Unit on Ethics

Slide 1: Worldviews

Slide 2: Ethical issues in therapy

Slide 3: Hospital, mental counselors sued after teen-ager's suicide

The 1996 suicide of a 16-year-old girl who was under the care of two mental health counselors  should have been prevented, according to a medical malpractice lawsuit filed yesterday by the child's  parents.

Richard and Constance Esler of Brown Township contend in their "psychological malpractice'' case  that a psychiatrist and a social worker at Grant/Riverside Methodist Hospital were negligent in their care of Katie Esler. The teen-ager was found dead at home Aug. 2, 1996. She had been receiving  treatments for bipolar disorder, sometimes referred to as manic depression….

The suit says the girl's treatment was marked by infrequent therapy sessions; inappropriate  treatments; and poor communication among her, her doctors and her parents.

The Eslers, both employed at Riverside -- he's a doctor and she's a nurse -- said their colleagues ignored "clear symptoms of suicidal thoughts and patterns of behavior that may have signaled suicide,  despite the fact that the girl was treated at Riverside for 17 months,'' ….
(The Columbus Dispatch, July 29, 1998)

Slide 4: General ethical guidelines

• Above all, do no harm.
• Practice only with competence.
• Do not exploit.
• Treat people with respect for their dignity as human beings.
• Protect confidentiality.
• Act, except in the most extreme instances, only after obtaining informed consent.
• Practice, insofar as possible, within the framework of social equity and justice.

Redlich & Pope, 1980

Slide 5:

4.01 Structuring the Relationship

• (a) Psychologists discuss with clients or patients as early as is feasible in the therapeutic relationship appropriate issues, such as the nature and anticipated course of therapy, fees, and confidentiality.  (See also Standards 1.25, Fees and Financial arrangements, and 5.01, Discussing the Limits of Confidentiality.)
• (b) When the psychologist’s work with clients or patients will be supervised, the above discussion includes that fact, and the name of the supervisor, when the supervisor has legal responsibility for the case.
• (c) When the therapist is a student intern, the client or patient is informed of that fact.
• (d) Psychologists make reasonable efforts to answer patients’ questions and to avoid apparent misunderstandings about therapy.  Whenever possible, psychologists provide oral and/or written information, using language that is reasonably understandable to the patient or client.  American Psychological Association (1992)

Slide 6:

Jeanne M. Slattery, Ph.D.
Clinical Psychologist, Licensed in Pennsylvania

214 S. Seventh Avenue, Suite 208
Clarion, Pennsylvania 16214

(814) 227-2930

INFORMATION FOR MY CLIENTS

Welcome! I believe we will work most productively and comfortably together if we are unambiguous with each other.  This letter is designed to answer some frequently asked questions about my practice and our relationship, so please read all of it before you sign at the end.  As you read, please feel free to mark any places that are not clear as well as write in any questions so we may discuss them at our next meeting.

A. The therapy process.

You will make the best decisions about therapy if you have good information about psychotherapy and an understanding of how it works.  Let me discuss some aspects of psychotherapy as I see them.

Psychotherapy is not like visiting a medical doctor in that it requires your active involvement and efforts to change your thoughts, feelings, and behaviors.  I will ask for your feedback and views on your therapy, the efforts and progress we are making, and other aspects of this process.  I expect you to be as open about these as you can be.  Offering your views and responses when they are important to you, even if I don’t ask, is one of the ways you can be an active partner in your therapy.  There are no instant, painless or passive cures.  To work, both you and I have to be active and committed members of this relationship.  Change can sometimes be easy and rapid.  Sometimes it is slow and frustrating.

So that we know exactly where we are going, I will ask for regular reviews of your progress and, if treatment is not progressing, I cannot ethically keep working with you without making changes.  I may consider asking you to see a physician for evaluation or prescription of medications or ….
 

Slide 7: 4.02 Informed Consent to Therapy

• (a) Psychologists obtain appropriate informed consent to therapy or related procedures, using language that is reasonably understandable to participants.  The content of informed consent will vary depending on many circumstances however informed consent generally implies that the person (1) has the capacity to consent, (2) has been informed of significant information concerning the procedure, (3) has freely and without undue influence expressed consent, and (4) consent has been appropriately documented.
• (b) When persons are legally incapable of giving informed consent, psychologists obtain informed permission from a legally authorized person, if such substitute consent is permitted by law.
• (c) In addition, psychologists (1) inform those persons who are legally incapable of giving informed consent about the proposed interventions in a manner commensurate with the persons’ psychological capacities, (2) seek their assent to those interventions, and (3) consider such persons’ preferences and best interests.  American Psychological Association (1992)

Slide 8:

Jeanne M. Slattery, Ph.D.
Clinical Psychologist, Licensed in Pennsylvania

214 S. Seventh Avenue, Suite 208
Clarion, Pennsylvania 16214

(814) 227-2930

Consent to treatment

This form is to document that I,  [insert name here], give my permission and consent to [insert name here], to provide psychotherapeutic treatment to me and/or [insert name here], who is/are my spouse/child/children.

While I expect benefits from this treatment, I fully understand that because of factors beyond our control, such benefits and particular outcomes cannot be guaranteed.  Furthermore, I understand that I/he/she/we may experience emotional strains because of the counseling or therapy, feel worse during treatment, and make life changes which could be distressing.

I understand that Dr. Slattery is not providing emergency services, and I have been informed of whom to call upon in an emergency or during weekend and evening hours.

I understand that regular attendance will produce the maximum benefits, but that I/we am/are free to discontinue treatment at any time.  If I decide to do so I will notify Dr. Slattery at least two weeks in advance so that effective planning for continuing care can be implemented.

I understand that conversations with therapists will almost always be confidential. I further….

Slide 9: 5.01 Discussing the Limits of Confidentiality

• (a) Psychologist discuss with persons and organizations with whom they establish a scientific or professional relationship (including, to the extent feasible, minors and their legal representatives) (1) the relevant limitations on confidentiality, including limitations where applicable in group, marital and family therapy or in organizational consulting, and (2) the foreseeable uses of the information generated through their services.
• (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.
• (c) Permission for electronic recording or interviews is secured from clients and patients.

                                                                    American Psychological Association (1992)

Although most of what we talk about is private, I understand that there are three kinds of problems I might tell that we would have to talk about with other people: (1) If someone has been seriously hurting or abuse me, Jeanne Slattery would have to tell the police and Children & Youth Services about it.  (2) If I tell her that I have a plan to seriously hurt myself, she would have to let my parents know.  (3) If I tell her that I have made a plan to seriously hurt someone else, she would have to warn that person.  I understand that she would not be able to keep these problems private between the two of us because the law says she can't.  A fourth place is if this information needs to go to court at any point, but we will talk about privacy in the legal system before we get that far.  Finally, we will need to work out how to communicate information to your parents in a way that works best for you and your family.  This is especially important for dangerous behaviors.

Slide 11:

I understand that Dr. Slattery consults with colleagues (Debi Jones Bean, M.S.W., Kay King, M.S.W., and Crystal Park, Ph.D) in order to improve the quality of treatment, but that names and identifying characteristics are not disclosed.

Slide 12: 5.02  Maintaining Confidentiality

Psychologists have a primary obligation and take reasonable precautions to respect the confidentiality rights of those with whom they work or consult, recognizing that confidentiality may be established by law, institutional rules, or professional or scientific relationships.  American Psychological Association (1992)
 

Slide 13: 4.05 Sexual Intimacies with Current Patients or Clients

Psychologists do not engage in sexual intimacies with current patients or clients.  American Psychological Association (1992)

Slide 14: 4.06 Therapy with Former Sexual Partners

Slide 15: 4.07 Sexual Intimacies with Former Therapy Patients

• (a) Psychologists do not engage in sexual intimacies with a former therapy patient or client for at least two years after cessation or termination of professional services.

(b) Because sexual intimacies with a former therapy patient or client are so frequently harmful to the patient or client, and because such intimacies undermine public confidence in the public’s use of needed services, psychologists do not engage in sexual intimacies with former therapy patients and clients even after a two-year interval except in the most unusual circumstances.  The psychologist who engages in such activities after the two years following cessation or termination of treatment bears the burden of demonstrating that there has been no exploitation, in light of all relevant factors, including (1) the amount of time that has passed since therapy terminated, (2) the nature and duration of the therapy, (3) the circumstances of termination, (4) the patient’s or client’s personal history, (5) the patient’s or client’s personal history, (6) the likelihood of adverse impact on the patient or client and others, and (7) any statements or actions made by the therapist during the course of therapy suggesting or inviting the possibility of a posttermination sexual or romantic with the patient or client.  American Psychological Association (1992)

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Last modified September 14, 2001.