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Ethical dilemmas and boundary challenges are parts of daily life for psychologists who live and practice within small communities. Although rural psychologists are most readily identified as 'small-community psychologists,' there are a number of other settings that can be considered small communities--colleges, communities of color/ethnicity/culture, lesbian/gay/bisexual/transgender (LGBT), military, faith-based, feminist, criminal justice and corrections, suburban, disability, deaf/hearing impaired, chemical dependency, school districts, sport psychology, graduate training programs, and therapists who see other therapists as clients. Psychologists in these small communities strive to balance a traditional individualist perspective with a need to participate in and contribute to the overall wellness of the community in which they live and work. The 3 invited commentaries provide additional depth through their perspectives on rural, LGBT, and Latina/o community practice. Their insights model thoughtful and contemporary practice that challenges, enriches, and educates the larger field of ethical psychological practice. Keywords: ethics, small communities, LGBT, multicultural, rural DOI: 10.1037/a0021689

Recognizing research which suggests that many practicing psychologists enter the field without training or with inadequate training in the knowledge, skills, and awareness needed to treat lesbian, gay, and bisexual (LGB) clients, the authors in this Focus on Ethics provide suggestions for psychologists seeking competence with this population. In the lead article, Lyons fleshes out the contours of competent practice, presents the current state of psychologist competence, and calls for greater levels of competence. Next, Bieschke and Dendy respond by applying the Ethical Acculturation Model to describe the question of competence for those who may come from cultures not condoning of an LGB affirmative stance. Worthington provides hypotheses for the current rates of competence in the field and encourages the use of evidenced-based training and practice to increase competence. Finally, Georgemiller confirms the role of practicing psychologists who are heterosexual allies and identifies resources for gaining competence. Keywords: ethics, competence, LGB, diversity, psychotherapy DOI: 10.1037/a0021121

Military psychologists must provide a full gamut of mental health evaluation, treatment, and consultative services in a variety of nontraditional settings. Internship training and postdoctoral supervision are key to producing competent military psychologists that can simultaneously serve effectively as commissioned officers. The context of supervision has evolved in recent years as the majority of military psychologists are deployed to the combat theater and many are tasked with nontraditional operational roles. This article explores the key ethical considerations faced by supervisors who prepare psychology interns, postdoctoral residents, or civilian psychologists for high-risk military roles in a time of war. Recommendations are provided for both clinical supervisors and military psychology leaders. Keywords: supervision, mixed agency, ethics, military psychology, competence DOI: 10.1037/a0019899

As a profession we are committed to maintaining and enhancing our competence as psychologists in order to most effectively serve the public throughout our careers. While this is a widely shared commitment among psychologists, there is considerably less consensus regarding how best to accomplish this goal. This dilemma is examined from the ethical, educational and legal perspectives. The American Psychological Association (APA) Ethics Code clearly articulates that competence is an ethical duty, although there is little guidance provided in the code as to how to meet this standard. As a profession we have tended to focus on the construct of life-long learning and we have incorporated this principle into our education and training standards. In fact, APA accreditation requires that doctoral programs inculcate this value into our foundational training. The majority of Psychology Licensing Boards have addressed this issue through the endorsement of mandatory continuing education requirements that primarily focus on hours and the content or structure of approved programs. Potential limitations to our ability to effectively self-assess our professional training needs are discussed and several innovative models are DOI: 10.1037/a0020424

Ethical principles developed for clinical/counseling psychologists are a useful, but incomplete, guide for sport and performance psychology (SPP) practitioners. Positive and virtue ethics are introduced to the SPP ethical literature as an additional resource. Positive ethics focus on practitioners' reaching their fullest potential rather than avoiding risk (Knapp & VanDeCreek, 2006). Virtue ethics emphasize the character of the professional rather than situational variables (Newman, Robinson-Kurpius, & Fuqua, 2002). The context in which SPP practice occurs is described and commonly resulting ethical dilemmas are identified. The aspects of SPP context explored are: the domain of performance, SPP settings, SPP interventions, and expectations. The ethical issues discussed are: multiple relationships (including boundaries and dual agency), confidentiality, and self-regulation. Drawing from positive and virtue ethics as well as small community and military psychology, advice for managing the issues is provided. The inclusion of character and fitness requirements in training programs is explored to address the self-governance necessitated by the professional isolation of SPP practitioners. Suggestions for future professional practice and research are offered. Keywords: ethics, sport psychology, performance psychology, character, self-regulation DOI: 10.1037/a0019483

The issue of whether to release a minor's treatment records to a parent presents a complex ethical dilemma for clinicians. This is made more complex when the child is an adolescent and when the parents are involved in a custody dispute. The author presents a case summary followed by a review of the literature. A section on court rulings in similar cases is included. In general, courts have ruled in favor of maintaining the privilege for mature minors involved in custody proceedings. Health Insurance Portability and Accountability Act regulations pertaining to minors whose parents may not be acting in their best interests are also reviewed. Procedural recommendations by several experts in the field are offered that may serve to establish the child's rights to privacy at the outset of treatment and thus avert ethical conflicts. The author concludes with the case outcome and an advisory for the clinician. Keywords: adolescents, child custody, children's rights, confidentiality, treatment records DOI: 10.1037/a0017419

The provision of psychological (e.g., psychotherapy, coparenting, mediation, collaborative divorce, child custody evaluation) services for families of divorce are growing specialties for many clinical and forensic psychologists. However, practice in domestic relations psychology, such as divorce and custody assessment and testimony, is a high-risk venture for incurring ethics complaints and law suits. The lead article and the three commentaries that follow enumerate the various roles practitioners might play, clarify how each role requires specific skill sets that may be outside one's particular competence and necessitate additional training, describe how countertransferential issues arise, urge meticulous record keeping, discuss some of the subtleties of confidentiality and the releasing of information, describe how transparency in clarifying expectations leads to a lowering of contentiousness, and provide tips for divorce and forensic practice. The special challenges associated with psychologists being tempted to move beyond their role on a case and those of particularly high-risk situations (e.g., complaints of child abuse or domestic violence) are also discussed. Suggestions are offered to help psychologists better serve the public while taking steps to better inoculate themselves from complaints. Keywords: child custody, divorce, ethics, forensic evaluations, psychotherapy Supplemental materials: http://dx.doi.org/10.1037/a0017853.supp DOI: 10.1037/a0017853

The provision of ethical and responsive treatment to clients of diverse cultural backgrounds is expected of all practicing psychologists. While this is mandated by the American Psychological Association's ethics code and is widely agreed upon as a laudable goal, achieving this mandate is often more challenging than it may seem. Integrating culturally responsive practices with more traditional models of psychotherapy into every practitioner's repertoire is of paramount importance when considering the rapidly diversifying population we serve. Psychologists are challenged to reconsider their conceptualizations of culture and of culturally responsive practice, to grapple with inherent conflicts in traditional training models that may promote treatments that are not culturally responsive, and to consider the ethical implications of their current practices. Invited expert commentaries address how conflicts may arise between efforts to meet ethical standards and being culturally responsive, how the application of outdated theoretical constructs may result in harm to diverse clients, and how we must develop more culturally responsive views of client needs, of boundaries and multiple relationships, and of treatment interventions. This article provides additional considerations for practicing psychologists as they attempt to navigate dimensions of culture and culturally responsive practice in psychology, while negotiating the ethical challenges presented in practice. Keywords: ethics, multicultural, psychotherapy, culture, cultural competency DOI: 10.1037/a0016871

The importance of continuing and updated training for professional psychologists in essential areas of practice and career development--that is, advocacy, ethical business practices, understanding of legislative and regulatory issues, leadership, and culturally informed policies and practices--has spawned the development and implementation of multiple mentoring programs within organized professional psychology. Four such programs are discussed that have been developed through or supported by the Committee for the Advancement of Professional Practice within the American Psychological Association (APA). These programs provide mentoring for graduate students, early career psychologists, and experienced practicing psychologists in the areas of effective and ethical business practices, legislative and regulatory advocacy, and ethnic minority leadership development. Included are descriptions of mentoring programs developed and implemented by the Massachusetts Psychological Association, the Texas Psychological Association, the APA Practice Federal Advocacy Coordinator network, and the APA State Leadership Conference Diversity Initiative. Keywords: mentoring, professional psychology, advocacy, SPTAs, diversity

Medicare/Medicaid billing fraud and abuse can be prosecuted under a wider array of laws than apply within the private sector. Cases are typically initiated by whistleblowers or through detection of unusual billing patterns. Few psychologists in independent practice have ever been convicted of Medicare/ Medicaid billing fraud or abuse, but government antifraud efforts against psychologists appear to be on the rise. These efforts are pursued under the auspices of containing spiraling health care costs, but they can uncover unintentional billing abuse by psychologists, arising from general ignorance of claim-processing procedures, lack of uniformity across insurance programs, constantly changing guidelines, and ambiguous interpretations. Recent investigations in south Texas have especially targeted the use of extenders for psychological and neuropsychological testing. Keywords: Medicare, Medicaid, fraud, abuse, risk management

Psychologists are frequently asked to work with the media in responding to current events or educating the public about psychological issues. This can run the gamut, from an occasional interview with a reporter to a weekly gig as a radio call-in host. Many psychologists have little or no training in media psychology, but it is critical to obtain such training before entering the quicksand that working with the media can easily become. There are many ethical dilemmas inherent in media work, and this article enumerates many, including competence and confidentiality. Psychologists must educate themselves about the topic being discussed, often with a 'heads-up' from the reporter in advance. Reporters will often ask for clients to be provided as examples to add depth to the story. The confidentiality and welfare of the client must be considered. It is important to think clearly about many ethical issues to make working with the media a positive professional experience and an important public service. Keywords: media psychology, competence, ethics, confidentiality, public education

Psychologists working as graduate student educators and clinical supervisors often encounter trainees who manifest problems of professional competence. At times, faculty members and supervisors may experience role conflict, ambiguity, and anxiety about how to respond to trainee competence problems. Psychologists engaged in the education, training, and credentialing of trainees are ethically and professionally obligated to balance their developmental and gatekeeping roles with respect to trainees. A discussion of several systemic concerns related to psychology's approach to competence problems is presented along with 3 expert commentaries that further elucidate the core issues from the vantage point of education, training, and licensure. Several recommendations for enhancing cooperation and excellent practice among psychologists who train and credential are offered. Keywords: competence, ethics, gatekeeping, professional, training

An estimated 49.7 million people in the United States live with one or more disabilities, representing nearly 20% of the 257.2 million individuals ages 5 and older in the civilian population (U.S. Census Bureau, 2003). Most psychologists are likely to have the opportunity to work with clients who have disabilities (R. Olkin, 2002) and need the competencies to provide ethical services to this growing proportion of the population. What constitutes ethical practice with people with disabilities? First, the ethical issues involved in providing services for people with disabilities are outlined, and 2 vignettes and a number of questions for practitioners and educators are presented. Then, 3 invited experts provide commentaries that address these issues, raise additional questions, and provide important resources. Keywords: ethics, disabilities, competencies, clinical practice

Clinical work with suicidal patients has become increasingly challenging in recent years. It is argued that contemporary issues related to working with suicidal patients have come to pose a number of considerable professional and even ethical hazards for psychologists. Among various concerns, these challenges include providing sufficient informed consent, performing competent assessments of suicidal risk, using empirically supported treatments/interventions, and using suitable risk management techniques. In summary, there are many complicated clinical issues related to suicide (e.g., improvements in the standard of care, resistance to changing practices, alterations to models of health care delivery, the role of research, and issues of diversity). Three experts comment on these considerations, emphasizing acute versus chronic suicide risk, the integration of empirical findings, effective documentation, graduate training, maintaining professional competence, perceptions of medical versus mental health care, fears of dealing with suicide risk, suicide myths, and stigma/blame related to suicide. The authors' intention is to raise awareness about various suicide-related ethical concerns. By increasing this awareness, they hope to compel psychologists to improve their clinical practices with suicidal patients, thereby helping to save lives. Keywords: suicide, informed consent, risk assessment, treatment, risk management

Some religious denominations hire psychologists to evaluate current clergy or candidates for religious professions. However, some psychologists question how they can responsibly conduct screenings for a denomination that bars the ordination of individuals because of their sexual orientation. Psychologists who conduct such screenings must consider the ethical mandate to respect persons because of their sexual orientation, as well as the ethical mandate to respect faith traditions. The authors suggest ways that psychologists can balance these concerns to provide complete and ethical services. Keywords: ethics, sexual minorities, sexual orientation, assessment, clergy

All psychologists must uphold the same ethical standards about confidentiality even though each state imposes different legal limits on their ability to protect clients' confidences. The resulting ethical-legal confusion is exacerbated by legally based confidentiality training that treats legal exceptions as if they were the rule and fosters the impression that attorneys are now the only real experts about this aspect of practice. This article provides an ethics-based confidentiality practice model that clarifies the ethical rule and puts its legal exceptions into ethical perspective. Like the Confidentiality section of the American Psychological Association's (2002) Ethical Principles of Psychologists and Code of Conduct, this outline would apply to all psychologists regardless of state laws, but the details of its implementation would vary according to role and setting. It can be used as a universal training outline, a consultation and supervision tool, a guide to professional practice, and a basis for clearer ongoing conversation about the ethics of 'conditional confidentiality.' Psychologists can use this practice model to regain their status as experts about the confidentiality ethics of their own profession. Keywords: ethics, confidentiality

Can psychologists apply the same standards of moral conduct when treating patients from diverse cultural backgrounds as they do when treating European-American patients? The authors recommend options to exercise when patients from diverse backgrounds engage in behaviors that violate generally accepted Western standards of conduct. Psychologists need to determine if such a cultural conflict really exists, as many such conflicts are more apparent than real. If such a conflict does exist, the authors recommend analyzing the conflict from the perspective of soft universalism, which holds that all cultures share basic, universal values, although they may vary in how those values are expressed. The authors recommend a decision-making process based on principle-based ethics for guiding behavior when such conflicts occur. Keywords: ethics, ethical decision making, cultural competence, multiculturalism

Listservs are often used by professional psychologists to share resources and references, seek consultation or support, find referrals, discuss important issues, keep informed about upcoming events, and access other useful information. Topics of discussion include clients, students, research, insurance companies, and even other professionals. Listservs can help keep otherwise isolated professional psychologists connected with the psychological community. Listservs make such discussions and information more accessible to psychologists who are geographically isolated or cannot easily attend meetings and other events because of other demands on their time. There are risks involved in listserv use, however. Nothing shared over the Internet is ever completely secure. Confidentiality cannot be guaranteed. Listservs potentially distribute messages about clients and other topics far more widely than a single e-mail communication does, thereby multiplying the risks involved. In this article, the author explains how listservs work, addresses the potential ethical problems connected with their use, and suggests some more secure methods for sensitive professional Internet exchanges. Keywords: Internet, listserv, e-mail, cyberspace, online counseling

The practice of psychology can be demanding, challenging, and emotionally taxing. Failure to adequately attend to one's own psychological wellness and serf-care can place the psychologist at risk for impaired professional functioning. An ongoing focus on self-care is essential for the prevention of burnout and for maintaining one's own psychological wellness. Salient aspects of self-care are discussed, including the ethical imperative of addressing self-care throughout one's career. Three invited expert commentaries provide additional insights and recommendations on positive actions, preventive strategies, and steps to be taken by individual psychologists, by those training the next generation of psychologists, and by professional associations. Realities of the current state of psychology and a clear call for action are highlighted, with the overarching goal being the ethical and effective treatment of clients and the successful management of the challenges and stresses faced by practicing psychologists. Keywords: self-care, psychologist wellness, distress, burnout, impairment

Obtaining informed consent has become a routine part of both initiating and continuing clinical services. Psychologists are trained to anticipate the risks and benefits, identify alternatives, understand limits to privacy, explain these factors to prospective clients, and assist them in making decisions about their participation. Only in recent years have psychologists begun to more formally incorporate the principles of informed consent into their work with supervisees. Providing supervisees with relevant information at the outset helps to minimize risks for supervisors and supervisees and to maximize benefits for supervisees and their clients. This article addresses the objectives and benefits of obtaining informed consent to supervision, highlights relevant ethical standards and guidelines, and describes the elements of a supervisory informed consent document. Keywords: supervision, ethics, informed consent, supervision contracts, ethical standards and guidelines for supervision

Every psychologist participates in clinical supervision during various aspects of his or her training. Many psychologists also provide supervision to less experienced colleagues and to those in training. But what makes for an effective and competent supervisor? Psychologists need to know because substandard or ineffective clinical supervision may have far-reaching consequences for the developing professional and for those be or she treats. This contribution provides key information on clinical supervision and related competence issues. A number of questions are raised that must be addressed by individual psychologists and the profession alike. Then, 3 invited expert commentaries are offered to address these issues, further this important discussion, and attempt to answer the challenging questions raised. Attention to the issues raised and recommendations made will hopefully lead to enhanced clinical competence and effectiveness by clinical supervisors. Keywords: supervision, clinical supervision, competence, competencies, ethics

As fiduciaries, supervisors are to act on behalf of their supervisees; there are at least 10 provisions in the American Psychological Association Ethical Principles of Psychologists and Code of Conduct (2002) that provide guidance for those in this role. Unfortunately, there are many questions the APA Ethics Code does not answer with regard to multiple relations in supervision. The authors address a variety of problems that can arise in this professional context and offer guidance for administrators, practitioners, and students. Keywords: ethical decision making, ethics, multiple relations, risk management, supervision

An article by S. A. Greenberg and D. W. Shuman (1997) has been prominently referenced as an authoritative document making the argument that 'explicit ethical precepts' (p. 50) are violated when a therapist provides expert forensic testimony. Greenberg and Shuman (1997) claimed that psychologists attempting to do so are engaging in an 'irreconcilable conflict between therapeutic and forensic roles' (p. 50). Their arguments are challenged here and shown to conflict with established ethical standards and guidelines for forensic psychologists. The current author discusses serious potential negative ramifications to the public interest and the profession of psychology if state boards of psychology adopt the position of Greenberg and Shuman as a basis for the discipline of psychologists both treating patients and providing expert testimony. Keywords: therapeutic and forensic roles, psychotherapy and testimony, ethics and multiple roles

The goal of the article 'Irreconcilable Conflict Between Therapeutic and Forensic Roles' (S. A. Greenberg & D. W. Shuman, 1997) was to help chart a course for the profession that would raise the quality of assistance provided by psychologists both to courts and to patient--litigants, without compromising the quality of either forensic examinations or therapeutic relationships. One solution was conceptually simple: Do not attempt to fulfill both roles for the same person. Although an individual psychologist might be competent in both the provision of therapy and conduct of forensic examination, this does not justify a psychologist providing both services to the same patient--litigant. Knowledge is necessary to provide both types of service. Wisdom is necessary to choose not to provide both services to the same person. Keywords: conflicts, ethics, forensic, roles, standards, therapists

At times the laws under which psychologists function may appear to contradict generally recognized ethical values and/or good clinical care. When these circumstances arise, psychologists must determine if a conflict really exists and, if so, seek solutions that reconcile respect for the law with their ethical values. At times, psychologists may decide to follow the taw despite their ethical concerns. At other times, they may determine that a conscientious objection is warranted. The authors recommend options to consider when these situations arise and offer a decision-making process. Keywords: laws, virtue ethics, principle-based ethics, ethical decision making