by Steven R. Doehrman, Ph.D.
Psychologists have an obligation to the public to behave ethically and follow ethical principles in all their professional conduct. Courses or substantial instruction in professional ethics are a given part of today’s graduate curricula. Psychologists trained prior to 1980, who had no formal graduate coursework in professional and scientific ethics, may have nonetheless spent the interim in work settings which have made them sensitive to and familiar with the core issues considered in contemporary ethics courses. They may daily consider confidentiality, multiple roles, or conflicts of interest as they interact with insurance companies, corporate departments, or professionals in related health care professions and consult with colleagues to handle questions like those that serve as case studies in ethics courses. Therefore, they may want or need to regularly update their knowledge. They are well served to consider formal coursework to keep pace with changing ethical constructs so as to put their hard-earned experiences in the proper conceptual framework. An easy way to accomplish this review is by online courses offered by experts in the field.
This paper will describe two on-line courses that I completed as part of an application for credentialing by the National Register of Health Service Providers in Psychology. The courses were:
1. APA Ethics Code: An Introduction and Overview. (4 CE credits, given by the American Psychological Association (APA))
2. Being an Ethical Psychologist. (16 CE credits, given by the Canadian Psychological Association (CPA))
The two courses were offered under the auspices of CAPTUS Press Inc., a provider of Internet learning courses. Each course had similar formats, including text to download, slides and audio lectures. The APA lecturer was Stephen Behnke, Ph.D., APA Ethics Director, and the CPA lecturer was Carole Sinclair, Ph.D., Chair of the CPA Committee on Ethics. The content of both courses as provided in the down-loaded texts and slides was excellent; the lectures were well written and, in general, should pique interest from any student. Both courses used software prevalent in contemporary online university courses; however neither made use of the group discussion pages, journals, writing assignments and other features that are available. The APA course had four progress quizzes and one final quiz whereas the CPA course had seven progress quizzes and one final quiz; all had 10 items in each quiz. The CPA course required a score of at least 70% correct on all quizzes for successful completion1 whereas the APA course required only a grade of 70% correct on the final quiz.
APA’s Ethics Code
The first APA Ethics Code was issued in 1953 whereas the 10th Code was adopted in 2002 (American Psychological Association, 2002). The 2002 APA Code has four sections:
- Introduction and Applicability
- General Principles
- Ethical Standards
The process of revising the Code was open and participatory. Behnke indicates that 1,400 comments and 7 drafts went into the latest Code. Most of the Code is written broadly such that no specialty areas of practice are carved out separately. The Code applies to scientific, educational or professional activities of psychologists and notes that psychologists perform many roles, ...researcher, educator, diagnostician, therapist, supervisor, consultant, administrator, social interventionist, and expert witness (American Psychological Association, 2002, page 3).
General principles are aspirational in nature; they provide a ceiling for professional activity, not obligatory hurdles which if not met could result in sanctions.
Ethical standards specify enforceable rules of conduct that give a floor to professional behavior. Some of the standards include modifiers such as reasonably, appropriate, potentially, among other reasons, to allow for judgment of the individual psychologist in a given situation and to allow for the code to be flexible, dynamic, and applicable to evolving circumstances (Behnke, 2007). The APA Code lists 10 Ethical Standards which have from 6 to 12 enforceable rules of conduct for psychologists. The standards, unlike the principles, do refer in some instances to specialty areas of practices.
CPA: Being an Ethical Psychologist
This course was more extensive than the APA course. It begins by sketching the history of Ethics starting with the Code of Hammurabi in the 18th century B.C. (discovered in the 20th century A.D.), one of the first sets of written laws for a society. Egyptian Papyri from the 16th century B.C. had the first written standards of practice for physicians. Sinclair covers in detail the Hippocratic Oath from the 4th century B.C., the first true code of Ethics, written by and for physicians; it established principles about giving benefit and avoiding harm to the members of the public, acting within limits of competence, maintaining confidentiality and protecting privacy.
Sinclair explains that the learned professions that required specialized knowledge and extensive preparation, maintained themselves as a community, and committed members to service to society. Only three existed in the 18th century: theology, law and medicine. By the 20th century, many more occupational groups claimed to be professions and established contracts with society in which they controlled entry requirements, trained new members, and developed knowledge/ skill domains. Each social contract included a code of ethics that socialized new members with attitudes, values and practices and concomitantly monitored and regulated the professional activities of its members.
Sinclair notes there was no code of ethics for psychologists before World War II but a sharp increase in the mention of ethical issues in psychological literature occurred after 1945. She attributes the change to the growing publicity in the late 40s of harmful experiments by physicians upon WWII concentration camp inmates. Physicians who had taken the Hippocratic Oath and had other codes of ethics to guide them justified those experiments as contributing to science and advancing knowledge. The Nuremberg Code of Ethics in medical research for physicians was promulgated in 1947 by one of the judges in the Nuremberg War Crime Trials. The APA established a committee in 1947 to develop Ethical Standards for Psychologists. The committee developed to provisional standards in 1953, with a first set of standards approved by APA in 1959.
The CPA adapted the APA Code of Ethics to use as their own from 1959 through 1978. Sinclair indicates that the Canadians starting working on their own code in 1979 which they adopted in 1986. The CPA wanted a national code as a way to adjudicate complaints about psychologists and because they felt the APA code was becoming more reflective of American legal structures/concerns. Sinclair says the CPA Code was designed to meet four objectives:
- Be conceptually cohesive and a good educational tool
- Include a range of ethical issues and areas of practice
- Have explicit guidelines for action when ethical principles are in conflict
- Articulate ethical principles to guide decision making to resolve ethical dilemmas
Sinclair addresses the differences between minimum and idealized standards and notes four aids to ethical decision making:
- Order ethical principles to show priorities or weighting
- Personal conscience has a role
- Model for ethical decision making
Sinclair describes the methodology used to develop the CPA code of ethics (Sinclair, Poizner, Gilmour-Barrett, & Randall, 1987; Sinclair & Pettifor, 1992). It was empirically derived using a set of 37 dilemmas representing applied, teaching and research activities; each situation/dilemma was followed by 6 questions eliciting self-accepted principles. The questionnaires were completed by 59 CPA psychologists who commented on 2-4 dilemmas, 5 responses per dilemma. Content analyses focused upon statements explaining why a psychologist chose a particular course of action to resolve the dilemma. The statements were assembled into groups of statements, each of which referred to a specific super-ordinate principle.
This process produced the four ethical principles of the CPA Code:
- Respect for the Dignity of Persons
- Responsible Caring
- Integrity of Relationships
- Responsibility to Society
Sinclair explains that the CPA principles are weighted differentially so that if two are in conflict, the above order determines their priority (Respect for the Dignity of Persons has the highest weight). Although the CPA principles were developed differently than the APA principles they are similar in some cases. In the CPA Code (Canadian Code of Ethics for Psychologists, 2000), each principle has a statement about its inherent values and standards applicable to the principle. The CPA standards are, like the APA standards, enforceable rules of conduct and derived from the aforementioned content analyses but also from an examination of other countries ethics codes as well as related literature. In generating the CPA’s standards, careful attention was also paid to ensure that more advanced levels of moral thinking were applied using Kohlberg’s criteria for moral development (Kohlberg, 1969). Furthermore, each CPA standard bears a special relationship to its Ethical Principle. A standard is paired to a principle so psychologists can understand the relationship between an aspiration statement and the related code of conduct. For example, the principle, Respect for the Dignity of Persons, has nine relevant values, the first of which is General Respect which has, in turn, four relevant standards, the first of which is: Demonstrate appropriate respect for the knowledge, insight, experience, areas of expertise of others (as listed in the Canadian Code). In another example, the code of conduct, competence or self knowledge, is more closely related to or aspires to responsible caring in a way different from integrity or the other principles. Similarly, poor objectivity or bias impairs integrity in relationships more directly than affecting responsibility to society.
The CPA course goes on to explain in detail each of the principles, their values, and standards. It uses separate case studies to elucidate each of the 30 standards with dilemmas relevant to real-world situations and ethical issues typically experienced by psychologists in their professional roles. In a final section, Sinclair presents an Ethical Decision Making model, part of the CPA Code, and uses it to resolve the final dilemma presented in the course. Case study 31 includes clients, professionals, community agencies, possible misconduct, with no easy questions and no easy solutions. Sinclair walks the student through the model’s ten steps grappling with complexities familiar to any psychologist beyond novice levels of professional experience.
Both courses delve into a detailed examination of how their respective codes set rules of conduct for a wide range of professional behaviors. As an experienced practicing psychologist, I found the courses to be informative and worthwhile. Sinclair’s model and both courses should provide professionals with an appreciation for what came before and guidelines to make our work more beneficial to those we serve and more meaningful to us.
Steven R. Doehrman, Ph.D., is a Clinical Psychologist with CHE Senior Psychological Services of Brooklyn, NY. He received his Ph.D. from the University of Michigan. Since 2003, he has been providing psychotherapeutic services in adult homes in Queens and Brooklyn, NY, to the seriously mentally ill. Dr. Doehrman has been a Registrant since 2006.
1 A CAPTUS administrator told me that the CPA course had a 50 item pool for each quiz such that if a student took a given quiz a second time, presumably because they scored below 70% previously, they would have a new randomly selected item pool on the next try.