. (That makes it a good bet he’s a Dem, which might be TMI for a GOP patient.)

The entire article is here.

Ethical Dilemmas of Confidentiality with Adolescent Clients: Case Studies from Psychologists

Rony E. Duncan, Annette C. Hall, Ann Knowles
Ethics & Behavior 
DOI:10.1080/10508422.2014.923314

Abstract

Navigating limits to confidentiality with adolescent clients can be ethically and professionally challenging. This study follows on from a previous quantitative survey of psychologists about confidentiality dilemmas with adolescents. The current study used qualitative methods to explore such dilemmas in greater depth. Twenty Australian psychologists were interviewed and asked to describe an ethically challenging past case. Cases were then used to facilitate discussion about the decision-making process and outcomes. Interviews were transcribed and analysed using interpretive content and thematic analysis. Three key findings are discussed. First, it is of little use to perceive confidentiality dilemmas as binary choices (breach/don’t breach) because psychologists described five distinct options. These can be conceptualised on a spectrum of varying degrees of client autonomy, ranging from ‘no disclosure’ (highest client autonomy) to ‘disclosure without the client’s knowledge or consent’ (lowest client autonomy). Second, confidentiality dilemmas often involve balancing multiple and conflicting risks regarding both immediate and future harm. Third, a range of strategies are employed by psychologists to minimise potential harms when disclosing information. These are primarily aimed at maintaining the therapeutic relationship and empowering clients. These findings and the case studies described provide a valuable resource for teaching and professional development.

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1. It is of little use to conceptualise confidentiality as a binary choice.

2. Reaching a final decision about confidentiality dilemmas often entails balancing multiple and conflicting risks.

3. Participants demonstrated significant practice wisdom about how to negotiate confidentiality with adolescents in a manner that minimises harm.

The entire article is here.

Are we journalists first?

The longstanding debate about whether and when a reporter can intervene in a story is rekindled in the age of inequality

By Alexis Fitts and Nicola Pring
Columbia Journal Review
Originally published July 1, l2014

Here are a few excerpts:

She watched children beg their way into play dates for the promise of a meal. She watched a teacher handing out apples be thronged by more hungry students than he could feed.

She never offered help. When a photographer she was working with gave a bag of groceries to one family, Nazario felt he had crossed an ethical line. “I think what was beaten into me early as a reporter was you don’t intervene or change a story that you’re writing about,” says Nazario. As she would patiently explain to each subject at the beginning of her reporting, she was there to observe, to tell a story that alerts the public to problems and hopefully motivates others to address those problems. It is a traditional notion of objectivity that has been American journalism’s defining ideal for more than a century.

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The irony is that Nazario’s story had real impact: Within 24 hours of its publication, child-abuse reports in Los Angeles County increased by 20 percent, and eventually rose 45 percent. The county ordered an audit of the Child Welfare Agency and reorganized its reporting hotlines. More federal and state funds were allocated to programs for addicted mothers. The story also improved the lives of the families she’d profiled: The county placed Tamika Triggs in a foster home; her mother was admitted to a choice rehabilitation program.

The entire story is here.

Thanks to Dr. Deborah Derrickson Kossmann for this story.

Editor's note: Clearly, psychologists face issues related to poverty, inequality, and emotional suffering. An ethical dilemma may emerge when a psychologist struggles with boundary issues while in their professional role.  These issues typically involve compassion overriding professional judgment and role.

Who’s Googled whom?

Trainees’ Internet and online social networking experiences, behaviors, and attitudes with clients and supervisors.

By P. Asay and Ashwini Lal
Training and Education in Professional Psychology, Vol 8(2), May 2014, 105-111.
doi: 10.1037/tep0000035

Abstract

The ubiquity of the Internet and online social networking creates rapidly developing opportunities and challenges for psychologists and trainees in the domains of relationships, privacy, and connection. As trainees increasingly are natives of an Internet culture, questions arise about the ways in which developing psychologists may view Internet issues and the guidance they receive from professional psychologists for whom the Internet is a significant cultural shift. A national survey of graduate students (n = 407) assessed student Internet behaviors (e.g., “Googling” clients, online social networking), training about online issues, attitudes toward online social networking and client or supervisor contact via these networks, and fears and comfort about making decisions regarding these networks. The survey also assessed what students reported they would do and what they would think if clients and supervisors contacted them via social networks. Results indicate that most trainees have changed and monitored their online presence since beginning graduate school. A quarter of respondents had “Googled” clients, and almost half had “Googled” supervisors. A small number indicated that both clients and supervisors had reported “Googling” the trainee. Students expressed concerns about making ethical decisions about online social networks. Half reported discussing Internet issues in their graduate training programs, whereas a quarter indicated they had discussed Internet issues at their training sites. Implications for training are discussed, with recommendations of program disclosure of Internet policies to students, discussion of Internet issues before trainee clinical work, role plays of ethical issues, and supervisor-initiated discussions of Internet issues.

The entire article is here.

Social media can cause problems for lawyers when it comes to ethics, professional responsibility

Bodies are trying to come up with guidelines for the legal profession when it comes to the use of social media

By Ed Silverstein
Inside Counsel
Originally published April 29, 2014

It is becoming increasingly confusing what lawyers, judges and courthouse employees can post on social media sites. For instance, can a judge “friend” someone who is an attorney on Facebook and then have the attorney appear before them in court?

Attorneys who post on sites like Facebook also have to worry about violating attorney-client confidentiality, disciplinary action, losing jobs, or engaging in the unauthorized or inadvertent practice of law, according to an article in the Touro Law Review. In addition, attorneys could “face sanctions for revealing misconduct or disparaging judges on social media sites,” the article adds.

The entire article is here.

How we were fooled into thinking that sexual predators lurk everywhere

By Dana Boyd
From It’s Complicated: The Social Lives of Networked Teens
Published by Yale University Press

Here are two excerpts:

As moral panics about child safety take hold, politicians feel that they should take action—or at least capitalize on the appearance of doing so. They regularly campaign over safety issues and implement or expand laws targeted at curtailing the freedoms of minors. In the 1980s and 1990s, this included curfew laws, anti-loitering laws, and truancy laws. To expunge teens from public places, cities and towns limited where, when, and for how long teens could gather or hang out in public places. Many believed that curfew laws would combat crime; a 1997 survey of US mayors found that 88 percent believed that youth curfews reduced crime. It did not. As researchers began to examine the effects of these laws, they found that there was no correlation between curfews and youth crime. After analyzing the data, sociologist Michael Males concluded that authority figures use curfews more as a symbol of social control than an actual crime deterrent.

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Through social media, teenagers have created digital streets that help define the networked publics in which they gather. In an effort to address online safety concerns, most adults respond by trying to quarantine youth from adults, limit teens’ engagement online, or track teens’ every move. Rhetoric surrounding online predation is used to drum up fear and justify isolation. But neither restrictions nor either adult or institutional surveillance will help those who are seriously struggling.

The entire chapter is here.

Thanks to Gary Schoener for this information.

Online Medical Professionalism: Patient and Public Relationships

Policy Statement From the American College of Physicians and the Federation of State Medical Boards

By Jeanne M. Farnan, Lois Snyder Sulmasy, and others
Ann Intern Med. 2013;158(8):620-627. doi:10.7326/0003-4819-158-8-201304160-00100

Abstract

User-created content and communications on Web-based applications, such as networking sites, media sharing sites, or blog platforms, have dramatically increased in popularity over the past several years, but there has been little policy or guidance on the best practices to inform standards for the professional conduct of physicians in the digital environment. Areas of specific concern include the use of such media for nonclinical purposes, implications for confidentiality, the use of social media in patient education, and how all of this affects the public's trust in physicians as patient–physician interactions extend into the digital environment. Opportunities afforded by online applications represent a new frontier in medicine as physicians and patients become more connected. This position paper from the American College of Physicians and the Federation of State Medical Boards examines and provides recommendations about the influence of social media on the patient–physician relationship, the role of these media in public perception of physician behaviors, and strategies for physician–physician communication that preserve confidentiality while best using these technologies.

The entire policy statement is here.

Digital and Social Media for Psychologist: Current Issues and Ethical Dilemmas

By Keely Kolmes, PsyD

Psychologists, whether they are in independent practice, working in an agency setting, or are teaching and supervision, are struggling more and more with issues related to their own, their trainees', and their clients' online access and availability.  Zur and Donner (2009) wrote about the accessibility of online information.  the compared unintentional vs. intentional disclosures clinicians may make during the psychotherapy hour and then compared these with the unintentional disclosures that psychotherapists might make available on the Internet when clients seek out information about providers.  They noted that the motivations could range from mild curiosity to criminal stalking, and they encouraged clinicians to maintain awareness of what information is made available about them.

The entire article is here.

The Workplace and Social Networking - Got Boundaries?

By Kate Anthony
Online Institute
Originally published January 23, 2014

Negotiating the boundaries between our professional and personal lives is increasingly a part of our work as therapists. If you use social media sites such as Twitter, Facebook and LinkedIn you are probably aware of the sometimes inappropriate statuses or updates people post.  Even if you are not a user of them, you will likely have seen the media reports about an staff’s Facebooks posts made while off sick coming back to haunt them, or ill-advised crude tweets resulting in an employee instantly losing their job despite having deleted it within 14 seconds of posting (see example here).

The entire article is here.

Managing Risk When Contemplating Multiple Relationships

By Jeffrey Younggren and Michael C. Gottlieb
Professional Psychology: Research and Practice, Vol 35(3), Jun 2004, 255-260.

Abstract

Entering into dual relationships with psychotherapy patients has been a topic of significant controversy in professional psychology. Although these types of extratherapeutic alliances have generally been considered to be unethical conduct, some authors recently have supported their development as both ethical and, in some cases, even therapeutic (A. Lazarus & O. Zur, 2002). In this article, the authors briefly review the general literature regarding dual relationships and offer the reader guidelines in applying an ethically based, risk-managed, decision-making model that could be helpful when a practitioner is considering entering into such relationships or when such relationships inadvertently develop.

The entire article is here, behind a paywall.

The authors ask many great questions from a risk management perspective.

Decline Facebook 'Friend' Appeals from Patients, Groups Say

By  David Pittman
Washington Correspondent, MedPage Today
Originally published April 12, 2013, and still relevant today

Physicians should avoid making or accepting "friend" requests through social networking websites with past or current patients, a new policy statement advises.

Instead, doctors should separate their professional and social lives online and direct patients to correct avenues of information if they contact doctors through social networks, according to the policy statement issued jointly on Thursday by the American College of Physicians (ACP) and the Federation of State Medical Boards (FSMB).

"There's this notion of blurring of our identity, blurring of our persona," David Fleming, MD, chair of ACP's Ethics, Professionalism, and Human Rights Committee, which helped draft the guidelines, said here at the ACP's annual meeting.

The entire article is here.

When Healers Get Too Friendly

By Abigail Zuger
The New York Times - Well
Originally published November 11, 2013

Here is an excerpt:

The incident that it set it off: Dr. Schiff (now 63, an experienced senior clinician) had tangled with an insurer on the phone for two hours before he gave up and handed an impoverished patient $30 to pay for her pain pills. A resident observed the transaction and turned him in. But Dr. Schiff is a proud repeat offender, whose past infractions include helping patients get jobs, giving them jobs himself, offering them rides home, extending the occasional dinner invitation and, yes, once handing over a computer.

He was told physicians should stay away from “random acts of kindness” — an activity that may sound harmless but is quite distinct from the practice of medicine, and has its risks. Patients might get too familiar, expect too much.

The entire story is here.

For Med Students, Love From the Drug Rep

By Pauline Chen
The New York Times - Well
Originally published October 3, 2013

Here is an excerpt:

A significant proportion of medical schools and teaching hospitals end up the beneficiaries of such promotional largesse. But in recent years, leaders in medical education and, more notably, a growing contingent of medical students, have called for changes in a professional culture that accepts interactions with industry as the “norm.” In 2007, the American Medical Students Association published the PharmFree Scorecard, a rating system that grades medical schools on the strength of their policies regulating interactions between industry and students and faculty. Around the same time, the Association of American Medical Colleges and several medical schools issued policy statements calling for a decrease in the influence of industry in education.

Observers hailed these initiatives as transformative, but in the years since it’s not been all that clear that a transformation has actually occurred.

The entire story is here.