10 ways practitio ners can avo id f requent ethical pitf alls
Boost your ethical know -how w ith these practical tips on avoiding common ethical quandaries.
By DEBORAH SMITH
Monitor Staff
January 2003, Vol 34, No. 1
Print vers ion: page 50
Talk to the ethics experts , and they'll tell you the bes t defens e agains t an ethical problem s is a good offens e. By looking out for fores eeable conflicts and dis cus s ing them frankly with colleagues and clients , practitioners can evade the m is unders tandings , hurt feelings and s ticky s ituations that lead to hearings before ethics boards , laws uits , los s of licens e or profes s ional m em bers hip, or even m ore dire cons equences .
However, being vigilant does n't m ean ps ychologis ts s hould s pend their days worrying about where the next pitfall could be, s ays Robert Kins cherff, JD, PhD, form er chair of APA's
Ethics Com m ittee, which adjudicates ethics com plaints . "Ins tead of worrying about the ways [they] can get in trouble, ps ychologis ts s hould think about ethics as a way of as king
'How can I be even better in m y practice?'" he explains . "Good ethical practice is good profes s ional practice, which is good ris k m anagem ent practice."
When ps ychologis ts do end up in ethical quandaries , it's often becaus e they unwittingly s lid too far down a s lippery s lope--a res ult of ignorance about their ethical obligations or thinking they could handle a s ituation that s piraled out of control.
Many problem s are what Ethics Com m ittee m em ber Anne Hes s , PhD, calls "s tealth" dilem m as : s ituations that develop gradually, m oving s tep by s m all s tep beyond once-firm profes s ional boundaries . Although each s tep s eem ed harm les s at the tim e, m any practitioners later realize that they have landed them s elves in deep trouble.
The Monitor interviewed s om e of ps ychology's leading ethics experts to talk about how practitioners can avert com m on ethical dilem m as , from m ultiple relations hips to whether to breach confidentiality, to term inating treatm ent. Here's their advice, boiled down to 10 ways to help avoid ethical pitfalls .
1. Understand w hat constitutes a multiple relationship
Is it ethical to volunteer at your daughter's s oftball team fund-rais er if you know a client is going to be there? Can you buy a car from a client who owns the only dealers hip in your s m all, rural town? Can you as k an intern to drive you to the airport?
"A central ques tion in any m ultiple relations hip s ituation is whos e needs are being m et here?" s ays Stephen Behnke, JD, PhD, director of APA's Ethics Office, which advis es ps ychologis ts on ethical dilem m as . "Whenever the ans wer is the needs of the ps ychologis t, that's a tim e when the ps ychologis t needs to take great care and get a cons ultation."
According to the Ethics Code, ps ychologis ts s hould avoid relations hips that could reas onably im pair their profes s ional perform ance, or could exploit or harm the other party.
Behnke em phas izes , however, that m ultiple relations hips that are not reas onably expected to have s uch effects are not unethical.
That's becaus e s om etim es it's im pos s ible for ps ychologis ts to com pletely avoid m ultiple relations hips , explains Steven Sparta, PhD, im m ediate pas t-chair of APA's Ethics
Com m ittee. For exam ple, the ps ychologis t in a rural town m ay decide to buy a car from his client becaus e going els ewhere could s ignal that the car dealer was in therapy.
How do you weigh the pros and cons in s uch s ituations ? APA Ethics Com m ittee m em ber Michael Gottlieb, PhD, s ugges ts in a Psychotherapy (Vol. 30, No. 1) article that ps ychologis ts think about three factors :
Pow er. How m uch of a power differential is there between the ps ychologis t and the other pers on? Since you als o s upervis e the intern, it m ight be better to as k a colleague to drive you to the airport.
Duration. Will it be brief contact or will it be continuous or epis odic contact over a long tim e? "We us ually don't know how long profes s ional contact will las t except in very s pecific circum s tances ," s ays Gottlieb. Before entering into a dual relations hip, ps ychologis ts s hould cons ider whether, for exam ple, a client could return for additional s ervices .
Termination. Has the therapeutic relations hip been perm anently term inated, and does the client unders tand that as well? If a ps ychologis t s ees patients with chronic illnes s es , they s hould keep in m ind that treatm ent could s top and s tart for years , precluding s om e relations hips that m ight be all right otherwis e.
"It's only an ethical problem when there's a reas onable bas is to s ee a fores eeable ris k, and the ps ychologis t fails to s ee it or ignores it and goes forth anyway," Sparta explains .
Moreover, one type of m ultiple relations hip is never acceptable: "Sexual relations hips with current clients are never perm is s ible," s ays Behnke.
While s exual relations hips with previous clients are not autom atic violations of the Ethics Code if they occur m ore than two years after therapy's term ination, "ps ychologis ts need to be m indful of the harm that can com e from a s exual involvem ent with a client no m atter when it occurs ," Behnke adds .
Las tly, if ps ychologis ts find that, des pite their efforts , a potentially harm ful m ultiple relations hip has aris en, they are ethically m andated to take s teps to res olve it in the bes t interes t of the pers on or group while com plying with the Ethics Code.
2. Protect confidentiality
Ps ychologis ts are often as ked to provide inform ation about their clients to em ployers , s pous es , s chool adm inis trators , ins urance com panies and others . While s uch reques ts m ay be well-intentioned, ps ychologis ts need to carefully balance the dis clos ure with their ethical obligations to protect their patients ' confidentiality.
Indeed, becaus e the public puts their trus t in ps ychologis ts ' prom is es of confidentiality, it's es s ential for ps ychologis ts to be clear on whether and why they are releas ing inform ation.
"As k yours elf, 'On what bas is am I m aking this dis clos ure?'" advis es Behnke. "Is there a law that m andates the dis clos ure? Is there a law that perm its m e to dis clos e? Has m y client cons ented to the dis clos ure?'"
APA's 2002 Ethics Code s tipulates that ps ychologis ts m ay only dis clos e the m inim um inform ation neces s ary to provide needed s ervices , obtain appropriate cons ultations , protect the client, ps ychologis t or others from harm , or obtain paym ent for s ervices from a client.
To help prevent confidentiality problem s , ps ychologis ts can:
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Discuss the limits of confidentiality, including their us es of electronic trans m is s ion and the fores eeable us es of confidential inform ation, as s oon as pos s ible.
Ensure the safe storage of confidential records. At the outs et, notify people what will be done with cas e m aterials , photos and audio and video recordings , and s ecure their cons ent. Als o, m ake s ure room s where confidential convers ations occur are s oundproof.
Know federal and state law . Know the ins and outs of your s tate's laws that relate to your practice. And keep in m ind how the recently im plem ented Health Ins urance Portability and Accountability Act affects your practice (s ee
HIPAA (/monitor/jan03/hipaa.as px ) ).
Obey mandatory reporting law s. Even if a ps ychologis t believes that reporting abus e could m ake the s ituation even wors e, "thes e laws are m andatory reporting laws , not dis cretionary reporting laws ," s ays lawyer Mathew D.
Cohen, who s pecializes in repres enting hum an-s ervice providers . Mandatory reporting laws were not created to have clinicians decide whether abus e or neglect is happening, s ays Cohen, but to have them bring the facts to the attention of authorities , who will decide.
"If you wait and nothing bad happens , you've s till violated the law," he s ays . "[But] if you wait and s om ething bad happens , not only have you violated the law, but you have injured a potential victim who could have been protected."
3. Respect people's autonomy
Ps ychologis ts need to provide clients with inform ation they need to give their inform ed cons ent right at the s tart.
When they fail to give details , s ticky s ituations can aris e. For exam ple, when ps ychologis ts fail to explain their duty to report abus e and neglect to an adoles cent client before therapy begins , they m ay be uns ure what to do if abus e is later revealed that the client does n't want reported.
For ps ychologis ts providing s ervices , the experts s ugges t they dis cus s :
Lim its of confidentiality, s uch as m andatory reporting.
Nature and extent of the clinician's record-keeping.
The clinician's expertis e, experience and training as well as areas where the therapis t lacks training.
Es tim ated length of therapy.
Alternative treatm ent or s ervice approaches .
The clinician's fees and billing practices .
Whom to contact in cas e of em ergency.
Client's right to term inate s es s ions and any financial obligations if that occurs .
Not only what s ervices the ps ychologis t will provide, but what they can't or won't do.
If individuals are not com petent to m ake decis ions for them s elves , then the pers on who's giving perm is s ion m us t have acces s to that s am e inform ation. Moreover, a s igned cons ent form does not s ubs titute for the inform ing proces s , which s hould occur firs t, s ay ethics experts --and that includes s ituations where inform ed cons ent is im plied,s uch as in an em ployee evaluation.
4. Know your supervisory responsibilities
Ps ychologis ts m ay be res pons ible for the acts of thos e who perform work under their watch, whether it's interns providing therapy or adm inis trative as s is tants helping with recordkeeping and billing.
That m eans s upervis ing ps ychologis ts s hould continually as s es s their s upervis ees ' com petence and m ake s ure they are m anaging them appropriately, s ay experts . Such s upervis ion s hould cover everything from ens uring that s upervis ees conduct the inform ed-cons ent proces s correctly to prohibiting them from us ing the s upervis or's s ignature s tam p on any bill or letter that the s upervis or has n't reviewed.
"If it goes out under your nam e, you're res pons ible," s ays APA Ethics Com m ittee Chair Michael D. Roberts , PhD. "If they releas e m edical files without proper cons ent, they're not going to s ue the receptionis t, they're going to s ue you."
According to the experts , s upervis ors s hould als o:
Es tablis h tim ely and s pecific proces s es for providing feedback--and provide inform ation about thes e proces s es at the beginning of s upervis ion.
Outline the nature and s tructure of the s upervis ory relations hip in writing before s upervis ion begins . Supervis ors s hould include both parties ' res pons ibilities as well as intens ity of the s upervis ion and other key as pects of the job. Docum ent their experience with the s upervis ees , including s upervis ion dates , dis cus s ions they've had and other relevant facts . Such inform ation will help if ethical dilem m as aris e later.
Explain to patients that the therapis t is in training and give clients the nam e of the s upervis or. Note that billing m ay be under a s upervis or's nam e, not the s upervis ee's , s o that clients don't accidentally report billing problem s when there are none.
Avoid delegating work to people who have m ultiple relations hips with the client that would likely lead to harm or the s upervis ee's los s of objectivity--for exam ple, avoid us ing a non-Englis h-s peaking pers on's s pous e as a trans lator.
5. Identify your client and role
When practicing ps ychologis ts work with organizations or groups of individuals , they s hould unders tand from the s tart who they were hired to help and what is expected of them .
Dilem m as crop up in a variety of s ettings :
In couples therapy. For exam ple, when one partner wants a better m arriage but the other wants a "painles s " divorce, ps ychologis ts s hould clarify at the beginning that they cannot decide whether the couple s hould s tay together or offer expert opinions later on during a divorce s uit.
In court, when it's not clear whether the ps ychologis t is s erving as an expert witnes s or advocate for one s ide.
Court-appointed evaluators s hould expres s well-balanced, objective opinions , s ays Ethics Com m ittee m em ber
Linda F. Cam pbell, PhD, while advocates are often therapis ts for one party who have had little direct contact with the other. Becaus e they can't provide an objective evaluation, ps ychologis ts who are therapis ts for one of the
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parties s houldn't s erve as expert witnes s es .
When ps ychologis ts provide s ervices to a pers on or entity at the reques t of a third party, s uch as a parent reques ting therapy for their child or a police departm ent reques ting an evaluation of an officer. "You m ay have one legal client, but s everal ethical clients ," cautions Kins cherff. "In each cas e it's im portant to know who it is that you're s erving and what your role is in providing that s ervice."
How can ps ychologis ts avoid role-related dilem m as ?
"Knowing who your client is , what your role is and being trans parent about what it is that you do and m indful about the profes s ional boundaries that aris e are good guidepos ts to effective practice," s ays Kins cherff. That m eans ps ychologis ts s hould, at the outs et, have frank dis cus s ions with all parties involved about the relations hip they will have with each pers on or organization--for exam ple, are they hired by a bus ines s to enhance worker productivity or are they there to help individual workers with m ental health problem s ?
Other things to cover include confidentiality lim its , what s pecific s ervices will be provided to which people and how the ps ychologis t and others could us e the s ervices or inform ation obtained. "If you're reas onable and s traightforward with people, treat them the way you would want to be treated in a s im ilar s ituation, find out what their expectations are, and clarify thos e expectations , you'll be in good s hape m os t of the tim e," adds Kins cherff.
6. Document, document, document
Docum entation can be ps ychologis ts ' bes t ally if they ever face ethical charges , s ays Ed Nottingham , PhD, an as s ociate m em ber of APA's Ethics Com m ittee. However, lack of docum entation--or the wrong kind of docum entation--can be detrim ental.
For s pecific guidance for practitioners , s ee APA's Record Keeping Guidelines (/prac tic e/guidelines /rec ord-keeping.pdf ) . Som e s pecifics to include in docum enting therapeutic interactions , according to the guidelines and ethics experts s uch as Nottingham :
Identifying inform ation and firs t contact.
Relevant his tory and ris k factors , m edical s tatus and attem pts to get prior treatm ent records .
Dates of s ervice and fees .
Diagnos tic im pres s ions , as s es s m ents , treatm ent plans , cons ultation, s um m ary and tes ting reports and s upporting data, and progres s notes . Include not only the treatm ents chos en, but treatm ents cons idered and rejected. Inform ed-cons ent docum entation, cons ent to audiotape or videotape, and releas e of inform ation docum entation.
Relevant telephone calls and out-of-office contacts .
Follow-up efforts when clients "drop out of s ight."
Details neces s ary, including thos e lis ted above, s o that another ps ychologis t could take over delivery of s ervice, s uch as in the event of a ps ychologis t's death or retirem ent.
A few other tips :
Only include germ ane inform ation. APA's Record Keeping Guidelines advis e practitioners to take into account the nature of the s ervices , the s ource of the inform ation recorded, the intended us e of the records and the ps ychologis t's profes s ional obligation.
Never alter a record after the fact. "It's illegal, and it gets you into trouble, and m ore tim es than not you get caught," s ays lawyer Jos eph T. Monahan. You can append additional inform ation to records , adds Behnke, but when doing s o, the record s hould clearly indicate that the inform ation was added later on.
Us e docum entation to your advantage. "The proces s of writing helps [ps ychologis ts ] crys tallize in their own m ind what they are s aying about the problem ," s ays Sparta. "It helps pinpoint when things don't m ake s ens e or where they need to get m ore inform ation."
7. Practice only w here you have expertise
Every ps ychologis t knows they are obligated by the Ethics Code to practice only where they are com petent. But s om etim es difficulties aris e when, for exam ple, they practice in em erging areas where there aren't clear s tandards .
"The problem is that, m any tim es , how does the ps ychologis t know when there's s om ething they don't know?" s ays Sparta. "If you don't know from the profes s ional literature that there are certain guidelines ...you m ay be well-intentioned, but not realize you're going beyond the boundaries of your com petence."
Com petence is s ues als o com e into a play in child-cus tody ethics , when ps ychologis ts are unfam iliar with the nuances of working with courts . Take the cas e of a ps ychologis t who is as ked to write a letter to a judge about the relations hip of a boy in treatm ent to his parents . If s he has little forens ic training, the ps ychologis t could land in ethical hot water if, for exam ple, s he failed to include the lim itations of her opinion, s uch as that s he's never m et one of the boy's parents .
Another area to keep in m ind is as s es s m ent, s ays Cam pbell: "If you find yours elf falling back on ins trum ents becaus e you feel confident with them and you don't know which others to us e, that m eans you haven't kept up with the advances in that particular area and need to re-exam ine what needs to be done to be proficient."
One of the bes t ways to addres s com petence is s ues is to s tay in touch with the profes s ion through conferences , continuing education, s eeking diplom ate s tatus , cons ulting with colleagues , and reading journals , guidelines and other publications , s ays Sparta. For exam ple, if you begin s eeing an adoles cent with anorexia, but infrequently treat eating dis orders , read up on the profes s ional literature and arrange for s upervis ion or cons ultation to ens ure that the treatm ent is adequate.
"In the age of long-dis tance telephone, teleconference and the Internet, it's hard to argue that you couldn't have gotten the right kinds of inform ation," s ays Kins cherff.
The 2002 Ethics Code does m ake exceptions for ps ychologis ts in extraordinary circum s tances : Ps ychologis ts with clos ely related experience can provide s ervices if there's no one els e who can--as long as they m ake a reas onable effort to obtain the com petence required. See Standard 2.01 for the details .
8. Know the difference betw een abandonment and termination
Every year, APA's Ethics Office fields calls from ps ychologis ts who want to end treatm ent with a patient, but are anxious becaus e they fear they're abandoning their client.
"Abandonm ent is not the s am e as treatm ent term ination," Behnke tells them , pointing to the 2002 Ethics Code, which s ays in Standard 10.10 that ps ychologis ts can dis continue treatm ent when clients :
Aren't benefiting from therapy.
May be harm ed by the treatm ent.
No longer need therapy.
Threaten the therapis t, them s elves or others .
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Ps ychologis ts s hould provide preterm ination couns eling and s ugges t alternative s ervice providers , s ays the Ethics Code, noting that this m ay not be pos s ible in all cas es , s uch as if a patient abruptly s tops attending therapy. Such preterm ination couns eling could include explaining the benefits of the new s ervices and why the current treatm ent is no longer helpful, addres s ing feelings of s eparation by em phas izing the trans fer is not a pers onal rejection, and identifying practical is s ues in trans ferring the client, s uch as res olving financial arrangem ents with the new provider before ending treatm ent.
"Involve the client in the plan," advis es Sparta. "Em power them to feel confident and com petent. Help the client unders tand that the trans ition is a cons tructive s tep toward achieving their goals ."
By contras t, abandonm ent occurs when a ps ychologis t inappropriately ends treatm ent, s uch as halting needed therapy with no notice.
In his tenure on various ethics groups , Sparta s ays he has s een as m any cas es when ps ychologis ts continued treatm ent beyond the point neces s ary as when they precipitous ly s topped treatm ent. While dependent clients can m ake it difficult to end treatm ent appropriately, the blurred m ultiple roles that can res ult from prolonged relations hips --giving a client a job, for exam ple--are too ris ky, s ays Sparta.
Ps ychologis ts can often head off term ination dilem m as by thinking ahead, s ay ethics experts . For exam ple, a ps ychologis t treats a wom an until her ins urance coverage expires , but when s he can't pay out of pocket, he explains that the relations hip m us t end and facilitates her care to another provider. To avoid the m is perception that the ps ychologis t
"dum ped" the client, the ps ychologis t dis cus s es the treatm ent tim eline at their firs t s es s ion, including the differences between s hort- and long-term therapy and what could happen if therapy was needed beyond what the wom an's ins urance covered.
If there are cas es in which it's apparent that a patient m ay have financial troubles at therapy's s tart, give cons ideration before you take the cas e, s ay ethics experts . And m ake s ure you are aware of clients for whom financial hards hip is developing.
9. Stick to the evidence
When you give your expert opinion or conduct an as s es s m ent, bas e your evaluation only on the data available. For exam ple, ps ychologis ts in child-cus tody cas es s hould be s ure they aren't being bias ed in favor of the parent who is m ore financially s ecure.
"The bes t approach is to s tay m indful about what you know, what you don't know and what your s ources of inform ation have been," s ays Kins cherff.
Ethics experts recom m end that ps ychologis ts :
Know w hat the referral question is and choose assessment tools that can validly answ er that question. That m eans ps ychologis ts need to read and unders tand tes t m anuals , s ays Sparta. For exam ple, pers onality tes ts appropriate for clinical us e are not neces s arily appropriate for em ploym ent s election.
Don't rely on third-party reports to formulate assessments and avoid giving an opinion of any person they haven't directly evaluated. According to the Ethics Code, when ps ychologis ts can't evaluate a pers on directly, they s hould docum ent the efforts they m ade and the res ult of thos e efforts . They als o need to dis cus s the lim ited inform ation's im pact on the accuracy and certainty of their opinion, and appropriately lim it their conclus ions or recom m endations .
Make sure the assessment is thorough. Ps ychologis ts can find them s elves in hot water when they give an expert opinion without cons ulting all of the s ources available. For exam ple, a ps ychologis t conducting a cus tody evaluation fails to check with child protection s ervices and therefore does not learn that one parent is being inves tigated for child neglect--a fact that m ight have changed the ps ychologis t's opinion.
Discuss the limitations of their w ork and m ake s tatem ents about the certainty of their findings . If no interview is pos s ible, note thos e lim itations in the report. "It's equally im portant to offer any plaus ible alternative hypothes es that would account for the data," adds Kins cherff. In fact, in court cas es where the facts are dis puted, Kins cherff lays out the contradictions between the two parties and then m akes a s et of recom m endations bas ed on each party's s ide of the s tory, leaving it up to the court to decide which party is truthful.
Ensure that tests w ere developed for the target population and that they are culturally appropriate, s ays Sparta.
If the tes t is n't, m ake the proper adjus tm ents and note the lim itations of thos e adaptations in your findings . New text in APA's 2002 Ethics Code s pecifies that ps ychologis ts take s uch m eas ures .
10. Be accurate in billing
There's nothing m ore im portant than accuracy when it com es to billing patients and ins urers for ps ychological s ervices , s ay ethics experts .
While s loppy bookkeeping can land s om e ps ychologis ts in hot water, others find them s elves in predicam ents becaus e they've worked the s ys tem to get clients m ore benefits than a third-party payor entitles them to.
To avoid s uch ethical problem s , a ps ychologis t s hould:
Bill only for services you have provided us ing correct procedure codes . Never bill an ins urer for a s ervice that is covered ins tead of the treatm ent actually provided. For exam ple, it's im proper to bill for individual therapy ins tead of couples therapy, for therapy ins tead of ps ychological tes ting or for ps ychoeducational tes ts as if they were health-related. Moreover, don't bill the ins urance com pany when clients m is s appointm ents ; bill the client.
"Be accurate, cons ervative, and cons ult when in doubt," advis es Ethics Com m ittee as s ociate Peter Mayfield, PhD.
Only list the dates you treated the patient. While it m ay be tem pting to tell an ins urer that only pays for one s es s ion a week that you s aw a client two Mondays in a row ins tead of the Monday and Friday you actually m et, ps ychologis ts s hould never "fudge" a treatm ent date.
Call it as you see it. Occas ionally, a patient m ight as k for a les s dam aging diagnos is for fear that em ployers or others m ight find out. Or ps ychologis ts m ay cons ider exaggerating diagnos es to jus tify m ore vis its to ins urers . No m atter what, don't do it: "Hones ty is the bes t policy," s ays Mayfield.
Discuss billing practices up front. "All of the financial policies need to be told to the client at the beginning of therapy," s ays Eric Harris , JD, EdD, a ris k m anagem ent cons ultant for the APA Ins urance Trus t. In fact, Harris recom m ends that ps ychologis ts as k clients to s ign inform ed-cons ent contracts that outline the financial arrangem ents , s uch as that clients will be billed for s kipped s es s ions and they m us t pay for the s ervices if the ins urer refus es coverage.
Be conscientious about collecting fees. "When a client is n't paying their fees , you need to rais e it with them as early as pos s ible," s ays Harris . "You need to s et appropriate lim its ." Allowing clients to run large balances is n't good for either party's finances . One s olution is to accept credit cards .
Take caution in pursuing delinquent accounts. When ps ychologis ts us e s m all claim s court or a collection agency to purs ue debtors , they are ethically obligated to firs t inform the client of their intent and give them the chance to pay. If the client does not pay, ps ychologis ts are ethically perm itted to provide only the m inim um inform ation neces s ary to purs ue their claim .
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W atch your paperw ork. Becaus e ps ychologis ts are accountable for everything that their offices bill, regardles s of whether they ever s aw the paperwork, Mayfield encourages ps ychologis ts to pers onally review any docum ent that goes out under their nam e.
Las tly, there's one, bes t s trategy that ps ychologis ts can take to m inim ize their expos ure to ethical and legal problem s , s ays Behnke: "Be the bes t ps ychologis t you can be."
F URTHER READING
Am erican Ps ychological As s ociation. (2002). Ethical principles of ps ychologis ts and code of conduct.
Am erican Psychologist, 57(12).
Benjam in, G.A.H., & Gollan, J.K. (in pres s ). Fam ily evaluation in custody litigation: Reducing risk s of ethical infractions and m alpractice. Was hington, DC: Am erican Ps ychological As s ociation.
Caudill, O.B. (2002). Ris k m anagem ent for ps ychotherapis ts : Avoiding the pitfalls . In L. VandeCreek & T.L.
Jacks on (Eds .), I nnovations in clinical practice: A sourceb ook . Saras ota, FL: Profes s ional Res ource Pres s .
Foxhall, K. (2000). How to protect your practice from fraud and abus e charges . Monitoron Psychology, 31(2),
6 4 -6 6 .
Gottlieb, M.C. (1993). Avoiding exploitive dual relations hips : A decis ion-m aking m odel. Psychotherapy,
3 0 (1 ), 4 1 -4 8 .
Haas , L.J., & Malouf, J.L. (2002). Keeping up the good work : A practitioner's guide to m ental health ethics
(3rd ed.). Saras ota, FL: Profes s ional Res ource Pres s .
Koocher, G.P., & Keith-Spiegel, P.C. (1998). Ethics in psychology: Professional standards and cases (2nd ed.). New York: Oxford Univers ity Pres s .
Nagy, T.F. (2000). Ethics in plain English: An illustrative caseb ook for psychologists. Was hington, DC:
Am erican Ps ychological As s ociation.
ON THE W EB
APA's Ethics Office: (202) 336-5930; e-m ail: Ethics (mailto:ethic s @apa.org) ; Web s ite: APA Ethics
( /ethic s /index .as px ) .
APA's Record Keeping Guidelines (/prac tic e/guidelines /rec ord-keeping.pdf ) .
APA's Child Cus tody Guidelines (/prac tic e/guidelines /c hild-c us tody .pdf ) as well as guidelines on m any other topics , s uch as evaluating dem entia, are als o available on APA's Web s ite (/index .as px ) .
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