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Ethics Code changes
take effect June 1
(April 2003
Issue)
By Catherine Robertson Souter
On June 1, the new American Psychological Association (APA) Ethics
Code will take effect. Although not a major overhaul of the 1992
code, the changes will affect psychologists across the country,
especially because many states have adopted the APA code or portions
of it as part of the rules and regulations for licensing boards.
Since its inception in 1953, the code has been revised several
times. While the 1992 code was drastically different from its predecessor,
this re-write is regarded as more of a fine-tuning.
"The '92 code was a major re-write," explains Bruce Bennett, Ph.D.,
chief executive officer of the APA Insurance Trust and member of
the Ethics Code Task Force. "It was more legalistic than the prior
one. This one is similar to '92 in format and structure and in the
way it works."
The new code, written over the course of five years, addresses
areas in the previous version that may not have been clear. Standards
were added to reflect the profession's evolving nature. APA membership
and constituencies, the public and various consumer groups provided
input on the re-write.
In some cases, such as one described by Celia Fisher, Ph.D., professor
of psychology and director of the Fordham University Center for
Ethics Education, 2002-2003 Bio-ethicist in Residence at Yale University,
and chairperson of the 14-member Ethics Code Task Force, blanket
statements made by the old code could actually hinder a psychologist's
ability to treat a client.
"For example, there was a requirement in the 1992 code that just
stated that psychologists do not abandon their clients. The task
force received comments that this was impeding good practice because
it was not clear when it would be appropriate to terminate therapy,"
Fisher says. "This kind of blanket statement would sometimes make
it difficult for psychologists to make that appropriate decision."
The new code mentions specific times when a psychologist may terminate
a relationship, such as when the psychologist feels physically threatened
by a patient or someone else in a relationship with the patient.
In addition, the code outlines times when a psychologist must terminate
therapy - if a patient is not likely to benefit from continued service
or is being harmed by continued service.
"The standard underscores when it is appropriate to terminate therapy
and what to do if you'd made a decision to terminate therapy. It
requires psychologists to provide pre-termination counseling if
possible," Fisher says.
Because a clinical decision to terminate therapy will vary from
patient to patient, the task force realized that the standard should
focus on procedure for terminating therapy.
"We wanted to make sure we were distinguishing between what is
a clinical decision, which doesn't belong in the code and an ethical
procedure, which is what to do if you do decide to terminate," Fisher
says.
Fisher reviewed a list of other changes in the code, including
new sections on getting informed consent from patients for new,
unproven therapy techniques, a more explicit definition of multiple
relationships in therapy, and the release of test data.
"There are two significant changes that have to do with the release
of test data," she explains. "In the previous code, psychologists
were prohibited from releasing test data to anyone who was not qualified
to use the data and only to the patient or client if appropriate.
One of the problems with that is that there wasn't a consensus within
the discipline as to who was qualified. Did it only mean another
psychologist? Did it mean any licensed professional? Did it mean
an attorney?"
"In addition, there was a certain amount of confusion as to when
it was appropriate to release the data to the client him- or herself,"
she adds.
In a shift toward giving patients more autonomy, new Health Insurance
Portability and Accountability Act (HIPAA) regulations require psychologists
to provide clients access to their own records. The new standard
was written with the HIPAA changes in mind.
"The HIPAA regulations really have changed the legal landscape
for privacy and protection and patient/client access to protected
health information. We couldn't have a standard that actually prohibits
psychologists from following the law," Fisher says.
The new code defines a difference between test data and test materials,
which are not required to be distributed. Test materials are the
actual "manuals, instruments, protocols and test questions or stimuli"
used to conduct the test. Test data are the patient's responses
to questions, scored or raw scores, and psychologists' notes. Fisher
says that if a client's response is written on the test materials,
that becomes test data and must be released. Since the release of
materials could weaken the effectiveness of the tests, it is recommended
that psychologists take care to keep data and materials separate,
writing notes on a separate piece of paper, for instance.
In some cases, changes were made to the code to remove sections
that should not be enforced as law.
"We took out things we were never going to enforce," says Gerry
Koocher, Ph.D., dean of the School for Health Studies at Simmons
College and a member of the task force, "For example, there was
a part of the old code that talked about psychologists donating
a portion of their services to the community. Well, that's wonderful
and it's appropriate, but nobody is ever going to try to revoke
your license for not doing that."
The goal in revising the code, says Koocher, is to create a document
that will be relevant to all psychologists, be better than the previous
code and not increase risk or potential harm to psychologists.
While not all the changes will affect every licensed psychologist
in the country, lack of knowledge about the code could impact any
one of them. When asked what area a psychologist would most need
to be aware of, especially from a liability standpoint, Bennett
says the real issue is not so much what is in the code, but the
fact that most psychologists have never read it at all.
"The important thing to realize," Bennett says, "is that the ethics
code not only applies to members of the APA, but by extension when
it's quoted in the laws and regulations of the state statute, it
would then apply to any licensed psychologist who may or may not
be a member of the APA."
The new code can be read online on the APA Ethics Office Web site
at www.apa.org/ethics.
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