Competence

4
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A recently licensed school psychologist opened a private

office in the county adjacent to the primary and second
schools in which she worked. In addition to providing
services to children, she developed an interest in offering
marital therapy to troubled couples, even though she
had received no formal training. She had, however,
consulted with many parents about their adolescent
children in the course of her work in the schools and
had taken an online seminar on marital therapy.
One day a woman telephoned her about her
husband who had recently lost his job as an auto
mechanic and had begun drinking heavily every night.
She met with the couple for several weeks, attempting to
treat the husband’s alcohol dependency. She sided with
his wife in lecturing him about the destructiveness of
drinking and urged him to use “willpower” to stop his
addictive behavior. In the middle of the third session the
man suddenly stood up, declared that he was “tired of
being ganged up on by two crazy women!” and walked
out of the session, never to return.
The psychologist realized at that point that she did
not have the skills to treat such a couple; she had never
addressed the husband’s depression about not working
and had never considered the wife’s contribution to the
marital problems. She had also failed to consider options
for treating his addiction, such as referral to an addictions
counselor, a rehabilitation program, or Alcoholics
Anonymous. She realized that to “retread” from school
psychology to clinical work would require a substantial
amount of academic training and supervision; instead,
she decided to focus her energy on her work as a school
psychologist, for which she was competently trained.

http://dx.doi.org/10.1037/12345-004 67
Essential Ethics for Psychologists: A Primer for Understanding and Mastering
Core Issues, by T. F. Nagy
Copyright © 2011 American Psychological Association. All rights reserved.
 68 ESSENTIAL ETHICS FOR PSYCHOLOGISTS

Introduction

Clinical competence has been defined as “the habitual and judicious use of
communication, knowledge, technical skills, clinical reasoning, emo-
tions, values, and reflection in daily practice for the benefit of the indi-
vidual and community being served” (Epstein & Hundert, 2002, p. 226).
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By remaining within one’s field of competence, psychologists maximize

the odds of making positive changes in the lives of those with whom
they interact in psychotherapy, supervision, research, and other settings.
Conversely, going beyond one’s area of competence increases the chance
of harming others. Examples of the latter are failing to provide the kind
of treatment that is needed, failing to recognize the urgency of a poten-
tially dangerous situation (e.g., a patient disclosing his intent to harm a
third party or a research participant who becomes suicidal), and provid-
ing substandard clinical supervision.
More recently, in applied psychology, there has been an emphasis
on the concept of evidence-based approaches.1 Even since the earliest
days of psychology, with the establishment of the first psychological
clinic in 1896, clinical competence has been linked to an evidence-based
approach to patient care, requiring psychologists to base their interven-
tions on relevant clinical experiences or research (American Psychological
Association [APA] Presidential Task Force on Evidence-Based Practice,
2006). The intent was not to inhibit creative interventions with clients
and patients but to reduce the likelihood of idiosyncratic or self-serving
behavior that might possibly harm recipients of their services while max-
imizing interventions likely to be effective. A neophyte therapist might
have confidence that his creative clinical strategy for a new patient with
social phobia constitutes the best treatment because it helped him to
get over his own social anxiety in past years. In a sense, this approach
would be evidence based because the therapist has the evidence of his
own experience to rely on. However, he is lacking clinical experience
with other patients with the same diagnosis, and he is failing to rely on
evidence-based interventions in diagnosing and treating this particular
patient. His approach—relying on his own personal experience—may
differ little from advice that one friend might give to another under sim-
ilar circumstances.
Competence is one of the standards that is commonly cited when
ethics complaints are brought against psychologists. There are many
ways for a psychologist to demonstrate incompetence:

1
Other names for evidence-based practice are empirically supported treatments, empirically
supported therapy, and empirically based interventions.
 Competence 69

❚ A chemical dependency counselor could improperly evaluate a

depressed alcoholic male with a history of suicide attempts and
fail to hospitalize him when needed (clinical incompetence).
❚ A therapist could misinterpret an Asian woman’s avoidance of
eye contact as a sign of deception or withholding and change the
therapy strategy accordingly, thus alienating an already anxious
client (incompetence in multicultural assessment).
❚ A marital therapist could befriend the wife in a couple he was
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treating as they move toward divorce and invite her to go for a

walk with him on a Friday afternoon after work (incompetence
in maintaining proper boundaries).
❚ A researcher may understate the risk of psychological distress on
the consent form in hopes of obtaining a greater number of partic-
ipants for his study (incompetence in providing adequate informed
consent).
❚ A psychologist appearing on television may overstate the value of
his innovative treatment for addiction to Internet pornography
(incompetence in media presentations).
In each of these situations the psychologist has failed to meet the min-
imally acceptable standard to carry out psychological work with adequate
skill, ability, or efficiency. And as a result, an individual—the patient,
patient’s spouse, research participant, or television viewer—could have
been harmed.
How do psychologists cope with such an all-embracing standard as
competence in the great diversity of professional roles that they play?
Does a doctoral degree from a regionally accredited university or profes-
sional school of psychology necessarily confer competence on an indi-
vidual aiming for a career in management consulting or carrying out
research? And for psychotherapists who are just beginning their careers,
how does the concept of evidence-based practice help define compe-
tence in the field of health care?
In answering these questions, one should consider the different roles
played by psychologists—researcher, teacher, supervisor, therapist, eval-
uator, consultant, forensic specialist, case manager, and administrator,
to name a few. In each role, maintaining competence is an ongoing
process rather than a static goal based on knowledge learned during ini-
tial training. Maintaining competence is in a constant state of flux and
renewal—to be created and recreated on a daily basis.
Furthermore, a psychologist’s competence in any role is vulnerable
to the effects of stress and life events (e.g., illness, changes in mental
health, major life transitions such as divorce or deaths of loved ones) that
can impair his or her ability to function adequately. It can be argued that
psychologists have an ethical imperative to maintain both their profes-
sional competence and their personal mental health at all times or to
 70 ESSENTIAL ETHICS FOR PSYCHOLOGISTS

take steps that would remedy the situation (Norcross & Guy, 2007). These
steps might include participating in educational and growth-promoting
activities such as reading books and professional journals, attending sem-
inars and other educational activities (e.g., lectures, hospital grand rounds,
online continuing education, psychological convention workshops and
presentations) obtaining individual or group consultation, or seeking
psychotherapy.
In the remainder of this chapter, I examine four areas of competence
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that psychologists must master: (a) achieving and maintaining their com-
petence while in their professional role, (b) keeping within their bound-
aries of competence and limitations of their techniques, (c) maintaining
competence in matters of human diversity in practice and research, and
(d) protecting others’ welfare when standards of competence are lacking.

Achieving and Maintaining

Competence

Those aspiring to become psychotherapists commonly complete doctoral

studies at a regionally accredited institution, follow their studies with a
period of clinical supervision and/or internship, pass the examination for
professional practice in psychology, and show evidence of a thorough
working knowledge of the state laws affecting clinical practice.2 After
completing these steps one may then become licensed to publicly refer
to oneself as a psychologist, to engage in activities that are commonly
understood to be psychological in nature, and to offer professional ser-
vices to the public for a fee. Such services include individual or group
psychotherapy, marital therapy, assessment, forensic activities, clinical
supervision of trainees, and management consulting.
Those working in academic or health care settings as teachers,
researchers, administrators, or in some other nonclinical capacity would
not normally need to obtain a psychology license. Although not directly
offering clinical or consultation services to the public and billing for those
services, they must still be mindful of maintaining competence in their
chosen area.

2 The APA allows its members to claim a doctoral degree from a nonregionally

accredited institution only if it serves as the basis for licensure in the state. This means
that a psychologist who wishes to move to a different state at some point may not use the
title Dr. in the new state if his or her degree is from a nonregionally accredited institution
of learning. It is possible for a professional school of psychology or university to be licensed
by a particular state but at the same time fail to meet the standards of the regional
accrediting body, such as the North Central Association of Schools and Colleges or the
Western Association of Schools and Colleges.
 Competence 71

EVIDENCE-BASED PRACTICE
Evidence-based practice in psychology is an integration of science and
practice and has become an important goal in current health care sys-
tems and health care policy. It primarily pertains to clinical practice and
was defined by the APA Presidential Task Force on Evidence-Based
Practice (2006) as the integration of the best available research with clin-
ical expertise within the context of patient characteristics, including cul-
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ture, values, and preferences. This definition grew from a similar concept
formulated by the Institute of Medicine (2001) and has as its purpose to
“promote effective psychological practice and enhance public health by
applying empirically supported principles of psychological assessment,
case formulation, therapeutic relationship, and intervention” (APA
Presidential Task Force on Evidence-Based Practice, 2006, p. 34).
The APA Presidential Task Force on Evidence-Based Practice consid-
ered “best available research” to include scientific results derived from
intervention strategies, assessment, clinical problems, and patient popu-
lations in both laboratory and field settings as well as clinically relevant
results of basic research in psychology and related fields. The report spells
out eight components of clinical expertise:
❚ assessment, diagnostic judgment, systematic case formulation,
and treatment planning (e.g., accurate diagnostic judgments, setting
goals and tasks appropriate to the patient);
❚ clinical decision making, treatment implementation, and moni-
toring of patient progress (e.g., skill and flexibility, tact, timing,
pacing, framing of interventions, balancing consistency of inter-
ventions with responsiveness to patient feedback, monitoring
progress);
❚ interpersonal expertise (e.g., forming a therapeutic relationship,
encoding and decoding verbal and nonverbal responses, creating
realistic and positive expectations, empathy);
❚ continual self-reflection and acquisition of skills (e.g. capacity to
reflect on one’s own experience, knowledge, hypotheses, emo-
tional reactions, and behaviors; awareness of limits of knowledge,
skills, and biases affecting one’s work);
❚ evaluation and use of research evidence in both basic and applied
psychological science (e.g., having an understanding of research
methodology, validity, and reliability; being open to data, clinical
hypothesis generation; and having the capacity to use theory to
guide interventions);
❚ understanding the influence of individual, cultural, and contex-
tual differences on treatment (e.g., individual, social, and cultural
variables, including age, development, ethnicity, culture, race,
gender, sexual orientation, religious commitments, and socio-
economic status);
 72 ESSENTIAL ETHICS FOR PSYCHOLOGISTS

❚ seeking available resources as needed (e.g., seeking consultation,

recommending adjunctive or alternative services when needed,
acquiring cultural sensitivity); and having a cogent rationale for
clinical strategies (e.g., a planful approach to treatment of psycho-
logical problems, reliance on the therapist’s well-articulated case
formulation concerning the client or patient, reliance on relevant
research supporting the effectiveness of a certain treatment if it
exists).
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To date, the majority of treatments that qualify as evidence-based

practice in psychology are the cognitive–behavioral treatments, ranging
from 60% to 90% of available interventions (Norcross, 2004).

PRACTICE GUIDELINES
Growing from the foundation of evidence-based practice, the APA has
developed professional guidelines and statements, in addition to the
Ethics Code, that apply to those offering direct services as well as those
who teach or do research. These guidelines and statements are generally
aspirational in nature. Unlike the ethical standards, with which psychol-
ogists must comply, these guidelines offer psychologists help and practi-
cal advice in competently carrying out their daily work in a variety of
situations. They do not raise or lower the bar established by the Ethics
Code; they simply flesh it out, going into far more detail than an ethics
code ever could or should. Although there may be no penalty for a ther-
apist’s failing to comply with a specific guideline, the therapist may wish
to carefully consider any deviation and have a well-developed rationale
for doing so if ever questioned later, particularly in a forensic setting.
The practice guidelines are all published by the APA, APA divisions,
or APA committees, and many are available online at http://www.apa.
org/practice/guidelines/index.aspx. They are periodically revised and
updated, reflecting changes in American culture, demographics, and
laws, as well as the nature of psychological practice.3
❚ Guidelines for Child Custody Evaluations in Family Law Proceedings
(2009),
❚ Guidelines for the Evaluation of Dementia and Age-Related Cognitive
Decline (1998),
❚ Guidelines for Psychological Evaluations in Child Protection Matters
(1999),

3Additional resources for members at large are as follows: APA Disaster Response Network

Member Guidelines (2005), Criteria for Evaluating Treatment Guidelines (2002), Criteria for the
Evaluation of Quality Improvement Programs and the Use of Quality Improvement Data (2008),
Criteria for Practice Guideline Development and Evaluation (2002), Statement on the Disclosure of
Test Data (1996), and Statement on Services by Telephone, Teleconferencing, and Internet (1997).
 Competence 73

❚ Guidelines for Psychological Practice With Girls and Women (2007),

❚ Guidelines for Psychological Practice With Older Adults (2004),
❚ Guidelines for Psychotherapy With Lesbian, Gay, and Bisexual Clients
(2000),
❚ Guidelines on Multicultural Education, Training, Research, Practice, and
Organizational Change for Psychologists (2003),
❚ Guidelines Regarding the Use of Nondoctoral Personnel in Clinical Neuro-
psychological Assessment (2006),
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❚ Record-Keeping Guidelines (2007), and

❚ Specialty Guidelines for Forensic Psychology (2008).4

RESEARCH, PUBLICATION, AND

INSTITUTIONAL REVIEW BOARDS
There are more ethical standards addressing research and publication
activities and than in any other section of the APA Ethics Code. These
standards provide rules and guidance in the areas of planning research,
informed consent, inducements to research participants for volunteering,
deception, debriefing, animal research, reporting results, publication
credit, plagiarism, sharing research data, and reviewing grant proposals.
Researchers are obliged to comply with ethical standards in planning
and carrying out investigations and also in the use of research assistants.
In addition, the scientific aspects of the design and implementation of
the study, investigators must be fastidious about how they interact with
human participants, providing thorough informed consent at the outset,
avoiding harming them, considering alternatives to deception, debrief-
ing, providing results, and other matters (U.S. Department of Health and
Human Services, National Institutes of Health, 1996). In addition to
complying with ethical standards, investigators working in hospitals or
universities must also submit their research proposals to their institu-
tional review board before proceeding. These topics are addressed in
Chapter 11.
An example of an ethical dilemma is the therapist who desires to do
clinical research with patients currently in treatment. This poses a con-
flict of interest because the two roles have potentially opposing goals.
As a scientist, the investigator’s responsibility is to gather data and make
new discoveries by carrying out research in accordance with the best
possible protocol. However, as a therapist, the psychologist’s primary
role is to offer the best possible care to the participant (in this case,
patients; Sales & Lavin, 2000). If therapist–researchers decide to recruit
clients to become participants in research, they must exercise caution
to avoid placing their roles as therapist and researcher in conflict out of

4
This guideline was being revised when the current volume went to press.
 74 ESSENTIAL ETHICS FOR PSYCHOLOGISTS

their desire to achieve a research goal that might not be in the clients’
best interests. The best way to avoid this potential conflict of interest is
by recruiting clients and patients who have no direct relationship with
the therapist–researcher; ideally, the therapist should not be conduct-
ing research with his or her own patients.

ACADEMIA AND TRAINING SETTINGS

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Psychologists in teaching settings at the high school, undergraduate, and

graduate school levels instruct, train, and supervise students as they
progress through various developmental stages of their education. They
may bring the first exposure to the formal study of human and animal
behavior to students. The APA’s (2005) National Standards for High School
Psychology Curricula is a detailed compendium of suggested content areas
to be covered in psychology courses at the secondary school level. With
a focus on sound research methodology for generating a database, this
document describes four principle topical areas: (a) cognitive (learning,
memory, individual differences), (b) developmental (life span develop-
ment, personality and assessment), (c) biopsychological (sensation and
perception, motivation and emotion, stress, health), and (d) variations
in individual and group behavior (diagnosis and treatment of psycho-
logical disorders, social and cultural issues).
At both the undergraduate and graduate levels, the teaching of psy-
chology provides an academic foundation for pursuing most subspecialty
areas in psychology. At the master’s and doctoral levels, research, train-
ing, and supervision in school, clinical, and counseling psychology are
generally carried out by those who are licensed to practice psychology.
The Association of State and Provincial Psychology Boards (2003) prom-
ulgated guidelines for the supervision of doctoral, nondoctoral, and uncre-
dentialed individuals who provide psychological services as well as other
important information, such as guidelines for continuing education for
licensed psychologists.
After successfully completing a doctoral degree, the neophyte psy-
chologist may obtain additional training in the form of a postdoctoral
internship. This process is facilitated by the Association of Psychology
Postdoctoral and Internship Centers, which is responsible for matching
individuals with internship settings for additional clinical experience and
supervision at hospitals and clinics in the United States and Canada.
Their website (http://www.appic.org/) is extremely useful for graduate
students who wish to learn about opportunities for further supervised
training in the field before they sit for the licensing examination.
As with every subspecialty area, those psychologists who teach have
an ethical obligation to update their knowledge by familiarizing them-
selves with the current professional literature (e.g., journals, books) and
participating in continuing education (e.g., seminars, workshops, online
 Competence 75

presentations). Although not required, becoming a member of profes-

sional associations and reading their journals is an excellent way to
remain well-informed about the latest research and professional matters
affecting competence.

ETHICS CODES OF OTHER

PROFESSIONAL ASSOCIATIONS
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Psychologists who belong to professional associations other than the APA

often encounter other ethics codes that require compliance. These codes
are likely to be shorter and less comprehensive than the APA Ethics Code
and to have a specific focus reflecting the goals and needs of the organi-
zation. These organizations usually have their own means of adjudicat-
ing complaints that are brought forward about their members, by means
of their own ethics committees. A sampling of professional organizations
with their own ethics codes includes the American Group Psychotherapy
Association, the American Music Therapy Association, the American
School Counselor Association, the Association for Applied Psycho-
physiology and Biofeedback, the Society for Clinical and Experimental
Hypnosis, the Feminist Therapy Institute, and the Society for Research
in Child Development. Sometimes a particular ethical standard of an
association will be more or less rigorous than a similar standard in the
APA Ethics Code. In the case of conflicting rules, the psychologist belong-
ing to both associations resolves the conflict by adhering to the standard
that is more rigorous and provides greater protection to clients, patients,
or other recipients of services. A complete list of ethics codes is available
through Pope’s website (http://kspope.com/ethcodes/index.php).

Keeping Within One’s

Boundaries of Competence
and Limitations of Techniques

The Ethics Code requires psychologists to keep within their areas of

competence as therapists, researchers, teachers, supervisors, or in any
other professional role. Competence may be measured by one’s formal
education, training, supervision (unlicensed), consultation (for licensed
practitioners), continuing education and independent study, and pro-
fessional experience. As a part of this rule, psychologists must also
refrain from using techniques or interventions that go beyond their
intended use on the basis of the empirical data, hence, evidence-based
techniques.
 76 ESSENTIAL ETHICS FOR PSYCHOLOGISTS

TREATMENT
An example of a situation that can suddenly emerge that might push a
therapist to venture beyond his area of competence is illustrated in the
following scenario.
A psychologist in a metropolitan area receives an urgent phone
call from the father of a 14-year-old boy who threatened him with
a baseball bat just hours before. In addition, the boy smashed a
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table in the living room and bashed several holes in his bedroom
wall, all the time cursing and yelling at his father. There were also
other changes in his behavior over the past month, including
being absent from home during the evening hours, and hanging
out with a new group of older friends whom his father had never
met. The psychologist did not treat adolescents but recognized
that immediate intervention was important. He referred the
father to another psychologist in town who specialized in
adolescents and family therapy, rather than attempting to
provide treatment himself.

Sometimes it is more difficult to remain entirely within one’s area of

competence when practicing in a part of the country that lacks broad
mental health resources. If the therapist described in this scenario had
recently moved to a small town in Oklahoma and opened the only
psychology practice in town, he would be presented with many situa-
tions that might require that he go beyond his area of formal training
and experience, particularly if he were recently licensed and lacked
much clinical experience. In this setting, it would be essential for him
to consult with experienced clinicians to provide the best care to his
patients, including telephone consultation or videoconferencing, pur-
suing online training seminars (“webinars”), attending workshops when-
ever possible, and taking advantage of other opportunities to upgrade
his skills.
In recognizing the limitations of one’s expertise, a psychologist must
be attuned to what can reasonably be expected and accomplished with
certain strategies, interventions, or techniques. Those lacking evidence of
effectiveness provide the most obvious examples of failure to recognize
the limitations of their expertise, as mentioned earlier. But sometimes a
patient can be unwittingly complicit in tempting a therapist to exceed his
or her boundaries of competence.
A therapist who has been treating a young man for depression
for 3 months and has a good working relationship with him is
now asked by the patient if she could use hypnosis with him for
treating his symptoms of irritable bowel syndrome. He has read
about this intervention online, and one of his friends in another
state had consulted a hypnotist with excellent results for the same
disorder. The young man has faith in his therapist, likes her, and
hopes that she will be willing to do hypnosis with him.
 Competence 77

The therapist had attended an introductory workshop in

hypnosis the previous year but has no specific training in the
protocol for treating irritable bowel syndrome, though she is
aware that such a protocol exists. She wisely declined his request
for hypnosis on the grounds that she was not sufficiently trained
to treat irritable bowel syndrome at the present time but stated
that she would attempt to locate a health care provider who was
trained in the hypnotic protocol for irritable bowel syndrome or
obtain the necessary training herself.
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A patient with panic disorder who is having nightmares about

childhood sexual abuse approaches her therapist with a request for
hypnosis to treat her panic and also “learn about her abusive past.”
Although she may have confidence in this therapist’s ability and
the use of hypnosis as a tool for uncovering the past, she may not
understand that if hypnosis were improperly used it could help
“create” memories of childhood sexual abuse that may not be
entirely accurate (Brown, Scheflin, & Hammond,1998; Nagy,
1995; Nash, 1994).

It is important to note that although others may have confidence in

the psychologist’s abilities to carry out certain interventions, it is the ther-
apist’s obligation alone to determine his or her own level of competence
and when to refuse and refer the patient to a more competent clinician.
Sometimes peer consultation is helpful for a therapist in determining
whether he or she has the requisite competence in a given situation.
An example of limitations of a technique is illustrated by the psychol-
ogist who is competent to use biofeedback training for pain management
but also believes, absent any supporting research, that biofeedback alone
can reverse the course of metastatic pancreatic cancer. In promoting this
intervention to a depressed cancer patient, he is engaging in professional
activities that are misleading, fraudulent, and potentially abusive because
there is no empirical basis for his claims. On the other hand, if there were
preliminary research showing that certain cancer patients had more fre-
quent remissions and a better quality of life as a result of biofeedback
training, then such claims by a therapist could be supported, at least in
a tentative fashion, with appropriate disclaimers and informed consent.
The ethically cautious therapist would never let his enthusiasm be a sub-
stitute for scientific rigor, resulting in false guarantees or assurances to
the patient.

TECHNOLOGY
The use of technology can sometimes lure psychologists to exceed the
boundaries of their competence or limitations of techniques. An exam-
ple is the therapist who attempts to provide long-term psychotherapy
over the telephone or via e-mail to individuals who have never been eval-
uated in a face-to-face setting and who have serious psychopathology,
such as a personality disorder. The therapist may be competent but is
 78 ESSENTIAL ETHICS FOR PSYCHOLOGISTS

attempting to use his or her skill in a setting or milieu for which effective-
ness may never been established. Attempting treatment exclusively over
the telephone or Internet for someone who is having a manic episode
or is actively alcoholic with paranoid personality disorder may or may not
be possible; however, thus far the empirical evidence is lacking.
Nevertheless, a patient may initiate such a process naively, lured by
the psychologist’s assurances, paying for consultations, and expecting to
be helped. Instead, it is possible that little or no progress will occur or that
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the patient’s mental health will decline, with the therapist attempting to
use conventional interventions in the electronic medium.
Therapists should certainly be aware of new technology and creative
ways of offering services to patients. However, they should evaluate new
interventions with caution and always take positive steps to protect
patients form harm while using them. Protecting patients while using
new interventions and techniques for which no standards exist is dis-
cussed at the end of this chapter.

ASSESSMENT
Psychological assessment is an area that may invite going beyond one’s
area of competence, particularly in forensic settings. To provide guidance
to psychologists, the APA first published Technical Recommendations for
Psychological Tests and Diagnostic Techniques in 1954 and has been revising
this document ever since. The most recent revision is the 1999 publica-
tion, Standards for Educational and Psychological Testing, a joint venture with
the American Educational Research Association and the National Council
on Measurement in Education (American Educational Research Associa-
tion, APA, & National Council on Measurement in Education, 1999).
It is essential that psychologists use psychological tests in an appro-
priate manner and be fully aware of a test’s purpose and limitations—
reliability, validity, normative statistics, and other factors that inform
its use. It is useful to consider using the Wechsler Adult Intelligence
Scale as the sole basis for assessing a parent who is attempting to win
custody of her 5-year-old son from her abusive ex-husband. By rely-
ing on an intelligence test for such an important legal case, the psychol-
ogist may be adversely impacting his client’s case by failing to use
instruments that would better evaluate her mental health and parent-
ing ability. There are many valid assessment instruments that could be
selected, and psychologists must always be cognizant of the test’s pur-
pose for which norms exist. Furthermore, when assessing those of a
particular age, gender, race, ethnic or minority group, culture, or phys-
ical or mental disability for which the test has never been standardized,
a psychologist must use cautious interpretations and disclaimers in his
or her report.
 Competence 79

TEACHING AND TRAINING

Remaining within one’s professional boundaries while teaching in sec-
ondary school, college, or in graduate programs or professional schools of
psychology can also be challenging at times. At the graduate level there
may be risks of overextending oneself or venturing into areas of limited
competence, such as the instructor who agrees to assume last-minute
teaching responsibilities for a colleague who is unable to teach a course,
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although she has never taught the course before.

Another example of an ethical issue in teaching is the neophyte
instructor who includes an experiential component along with the course
work, such as an ongoing, self-disclosing “therapy group,” ostensibly for
the purpose of better understanding the theories of group process. The
professor who is a didactic presenter in the classroom one day and a group
therapist in his office on another places students in a potentially confus-
ing situation. They are being asked to participate in a group therapy expe-
rience with the same authority figure who will be judging and grading
their academic performance in the classroom the next day. This consti-
tutes a multiple-role relationship for the instructor, whose objectivity in
both roles may be compromised, and thus students coping with traumatic
past events may be harmed more than helped to appreciate group
dynamics.

CLINICAL SUPERVISION
Clinical supervision of pre- or postdoctoral trainees is a pivotal part of
psychologists’ training, and training and online resources are increas-
ingly available for licensed psychologists to learn successful techniques
involved in supervision. According to Rodolfa (2001), there are at least
four different roles: teacher, therapist, consultant, and evaluator. In the
role of teacher, the supervisor establishes clear goals for supervision and
for therapy, provides instruction, comments on specific skills and case
management, models intervention techniques, explains the rationale of
various interventions, assigns and discusses readings, and interprets sig-
nificant events in the therapy setting. The therapeutic role includes pro-
viding emotional support as needed, encouraging the supervisee to
express feelings, exploring personal reactions to patients (either over-
identifying or repellent reactions to patients), building trust, reflective
listening, and modeling relationship skills. The supervisor as consultant
monitors the overall system of therapist–patient–supervisor setting,
intervenes at the strategic level (how the supervisee, not just the patient,
changes), and collaborates with the supervisee to work out problems.
And ultimately, the supervisor-as-evaluator assesses the attainment of
goals and integration of suggested changes by the supervisee; follows
up on patient and supervisee progress; helps the supervisee assess
 80 ESSENTIAL ETHICS FOR PSYCHOLOGISTS

strengths and weaknesses; monitors the supervisee’s awareness and

application of ethical standards; and provides feedback on the super-
visee’s knowledge of theory, intervention skills, and personal qualities.
Supervisors of trainees in a practicum or internship setting could risk
going beyond their level of competence whenever they encounter a clin-
ical situation for which they have little or no experience. This is particu-
larly true in high-risk situations requiring specialized experience in which
supervisors may find themselves lacking needed skills. This might include
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a high-conflict divorcing couple who have already experienced physical

assault; an expressed threat of violence to a third party that would neces-
sitate breaking confidentiality; working with a lesbian or gay couple; or
dealing with a psychotherapy patient from a different culture whose val-
ues, customs, and interpersonal style may be quite foreign to the super-
visor. In any of these situations, the supervisor may opt to continue
supervising, assuming that his or her skills may be adequate in spite of his
or her inexperience or cultural difference. However, this may well con-
stitute going beyond his or her professional boundaries of competence,
with the possible result of a harmful or even catastrophic impact on the
patient. A better choice, and one that would model exemplary behavior
for his or her supervisee, would be for the supervisor to either seek con-
sultation him- or herself or temporarily delegate supervision of work with
this patient or couple to another psychologist who is experienced in these
areas. In this way everyone benefits: The student therapist receives com-
petent supervision with a difficult case; the patient likely receives better
care; and the supervisor does not risk exercising poor judgment or advo-
cating ineffective strategic interventions.

FORENSICS
Psychologists have become more engaged with the legal system by being
called on to do forensic work in a variety of roles such as expert witness,
child custody evaluator, worker’s compensation evaluator, consultant to
a lawyer for the plaintiff or the defendant, or consultant to a patient or
former patient who is engaged in litigation with a third party as well as
by either suing or being sued, contesting a will, or some other legal mat-
ter. Psychologists should not presume competence in these areas, partic-
ularly when a deposition will be taken or a court appearance is expected,
because it is not a normal part of their educational training. Seeking train-
ing, supervision, or consultation for these nonclinical roles would help
assure that psychologists remain within their boundaries of competence.
The forensic arena is dramatically different from the clinical con-
sulting office in that it is fundamentally adversarial in nature, frequently
subjecting psychologists to public scrutiny and even attacks on their cred-
ibility and professional work from opposing attorneys. By virtue of its
adversarial context, a psychologist may feel demeaned or personally
 Competence 81

undermined and become defensive or hostile in return. A psychologist

may also allow him- or herself to be manipulated into an advocacy role,
such as making supportive statements or taking positions on behalf of his
client that cannot be substantiated by the data. For example, a therapist
who is being deposed in a child custody case may voluntarily advocate
that the father have physical and legal custody of the child primarily
because that individual has been a patient and the therapist happens to
be very familiar with his strengths. However, the therapist may not be the
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one who carried out the evaluation of both parents and is certainly not
objective; it would likely be improper for the therapist to make any rec-
ommendation about parenting, much less to volunteer it unasked. The
assessment and testimony of the psychologist involved in a child custody
case could have major, long-term implications for the lives of the parents
as well as their children and extended family.
Incompetent testimony by an expert witness could result in a cus-
tody arrangement that would be harmful to children and possibly place
them at significant ongoing risk were the custodial parent neglectful
or abusive. In summary, keeping within one’s boundaries while carry-
ing out assessment is crucial in every area in which psychologists
find themselves—forensic, neuropsychological, management consulting,
school settings, or treatment settings (hospitals and clinics), to name a
few—as it may strongly impact on the decisions and services delivered by
other professionals.

Competence in
Human Diversity

What is termed competence in human diversity consists of having a full

awareness of the range of human diversity and acknowledging that
(a) people differ greatly on a variety of criteria and (b) various skills and
training, commensurate with these differences, must be acquired to
successfully intercede in their lives. As mentioned in Chapter 3, the rich
variety of human traits may be categorized as follows: age, gender, race,
sexual orientation, ethnicity, national origin, religion, disability, socio-
economic status, or any basis prescribed by law. These are examined in
detail in the sections that follow.
It is important for a therapist, researcher, or teacher to be aware of
his or her own bias or outright bigotry and how it may impact others. An
individual may hold a systematic prejudice against a member of a minor-
ity group, resulting in absence of objectivity, stereotyping, offensive
humor, unfair treatment, hostility or some other unwarranted attitude
or behavior, and ultimately, flawed psychotherapy or poorly designed
 82 ESSENTIAL ETHICS FOR PSYCHOLOGISTS

research. Assessing one’s own bias may be possible if one is aware of

dysphoric feelings such as disgust, impatience, anxiety, resentment,
shame, oversensitivity, powerlessness, or some other telling emotion
when working with a particular individual or group. Unusual verbal or
nonverbal behavior by the psychologist, such as poor eye contact, avoid-
ance of topics that should be addressed, sarcastic humor, certain physi-
cal gestures, insensitivity or harshness, aggressiveness, or other rejecting
behaviors that seem to be out of character, may be indicators that a prob-
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lem exists. Such telltale signs of bias should herald a warning to remedy
the situation by consulting a knowledgeable colleague, obtaining addi-
tional education or training (e.g., workshops, other training experi-
ences), reading and studying, engaging in personal psychotherapy, or
ultimately withdrawing from the setting altogether (treatment, research,
or teaching) if the bias cannot be resolved. The areas of diversity are
presented next.

AGE
Developmental issues manifest themselves continuously throughout the
life of the individual, demanding that psychologists maintain their knowl-
edge and skills commensurately. The needs of the infant are unique and
differ greatly in the first and second 6-month periods. These needs con-
tinue to change throughout stages of early childhood, adolescence, adult-
hood, and old age. Psychologists who diagnose, provide treatment, teach,
or do research with these individuals must be well-informed about these
stages and not presume competence unless they have had proper educa-
tion, training, supervision, or other life experiences.
Legal requirements may also pertain to those who are minors or in
the elderly group. This is particularly important when seeking informed
consent when counseling or conducting research with young children or
adolescents, hospitalized mental patients, geriatric patients, or members
of any disenfranchised group. Psychologists must always obtain informed
consent from parents, legal guardians, or conservators before beginning
any research or clinical work with these groups.

GENDER
Gender may be considered a subculture unto itself, one into which a per-
son is born, with its own range of genetic predispositions, cognitions, per-
ceptions, and behavior patterns conditioned by family and culture since
birth. A researcher may unwittingly introduce gender bias into any phase
of an investigation, including formulating the hypothesis to be explored,
collecting data (the manner or extent of collection), interpreting data
(what is systematically ignored or emphasized), and drawing conclusions
(implications and recommendations).
 Competence 83

Similarly, those engaged in teaching who do not accept males and

females equally may reflect their bias in unfair evaluations and grades,
unwarranted assumptions about abilities, demeaning verbal or nonverbal
behavior, and inappropriate and damaging humor. Furthermore, they
may subtly or explicitly sexualize their relationships with students, invit-
ing a multiple-role relationship that is confusing, coercive, or otherwise
destructive to the student. Sexualized behavior with students, supervisees,
research participants, colleagues, or others over whom the psychologist
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has evaluative or other authority is fundamentally exploitative and con-

sidered a grave offense in the APA Ethics Code.
Therapists and organizational consultants with a gender bias harm
patients and clients by what they do and what they fail to do. Assessment,
psychotherapy, consulting with management, human relations work,
and other direct services provide many situations in which differences
in social power can result in exploitation of the opposite sex (more com-
monly, men exploiting women).
Other harm perpetrated by psychologists with a gender bias include
making invalid formal assessments and recommendations, adversely
influencing a employee’s job, making inept recommendations about
hiring or firing that are not warranted by any objective criteria, failing
to make progress in treatment or contributing to actual deterioration
in mental health, or siding with the husband or the wife in marital
therapy.
Unfair gender discrimination has been a part of the fabric of our
culture for many years—invisible to many men and women—as it is sim-
ply “the way life is.” As a means of helping clinicians to understand these
issues, the APA published Guidelines for Psychological Practice With Girls and
Women in 2007, a lengthy document including eight guidelines that
focuses on cultural issues, socialization, oppression, bias and discrimina-
tion, the sociopolitical context, health matters, education, and commu-
nity resources (APA, 2007).4

SEXUAL ORIENTATION
Being familiar with and accepting the variety of sexual orientations is
also a vital part of psychological training. As a part of educating psychol-
ogists, the APA published Guidelines for Psychotherapy With Lesbian, Gay,
and Bisexual Clients, containing 16 guidelines addressing diagnosis, treat-
ment, family relationships, social prejudice and discrimination, risks and

4An important book on this topic, including the writings of various ethicists, is

Practicing Feminist Ethics in Psychology (Brabeck, 2000); it outlines the subtleties of the
marginalization of women, how it has affected American society, and what steps need to
be taken as a remedy.
 84 ESSENTIAL ETHICS FOR PSYCHOLOGISTS

challenges of being gay, health matters, obligations of the psychologist

working with gay clients and patients, and other matters (APA, 2000).
A systematic bias or fear of homosexuals (or heterosexuals) impairs a
psychologist’s work in the same way that gender bias does. A psychol-
ogist’s vulnerable or panicky feelings, anger, avoidant or hostile behav-
ior, or other signs of a homophobic response can adversely affect the
working relationship with a gay patient or student. If therapists, consult-
ants, or researchers are aware of their own bias against gays or lesbians,
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they should either limit their professional contacts or obtain supervision,

consultation, psychotherapy, or some other rehabilitative experience to
provide better coping skills.
In many situations, such as in the classroom or work setting (with
colleagues), it may be impossible to limit one’s contact with those with a
different sexual orientation. Instead, it may be wise to welcome such
exposure and increase one’s knowledge and understanding through con-
tinuing education, training, supervision, and consultation as an oppor-
tunity for personal growth.

RACE, ETHNICITY, NATIONAL ORIGIN,

AND LANGUAGE
The extensively diverse population within the United States poses a
significant challenge for psychologists to learn of the values, norms,
social customs, idiosyncrasies, and other attributes of those from other
cultures. This topic is addressed in the APA publication Guidelines on
Multicultural Education, Training, Research, Practice, and Organizational
Change for Psychologists (APA, 2003).
Ignorance or prejudice about race or national origin of immigrants’
or first generation Americans can impair a psychologist’s ability to work
competently and effectively in university, clinical, research, and man-
agement consulting settings. An example is the therapist working with
a Mexican American man who wants to bring a family member into the
consulting office. Although this might generally seem to be an unusual
practice, personal boundaries among Hispanics are more inclusive of
others, and it might be quite a natural practice to include a sibling or even
a close friend. Likewise, the therapist working with a Japanese patient
who is avoiding eye contact should remember that such a behavior may
not be clinically significant but is more likely to represent the Japanese
communication of respect for an authority figure.
Psychological assessment with language-based instruments can be
compromised when evaluating individuals from other cultures. This is
particularly true when the instruments have not been appropriately
standardized or English proficiency of the client is limited. An example
 Competence 85

is a neuropsychological evaluation on a cognitively impaired Vietnamese

woman who speaks broken English. In this situation an interpreter
should be used, one provided by the hospital or institution for reasons
of confidentiality and impartiality, instead of asking a family member
to do the translating. Psychologists should consider using culture-fair
tests, if available, or otherwise issue a disclaimer when the validity of an
assessment is diminished as a result of inadequate norms, language pro-
ficiency, cultural bias, or other reasons pertaining to the client’s race,
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ethnicity, or culture.

RELIGION
Religious differences can also detract from objectivity and competence if
there is a pervasive bias on the part of the investigator, teacher, consult-
ant, or therapist. Whether the bias is against atheists, Mormons, Jews,
Muslims, or those of any other faith, the psychologist hobbled by such
bigotry risks carrying out poorly conducted research, substandard teach-
ing or supervision, and incompetent consulting or psychotherapy. It is
useful to consider the therapist who has lost a brother in the Iraq war
and cannot bring herself to make eye contact with a Muslim supervisee–
trainee from a Middle Eastern country. Bias based on religion is partic-
ularly important when psychologists serve or assess members of the
clergy; in addition to being impartial, the psychologist should also be
familiar with beliefs, values, habits, and other attributes of the group
with which he or she is working.

DISABILITY
In serving, teaching, or investigating those with physical or mental
impairments, psychologists must be alert to the array of factors unique
to each disability. The designation special needs includes sensory impair-
ments (e.g., blind or hearing impaired), chronic pain or degenerative dis-
eases, spinal cord or other severe injuries, fatal illnesses, or some other
condition impairing daily functioning. The range of mental disorders
includes mental retardation or pervasive developmental disorders (e.g.,
autism, Asperger’s syndrome), schizophrenia, dementias, or other brain
disorders resulting from accidents or illness (e.g., stroke, heart attack,
or any event resulting in brain anoxia and subsequent permanent dam-
age). Therapists, teachers, and researchers who work with impaired or
disabled individuals must have the necessary education and training to
address the special needs of these individuals. By so doing, they reduce
the chance of harming students, clients or patients, or research partici-
pants by what they do or fail to do and enhance the likelihood of success-
ful outcomes.
 86 ESSENTIAL ETHICS FOR PSYCHOLOGISTS

SOCIOECONOMIC STATUS
Sometimes special skills must be acquired for working with those from
a lower or higher socioeconomic status. In practical terms, this could
involve learning of any special needs or requirements of a student, patient,
consultee, or research participant. For example, a woman who has been
physically abused by her husband and is living in a housing project will
have special needs of protection and safe refuge as well as concerns for
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the security of her children. She will be less motivated to begin a course
of long-term psychotherapy focusing on the impact of early childhood
experiences on her current circumstances. Likewise, the therapist work-
ing with a homeless person may need to first help him or her fulfill
immediate requirements such as food and housing or getting a job and
not press for psychological insight that fails to address the urgent issues
at hand. Disregarding such exigencies runs the risk of jeopardizing the
very safety of the patient or his or her dependents whom the therapist
is attempting to help.
A different array of problems confronts the psychologist treating the
very wealthy client or patient. For example, the millionaire who is will-
ing to pay the full fee and more for visits to a therapist, regardless of the
productivity of the sessions, may be functionally “buying a friend” once
a week instead of resolving his life problems or learning more adaptive
behavior. Or one might consider the wealthy patient who may wish to
fund his clinic therapist’s innovative research or donate a building to the
hospital or university campus in exchange for public recognition of his
philanthropy. This might constitute a strong inducement for this thera-
pist to prolong treatment and continue working with this lucrative patient,
regardless of the mental health benefits to him or her. In these situations,
the therapist must monitor his or her own conflicting motivations and
interests to avoid falling into a multiple-role relationship consisting of
therapist and fundraiser. The Ethics Code specifically prohibits multiple-
role relationships that could impair one’s objectivity or competence
because they can be confusing to all parties and ultimately result in con-
flicting loyalties that are not easily resolved.
Researchers who investigate those of lower or higher socioeconomic
status must take steps to educate themselves about attributes of these
groups that might affect the validity of the results. These attributes might
include such things as dialects, dress, nonverbal cues, interpersonal style,
and prejudices of the group under study, all of which could impact on the
research hypothesis, experimental design, data gathering, interpersonal
relationship with the investigator or research assistant, or other aspects
of the study. Failure to pay attention to these factors could have direct
consequences for the investigation and ultimately for the knowledge
base by making a contribution that is biased, distorted, or inaccurate in
some other way.
 Competence 87

Protecting the Welfare of

Others When Standards of
Competence Are Lacking

Ideally, much of what psychologists do should be founded on evidence-

based techniques or find support in their experience and training.
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However, there will inevitably be some emergent situations that the

researcher, therapist, teacher, or consultant may not be prepared for and
for which they lack specific guidance from their knowledge base, ethics
code, legal statutes, or other sources. In these situations in which lack of
education or training is the issue, one must use his or her best judg-
ment to avoid harming the recipient–patient, supervisee, or other. This
invokes the general principle of Beneficence and Nonmaleficence, and
good ethical compliance would prompt psychologists to use all resources
available—telephone consultation with other clinicians experienced in
the emergent situation, use of online resource (e.g., journal articles and
training experiences, training seminars and workshops), face-to-face
consultation with those who are knowledgeable, and other educational
experiences.
The Ethics Code allowed for these situations in the 2002 revision by
adding two standards (APA, 2002). One standard allows psychologists
to provide services in emergencies even though they do not possess the
necessary competence as long as they discontinue when the emergency
passes or another competent provider can take over. Another standard
deals with nonemergency situations in which psychologists are asked to
provide a service for which they are not specifically trained; this stan-
dard allows psychologists who are competent in a closely related area
of practice to effectively address the situation. This might apply more
commonly in a rural situation where few therapists are practicing and
the therapist must be a “Jack or Jill of all trades” at times.
Even well-trained and experienced psychologists occasionally
encounter situations for which standards may be lacking. It is useful to
consider the therapist treating someone diagnosed with a disorder char-
acterized by the Diagnostic and Statistical Manual of Mental Disorders (4th ed.;
American Psychiatric Association, 2000) as falling outside of the usual
range of symptoms for a particular syndrome such as Personality Dis-
order Not Otherwise Specified, or Depressive Disorder Not Otherwise Specified
(italics added). Or one may consider the clinical researcher who thinks
that the use of deception in his or her research is justified by the study’s
prospective scientific, educational, or applied value, as required by the
Ethics Code, even though an objective colleague might view the study’s
value as falling well below the criterion justifying deception. What are
 88 ESSENTIAL ETHICS FOR PSYCHOLOGISTS

psychologists to do when existing standards do not specifically address

every situation that may arise in affecting the lives of others?
Avoiding harming or exploiting others, whether because of lack of
competence or other factors, is a central feature of the Ethics Code and is
the focus of Chapter 6. General guidance for psychologists concerning the
ongoing obligation to protect the welfare of others and avoid harming
them in the course of carrying out psychologists’ work has been provided
by every edition of the psychology ethics code since 1953. Where there
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is even a small possibility that another could be harmed, psychologists

must take steps to protect recipients of their services.
The following should be considered a good beginning when there
is a question of how to proceed as a result of inadequate standards or
guidelines in one’s area of work:
❚ Remain current about existing standards of practice, recent
research, and changes in ethical rules that affect your area of work
(e.g., participate in continuing education seminars and workshops,
read journals, attend peer consultation groups).
❚ Provide adequate informed consent ahead of time about the atten-
dant risk when standards are lacking (e.g., a therapist informing a
patient that although the therapist has never treated this exact
symptom before, he or she has worked with similar disorders).
❚ Consult with others who are knowledgeable about the area or
situation about which you feel uncertain (e.g., experienced col-
leagues, former supervisors and mentors, institutional review
boards, a university’s or hospital’s ethics or risk management office,
the APA Ethics Committee or state ethics committees, state licens-
ing boards, attorneys).
❚ Minimize the risk of foreseeable harm when it is unavoidable
(e.g., not reporting a parent’s HIV status in a child custody eval-
uation when it is irrelevant to the assessment).
Psychologists seek education, training, or supervision as prepara-
tion for working with individuals and groups and need additional train-
ing to work effectively with those who differ from them in important
ways. It serves the science of psychology and the public for psychologists
also to be well trained in multicultural factors, gender issues, and other
important characteristics representing human diversity. Maintaining one’s
competence and pursuing learning should be an ongoing project through-
out one’s career, independent of legal regulations requiring continuing
education, because the field of psychology continues to evolve.