Ethics in Psychotherapy and Counseling. Kenneth S. Pope

       “A 7 year-old boy was severely sexually abused and severely depressed. I evaluated the case and recommended six months' treatment. My recommendation was evaluated by a managed health care agency and approved for 10 sessions by a nonprofessional in spite of the fact that there is no known treatment program that can be performed in 10 sessions on a 7-year-old that has demonstrated efficacy.”

       “Much of my practice is in a private hospital that is in general very good clinically. However, its profit motivation is so very intense that decisions are often made for $ reasons that actively hurt the patients. When patients complain, this is often interpreted as being part of their psychopathology, thus re-enacting the dysfunctional families they came from. I don’t do this myself and don’t permit others to do so in my presence—I try to mitigate the problem—but I can’t speak perfectly frankly to my patients and I’m constantly colluding with something that feels marginally unethical.”

       “A managed care company discontinued a benefit and told my patient to stop seeing me, then referred her to a therapist they had a lower fee contract with.”

       “I employ over 600 psychologists. I am disturbed by the fact that those psychologists with marginal ethics and competence were so identified in graduate school and no one did anything about it.”

       “A psychologist in my area is widely known to clients, psychologists, and the legal community to give whatever testimony is requested in court. He has a very commanding presence, and it works. He will say anything, adamantly, for pay. Clients/lawyers continue to use him because if the other side uses him, that side will probably win the case (because he’s so persuasive, though lying).”

       “Another psychologist’s report or testimony in a court case goes way beyond what psychology knows or his own data supports. How or whether I should respond.”

       “I find it difficult to have to testify in court or by way of deposition and to provide sensitive information about a client. Although the client has given permission to provide this information, there are times when there is much discomfort in so doing.”

       “I am co-investigator on a grant. While walking past the secretary’s desk, I saw an interim report completed by the PI [principal investigator] to the funding source. The interim report claimed double the number of subjects who had actually entered the protocol.”

       “I have consulted to research projects at a major university medical school where ‘random selection’ of subjects for drug studies was flagrantly disregarded. I resigned after the first phase.”

       “Deception that was not disclosed, use of a data videotape in a public presentation without the subject’s consent (the subject was in the audience), using a class homework assignment as an experimental manipulation without informing students.”

       “As a faculty member, it was difficult dealing with a colleague about whom I received numerous complaints from students.”

       “At what point does ‘direct knowledge’ of purportedly unethical practices become direct knowledge which I must report—is reporting through a client ‘direct’ knowledge?”

       “I referred a child to be hospitalized at a nearby facility. The mother wanted to use a particular psychiatrist …. When I called the psychiatrist to discuss the case, he advised me that, since he was the admitting professional, he’d assume full responsibility for the case …. He advised how he had a psychologist affiliated with his office whom he preferred to use.”

       “I see foster children who have little control over their lives and case workers who have little time/interest in case management. How can I maintain good professional relationships with those who don’t function up to their duties?”

       “A director of the mental health center where I worked was obviously emotionally disturbed, and it impacted on the whole center—quality of service to clients, staff morale, etc. He would not get professional help or staff development assistance.”

       “The toughest situations I and my colleague seem to keep running into (in our small town) are ones involving obvious (to us) ethical infractions by other psychologists or professionals in the area. On three or more occasions he and I have personally confronted and taken to local boards … issues which others would rather avoid, deal with lightly, ignore, deny, etc., because of peer pressure in a small community. This has had the combined effect of making me doubt my reality (or experience), making me wonder why I have such moral compunctions, making me feel isolated and untrusting of professional peers, etc.”

       “A student after seeing a client for therapy for a semester terminated the therapy as was planned at the end of the semester, then began a sexual relationship with the client …. I think APA should take a stronger stance on this issue.”

       “I currently have in treatment a psychiatrist who is still in the midst of a six-year affair with a patient. He wishes to end the affair but is afraid to face the consequences.”

       “My psychological assistant was sexually exploited by her former supervisor and threatened her with not validating her hours for licensure if she didn’t service his needs.”