Abnormal Psychology

718 CHAPTER 16

Ethical Issues

Various mental health professionals had some contact with Andrew Goldstein during

the years that led up to his pushing Kendra Webdale to her death. Any mental health

professional may at times have to balance ethical and legal obligations to a patient

against the safety of others. Suppose Goldstein had confi ded to a mental health profes-

sional that he sometimes had impulses to hurt people—impulses that he felt he might not

be able to control. How should the clinician treat such information? If Goldstein gave

specifi cs about when, where, or with whom he was likely to become violent, would that

affect how the clinician should treat such information? What is the clinician ethically

bound to do in such instances? We address these questions in the following sections.

An Ethical Principle: The Role of Confi dentiality

Different types of mental health professionals assess, and provide treatment for, psy-

chological problems. Each profession has its own code of ethics, although there are

commonalities among all of the codes (Web sites containing the specifi c codes of ethics

for the different types of mental health professionals are listed in Table 16.1). The most

important commonality is the ethical requirement to maintainconfi dentiality—not to

disclose information about a patient (even whether someone is a pa-

tient) to others unless legally mandated to do so. Let’s look closely at

the ethical principle of confi dentiality.

The ethical principles and code of conduct of the American Psycho-

logical Association requires that mental health records remain confi -

dential. In addition, the clinician must inform patients about the limits

of confi dentiality—that is, under what circumstances confi dentiality

may be broken. At fi rst glance, this ethical rule might seem to imply

that a clinician would have been required to keep anything Goldstein

discussed confi dential, even if it concerned violent impulses he felt un-

able to control. However, the situation is not quite so simple.

Ambiguities Regarding Confi dentiality

The principle of confi dentiality appears to be straightforward, but

some clinical situations are thorny and diffi cult to resolve. When a

therapist is treating a couple, for instance, the therapist is bound by

confi dentiality, but each person in the couple is not; this means that

each partner may tell other people about what transpires in therapy sessions. Simi-

larly, in group therapy, although the therapist is bound by confi dentiality, each mem-

ber is not (although group members are asked not to talk about anything they hear

from other members). However, when a patient is a minor (under 18 years of age),

the clinician may inform the parents about information that the child has told the

clinician. The clinician usually discusses the limits of confi dentiality with a child old

enough to understand them—or at least discusses possible circumstances in which

the clinician may need to share information with parents or others.

Mental Health Profession URL of Web Site Presenting Ethical Code

Psychologist http://www.apa.org/ethics

Psychiatrist http://www.psych.org/psych_pract/ethics/ppaethics.cfm

Social worker http://www.socialworkers.org/pubs/code/code.asp

Psychiatric nurse http://nursingworld.org/mods/mod580/code.pdf

List of specifi c types of mental health clinicians http://kspope.com/ethcodes/index.php

Table 16.1 • Web Sites for the Ethical Codes of Various Mental Health Professions

A mental health clinician is bound by confi denti-

ality, but each member of a couple participating

in couples therapy is not.

David Buffi

ngton/age footstock/Photolibrary