Samuel Knapp

Given the increase in suicidal behavior in recent years, psychologists should think through their policies about working with suicidal patients. Unfortunately, many psychologists have such an aversion to treating suicidal patients that they have developed policies of avoiding them, even to the extreme of refusing to treat any suicidal patients. How...

The ending of the psychotherapy relationship is an important clinical, legal, and ethical matter. While some guidance and requirements are found in the American Psychological Association Ethical Principles of Psychologists and Code of Conduct, psychologists may at times experience challenges regarding when and how to most appropriately end the trea...

The enforceable standards of the Ethical Principles of Psychologists and Code of Conduct do not tell psychologists how to behave or respond to every problematic ethical situation. Psychotherapists can use the aspirational General Principles to guide their behavior in these situations. However, psychotherapists can only implement these principles ap...

Working with a suicidal patient is a high-risk enterprise for the patient who might die from suicide, the patient’s family who might lose a loved one, and the psychologist who is likely to feel extreme grief or fear of legal liability after the suicide of a patient. To minimize the likelihood of such patient deaths, psychologists must ensure that t...

Although persons of color have lower rates of death by suicide than White Americans, the frequency of suicidal ideation and attempts is close to that of White Americans, and suicide rates among persons of color are increasing. Consequently, psychotherapists should be as vigilant for suicidal behavior among their patients of color as they are for th...

The death of a patient by suicide is one of the professional events most feared by psychotherapists and firearms are the most commonly used means of suicide. However, as the number of firearm owners within the United States has increased in recent years, so has the risk of firearm-related suicides. Suicidal patients with easy access to their firear...

Safety planning type interventions (SPTIs) reduce suicide attempts as either stand-alone interventions or as part of a more comprehensive treatment. They now represent the standard of care when working with suicidal patients. This article reviews the goals of SPTIs, their effectiveness, rationale, legal and risk management implications, composition...

Out of a concern for keeping suicidal patients alive, some psychotherapists may use hard persuasion or coercion to keep them in treatment. However, more recent evidence-supported interventions have made respect for patient autonomy a cornerstone, showing that the effective interventions that promote the wellbeing of suicidal patients also prioritiz...

Many suicidal patients fail to disclose their suicidal thoughts and behaviors to their psychotherapists, thus increasing the likelihood that they will receive less-than-optimal treatment. This article reviews why patients may withhold this information and presents 6 strategies that psychotherapists can use to increase the likelihood that their pati...

Some psychologists may encounter patients who fail to follow basic public safety measures to prevent the spread of COVID-19 and thus put themselves and others at risk of an infection. These behaviors may cause psychologists to worry about the impact of their patient’s behaviors on the public in general, and when or whether they should address their...

The authors argue that individual psychologists have an obligation to understand, review, and comment on upcoming revisions of the Ethical Principles of Psychologists and Code of Conduct. Psychologists may want to consider several factors as they review and prepare comments on these revisions. Among other things, commenting psychologists should con...

O’Donohue has identified 37 criticisms of the American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct (Ethics Code), although many of his criticisms go far beyond what is found written in the APA Ethics Code, to include the process of adjudicating ethics complaints by the American Psychological Association Ethic...

Psychologists will often encounter patients who make prejudiced comments during psychotherapy. Some psychologists may argue that the obligations to social justice require them to address these comments. Others may argue that the obligation to promote the psychotherapeutic process requires them to ignore such comments. The authors present a decision...

Positive ethics is a perspective that encourages psychologists to see professional ethics as an effort to adhere to overarching ethical principles that are integrated with personal values, as opposed to efforts that focus primarily on avoiding punishment for violating the ethics codes, rules, and regulations. This article reviews the foundations of...

Self-awareness has been identified as a key quality of effective psychotherapists. Nonetheless, self-awareness requires effort. We review various areas where a lack of self-awareness could pose a risk to psychotherapists’ effectiveness, and we present a series of questions that psychotherapists can ask themselves to increase their self-awareness. S...

In this article we review the actions that psychologists can take to improve their ability to self-reflect. These activities include building professional networks, engaging in personal psychotherapy, taking part in continuing education, soliciting feedback from patients and colleagues, participating in Balint groups, engaging in expressive writing...

Professional associations often recommend consultation as an essential activity to ensure competence. Although consultation differs from supervision and includes generally few legal risks to the consultants, consulting psychologists should nonetheless strive to promote the effectiveness of the consultee’s practice. Few data exist to guide psycholog...

Ideally psychologists strive to act ethically within their professional roles. However, they are unlikely to achieve the highest standards of ethical behavior if they become overly legalistic or if they engage in behaviors that can be virtuous in a personal context but harmful in a professional relationship. Such problems may arise when some justif...

Social conventions are everyday habits or preferences that most people would not consider to be moral or ethical issues. However, some social conventions, such as what names and titles to use or how to dress, may affect the quality of professional services and the way the public perceives psychologists; therefore, they may have ethical implications...

Psychologists are socialized to seek consultation to improve patient welfare, deal more effectively with students and trainees, and maintain ethical standards in research. In this article we propose an integrated model for ethics consultation that augments traditional models of risk management and ethical decision making with more recent research o...

Every year since 1996, the Pennsylvania Psychological Association (PPA) has its surveyed members to monitor practice patterns, changes in workforce demographics, and to determine the opinions of its members on issues related to the practice of psychology. This article reviews those surveys and discusses how PPA has used the information. Implication...

Responds to the comments by Pomerantz (see record 2012-12428-009) and Sisti and Baum-Baicker (see record 2012-12428-010) on the current authors' original article, "Nonrational processes in ethical decision making" (see record 2011-19198-001). Pomerantz (2012) further explicated one interpersonal and contextual factor-the perceived characteristics o...

Psychology has a history of approaching ethics from a rule-based perspective. The APA Ethics Code was developed by focusing on problematic behaviors, and ethics training is often concerned with helping psychologists protect themselves from ethics complaints and lawsuits. Recently, many scholars have been focusing on positive approaches to ethics. P...

Most current ethical decision-making models provide a logical and reasoned process for making ethical judgments, but these models are empirically unproven and rely upon assumptions of rational, conscious, and quasilegal reasoning. Such models predominate despite the fact that many nonrational factors influence ethical thought and behavior, includin...

Although religious affiliation is generally associated with good mental health, at times patients may present with religious beliefs that appear to harm their well-being or social functioning. On the one hand, it would appear that respect for the patient's religious traditions requires psychologists to refrain from challenging those problematic rel...

All psychotherapists engage in self-disclosure with their clients. At times it may be deliberate or nondeliberate, verbal or nonverbal, and avoidable or unavoidable. Yet, modern-day Internet technologies have redefined the meaning and applications of self-disclosure and transparency in psychotherapy. Consumers of mental health services can easily a...

In 2005, the authors (Handelsman, Gottlieb, & Knapp, 2005) proposed that ethics education be conducted based on a model of ethics acculturation. Here, the authors extend that work by offering some principles that support implementation of an ethics acculturation model (EAM) over the full course of professional preparation. The authors argue that et...

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 t...

Psychotherapists must deal with practical business matters such as advertising, billing, collecting fees, and other practice management topics. We review the enforceable standards of the American Psychological Association's (2002) Ethics Code that deal with advertising, fees, billing, and related business matters in psychotherapy. Using a principle...

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 nee...

Psychologists sometimes find themselves in situations in which they need to balance respect for patient autonomy with other competing values and neither the laws nor ethics codes provide clear direction on how they are to do so. With the use of a model from principle-based ethics, this article recommends a strategy for resolving those dilemmas in a...

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 dec...

Boundaries refer to the rules of the professional relationship that set it apart from other relationships. They clarify which behaviors are appropriate and inappropriate in therapy as compared with those behaviors that are appropriate or inappropriate in other settings. Boundaries set limits, provide structure, and thereby prevent harm to patients....

Incidents of ethical misconduct risk harming individual patients and the public's confidence in the profession of psychology. Consequently, many state, provincial, and territorial psychological associations have a goal of educating and advising their members on ethical conduct. This article describes how one state psychological association, through...

Psychologists are increasingly encountering philosophers in independent practice who use philosophy to help individuals or groups work through practical problems. An overview of the diverse expressions of the philosophical counseling movement is provided, including scope of practice, methods, training curriculum, codes of ethics, and evidence of ef...

As the population of America ages, psychologists will be treating more older adults who are, or are at risk of becoming, impaired drivers. Consequently, psychologists will need to address the issue of driving impairment with many of their patients. Although psychologists should generally respect the autonomy of patients to determine the direction a...

This article presents an approach to graduate (and professional) training that views becoming an ethical psychologist as an acculturation process. J.W. Berry's (1980, 2003) model of acculturation strategies is used as a framework for understanding ethical acculturation, a developmental process during which students can use several types of adaptati...

Psychologists are increasingly delivering or supervising services in the homes or residences of their clients. However, the very process of delivering home-based services creates challenges to the psychologist-patient relationship and an opportunity for clients to challenge the boundaries in ways that would not ordinarily occur in office-based serv...

The authors adopt a position that the Standards in the American Psychological Association (APA; 2002) Ethics Code should be based on or be logically related to some underlying ethical theory. The authors then review the 2002 APA Ethics Code from the standpoint of principle-based (prima facie) ethics. Their analysis shows that almost all of the enfo...

All psychotherapists engage in self-disclosure with their clients. At times it may be deliberate or nondeliberate, verbal or nonverbal, and avoidable or unavoidable. Yet, modern-day Internet technologies have redefined the meaning and applications of self-disclosure and transparency in psychotherapy. Consumers of mental health services can easily a...

We provide, examples of how to use case law in teaching professional ethics. Instructors can use the case law to illustrate crucial ethical issues facing professional psychologists, review the essential ingredients in disciplinary actions, and reflect on fundamental philosophical issues facing professional psychologists. We also recommend some usef...

This article summarizes the major changes that were made to the 2002 Ethical Principles and Code of Conduct of the American Psychological Association. The 2002 Ethics Code retains the general format of the 1992 Ethics Code and does not radically alter the obligations of psychologists. One goal of the Ethics Committee Task Force was to reduce the po...

Continuing professional education in ethics for psychologists is becoming more common, as psychology licensing boards in 14 states now require continuing education in ethics as a condition of licensure renewal. This article suggests ways to improve the quality of ethics continuing education by diversifying the content and teaching methods.

Psychology after World War II became a science largely devoted to healing. It concentrated on repairing damage using a disease model of human functioning. This almost exclusive attention to pathology neglected the idea of a fulfilled individual and a thriving community, and it neglected the possibility that building strength is the most potent weap...

In this article we address several ethical issues of concern for psychologists who are engaged in personality assessment in forensic settings such as for courts or attorneys. The ethical issues reviewed include the role of the psychologist as an expert witness, matters of competence, informed consent, confidentiality, multiple relationships, and sp...

Although psychologists generally have a legal duty only to their patients, some courts have created a duty to third parties who have been accused of child abuse. The authors review those cases and conclude that it is too soon to discern whether they represent aberrant decisions precipitated by unusual circumstances or whether they present an ominou...

The professional associations of psychologists are working to revitalize professional psychology. In response to recent challenges, these associations have attempted to (a) remove barriers to quality services within the mental care health delivery system; (b) help psychologists become better integrated within the overall health care system, as oppo...

This article reviews the legal and ethical issues that arise in the treatment of patients who may pose a threat to harm themselves or others. The recent practice of developing empirically validated treatments has not yet been applied to the diagnosis and treatment of patients who present an imminent danger of harm to themselves or others. Instead,...

The Tarasoff decision established a “duty to protect” for psychotherapists in California who treat patients who present an imminent danger of substantial physical harm to an identifiable person or persons. Subsequent court cases and legislation in other states, as well as recommendations from mental health experts, have led to the widespread accept...

Despite the controversy regarding the existence, nature, and accuracy of false (recovered) memories, there is an apparent professional consensus regarding child abuse, the nature of human memory, standards for diagnosis and treatment of adults who have or may have lost memories of abuse, and the appropriate role of the psychotherapist in dealing wi...

How does one maintain an ethical practice while facing the requirements and limits of a health care system that is dominated by managed care? Psychologists are increasingly raising such questions about ethical issues when working in or contracting with managed care organizations. The authors review the process involved in ethical decision making an...

The area of treatment of adults with memories of childhood abuse has become controversial in recent years. An analysis of the memory-recovery techniques that have been described in the recanter literature and promoted in the popular self-help press shows that they appear to disregard the moral principles (respect for patient autonomy, nonmaleficenc...

According to classical utilitarianism behavior is morally correct if it leads to the greatest amount of happiness for the greatest number of persons. I examine utilitarianism from the standpoint of the important purposes of an ethical theory, which are to (a) identify and justify the underlying moral principles that ethics codes rely on, (b) assist...

"The Commerce of Professional Psychology and the New Ethics Code" / Gerald P. Koocher / impact of American Psychological Association (APA) ethics code on commercial aspects of professional practice of psychology "Record Keeping Guidelines" / APA, Board of Professional Affairs, Committee on Professional Practice and Standards / record keeping guid...

The recent Supreme Court decision Jaffee v. Redmond (1996) recognized a psychotherapist–patient privilege in federal court. The background of privileged communication laws in general, the federal privileged communications rules in particular, the facts behind Jaffee v. Redmond, and the final court ruling are reviewed. The impact of the decision a...

The recent Supreme Court decision Jaffee v. Redmond (1996) recognized a psychotherapist–patient privilege in federal court. The background of privileged communication laws in general, the federal privileged communications rules in particular, the facts behind Jaffee v. Redmond, and the final court ruling are reviewed. The impact of the decision and...

One hundred and sixty-two licensed psychologists in Pennsylvania responded to a survey concerning their attitudes toward educational levels and licensing as a psychologist. Most respondents endorsed the concept of a “psychological associate” designation for persons with terminal master's degrees in psychology, but most also preferred to keep the do...

By reviewing the litigation surrounding the false memory debate, the authors hope to provide psychologists with an extra measure of judiciously applied "defensive practice." This review identifies certain treatment procedures that courts have found to fall outside the gambit of acceptable professional practice. Ethical violations commonly alleged i...

A total of 147 licensed psychologists in Pennsylvania responded to a survey sent to an anonymous random sample of Pennsylvania psychologists. The survey was designed to: (I) gather systematic data on the impact of managed care on the quality and accessibility of patient services; (2) update data on the utilization of Medicare and Medicaid treatment...

The mental health community and, in certain respects, society itself have become polarized over the issue of lost and recovered memories of childhood abuse. Psychologists who treat patients who recover lost memories of childhood abuse during psychotherapy may find themselves vulnerable to lawsuits from patients who later recant the memories of abus...

The mental health community and, in certain respects, society itself have become polarized over the issue of lost and recovered memories of childhood abuse. Psychologists who treat patients who recover lost memories of childhood abuse during psychotherapy may find themselves vulnerable to lawsuits from patients who later recant the memories of abus...

A total of 174 psychologists in private practice who were members of the Pennsylvania Psychological Association responded to a survey on recent problems in insurance reimbursement. Psychologists reported problems with managed care entities including decreased fees, increased paperwork, and difficulties getting authorization for longer treatment. In...

Communications between a psychologist and a defendant in a judicial proceeding are not covered by a psychologist-patient privileged communication law when the evaluation is performed to help an attorney prepare the case ("in anticipation of litigation"). Under some circumstances, the attorney-client privilege may still protect the communications of...

Reviews the legal and ethical issues in billing patients, filing insurance claims, and collecting fees by psychologists. It is hoped that the likelihood of patients, insurance companies, and psychologists having disputes over fees and reimbursements is reduced. Guidelines are provided on how psychologists should proceed when financial disputes aris...

187 psychologists responded to a survey sent to an anonymous random sample of licensed psychologists in Pennsylvania. Ss expressed limited interest in Medicaid services, although 81% provided either pro bono or reduced fee services. Ss appeared to strongly favor increased hospital privileges. Fee practices related significantly to geographic locati...

Offers a brief history of duty-to-protect statutes, which limit the liability of psychotherapists who treat life-endangering outpatients and protect therapists who make good-faith warnings when danger to identifiable victims is predictable. Fears are discussed that surround the possibility that courts will continue to expand the Tarasoff (1976) de...

The spread of AIDS has led to new questions regarding the limits of confidentiality in the psychotherapeutic relationship. We describe the duty-to-protect doctrine that has arisen out of Tarasoff and subsequent court decisions and apply it to situations in which HIV-positive patients may pose a health threat to others. No courts have as yet applied...

We review literature on effectiveness of continuing education (CE) in enhancing quality of services in health professions. We conclude that if CE is properly implemented, health care can be positively impacted. Two examples of effective CE programs are described. We also review current status of mandatory CE (MCE) in health fields, especially psych...

We review guidelines for providing supervision for trainees and employees, an expected part of the job for many psychologists, many of whom carry out their supervisory duties with only a cursory awareness of the ethical and legal pitfalls that may accrue. The guidelines are drawn from ethical principles, other documents promulgated by various secto...

Clinical reports have appeared about patients who present for mental health treatment with the major symptom of fearing that they have AIDS. The clinical reports of patients who fear AIDS are similar to those made many years ago by patients who feared syphilis. As with the syphilophobia of years ago, the AIDS group represents a divergent set of pat...

State legislatures develop privileged communication statutes on a state-by-state basis for use in state courts. However, psychotherapists may also be called to testify in federal courts which have no specific privileged communication statute to follow. Federal courts apply state privilege laws in civil cases. However, privilege situations in crimin...

Psychotherapy clients expect and deserve confidentiality. However, privileged communication laws vary by state and profession. The authors discuss and recommend a functional privilege that would apply to all psychotherapy clients of all recognized mental health professions.

Psychotherapists, like other health professionals, are concerned about the increase in malpractice litigation and insurance rates. Properly kept records, made in anticipation of future litigation, may be crucial for the psychotherapist who is faced with a malpractice suit. We review cases in which records influenced the outcome of malpractice suits...

The grounds for liability in cases of involuntary civil commitment have been broadened in recent years. Psychiatrists and other mental health professionals have been found liable for infringement of civil rights under Section 1983 of the Civil Rights Act and for failure to commit an individual who is subsequently involved in a tragedy. This article...

Reviews areas of special vulnerability and the legal penalties that may befall psychotherapists who improperly manage dangerous patients (DPs). General rules of malpractice are discussed. While ethical and professional principles are important in the management of DPs, emphasis is placed on legal principles. The potential pitfalls include the failu...

This article reviews the statutory and case law concerning privileged communications for psychotherapists. Privileged communication laws exempt psychotherapists-under certain circumstances-from testifying about their patients in judicial proceedings. But psychotherapists should not assume broad protection because these laws may be vitiated by the e...

Notes that privileged communication laws protect the confidential statements of parishioners to their clergy from intrusion by the courts but that the legal status of counseling performed by ministers is less clear or uniform. Argues that common and statutory laws which protect religious confessions should not be construed to protect communications...

This article reviews privileged communication laws for psychotherapists as these laws apply to child custody cases. Although many states have privileged communication laws for mental health clients, these laws contain several exceptions and waivers. In addition, judges are likely to interpret privileged communication laws strictly because they plac...

Discusses the increasing importance of legal research for psychologists, the structure of the US judicial system, and the means by which relevant legal decisions can be retrieved. The use of 3 categories of legal materials is described: primary sources on case, statutory, and administrative law; finding tools such as case digests, computerized sear...

Discusses the increasing importance of legal research for psychologists, the structure of the US judicial system, and the means by which relevant legal decisions can be retrieved. The use of 3 categories of legal materials is described: primary sources on case, statutory, and administrative law; finding tools such as case digests, computerized sear...