Professional Practice

Link to the Code of Ethics: http://www.psychologistsboard.org.nz/cms_show_download.php?id=237

Four principles of the Code of Ethics:

The Code of Ethics identifies four ethical principles:

1. Respect for the Dignity of Persons and Peoples
2. Responsible Caring
3. Integrity in Relationships
4. Social Justice and Responsibility to Society

Subsumed under each Principle are a number of Values that stem from it and these Values are in turn linked to Practice Implications – statements of the appropriate professional behaviours of psychologists in relation to that Value. Associated with many of the Practice Implications are comments – drawing attention to important issues of practice. The Practice Implications included are to be considered as guides to practice and should not be understood to exhaust the implications of the associated value for practice.

Six-step model for Ethical Decision Making

In applying the Code in practice it is likely that many ethical decisions will be resolved by reference to more than one section of the Code. In rare circumstances it may appear that there is a conflict between the guidelines in these different sections, or a conflict between the Code and other workplace codes of practice. In all circumstances psychologists should proceed as follows:

1. Identify the issues and practices that are ethically relevant
2. Develop alternative courses of action, preferably in consultation with a professional colleague or supervisor.
3. For each identified course of action analyse the likely short-term, ongoing, and long-term risks and benefits for the individual(s) and/or groups involved or likely to be affected.
4. Conscientiously apply the Principles, Values, and Practice Implications for each course of action in the light of the identified risks and benefits and decide which offers the best balance between these.
5. Take the chosen course of action, accepting responsibility for the consequences of the chosen course of action.
6. Evaluate the consequences of the action, correcting negative outcomes if possible and, if the issue(s) originally identified is (are) not resolved, re-engaging in the decision-making process.

Informed Consent

Key principles:

• Respect each person as an individual and give enough information to enable them to participate in decision-making while thinking of their needs within the context of their culture and family.
• Effective and clear communication is a key component to good practice as is documenting that communication and the outcomes.
• Importantly, be familiar with and be guided by clear policies and codes in order to proceed with a client.
• Ultimately, be guided by what is in the best interests of the client.

Confidentiality and Privacy

Privacy

Information Privacy Principles from the Privacy Act 1993: Principles 1-5: Information should be collected for a lawful and necessary purpose and from the individual concerned (where possible). The individual should be fully informed of:

• The purpose for which the information is sought
• Any intended recipients of the information
• Whether the provision of information is voluntary or mandatory
• Any consequences of not supplying the information

Storage and security of information must be safeguarded.

Principle 6: An individual is entitled to have access to personal information (with limitations outlined in Parts 4 and 5 of the Privacy Act 1993) Principle 7: An individual is entitled to insist that any incorrect information is corrected to their satisfaction Principle 10: There are limits on the use of personal information, including the limitation that information collected from an individual for one purpose cannot be used for another without informed consent of that person. Principle 11: Outlines limits on the disclosure of personal information, including the exception where "... disclosure of the information is necessary to prevent or lessen a serious and imminent threat to (i) public health or public safety; or (ii) the life or health of the individual concerned or another individual.

The Privacy Act 1993 does not apply in some areas of the work of psychologists. For example, Family Court assessments by psychologists that are conducted under the Care of Children Act 2004 or Children, Young Persons, and Their Families Act 1989 are exempt from the Privacy Act 1993 including the report and any notes or materials used by a specialist report writer in preparing that report. This means that any third party requests for information in this context should not be complied with and the person should be referred to direct their enquiry to the Family Court. The same applies to reports prepared for Child, Youth and Family (CYF). The report is owned by the referring agency, and Family Court case law "has determined the report is the property of the court and the extent of its circulation is governed by the exercise of the court's discretion". In most cases, however, the court and CYF will allow each of the lawyers to have access to the psychologist's report and for it to be read by the parties. Requests to withhold all or parts of a report are always at the discretion of the presiding Family Court judge.

Privilege

Privelege is a much narrower concept than confidentiality and privacy. It applies only to the right to refuse to answer questions in judicial, quasi-judicial, or statutory enquiries. The legislation guiding legal privilege in Aotearoa New Zealand is the Evidence Act 2006. Under section 59 of this legislation, privilege applies to information obtained by medical practitioners and clinical psychologists during assessment or treatment "for drug dependency or any other condition or behaviour that may manifest itself in criminal conduct" (p. 47). Privilege is held by the client, regardless of their age, with the purpose of protecting the client (not the practitioner) from disclosure of private information in the context of a court or other judicial process. Therefore, only the client can make a decision to waive their right to legal privilege and no competing interests such as the public interest or a parent's viewpoint can be used to challenge it (although a judge has overriding discretion as to confidential information).

For the communication to be deemed privileged, the client must believe that the communication is necessary to enable the clinical psychologist to "examine, treat, or care for" them. When assessment or therapy is mandated by the court, no privilege exists. Privilege for the client is more likely to be granted if the following conditions (Wigmore Principles) are met:

• The communication must originate in a setting where it was revealed in confidence and the client assumed that it will not be disclosed.
• This element of confidentiality must be essential to the full and satisfactory maintenance of the relationship between parties.
• The relationship must be one which, in the opinion of the community, must be fostered, such as the professional standing of psychologists.
• The injury that would occur to the relationship by disclosure must be greater than the benefit that would be granted from the correct disclosure under litigation.

Confidentiality

The Code of Ethics provides guidelines on how confidentiality should be dealt with in therapeutic situations. Some of the Practice Implications listed under Principle 1.6 of the Code recommend that: 1.6.2. Psychologists explain clearly the measures they will take to protect confidentiality when engaged in services to, or research with, individuals, families, groups or organisations. Furthermore, psychologists convey to family, hapu/iwi organisations, and community members the responsibilities on them for the protection of each other's confidentiality. 1.6.3. Psychologists discuss with persons and organisations with whom they establish a research or professional relationship (a) the limits of confidentiality... and (b) the foreseeable uses of the information generated through their services/activities. 1.6.4. Psychologists seek to collect only that information which is germane to the purpose(s) for which informed consent has been obtained. 1.6.5. Psychologists record only that information necessary for the provision on continuous, coordinated service to a client, or for validating or identifying or identifying conclusions in a report, or for goals or the particular research study being conducted, or which is required by law. 1.6.6. Psychologists store, handle, transfer, and dispose of all records, both written and unwritten (e.g., computer files, video tapes) in a way that attends to needs for privacy and security. 1.6.9. Psychologists do not disclose personal information obtained from an individual, family, whanau or community group, or colleague without the informed consent of those who provided the information (subject to any limits to confidentiality)

Discretion to Disclose when Working with Children Child Abuse. Sometimes the law permits a psychologist discretion to disclose confidential information about a client. This is identified by the use of the word "may" rather than the mandatory "shall" or "must" as it relates to disclosure in relevant Acts.

Supervision

Jess McIvor advised us to advocate for weekly supervision rather than just fortnightly. She said that it is not therapy, so don't treat it as that. It is okay to talk about personal dynamics and how they impact on what is going on in therapy, however.