Psychology and treating mental illness

By T. Richard Saunders, Ph.D.
May 1, 2001



It was a pleasure to see the recent article by my friend and colleague, Arnold Lazarus, in the National Psychologist (Lazarus, 2001). In addition to his many other contributions to the field of psychology, Dr. Lazarus has repeatedly spoken out on issues related to ethics (e.g., Lazarus, 1998), even at the risk of misperceptions by colleagues. I think he should be congratulated for once again addressing the fuzzy notion of “multiple relationships” and their potentially negative impact on psychotherapy. However, an important application of Dr. Lazarus’ words of wisdom might be missed, since he did not mention it in his article.

What Dr. Lazarus does not note is that the present Code of Conduct wording (Section 1.17) fails to make it clear that only harmful relationships are being forbidden, nor does it specify what it means by “harmful.” It also does not clarify that all items not mentioned are not prohibited. What is lacking is behavioral specificity, an adequate definition, and a specification of “harm.” This makes it more difficult for the psychologist seeking guidance to adhere to the Code.

I think that the “Multiple Relationships” section of the Code of Conduct is a prime example of fuzzy thinking by psychologists. We may mean well, but our intentions do not match our words. This courts professional disaster for the psychologist accused of unprofessional behavior under the Code– whether before an Ethics Committee, or before a statutory Board of Examiners. Legal reviews of the present Code of Conduct and of earlier revisions of the present Ethics Revision Task Force document (Fleer, 2000) have reached the same conclusion.

The new revised version from the APA Task Force (Jones, 2001; Section 3.06) is a partial improvement, but still fails to distinguish adequately what is, as well as what is not, included. As Dr. Lazarus has noted, some multiple relationships can be actually helpful. My question is this: Why continue to struggle with the nebulous term, “multiple relationships?” Is it not pointless to note them in the first place, if they are beyond both definition and example? Second, most multiple relationships do not exist as a dichotomy, but as a continuum. The Ethical Principles should clearly specify what is forbidden, not leave us to guess.

The same reasoning can be applied to the insistence of the Ethics Revision Task Force on attempting to impose notions of “roles” on psychologists in forensic work (Section 11 in the proposed revision) as well as some other parts of the proposed Code. The Task Force seems unable to recognize that the notion of “roles” in this context is strictly a post hoc attribution by an observer, not a fact or a concretely observable matter. Although there may be some merit in discussion of “roles” by psychologists as a heuristic or analytical tool, when it comes to adjudication, we need to stick to the facts. The more observable the behavior in question, the easier it is for (a) the conscientious psychologist to recognize and avoid it, and (b) for an ethics body or statutory Board to recognize it and act accordingly.

There is a large and growing body of anecdotal evidence (e.g., Lazarus, 1998; Sall, 1994; Saunders, 2001; Sherven, 1994; Billet-Ziskin, 1995) that at least at times, agencies charged with the responsibility of enforcing the APA Code of Conduct in various forms are misapplying or misconstruing it. While those errors may occur infrequently or unintentionally, they are no less devastating for the psychologists involved. This is especially important because mistakes are definitely preventable if the Code of Conduct is properly drafted.

Coincidentally, this Task Force document also desperately needs another form of correction. That is, the need for specific boundary conditions regarding to what and to whom it applies. Though this may seem obvious at first, there is reason to think that, since the Code of Conduct has the force of law in the majority of jurisdictions in the United States (Fleer, 2000), the document needs to specify its intended use, in order to prevent its misuse.

Arthur Kovacs and Christie Morehead (personal communication, September 28, 2000) recently adapted language from the American Bar Association Model Rules of Professional Conduct, (ABA, 1999) and introduced that language into the American Psychological Association Code. Their revision now explicitly states that the Code of Conduct is intended only for the regulation of the professional behavior of psychologists by other psychologists, and that its application in other venues for other purposes will distort its meaning and intention. This will have the net effect of cautioning those outside the profession, often attorneys or litigants who may be looking for “deep pockets” of recovery, or seeking retaliation, that they can no longer look to “expert opinion” based on our own Code of Conduct for a rationale to sue or make a claim of harm, which would otherwise be unjustified (M.H. Williams, in press).

Many elements of the existing Code of Conduct and the Task Force revision are exhortational. That is, they are, in effect, written to inspire, rather than to inform. Similar critiques have been registered against the rapidly proliferating “Guidelines” that the American Psychological Association has produced or is producing on such topics as child custody, child maltreatment, geriatrics, and a host of other topics. All these are clearly “aspirational” rhetoric, not substantive documents that are adjudicatable. The distinction may be obvious to a psychologist, or it may not be. However, in the hands of legal counsel or another motivated party, such documents become explosive for unsuspecting psychologists who may have no idea how vulnerable they are professionally to attack by litigation or complaints.

Thanks again to Arnold Lazarus for his enlightening article about multiple relationships. Perhaps if we can do away with the fuzzy concepts in the Code of Conduct, he can carry on without fear that APA musings about “multiplicity” will land him (or the rest of us) in hot water.

——

T. Richard Saunders, Ph.D. is a psychologist in fulltime practice in Annapolis, MD. He is a member of the Division 42 Task Force on Revision of the APA Ethics Code, and former editor of the Independent Practitioner, the division’s newsletter. He may be contacted at anchorbh@juno.com

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