Topic 8: Ethical Principles for Psychology

INTRODUCTION

In the previous topic, we mentioned the scientist-practitioner model which

can be useful model to encourage psychologists to develop their
professional competency. As scientists or researchers, psychologists can
generate a theory about their practice. Hence, such theory can contribute
towards improving the quality of psychological practices and encouraging
practitioners to become more competent in their work.

However, as with research and publication, there are ethical principles for
psychological practitioners.

This topic will focus more on addressing the following two questions:

- What are the responsibilities of a psychology practitioner?

- How do practitioners comply with laws and standards?

It is envisioned that the knowledge garnered from this topic will contribute
to a professional psychologists' journey to become a legally-and-ethically
competent practitioner.

8.1 RESPONSIBILITY OF PRACTITIONERS

In order to become an ethically competent psychological practitioner,

professionals must be aware and knowledgeable of the responsibilities of
being a psychological practitioner.

Before these responsibilities are discussed, let us define the term

"psychology practitioner."

Psychology practitioners. This term generally refers to professionals in the

field of applied psychology whose main duties are to provide psycological
services to clients based on relevant codes of ethics or codes of practice.

For example, Malaysian registered counsellors can also be known as

psychology practitioners for two reasons:

(a) Counselling is one of the areas in the applied psychology field. In

Malaysia, the definition of counselling according to the Counsellors Act
(580) 1998 (Lembaga Penyelidikan Undang-Undang Malaysia, 1998) is:

A systematic process of helping relationship based on psychological

principles performed by a registered counsellor in accordance with the
counselling code of ethics to achieve a voluntary favourable holistic
change, development and adjustment of the client such that the change,
development and adjustment will continue throughout the lifespan of the
client. (p. 6)
(b) The term counsellor only refers to registered counsellors who are also
holders of a practising license (Lembaga Penyelidikan Undang-Undang
Malaysia, 1998).

Therefore, other professionals in Malaysia cannot simply use the term

"counsellor" as their job title if they are not yet registered with the
Malaysian Board of Counsellors, locally known as Lembaga Kaunselor
Malaysia (LKM).

Even if they are already registered with the LKM, they cannot simply
practise counselling unless they apply for a practising license (Sijil
Perakuan Amalan) endorsed by the registrar of the LKM.

According to the Act, only registered practising counsellors [Registered

Counsellor (RC), Legal Practice Course (LPC)] are legally allowed to use the
term counsellor and to practise in the Malaysian context. The rule has
been applicable since 1998.

Once we have understood the term psychological practitioners, let us

move on to identifying the responsibilities of a psychological practitioner.
We will focus on the Malaysian registered practising counsellors
community as an example.

8.1.1 Professional Responsibilities of a Practitioner

There are several ways to understand the professional responsibilities of a

practitioner. The first involves understanding the core defining
characteristics of a profession and then translating this understanding into
behavioural responsibilities.

For example, consider the following discussion on the criteria of a

profession .

Six Criteria of a Profession

Specialised knowledge: One of the responsibilities of a psychological

practitioner such as a registered practising counsellor in Malaysia is to
have specialised knowledge in counselling. This can be achieved by
pursuing tertiary education in any university (locally or overseas) which
offers counsellor education programmes recognised by the Malaysian
government. For example, the University of Malaya offers a four-year
Bachelor in Counselling programme with the objective to educate and
train those who aspire to become counsellors in educational institutions,
public departments, or the private sector. To graduate, the students have
to fulfil 120 credit hours: 18 credit hours from compulsory university
courses; 69 credit hours from Counselling courses such as theories,
techniques, and laboratory, which lead to professional training; 24 credit
hours from psychology courses; and 9 credit hours from electives (Fakulti
Pendidikan Universiti Malaya, 2008).

Intensive and Continuous Training: Besides fulfilling the requirement for

registration set by the LKM, Malaysian counsellors have ethical and legal
responsibilities to continuously upgrade their knowledge and skills through
participation in professional development training (Lembaga Kaunselor
Malaysia, 2003). In Malaysia, counsellors can choose to participate in
intensive and continuous training developed by their own work
organisations such as schools or hospitals or to participate in professional
development training organised by the LKM. However, it is important to
note that the availability of continuous training programmes in Malaysia is
still limited, and there is a need to provide more training opportunities to
Malaysian counsellors and other psychology practitioners such as clinical
psychologists.

Professional bodies: Every professional must have a professional body or

association. It is the psychology practitioners’ responsibility to be active
members in their respective professional associations. For example,
Malaysian psychologists and counsellors must become members in the
Persatuan Psikologi Malaysia (PSIMA) and the Persatuan Kaunseling
Malaysia (PERKAMA) before establishing their professional identity.

Licensure, accreditation and certification: As mentioned earlier, another

responsibility of a psychology practitioner is to ensure that they are
licensed and certified before providing professional psychology services to
clients. They must ensure that their license is renewed before its expiry
date.

Ethical standards: It is the responsibility of all practitioners to have a copy

of the relevant code of ethics for reference purposes. For example, the
American psychologists must read and understand the APA Code of ethics
(2010), the Australian Psychologists must understand their APS Code of
Ethics, and the Malaysian counsellors must understand their PERKAMA
Code of Ethics. These codes become their main source of reference
whenever these practitioners encounter ethical dilemmas in their
practices.

Professional identity: This refers to a strong identity with the field as a

profession or vocation. For example, Othman et al. (2000) stated that
counsellors in Malaysia have a professional identity especially after the
introduction of the Counsellors’ Act (580) in 1998.

8.1.2 Legal Responsibilities of a Practitioner

Practising professionals in specific cultural contexts not only have

professional responsibilities but also have legal responsibilities to conform
to state and federal laws. Else, their credibility as professional
practitioners will be questioned and sometimes can be subjected to legal
proceedings. For example, as a Malaysian Malay-Muslim practitioner, a
counsellor must make sure his or her practice is consistent with Islamic
laws, state laws, and federal laws. Therefore, every practitioner must have
awareness, knowledge, and skills regarding the legal system in their
specific cultural contexts.

Section C of the Counsellor Code of Ethics by the Board of counsellors

(Malaysia) stated the following:

Counsellor must aspire to communicate openly, honestly, and accurately

in dealing with the public and other professionals. They shall practice in a
nondiscriminatory environment, within the boundaries of professional and
personal competence, and abide by the Board of Counsellors Code of
Ethics. Counsellors shall actively participate in local, state, and national
associations that foster the development and improvement of counselling.
Counsellors shall advocate promotingchanges at the individual, group,
institutional, and societal levels that improve the quality of life for
individuals and groups and remnove barriers to the provision or access of
appropriate services being offered. Counsellors have a responsibility to
the public to engage in counselling practices that are based on accurate
and rigorous research methodologies. In addition, counsellors shall
engage in self-care activities to maintain and promote their own
emotional, physical, nmental, and spiritual well-being to best meet their
professional responsibilities. (p. 25)

Now, let us talk about domestic violence cases among Malay-Muslim

couples.

- What would be the necessary preparation that practitioners must

have before they can help victims of domestic violence who come
from the Malay-Muslim community?
- How much of Islamic law matters do practitioners need to know?
- How about state laws and civil laws? To what extent do these
practitioners need to know the laws and standards to help clients
ethically and effectively?

Corey et al. (2010) discuss matters which constitute a situation of

"reportable abuse" (p. 250). They commented: If children, the elderly, or
other dependent adults disclose that they are being abused or neglected,
the professional is required to report the situation under penalty of fines
and imprisonment. If adults reveal in a therapy session that they are
abusing or have abused their children, the matter must be reported... The
professional has an obligation to protect those who cannot advocate for
themselves. (pp. 250-251)

Corey et al. (2010) further provided the following questions to help

psychological practitioners evaluate their preparedness to carry out the
duty to protect children, the elderly, and other dependent adults (e.g.,
spouses) from abuse or neglect:

(a) How well prepared do you think you are in determining when to report
suspected abuse of a child, an older person or a dependent adult?

(b) Would you consider cultural factors in determining whether a situation

indicates actual abuse? How would you account for cultural differences in
assessing abuse?

(c) Can you think of ways in which you could file a report on an adult
abuser and continue working with the client therapeutically?

(d) What struggles, if any, have you encountered with respect to following
the laws regarding reporting child, dependent adult, or abuse of older
adults?

(e) If you follow the law in all cases, are you also following an ethical
course? What potential conflicts are there between doing what is legal and
what is ethical?

(f) If an adult admits having abused a child, what are your thoughts about
a therapist who argues that keeping the client in therapy is the best way
to help him/her work through this problem, even if it means failing to
report the abuse to authorities?

g) Do you think therapists should have some flexibility in deciding when it

would be best to make a report? Why or why not?

These questions really test practitioners' understanding of themselves as

individuals and professionals. As a result, they must be aware of their own
values, biases, and beliefs about victims of abuse or neglect. They must
be familiar with the laws and standards that apply to their specific cultural
context. This means that psychological practitioners must follow laws and
standards.

The following subtopic discusses the issue of compliance with laws and
standards in more detail by referring to hypothetical scenarios.

8.2 COMPLIANCE WITH LAWS AND STANDARDS

What are your expectations on this topic now that you understand the
responsibilities attached to a psychological practitioner? What comes to
mind when you compare and contrast the influence of the laws and moral
standards in governing practices? For you to really understand the need to
comply with the laws and moral (ethical) standards, it requires deep
thinking and self-awareness. Having laws and regulations help to promote
order in a society and having ethical standards helps to promote wellness
and personal growth in a society. However, practitioners must always
remember that laws and ethics are both man-made and hence not always
right and applicable in all cases and contexts.

In addition, practitioners must also be prepared to encounter conflicting

values between the laws and ethics, especially when their cases involve
certain groups of individuals such as victims of violence, neglect, and
human trafficking. These are groups who may have needed legal
intervention to resolve their issues and concerns. But as a professional
practitioner, counsellors must have a position (stance) with respect to
situations involving these special groups of clients. In particular, ask
yourself how far you should go in reporting suspected abuse. Does the
fact that you have reported a situation to the officials end your ethical and
legal responsibilities?

Then, look for ways to differentiate between:

- ethical practice; and

- legal practice.

Finally, ask yourself what you would be inclined to do if there is a conflict

between ethics and the law.

8.2.1 Addressing Ethical Dilemmas for Psychologists

Well, the above questions are tough to answer because they involve
finding a balance between your values as a person and as a professional.
Yet, they are important questions which need answers from each
practitioner in counselling and psychotherapy.

To help you clarify your stance with respect to compliance with laws and
standards, consider the following example:

The Case of Marina (Part 1)

Marina, a secondary school counsellor, has reason to believe that one of

her student clients is being physically abused. However, she also knows
that the abuser, the student’s father, has enrolled in a substance abuse
programme.

Marina knows that the statute in her state clearly specifies that she is
required to report this incident. So, she reports the incident to Child
Protective Services and gives all the information she has to the
caseworker (the assigned social worker). Marina even follows up the
phone conversation with the caseworker with a written report.

Now, try to answer the following questions:

(a) Has Marina adequately fulfilled her responsibility by making the

report?

(b) Does Marina have an obligation to inform the school administration?

(c) Does the school have a responsibility to see that action is taken?

Commentary

This seems a clear-cut scenario and Marina’s actions are in compliance

with the law and standards. Indeed, in most countries, suspected physical
abuse is an example of immediate reportable matters. Perhaps Marina
should check her school policies regarding cases involving the law so that
she can inform the school administration and share the responsibility of
seeing that action will be taken to help the student client. As an
employee, counsellors have to notify their organisation regarding any
cases which are legally and ethically reportable to officials. Now, consider
Part 2 of the case.

The Case of Marina (Part 2)

Two weeks later, the student client tells Marina that nothing has been
done.

(a) Does Marina have a responsibility to report the agency for not having
acted?

(b) If the agency does not take appropriate action, does Marina have a
responsibility to take other measures?

(c) Would it be ethical for Marina to take matters into her own hands and
to call for a family session or make a house call, especially if the student
client requests for it?

Commentary

Now, these are tough questions which need deep thought and
understanding of the law and ethical standards. Although as a counsellor
Marina has complied with her legal duty to protect the child by reporting
the matter to Child Protective Services, she also has an ethical obligation
to follow up on the report until the matter has been officially investigated
and acted upon.

Perhaps there are three possible things Marina could do:

(a) Marina could make another phone call to the original caseworker to
ask for progress notification.

(b) Should this course of action prove unsatisfactory, she might contact
the caseworker’s supervisor to speed up action.

(c) Marina should document these efforts in her log book and inform the
administration too.

The case illustrates some of the difficulties counsellors face when it comes
to reporting an incident of abuse. Each of the ethics codes in the mental
health professions recommend therapy practitioners to adhere to the law
when there is a conflict between legal and ethical requirements.

For example, the APA Ethical Principles of Psychologists and Code of

Conduct 2010 state:

Psychologists disclose confidential information without the consent of the

individual only as mandated by law, or where permitted by law for a valid
purpose such as to (1) provide needed professional services; (2) obtain
appropriate professional consultations; (3) protect the client/patient,
psychologist, or others from harm; or (4) obtain payment for services from
a client/patient, in which instance disclosure is limited to the minimum
which is necessary to achieve the purpose (4.05.b).

So, depending on how the therapist handles the matter with the family, it
may be possible to continue a therapeutic relationship in this case.

8.2.2 Formulating an Ethical Model for Practice

What we have discussed earlier gives us a better understanding on how to

make a legal and ethical decision on whether or not to report abuse cases.

However, Sonkin and Linbert (1999) caution therapists regarding the

inconsistencies and discrepancies in laws and ethics in some contexts.
They further comment:

Experience shows us that not only are there differences in specific laws
and ethical standards but there are also differences in their interpretation
across individuals. Legal and ethical standards can appear, at best,
ambiguous and open to interpretation guided by such vagaries as the
“unique aspects of the case,” personal and professional experience,
theoretical bias, and other such issues, yet statute and the teleogic basis
underlying most ethics codes assume a decision rule based on predictable
outcome. (An excerpt from [Link]

In light of this awareness, practitioners in mental health professions must

develop their own models for guiding their practices, especially those
involving the duty to protect children, the elderly, and other dependent
adults (e.g., spouses) from abuse or neglect.

Sonkin and Linbert (1999) discuss a child abuse decision-making model

for clinicians proposed by previous literature. The model argues that legal
factors, clinician characteristics and situational factors appear to interact
synergistically to influence whether or not a clinician chooses to report.

These factors are briefly described as follows:

(a) Legal Factors

Any common legal factors which may affect the decision-making process
of reporting child abuse cases such as knowledge of the child abuse laws,
the clarity of the law (i.e., wording) and its legal requirements.

(b) Clinician Characteristics

Any typical factors which may affect a clinician’s decision of reporting a

child abuse case such as clinician demographics, training background,
years of experience, attitudes and beliefs, as well as experience making
child abuse reports.

(c) Situational Factors

Any situational factors surrounding the child abuse case such as the
victims’ characteristics (e.g., age appears to be an important variable in
reporting child abuse), type of abuse, severity of abuse and availability of
evidence.

Child Abuse Decision-making – A Model for Clinicians

- Legal factors: Be legally aware and knowledgeable of the child

abuse laws
- Clinical characteristics: Seek opportunities to upgrade knowledge
and skills through continuous training and peer consultation
- Situational factors: Gather as much information regarding the child
abuse case in order to understand the presenting concerns and the
real problems

Source: Sonkin & Liebert (1999)

The model seems applicable to cultural context other than the US because
the factors highlight the generic elements that exist across cultures and
across contexts (i.e., cultural universal elements). However, it would be
better if mental health practitioners can develop their own individualised
approaches to handling abuse or neglect cases involving children, the
elderly, and dependent adults based on their training background and
practice experience. If counsellors are able to have their own
individualised approaches, they would always be prepared and confident
to deal with any abuse or neglect issues throughout their professional
practice.

So, would you like to develop your own approach to counselling victims of
abuse or neglect?

In order to help you formulate an individualised approach, ask yourself the

following questions:

(a) Is it an ethical, legal, professional, or clinical problem?

(b) Is it a combination of more than one of these?

(c) If a legal question exists, seek legal advice.

(d) Is the issue related to me and what am I doing or not doing about it?

(e) Is it related to a client and/or the client's significant others and what
are they doing or not doing?

(f) Is it related to the institution or agency and their policies and

procedures?

Recall the ethical decision-making model which was introduced in Topic 1.

Briefly, the model has eight steps as follows (and shown previously in
Figure 1.3):

(a) Identify the problem or dilemma.

(b) Identify the potential issues involved.

(c) Review the relevant code of ethics.

(d) Know the applicable laws and regulations.

(e) Obtain consultation.

(f) Consider possible and probable courses of action.

(g) Enumerate the consequences of various decisions.

(h) Decide on what appears to be the best course of action.

Then, compare and contrast the model with the American practitioner’s
Guide to Ethical Decision Making proposed by Forester-Miller and Davis
(1996). Briefly, the guide has seven steps .

Seven Steps of Guide to Ethical Decision Making

Step 1: identify the problem

Step 2: Apply the ACA Code of Ethics (e.g., ACA Code of Ethics 2005)

Step 3: Determine the nature and dimensions of the dilemma

Step 4: Generate potential courses of action

Step 5: Consider the potential consequences of all options, choose a

course of action

Step 6: Evaluate the selected course of action

Step 7: Implement the course of action

Now, let us answer the following questions.

• Which did you find to be most comfortable, the cultural universal or

culture specific model? State your reasons.
• Which one is feasible to be used in the Malaysian context? Are your
reasons clear to you?

It is not surprising to realise that different practitioners may adopt

different courses of action in the same situation. This is the reality of
being human with different values, beliefs and attitudes, styles, and ways
of doing things. After all, there is rarely one right solution for a complex
ethical dilemma especially if it conflicts with the laws. However, if you
follow the step-by-step model that you are familiar with, you will be able
to give a professional explanation for the course of action taken.