Clinical psychologists work closely with clients to diagnose and treat mental illnesses, as well as to work through interpersonal problems. As a result of this interaction, psychologists develop intimate bonds with clients that depend deeply on mutual trust. These relationships also create ethical dilemmas when conflicts of interest arise or clients reveal an intention to harm self or others.

APA Code of Conduct

The American Psychological Association sets forth five principles by which practitioners should act: beneficence and nonmaleficence, fidelity and responsibility, integrity, justice, and respect for people's rights and dignity.

Beneficence and nonmaleficence mean that psychologists should try to benefit clients and do no harm. Fidelity and responsibility mean that psychologists must create trusting, respectful bonds with clients. The commitment to integrity requires that psychologists be honest and accurate in reporting facts and scientific data. The fourth principle, justice, asks that clinical psychologists recognize each individual's right to caring, compassionate psychological care. The final principle, respect for people's rights and dignity, means that a psychologist should respect a client's right to privacy, his ability to determine his own path, and confidentiality.

Confidentiality

An American Psychological Association survey found that psychologists reported confidentiality as the most ethically troubling issue they faced. Most commonly, clinical psychologists felt conflicted about reporting potential risks to third parties (someone other than the psychologist and client). While psychologists must report it to the authorities if they feel a person is in imminent danger, disclosing information revealed in a private session with a client is tremendously damaging to the clinical relationship. This creates a difficult ethical issue that may be best resolved by consulting another professional's opinion or returning to the APA Code of Conduct.

Conflicted Relationships

The second most common ethical dilemma reported by psychologists is conflicted relationships with a client. A clinical psychologist is taught to maintain clear, responsible boundaries between herself and a client. However, if a client is a fellow community member or part of the psychologist's social circle, it can be difficult to maintain appropriate boundaries. Again, when an ethically questionable relationship develops, it is best to assess it in light of the American Psychological Association Code of Conduct or to consult a colleague for advice.

Payment

The third most common ethical dilemma reported by clinical psychologists involves payment source or method. Most of these dilemmas concerned insurance coverage, in which psychologists felt that they were being required to provide inadequate care because of the financial limitations placed on the client by insurance policy coverage. These ethical issues can be difficult to resolve because of the bureaucracy involved in negotiating with insurance providers.

Considerations

The ethical issues facing clinical psychologists are widespread and difficult to resolve. While the Code of Conduct lays forth five important ethical principles, these principles sometimes conflict and create problems. It is important to remember to treat the client with respect and dignity, while maintaining a clear and appropriate therapeutic relationship with him.

If ethical questions arise in your clinical practice, consult a colleague or the APA Code of Conduct for advice. Many hospitals also have bioethicists who can answer tough ethical questions about medical issues.