principles condemn such behaviors in no uncertain
terms. What is alarming here is the apparent
increase in the number of complaints filed against
psychologists for sexual improprieties. Further, data
on the impact of therapist–client sexual intimacies
indicate that only a small percentage of clients
reported any kind of positive effect from these inti-
macies (Pope, 2001).
Another aspect of client welfare involves the
clinician’s willingness to terminate therapy when it
is no longer helping the client. For example, in one
case referred to an ethics committee, a clinical psy-
chologist had been treating a child continuously for
more than 2 years and had informed the parent that
2 more years of therapy would be necessary. A
review committee decided that the treatment was
not consistent with the diagnosis and that there
was no evidence of reasonable progress (American
Psychological Association, 1981).
What types of ethical dilemmas do psycholo-
gists most frequently face? This question was
addressed in a study by Pope and Vetter (1992).
To assess the most commonly encountered“ethi-
cally troubling incidents,” the authors surveyed
a randomly selected sample of APA members.
Approximately 80% of the respondents indicated
that they had encountered at least one such incident
in the previous 1 or 2 years. The most frequently
reported type of ethical dilemma involved confi-
dentiality (breaching confidentiality because of
actual or potential risks to third parties, suspected
child abuse, or other reasons). Incidents involving
blurred, dual, or conflicted relationships were the
second most frequently reported (maintaining ther-
apeutic boundaries with clients, personal vs. profes-
sional relationships with clients). The third most
frequently cited category of ethically troubling inci-
dents involved payment sources, plans, settings, and
methods (e.g., inadequate insurance coverage for
clients with urgent needs). Other areas in which
ethically troubling incidents arose included training
and teaching dilemmas, forensic psychology,
research, conduct of colleagues, sexual issues, assess-
ment, questionable or harmful interventions, and
competence.
Psychologists, whether laboratory researchers
or practicing clinicians, are being increasingly scru-
tinized for evidence of ethical violations. Ethical
issues in research or in practice are not always easy
to resolve, nor are violations easy to monitor. But if
clinical psychology is going to survive as a profes-
sion, it must find ways of ensuring adherence to the
highest standards of conduct.CHAPTER SUMMARY
Many contemporary issues challenge the field of
clinical psychology. First, several training models
are available, each with different emphases and out-
comes. The scientist-practitioner model is clearly
the most popular one, but some have become dis-
enchanted with this model and question whether a
true integration of science and practice can be
achieved. Several training models that emphasize
the practice of clinical psychology (Psy.D. degree,
professional schools) have become increasingly
popular in recent years. Finally, the clinical scientist
model of training represents an alternative that
emphasizes research and empirically supported
approaches to assessment and intervention.
The professional regulation of clinical psychol-
ogists involves methods aimed at protecting the
public interest and assuring competence. Certifica-
tion and licensure occur at the state level and are
attempts to make the public aware of those who are
deemed to be well-trained and competent clinical
psychologists. ABPP and membership in the
National Registerare more advanced forms of certi-
fication pursued by some clinical psychologists.
Although a large percentage of clinical psychol-
ogists work in private practice settings, changes in
health care suggest that private practice, as we once
knew it, will never be the same. Specifically, most
Americans subscribe to managed care plans that, inCURRENT ISSUES IN CLINICAL PSYCHOLOGY 89