This paper examines the ethical and legal framework governing clinical psychologists in the United States, with a focus on the 2002 APA Ethics Code and related guidelines. It surveys the most common ethics violations — including sexual misconduct, confidentiality breaches, and practicing outside areas of competence — and discusses the tensions that arise when legal obligations conflict with professional duties. The paper also addresses confidentiality challenges posed by modern technologies such as email and cell phones, outlines requirements for child custody evaluations, and concludes with an overview of how psychologists can navigate competing ethical and legal demands throughout their careers.
All psychologists are required to follow the ethical guidelines found in the 2002 Ethical Principles of Psychologists and Code of Conduct of the American Psychological Association (APA), commonly known as the Ethics Code. Other important ethical guidelines are found in the 2007 Competing Development Achievement Levels (DALs) of the National Council of Schools and Programs in Professional Psychology (NCSPP) and the Assessment of Competing Benchmarks Work Group of the APA. These ethics codes cover compliance, privacy and confidentiality, assessment, therapy, research and publications. There are also special guidelines for dealing with children, minorities, culturally diverse populations, forensic psychology, and gay and lesbian clients.
Both the Ethics Code and state laws require psychologists to maintain the confidentiality of clients and their records, apart from legal requirements to report verified or suspected child abuse or clients who are a danger to others. Psychologists can only provide services "based on their education, training, supervised experience, consultation, study, or professional experience," and are also required to do no harm to clients and to maintain a "reasonable standard of care" (Arnaut and Hill, 2010, pp. 74–75). Those who do not follow the relevant guidelines and legal requirements will face suspension or revocation of their state licenses, civil penalties, reprimands, and lawsuits.
Sexual misconduct is one of the most common ethics complaints made against psychologists, followed by insurance and fee issues, child custody cases, violation of confidentiality, practicing outside of areas of competence, false and misleading advertising, and test misuse. In many of these areas, the Ethics Code is clear-cut: it forbids sexual or romantic relationships with clients, false advertising, and practicing outside areas of competence, and in child custody cases it requires that the welfare of the child be the primary consideration.
Studies by the APA and other organizations have found that a significant minority of psychologists will violate legal and ethical norms, and that 1–2% will be brought up on ethics charges every year before state licensing authorities. A 1988 survey found that 9% of psychologists had had sexual contact with clients; 6% had failed to report dangerous clients as required by law; 21% had failed to report child abuse; and 21% had disclosed confidential information. According to a 1992 APA study, the most common ethical dilemmas "involved confidentiality, followed by blurred, dual, or conflicted relationships with clients" (Arnaut and Hill, p. 83). Violations of confidentiality may involve simply discussing a client's case with friends and colleagues, or more seriously being required to give testimony against clients in court cases or to the police in ways that have a detrimental effect on them.
By the time they receive their PhDs, all psychology students should be well versed in ethical and legal issues, including duties to the profession, clients, and third parties. State licensing laws also require them to be "exposed to current knowledge in professional standards and ethics in their graduate clinical psychology curriculum" (Arnaut and Hill, p. 81). Ethical and legal topics in such training should include assessment, testing, dealing with diverse populations, knowledge of common ethical dilemmas, use of power relationships, and models for making ethical decisions.
Legal requirements may also conflict with the Ethics Code or with other laws, and the Ethics Code requires psychologists to "take steps to resolve the conflict in a responsible manner" (Arnaut and Hill, p. 82). All evaluations must be based on the professional literature rather than personal biases and opinions, including attention to cultural, racial, and ethnic factors. Disclosing confidential client information in a court setting is a very common ethical dilemma, particularly when opposing attorneys solicit testimony that adversely affects clients. According to the Ethics Code, the first principle of psychology is to do no harm to the client, but legal requirements may make this impossible. By law, all therapists and clinicians are required to report verified or suspected child abuse; yet 40–70% of psychologists have failed to report at least one such instance out of concern for damaging the therapeutic relationship or violating confidentiality.
"HIPAA, email, and digital privacy challenges"
"APA guidelines and parental fitness assessment duties"
"Navigating conflicts between law and ethics in practice"
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