Practice of Clinical Psychology

What are at least two legal issues associated with clinical psychology? Provide an example of a situation that could be legal but unethical.

Confidentially is an issue that involves the codes of both ethics and legality. Maintaining confidentiality is a significant issue in clinical psychology, and one by which the psychologist is bound by law as well as the ethical codes. These laws require the psychologist to refrain from referring to a patient's treatment or results of assessment outside of the appropriate context (Hogan, 2007). Furthermore, regarding confidentiality in record keeping, psychologists must maintain records efficiently, securely, and effectively so results are not prone to dissemination by other inappropriate parties. The psychologist does; however, have the responsibility to waive confidentiality when he or she suspects harm to self (Hogan, 2007).

Another legal issue is obtaining written informed consent before counseling, consulting, or providing any type of treatment. If the patient is incapable of giving such consent, a parent, legal guardian, or other individual functioning in an official capacity must do so. Patients can revoke informed consent at any time during treatment, in most cases. Furthermore, issues involved in obtaining such consent must be provided to the client is understandable terms.

Participating in a sexual relationship with a client is one example of behavior, not considered illegal (in most states) although definitely unethical. According to Plante (2011), dual relationships are common ethical violations. Even if it were legal, it is neither fair to a client/patient nor is it conducive to maintaining healthy, appropriate, and uncompromising boundaries for both the client and the psychologist. Plante (2011) claims "clinical psychologists...are entrusted with the emotional and often physical vulnerabilities, confidences, and wellbeing of the people who seek their guidance" (p. 371). Dual relationships, such as participating in a sexual relationship with the client, compromises the therapeutic relationship.

What are at least two ethical issues associated with clinical psychology? 

Competence is an ethical principle that requires psychologists have appropriate training, education, and experience in their use and practice of therapeutic applications. According to Plante (2011), maintaining competence by ongoing efforts that include continuing education and understanding personal limitations is essential. The idea of competence is not absolute, and psychologists must rely on the general standard of care as recommended by the psychological community. Plante (2011) also emphasizes the importance of maintaining a progressive understanding of available treatments as well as personal mental and physical health when treating clients.

Another ethical concern is the fundamental respect for people's rights and dignity. Psychologists must respect and protect individuals' right for privacy and the protection of their welfare with no bias toward their "age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, and socioeconomic status" (Plante, 2011, p. 491). Although psychologists are aware of vast differences between people, they must continually work toward treating and counseling without bias or prejudice.

Both issues are of significant consequence to clinical psychology. Individuals depend upon educated and professional assistance, ethical judgment, treatment, and applications formed without bias and toward their betterment. Protecting these fundamental rights supports the attempt of every individual toward achieving and a more positive quality of life.

One issue that continues to involve the jurisdiction of ethical and legal considerations is assisted suicide. Many people believe it is an individual's right to commit suicide under certain conditions, and providing assistance for its accomplishment is both humane and appropriate. This action crosses legal boundaries in most states. Although a psychologist may have a personal belief that assisting the suicide of a client is ethical and in the patient's best interest, in most states, it is clearly illegal.

Define professional boundaries, boundary crossings, and boundary violations. What effects do boundaries have on the therapeutic relationship?
"What is a boundary? Is it too amorphous, protean, and abstract to define at all? Should we take refuge by saying, as St. Augustine was supposed to have said about time, 'Time? I know what time is, provided you do not ask me'?" (Gutheil & Gabbard, 1993, para. 8). Professional boundaries are psychological borders or margins drawn between acceptable and not acceptable behavior. Incorporating boundaries allows professionals to claim personal space, set limits for interactions with others, decide which behaviors are acceptable, and create a personal sense of individualism. In clinical psychology these boundaries define the limits of a professional, therapeutic relationship and responsibilities of the therapist and his or her behavior with the client as well as designating the borders between a professional therapeutic relationship and a personal relationship (Learning Nurse Resource Network, 2011). Boundary crossings are brief deviations from or across professional boundaries that may be accidental, inconsiderate, or done on purpose for therapeutic reasons. A boundary violation takes place when professionals confuse their personal needs with the needs of their clients (Learning Nurse Resource Network, 2011). Boundary violations can degrade a therapeutic relationship and confuse clients (Plante, 2011). One difficulty is that professional boundaries are not always fixed and clearly defined, although ethical standards ordered by the American Psychological Association provide definitive guidance on the subject of ethics in psychology (Plante, 2011).

What are at least two cultural limitations associated with assessment and treatment? In your response, discuss the use or misuse of assessment instruments, therapy techniques, research results, or any other facet of clinical practice that could have potentially harmful, culture-specific implications.
Any action undertaken by psychologists, whether it is treatment, counseling, or simple advice, if the offering does not take into account the client's culture, is inappropriate. Furthermore, any judgment or treatment for individuals of a specific culture must consider the underlying values of the cultural context of the individual (Solomon, Greenberg, & Pyszczynski, 1991). When treating or assessing individuals from a foreign culture, it is difficult to understand their values and norms without first understanding their intrinsic or indigenous ideologies (Shiraev & Levy, 2010). The accommodation of the patient's cultural rules, norms, and ideologies must play a significant role in the therapeutic design of the treatment as well as any judgment placed upon the patient. Without such accommodation neither the judgment nor the therapy will have a basis in the reality embraced by the individual or his or her culture. Without cultural consideration, a therapy would have no positive consequence for the individual in treatment.

Cultural limitations are especially true of psychometric testing. Although assessment has an important role in clinical psychology, it is essential to assess clients with constructs that fairly and appropriately assess them within their cultural context. Some types of testing overrates skills and underestimates or simply does not assess individuals adequately according to the traditions, beliefs, and values of their culture. It is also important that individuals understand the language of the assessment as well as its results. Understanding the detrimental nature of generalizing assessments to minority clients is critical to their treatment. When an assessment was originally based on norms of White American males, it is not appropriate to measure an individual who does not fit into such a narrow category.

Equally essential is the treatment plan for individuals of minority status or culturally different affiliations. Americans tend to believe their ideas, beliefs, standards, and norms, are superior to those of culturally different ethnicities. Plante (2011) emphasizes the importance in treatment to "develop appropriate culturally informed intervention strategies and techniques" (Plante, 2011, p. 254). If psychologists treat according to their own set of cultural norms, the results may not be of consequence or help to the culturally different individual.

References:

Gutheil, T., & Gabbard, G. (1993). The Concept of Boundaries in Clinical Practice: Theoretical and Risk- Management Dimensions. Boundaries in Psychotherapy. Retrieved August 31, 2011, from http://kspope.com/ethics/boundaries.php

Hogan, T. P. (2007). Psychological testing: a practical introduction (2nd ed.). Hoboken, NJ: John Wiley & Sons.

Learning Nurse Resource Network. (2011). Professional Boundaries Quiz. Scrubsmag.com. Retrieved August 31, 2011, from http://scrubsmag.com/professional-boundaries-quiz-i/

Plante, T. G. (2011). Contemporary clinical psychology. Hoboken, NJ: John Wiley & Sons.

Shiraev, E. B. & Levy, D. A. (2010). Cross-cultural psychology: critical thinking and contemporary applications (4th ed.). Boston: Pearson/Allyn Bacon.

Solomon, S., Greenberg, J., & Pyszczynski, T. (1991). Advances in experimental social psychology. San Diego: Academic Press.

Interview and Response

Professional careers in psychological disciplines vary widely and this is certainly evident in the settings of the two professionals chosen for the required interviews. Perhaps the two defining characteristics of both professionals was their desire to be flexible and helpful during the difficult current economic climate and the reward and fulfillment they enjoy in their work.

Professional Identities

The two professionals used for this interview are Kelly Bass and Alton Shimodoi. Bass has a PhD in clinical psychology, and is a practicing clinical psychologist. She maintains a private practice in Wailuku, Hawaii. Alton Shimodoi has spent the last 12 years as a behavioral health specialist working at Maui High School in both office and classroom settings. Both professionals use a variety of approaches and modalities, although both claim making a difference in individuals' lives is the most rewarding and fulfilling part of their work.

Clinical Focus, Modalities, and Techniques


Central issues in Shimodoi's work relate to the developmental period between ages 14 and 18. His students highly contrast Bass' older clientele on whom the focus is couple's and marriage counseling, and individual therapy. Although the working environment of each is vastly different, both tend many cases of ADHD, depression, anxiety, and substance abuse. Shimodoi is far more restricted in his ability to help his students because the school setting does not allow sufficient time for therapeutic sessions. Furthermore, he provides service to his students for a limited four years, whereas Bass has counseled many of her patients through life challenges during her 27-year practice. Shimodoi uses cognitive-behavioral, reality therapy, and casual dialog with students, whereas Bass uses a holistic and family systems therapy and traditional psychotherapy.

Training and Psychology's Future

Shimodoi has a master's degree, is a Licensed Mental Health Counselor, and was trained on-the-job at the high school. Bass received her post-doctorate in pharmacology, and has certification in eye movement desensitization and reprocessing, and hypnosis. Although Shimodoi had no perspective on the future direction of psychology, Bass has counseled successfully using Skype, and believes phone counseling, tele-health, and cyber-health are future psychological directions. Furthermore, she believes these issues will require different forms of licensure to allow clinicians to practice across state borders when counseling individuals using the Internet or telephone venue. Perhaps because of her level of education, Bass appears to have far more flexibility in the range of services she performs, and the options of expertise she can offer. She has provided forensic psychological services in several high profile cases in Hawaii.

Ethical and Legal Considerations

Shimodoi's greatest concern is the mental health of practicing counselors. He believes an essential part of helping others must include maintaining one's own mental health because when professionals engage in engineering treatment and change for another individual, it must come by way of mental clarity. Bass believes some of the most challenging legal concerns she encounters are those in which families argue over custody rights. It not only requires legal management, but she sees the greatest difficulty as watching the child cope with the dissolution of the family during these battles.

Advice for the Aspiring Psychologist

Shimodoi advises aspiring psychologists to keep themselves healthy and relieve stress through exercise, eating a healthy diet, and engaging in enjoyable activities. Furthermore, he recommends supervision throughout the educational process by an objective individual. Bass has similar beliefs regarding psychologists and the maintenance of personal health and emphasizes the importance of engaging in a variety of work environments to circumvent exhaustion in one area of psychological service. She advised broadening psychological interests to engage in continued learning. To have the most flexibility and control to accomplish established goals, she recommends attaining doctoral level education.

Conclusion

Fortunately, the two individuals interviewed were passionate service providers in a profession that manages anger, anxiety, misery, and challenges that often seem insurmountable. The positive hopes and perspectives of Alton Shimodoi and Kelly Bass were a reminder of the potentially significant contribution such professionals can offer in support of the human journey. Although a worthy challenge, there is considerable responsibility in managing mental health, yet it seems to provide abundant reward and fulfillment in making a difference.