An old colleague recently posed this question on social media. I didn’t know there was a character limit (LOL). So I guess it’s a blogpost instead… He wrote:
“Ethically is a psychologist supposed to talk to a client in public?
AI answer: Generally, it’s considered unethical for a psychologist to initiate a conversation with a client outside of a professional context, such as in public. This is primarily due to the importance of protecting client confidentiality and maintaining professional boundaries. While a brief, neutral interaction might be acceptable if the client initiates it, the psychologist should avoid anything that could disclose the client’s identity or create a dual relationship.
Applied to Sport Psychology: Is it ethical to work with an athlete/performer in an office setting on clinical issues, then interact with them on the playing field in front of other athletes, coaches, staff, public?”
Great dialogue here. I think it is more nuanced than people are making it out to be, for Licensed Psychologists, other types of licensed providers and for CMPCs. For starters, folks should be aware that licensed providers must abide by their jurisdiction’s (state in the US) laws. State boards govern the statutes of licensed psychologists and other licensed providers. State boards also tend to adopt a code of ethics, which usually mirrors the professional association’s ethics code (e.g., APA for psychologists, ACA for licensed counselors, etc.). Of course, non-licensed people also have to abide by state law (e.g., not practicing psychology if not a licensed psychologist).
In addition to laws, licensed practitioners and CMPCs alike (a venn diagram), should abide by their professional organization(s)’ ethics codes. Sometimes this means, one, two, or more codes simultaneously. Codes tend to contain ethical principles which are more aspirational and less concretely enforceable AND ethical standards, which ARE enforceable (e.g., via sanctions such as suspended membership from an organization).
Regarding public interaction, a few ethical standards come to mind. I will cite both some excerpts of standards from both APA’s ethics code and AASP’s, after giving my own $.02. For both, the standards that I think are most relevant are: Avoiding Harm, Multiple Relationships, Exploitative Relationships, Informed Consent, and Confidentiality.
Tim’s $.02 regarding public interaction (mind you, I need to attend to multiple ethics codes)
Avoiding Harm: In most instances, given my personality and the nature of my interactions with clients, many of them would find it weird if I didn’t say hello. But as a human being (and sometimes space cadet), there might be occasions where they see/recognize me before I recognize them. In general, I follow their lead, and try to be mindful of the nature of our relationship. Is it (or was it) psychotherapy, counseling, or mental performance consultation? Was it a hybrid? Did it evolve from one kind of relationship into another? What is my best guess regarding what I think the client will be most comfortable with? How can I best manage the situation in advance, in the moment, and after? For instance, I am very much a part of the competitive sailing community. When I run into people, others often have no idea how we know each other. When I think it might be relevant to a particular client, I address it with them in advance. There have been times when I haven’t immediately acknowledged already knowing someone when “introduced,” but unless I’m sensing a weird “vibe,” I have often found it easier (less weird for them) to acknowledge that we DO know each other. If asked how, I might say, “I dunno, somehow along the way through sailing.” I did have one occasion when I sailed with a former therapy client because someone else arranged the whole thing. If it was strictly performance I probably would’ve thought nothing of it. Because it was much more than that, I tried to pre-emptively/quickly chat with this person in private, but they said it was no big deal. The vibe suggested otherwise, and I checked in after. It was all fine “enough,” and I knew they were resilient enough to recognize the situation for what it was. (I was more worried about it than they were!). One or two others knew we worked together previously, but clearly assumed it was just performance.
Multiple Relationships: Look carefully at these standards in both codes below. Consider when to refer one role out vs. when it’s better for the client to experience one stop shopping. Make sure they’re aware of the options (informed consent). One important consideration is considering risk of impairment, exploitation, or harm. Not all multiple relationships are unethical. However, that notion can’t be used as justification to mindlessly do whatever one wants. Frequently in discussing virtue ethics with grad students, I have witnessed a quick rationalization to be completely laissez faire…. Not ok. This requires very deliberate consideration, consultation is a good idea, and document! I have a book chapter (with Tracy Heller and Angel Brutus) coming soon in A. Friesen, S.Brueckner, & L. Tashman (Eds.), Becoming a sport, exercise, and performance psychology professional: A global perspective (2nd ed.). Routledge…. Coming soon. Encourage folks to check it out!
Exploitative Relationships: Intentions and perceived intentions of your interactions with clients in the world should clearly be for the client’s benefit (not yours). Unfortunately, I frequently see people in our field milking relationships for their own benefit….somehow putting their clients on display to further their own careers. For instance, it’s one thing if your client posts something about your work together and you repost it; it’s another thing if YOU are the one doing the posting. At the same time, an argument can maybe be made for conforming to the norms of an organization (e.g., mental performance coaching is no different here than strength and conditioning). Again, nature of the relationship is everything….is it psychotherapy or mental performance? Just because a practitioner is licensed doesn’t mean that they aren’t doing mental performance.
Informed Consent: This is HUGE. Regardless of role, try to get as much laid out in writing, and orally, as possible (continuing to strive for anti-weirdness). Make sure it’s clear…. Are we doing mental performance coaching, or therapy, or hybrid, or does it depend on the day? Create clear expectations. While I have written and presented extensively on this topic, the most succinct way I can break it down is to say: “If we are doing psychotherapy or counseling, the goal is improved mental health, and maybe as a bi-product, performance improves. If we’re doing mental performance coaching, the goal is improved performance, and maybe as a bi-product, mental health improves. Be on the same page as your client regarding what your goals are and how you’re getting there, and revisit this frequently if need be (particularly if the role is evolving or has to alternate based on circumstance).
Confidentiality: Talk with clients about limits of confidentiality (back to informed consent). If you’re doing on-site work with a client, try to talk through what is said to others. For instance, I was once onsite with a client and it would’ve been weird to suggest I wasn’t working with them! I asked how they wanted me to respond, and what titles to use… “Sport Psychologist? Mental Performance Coach?” I wasn’t going to even suggest Clinical Psychologist even though I was sometimes also that. They said, “Performance Coach.” Great! Makes no difference to me 😊.
Bottom line: All of this can be addressed via good communication…as best you can in advance, to some extent maybe in the moment, and certainly after (in anticipation of next time). And…..be sure to read the excerpts below (along with the rest of the ethics codes….there’s good stuff in there!). Sidenote: After being on the AASP’s ethics committee for over a decade, I stepped down last year while busy with other pursuits. Before my departure we completed a large scale overhaul of the ethics code.
APA’s Ethics Code Excerpts:
3.04 Avoiding Harm
(a) Psychologists take reasonable steps to avoid harming their clients/patients, students, supervisees, research participants, organizational clients, and others with whom they work, and to minimize harm where it is foreseeable and unavoidable.
3.05 Multiple Relationships
(a) A multiple relationship occurs when a psychologist is in a professional role with a person and (1) at the same time is in another role with the same person, (2) at the same time is in a relationship with a person closely associated with or related to the person with whom the psychologist has the professional relationship, or (3) promises to enter into another relationship in the future with the person or a person closely associated with or related to the person.
A psychologist refrains from entering into a multiple relationship if the multiple relationship could reasonably be expected to impair the psychologist’s objectivity, competence, or effectiveness in performing his or her functions as a psychologist, or otherwise risks exploitation or harm to the person with whom the professional relationship exists.
Multiple relationships that would not reasonably be expected to cause impairment or risk exploitation or harm are not unethical.
3.08 Exploitative Relationships
Psychologists do not exploit persons over whom they have supervisory, evaluative or other authority such as clients/patients, students, supervisees, research participants, and employees.
10.01 Informed Consent to Therapy
(a) When obtaining informed consent to therapy as required in Standard 3.10, Informed Consent , psychologists inform clients/patients as early as is feasible in the therapeutic relationship about the nature and anticipated course of therapy, fees, involvement of third parties, and limits of confidentiality and provide sufficient opportunity for the client/patient to ask questions and receive answers.
4.02 Discussing the Limits of Confidentiality
(b) Unless it is not feasible or is contraindicated, the discussion of confidentiality occurs at the outset of the relationship and thereafter as new circumstances may warrant.
AASP’s Ethics Code Excerpts:
- Avoiding Harm
AASP members and CMPCs:
(a) take reasonable steps to avoid and/or minimize harming their clients, research participants, students, and others with whom they work. In addition, they:
(1) take reasonable steps to reduce the impact of harm if harm has occurred.
(2) take reasonable steps to consult, communicate with those involved, and document their efforts when there is disagreement related to harm.
- Multiple Relationships
AASP members and CMPCs:
(a) acknowledge that multiple relationships may have an increased occurrence given the varied roles they perform professionally. They have ongoing awareness of potential power imbalances and various ethical concerns (e.g., confidentiality, informed consent) when providing services to clients, and work to act in the best interest of the client.
(b) carefully evaluate the nature of their professional relationships before or as soon as possible after becoming aware of the existence of a multiple relationship (e.g., acquaintances, friends, family members, and/or business relationship). Considerations might include their ability to maintain an appropriate amount of objectivity, the type of work to be performed (e.g., individual, group, mental health, performance), perceptions of credibility, frequency of sessions, and/or adverse effects on the client relationship.
(c) remain aware that social or other nonprofessional interactions (e.g., social media) can lead to potential harmful and unintended effects on others, which might impair the AASP member or CMPC’s objectivity or might risk harm or exploitation. To avoid impairment and mitigate potential harm, they take appropriate precautions such as (but not limited to) avoiding nonprofessional interactions and/or gaining informed consent.
- Exploitation, Harassment, Sexual Misconduct, and Misuse of Influence
(a) do not exploit persons over whom they have supervisory, evaluative, or other authority, such as students, supervisees, employees, research participants, and clients.
(d) do not solicit or use testimonials from current clients. AASP members and CMPCs can use unsolicited testimonials from other persons (e.g., past clients, administrators) after obtaining written permission only if testimonials are de-identified and when there is no potential for undue influence. AASP members and CMPCs must place current and former clients’ best interests above their potential opportunities for marketing or career advancement.
(f) refrain from publicly taking credit or sharing inaccurate testimonials.
- Informed Consent to Practice
AASP members and CMPCs:
(2) the person has been informed of relevant information (e.g., risks/benefits of consultation, fees, process, time of meetings, social media use, privacy, expectations concerning the consultation process)
- Maintaining Confidentiality
AASP members and CMPCs:
(b) discuss with persons and organizations with whom they work: (1) the relevant limitations of confidentiality, including limitations where applicable in group, relationship, family counseling, and in organizational consulting; and (2) the foreseeable uses of the information generated through their services.
(c) do not disclose confidential identifiable information across professional activities concerning their individual or organizational clients, or other recipients of their services unless the person or organization has given explicit consent.
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