Ethical and legal issues in e-mail therapy

Psychologists and psychiatrists recently started using electronic mail (e-mail) to conduct therapy. This article explores relevant ethical and legal issues including, among others, the nature of the professional relationship, boundaries of competence, informed consent, treating minors, confidentiality, and the duty to warn and protect. To illustrate these complex issues, two services currently operating are discussed. To address potential hazards to clients and the profession, a new ethical standard for e-mail therapists is offered.

Sex with ex-clients: theoretical rationales for prohibition

Two decades of literature and discussion on the topic of therapist-client sexual relationships have revealed much about the nature and consequences of these relationships and have produced an explicit prohibition against such relationships in American Psychological Association (APA) Ethical Principle 6a. This article reviews the literature as it relates to the ethically gray area of sex with former clients. The relative lack of an empirical basis for extending the prohibition of Principle 6a to posttermination relationships is noted. This article describes concepts from three theoretical perspectives about psychotherapy that support an extension of the prohibition to sexual relationships with ex-clients.

Ethical and legal risks associated with archival research

Mental health facilities and practitioners commonly permit resarchers to have direct access to patients' records for the purposes of archival research without the informed consent of patient-participants. Typically these researchers have access to all information in such records as long as they agree to maintain confidentiality and remove any identifying data from subsequent research reports. Changes in the American Psychological Association's Ethical Principles (American Psychological Association, 1992) raise ethical and legal issues that require consideration by practitioners, researchers, and facility Institutional Review Boards. This article addresses these issues and provides recommendations for changes in ethical standards as well as alternative avenues for conducting research using archival mental health records.

Toward a hermeneutic model of ethical decision making in clinical practice

Documented ethical violations and empirical research have demonstrated that, despite professional standards and formal training in ethical principles, some psychotherapists engage in unethical behaviors that compromise the welfare of clients. It appears that competing values and interests that emerge in the therapeutic endeavor can interfere with therapists' considerations of ethical standards and their willingness to act ethically. Expanding current models of ethical decision making, this article offers a hermeneutic model that recognizes that in addition to moral reasoning, the context of the therapeutic relationship and the therapist's subjective responses are fundamental considerations in the interpretation and application of ethical interventions. Implications for understanding and training of ethics in psychotherapy in this broader context are explored.

Sexual intimacies with clients after termination: should a prohibition be explicit?

The Revisions Task Force of the Ethics Committee of the American Psychological Association (APA) has proposed that prohibition of sexual intimacies with clients after termination of therapeutic relationships be made an explicit part of the new code. This decision was based on much careful deliberation and input from various individuals and groups. This article supports the proposed change and provides a rationale based on emerging theoretical positions and research findings regarding risks to clients, risks to professionals, and risks to the various mental health professions. The revision would read, "Psychologists do not engage in sexual intimacies with current or former psychotherapy clients."

Reports of assent and permission in research with children: illustrations and suggestions

This study ascertained reports of assent (affirmative agreement) and permission (agreement by an adult fully capable of being informed) in 114 children's research articles in 1990 in Child Development (CD), Journal of Consulting and Clinical Psychology (JCCP), Journal of Pediatric Psychology, and Journal of Clinical Child Psychology. Of the research projects, 43% failed to specify permission, and 68.5% failed to specify assent. JCCP reported assent significantly more than CD. Assent was reported significantly more in research with older children than with younger children. This lack of sensitivity to assent and permission suggests that many authors, reviewers, and editors consider reporting assent and permission unessential. We recommend specifying assent and permission in all manuscripts, highlighting children's research issues in graduate training, and using specific safeguards when conducting research with children.

Ethical principles of the American Psychological Association: an argument for philosophical and practical ranking

Unlike the American Psychological Association (APA), the Canadian Psychological Association has adopted a code of ethics in which principles are organized in order of importance. The validity of this hierarchical organization has received some empirical and theoretical support. We conducted a theoretical analysis that revealed conceptual justification for a ranking of the 6 principles in the APA code. Such a ranking could assist psychologists in making more informed and consistent moral choices when confronted with ethical dilemmas that involve conflicts among principles.

Case vignette: to share or not to share

For years, the notion that researchers should share data freely with fellow scientists has been discussed widely. Some argue that this is especially true when the data are generated in federally funded projects. A recent provision in the reauthorization bill for the National Institutes of Health (NIH) would ensconce this principle in law. NIH grantees would be required, on demand, to furnish their data to other researchers. According to the proposed legislation, research data would have to be preserved and made avilable for 3 years after the completion of a project, and for 5 years following publication of the results in a scientific journal. One objective, according to a congressional aide, would be to make it easier for scientists with dissenting views to obtain and reanalyze data collected with public funds. It would also facilitate publication of alternative analyses. Personal records and patent applications would be exempted, but other data from clinical, behavioral, or epidemiological research focused on the evaluation or efficacy of a drug, medical device, or treatment of any sort would be covered immediately. Is such mandatory sharing of data ethical and appropriate scholarship? Does it raise potential for abuse? Should colleagues be required to provide such access to data, whether or not federal support was used in its collection?

Dual relationships in psychotherapy

A dual relationship in psychotherapy occurs when the therapist engages in another, significantly different relationship with the patient. The two relationships may be concurrent or sequential. For both sexual and nonsexual dual relationships, men are typically the perpetrators and women are typically the victims. This article presents examples of dual relationships, notes the attention that licensing boards and other agencies devote to this topic, reviews the meager research concerning nonsexual dual relationships, and discusses common strategies that promote both sexual and nonsexual dual relationships.

Ethical implications in screening for ethics violations

The process of admittance to membership in a psychological organization is an opportune time to take into consideration any questionable behavior in the professional background of a prospective member. Membership application forms of the American Psychological Association (APA) and 58 affiliated organizations are reviewed to determine the kinds of questions that are asked about ethical misconduct. The nature of the inquiry differs considerably from one association to another, with a preponderance of organizations avoiding any direct questions about professional ethics. Discussion is focused on how these different screening strategies impact on the applicant and the organization. There is a demonstrated need for appropriately formulated queries. A case is made for resolving current inconsistencies among associations by adhering to a unified procedure in the ethical screening of psychologist applicants.

Sanctions for ethics violations: does licensure of socioeconomic status matter?

Although sexual relationships between therapists and their clients are unethical, such beahviors still occur. This study investigated whether psychologists with applied versus nonapplied training differed in the severity of sanctions advocated for psychologists charged with sexual ethical violations toward high- or low-socioeconomic status victims. Licensed and Nonlicensed psychologists (N=48) viewed a 15-min videotape simulating the adjudication process about an alleged sexual involvement between client and psychologist, then prescribed either: Dismissal of Charges, Educative Advisory, Educative Warning, Reprimand, Censure, Stipulated Resignation, Permitted Resignation, or Expulsion. The alleged victim was described as a college professor of home economics or a hairdresser. Licensed psychologists chose more severe sanctions ("Stipulated or Permitted Resignation") than did Nonlicensed psychologists ("Censure"). Socioeconomic status made no significant difference in sanctions. Apparently, applied therapy training results in more severe judgements toward those who violate American Psychological Association ethical guidelines than other types of psychology training.

Do authorship policies impact students' judgments of perceived wrongdoing?

Although authorship policies exist, researchers understand little about their impact on perceptions of authorship scenarios. Graduate students (N=277) at a large university read 1 of 3 vignettes about a graduate student-faculty collaboration. One half of the surveys included the American Psychological Association's statement on authorship. Participants rated (a) the ethics of the professor as first author and (b) the likelihood of a dissatisfied student reporting the authorship result, as well as the effectiveness and negative consequences of reporting. Work arrangements on the project had a consistent main effect. Also, an authorship policy impacted women's ratings of first authorship when the student contributed the idea for a project. For men, a policy impacted only ratings of the likelihood of reporting when a professor was first author on a student's dissertation. Apart from sex, no other demographic variables on participants were predictive. Discussion focuses on the policy's potential for making only some specific issues salient.

Deception methods in psychology: have they changed in 23 years?

To learn whether criticism and regulation of research practices have been followed by a reduction of deception or use of more acceptable approaches to deception, the contents of all 1969, 1978, 1986, and 1992 issues of the Journal of Personality and Social Psychology were examined. Deception research was coded according to type of (non)informing (e.g., false informing, consent to deception, no informing), possible harmfulness of deception employed (e.g., powerfulness of induction, morality of the behavior induced, privacy of behavior), method of deception (e.g., bogus device or role, false purpose of study, false feedback), and debriefing employed. Use of confederates has been partly replaced by uses of computers. "Consent" with false informing declined after 1969, then rose in 1992. Changes in the topics studied (e.g., attribution, socialization, personality) largely accounted for the decline in deception in 1978 and 1986. More attention needs to be given to ways of respecting subjects' autonomy, to appropriate debriefing and desensitizing, and to selecting the most valid and least objectionable deception methods.

Five points and a lament about Range and Cotton's "Reports of assent and permission in research with children: illustrations and suggestions

This comment responds to an article by Range and Cotton (1995) on reporting of parental permission and child assent procedures in published articles for 4 psychology journals. Issue is taken with the assumptions, methodology, interpretations, and implications of listing researchers in the Range and Cotton article. There is no evidence researchers failed in their ethical obligations or that children were put at risk. Reporting permission/assent in publications is not an ethical requirement. Listing researchers as "failing" to do something not part of an ethical code is lamentable. Too many unfortunate implications and problems can be derived from Range and Cotton's analysis and conclusions.

Nonsexual relationships between psychotherapists and their former clients: obligations of psychologists

This article examines the issue of nonsexual relationships between psychologists and their former therapy clients. What little research is available concerning nonsexual relationships with former clients suggests that psychologists have clear reservations about some of these relationships, especially personal ones and intentional social interactions. Relationships immediately following termination are seen as particularly suspect. Drawing on the literature dealing with multiple relationships in general, and sexual relationships with former clients in particular, a number of arguments are made outlining why psychologists should avoid significant nonsexual relationships with former clients for at least some period of time following termination.

The emergence of interest in the ethics of psychological research with humans

We describe the growth of interest in the ethics of research with human participants based on articles abstracted in Psychological Abstracts and PsycLIT. Interest was low and variable until 1974, after which there was a marked increase in the number of articles published. We explain this emergence of ethical interest in terms of the social climate of concern for human rights in the 1960s and 1970s, the 1973 revision of the American Psychological Association's ethical principles, and the development of federal regulation of research with human participants.

Mental health professionals and assisted death: perceived ethical obligations and proposed guidelines for practice

I have three purposes in this article: (a) to briefly review the legal obligations a mental health professional has when working with a client who is talking about taking some action that could lead to his or her death, (b) to clarify the positions of the 4 major national mental health organizations regarding the acceptable roles of their members with clients who are discussing the possibility of receiving assisted death, and (c) to propose a set of guidelines for practice for mental health professionals working with clients who are considering assisted death that comport with the various laws and codes of ethics.

Nonerotic dual relationships between therapists and clients: the effects of sex, theoretical orientation, and interpersonal boundaries

We surveyed 223 APA members to investigate the roles of therapists' sex, theoretical orientation, interpersonal boundaries, and clients' sex in predicting therapists' assessments of the ethicality of nonerotic dual relationships with their clients. Results indicated that therapists' sex, interpersonal boundaries, and theoretical orientation influenced ethical judgments of these relationships. Theoretical and practical implications of our findings are discussed.