USA: +1(669)289-8683 
Sign in
Assignment 2: LASA: Therapeutic and Forensic Roles
For many years, the ethical dilemma of playing both a therapeutic role and a forensic role has been debated in the literature. Some authorities argue that there is always a conflict of interest in such dual relationships, while other authorities argue that the two roles can be reconciled and impartiality can be maintained. Using the Argosy University online library resources and the Internet, locate at least ten articles that discuss the therapeutic role and the forensic role and take a stance on this particular debate. Make sure that your collection of articles is balanced with regard to the roles and the viewpoints.
Tasks:
Utilize the ethical decision-making process you learned about in M1 Assignment 3 to create a 7- to 8-page argumentative paper supporting your stand. First, compare and contrast the roles, articulate the potential ethical conflicts, and discuss how those conflicts might be managed. Then, in a reasoned fashion, develop an argument for whether the two roles—therapeutic and forensic—should ethically coincide.
The course paper is essentially an argumentative essay. Refer to the following for guidelines about writing argumentative essays:
· Refer to
this guide
for tips about writing argumentative essays.
Ensure that you follow these instructions:
·
Identify and articulate the similarities and differences between the therapeutic and forensic roles for both assessment and treatment.
· Articulate the potential ethical conflicts and discuss how those conflicts might be managed.
· Using multiple sources, defend your thesis on how and why therapeutic and forensic roles should or should not be reconciled.
· Be sure to address the issues of dual relationships as they apply to assessment as well as treatment.
· Ensure that you argue for a particular side of the issue (not arguing both sides) and that your argument is well-supported by scholarly literature, professional ethical guidelines, and the law.
· Include solid reasoning and a compelling thesis.
· Remember, a strong argument always supports its ideas and proves the other side wrong. Make sure to both support your views with credible arguments and sources and refute the other side.
Use proper grammar and spelling. Additionally, the paper should be written and formatted in APA style.
This LASA is worth 300 points and will be graded according to the following rubric.
|
Assignment Component |
Proficient |
Maximum Points Possible |
||
| Identify and articulate the similarities and differences between the therapeutic and forensic roles for both assessment and treatment. |
Discussion indicates understanding of the therapeutic and forensic roles through specific details within each role. However, relations are not drawn between the two, or arguments, although accurate, are common. |
72 |
||
|
Articulate the potential ethical conflicts and discuss ways on how those conflicts might be managed. |
The most pertinent potential ethical conflicts related to the dual relationship of therapeutic and forensic roles were identified and ways to address them were discussed. |
|||
|
Present a cogent argument for whether forensic and therapeutic roles should coincide. |
Thesis statement clearly takes a stance on whether therapeutic and forensic roles can ethically coincide. |
|||
|
Present well-reasoned arguments supported by scholarly resources. |
Arguments are clear and reasonable. They are supported by scholarly literature, professional ethical guidelines, and/or the law. All arguments directly support the thesis. |
56 |
||
|
Academic Writing |
|
|||
|
Writing is generally clear and in an organized manner. It demonstrates ethical scholarship in accurate representation and attribution of sources; and generally displays accurate spelling, grammar, punctuation. Errors are few, isolated, and do not interfere with reader’s comprehension. |
28 |
|||
|
Total: |
300 |
1
THE INTERFACE OF LAW AND
PSYCHOLOGY: AN OVERVIEW
The profession of psychology has much to offer the legal system and
those with possible or clearly identified psychological difficulties who find
themselves negotiating the legal system. As a result, forensic psychology
has emerged as a distinct specialty area within the broader field of psychology.
Forensic psychology includes both scholarly and applied activities and repre-
sents the intersection of clinical and experimental psychology and the law
(Heilbrun, 2001). The clinical and experimental forensic arenas are them-
selves composed of diverse psychological specialties, such as counseling,
developmental, and social psychology. Thus, forensic psychologists may have
multiple professional identities representing both their primary areas of
training and experience and their subsequent application of their knowledge
and skills to forensic matters.
In addition to psychologists who pursue professional involvement
in
the legal system, some clinicians inadvertently find themselves involved in
the legal matters of their patients. Involvement of the clinician may be
either requested or required. For example, a neuropsychologist may be
subpoenaed to testify about the evaluation findings of a patient who sustained
a traumatic brain injury in a motor vehicle accident. Understanding the
professional, ethical, and legal issues involved in such situations is necessary
for successful performance of one’s responsibilities.
http://dx.doi.org/10.1037/11469-001
Ethical Practice in Forensic Psychology: A Systematic Model for Decision Making,
by S. S. Bush, M. A. Connell, and R. L. Denney
Copyright © 2006 American Psychological Association. All rights reserved.
Co
py
r
i
gh
t
Am
er
ic
an
P
sy
ch
ol
o
g
ic
al
A
s
s
oc
ia
ti
on
.
No
t
f
o
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
Because of the varied contexts in which forensic psychologists practice,
there will likely be exceptions to many of the topics examined in this text.
Nevertheless, an increased understanding of the ethical issues that pertain
to forensic psychology in general will assist psychologists in all forensic
contexts to better serve those with whom they interact professionally. For
the purposes of this text, the term forensic psychologist is used broadly to
refer to those psychologists who perform forensic activities or work in forensic
settings; it is not used solely to denote those with specialized training or
board certification in forensic psychology.
FORENSIC PSYCHOLOGY IN CIVIL AND CRIMINAL CONTEXTS
Psychologists serve the justice system in a variety of contexts (Blau,
1998; Heilbrun, 2001; Koocher & Keith-Spiegel, 1998; Melton, Petrila,
Poythress, & Slobogin, 1997; Walker & Shapiro, 2003). They can be found
practicing and conducting research in both civil and criminal legal arenas.
Civil law includes matters of family law; administrative proceedings, such
as Worker’s Compensation; and tort law, such as personal injury litigation.
Typically, the purpose of civil law is to assign responsibility for harm and
to provide a remedy. However, family law, a type of civil law, differs from
other civil matters in several important ways. In family law matters, the court
is generally called on to resolve disputes having to do with the following:
(a) marital dissolution, where there may or may not be a finding of fault;
(b) determinations regarding parenting relationships, such as parenting
agreements following divorce, adoption proceedings, or proceedings to termi-
nate parental rights; and (c) matters of juvenile justice that do not fall
within the purview of criminal law, owing to the status of the actor as a
minor.
In contrast to civil law, criminal law is based on the concept of “moral
blameworthiness” (Behnke, Perlin, & Bernstein, 2003). When an individual
has been found guilty of a crime, a moral sanction applies, including removal
from society if deemed necessary by the court. Criminal law addresses a
number of steps in determining the guilt or innocence of a defendant
and providing a consequence if the accused is found guilty. Psychological
expertise and services can be found across the continuum of criminal law.
In both civil and criminal contexts, psychologists engage in professional
activities relevant to a wide range of legal and psychological issues. According
to Standard 7-11 of the Criminal Justice Mental Health Standards (Ameri-
can Bar Association [ABA], 1989),
Mental health and mental retardation professionals serve the adminis-
tration of criminal justice by offering expert opinions and testimony
10 ETHICAL PRACTICE IN FORENSIC PSYCHOLOGY
Co
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
within their respective areas of expertise concerning present scientific
or clinical knowledge; by evaluating and offering expert opinions and
testimony on the mental condition of defendants and witnesses; by
providing consultation to the prosecution or defense concerning the
conduct of individual cases; and by providing treatment and habilitation
for persons charged with or convicted of crimes. Because these roles
involve differing and sometimes conflicting obligations and functions,
these professionals as well as courts, attorneys, and criminal justice
agencies should clarify the nature and limitations of these respective
roles.
Forensic Evaluation Services
The forensic psychology evaluation differs considerably from the clini-
cal psychology evaluation. Differences begin with the language used to
describe the evaluation. Psychological evaluations performed by practitioners
who are hired as independent contractors by third parties, such as disability
insurers, attorneys, or the courts, are often referred to as independent psycholog’
ical examinations or independent medical examinations. Differences between
forensic and clinical evaluations also include the nature of the requested
evaluation, which has theoretical and practical implications for the manner
in which the task is approached (Denney & Wynkoop, 2000). With forensic
evaluation services, context affects (a) the goals of the evaluation, (b) the
psychologist’s role, (c) the assumptions the psychologist makes about the
accuracy of information received from the examinee, (d) alliances formed,
and (e) methodology used by the psychologist.
The purpose of a forensic evaluation is to assist the legal decision
maker (Melton et al., 1997), who may be a judge, juror, mediator, or other
hearing officer. This forensic purpose stands in contrast to the clinician’s
goal of assisting the patient. Accepting that the psychologist’s primary
obligation is to the legal decision maker rather than to the examinee may
be a difficult transition to make for psychologists who have been clinically
trained. However, it is necessary for examining psychologists to understand
that the retaining party is the client and that the examinee is neither a
patient nor the client of the examining psychologist. Exceptions may exist
in forensic treatment settings in which evaluations may be performed to
facilitate clinical services rather than to inform legal decisions.
The goal of the psychologist retained to serve as an expert witness is
to provide information useful to the trier of fact in its effort to answer a
specific legal question, such as the presence or absence of psychological
“damages” or competency to stand trial. To achieve this goal, the psycholo-
gist assumes the role of seeker of truth and judicial educator (Denney &
Wynkoop, 2000; Saks, 1990). The opinions provided are not designed to
THE INTERFACE OF LAW AND PSYCHOLOGY 11
Co
py
ri
gh
t
Am
er
ic
a
n
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
help the examinee; in some instances, the opinions offered may conflict
with the litigant’s wishes.
The psychologist retained to serve as an expert witness cannot assume
that the information received from the litigant is accurate. Litigants may
not even be voluntary participants in the evaluation. The possible outcomes
of litigation can create tremendous motivation for the litigant to manipulate
the evaluator. It is counterproductive to trust the presentation of such highly
invested examinees without verification.
The alliances that a psychologist maintains may differ depending on
the context of the service provided. Although a psychologist providing
treatment typically forms a therapeutic alliance with the patient, such an
alliance with a forensic examinee may not be necessary or appropriate
(S. Greenberg & Shuman, 1997). The psychologist retained as an expert
witness forms an alliance with the truth. The investment in determining
and reporting the truth may make problematic the establishment of rapport
between examiner and examinee. Rapport may be misconstrued as an offer
of advocacy and may lure the examinee into a level of disclosure that is
not in the examinee’s best legal interest. A posture of respectful receptivity
with an arms-length, or dispassionate, mien may be the most appropriate
posture to assume during the examination.
The context in which the evaluation is performed also affects the
methodology used by the psychologist. Forensic psychological evaluations
require a broader base of information sources than is typical of clinical
practice, a base that extends well beyond the self-report of the examinee
(Denney & Wynkoop, 2000). In contrast to the urgency that is often required
in the provision of clinical evaluation services, psychologists practicing in
forensic contexts must take the time necessary to ensure that the broad
base of information that is needed (e.g., interviews, observations, records,
test data) can be obtained and thoroughly reviewed before conclusions
are offered.
The Distinction Between the Roles of Expert Witness and
Treating Doctor
The distinction between the roles of treating doctor and forensic 12 ETHICAL PRACTICE IN FORENSIC PSYCHOLOGY
Co
an ch court on a legal matter in which the psychological functioning or treatment Opinions about the clinical interpretation of data are relevant contribu- To facilitate clinical treatment, the treating doctor may provide diag- ‘The distinction between fact witness and expert witness, although common in psychological writings, THE INTERFACE OF LAW AND PSYCHOLOGY 13
Co to the clinical role, the forensic psychological expert role requires (a) a The term treating doctor has at times been used inappropriately to The distinction between treating doctor and expert witness is limited Blurring of Professional, Clinical, and Forensic Roles
The role held by the psychologist has implications for objectivity and ts
(Standards 3.05, Multiple Relationships, and 3.06, Conflict of Interest, One potential exception to the principle of avoiding dual relationships 14 ETHICAL PRACTICE IN FORENSIC PSYCHOLOGY
Co who is asked to not write a report, and who will not later testify might Some forensic mental health professionals want to have it both ways, Although psychologists may define the factors that compose a forensic THE ADVERSARIAL ENVIRONMENT
Expert witnesses play a prominent role in the U.S. litigation process THE INTERFACE OF LAW AND PSYCHOLOGY I 5
Co practitioner’s methods, opinions, and qualifications. A psychologist retained The adversarial environment may also pit psychologists against those Psychologists are not always adequately prepared by their education THE NEED FOR INFORMATION ON ETHICS The pulls to sacrifice objectivity, the differences between clinical and 16 ETHICAL PRACTICE IN FORENSIC PSYCHOLOGY
Co APPLYING GENERAL BIOETHICAL PRINCIPLES All ethical principles are based on fundamental human values. Values Autonomy refers to self-determination, the ability to make decisions Justice is a beneficence to a society of unidentified persons—that is, to Biomedical ethical principles can be readily applied to most ethical In forensic practice, psychologists have a responsibility to respect the THE INTERFACE OF LAW AND PSYCHOLOGY 17
Co examinees with courtesy, dignity, and fairness. Beyond the possibility of For forensic examinations, helping the examinee is not a primary Although helping the examinee may not be a primary goal of the Applying bioethical principles in forensic practice can be more complex The adversarial process is built on the assumption that right will prevail J8 ETHICAL PRACTICE IN FORENSIC PSYCHOLOGY
Co model in the more comprehensive decision-making model that is presented APPLYING PSYCHOLOGICAL ETHICS IN FORENSIC ARENAS
The 2002 APA Ethics Code is the 10th version of the Ethics Code, Understanding changes between different versions of the APA Ethics General Principles
The 2002 APA Ethics Code’s General Principles reflect increased 2 For interested readers, comparisons of the two APA Ethics Codes can be found on the APA Ethics THE INTERFACE OF LAW AND PSYCHOLOGY 19
Co to five. Prior principles, titled “Competence” and “Social Responsibility,” Ethical Standards
The elimination of a separate group of standards on forensic activities The manner in which psychologists are to resolve ethical issues was Standard 3.10c, Informed Consent, is a new addition to the APA 20 ETHICAL PRACTICE IN FORENSIC PSYCHOLOGY
Co sent process in detail, including exceptions to the need to obtain informed Standards addressing multiple relationships (Standards 3.05, Multiple The 2002 APA Ethics Code includes an increased emphasis on cultural The 2002 APA Ethics Code includes a significant change to the THE INTERFACE OF LAW AND PSYCHOLOGY 21
Co refers to “raw and scaled scores, client/patient responses to test questions The 2002 APA Ethics Code includes a section on record reviews and RELATED PROFESSIONAL GUIDELINES
As the “Introduction and Applicability” section of the 2002 APA 22 ETHICAL PRACTICE IN FORENSIC PSYCHOLOGY
Co foundation for many aspects of forensic practice, but more specific application The Specialty Guidelines for Forensic Psychologists: A Brief Overview
The SGFP were prepared by the American Psychology-Law Society The SGFP consist of an introductory section followed by seven topical CONSIDERATION OF JURISDICTIONAL LAWS
The Introduction and Applicability section of the APA Ethics Code The Health Insurance Portability and Accountability Act
At the federal level, the Health Insurance Portability and Accountabil- THE INTERFACE OF LAW AND PSYCHOLOGY 23
Co T B 1 P ro
f e io na
l u
e e R va to F
or si P o g _CB
F C O
CD
o CO
N O CO c -2 CD n| ‘S
m w – ^ E
— C CO I ‘c? 8 1 * 1 Sii i r i fi P ct e a m r s o C ld u o E lu i o P t h F
o n c va a n f hi re a n d sc P h ic a o S e a A u d ol y t U
o N o o l- l er nn i C du in C
li n al P ic S te e o h re n o T P ty b rv i eu ps h ff i a P t io o th e m e n ca d y C ic N e p ch o g o A st lin a N p ch lo
g ts ur g d rs ro e g G de es or he va f e e A b o ld n: ub ct e\ th a u e o P ct e f F n c sy ia y
S n s d tio n a P
sy a T e in M o l
S s f ra ic o C h C o va n T I n D en i n rim a T ls n im tio s f ia T i ap ic S e ic B g ro m o W en ris a d h e b C re A A B S te e n rp fe io e tio h ic n n tl u D P ce C e lit ry m ye h n e a E P n h n e tio ip i h C xt f o -R te n de G e E e W e P r e e a e a xp W im P o a d re m t ro D g es A rm n xp S e ic ta s e in e lle io b se f yp s CO -Q CO -O C O J 2 C O – Q C 0 ^ 3 O C O J 2 O
O 5 O 3 O 5 O O O > O 5 O 5 O ) O 5 O ) O 3 O 3 O 5 O ) O 3 O O O O O O
LU
O Q̂.
Q. 24 ETHICAL PRACTICE IN FORENSIC PSYCHOLOGY
Co ^.w 1 ra Hi,8 ^ P ci p s f e s it h n tio n E e G lu n in iv e 00 f̂
CD CD
* *
Q. Q.
T S ri : ro ct g h n g o e s th P p s P ch g ts nd o C CD CM
CD O A P B od f o in CD S a G e c sy •̂
o QL CO 8
C n f th ts 3 e P e u vi o sy a e O T-
o o ĈL CO tO .g
G in h P t e CD CO “to *” “o
C; “S ‘S “to .g P se o T a y b D g e A d y N p § Z
Z §> 1 CD E T : ff ia P tio ta m o th N
at na J2 to *£- CD CO “to ^ 1•̂ T T n ia in i ca y o CM fco 1stI1 a fjIs 2 W.Q) co n
In rm C n ffi a ta m o e a n c e rit A p . ffi at CO CO
S oo 1 CD o 1 1o S. UJ ° In a C rd d o c e ch N n y e g S p m a ity ss m ra ic ss s e m m >, rf
c?| B Q > o uj
III 11 < 1 s i °
0 C O ^ C/J n E .13 ~ lOH o Sgjil <
w J2 <: "co
O ii c CD O
g 0 1 1|
C a d sc P ch tr A C = m n ic ry n h a ; E A A e a d R a h ss a n A A ic ss A A = o G ts f m a P g L :ti ; P S C m e o ro ss n e n ta s; A = om et e re s a ila i r re s io o 3 ,” .9 ‘§ d 5 CL < c < g£
CD •*; '• r tO "O f«O O c QJ (j uj lu
( D ^ ‘ o E O ‘ p — – 2 ills-iiiie • _I’C”2 ^ C – C – C 2 : < < c o o o t ? S
3 9 - 1
THE INTERFACE OF LAW AND PSYCHOLOGY 25
Co DHHS], 1996) took effect in April 2003 and has been a source of confusion Of particular relevance to this chapter is the determination of whether Connell and Koocher (2003) opined that forensic practice may not Legitimate arguments, also noted by Connell and Koocher (2003), When considering the applicability of overlapping state and federal 26 ETHICAL PRACTICE IN FORENSIC PSYCHOLOGY
Co Conflicts Between Ethics and Law
Jurisdictional laws provide guidelines for professional behavior that If this Ethics Code establishes a higher standard of conduct than is In many instances, efforts to compromise will result both in the legal A PROPOSED MODEL OF ETHICAL DECISION MAKING Determining a course of professional behavior that not only avoids THE INTERFACE OF LAW AND PSYCHOLOGY 27
Co Ethical-decision-making models for psychologists have previously been The eight-step model proposed in this text incorporates the five com- Identify the Problem
Some professional activities considered by, or requested of, forensic 28 ETHICAL PRACTICE IN FORENSIC PSYCHOLOGY
Co tives. These overlapping concepts may need to be parsed out to clarify the Clearly ethical or unethical behaviors need little explanation or discus- Consider the Significance of the Context and Setting
Forensic psychologists work in widely varying settings and contexts. In any forensic role there may be a number of individuals or institutions Just as there exists a range of individuals or institutions owed obliga- THE INTERFACE OF LAW AND PSYCHOLOGY 29
Co the forensic psychologist has an obligation to provide competent services Identify and Use Ethical and Legal Resources
This step may be the most challenging in the ethical-decision-making The various resources are presented here in an order consistent with Second, determine the applicable bioethical principles. Beauchamp Applying the Beauchamp and Childress (2001) model to ethical chal- 30 ETHICAL PRACTICE IN FORENSIC PSYCHOLOGY
Co an appropriate course of action. However, dilemmas emerge or increase in Third, review relevant professional ethics codes. Ethics codes are devel- Fourth, psychologists must be familiar with the jurisdictional laws that Fifth, refer to position statements (i.e., white papers) of relevant profes- Sixth, review journal articles, books, and book chapters: “Theory and THE INTERFACE OF LAW AND PSYCHOLOGY 31
Co exist many published resources that can assist the forensic psychologist who Seventh, consult colleagues. Such consultation may occur informally Consider Personal Beliefs and Values
In addition to, or at times in contrast to, the collective values of a Develop Possible Solutions to the Problem
When one is faced with an ethical dilemma, inaction is typically not 32 ETHICAL PRACTICE IN FORENSIC PSYCHOLOGY
Co remediates potential suffering on the part of a party in the situation. The Generating a list of possible solutions requires integration of the sig- Consider the Potential Consequences of Various Solutions
Once possible solutions to the ethical problem have been developed, Choose and Implement a Course of Action
Once potential solutions have been examined and consequences con- THE INTERFACE OF LAW AND PSYCHOLOGY 33
Co course of action. The timing of the action may be critical to its success. Assess the Outcome and Implement Changes as Needed
With many difficult ethical decisions, the chosen action will likely be APPLYING APPROPRIATE RISK-MANAGEMENT STRATEGIES In 1984, Alan Stone wrote, “The philosophers say life is a moral Most professionals do not know about, much less understand, most of Continuing education in the areas of one’s psychological specialty, the 34 ETHICAL PRACTICE IN FORENSIC PSYCHOLOGY
Co knowledge is not enough. Forensic psychologists must be committed to To justify one’s positions and behaviors, clear and detailed documenta- As G. W. Lynch (1993) stated, “Historically, there has been tension, THE INTERFACE OF LAW AND PSYCHOLOGY 35
Co 2 The process that ultimately results in the provision of forensic psycho- THE RETAINING-PARTY/EXAMINER RELATIONSHIP
The fundamental human value underlying the retaining-party/ When agreeing to accept a case that involves or may involve litigation, 37
http://dx.doi.org/10.1037/11469-002
Co
ri
t
er
an ch
on No
rt
r
st
bu on within the legal forum (Hartlage, 2003). The relationship between the As Barsky and Gould (2002) noted, “A vital first step in becoming Established through discussions between the psychologist and the re- Objectivity in the Role of Forensic Expert
When retained as forensic experts, psychologists should anticipate Despite efforts to achieve objectivity, a good psychologist is highly 38 ETHICAL PRACTICE IN FORENSIC PSYCHOLOGY
Co
ch rt treating health care provider and forensic expert is on thin ice ethically By anticipating this possibility at the outset, the psychologist may be better Psychologists retained as forensic experts should also consider whether Self-examination should assess past objectivity and maximize current Self-examination questions, such as those offered by Sweet and Moul- THE REFERRAL 39
Co will be well served by ensuring professional competence (e.g., through appro- Advocacy in the Role of Trial Consultant
In assuming the role of trial consultant, the psychologist enters a Not uncommonly, psychologists may find this distinction between 40 ETHICAL PRACTICE IN FORENSIC PSYCHOLOGY
Co COMPETENCE
Psychological services, to be effective and useful to consumers, must be The concept of professional competence is based on the fundamental The 2002 APA Ethics Code requires professional competence (Stan- Just as competence is not universal, it is not static (Standard 2.03, THE REFERRAL 41
Co difficulty may lie in determining what represents competence in forensic FINANCIAL ARRANGEMENTS
The strength of the judicial system derives from society’s expectation Forensic psychologists do not provide professional services to parties to 42 ETHICAL PRACTICE IN FORENSIC PSYCHOLOGY
Co representations intended to be relied upon by third parties. (SGFP IV, It can be argued that contingency fees pose no greater threat to objectiv- The nature of trial consultation, in which a psychologist is retained Another potential financial arrangement that may provide the psychol- THE REFERRAL 43
Co payment, the availability of higher fees may provide motivation to engage Ethically preferable financial arrangements include setting fixed rates CASE 1: HANDLING REFERRALS IN A personal injury attorney contacts a psychologist who has experience Analysis
Identify the Problem
The psychologist accepted a referral from an attorney without exploring 44 ETHICAL PRACTICE IN FORENSIC PSYCHOLOGY
Co Consider the Significance of the Context and Setting
This apparent clinical referral occurred within the context of civil Identify and Use Ethical and Legal Resources
A fundamental societal value is the right of its members, whether The blurring of roles is one of the most frequent reasons for ethics THE REFERRAL 45
Co important for all parties, particularly because the assumptions generally held In the present case, once the referral was accepted, the relevant issues Consider Personal Beliefs and Values
This psychologist believes that any individual reporting symptoms that Develop Possible Solutions to the Problem
The psychologist, feeling somewhat uneasy about the referral, consid- Consider the Potential Consequences of Various Solutions
The psychologist considered possible beneficial and adverse effects 46 ETHICAL PRACTICE IN FORENSIC PSYCHOLOGY
Co harm to his relationship with the patient and, thus, the patient’s psychologi- Choose and Implement a Course of Action
The psychologist did not believe that declining the referral or referring Assess the Outcome and Implement Changes as Needed
The colleague suggested that the most ethically appropriate course of THE REFERRAL 47
Co refer them, hoping that it could be this psychologist, but only if he were 48 ETHICAL PRACTICE IN FORENSIC PSYCHOLOGY
Co
psychological expert has been the focus of some discussion in forensic
psychology ethics (e.g., J. M. Fisher, Johnson-Greene, & Earth, 2002;
S. Greenberg & Shuman, 1997; Iverson, 2000). Both of these roles are
subsumed under the first ABA role definition cited earlier, that of “offering
expert opinions and testimony concerning present scientific or clinical
knowledge” (ABA, 1989, Standard 7-1.1,
py
ri
gh
t
Am
er
ic
P
sy
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
of a patient may be relevant to the court. In such instances, the psychologist
is considered a fact witness,1 testifying about diagnostic impressions and the
facts of the treatment.
tions, but the treating therapist rarely has accomplished an arms-length,
comprehensive assessment that would lead to defensible opinion on the
psycholegal issue. Although there is controversy about whether the treating
clinician should offer opinion on the ultimate issue before the court, the
treating psychologist must limit opinion to that for which adequate data
has been gathered. For example, a therapist might opine about the likely
impact of the child patient’s visitation with a parent the therapist has never
met, if the therapist makes clear the limitations of that opinion (i.e., that
it is based only on the child’s and possibly other parent’s presentation; that
the therapist is an advocate for the patient and has not “heard the other
side of the story”; that the interpretation of data collected in therapy is
more subjective and potentially less reliable than data gathered from a range
of sources including objective measures, careful records review, collateral
consultation, and so on). Even with such careful statement of these limita-
tions, the therapist testifying about matters before the court must be aware
of the potential for the court to misconstrue or misuse the opinion data.
The therapist who has risked this misuse of data may find little support in
the professional community for offering opinion derived through provision
of psychotherapy as an expert evaluation of the forensic issue (S. Greenberg
& Shuman, 1997; Heilbrun, 1995, 2001; Melton et al, 1997). The distinc-
tion, then, is between being an expert clinician and being a forensic examiner
for the purpose of developing an opinion, to be offered in court, on a
psycholegal matter. Both may function as experts in the court, and the
clinician may be able to provide expert opinion on the clinical data, but
generally the clinician has insufficient data to offer an opinion on the matter
before the court.
nostic impressions prior to performing a complete review of relevant records,
interviewing collateral sources of information, conducting thorough psycho-
diagnostic testing, or otherwise performing an evaluation adequate to answer
questions before the court “with a reasonable degree of certainty.” In contrast
is not found in the Federal Rules of Evidence (FRE; 1975). The FRE (Article VII, Opinions and
Expert Testimony) distinguishes only between expert and lay witnesses, and it is the court that
makes the determination for any given case. The term fact witness is not found in the FRE.
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
review of all materials and completion of all procedures upon which to base
an opinion sufficient to withstand judicial scrutiny and (b) an objective
and judgmental position that may be impossible for the typically accepting
and nonjudgmental clinician to achieve (Shuman & Greenberg, 1998).
describe all clinical activities, such as clinical diagnostic evaluations that
do not involve remedial intervention or advocacy (Bush, 2004b). Although
clinical evaluations are typically performed to facilitate therapy, they are
not intended to be therapeutic in and of themselves. Thus, the goals,
assumptions, and alliances of the clinical examiner may more closely parallel
those of the forensic examiner than those of the treating therapist.
and is insufficient to understand the forensic roles of psychologists (Bush,
2004b). Heilbrun (2001) described five possible roles for mental health
professionals in forensic assessment contexts: clinical or court-appointed
evaluator; defense, prosecution, or plaintiffs expert; scientific advisor to
the court; consultant; and fact witness. This broad description of roles
better reflects the breadth of psychologists’ potential professional forensic
involvement.
accuracy in the presentation of information to the court and, by extension,
the accuracy of judicial determinations (Shuman & Greenberg, 1998). Blur-
ring of professional, clinical, and forensic roles has the strong potential to
invoke conflicts of interest that negatively affect one or more of the roles
(Shuman & Greenberg, 1998). Psychologists have a responsibility to recog-
nize the potential for conflicts of interest in dual or multiple relationships
with parties to a legal proceeding and to seek to minimize their effec
of the American Psychological Association’s [APA’s] Ethics Code, 2002;
Specialty Guidelines for Forensic Psychologists [SGFP] IV, Relationships,
subsection D, from the Committee on Ethical Guidelines for Forensic Psy-
chologists, 1991). In general, to maximize objectivity, these roles should
not be combined in a single case (Denney, 2005; Heilbrun, 2001).
may be seen in the psychologist who transitions from the role of examiner
to that of trial consultant after all evaluation-related responsibilities have
been completed. For example, a psychologist who is retained by a criminal
defense attorney to conduct an evaluation and provide verbal feedback,
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
appropriately transition to the role of consultant. The psychologist in this
scenario will have completed the role of examiner and will no longer be
required to maintain impartiality.
to be healers and to serve the adversary system (Stone, 1984). L. R. Green-
berg and Gould (2001) took the position that, in some situations, psycholo-
gists may ethically have it both ways. They described a “hybrid role” in
which the treating psychologist whose patients have impending or ongoing
litigation should be sensitive to the unique experiences and needs of such
patients, should be aware that the litigation will likely impact the therapy,
and should possess many of the practice-related traits of the forensic exam-
iner, while maintaining firm limits regarding the nature of the opinion
testimony provided (L. R. Greenberg & Gould, 2001). As these researchers
described, although the treating psychologist may provide opinions regarding
diagnosis, treatment, and prognosis, “the treating expert generally declines
to express opinions on psycholegal issues (e.g., custody recommendations
and parental capacity)” (p. 477). When overlapping or multiple roles are
adopted, it is how the overlap is managed that distinguishes ethical conduct
from misconduct.
psychological evaluation and the factors that characterize a competent expert
witness, it is ultimately the court that determines what evidence will be
allowed and who will be considered an expert in a particular case. The
adversarial system is designed to provide the checks and balances for deter-
mining the adequacy (relevance and reliability) of the psychologist’s work
product. It is the psychological sophistication of the attorneys, trial consul-
tants, and trier of fact involved in the case that will determine the effective-
ness of the adversarial system for cases in which psychological functioning
is at issue. It is the responsibility of the psychologist to provide education
to those who do not appreciate the threats to impartiality and to attempt
to maintain clear distinctions in professional roles.
(Crown, Fingerhut, & Lowenthal, 2003); however, the adversarial nature
of the U.S. legal system presents unique challenges for psychologists. A
primary issue that is unique to many forensic situations is that the prac-
titioner’s opinions may be challenged or questioned. The “opponent” mount-
ing this challenge is an individual or team of individuals who question the
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
by the defense attorney in a civil case or by the prosecution in a criminal
case to provide an “independent” opinion will be seen by some examinees
as an opponent, a perception that may alter the examinee’s behavior during
the exam. The perception of the psychologist as an opponent leads to many
of the ethical dilemmas that are faced by forensic psychologists.
who have retained their services. The attorney who has retained a psycholo-
gist to perform an evaluation has an allegiance to the client and must
diligently advocate for the client. In contrast, the examining psychologist
has a responsibility to remain objective. Although retained by the attorney,
the psychologist has an allegiance to the court. This inherent clash between
the attorney as advocate and the expert witness, whose single most important
obligation is to approach each question with independence and objectivity
(Crown et al., 2003; Lubet, 1999), is also a source of ethical conflict for
psychologists.
and predoctoral training for these challenges. Thus, for many psychologists,
the transition from the classroom or clinical setting to a forensic environment
may involve a substantial paradigm shift and a corresponding struggle with
the ethical, moral, and legal issues involved (Martelli, Bush, & Zasler, 2003).
The most logical approach to both advancing ethical practice and availing
the legal system of one’s expertise may be to develop an increased sensitivity
to the disparities between conflicting interests and ethics.
IN FORENSIC PSYCHOLOGY
forensic activities, and the enticement to step beyond the boundaries of one’s
competence all provide opportunities for ethical misconduct. Particularly in
today’s health care environment, in which shrinking reimbursement for
services is often coupled with increased time-consuming clerical require-
ments, the lure of higher fees for one’s services may draw inadequately
prepared clinicians into professionally dangerous waters. Similarly, financial
incentives may lead even the most qualified forensic psychologist into uneth-
ical behaviors that are harmful to the retaining party, examinee, legal system,
and profession of psychology. An awareness of the common ethical chal-
lenges in forensic psychology can help psychologists examine their own
practices and the practices of their colleagues.
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
IN FORENSIC ARENAS
that a society deems important, such as the right to self-determination
and the right to quality health care, are applied to specific industries and
professions. Beauchamp and Childress (2001) offered a model of biomedical
ethics that has been widely adopted by writers in a variety of health care
specialties, including psychology. The model is composed of four basic
principles: autonomy, nonmaleficence, beneficence, and justice. Psycholo-
gists may recognize the last three principles from the APA Ethics Code.
The first principle, autonomy, is also present in the Ethics Code, embedded
in General Principle E (Respect for People’s Rights and Dignity).
regarding one’s life. Nonmaleficence is closely related to the Hippocratic
Oath: First, do no harm. Beneficence takes clinician responsibility a step
further by requiring an attempt to promote that which is beneficial to
the patient. In health care settings, justice typically refers to the equitable
distribution of the burdens and benefits of care (Hanson, Guenther, Kerkhoff,
& Liss, 2000). Stone (1984) noted that “to many moral philosophers, justice
is itself a beneficence” (p. 71). He elaborated as follows:
the general good. In contrast, the doctor’s practical ethical duty is to
ease the suffering of particular identified patients. Medicine has not yet
solved the problem of how to balance the particular good of the identi-
fied patient against the general good of the unidentified masses. We
lose our practical ethical guidelines when we try to serve such greater
good in the courtroom, (p. 71)
challenges in clinical psychology where the clinician’s goal is to help patients,
to avoid harm, to respect the wishes of patients regarding their treatment,
and to practice in a just and fair manner. However, in an adversarial judicial
system, the application of these principles may initially appear to be far
more challenging.
rights of examinees and other clients to determine their involvement in
psychological services. Examinees participate in independent psychological
evaluations more or less of their own accord, albeit at times under the threat
of negative consequences should they choose not to participate. In legal
contexts, the concepts of “nonmaleficence” and “justice” are closely tied
(Martelli et al., 2003). Forensic psychologists have a responsibility to treat
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
invoking emotional reactions to evaluation questions or tasks, practitioners
must not bring direct harm to examinees during evaluations. Nevertheless,
the results of forensic psychological evaluations and subsequent testimony
have the potential to result in considerable negative effects on the lives of
examinees. It is the psychologist’s responsibility to perform a fair evalua-
tion and to present the findings objectively and dispassionately. The legal
decision maker then has the task of ensuring a just outcome. An examinee
who believes he or she has been treated fairly and respectfully is less likely
to perceive the examiner as being maleficent, even given an unfavorable
determination.
goal of the examiner. Helping the trier of fact to make an appropriate
determination taking into account the examinee’s cognitive or psychological
functioning is a goal. The examinee may or may not benefit from the
examination findings. Thus, the principle of beneficence as it relates to
forensic psychological services may generally fall within the ambit of the
justice system rather than the individual examinee.
examiner, there are nevertheless situations in which the examiner is ethically
obligated to assist the examinee. When evidence of maleficence is observed
in the course of professional duties, forensic psychologists have a responsibil-
ity to report or ameliorate it, with strongest advocacy taken on behalf of
the most vulnerable individuals.
still. For example, psychologists hired as trial consultants by defense attorneys
in civil litigation cases strive to harm the plaintiffs case and, by extension,
the plaintiffs financial security. One of the psychologist’s roles is to identify
errors in the work of the psychologist retained by the plaintiffs attorney,
errors that may lead to a decision for the defendant, even if the psychologist
believes that the plaintiff actually deserves to win the case. In such a
situation, determining whether justice was served may be a difficult thing
to do.
if the responsibilities of all participants are fully discharged. It is not the
forensic psychologist’s responsibility to ensure retention by the party deserv-
ing to prevail. It is the forensic psychologist’s responsibility to thoroughly
and adequately perform his or her duties; if the resultant outcome favors
the “unjust,” we believe that the psychologist must forgo a sense of personal
responsibility for that injustice. The differences between clinical and forensic
contexts notwithstanding, we believe that the Beauchamp and Childress
(2001) model is useful in forensic psychology and have chosen to use their
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
later in this chapter.
and it reflects the continuing evolution and maturation of the profession
of psychology. The Ethics Code applies to all psychology specialty areas,
including forensic psychology. However, sections of the Ethics Code may
hold more or less relevance for various aspects of forensic practice than
they do for clinical psychology or other areas of practice. For example, it
may be more common to have one’s credentials called into question (Stan-
dard 2.01, Boundaries of Competence) in forensic practice than it is in
clinical practice.
Code that are relevant to forensic practice is essential when determining
appropriate professional conduct.2 Because previous texts addressed the
changes to the Ethics Code in some detail (e.g., C. B. Fisher, 2003a; Knapp
& VandeCreek, 2003), this section provides only a brief overview, with
emphasis on those changes that are most relevant to forensic psychology.
emphasis on the model of biomedical ethics described by Beauchamp and
Childress (2001). This model centers on four ethical principles: autonomy,
beneficence, nonmaleficence, and justice. Autonomy, the right to self-
determination, remains reflected in General Principle E (Respect for People’s
Rights and Dignity). Beneficence and nonmaleficence (new General Princi-
ple A) were previously reflected in the Ethics Code but now emphasize,
in greater detail, the goal of assisting without harming those with whom
psychologists work. Justice, a new addition to the Ethics Code, is addressed
in General Principle D. The principle of justice emphasizes the right to
equality in access to psychological services and in the nature of the services
provided. It also emphasizes for psychologists the importance of ensuring
that potential biases and limitations of professional competence do not
result in unfair practices. The Ethics Code was reduced from six principles
Office Web site at http://www.apa.org/ethics/codecompare/html. The comparisons describe which
principles and standards were added, deleted, or incorporated into other areas of the Ethics Code.
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
were deleted. Issues of professional competence, on the basis of the underly-
ing principle of nonmaleficence, now compose Standard 2 (Competence).
Previous content related to social responsibility was incorporated in the
Preamble and Introduction.
(Standard 7) is of particular significance and interest to psychologists who
are involved in forensic practice. Of the five subsections of Standard 7 in
the 1992 APA Ethics Code (APA, 1992), four were deleted, and the content
related to role clarification was integrated into Standard 3 (Human Rela-
tions) in the 2002 Ethics Code. The purpose of deleting Standard 7 was to
eliminate the focus on any one specialty area and to keep the focus of the
Ethics Code on issues that are relevant to psychology in general. The Ethics
Code Task Force intended to make the Ethics Code as generic as possible
(Knapp & VandeCreek, 2003). Nevertheless, forensic activities received
emphasis in some sections of the 2002 Ethics Code, including Standards
2.01f, Boundaries of Competence; 9.01a, Bases for Assessments; 9.03c, In-
formed Consent in Assessments; and 9.10, Explaining Assessment Results.
In addition to the Ethical Standards that specifically mention forensic activi-
ties, the following changes, outlined in this section and presented in greater
detail in subsequent chapters, hold particular relevance for forensic practice.
moved from the last standard to the first (Standard 1, Resolving Ethical
Issues). This standard is particularly relevant because of the sensitive nature
of handling ethical misconduct during the course of litigation. Issues of
competence now compose Standard 2 (Competence). The transition of
Competence from a General Principle to an Ethical Standard reflects an
increased emphasis on the importance of psychologists understanding that
attainment of competence is not simply aspirational but is an essential
requirement for ethical psychological practice. Attainment of competence
in one area of psychology does not imply competence in another. Compe-
tence must be established in each area within which forensic psychologists
practice and with each population with which forensic psychologists work.
Competence must be maintained through continuing education and peer
consultation.
Ethics Code that explains consent obligations when psychological services
are court ordered or otherwise mandated. In addition, issues related to
informed consent were included, for the first time, in the section on assess-
ment. Standard 9.03, Informed Consent in Assessments, describes the con-
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
consent. These standards support the obligation of psychologists to attempt
to describe to patients and examinees the potential foreseeable uses and
implications of treatment records or evaluation results as early in the profes-
sional relationship as possible.
Relationships; 3.06, Conflicts of Interest; and 10.02, Therapy Involving
Couples or Families) were clarified in the new APA Ethics Code. Forensic
psychologists must refrain from accepting a professional role if it may be
reasonably assumed that there is compromised objectivity or some circum-
stance that negatively affects the psychologist’s ability to effectively perform
professional activities. In addition, the 2002 Ethics Code indicates that
multiple relationships that would not be reasonably expected to interfere
with professional behavior or result in harm are not unethical (Standard
3.05a).
competency in situations in which it has been determined that such compe-
tency is essential for effective service delivery (Standard 2.01b, Boundaries
of Competence). The new Ethics Code also emphasizes the importance of
sensitivity to the difficulties inherent in providing services when language
fluency between psychologist and patient or examinee differs. Standard
9.02b, Use of Assessments, requires psychologists to use assessment instru-
ments for which reliability and validity have been established with members
of the population that the examinee represents. Standard 9.02c, also new,
requires psychologists to use measures that are appropriate given the exami-
nee’s language preference and competence, unless use of an alternative
language is relevant to the evaluation. Standard 9.06, Interpreting Assess-
ment Results, states that linguistic and cultural differences must be appropri-
ately considered when interpreting results. Throughout Standard 9, the
Ethics Code stresses the importance of describing the limitations of one’s
interpretations. Standard 9.03, Informed Consent in Assessments, describes
the need to obtain informed consent from the examinee regarding the
use of an interpreter. Information provided to the examinee includes the
possibility that interpretation may result in a degree of imprecision in
the evaluation results, and the extent of the imprecision will be greater the
more the interpreter and the examinee vary in their dialect or regional
nuances. Standard 9.03c also emphasizes the need for psychologists to ensure
that interpreters appreciate confidentiality rights and limitations and that
they maintain test security.
manner in which psychologists are to handle requests for test data and
materials. In the Ethics Code a distinction is made between test data and
test materials. Test data (as defined in Standard 9.04a, Release of Test Data)
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
or stimuli, and psychologists’ notes and recordings concerning client/patient
statements and behavior during an examination.” Under the 1992 Ethics
Code, psychologists were required to refrain from releasing raw data to
anyone (other than the patient or client under certain circumstances) not
qualified to interpret or appropriately use the data. Under current guidelines,
with a client-patient release, psychologists must provide test data to the
client-patient or to anyone identified in the release, unless the psychologist
believes that “substantial harm or misuse or misrepresentation” (Standard
9.04a) may result. In Standard 9.11, Maintaining Test Security, test materials
are defined as “manuals, instruments, protocols, and test questions.” In
contrast to what is required for test data, psychologists are required to “make
reasonable efforts to maintain the integrity and security of test materials”
(Standard 9.11). Standard 9.04a includes as test data those materials that
have examinee responses written on them. That is, test materials that must
be safeguarded convert to test data that can generally be released (with
client consent) once the psychologist or examinee has written responses
on them (Behnke, 2003).
opinions proffered without the psychologist having examined the subject
of the opinion (Standard 9.01c, Bases for Assessments). When an opinion
is offered in the absence of an examination, the psychologist must explain
the reasons for not conducting an examination and describe the information
upon which the decisions and opinions were based, including any limitations
inherent in the absence of the examination. Standard 9.01c reflects a depar-
ture from the 1992 requirement that, with some exceptions, psychologists
perform face-to-face examinations when offering diagnostic or evaluative
statements or recommendations, particularly in forensic contexts (APA,
1992 [1992 Standards 2.01, Evaluation, Diagnosis, and Interventions in
Professional Context; 7.02b and 7.02c, Forensic Assessments; Knapp &
Vandecreek, 2003).
Ethics Code states, “Psychologists may consider other materials and guide-
lines that have been adopted or endorsed by scientific and professional
psychological organizations” during the process of making decisions about
professional behavior. To go a step further, we suggest that forensic psycholo-
gists must consider guidelines promulgated within their areas of specialization
and appropriately endorsed by recognized organizations leading the field to
which they apply. The general nature of the Ethics Code offers a solid
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
of ethical principles and acceptable practice parameters is required and can
be found in a number of publications from APA and other professional
organizations. Table 1.1 provides a summary of some of the available guide-
lines. Some of these guidelines undergo periodic revision; as a result, psychol-
ogists are encouraged to check the Web sites and publications of the sponsor-
ing organizations periodically to ensure that they are in possession of the
most recent versions of the documents.
(APA’s Division 41) and are endorsed by the American Academy of Forensic
Psychology (Committee on Ethical Guidelines for Forensic Psychologists,
1991). Although designed to be consistent with the APA Ethics Code,
the SGFP were developed to provide more specific guidance to forensic
psychologists than was offered in the Ethics Code, The purpose of the SGFP
is to improve the quality of forensic psychological service.
sections: Purpose and Scope, Responsibility, Competence, Relationships,
Confidentiality and Privilege, Methods and Procedures, and Public and
Professional Communications. The SGFP provide a useful supplement to
the APA Ethics Code. As of this writing, they are undergoing revision and
a multiyear approval process. (The most current draft of the SGFP can be
found on the American Psychology—Law Society Web site at http://www.
ap-ls.org/links/professionalsgfp.html.)
instructs psychologists to consider applicable laws and psychology board
regulations during their ethical decision-making processes. Psychologists
should know the source of the jurisdictional regulations that govern their
professional conduct, whether it is the Ethics Code, the Canadian Code of
Ethics for Psychologists (Canadian Psychological Association, 2000), the
Association of State and Provincial Psychology Boards (2005) Code of
Conduct, or some other source.
ity Act (HIPAA; U.S. Department of Health and Human Services [U.S.
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
A
LE
.1
ss
G
id
lin
s
e
le
n
t
en
c
sy
ch
ol
y
‘c
CO
OJ
c
o co— c
CO .O
(O > — CO
CD CO CD CO ^
> o c •g LLJ
— ~o 0> CL 0
«« to c ^
r Z 0 W • ; – P O m C b
ra
ic
P
ra
e
te
f
r
hi
C
st
d
y
va
at
n
ra
ct
ic
e
P
a
ra
m
e
te
rs
f
o
r
e
re
si
E
lu
tio
o
C
ld
n
d
A
o
le
e
r
ys
lly
r
xu
lly
b
se
P
ic
on
he
se
f
o
n
-D
ct
ra
L
e
ve
P
so
el
n
on
ct
g
ic
1
ol
y
ta
m
n
t
n
t
e
P
se
ce
f
h
ird
ar
O
se
e
rs
n
N
ro
yc
O
ic
l
o
si
n
f
A
ri
ca
A
e
m
o
f
lin
a
l
u
ro
sy
lo
y
n
g
a
in
C
ic
l
e
u
ro
sy
o
is
D
in
A
ve
a
ri
a
l
P
ce
d
in
s
ui
lin
f
t
E
lu
a
tio
n
o
th
S
xu
a
l
u
se
f
C
hi
re
S
je
R
E
ic
l
G
id
e
lin
s
f
r
th
e
ra
ic
o
o
re
si
P
ch
tr
ta
d
a
rd
f
o
r
E
u
ca
a
l
n
d
ch
o
lo
g
ic
l
st
g
d
e
ta
n
d
a
rd
o
P
ct
e
f
r
ild
u
st
d
y
E
lu
a
tio
he
n
sa
ity
ef
se
C
in
l
ria
a
d
L
ita
n
o
P
sy
ch
tr
ic
e
st
R
e
V
tim
rv
e
s
o
n
d
in
P
g
ra
s
f
r
om
P
o
n
e
rs
n
T
e
ir
N
w
o
rn
h
ild
n
M
-A
A
ta
m
n
t
o
n
I
te
ro
ss
n
a
l
R
la
n
s
f
o
r
P
ys
ia
s
a
d
A
G
id
e
lin
e
s
f
o
r
u
e
ro
ss
o
n
fid
n
tia
y
I
n
d
u
st
-E
p
lo
d
P
ys
ic
ia
n
s
a
d
I
n
d
e
p
e
n
d
e
n
t
M
d
ic
l
x<
a
tie
t-
P
ys
ic
ia
R
la
n
sh
s
n
t
e
o
n
te
o
W
rk
e
la
d
a
d
In
p
u
id
lin
e
s
f
o
r
xp
rt
itn
ss
ee
R
vi
w
n
d
M
d
ic
l
E
e
rt
itn
e
ss
T
e
st
o
n
y
ris
n
-B
se
T
at
en
P
g
ra
m
s
f
o
r
ru
A
b
u
se
E
xp
e
rt
W
itn
s
ffi
a
tio
E
e
rt
W
itn
es
s
T
e
st
im
o
n
y
ci
n
tif
S
tu
o
f
R
fr
e
sh
g
R
co
ct
n
y
t
h
e
U
o
H
n
o
si
z
*
< Z _l < O ..
o o Q. Q. a: o <
< < < < LU LU 2
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
5
5
-CD
B. ̂
t CD
. O
rin
le
o
M
d
ic
a
l
E
th
ic
W
A
n
o
ta
s
sp
ci
a
lly
u
id
e
lin
e
s
fo
r
C
h
ild
C
u
st
o
d
y
E
va
a
tio
s
D
o
rc
P
ro
e
st
e
cu
ty
P
te
in
t
e
I
te
ri
ty
f
T
st
E
ic
a
l
ri
n
ci
le
of
sy
o
lo
is
a
C
d
e
o
f
o
n
d
u
ci
CD O
i- CM
S
P
C
e
o
C
n
d
u
ct
CM
0-
Q_
CO
p
e
ci
lty
u
id
lin
e
s
fo
r
F
o
re
n
si
P
ch
o
lo
g
is
ts
0)
LL
O
HI
O
a
n
a
d
ia
C
od
e
o
E
ic
s
f
o
r
P
sy
ch
o
lo
g
is
(
rd
d
.)
ra
ct
ic
G
id
e
lin
e
s
f
o
r
P
ro
d
e
rs
f
P
ch
o
lo
g
ic
l S
rv
i
0 0
CM CM
o
CD
s
u
id
e
lin
e
s
fo
r
P
sy
ch
o
lo
g
ic
a
l
E
va
lu
a
tio
n
s
C
ild
ro
c
0)
CD
Q-
CL
o
c
_g
™
z
CD
CD
E
CD
“crt^y
CO
‘o
it
O
O)<—
Q
re
n
ce
f
h
ir
d
P
rt
O
se
rv
e
rs
u
rin
N
u
ro
p
sy
ch
o
ca
e
m
of
e
u
ro
sy
ch
o
lo
g
y
CO
CM
“o
o
z
“o
CD
•a
to
e
st
S
e
cu
ri
ty
O
ic
l
o
si
n
S
te
e
n
t
f
e
io
o
8
CM
C
g
03
Z
CD
„
C
CD
«
;o
°
2£
“m
he
U
se
o
f
N
e
u
ro
p
sy
ch
o
lo
g
y
T
e
st
e
ch
ic
n
s
C
lin
ic
A
d
e
m
o
f
N
e
u
ro
p
sy
ch
o
lo
g
y
o
0
0 P
i x
CD C
**— “̂ 3
O CB
-^ ^
E 2
fo
e
d
o
n
se
t:
O
ci
l
S
te
e
n
t
f
th
N
tio
a
l A
T
st
S
e
cu
y:
n
U
d
a
te
O
ci
a
l
S
ta
te
m
e
n
t
o
f
th
e
N
it
CM C\l
“o
E CD
•22 *”>
2 n5
CO
75 §
to Z
c <
O "^
'•C ^̂
<0 -•
.C £•
f. 'to
S
“to ^
“™— nj
D> O
O -7^
d
e
p
e
n
d
e
n
t
n
d
o
u
rt
-O
e
re
F
re
n
si
N
u
ro
p
sy
o
l
a
tio
a
l A
ca
d
e
m
o
f
N
u
ro
p
sy
ch
o
lo
y^
ym
to
V
lid
A
e
ss
e
n
t:
P
ct
e
I
ue
a
n
d
M
c
o o
o o
CM CM
»•
<3 ~ m CL >^
C 03 __ ̂ Q.
< >– 0 Q) 2
1 .1 “» g 1
h
ild
n
d
A
o
le
e
n
t
sy
ia
y;
A
N
A
e
ri
ca
A
ca
d
e
m
y
o
f
C
lin
a
l
a
d
t
e
L
w
A
R
=
m
ric
n
E
u
ca
tio
n
a
l
e
se
rc
A
o
ci
tio
;
l
m
e
ri
ca
n
P
sy
ch
ia
tr
A
o
ci
a
tio
n
;
P
*
A
m
e
ri
ca
n
P
sy
ch
o
lo
g
ic
a
l
A
ss
.1
u
id
e
lin
e
s
fo
r
F
o
re
n
si
c
P
sy
ch
o
lo
g
is
o
th
e
A
e
ric
n
sy
ch
o
lo
y-
a
w
on
C
P
=
o
m
itt
e
n
P
fe
io
a
l
P
ra
ct
ic
a
d
S
n
d
a
rd
N
N
C
pl
e
r
fe
n
ce
a
re
va
b
le
n
t
h
e
e
fe
n
ce
e
ct
n
.
>i ~R * – c o o
C >s ̂ JJJ in ”m O
. ^ ” O O F – R C D ^ O ^
o> S S o >j£| i
< |f2 c 2 J ^ ^
^ < c O ^ o c * " 1 * ^
^ ii o w" := ° •— ®
•^-^ p ( 0 ^ 3 ” o D 3
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
for forensic psychologists. This legislation was intended to simplify and
protect the confidentiality of electronic billing and transmission of health
information and to provide increased patient access to their medical records,
including patients’ right to amend their medical records to clarify errors.
Although those goals may seem logical and straightforward, the legislation
evolved into a complex series of administrative rules, with exceptions for
certain settings.
HIPAA applies to forensic services, and if so, to what extent. HIPAA states
that information compiled in anticipation of use in civil, criminal, and
administrative proceedings is not subject to the same right of review and
amendment as is health care information in general (U.S. DHHS, 1996,
§164.524(a)(l)(ii)).
be subject to HIPAA, because (a) forensic services are designed to serve a
legal purpose, rather than a therapeutic purpose; (b) forensic services are
provided at the request of a party or entity outside the health care system;
(c) forensic services fall outside health insurance coverage, because they do
not constitute health care; and (d) forensic psychologists do not ordinarily
transmit data electronically except in the specific ways for which consent
has historically been obtained from the litigant, and (e) no new protections
or rights accrue to examinees by way of HIPAA compliance (i.e., no new
right of access and amendment of information gathered in anticipation of
litigation; U.S. DHHS, 1996, §164.524(a)(l)(ii)).
posit that forensic practitioners indeed need to become HIPAA compliant.
Such arguments include (a) the observation that assessment and diagnosis
with respect to an individual’s mental condition or functional status may
in fact constitute health care, according to HIPAA; as a result, psycholo-
gists who provide forensic assessment services may be considered by
HIPAA to be covered entities; (b) to obtain health care information about
a litigant from other service providers, forensic psychologists must provide
assurance that that the information will be handled in a secure way; and
(c) the question of whether forensic psychologists are covered entities will
likely fall to case law for resolution, and it may prove less expensive and
burdensome to become compliant than to become the case that decides
the issue.
laws, the more stringent of the two applies. With regard to HIPAA, this
means that the law that provides the most protection of private health care
information applies.
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
ultimately must be followed. However, psychologists also have a duty to
pursue the highest standard of conduct, which may require attempts to
compromise with legal authorities when the APA Ethics Code requires a
higher standard of professional behavior than does the law. The Introduction
and Applicability section of the Ethics Code states,
required by law, psychologists must meet the higher ethical standard.
If psychologists’ ethical responsibilities conflict with law, regulations,
or other governing legal authority, psychologists [must] make known
their commitment to this Ethics Code and take steps to resolve the
conflict in a responsible manner. If the conflict is unresolvable via
such means, psychologists may adhere to the requirements of the law,
regulations, or other governing authority in keeping with basic principles
of human rights.
system receiving the information or action it requires and in the preservation
of the integrity of psychological information or techniques. Although all
such attempts will not meet with equal success, the attempts themselves
help to educate others about the ethical concerns of psychologists and
demonstrate the psychologist’s commitment to high practice standards.
IN FORENSIC PSYCHOLOGY
ethical misconduct according to an ethics code but also adheres to high
aspirational principles requires a commitment to ethical ideals. Determining
such a course of action requires access to the necessary tools, and it requires
effort and time. Some practitioners may find adherence to the letter of
enforceable ethical standards to be sufficient. In our view, however, it is
difficult to justify choosing not to pursue the highest standard of ethical
behavior available to psychologists. As Knapp and VandeCreek (2003)
stated, “Ethics Codes of professions are, by their very nature, incomplete
moral codes” (p. 7). Positive ethics requires a shift from an emphasis on
misconduct and disciplinary action to an emphasis on the pursuit of one’s
highest ethical potential (Handelsman, Knapp, & Gottlieb, 2002). The
forensic psychologist must understand not simply that certain practices are
unethical but, rather, why they are unethical (Shuman & Greenberg, 1998).
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
provided (e.g., Canadian Psychological Association, 1991; Haas & Malouf,
2002; Kitchener, 2000; Koocher & Keith-Spiegel, 1998). Knapp and
VandeCreek (2003) reviewed these models and identified five common
steps: (a) identification of the problem, (b) development of alternatives,
(c) evaluation of alternatives, (d) implementation of the best option, and
(e) evaluation of the results. Knapp and VandeCreek also noted that these
models, although valuable, do not adequately consider emotional and situa-
tional factors or the need, in some situations, for an immediate response.
They proposed that when considering emotional and situational factors,
psychologists engage in self-care activities, become aware of when their own
emotional needs begin to interfere with sound professional judgment, and
be alert to situational pressures. To best address the need for urgent ethical
decision making, they recommended that psychologists anticipate the types
of problems that may be encountered in one’s practice and then develop
decision-making steps for such problems that can be implemented when
needed.
mon steps of the models reviewed by Knapp and VandeCreek (2003) and
integrates the decision-making components that were found to be lacking
in those models. This model was designed to provide forensic psychologists
with a means to resolve ethical challenges. Given the complexity of many
ethical challenges and the range of information and consultation that may
be needed to determine an appropriate course of action, it may be beneficial,
as Knapp and VandeCreek suggested, for practitioners to anticipate potential
ethical conflicts and determine a priori optimal courses of action. The steps
of the forensic psychology ethical-decision-making model are as follows:
(a) identify the problem, (b) consider the significance of the context and
setting, (c) identify and use ethical and legal resources, (d) consider personal
beliefs and values, (e) develop possible solutions to the problem, (f) consider
the potential consequences of various solutions, (g) choose and implement
a course of action, and (h) assess the outcome and implement changes
as needed.
psychologists are clearly appropriate and ethical, and some are clearly not.
However, many options considered by practitioners are ambiguous or present
complex layers to be considered. Forensic psychologists must keep in mind
that a wide range of potential behaviors may be appropriate when considering
courses of action and when reviewing the work of colleagues. A distinction
may need to be made between ethical, legal, moral, and professional perspec-
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
ethical problem or dilemma.
sion. If one engages in blatantly unethical behavior, one risks a host of
negative consequences. If one observes such behavior in a colleague, a course
of action must be taken to remedy the situation. However, in the less clear
circumstances often encountered in practice, a psychologist may encounter
a request or a situation that arouses feelings of uneasiness, a sense that
something may be wrong with the situation. In such situations, the psycholo-
gist must consider possible reasons for the unease and attempt to narrow
down the possibilities, eventually focusing on those elements of the situation
that are contributing to the initial feelings of discomfort. For example, a
psychologist treating a patient who sustained posttraumatic stress in a motor
vehicle accident may be called by the patient’s attorney with a request for
a report that describes the patient’s symptoms, degree of disability, and link
between the accident and the posttraumatic stress. The psychologist may
be conflicted about the appropriateness of writing such a report. A request
such as this that may seem straightforward on the surface may involve a
host of issues that would need to be considered by the psychologist. The
psychologist would benefit from determining, as specifically as possible, what
it is about the situation that is troubling. If such a situation had been
considered in advance, the psychologist would likely know exactly how to
respond to the request.
Professional activities that are appropriate in one forensic setting or context
may be inappropriate in others. Consequently, some professional guidelines
that are relevant in one setting or context may be less relevant or wholly
inapplicable in other situations. For example, a forensic psychologist’s fee
structure may differ, quite appropriately, depending on the nature of the
services provided. To the extent that the fee structure may compromise
objectivity, the distinction made regarding context is of ethical importance.
to whom or to which obligations are owed. Although this will differ by
context, some possible parties to whom obligations may be owed include the
following: referral source, client, examinee, patient, guardians of examinee or
patient, employing institution, profession of psychology, trier of fact, court,
legal system, and society at large. In some contexts, these parties may overlap,
whereas in others they are distinct.
tions, there is a range of obligations that may be owed. In general terms,
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
that advance the welfare of the individuals and institutions to which obliga-
tions are owed, without bringing unjust harm to the other individuals and
institutions involved. The nature of the harm to be avoided has been
specified as unjust harm. This clarification is provided because, given the
adversarial nature of the legal system, many of the opinions offered or
determinations made by psychologists may be considered unfavorable and
thus harmful to one of the parties involved in a case. Such opinions or
determinations are only unethical if they were reached in an inappropri-
ate manner.
process. There exist a number of published resources, sometimes offering
conflicting guidance, relevant to ethical issues encountered in forensic psy-
chology. Nevertheless, by using both the published and interpersonal re-
sources described in this section, the forensic psychologist can likely find
solid footing when determining courses of action that are consistent with
ethical practice.
a deductive or top-down method of ethical reasoning and decision making
(Beauchamp & Childress, 2001). This method involves applying a general
rule to a specific case. First, assess the foundational values. General bioethical
principles, the ethics codes of professional organizations, and jurisdictional
laws all reflect the values of a society. Examples of North American values
include the right to self-determination and the right to adequate health
care. These values underlie general bioethical principles, such as respect for
a client’s autonomy and the need to “do no harm” to the parties served by
the health care professional. Determining the values underlying a given
ethical standard or law will help to clarify the spirit behind the letter of
the standard or law and, by extension, will help to clarify the appropriate
course action (Behnke et al., 2003). Behnke et al. (2003) advised that an
ethical dilemma be approached by first asking the following questions: “What
values are at issue? And how can I act consistent with those values?” (p. 225).
and Childress (2001) presented a model of bioethical principles reflecting
society’s fundamental values. Their model, which has been widely adopted
across health care disciplines, posits four core principles: autonomy, benefi-
cence, nonmaleficence, and justice. As previously indicated in the chapter,
these principles are clearly evident in the 2002 APA Ethics Code.
lenges in forensic psychology can be of considerable value in determining
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
complexity in situations in which one value is pitted against another. For
example, from an ethical perspective, releasing raw test data to a patient
may, depending on the context, be consistent with respecting the patient’s
autonomy, but it may also result in psychological harm to the patient and
harm to society at large depending on the uses to which the data are put.
Weighing the relative importance of the principles involved and attempting
to strike a balance that satisfies the greater good is the task of the forensic
psychologist. Of course, such determinations need not, and often should
not, be made in isolation.
oped to reduce the vagueness inherent in professional values (Beauchamp
& Childress, 2001). The APA Ethics Code provides guidance for ethical
psychological practice. Whereas the Ethics Code’s General Principles are
aspirational in nature, the Ethical Standards provide more concrete dicta
for ethical practice and should be consulted to achieve an ethical solution.
The Ethical Standards are the enforceable minimum level of ethical conduct
for psychologists who are APA members or whose state boards have adopted
the Ethics Code as the professional regulations or rules of practice for licensed
psychologists.
regulate the profession of psychology where they practice. State and federal
laws offer specific guidance on how to manage fundamental aspects of psycho-
logical practice; however, more specific practices pertaining to psychological
specialty areas may not be adequately addressed by statutory or case law.
sional psychological associations. These position statements offer clarifica-
tion of details of practice areas that are beyond the scope of an ethics code.
Many of these statements are readily available from the Web sites of the
organizations authoring or endorsing them. The SGFP, currently under
revision, provide ethical guidance specific to forensic activities (Committee
on Ethical Guidelines for Forensic Psychologists, 1991).
principle are only starting points and general guides for the development
of norms of appropriate conduct. They are supplemented by paradigm cases
of right action, empirical data, organizational experience, and the like”
(Beauchamp & Childress, 2001, p. 2). General ethics texts provide coverage
of ethical issues of concern to forensic psychologists and may offer vignettes
specific to forensic practice. Forensic psychology books cover, to varying
degrees, many of the practice issues that are of ethical concern, and some
provide specific ethics chapters. In addition, texts from related psychology
specialty areas, such as child and family psychology and neuropsychology,
include chapters that address forensically relevant ethical issues. Thus, there
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
is anticipating or experiencing ethical challenges.
through discussions with colleagues and formally through contact with ethics
committees, or both. The experiences of colleagues who have faced similar
ethical challenges and the collective knowledge and experience of ethics
committees may provide invaluable assistance to the psychologist facing an
ethical dilemma. Consultation with others in one’s own jurisdiction may
offer the advantage of sensitivity to both the legal and ethical aspects of a
case. However, one might also need, in certain circumstances, to seek
consultation from outside the geographic area to preserve confidentiality of
case involvement or of details of the matter. It is useful to establish several
collegial consultative relationships and also to seek expertise to address the
relevant issues of the matter at hand. The consultation may be formalized,
even on a case’by-case basis, by establishing a consultation agreement,
retaining the consultant at an hourly fee, and requesting that the consultant
maintain a record of the consultation. Such consultation can then be identi-
fied, if later needed, as one of the ways the psychologist strived to meet the
ethical challenge in a professional and thoughtful way.
society that were previously described, the psychologist may endorse a partic-
ular value to some degree along a continuum. Forensic psychologists have
a responsibility to evaluate the degree to which their personal moral positions
are consistent with those of the larger society and the organizations with
which they are involved. To the extent possible, they should attempt to
understand their biases and the potential impact that their values and biases
have on their professional and ethical decision making. Psychologists may
also draw on personal values other than those reflected in a model of
professional ethics, such as their religion or cultural background. It is criti-
cally important that forensic psychologists, whose work often involves mat-
ters laden with moral and values implications, attempt to understand the
potential influences of their personal beliefs on their professional behavior.
an ethical option. The legal counsel that one may obtain may address the
issue from a risk-management perspective, arguing for temporary inaction
or for avoidance of efforts at resolution that might incur liability, whereas
the principles by which the psychologist practices may argue for action that
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
complex dilemmas that pit one ethical principle against another, or ethical
against legal considerations, may tax the most thoughtful practitioner.
nificance of the context, information obtained from available resources, and
personal beliefs and values. In some situations, the best course of action may
be clear upon such consideration. However, in other ethically challenging
situations, practitioners may need to generate a number of potential solutions
in as much detail as possible. Consider the example of releasing raw test
data to an opposing attorney. When provided with an appropriate client
release, there are a variety of options that the forensic psychologist should
consider. Some of these options include (a) immediately releasing the data
as requested, (b) refusing to release the data on the basis of published
professional guidelines, (c) offering to release the data to a psychologist
retained by the opposing attorney, (d) requesting a court order to release
the data, and (e) requesting a protective order from the court.
potential consequences must be considered. Both positive and negative
consequences must be anticipated. Just as the relative importance of underly-
ing values was assessed, the potential positive and negative consequences
of each action may need to be weighed to determine the best course of
action. In the example of releasing raw data, a variety of potential conse-
quences emerge. Spending time and resources striving to safeguard the test
data, which includes the materials on which responses are recorded, may
seem futile in the adversarial forum where rights to discovery of such materi-
als are legally defined. In contrast, the psychologist may believe that it is
ethically preferable to minimize the opportunity for nonpsychologists to get
access to test questions and stimuli, thus justifying the expenditure of time
and resources. However, by taking steps that may be perceived as obstructive
or oppositional, the psychologist may fear repercussions such as antagonizing
the court or the attorneys, thereby reducing good will with those with whom
one wishes to work. Thus, the potential consequences may extend beyond
solely ethical considerations to those with business and other implications.
Forensic psychologists must consider potential consequences, weigh their
options, and pursue the highest ethical option available.
sidered, the practitioner must select and implement the most appropriate
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
Depending on the issues involved and the context, the course of action
may need to occur quickly or may need to be delayed. Again using the
example of a request for test data, the request may have attached to it an
instruction to delay release for a specified period of time, to provide counsel
time to consult with the litigant, if necessary, and to file a motion to quash
the request or subpoena. Consultation with colleagues may be particularly
valuable in weighing the best time to respond to situations in which timing
must be taken into account.
unsatisfactory to one or more of the parties involved. The psychologist
should be prepared to receive and respond to feedback about the decisions
made and actions taken. Similarly, the psychologist must evaluate the effec-
tiveness of his or her own decision or action and implement changes as
needed.
IN FORENSIC PRACTICE
adventure; I would add that to choose a career in forensic psychiatry is to
choose to increase the risks of that moral adventure” (p. 73). Psychologists
engaging in forensic professional activities enter an environment with moral,
ethical, and professional challenges that are often quite different from those
found in clinical practice. These challenges and their associated potential
ethical pitfalls put the unprepared psychologist at considerable risk for profes-
sional misconduct. A significant contribution to decreasing one’s vulnerabil-
ity to professional misconduct can be made by striving to understand the laws
that govern one’s practice. As Sales and Miller (1993) indicated, however,
the laws that affect their practice, the services they render, and the
clients they serve . .. not knowing about the laws that affect the services
they render can result in incompetent performance of, and liability for,
the mental health professional, (p. 1)
laws that regulate one’s practice, the interface of the specialty practice with
the legal system, and risk management itself are all necessary for maximally
reducing the likelihood of engaging in professional misconduct. However,
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
applying that knowledge in a manner that is consistent with ethical practice.
Where professional competence has been established and is being
maintained, the greatest risk to ethical misconduct in forensic psychology
seems to be the potential influence of bias. Bennett, Bryant, VandenBos,
and Greenwood (1990) stated, “Too often, we fail to evaluate our own
performance, attitudes, behaviors, and work skills objectively in terms of
the ethics and practice guidelines of the profession” (p. 7). For example, a
strong belief in a particular methodology or symptom etiology may over-
shadow objectivity (Bennett et al., 1990). Bias in this context, however,
addresses not just a philosophical preference for one aspect of the professional
literature or another but also the intentional modification of behaviors,
written opinions, or testimony designed solely to support the position of
the retaining party. Bias can exert its influence even when the psychologist
is well armed with information about the professionally correct course of
action.
tion of the rationale should be maintained. As Behnke et al. (2003) stated,
“the process by which a clinician decides what to do becomes as important as
the decision itself (p. 13). Documentation that the psychologist understood
the values at stake and followed a rational process of ethical decision making
will, if necessary, inform any outside reviewer that the ethical challenge
was addressed in a thoughtful and systematic manner. Such documentation
of the decision-making process will be the forensic psychologist’s best protec-
tion against liability (Behnke et al., 2003).
and indeed antipathy at times, between attorneys and mental health profes-
sionals” (p. 7). Nevertheless, when issues of professional liability are in
doubt, psychologists would be well served to consult both their own attorney
and their professional liability insurance carrier. In considering the consulta-
tion, it is essential to keep in mind that the interests of the attorney or
insurance carrier may overlap with one’s own, but in some respects, may
not, and at the end of the day, one must be comfortable that the action to
be taken reflects the values and ethics held to be meaningful.
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
THE REFERRAL
logical evaluation or treatment services begins when the psychologist is
contacted by an interested individual or organization. Initial contacts are
often made by the individual or organization that will become the retaining
party. The nature of the relationship between the psychologist and the
retaining party and the manner in which the relationship is established
have ethical implications for the remainder of the psychologist’s involvment
in the case.
examiner relationship is that all parties are entitled to a clear understanding
of the expectations of the others involved to make an informed decision
about whether to engage in the relationship. The court is entitled to expect
from its experts the clarity of purpose on which reliable testimony is based
and can best derive benefit from expert testimony borne out of clearly
defined roles. The principle of autonomy reflects this informed decision-
making process.
psychologists should perform each step of their work in a manner defensible
Ethical Practice in Forensic Psychology: A Systematic Model for Decision Making,
by S. S. Bush, M. A. Connell, and R. L. Denney
Copyright © 2006 American Psychological Association. All rights reserved.
py
gh
Am
ic
P
sy
ol
og
ic
al
A
ss
oc
ia
ti
.
t
fo
r
fu
he
di
ri
ti
.
retaining party and the examiner is the foundation on which all psychological
services are based: “Clarifying issues will tend to ensure that later conflict
does not develop about the conduct of the evaluation or testimony” (Melton,
Petrila, Poythress, & Slobogin, 1997, p. 82). A lack of clarity among involved
parties regarding roles and responsibilities renders the working relationship
vulnerable to subsequent misunderstanding and conflict and in itself repre-
sents ethical misconduct (Standard 3.07, Third-Party Requests for Services,
of the American Psychological Association’s [APA’s] Ethics Code, 2002).
an intentional witness is to identify your roles” (p. 27). Identifying one’s
role is not always as straightforward as might be anticipated. Clarifying the
questions to be answered or forensic issues to be addressed in the context
of a matter is essential to understanding one’s role. The forensic issues
may involve a plaintiffs or criminal defendant’s cognitive or psychological
functioning or the relationships among individuals. Increasing the decision
maker’s understanding of such functioning serves the larger legal question
on which the case is based, such as the plaintiffs right to compensation,
the innocence or guilt of the accused, or the allocation of parental responsi-
bilities in a way that serves the best interests of the child. Therefore, when
identifying one’s role, “an important first step is to identify the forensic
issues contained in the legal questions that have triggered the need for the
evaluation” (Heilbrun, 2001, p. 22).
taining party and at least partially deriving from statutory or case law is an
understanding about the nature of the information the psychologist gives
the examinee and the extent to which information obtained during the
evaluation process will be kept confidential or, conversely, will be discover-
able (Melton et al., 1997). Thus, the psychologist and the retaining party
must be clear about their mutual expectations from the outset: “Clarifications
such as these at the early stages of consultation will result in a smoother
relationship as the case proceeds” (Melton et al., 1997, p. 83).
attempts by attorneys or clients to elicit opinions for which adequate support
does not exist (Barsky & Gould, 2002). This may occur at trial, when
tensions are high and there is little opportunity to re-examine and discuss
expectations and resolve conflicting interpretations of the data:
motivated to help the patient. The expert who agrees to serve as both
py
ri
gh
t
Am
er
ic
an
P
sy
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
he
r
di
st
ri
bu
ti
on
.
because of the potential conflict in these dual roles. (Lees-Haley &
Cohen, 1999, p. 445)
prepared to maintain previously agreed-on boundaries. The success of a
patient’s litigation should not be the direct concern of the testifying expert.
Rather, the expert’s carefully developed opinion, and the sound data underly-
ing it, remains the focus. The task is to assist the court by providing reliable
information relevant to the matter to be decided.
they were retained because their opinions tend to be predictable; that is,
their opinions consistently reflect advocacy for a particular belief or they
consistently favor the retaining party, rather than being based on the facts
of a given case. Psychologists are encouraged to assess their practices and
take steps to maximize their potential for arriving at impartial conclusions.
Such steps include ensuring professional competence (discussed later in this
chapter) and engaging in self-examination.
and future objectivity. To assess past objectivity, practitioners may calculate
an objectivity quotient, determined by dividing the number of cases in
which there was agreement with the referring attorney by the total number
of cases (Brodsky, 1991). Agreement with referring parties in greater than
80% of cases is considered consistent with excessive favorability and pre-
existing bias. This formulation is to be contrasted with the illogical concept
focusing on percent of opinions that favor one side or the other in forensic
proceedings (e.g., 50% prosecution and 50% defense, or whatever percentage
plaintiff vs. defense). Although Brodsky’s formulation reasonably addresses
the concern of bias, the second concept may actually reflect bias when the
expert changes an opinion to favor the retaining side. Take, for example,
the clinical researcher whose published research demonstrates repressed
memories are false. The examiner will rarely be called as an expert by the
side of a plaintiff alleging childhood sexual abuse on the basis of repressed
memory evidence; if this were to occur, and the expert disregarded or
“explained away” the research to support the plaintiffs claim, one might
suspect bias in favor of retaining parties.
throp (1999b), offer practitioners a possible means of maximizing current
and future objectivity. Such debiasing procedures have been criticized for
their lack of empirical support (see, e.g., Lees-Haley, 1999; response by Sweet
& Moulthrop, 1999a). However, given the current absence of empirically
supported debiasing procedures, psychologists practicing in forensic contexts
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
priate education, training, experience, and peer review of one’s work) and
using self-examination techniques.
relationship with an attorney that is different from that of an attorney and
a testifying expert, in that advocacy may more reasonably be expected
in the former. Nevertheless, the nature of the psychologist’s role requires
clarification at the outset. In this context, the psychologist essentially joins
the retaining attorney’s team to bring psychological expertise to the partisan
adversarial process. Impartiality is not required of the trial consultant, but
the psychologist trial consultant who holds a place on the “trial team” is
cautioned against agreeing to transition into or concurrently participate in
the case as an examining or testifying expert (Brodsky, 1999). Although
some authors have maintained that a consultant can assume a partisan role
in assisting an attorney’s case and serve as an impartial evaluator until the
time of trial, at which point only the role of impartial evaluator is maintained
(e.g., Halleck, 1980), separating the acceptable bias of the consultant from
the necessary objectivity of the evaluator is an extremely difficult endeavor
to undertake, if possible at all. Heilbrun (2001) identified as an emerging
principle the “single-role” maxim that should be familiar to the practicing
forensic psychologist and advised declining a referral when impartiality
would likely be jeopardized.
testifying expert and consultant difficult to maintain. For example, an
attorney may ask a psychologist that she has retained as a testifying expert
for feedback regarding the opposing expert’s report and invoke discussion
about a point of disagreement between the experts. The testifying expert,
in explaining the source of the difference, essentially offers the attorney a
roadmap for cross-examining the opposing expert. Although there is no
clear line distinguishing the appropriate contribution of a testifying ex-
pert from that of a nontestifying, consulting expert, practitioners may
help clarify the appropriate course of action by examining their motiva-
tions. Being motivated to clarify genuine professional disagreement and its
genesis, to assist an attorney in making appropriate use of one’s opinion,
the testifying expert is on solid ground. When the motivation is to contribute
as a member of the trial team, sharing its goal to win the case, the psychologist
has become an advocate whose opinions should not be offered as objec-
tive expertise.
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
performed competently. Such professional competence is typically obtained
through a combination of education, formal practical training, and experi-
ence (Melton et al., 1997). Competence is not universal; that is, competence
in one area of psychology does not imply competence in another area. This
is true across and within specialty areas of practice. Within specialty areas,
competence does not necessarily transfer across patient populations or clini-
cal settings. This specificity of competence is particularly significant in
forensic settings or contexts, in which specialized knowledge of the rules
or laws governing the activity is essential. Further, competence in a particular
psychology specialty area does not necessarily translate into competence in
performing that specialty in a forensic context or setting (Heilbrun, 2001;
Nagy, 2000). Psychologists who provide expert testimony without having
had proper specialty training, including training specific to forensic practice,
are practicing beyond the scope of their competence (Slick & Iverson, 2003).
human value that people have the right to psychological services that are
not harmful and that provide the assistance that they purport to provide.
The bioethical principles of nonmaleficence and beneficence reflect this
underlying value. Psychologists who lack the necessary competence to pro-
vide their services in forensic contexts may not be able to provide an
acceptable level of accuracy and reliability, and risk harming those with
whom they interact professionally.
dards 2.01, Boundaries of Competence, and 2.04, Bases for Scientific and
Professional Judgments) but allows an exception for services provided in
emergency situations when services would otherwise be unavailable (Stan-
dard 2.02, Providing Services in Emergencies). When provided in this con-
text, services are discontinued when the emergency has ended or more
appropriate services are available. The Specialty Guidelines for Forensic
Psychologists (SGFP; Committee on Ethical Guidelines for Forensic Psy-
chologists, 1991) stipulate that the SGFP, including those related to profes-
sional competence, apply to psychologists who regularly engage in forensic
activities. Thus, psychologists whose professional activities regularly involve
interaction with the legal system are responsible for demonstrating compe-
tence to perform their activities in that context.
Maintaining Competence). Competence must be maintained through con-
tinuing education and relevant professional activities (Blau, 1998). However,
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
psychology. Psychologists who engage in forensic activities represent a range
of specializations. Such diversity is important for assisting the court with
the range of questions that emerge; however, ambiguity regarding qualifica-
tions may emerge in individual cases. In fact, despite the existence of a
division of the APA devoted to psychological and legal issues (i.e., Division
41 [American Psychology-Law Society]) and the creation of the American
Board of Forensic Psychology, there remains debate within the field regarding
the definition of forensic psychology (Brigham, 1999; Heilbrun, 2001). In the
individual case, however, this difficulty is reduced somewhat in that it is
the court that determines who qualifies as an expert for the matter at hand.
Rule 702 of the Federal Ruks of Evidence for the United States Courts and
Magistrates (FRE; 1975) and state laws define who is qualified to testify as
an expert. The psychologist is responsible for accurate representation of the
knowledge, skill, experience, training, and education that compose the
relevant credentials (Standard S.Ola, Avoidance of False or Deceptive State-
ments; Barsky & Gould, 2002; FRE 702). The court then weighs the probable
relevance and reliability of the testimony to be offered in determining
whether to qualify the proffered witness as an expert whose opinion testi-
mony will assist the trier of fact (FRE 702). Nevertheless, that psychologists
must only provide services within their areas of competence is considered
an established principle (Heilbrun, 2001).
that the decisions rendered by the court are just. To that end, society
anticipates that expert witnesses involved in serving the court will perform
their duties objectively. Practices that have the potential to negatively
affect objectivity, and by extension justice, must be carefully considered by
psychologists. The manner in which the psychologist’s fees are arranged is
one factor that has the potential to significantly interfere with, or appear
to interfere with, objectivity. When a psychologist’s fees are contingent on
the outcome of a legal case, the psychologist is vulnerable to intentionally
or unintentionally producing a report or testimony that favors the retaining
party. As a result, the SGFP state as follows:
a legal proceeding on the basis of “contingent fees,” when those services
involve the offering of expert testimony to a court or administrative
body, or when they call upon the psychologist to make affirmations or
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
B, Relationships)
ity than does retention by any party with a stake in the outcome of an
adversarial proceeding. Although some attorneys appreciate an objective
expert opinion even when it does not support their position—and attorneys
may articulate just that position—the expert is well aware that sometimes
attorneys are seeking an opinion that does support their case. If the psycholo-
gist’s opinion does not support the retaining attorney’s case, the attorney
may attempt to massage the opinion into shape. The psychologist who holds
firm to the data is sharply aware that the attorney may be lost as a referral
source. Thus, it could be argued that psychologists who are retained by one
side in a legal case, regardless of how they choose to bill for their services,
are subject to the same threats to objectivity. Although it is true that the
potential for biased reporting exists for all forensic experts, those whose fees
are directly related to litigation outcome face a greater threat to objectivity
and a clearer appearance of compromised objectivity. The provision of an
opinion for which payment is contingent on the outcome of the case is both
unethical and strongly discouraged in the professional literature (Heilbrun,
2001). Thus, contingency fees should not be accepted (American Academy
of Psychiatry and the Law, 1995; Committee on Ethical Guidelines for
Forensic Psychologists, 1991) except when one is working as a nontestifying
expert in trial consultation.
by an attorney to assist in preparing the case against the other side, raises
an exception to the proscription against contingency fees. In this role, the
psychologist, like the retaining attorney, assumes a position for one party.
The role is not to inform the trier of fact. Given that the objective review
and presentation of information to the retaining attorney is expected to
clarify the mental health issues in a way that will assist the attorney in case
presentation and therefore strengthen the attorney’s case, the role is not
one of neutrality (Heilbrun, 2001). In this context, the manner in which the
psychologist is paid does not alter the service provided. Because impartiality is
not a requirement of the consultant role, it cannot be affected by contingency
fees. Thus, it would be ethical for the nontestifying consulting psychologist,
like the attorney, to choose to accept payment for services contingent on
the outcome of the case.
ogist with incentive to deviate from ethical practice is charging higher fees
for testimony (Heilbrun, 2001). Although the added stress and inconve-
nience that can be associated with testimony may seem to justify increased
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
in inappropriate activities to increase the likelihood that one may be asked
to testify. One such example would be omitting an important piece of
information from a report and then informing the attorney of the omission
and the need to elicit the information during testimony. The psychologist
wishing to avoid the appearance of ethically questionable practice is advised
to avoid charging higher fees for testimony.
for a given service, which may be required in some states, and when billing
an hourly rate, doing so in a manner that is consistent across various forensic
services provided. In considering billing options, the goal is not only to be
adequately and fairly compensated for one’s services but also to limit the
potential to have one’s opinions or work product swayed by the possibility
of increased revenue. Psychologists and their clients should establish com-
pensation and billing arrangements as early as possible in the professional
relationship (Standard 6.04, Fees and Financial Arrangements).
PERSONAL INJURY LITIGATION
working with people who have been involved in car accidents. The attorney
explains that her 63-year-old client was involved in a motor vehicle accident
a month ago and, in her opinion, has posttraumatic stress disorder (PTSD).
She is making the referral for psychological treatment because her client
lives alone, has no close relatives, and does not know how to access the
services he needs. The attorney explains that the patient’s no-fault car
insurance will be the payment source. She offers to fax the police report and
ambulance and emergency room records, and she requests an appointment for
her client. The psychologist, feeling a little uncomfortable about the pro-
posed fee arrangement, nevertheless accepts the referral and provides an
appointment time for the litigant to be seen. After hanging up, the psycholo-
gist reflects on the nature of the referral.
his possible role in the litigation. The psychologist asked no questions about
the attorney’s expectations and conveyed no information regarding his
practices with respect to patients who are involved in litigation.
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
litigation. The attorney, although possibly interested in the psychological
welfare of her client, likely had additional motivation for initiating psycho-
logical treatment. The attorney seemed to have made the diagnosis of PTSD
and was sending records that the psychologist had not requested and may
or may not have found necessary. The psychologist, in musing about this
referral, considered that the attorney would likely be making requests of
him once his initial assessment was performed and treatment was underway.
He wondered whether he should have addressed these expectations proac-
tively, before accepting the referral.
involved in litigation or not, to access appropriate psychological services.
An additional value is that society at large, through increases in insurance
premiums, should not be expected to pay for health care services that are
undertaken to strengthen one’s lawsuit. These values are consistent with
bioethical principles: beneficence, nonmalefkence, and justice. The psychol-
ogist has a responsibility to assist an appropriate patient (beneficence). At
the same time, he also must avoid harming the patient (nonmaleficence),
which may occur through entering into multiple, potentially conflicting,
roles without thoroughly clarifying expectations with the referring attorney
and the examinee or treatment recipient (General Principle A; Standards
3.05, Multiple Relationships; 3.07, Third-Party Requests for Services; and
3.10, Informed Consent). The psychologist has ethical and legal obligations
to bill the appropriate party for services provided (General Principles C,
Integrity, and D, Justice; Standards 6.04a, Fees and Financial Arrangements,
and 6.04b). If the symptoms experienced by the patient predate or are
otherwise not related to the accident, it would be illegal to bill the no-fault
carrier. The psychologist had a responsibility to discuss with the attorney
during the initial consultation any factors that may affect the attorney’s
decision to use the psychologist’s services or the psychologist’s decision to
accept the referral (SGFP IV, A and D2, Relationships).
complaints against psychologists in custody cases (Heilbrun, 2001). In addi-
tion to role-clarity problems in forensic matters, maintaining multiple roles
can have a negative effect in a therapeutic relationship. When a clinician
is asked to monitor a patient and report the findings to an outside authority,
for example, the clinician may have difficulty maintaining the trust of the
patient (Barsky & Gould, 2002) and the patient may be less than forthcom-
ing with the therapist. In forensic contexts, role clarification is critically
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
about psychological treatment, such as the confidential and helping nature
of the relationship, generally do not apply. Professional guidelines, then,
are clear on the dangers of assuming multiple roles. State psychological
guidelines also generally echo the standards and guidelines on this issue.
of potential role conflict would need to be discussed not only with the
referring attorney but also with the patient (litigant; SGFP V, B, Confidenti-
ality and Privilege). However, no laws of that state were found that applied
to clarification of roles.
seem to be consistent with PTSD deserves access to his services. He is
generally not concerned about where the referral comes from; however, the
nature of this referral was somewhat different for him in that the attorney
seemed to have proposed a diagnosis and was sending records that the
psychologist typically did not request. Because he had not been retained by
the attorney, he preferred to be open to, and accepting of, the patient’s
experiences. Based on his understanding, if the patient reported that the
symptoms emerged or worsened following the automobile accident, then
the no-fault carrier would be the appropriate payor.
ered four options. First, he considered refusing the referral and possibly
suggesting alternative treatment providers. Second, he considered accepting
the referral and not worrying about any unexplored expectations at this
time. Third, he considered calling the attorney back to obtain further
clarification about the attorney’s expectations of the nature of his involve-
ment in the matter. Fourth, he considered contacting a colleague to get a
second opinion.
associated with each of the possible solutions that he had identified. First,
he believed that declining the referral and suggesting alternative clinicians
without further clarifying expectations would have no significant impact on
the patient either way but may not be good for his practice from a business
perspective. Second, the psychologist thought that accepting the referral
without clarifying expectations could be harmful for all parties at some point
during the course of treatment. He was most concerned about the potential
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
cal state should different expectations about the psychologist’s role in the
litigation emerge during the course of treatment. Additionally, although he
would not be accepting the patient into treatment for purpose of assisting
the patient’s legal case, the psychologist also did not want to interfere with
the legal case and the ability of the patient to receive compensation for
damages resulting from the accident. Furthermore, the psychologist did not
want to unnecessarily hurt the case for the attorney. The psychologist
believed that each of these potential adverse consequences, in addition to
harming others, had the potential to negatively affect his reputation and
professional standing in the community. Third, the psychologist believed
that contacting the attorney for clarification would help to clarify expecta-
tion so that all parties were in agreement from the outset; however, the
thought that such a call may be perceived as offensive by some attorneys
may result in the current patient and future patients being referred to another
clinician. Fourth, the psychologist believed that seeking a colleague’s advice
could only be of value.
to someone else was necessary. He believed that he could work out the
potential conflicts and still provide the patient with appropriate treatment.
However, having reflected on the relevant values and ethical guidelines,
he believed that the attorney’s expectations should be addressed in some
way before treating the patient. He thought that a reasonable option would
be to call the attorney to clarify expectations, but he also thought that it
might be more appropriate to discuss expectations with the patient, without
further involving the attorney. However, he wanted to know what others
would do, so he chose to call an experienced colleague.
action would be to call the referring attorney prior to seeing the patient to
clarify expectations. Indeed, when the psychologist called, the attorney
clarified that although the patient’s mental health was the first priority,
she would be asking for periodic reports on the patient’s accident-related
psychiatric disability and treatment. The psychologist responded that he
appreciated the referral but that he could not promise such reports, as he
had not yet met with the patient and had no idea about the patient’s
psychiatric status or his interest in having that information shared with
anyone. The attorney, seemingly losing patience, indicated that she had a
number of such clients and was looking for someone to whom she could
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
“sensitive to litigation issues.” The psychologist stated that he would be
glad to have the additional referrals, but he maintained his position—an
unwillingness to commit prematurely to periodic reports. The attorney said
she would send her client somewhere else, and hung up. The psychologist,
frustrated by the attorney’s determination to select a clinician on the basis
of the clinician’s willingness to endorse her position, was satisfied that he
had made the right decision.
py
ri
gh
t
Am
er
ic
an
P
sy
ch
ol
og
ic
al
A
ss
oc
ia
ti
on
.
No
t
fo
r
fu
rt
he
r
di
st
ri
bu
ti
on
.
