The Elements of Ethical Practice: Applied Psychology Ethics in Australia 9780367196332, 9780367187941, 9780429259319

Table of contents :
Cover
Half Title
Title
Copyright
Dedication
Contents
Acknowledgements
Contributor information
Part A Introductory information
Preface: Rationale for an Elements book on ethical case dilemmas
General ethical principles
Overview of ethics in Australian psychology
Part B Ethical dilemmas
I. Practice-focused ethical dilemmas
1 Sleepy drivers die: when a safety slogan is also an ethical concern
2 Competing agendas and the early career athlete: treatment of depression in the performance context
3 Maintaining a therapeutic relationship while developing advanced competence
II. Culture and diversity-focused ethical dilemmas
4 Working with interpreters while delivering trauma therapy
5 Cultural considerations in maintaining financial boundaries
6 Maintaining professional boundaries when both client and psychologist belong to a common sub-culture: being part of a sexual minority community
III. Impairment- and crisis-focused ethical dilemmas
7 The wounded healing others: a ticking ethics time bomb?
8 Ethical issues associated with competence and limits of confidentiality
9 Reporting considerations for psychologists: when treating health practitioners with possible impairment
10 An ethical response to disclosures of suicidal ideation or behaviour
IV. Family and relationship-focused ethical dilemmas
11 Confidentiality in domestic violence situations
12 Informed consent and confidentiality in relationship therapy
13 Confidentiality in the psychological treatment of self-harming adolescents
14 Client-therapist confidentiality in an independent school setting
V. Educational and professional representation-related ethical dilemmas
15 When being tidy requires follow-up in a university setting
16 The availability of discredited historical applied educational materials in psychology
17 The ethics of image management and collegiality
Index

Citation preview

The Elements of

Ethical Practice

The Elements of Ethical Practice: Applied Psychology Ethics in Australia is a comprehensive and applied guide to practising psychology in an ethical and professional manner. This book is designed to assist applicants for general registration as a psychologist successfully navigate one of the eight core competencies for general registration set by the Psychology Board of Australia; specifically ethical, legal, and professional matters. The exploration of ethical dilemmas is a core task for the 4+2 pathway to general registration, while related ethical applications require exploration in the 5+1 and higher education pathways to registration as well. This book will teach readers how to identify, explore, and choose the appropriate professional course of action when confronted by ethical dilemmas in practice. The chapters include personal reflections from expert contributors relating to each of the ethical dilemmas, expertly highlighting clients’ and stakeholders’ circumstances, ethical codes and guidelines, scholarship and research, as well as other key elements in the ethical decision-making process. Especially relevant to those applying to become a registered psychologist in Australia, this book offers invaluable guidance on responding to ethical dilemmas as required by the Psychology Board of Australia in various pathways to general registration. Nadine J. Pelling is a fellow of the Australian Counselling Association, clinical psychologist, and member of the Australian Psychological Society, as well as the College of Clinical Psychologists. She is employed full-time as a senior lecturer in clinical psychology and counselling at the University of South Australia in the School of Psychology, Social Work and Social Policy. Dr Pelling also maintains a small private practice in the southern suburbs of Adelaide where she lives with her daughter. This Elements book on ethical case dilemmas is Dr Pelling’s seventh edited book. Dr Pelling has also published numerous special journal issues and over 80 individual articles/book chapters. Lorelle J. Burton Professor Burton is the head of the School of Psychology at the University of Southern Queensland. Professor Burton has been an invited assessor for national teaching excellence awards and grants and has led numerous national collaborative research projects on student transition. She is an internationally recognised psychology educator, and her current research focus involves leading cross-community collaborations to promote community capacity building and wellbeing. Professor Burton was awarded the Distinguished Contribution to Teaching Award by the Australian Psychological Society in 2016.

The Elements of

Ethical Practice Applied Psychology Ethics in Australia Edited by Nadine J. Pelling and Lorelle J. Burton

First published 2019 by Routledge 2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN and by Routledge 52 Vanderbilt Avenue, New York, NY 10017 Routledge is an imprint of the Taylor & Francis Group, an informa business © 2019 selection and editorial matter, Nadine J. Pelling and Lorelle J. Burton; individual chapters, the contributors The rights of Nadine J. Pelling and Lorelle J. Burton to be identified as the authors of the editorial material, and of the authors for their individual chapters, has been asserted in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data A catalog record for this book has been requested ISBN: 978-0-367-19633-2 (hbk) ISBN: 978-0-367-18794-1 (pbk) ISBN: 978-0-429-25931-9 (ebk) Typeset in Bembo by Apex CoVantage, LLC

This work is dedicated to past, current, and future psychologists who endeavour to engage ethically and professionally in their work. Experience has taught us that ethical action is not always easily taken nor clearly identifiable. We understand and support your efforts to do your best for your clients and the profession.

Contents

Acknowledgements

x

Contributor information

xi

Part A Introductory information

1

Preface: Rationale for an Elements book on ethical case dilemmas

3

Nadine J. Pelling

General ethical principles

9

Nadine J. Pelling

Overview of ethics in Australian psychology

12

Nadine J. Pelling

Part B Ethical dilemmas

1

I. Practice-focused ethical dilemmas

39

Sleepy drivers die: when a safety slogan is also an ethical concern

41

Saul Gilbert, Kerry Maxfield, Michael Chia, Jillian Dorrian, Siobhan Banks and Kurt Lushington 2

Competing agendas and the early career athlete: treatment of depression in the performance context

58

John Baranoff and Kate Hall 3

Maintaining a therapeutic relationship while developing advanced competence William Hough

70

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Contents

4

II. Culture and diversity-focused ethical dilemmas

79

Working with interpreters while delivering trauma therapy

81

Ekaterina Orozco 5

Cultural considerations in maintaining financial boundaries

93

Celine Leslie 6

Maintaining professional boundaries when both client and psychologist belong to a common sub-culture: being part of a sexual minority community

105

Stephanie Webb

7

III. Impairment- and crisis-focused ethical dilemmas

115

The wounded healing others: a ticking ethics time bomb?

117

Paul D. Kremer and Mark A. Symmons 8

Ethical issues associated with competence and limits of confidentiality

131

Bianca Denny 9

Reporting considerations for psychologists: when treating health practitioners with possible impairment

140

Paige Knott 10

An ethical response to disclosures of suicidal ideation or behaviour

155

Helen M. Stallman

11

IV. Family and relationship-focused ethical dilemmas

167

Confidentiality in domestic violence situations

169

Ruby Z. Basocak and Lisa J. Warren 12

Informed consent and confidentiality in relationship therapy

180

Alexis Wheeler 13

Confidentiality in the psychological treatment of self-harming adolescents Lauren Frensham

191

Contents 14

Client-therapist confidentiality in an independent school setting

203

Adele Murphy and Timothy Upsdell

15

V. E  ducational and professional representation-related ethical dilemmas

209

When being tidy requires follow-up in a university setting

211

Nadine J. Pelling 16

The availability of discredited historical applied educational materials in psychology

219

Travis Gee and Nadine J. Pelling 17

The ethics of image management and collegiality

226

Nadine J. Pelling

Index

233

ix

Acknowledgements

Nadine J. Pelling and Lorelle J. Burton wish to acknowledge their families for their support during the preparation of this book. Specifically, Nadine wishes to thank Jasmine Pelling-Schweis for her patience throughout the editing progress. Nadine also wishes to acknowledge her 2017 Clinical Psychology Professional Practice and Ethics class at the University of South Australia for their lively discussion and engagement with ethical matters, some of which are presented in this book.

Disclaimer The regulation of applied psychological practice in Australia is subject to regular reviews. As a result, changes and updates to various standards and regulations can occur. While accurate at the time of printing, readers are encouraged to visit the Psychology Board of Australia and the Australian Health Practitioner Regulation Agency webpages regularly to check for updates. This book does not constitute legal or ethical advice. When confronted by an ethical dilemma, practitioners are encouraged to read their relevant code of ethics, gain legal advice, consult with their indemnity insurers, and consult with a senior colleague and/or their professional association. The editors wish to acknowledge that the chapter “Ethics in Australian Psychology: An Overview” is an updated version of Chapter 2: “Ethics” in Pelling and Burton’s 2017 The Elements of Applied Psychological Practice in Australia: Preparing for the National Psychology Examination.

Contributor information

Editors Nadine J. Pelling Dr Pelling is a fellow of the Australian Counselling Association, clinical psychologist, and member of the Australian Psychological Society as well as the College of Clinical Psychologists. She is employed full-time as a senior lecturer in clinical psychology and counselling at the University of South Australia in the School of Psychology, Social Work and Social Policy. Dr Pelling also maintains a small private practice in the southern suburbs of Adelaide where she lives with her daughter. This Elements book on ethical case dilemmas is Dr Pelling’s seventh edited book. Dr Pelling has also published numerous special journal issues and over 80 individual articles/book chapters. Lorelle J. Burton Professor Burton is the head of the School of Psychology at the University of Southern Queensland. Professor Burton has been an invited assessor for national teaching excellence awards and grants and has led numerous national collaborative research projects on student transition. She is an internationally recognised psychology educator, and her current research focus involves leading cross-community collaborations to promote community capacity building and wellbeing. Professor Burton was awarded the Distinguished Contribution to Teaching Award by the Australian Psychological Society in 2016. Both Dr Pelling and Professor Burton are former recipients of the Pearson Education Australia/Australian Psychological Society Early Career Teaching Award.

Part A: Introductory information OO

Preface: Rationale for an Elements book on ethical case dilemmas – Nadine J. Pelling

OO

General ethical principles – Nadine J. Pelling

OO

Overview of ethics in Australian psychology – Nadine J. Pelling

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Contributor information

Part B: Ethical dilemmas Siobhan Banks Associate Professor Banks is co-director of the BehaviourBrain-Body Research Centre at the University of South Australia. Siobhan’s research examines the impact of sleep deprivation and shift work on psychological and physiological functioning and how countermeasures may be used to prevent the deleterious effects of disturbed sleep, in particular dietary interventions, napping, and caffeine. She has expertise in the objective measurement of fatigue and with designing tools and protocols to investigate the biological and behavioural responses to sleep deprivation, irregular work hours, and stress. She is on the editorial board of the specialty journal SLEEP, has been awarded a South Australian Young Tall Poppy Science Award and the Sleep Research Society Young Investigator Award, and she also serves on the Sleep Health Foundation Board of Directors. John Baranoff Dr Baranoff is team manager/senior clinical psychologist at the Centre for Anxiety and Depression, South Australia, and senior clinical lecturer at The University of Adelaide. He has over 15 years of experience as a psychologist in both private and public settings. Prior to his current role, he was a member of the Performance Psychology Unit at the Australian Institute of Sport and a psychology consultant for the AFL Players’ Association. John is involved in research in the areas of adjustment to athletic injury, pain, performance anxiety, and the treatment of depression. Ruby Z. Basocak Ms Basocak is a registered psychologist at Code Black Threat Management, working in the forensic setting. She has a special interest and experience working in the area of family violence, stalking, and harassment. She also has experience working in the school context with children and adolescents with a range of emotional and behavioural difficulties. Ruby earned a dual master’s degree from The Cairnmillar Institute (Master of Professional Psychology/Master of Professional Psychology Practice). Michael Chia Dr Chia is currently a visiting consultant physician in the Departments of General and Thoracic Medicine at The Royal Adelaide Hospital. He completed his internship and postgraduate studies at the Royal Adelaide Hospital and spent three years in the United States of America for his postfellowship training, first at NIH then University of Texas in Dallas. He has 30 years of experience in Sleep Medicine and started the Burnside Sleep Centre in 1996. He spent time as a visiting specialist at the Repatriation Hospital, Daw Park, working with Professor Douglas Mc Evoy and is affiliated with Sleep SA at the North Eastern Community Hospital, Campbelltown. Bianca Denny Dr Denny is a clinical psychologist and principal psychologist at Greenview Psychology (Melbourne, Australia). Her clinical and research interests broadly encompass health and clinical psychology, psychological

Contributor information

distress in the context of acute and chronic illness, supervision, and training and wellbeing of health professionals. Jillian Dorrian Associate Professor Dorrian is Co-Director of the BehaviourBrain-Body Research Centre (BBB) at the University of South Australia. She has a PhD in Psychology and a Master of Biostatistics. Her primary research experience is in human sleep, biological rhythms, and performance. She works primarily with the Australian Healthcare and Rail and Industries investigating fatigue, workload, operational performance, safety, and health. She also works with mining, construction, and manufacturing, providing research and education to promote fatigue management, worker health, and safety. Jillian has written over 100 peer-reviewed journal articles and book chapters, and is heavily involved with research student supervision and training in publishing and other forms of research communication. She has been recognised by the Australian Graduate Research Council for her excellence in graduate research supervision. Lauren Frensham Dr Frensham is a Master of Psychology (Clinical) student at the University of South Australia. Lauren has a Bachelor of Psychology (Hons) and a PhD in Health Science from the University of South Australia. Lauren’s PhD evaluated the feasibility and effectiveness of an online tool designed to improve physical activity and nutrition behaviours among cancer survivors living in rural South Australia. During her PhD candidature Lauren was awarded the Maurice de Rohan International Travel Scholarship, which provided her the opportunity to advance her research through visiting research groups in America. Lauren is extremely passionate about helping people live healthier lives by bringing evidence-based research to life. Travis Gee Dr Gee is a psychologist in private practice in the Brisbane area. He has lectured in various areas of psychology at several Canadian and Australian universities, and worked in epidemiology and health psychology at Ottawa University and the University of Queensland. He is a member of the Executive Board of the Australian Counselling Association. Outside of assisting people with a broad range of psychological problems, he also takes on psycholegal work that falls within his areas of expertise. Saul Gilbert Dr Gilbert is an adjunct research associate at the University of South Australia and the Principal Sleep Scientist and Laboratory Manager at Sleep SA, a private clinical sleep laboratory located at the North Eastern Community Hospital in Adelaide. He completed his PhD in Human Sleep and Circadian Physiology at the University of South Australia and has published his research findings in prestigious international journals including both the Journal of Physiology and the American Journal of Physiology. Kate Hall Dr Hall is a clinical psychologist, DPsych (Clinical), and a member of the Australian Psychological Society and the College of Clinical Psychologists. Kate is an experienced clinician and academic who has specialised in the

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treatment of substance use and mental health issues for more than 17 years. She is a senior lecturer in Addiction and Mental Health at Deakin University and leads the treatment stream for Deakin University’s Centre for Drug use, Addictive and Anti-social behaviour Research (CEDAAR). She is a clinical researcher whose current research involves the development of psychological interventions for disadvantaged young people that reduce emotion dysregulation. She runs a private clinical psychology practice in Melbourne, Australia. William Hough Dr Hough is a senior clinical psychologist employed in the mental health services of South Australia. He also has a part-time private practice where he specialises in the treatment of mental disorders and in particular PTSD. He has had a long history of employment in acute hospital settings and thus brings a great deal of clinical experience to his practice. William has published in the field and worked as a guest lecturer at university, and his PhD thesis was concerned with the aetiology of PTSD and the bidirectional relationship between trauma and sensitisation. Paige Knott Ms Knott is a provisional psychologist, currently completing a Master of Psychology (Clinical) at the University of South Australia. Paige has a Bachelor of Psychology (Hons) from the University of South Australia and has over six years of experience working in various roles within non-government mental health services. Paul D. Kremer Dr Kremer holds almost 10 years in professional practice working with a diverse range of clients, including industry professionals. More recently however, Dr Kremer is involved in research with several affiliations at universities in Australia and New Zealand, including the University of Melbourne, Monash, Deakin, and the universities of Canterbury and Victoria in New Zealand. Celine Leslie Ms Leslie is a provisional psychologist who is completing her Master of Psychology (Clinical) at University of South Australia. Kurt Lushington Professor Lushington is the head of the School of Psychology, Social Work and Social Policy at the University of South Australia. Kurt completed his Master of Psychology (Clinical) and PhD at Flinders University of South Australia in 1998. His thesis examined the age-related decline in the pineal hormone melatonin as an explanation for sleep maintenance insomnia in the aged. He has since written extensively on all aspects to do with sleep and its disorders with 120+ peer-reviewed publications. He has a keen interest in promoting sleep science and the treatments of sleep disorders using psychologybased interventions. Kerry Maxfield Ms Maxfield is a lecturer at the University of South Australia, School of Psychology, Social Work and Social Policy. Kerry has presented at educational conferences on her teaching and learning initiatives in regard to

Contributor information

social justice and social workers within court settings. Kerry is an admitted barrister and solicitor to the Supreme Court of SA and her Bachelor of Laws is from The University of Adelaide. Prior to being admitted to the Law Bar she had extensive experience as a senior social worker in mental health, worked overseas at the American University in Cairo, Egypt, child protection services in the State of Hawaii, USA, and with refugees in Thailand. Adele Murphy Ms Murphy works as a provisional psychologist at Aspect Treetop School and is undertaking her internship at Fleurieu Psychology Services under the supervision of Tim Upsdell. Adele completed her BA (Psychology and Counselling) at Edith Cowan University in 2013 and completed her BA Psychology (Hons) at Flinders University in 2016. She is the lead researcher in a team currently evaluating the efficacy of the What’s the Buzz? social skills program. Her primary area of interest is working with children involving behavioural issues, Autism Spectrum Disorder, and anxiety, and collaborating with families to ensure they have the appropriate support. Ekaterina Orozco Ms Orozco is a clinical psychologist working within a specialist refugee health clinic in South Australia. She works primarily with the assistance of interpreters to deliver psychological assessment and therapy. She has previous experience in a number of government and private settings, including inpatient and community mental health services. She also has several years of experience in providing counselling to survivors of torture and trauma from refugee and asylum seeker backgrounds. Helen M. Stallman Dr Stallman is a clinical psychologist, The Hospital Research Foundation Fellow, and senior lecturer at the University of South Australia. She has significant experience in the development, evaluation, and dissemination of clinical interventions to improve health and wellbeing. Dr Stallman has authored 60 peer-reviewed publications, and the quality and impact of her work has been recognised by numerous awards. Mark A. Symmons Dr Symmons has co-authored more than 100 research outputs across a wide range of psychology-related fields. Since completing a PhD in 2005 he has occupied roles as psychology academic, research fellow, project manager, and research coordinator. His practical clinical experience is primarily derived from a stint as a volunteer Lifeline telephone counsellor. Timothy Upsdell Mr Upsdell is the principal psychologist of a growing practice in the South of Adelaide and the Fleurieu Peninsular in South Australia. His academic qualifications include a Master of Psychology (Clinical) and a Master of Psychology (Organisational), and he is endorsed by the Psychology Board of Australia in Clinical and Organisational Psychology. The thesis submitted for the degree of Master of Psychology (Clinical) was titled “Australian Internet-based psychological counselling services – an examination of ethical

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guidelines and practice.” He has supervised a number of provisional psychologists for registration. Lisa J. Warren Dr Warren (clinical/forensic psychologist) is a pioneer of the behavioural threat management field in Australia. This is an internationally recognised field of expertise in the evaluation of those who persistently perpetrate aggression, sexual harms, and social media harms. She was the foundation president of the Asia Pacific Association of Threat Assessment Professionals (APATAP) and is a senior editor for the Journal of Threat Assessment and Management. Her research in this field has focused on clinical and risk evaluation of those who threaten to kill themselves and others. Dr Warren is the current chair of the Australian Psychological Society’s Ethics Committee. Stephanie Webb Dr Webb is a provisional psychologist, with a degree in psychology and counselling, and over four years of experience working within mental health services in Australia as a support worker. Stephanie is currently a lecturer at the University of South Australia, coordinating undergraduate psychology courses. Stephanie earned a BPsych (Honours) and a PhD in Psychology from the University of South Australia. Alexis Wheeler Dr Wheeler is a provisional psychologist and research assistant. Her research experience includes working in a variety of settings, such as psychology outpatient clinics, hospitals, and universities. Alexis obtained her PhD from The University of Adelaide, specialising in co-morbid mental health and medical conditions, and has published articles in psychological, psychiatric, and medical journals. Alexis is also a supervisor to psychology honours students and peer-reviews both psychology honours and master’s theses.

Part A

Introductory information

Preface Rationale for an Elements book on ethical case dilemmas Nadine J. Pelling

National regulation National regulation of psychologists in Australia, the General Registration standard, took effect on 1 July 2010, pursuant to the Health Practitioner Regulation National Law (Australian Health Practitioner Regulation Agency, 2018). Recently the general and provisional registration standards were changed, basically streamlining the number of internship hours required (Psychology Board of Australia, 2016, 2017c). Readers interested in the process and application of the National Law relating to psychology are referred to the Board for additional information (Australian Health Practitioner Regulation Agency, 2018). Similarly, readers interested in broad information regarding the nature of psychology education and regulation in Australia are referred to Kavanagh (2015). Ultimately, the goal of the General Registration standard is to protect the public by ensuring that psychologists can demonstrate an appropriate level of professional knowledge and competence for applied practice. Basically, the General Registration standard indicates that to become eligible for registration as a psychologist an applicant is generally required to have completed a four-year undergraduate sequence of study in psychology (such as a bachelor’s degree with honours) followed by at least two years of practical experience as a registered provisional psychologist. The practical experience is often obtained by undertaking an approved postgraduate degree accredited at fifth- and sixth-year level (such as a two year master’s degree) or higher (such as a three- or four-year doctorate degree). However, some individuals choose to obtain the required practical experience by completing a 4 + 2 or a 5 + 1 internship program. Thus, there are currently various pathways available for becoming a registered psychologist in Australia. The different pathways to becoming a psychologist all involve a six-year sequence, but the nature of the two years of practical experience is different for different pathways (Psychology Board of Australia, 2013, 2017a, 2017b). The different pathways to registration entail different requirements. For instance, those taking the 4 + 2 or the 5 + 1 pathways are to submit four case

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reports (two assessment and two intervention) or two case reports (one assessment and one intervention) to the Board, respectively (Psychology Board of Australia, 2013, 2017a, 2017b). Those completing assessments, assignments, and essays in master’s or doctorate programs are assumed to have at least the equivalent to the 4 + 2 and 5 + 1 case report requirements and thus are not currently required to submit same to the Board. Similarly, on 1 July 2013 the National Psychology Examination (NPE) became a requirement for most seeking General Registration as a psychologist. Currently those completing their pathway to registration via a master’s or doctoral degree are exempt from taking the NPE, although this exemption is due to expire on 31 December 2019, extended from 1 July 2019 by the Board (Psychology Board of Australia, 2018a). Readers interested in information regarding case report writing and/or studying for the NPE are referred to Pelling and Burton (2017, 2018, in press).

Core competencies Despite the different requirements outlined for each pathway to registration, there is a set of common competencies required for all psychologists (Psychology Board of Australia, 2016): OO

Knowledge of the discipline

OO

Ethical, legal, and professional matters

OO

Psychological assessment and measurement

OO

Intervention strategies

OO

Research and evaluation

OO

Communication and interpersonal relationships

OO

Working with people from diverse groups (what was previously referred to as working in a cross-cultural context; Psychology Board of Australia, 2013, 2017a)

OO

Practice across the lifespan

Ethical, legal, and professional matters Ethical, legal, and professional matters are considered core competencies for registration, and this includes those completing a 4 + 2 or 5 + 1 program towards registration (Psychology Board of Australia, 2013, 2016, 2017a, 2017b, 2017c). Individuals seeking registration via the 4 + 2 or 5 + 1 route are required to demonstrate competence in ethical, legal, and professional matters. All provisional psychologists must be observed as participating in ethical practice. Furthermore, supervisors for the 4 + 2 pathway must review three short written or oral reports by the provisional psychologist on specific ethical dilemmas

Preface

during their first year, preferably the first six months, of the internship (Psychology Board of Australia, 2017b).Whether the 5 + 1 internship program will require similar ethical dilemma-focused written or oral reports after the Board reviews the guidelines for the 5 + 1 internship program remains to be seen. This 5 + 1 internship program review is to occur soon (Psychology Board of Australia, 2017a). Thankfully, the Board has a user-friendly website providing valuable information to those interested in registration and related standards (www. psychologyboard.gov.au). It is recommended that readers visit the Board’s website often to explore notices and gain current information regarding the regulation of applied psychology in Australia. Indeed, it is important to keep up to date with registration requirement changes as a provisional or general psychologist as well as an approved supervisor. Currently changes are afoot regarding pathways to registration with the Board seeking public consultation (opportunities to comment on the proposal closed on 1 June 2018) on reducing regulatory burden by retiring the 4 + 2 internship pathway to General Registration (Psychology Board of Australia, 2018b). The Board has guidelines regarding the ethical dilemma tasks for the 4 + 2 pathway and provides a template for summarising the ethical dilemma tasks completed (Psychology Board of Australia, 2017b, 2017d). Specifically, each presentation or report should: OO

Describe a different ethical dilemma and summarise their response

OO

Focus on at least two different age groups

OO

Where possible include a client from a different cultural background

OO

Be approximately 500–1000 words in length if written

OO

Address: {{The

client problem

{{The

nature of the dilemma or conflict

{{The

specific aspects of the situation that raised issues

{{The

ethical principles that were relevant to those aspects

{{How

ethical principles were applied in the situation

Exploring ethical dilemmas It is the exploration of various ethical dilemmas involving different client difficulties and ages, and diverse groups/cultural backgrounds that the present Elements book has as its focus. A variety of provisional psychologists, generally registered and endorsed psychologists, and university academics involved in applied work were thus asked to put into writing an ethical dilemma and then examine same. Contributors were asked to write about a real de-identified

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client ethical dilemma with client approval, a composite case involving real client detail gleaned from numerous clients but not illustrative of any one individual person or situation, or a created case for illustration purposes. Contributors were to provide background information on the dilemma, relevant ethical standards and scholarship to the dilemma, explore options for dealing or resolving the dilemma, and a personal reflection on the dilemma given that working with ethical dilemmas can be emotionally confronting and challenging. Contributors were asked to keep submissions relatively short and follow a standard format. The format used for presenting the ethical dilemmas was designed to help the reader explore their thoughts and approach ethical dilemmas in a measured manner, including self-reflection.Thus, you will note that each ethical dilemma contains: OO

A succinct statement identifying the ethical dilemma

OO

Background relevant to the ethical dilemma

OO

Identification of the basic ethical principles involved

OO

Identification of the Australian Psychological Society (APS) Code of Ethics (2007) as relevant to the dilemma

OO

Progression through an ethical decision-making model, including an identification of scholarship germane to the ethical dilemma

OO

Personal reflection

OO

Details statement identifying if the dilemma presented was de-identified and used with client permission, a composite example, or a created example

The ethical dilemmas chosen for inclusion in this Elements book can be placed into five main categories: (1) ethical dilemmas involving a practice focus (sleep apnoea, sports psychology, and posttraumatic stress treatment); (2) culture and diversity-focused ethical dilemmas (interpreter use, cultural financial boundaries, and sexual minority sub-culture boundaries); (3) impairment- and crisis-related dilemmas (being a wounded healer, competence and confidentiality, impaired practitioners, and responding ethically to suicidal disclosures); (4) family and relationship associated dilemmas (domestic violence, relationship therapy, self-harming adolescents, and school settings); as well as (5) educational and professional representation matters (university care of students, historical discredited applied educational materials, and professional image management). We hope that reading and exploring the ethical dilemmas presented will help develop your ability to identify, explore, and choose appropriately a professional course of action when confronted by similar dilemmas. Moreover, we hope that the standard presentation relating to each dilemma assists in the development of a professional approach to ethical matters that considers client/s and stakeholders,

Preface

circumstances, ethical codes and guidelines, scholarship, and other relevant items in one’s ethical decision-making as a matter of course. The inclusion of a personal reflection by contributors relating to the ethical dilemma was to highlight and honour the fact that ethical challenges and dilemmas can be confronting and emotional events. We thus hope you enjoy and find illuminating your journey through the various ethical dilemmas presented.

References Australian Health Practitioner Regulation Agency. (2018). Legislation. Melbourne, Australia: Author. Retrieved from www.ahpra.gov.au/AboutAHPRA/What-We-Do/Legislation.aspx Australian Psychological Society. (2007). Code of Ethics. Melbourne, Australia: Author. Kavanagh, P. (2015). Psychology regulation, education, and representation in Australia. In N. J. Pelling (Ed.), Special Issue: Mental Health in Australia. International Journal of Mental Health, 44(1–2), 4–10. Pelling, N. J., & Burton, L. J. (Eds.). (2017). The elements of applied psychological practice in Australia. Oxon, UK: Routledge. Pelling, N. J., & Burton, L. J. (Eds.). (2018). The elements of psychological case report writing in Australia. Oxon, UK: Routledge. Pelling, N. J., & Burton, L. J. (in press). The elements of applied psychological practice in Australia (2nd ed.). Oxon, UK: Routledge. Psychology Board of Australia. (2013, December 16). Guidelines for the 5 + 1 internship program. Melbourne, Australia: Author. Retrieved from www. psychologyboard.gov.au/Standards-and-Guidelines/Codes-GuidelinesPolicies.aspx Psychology Board of Australia. (2016, May 2). Registration standard: General Registration Melbourne, Australia: Author. Retrieved from www.psychology board.gov.au/standards-and-guidelines/registration-standards.aspx Psychology Board of Australia. (2017a, June 6). Fact sheet for the 5 + 1 internship program. Melbourne, Australia: Author. Retrieved from www.psychology board.gov.au/Standards-and-Guidelines/FAQ.aspx Psychology Board of Australia. (2017b, July 14). Guidelines for the 4 + 2 internship program. Melbourne, Australia: Author. Retrieved from www.psychology board.gov.au/Standards-and-Guidelines/Codes-Guidelines-Policies.aspx Psychology Board of Australia. (2017c, June 1). Registration standard: Provisional registration. Melbourne, Australia: Author. Retrieved from www.psychology board.gov.au/standards-and-guidelines/registration-standards.aspx Psychology Board of Australia. (2017d). Summary of ethical dilemma tasks for the 4:2 internship program. Melbourne, Australia: Author. Retrieved from www. psychologyboard.gov.au/Search.aspx?q=summary+of+ethical+dilemma+ tasks

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The Psychology Board of Australia. (2018a, August 10). Extension of the higher degree exemption from sitting the national psychology exam. Melbourne, Australia: Author. Retrieved from www.psychologyboard.gov.au/News/2018-08-10exemption-of-higher-degree.aspx The Psychology Board of Australia. (2018b, March 30). Reducing regulatory burden: Retiring the 4 + 2 internship pathway to general registration. Melbourne, Australia: Author. Retrieved from www.psychologyboard.gov.au/Search. aspx?q=retiring+4%2b2

General ethical principles Nadine J. Pelling

Helping professions The helping professions consist of psychology, counselling, social work, nursing, mediation, and others. Some of these helping professions are regulated legally in Australia nationally by legislation and thus fall under the auspices of the Australian Health Practitioner Regulation Agency (AHPRA). For instance, both psychology and nursing are regulated by their relevant practitioner boards under AHPRA. Other helping professions are self-regulated or voluntarily regulated via membership with a professional representing body. For social work, this involves the Australian Association of Social Workers. For mediators, this involves the Australian Mediation Association and the Resolution Institute. Similarly, in Australia, counselling is voluntarily regulated and has two main associations purporting to represent counsellors: The Australian Counselling Association and the Psychotherapy and Counselling Federation of Australia.

Ethical codes Most helping professions in Australia, including those that are voluntarily regulated, have their own ethical code or code of conduct (Australian Association of Social Workers, 2010; Australian Counselling Association, 2015; Psychotherapy and Counselling Federation of Australia, 2017; Australian Psychological Society, 2007). Indeed, even unregulated health and community services practitioners can be required to adhere to a code of conduct, if they practise in Australia where a Health and Community Services Complaints Commissioner (HCSCC, 2018) is active. There are differences in detail and presentation for each of the ethical codes available to professionals in Australia. Certainly, there are differences in how even specific professions, including psychology, conduct their applied work across countries. For example, the American Psychological Association’s (2017) Code of Ethics is specific to work in the United States. Some international standards exist as well. Specifically, the International Union of Psychological Science had their Universal Declaration of Ethical Principles for Psychologists

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adopted by the Assembly of the International Union of Psychological Science in Berlin on July 22nd, 2008, and the Board of Directors of the International Association of Applied Psychology in Berlin on July 26, 2008 (International Union of Psychological Science, 2008). Regardless of the geographical context, generally the focus of psychology ethics is on promoting optimal ethical behaviour, encouraging reflection and decision-making, and to discourage unethical behaviour (Pettifor, 1996).

Ethical principles Ethical codes tend to be organised, or grouped, into common principles. Groupings, however, differ from ethical code to ethical code. The codes of ethics for the International Union of Psychological Science (2008) and the Australian Psychological Society (2007) are good examples of this differential, variation in, grouping. The International Union of Psychological Science (2008) focuses upon four principles: 1 Respect for the dignity of persons and peoples 2 Competent caring for the well-being of persons and peoples 3 Integrity 4 Professional and scientific responsibilities to society The Australian Psychological Society (2007) focuses upon three general principles: A Respect for the rights and dignity of people and peoples B Propriety C Integrity

Common principles Regardless of the grouping used, there tends to be five common principles (which can be defined as rules of action or conduct or fundamental doctrines) across almost all ethical codes. The five common ethical principles are (Frankcom, Stevens, & Watts, 2016; Kitchener, 1984): 1 Autonomy (take responsibility for one’s own behaviour and allow others to do the same; this principle relates to the concept of independence) 2 Non-maleficence (do not inflict harm intentionally; do/prevent/minimise harm) 3 Beneficence (do good/promote wellbeing) 4 Justice (fair and equal) 5 Fidelity (honesty/integrity)

General ethical principles

These five common ethical principles guide professional work and as a result safeguard client wellbeing. Unfortunately, there are times when these five ethical principles may conflict with each other or with what is happening in applied practice. When such a conflict occurs, we consider it an ethical dilemma that needs to be carefully processed and addressed in a professional manner. When ethics are violated, a complaint can be made against a practitioner. When harm has been proven to occur to the client involved because of the conduct, possible legal action against the practitioner may result (Pelling, 2019).These five ethical principles, along with the ethical code for psychologists in Australia published by the Australian Psychological Society (2007), are used in the present Elements book in the examination of psychological ethical dilemmas.

References American Psychological Association. (2017). Ethical principles of psychologists and code of conduct (2002, Amended June 1, 2010 and January 1, 2017). Retrieved from www.apa.org/ethics/code/ethics-code-2017.pdf Australian Association of Social Workers. (2010). Code of ethics. Canberra, ACT: Author. Australian Counselling Association. (2015). Code of ethics and practice. Newmarket, Australia: Author. Australian Psychological Society. (2007). Code of Ethics. Melbourne, Australia: Author. Frankcom, K., Stevens, B., & Watts, P. (2016). Fit to practice. Samford Valley, Australia: Australian Academic Press. Health and Community Services Complaints Commissioner. (2018). Information about the code of conduct for unregistered health practitioners. Retrieved from www.hcscc.sa.gov.au/information-code-conduct-unregistered-healthpractitioners/ International Union of Psychological Science. (2008). Universal declaration of ethical principles for psychologists. Retrieved from www.iupsys.net/about/ governance/universal-declaration-of-ethical-principles-for-psychologists .html Kitchener, K. S. (1984). Intuition, critical evaluation and ethical principles: The foundation for ethical decisions in counseling psychology. Counseling Psychologist, 12(3), 43–55. Pelling, N. J. (2019). Ethics [Call out boxed feature]. In L. J. Burton, D.Westen, & R. Kowalski (Authors), Psychology: 5th Australian and New Zealand edition. Milton, Australia: John Wiley & Sons. Pettifor, J. L. (1996). Ethics: Virtue and politics in the science and practice of psychology. Canadian Psychology, 37, 1–12. Psychotherapy and Counselling Federation of Australia. (2017). PACFA code of ethics. Melbourne, Australia: Author.

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Overview of ethics in Australian psychology Nadine J. Pelling

Psychology regulation in Australia The Psychology Board of Australia (the Board) expects all registered psychologists (general and provisional) to be familiar with how legal, ethical, and professional conduct ideals are applied to psychological practice. As a result, psychologists are expected to be familiar with relevant legislation as well as the standards, policies, and guidelines of the Board (Psychology Board of Australia, 2018g). Similarly, psychologists must be familiar with the adopted code of ethics for the profession and conversant with general professional conduct (Australian Psychological Society, 2007; Psychology Board of Australia, 2018b). Each of these will now be explored in turn. Please be aware, however, the standards, policies, and guidelines undergo regular review and at times update. As a result, readers are referred to both the Psychology Board of Australia (www.psychologyboard.gov.au) and Australian psychological Society (www.psychology.org.au) websites for a listing of retired as well as current standards, policies, and guidelines impacting practice.

Legal conduct Psychologists need to be aware of the Health Practitioner Regulation National Law as well as the standards and policies of the Board. The Board also publishes guidelines to help clarify expectations regarding psychologist conduct.

Legislation National legislation Under the Health Practitioner Regulation National Law which came into effect on 1 July 2010, a number of national boards were established to regulate health professions in Australia (Health Practitioner Regulation, 2010).The Psychology Board of Australia is one such board (Australian Health Practitioner Regulation Agency, 2018). The Board registers psychologists and provisional

Ethics in Australian psychology

psychologists; develops standards, codes, and guidelines; handles notifications, complaints, and investigations as well as disciplinary hearings; assesses overseas trained practitioners for practice in Australia; and approves accreditation standards and accredited courses of study (Psychology Board of Australia, 2018a). The Australian Health Practitioner Regulation Agency (AHPRA) supports the Board in its functions (Australian Health Practitioner Regulation Agency, 2018). The National Law as it applies to psychologists in various states can be found through AHPRA’s website. One such example is the application of the National Law in South Australia (Health Practitioner Regulation, 2010). The National Law sets out regulations concerning the use of specialist titles, eligibility for registration, and notification processes. Psychologists need to be aware of the National Law under which they practise. A number of psychology regional boards have been established to enable local and timely responses to concerns (Psychology Board of Australia, 2018a).

Additional national, state, and territory legislation The Health Practitioner Regulation National Law is not the only legislation with which psychologists need to be familiar. Psychologists also need to know about other relevant national, state, and territory legislation as well as principles of best practice. Areas in need of review may include legislation relating to: privacy, freedom of information, and the maintenance of health records; antidiscrimination and equal opportunity; mental health care; principles involved in the duty to protect and report abuse or neglect; working with children and adolescents; workers’ compensation/return to work; disability services; and victims of crime (Psychology Board of Australia, 2018g). Of special interest may be the 1988 Privacy Act (1988) (Cth), section 16A, Item 1 which states a Permitted General Situation provides an exception to the Australian Privacy Principles and allows disclosure of client information under certain circumstances (Privacy Act, 1988). Situations which meet the criteria for allowable disclosures are listed in sections 16A and 16B of the Privacy Act. Specifically, the Australian Privacy Principles indicate that a psychologist may break confidentiality if a psychologist: Reasonably believes that the collection, use or disclosure is necessary to lessen or prevent a serious threat to the life, health or safety of any individual, or to public health or safety. The threat does not have to be immediate or specified for information to be disclosed. (Privacy Act, 1988)

Board standards The Board notes that psychologists have an obligation to be familiar with and adhere to the Board’s registration standards (Psychology Board of Australia, 2018g).

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These standards include the continuing professional development (CPD; Psychology Board of Australia, 2015a, 2015d); criminal history (Psychology Board of Australia, 2015b); English language skills (Psychology Board of Australia, 2015c); general (Psychology Board of Australia, 2016c); professional indemnity insurance (Psychology Board of Australia, 2012c); provisional (Psychology Board of Australia, 2017c); recency of practice (Psychology Board of Australia, 2016e, 2016f); and area of practice endorsements standards (Psychology Board of Australia, 2011a, 2011b). Psychologists must refer to the Board’s website regularly as updates to standards are published when changes are made. For instance, while this manuscript was being created the Board finished collecting responses to their communication regarding plans to streamline pathways to registration and thus internationalise psychology in Australia, by retiring the 4 + 2 internship program and will soon note the results regarding same and any possible impact on said internship program (Psychology Board of Australia, 2016b, 2018b). There are penalties for not adhering to the standards, and psychologists can be audited to ensure their compliance with various standards. While it is not possible to summarise each of the standards here it may be helpful to note some highlights from the standards. Thus, some key items from the standards are noted as follows: OO

Continuing professional development – Psychologists have a responsibility to ensure that their knowledge and skills are not only maintained but improved and extended throughout their careers. All registered psychologists except those with provisional or non-practising registration must comply with this standard. A learning plan based on a skills and knowledge self-assessment identifying areas for development needs to be conducted. Learning objectives are then set and one is to engage in a minimum of 30 hours of continuing professional development (CPD) activities meeting your individual requirements annually. One must gain the full amount of CPD even if they work part-time versus full-time. If one is not registered for an entire year the amount of CPD required is adjusted on a pro rata basis resulting in 2.5 hours of CPD for every full month one is holding general registration. A minimum of 10 of these hours, or one third of the pro rata CPD, must be peer consultation, and the CPD is to be directly related to ensuring quality of practice (broadly defined). Psychologists must maintain an up-to-date CPD portfolio including their learning plan, CPD log, written reflections, and associated receipts and keep this for five years in case of audit (Psychology Board of Australia, 2015a, 2015d). Learning plans identify learning needs and activities designed to meet such needs, have plans and time lines for meeting said needs, and outline the outcomes anticipated and achieved. Finally, those with area of practice endorsements must focus a portion of their CPD on their specific area/s of endorsement (Psychology Board of Australia, 2015a, 2015d).There are many sources of CPD. One can

Ethics in Australian psychology

even focus on the development of their ethical and clinical understandings through online development offered by Mental Health Professional Online Development (MHPOD) which offers modules on professional ethics, healthcare research, human rights, confidentiality and practice, and legislation as well as applied topics such as strategies for working with people at risk of suicide (Mental Health Professional Online Development, 2018). OO

Criminal history – The Board will determine based on 10 factors (including the nature and gravity of the offence/alleged offence to health practice and the likelihood of future threat to a patient) the relevance of a health practitioner’s criminal history to the practise of their profession (Psychology Board of Australia, 2015b).

OO

English language skills – Internationally qualified applicants, and those who did not complete secondary education in English, must demonstrate they have proficiency in the English language for registration. Certain exemptions exist to the English language standard. For instance, in some situations exemptions are applied to non-practising registration or undertake research involving limited patient contact (Psychology Board of Australia, 2015c).

OO

Professional indemnity insurance – Psychologists are required to hold professional indemnity insurance at a minimum $2 million level for any one claim. Appropriate run-off and retroactive cover for previous practice is needed for those who are not currently practicing but have previously (Psychology Board of Australia, 2012c, 2012a, 2012c). One must be covered for volunteer as well as paid work. One may be covered by individual, group cover provided by an employer/union/membership, or educational institution provided insurance. Individual psychologists must ensure they are adequately covered in their applied work (Psychology Board of Australia, 2012a).

OO

Recency of practice – In order for a psychologist to renew or successfully apply for registration they must demonstrate evidence of recent practice as a registered psychologist. Nonpsychological activities do not count towards recency of practice despite their being performed by a psychologist. Practice is broadly defined by the Board and can include working in management, education, research, as well as direct clinical care (Psychology Board of Australia, 2016e, 2016f).

OO

General – This standard sets out the qualifications that lead to General Registration. Basically, an accredited master’s degree; or a five-year accredited sequence of study with a Board-approved year of internship; or a fouryear accredited sequence with Board-approved two years of internship; or a qualification the Board determines is equivalent. Please note, however, that the Board is currently considering retiring the 4 + 2 pathway (Psychology Board of Australia, 2018j). Additionally, one may be required to pass an

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examination before being accepted for General Registration (Psychology Board of Australia, 2016a). Indeed, extended exemptions from sitting the NPE will be ending December 2019 and thus there will be few general psychology applicants for registration who will not have to sit the NPE (Psychology Board of Australia, 2018h). There are, for example, Trans-Tasman Mutual Recognition exemptions to sitting the NPE (Psychology Board of Australia, 2018i). OO

Provisional – The provisional standard outlines what is needed for an applicant to be a provisional psychologist. Specifically, a four-year accredited sequence of study, or what the Board considers to be equivalent, completed in the last 10 years. The four-year accredited sequence is then followed by a two-year Board-approved internship (4 + 2), or a master’s degree (5th and 6th year), or a five-year accredited sequence of study followed by a one-year Board-approved internship (5 + 1), or an approved educational qualification covering 5th through 7th year. Certain transitional programs may also apply (Psychology Board of Australia, 2017b). Guidelines relating to 4 + 2 and 5 + 1 internship programs as well as transitional programs for overseas applications are available and detail the requirements of the internship/transitional program, time frames, and related foci (Psychology Board of Australia, 2013, 2017a, 2017b).

OO

Area of practice endorsements standards – These standards outline that those psychologists with General Registration who practice in certain areas of psychology may be eligible for endorsement in various approved areas. The current endorsement areas include clinical, counselling, forensic, clinical neuropsychology, organisational psychology, sport and exercise, education and developmental, health, and community psychology. One is required to have an accredited doctorate or master’s, or equivalent, in an approved area to be eligible for endorsement. Specifics regarding endorsements, including the competencies for each endorsement area, and the use of related titles can be found in the area of practice endorsement guidelines (Psychology Board of Australia, 2011a, 2011b).

Board policies and guidelines The Board has developed a number of policies and guidelines to direct the profession. Included are policies relating to social media, court appointed expert psychologists in Family Court proceedings, practice removal, recency of practice, and candidates who fail the National Psychology Examination three times (Psychology Board of Australia, 2011c, 2012b, 2014d, 2016c, 2016e). Additional policies include those related to higher degree students (Psychology Board of Australia, 2015e, 2016d).

Ethics in Australian psychology

Board policies Once again, while it is not possible to summarise each Board policy here it may be helpful to note some of the highlights from various policies.Thus, some important items from the policies are noted as follows: OO

Social media – Psychologists must comply with professional obligations, including confidentiality, when posting information via social media. No unsubstantiated claims regarding services must be advertised on social media. Psychologists are urged to remember that items posted on social media can become public and this includes information related to social networking, personal websites, discussion forums, and blogs. Psychologists are reminded that the use of testimonies are not allowed under the National Law (Psychology Board of Australia, 2014d).

OO

Single court appointed expert psychologists in Family Court proceedings – Courts have jurisdiction to control proceedings before them and this includes the use of expert psychologists appointed by the court. Therefore, the management of notifications regarding single court appointed expert psychologist is impacted by the court. Therefore, the Board generally must not undertake an investigation or take certain actions unless the leave of the relevant court is obtained or the matter before the court is concluded (Psychology Board of Australia, 2012b).

OO

Place of practice removal – The Board may decide to include or remove the place of practice for a registered psychologist from the National Register. In making such a decision the Board will balance the overriding public interest for the details of the place of practice and the applying practitioner’s privacy (Psychology Board of Australia, 2011c).

OO

Recency of practice – The policy for recency of practice requirements sets out what applicants may be required to complete if they have been deemed unable to comply with the recency of practice registration standard in order to gain registration (general or provisional). Required remedial action is generally identified for those who lack recency of practice and may include the completion of various amounts of hours of supervised practice as a provisional psychologist prior to being granted general registration, the completion of a case report, and the passing of the National Psychology Examination (Psychology Board of Australia, 2016e).

OO

Higher degree student-related policies – The Board has policies in place outlining the requirements of higher degree students working in addition to serving in placements including the need for supervision of one’s psychological work. Additionally, the Board outlines how those enrolled in a higher degree program can apply for General Registration under certain circumstances (Psychology Board of Australia, 2015e, 2016d).

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Board guidelines Board guidelines are designed to provide guidance to the profession and clarify expectations held for psychologists (Psychology Board of Australia, 2018b). Guidelines exist regarding mandatory notifications, advertising, supervisors and supervisor training, professional indemnity insurance, continuing professional development (CPD), practice endorsements, internship programs, provisional psychologists, overseas transitional programs, place of practice, and the National Psychology Examination (Psychology Board of Australia, 2011b, 2012a, 2013, 2014a, 2014b, 2015d, 2017a, 2017b, 2018c, 2018d, 2018e, 2018f, 2018g). The various guidelines provided by the Board detail how psychologists are to conduct themselves professionally.This includes the circumstances under which mandatory notifications are to occur, that is, the circumstances under which a psychologist must inform AHPRA of notifiable conduct is outlined. These circumstances may include a health practitioner practicing while intoxicated or engaging in sexual misconduct or practicing in such a way that the public is at risk. Certain exceptions to mandatory notification requirements exist in Western Australia and Queensland, and thus it is important that practitioners in various states and territories are aware of their specific regional requirements. Nevertheless, the ability to make voluntary notifications for behaviours that represent a risk, but are not notifiable in a mandatory manner, is also explored in the available materials (Psychology Board of Australia, 2014b). Health practitioners registered under the National Law, employers of practitioners, and education providers need to be familiar with the mandatory notification guidelines. Individuals with the most direct knowledge of notifiable contact are themselves encouraged to make a notification. The guidelines offered by the Board also detail limitations to advertising regulated health services. For instance, false or misleading or deceptive advertising is not allowed. Similarly, the use of testimonials or creating an unreasonable expectation of benefit from treatment or encouraging the unnecessary use of health services is prohibited (Australian Health Practitioner Regulation Agency, 2014). How overseas qualified applicants can apply for registration to become psychologists in Australia via the assessment of their qualifications is outlined in the guidelines regarding same. This does not apply to New Zealand psychologists with a current practising certificate and registration as they apply for registration in Australia under the Trans-Tasman Mutual Recognition Agreement (Psychology Board of Australia, 2017b, 2018i). Supervision-related guidelines outline how applicants can be refused or have their supervisor status revoked (e.g., if General Registration is not held by the proposed supervisor). Additionally, Board-approved supervisor training provider status can be revoked should the provider no longer meet the standards set by the Board (Psychology Board of Australia, 2018e, 2018f).

Ethics in Australian psychology

Ethical conduct Ethics are basic rules that govern professional behaviour. Thus, referring to a code of ethics promotes consistency in professional behaviour and avoids situations in which individual psychologists rely on their own judgement of what is right and wrong when interacting professionally (O’Donovan, Casey, van der Veen, & Boschen, 2013). The Board has adopted the Australian Psychological Society (APS) Code of Ethics (the Code) for the profession (Australian Psychological Society, 2007; Psychology Board of Australia, 2018b). The APS has also published more than 30 ethical guidelines applying the Code to everyday practice issues (Australian Psychological Society, 2014a, 2014b, 2014c, 2014d, 2014e, 2014f, 2014g, 2014h, 2014i, 2014j, 2014k, 2014l, 2014m, 2014n, 2014o, 2014p, 2014q, 2014r, 2014s, 2014t, 2014u, 2014v, 2014w, 2018). The Code itself is ordered into three main principles: respect for the rights and dignity of people and peoples, propriety, and integrity. Respect for the rights and dignity of people and peoples includes the right to autonomy and justice. Propriety incorporates the principles of beneficence; non-maleficence; competence; and responsibility to clients, the profession, and greater society. Integrity includes the need for good character, the importance of trust in psychological practice, and the impact of professional conduct on the overall profession. Each general principle is explored in detail with standards being outlined for appropriate professional behaviour. While the Code will not be reproduced here a complete copy of the Code can be downloaded from the Australian Psychological Society (www.psychology.org.au). What follows is a brief summary of the general principles outlined in the Code and some of the practice topics addressed therein.

Respect for the rights and dignity of people and peoples Psychologists respect clients’ legal and moral rights and their dignity. Clients have a right to participate in decisions affecting them. Justice, respect, informed consent, privacy, confidentiality, and access to one’s personal information are key concepts.

Justice and respect Culturally appropriate and individualised services are required for the professional practice of psychology in Australia. As a result, unfair discrimination is to be avoided and psychologists are obliged to assist clients to address unfair discrimination. Indeed, the APS specifically supports the . . . reparation of relationships between non-indigenous and indigenous people to action which in its view and in the view of indigenous

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people restores their human rights and privileges, and to all informed attempts to address the substandard living conditions that exist in many indigenous households and communities. (Australian Psychological Society, 2014r, p. 8) Similarly, psychologists are aware that same-sex attraction or a non-heterosexual orientation is not to be considered evidence of a mental disorder and there is no evidence of disproportionate psychopathology in same-sex attracted nonclinical populations (Australian Psychological Society, 2014g). Psychologists recognise that same-sex attraction is one variant of sexuality and that gay, lesbian, and bisexual clients have often experienced discrimination (Australian Psychological Society, 2014g). Psychologists are aware of their own attitudes and relevant knowledge when working with gay, lesbian, and bisexual clients which may include avoiding the use of stereotypes and being aware of the ‘coming out’ process (Pelling & Kocarek, 2003). The needs of clients presenting from various age ranges, women and girls, as well as sex and/or gender diverse clients are similarly attended to with sensitivity (Australian Psychological Society, 2014h, 2014j, 2014k, 2014p). For instance, those working with older adults in residential or community settings take steps to ensure privacy and check with their clients that they are satisfied with the level of privacy possible for therapeutic work or respect the client’s right to refuse service (Australian Psychological Society, 2014j). When psychologists are aware of unfair discrimination or prejudice that is directed against a client they assist their clients to address same and react appropriately when prejudice or discrimination by others is directed at an indigenous client (Australian Psychological Society, 2007, 2014r). Psychologists use language and behaviour that communicates respect to clients and colleagues and in their general professional activities. Clients in forensic settings may be especially vulnerable due to intellectual disability, learning difficulty, or being from culturally and linguistically diverse backgrounds. Regardless of whether a client has been convicted of a serious crime all clients are to be treated with respect (Australian Psychological Society, 2014e).

Informed consent Psychologists help clients make informed decisions regarding psychological services by providing information in plain language explaining the nature of services. This includes the client’s right to withdraw from services, foreseeable risks, the nature of information collection and storage, confidentiality and its limits, and other such relevant information. As noted by Delany (2008), informed consent involves the disclosure of information relating to a proposed treatment, comprehension/understanding regarding the proposed treatment, voluntariness, competence, and consent.

Ethics in Australian psychology

Specifically related to hypnosis, and other interventions that may involve alternations of conscious, psychologists need to inform clients of the likely impact same can have on litigation where information gathered during hypnosis may not be accepted as evidence (Australian Psychological Society, 2014o). Psychologists are aware of when consent is not required and attempt to obtain client consent as far as is possible practically. Specifically relating to therapeutic aversive procedures, in which an unpleasant consequence is presented contingent on the occurrence of a targeted behaviour, psychologists ensure that the goals for treatment have been adequately defined and considered, participation is voluntary, informed consent is obtained, the treatment is considered efficacious, client confidentiality is protected, the treatment provider is suitably trained, and an exit plan for the ending of treatment has been outlined (Australian Psychological Society, 2014s). Clients, similarly, need to know what role a psychologist is in when they are receiving services from a psychologist. Clients need to know if the service with which they are engaging is provided on a volunteer basis as a member of the general public or as a psychologist providing pro bono psychological assistance (Australian Psychological Society, 2014l).When responding in disaster situations as a psychologist it may be difficult to gain informed consent and when this occurs, psychologists use considered judgement regarding whether to proceed without informed consent (Australian Psychological Society, 2014m). Likewise, clients in forensic settings need to know the purpose and nature of psychological services offered, the anticipated use of any findings from same, who will access the information collected, limitations on their privacy in engaging in service, and the voluntary or involuntary nature and consequences of nonparticipation. Moreover, psychologists need to inform clients of any responsibilities they have to the court or tribunal, who is responsible for service payment, and likely cost if relevant (Australian Psychological Society, 2014i, 2014w).

Privacy Psychologists collect information that is relevant to service provision and thus avoid undue privacy invasion.

Confidentiality Information gained while providing psychological services is safeguarded so that it remains confidential. Basically, confidentiality protects the trust a person places in having private information kept private (Ka¨mpf, McSherry, Ogloff, & Rothschild, 2009a). Disclosure of such information occurs when legally required to disclose the information, when consent is provided, and to safeguard an identifiable person from a specified risk of harm. Clients are informed of confidentiality limits at the start of a professional relationship and

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as necessary throughout the professional relationship. The assurance of confidentiality helps to develop a trusting professional relationship. Confidentially is impacted by the 1988 Commonwealth Privacy Act (Australian Psychological Society, 2014t). Psychologists need to know that, as stated by the APS (Australian Psychological Society, 2014v, p. 26): “While confidentiality is a cornerstone of psychological practice, it is not absolute.” Clients need to be informed of this as well. Clients are informed that communication with psychologists is not privileged and thus psychologists can be compelled at some point to reveal the information in a court of law. Mandated reporting means that certain people, generally from certain occupational groups, are legally mandated to report suspected abuse or neglect. Additionally, in certain circumstances disclosure may be discretionary or permitted versus mandated (McMahon, 2006). Psychologists are urged to investigate their own mandated reporting requirements by visiting the Australasian Legal Information Institute website (www.austlii.edu .au) for Acts relevant to their location.The APS has provided specific guidelines relating to reporting abuse, neglect, and criminal activity (Australian Psychological Society, 2014t). When working with clients, psychologists may become aware of illegal activity or an intent to engage in illegal activity. Generally, simply having knowledge about an offence does not require a psychologist to report an offence if that offence is not itself subject to mandated reporting (Australian Psychological Society, 2014t; McMahon, 2006). O’Donovan et al. (2013) suggest that once a psychologist has decided to break confidentiality that they, if it is safe to do so, inform the client and discuss any concerns they may have regarding the limits of confidentiality. Psychologists work in diverse settings and with diverse clientele. When psychologists are working with young people the psychologist is to determine the capacity of the client to provide informed consent including the nature of the psychological service, benefits and risks of the service, consequences of receiving or not the service, ability to make an informed choice, and understanding the limits to confidentiality. When working with young people psychologists should make clear the limits to confidentiality, including parents, when involved with the consent process. Similarly, working in rural and remote settings can entail an increase in confidentiality issues experienced by local psychologists (Australian Psychological Society, 2014f, 2014k, 2014t).

Release and collection of client information Psychologists do not refuse reasonable requests from clients to access their client information. When collecting information from parties associated with clients, psychologists gain consent from the client or those responsible for the client’s consent and where possible also gain client consent if another has legal

Ethics in Australian psychology

authority to act on the client’s behalf. Psychologists clearly identify the purpose, source, nature of information, and method of information collection. Clients are made aware that they can withdraw their consent for contact and information gathering from associated parties (Australian Psychological Society, 2012).

Propriety Psychologists provide services that are beneficial and do not harm clients. They ensure they are competent to work with the clients they serve. Client welfare, public welfare, and professional standing are maintained by competent practice. Competence, record keeping, professional responsibility, and the involvement of multiple people in a therapy contact are of particular relevance. Regarding the involvement of multiple clients, psychologists clarify with each individual involved issues impacted by multiple party involvement including confidentiality, record management, access to personal information, and financial arrangements (Australian Psychological Society, 2014i). Similarly, research and the use of assessments are specifically addressed through the appropriate application of this principle.The APS guidelines concerning psychological assessment and the use of psychological tests examine this concept further (Australian Psychological Society, 2014d). Specifically, the impact of language and culture on such assessment is taken into account by competent psychologists. Moreover, psychologists do not support the use of any single intelligence quotient (IQ) score as a rationale for service provision and supply information regarding error in measure and confidence intervals when providing such test results to clients, as they are aware of the harm providing such IQs can cause (Australian Psychological Society, 2014d).

Competence Psychologists undertake continuing professional development (CPD) to ensure they are maintaining their competence.This may include the psychologist being aware of and using current nomenclature and research-based theoretical understandings. For instance, psychologists discuss previously unreported traumatic memories versus repressed memories (Australian Psychological Society, 2014a). Similarly, psychologists need to assess their competence when using current technologies. Psychologists are aware of the professional and ethical issues that may come about when using the Internet and telecommunication technologies in the provision of psychological services and only provide those services, and means of providing such services, in a professional responsible manner. Specific issues involved with telecommunication technologies may include ensuring one is complying with privacy legislation and that the methods used to intervene with clients have an evidence base (Australian Psychological Society, 2014c; Flood & Pelling, 2008; Simpson, Richardson, & Pelling, 2015).

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Competence also includes caring for one’s own physical and mental health. Psychologists ensure they are not impaired by their emotional, mental, and physical state. Supervision and consultation are acquired as needed.

Record keeping Adequate records are kept for psychological work. Records are kept for a minimum of seven years (after the age of 18) unless legally required for a different time. Records are kept confidential and may include notes, messages, email, diary entries, and appointment arrangements as well as test results and reports. The APS has developed guidelines on record keeping that outline details regarding ownership and access to records, and record retention.These guidelines, among other things, indicate that it is important for clients to be aware of their rights with regard to access to their records and that electronic records are maintained securely and that safeguards are in place to prevent amending of such records retrospectively (Australian Psychological Society, 2012, 2014n). Record keeping and communication with appropriate stakeholders as required, and allowed, is an important aspect of psychological service. Notes and reports as well as letters and other forms of communication can vary in detail as well as style. One Australian repository of counselling and psychological note templates exists at psychologytemplates.com.au if individuals are interested in various examples of client-related templates.

Professional responsibility Psychological services are provided in a responsible manner with care and skill, are aimed at preventing harm, are necessary to the client, maintain professional boundaries, and do so with the informed consent of the client involved. The APS has guidelines regarding the prohibition of sexual relationships with clients, for managing professional boundaries and multiple relationships, and procedures involving psychologist and client physical contact (Australian Psychological Society, 2014i, 2014v, 2014q).

Third parties, multiple clients, and task delegation Limits to confidentiality and the nature of professional relationships with each person involved or connected to the psychological services provided are made clear. Each of the multiple clients explicitly accepts the limitations outlined when multiple clients/third parties are involved. Psychologists ensure as much as possible that coercion to accept said limitations has not occurred. When tasks are delegated to assistants or interpreters or similar, psychologists act to see that the Code is adhered to and their duties are overseen to ensure competent service. This includes the psychologist avoiding the existence of multiple

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relationships involving the assistant or interpreter and client/s. Psychologists themselves manage dual relationships with clients as can commonly occur in rural settings. Management of a dual relationship may involve questioning if the dual relationship is necessary, exploitative, benefits anyone, or is likely to damage the client or disrupt the therapeutic relationship (Scopelliti et al., 2004).

Collaboration with others and professional consideration Psychologists maintain confidentiality when cooperating with other professionals for client benefit; offer second opinions to clients who would like same; and accept clients of other professionals only after considering the implications of same, client welfare, and the impact on all involved.

Ending or suspending services Psychologists make arrangements for the care of their clients when they are absent. When a client is not benefiting from service they end same with said client. Psychologists make arrangement for continuity of service when they can no longer provide same and will provide referrals for alternative service provision where appropriate.

Psychological assessments and research Psychologists are clear in describing the purposes for assessment measures used with clients, use valid procedures, are accurate in reporting results, and do no misuse or disclose test contents inappropriately. Psychologists comply with national and local guidelines and codes relating to human and animal research. Data are accurately reported in research and can be made available for reanalysis.

Integrity Psychologists are in a position of power and trust. Psychologists act with decency and honesty. Being reputable in behaviour and communication, how one handles conflicts of interest and financial matters, as well as ethical concerns are key to this principle.

Reputable behaviour and communication Psychologists avoid conduct that reflects badly on their ability to practise or on the profession. Psychologists communicate honestly and correct misrepresentations about them and avoid advertising that is misleading or false. Psychologists do not hold out their services as superior over other psychologists.

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Conflict of interest and non-exploitation Psychologists avoid multiple relationships that may impair competence or harm others. Similarly, psychologists do not exploit others with whom they have or had a professional relationship, including clients, employees, colleagues, or assistants. Sexual relationships with former clients are not to occur for a period of two years from the termination of psychological service and then consulting with a colleague is advised prior to engaging in such a relationship. One does not see as a client a person with whom they have had sexual activity (Australian Psychological Society, 2014v).

Authorship and finances Psychologists are proactive and honest in the assigning of authorship of scholarship, discussing authorship early in the work and having authorship accurately reflect the work performed. Psychologists are honest in their financial dealings and discuss up front financial arrangements and do not receive remuneration or give same for client referrals. Psychologists clearly inform their clients, in advance, regarding the expected frequency and duration of therapeutic contact and associated fees. Should client circumstances change, psychologists act responsibly in reviewing contractual client arrangements with clients, including fees. Clients are to be informed of administrative-related fees including, but not limited to, session cancellation fees and travel fees. Psychologists carefully contemplate bartering arrangements to ensure that potential problems are considered. Related to training and unpaid workers, psychologists do not exploit students or volunteers by requiring them to engage in work that is of no benefit to them (Australian Psychological Society, 2014w).

Ethical concerns Psychologists address ethical concerns as they become aware of and are impacted by them. They cooperate with ethics investigations and it is generally in their own best interests to do so (Wingenfeld-Hammond & Freckelton, 2006). Clients, and others including fellow professionals, who are concerned regarding the behaviour of a particular psychologist can contact the Board or the APS or both. In Australia, most misconduct cases appear to be related to poor communication. Other complaints involve professional incompetency, poor business practices, boundary violations, poor character, registration difficulties, impairment, and the inappropriate use of specialist titles (Grenyer & Lewis, 2012). When confronted by an ethical dilemma psychologists are encouraged to consult with senior colleagues, indemnity insurers, and professional bodies, and engage in thoughtful, ethical decision-making and document same. Ethical decision-making can be difficult as psychologists are impacted by many personal, situational, and contextual influences when engaged in practice

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(Kennedy, Richards, & Leiman, 2013). One ethical decision-making process relating to confidentiality matters is presented by (Ka¨mpf et al., 2009b). Indeed, many contributors to this Elements book on ethics use the Ka¨mpf et al. (2009b) model in their explorations of their chosen ethical dilemma. In this exploration of ethical decision-making it is suggested that the problem encountered be clearly defined including identifying those individuals and groups potentially

Defining the problem

affected by the decision.

. Step 3. Consider the significance of the context and . d professional resources.

the problem. . • Consider how your personal beliefs, values, and biases may affect your decision-making.

Step 6. Choose and implement the most appropriate

Step 7. Monitor and assess the outcome chosen.

Resolving the problem

Problem resolved? Yes

No

Step 8a. Consider the need for

Step 8b. Repeat

.

(Ethical decision-making model from Ka¨mpf et al., 2009b)

.

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impacted by the decision.The problems, including the relevant ethical and legal issues, need to be identified, and any impact the specific context or setting may have is outlined. Additionally, relevant legal and ethical professional resources are identified. After the problem has been explored in detail the various alternative solutions to the problem are identified and analysed for risks and benefits. After an option for action is chosen it is then implemented and monitored so that the outcome can be assessed. If the problem is not resolved then additional options for resolving the problem need to be considered. Many ethical decision-making models follow similar steps involving problem recognition, alternative identification, alternative evaluation, and selection and commitment to a course of action (Miner, 2006; Koocher & Keith-Spiegel, 1998). Specific guidelines provided by the APS are designed to complement the Code and include numerous topics (Australian Psychological Society, 2018): Aboriginal and Torres Strait Islander people of Australia; abuse; assessment; aversive procedures; child abuse; confidentiality; criminal activity; disaster response; financial dealings and fair trading; forensic contexts; gay clients; harm to others; hypnosis; Internet; lesbian, gay, and bisexual clients; memories; multiple clients; older adults; physical contact; pro bono services; professional boundaries; prohibition of sexual relationships with clients; record keeping; relationships; risk; rural and remote; sex and/or gender diverse clients; suicidal clients; supervision; tests; traumatic memories; voluntary services; women; and working with young people (Australian Psychological Society, 2014a, 2014b, 2014c, 2014d, 2014e, 2014f, 2014g, 2014h, 2014i, 2014j, 2014k, 2014l, 2014m, 2014n, 2014o, 2014p, 2014q, 2014r, 2014s, 2014t, 2014u, 2014v, 2014w).

General professional conduct Psychologists are expected to understand how one can develop, update, and enhance their knowledge through continuing professional development (CPD). Similarly, psychologists are expected to engage in self-management including reflective, assessment, and care activities for their professional and personal selves. Furthermore, the benefits and uses of supervision and peer consultation are to be considered and applied to one’s professional work (Psychology Board of Australia, 2014c, 2015a, 2015d). We will now take a brief look at each of these and the minimum requirements for each in Australia, in turn.

Continuing education Psychology is both a science and an applied practice. Science informs the applied work of psychologists, what we know about clients and their experiences, and how to intervene with client-presented difficulties.The development of science, and therefore its impact on and integration into practice, does not stop after one becomes a registered psychologist. To conduct oneself in a legal,

Ethics in Australian psychology

ethical, and professional manner involves engaging in continuing education and thus continuously developing one’s competence. As stated by O’Donovan et al. (2013, p. 14): “Ethical issues are common in practice and maintaining professional development in ethics is essential.” Indeed, this sentiment can be applied to various areas of applied psychological practice including the broad areas of assessment, intervention, and communication also discussed in the current book. Practicing as a registered psychologist requires that psychologists participate in regular continuing professional development (CPD) and document this engagement. The Board has specific guidelines regarding CPD (Psychology Board of Australia, 2014c, 2015a, 2015d).Training, education, workshop participation, as well as individual study and scholarship can all be considered CPD activities, but the Board specifically notes that CPD implies self-directed and practice-based learning activities rather than supervised education and training. CPD is specifically designed to maintain, improve, and broaden knowledge, expertise, and competence. This learning can involve developing the personal characteristics that aid professional functioning. As a result, CPD helps provide optimal evidence-based services to clients as well as preserves job satisfaction. One’s learning tends to be enhanced when CPD is intentional, planned, targeted, actively engaged with, and thoughtfully reviewed. When professionals are self-aware they can identify professional areas in need of improvement, or refinement, and plan as well as subsequently engage in CPD activities considered for same. The Board requires a learning plan each year which can be amended as needed. A learning plan ensures that the CPD follows an educational rationale. CPD activities must be recorded and often this is done in a logbook with an accompanying journal entry noting the content and relevance of the CPD activity that ensures learning reflection has taken place. Currently a total of 30 hours of CPD are required each year (Psychology Board of Australia, 2015a, 2015d). A minimum of 10 hours of the 30 hours of CPD are to be peer consultation hours focused on the psychologist’s own practice. Peer consultation similarly should follow an educational reasoning serving the goals of the overall CPD plan. The Board recommends that one’s CPD is active in nature and demonstrates reflective learning. Clearly, CPD that engages the participant in active training through written or oral activities to enhance and test learning is preferable to passive learning. The Board provides forms upon which one can record their CPD goals, details, and active reflection on same. Psychologists who are members of the APS can also choose to log their CPD online via the APS membership portal if they are a member of the APS (Psychology Board of Australia, 2015d).

Professional self-management Being a psychologist and helping others with their thoughts, feelings, behaviours, and relationships can be extremely rewarding. However, there are both

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personal and work-related daily stressors as well as less common events that can lead to inadequate coping and a need for support. Psychologists must be able to engage in self-reflection, self-assessment, and self-care or their competence will be negatively impacted by personal difficulties as well as work-related burnout, emotional fatigue, secondary traumatisation, or vicarious traumatisation (O’Donovan et al., 2013). Work-related difficulties as well as the impact these have on applied practitioners have been explored by various authors. Greenstone and Leviton (2002) list a number of signs and symptoms of stress and burnout relevant to practitioners involved with crisis intervention work. The signs and symptoms of burnout listed include feelings (anger and resentment), thoughts related to failure (“I can’t do enough”; “I can’t get it right”), as well as behaviours (isolation and withdrawal as well as frequent clock watching). Pelling (2017) outlines five common therapy scenarios listed by developing practitioners that lead to fear and indecision. These include clients in danger of harm/in great pain, difficult or recalcitrant clients, the practitioner being in a position of danger from the client, clients questioning practitioner competence, and having to make difficult ethical decisions. McGlothlin (2008) reviews client suicide and the impact this can have on therapists, and Trippany,White Kress, and Wilcoxon (2004) discuss vicarious trauma when working with trauma survivors. All of these authors indicate that applied professionals will need to self-reflect and self-assess how they are coping and how they have been impacted by events and then choose a means of self-management. In response to difficulties, Greenstone and Leviton (2002) suggest that practitioners need to attend to their overall level of health including needs for nutrition, sleep, and realistic engagement with work activities if one is to function adequately. Similarly, Pelling (2017) indicates that practitioners need to continuously update their knowledge, develop their self/other awareness, and engage in skill building activities with supervisory feedback to aid in one’s coping with work-related fear and indecision. McGlothlin (2008) echoes these suggestions for self-care and also notes that practitioners, particularly in response to a client having died by suicide, need to not hesitate to gain personal therapy if needed. Similarly, Trippany et al. (2004) stress the need for social support, engagement in leisure activities, and finding meaning in the difficulties presented by clients. O’Donovan et al. (2013) make a point of encouraging practitioners to develop a proactive self-care practice and not just coping skills. Psychologists are trained to assess and respond to client needs and difficulties. They must also assess and respond to their own personal and professional needs as difficulties arise. This professional self-management will involve continuous assessment of one’s own emotions, thoughts, and behaviours, as well as sensitivity to professional difficulties as they occur. Engaging in regular self-reflective activities such as journaling and attending to the impact of one’s own feelings,

Ethics in Australian psychology

thoughts, and behaviours on one’s work in supervision and peer consultation can aid in managing one’s own professional conduct and personal functioning. When a professional is in need of support due to being personally impacted in or by their work they gain support. At times this support will include personal therapy. At other times professionals will simply engage in supervisory and peer consultation or an array of self-care activities. It is best if this self-care is proactive versus reactive.

Supervision and peer consultation The term supervision implies a hierarchical structure. Thus, supervision generally involves an unequal relationship in terms of expertise and experience with a more senior person providing professional guidance to a less practiced, or expert, colleague. Peer consultation implies a non-hierarchical relationship and generally is a process whereby psychologists collaborate with peers to assess and share information, opinions, support, and monitor as well as evaluate their own professional activities. Both supervision and peer consultation may involve formal or informal case presentations and review (Australian Psychological Society, n.d.), and the purpose can be to support or maintain, improve, and broaden knowledge, expertise, and competence as well as develop professional functioning related personal characteristics. Supervision and peer consultation as reviewed here refer to CPD activities. Non-CPD-related supervision requirements relevant to the various pathways to General Registration are outlined by the Board separate from the CPD standard (Psychology Board of Australia, 2015a, 2015d, 2016a). As noted above, psychologists are to engage in a minimum of 10 hours of peer consultation or supervision focused on their work per year, and the 10 hours is to be an integrated part of their CPD plan for the year. The Board recommends that although peer consultation is collegial, it should occur with a peer or senior psychologist, someone who is experienced or knowledgeable regarding the practice aspects being discussed (Psychology Board of Australia, 2015d).

Conclusion In this chapter we have reviewed the legal, ethical, and professional conduct ideals held for the profession of applied psychology in Australia. These ideals serve to protect the public as well as guide professional activities. Minimum standards for professional behaviour have therefore been noted, but practitioners are encouraged to actively choose to exemplify professional conduct and not simply conform to the minimum requirements of professional conduct. Choosing to be proactively intentional and engaging in behaviour that aligns with the values of the profession will encourage exemplary conduct and workrelated satisfaction.

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References Australian Health Practitioner Regulation Agency. (2014). Guidelines for advertising regulated health services. Retrieved from https://www.ahpra.gov.au/ Publications/Advertising-resources/Legislation-guidelines/Advertisingguidelines.aspx Australian Health Practitioner Regulation Agency. (2018). AHPRA – regulating Australia’s health practitioners in partnership with the national boards. Retrieved from www.ahpra.gov.au/ Australian Psychological Society. (2007). Code of Ethics. Melbourne, Australia: Author. Retrieved from www.psychology.org.au/About-Us/What-we-do/ ethics-and-practice-standards?Redirected=true Australian Psychological Society. (2012). Psychologist’s records: Management, ownership and access:APS professional practice. Retrieved from http:/www.psychology .org.au Australian Psychological Society. (2014a). Ethical guidelines for psychological practice with clients with previously unreported traumatic memories. Melbourne, Australia: Author. Australian Psychological Society. (2014b). Ethical guidelines for managing professional boundaries and multiple relationships. Melbourne, Australia: Author. 15031–0049d-1pass-r03.indd 34 18–04–2016 15:48:47. Australian Psychological Society. (2014c). Ethical guidelines for providing psychological services and products using the Internet and telecommunications technologies. Melbourne, Australia: Author. Australian Psychological Society. (2014d). Ethical guidelines for psychological assessment and the use of psychological tests. Melbourne, Australia: Author. Australian Psychological Society. (2014e). Ethical guidelines for psychological practice in forensic contexts. Melbourne, Australia: Author. Australian Psychological Society. (2014f). Ethical guidelines for psychological practice in rural and remote settings. Melbourne, Australia: Author. Australian Psychological Society. (2014g). Ethical guidelines for psychological practice with lesbian, gay, and bisexual clients. Melbourne, Australia: Author. Australian Psychological Society. (2014h). Ethical guidelines for psychological practice with women and girls. Melbourne, Australia: Author. Australian Psychological Society. (2014i). Ethical guidelines for psychological services involving multiple clients. Melbourne, Australia: Author. Australian Psychological Society. (2014j). Ethical guidelines for working with older adults. Melbourne, Australia: Author. Australian Psychological Society. (2014k). Ethical guidelines for working with young people. Melbourne, Australia: Author. Australian Psychological Society. (2014l). Ethical guidelines on providing pro bono or voluntary psychological services. Melbourne, Australia: Author. Australian Psychological Society. (2014m). Ethical guidelines on providing psychological services in response to disasters. Melbourne, Australia: Author.

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Australian Psychological Society. (2014n). Ethical guidelines on record keeping. Melbourne, Australia: Author. Australian Psychological Society. (2014o). Ethical guidelines on the teaching and use of hypnosis, and related practices. Melbourne, Australia: Author. Australian Psychological Society. (2014p). Ethical guidelines on working with sex and/or gender diverse clients. Melbourne, Australia: Author. Australian Psychological Society. (2014q). Ethical guidelines relating to procedures/ assessments that involve psychologist-client physical contact. Melbourne, Australia: Author. Australian Psychological Society. (2014r). Guidelines for the provision of psychological services for, and the conduct of psychological research with aboriginal and Torres Strait islander people of Australia. Melbourne, Australia: Author. Australian Psychological Society. (2014s). Guidelines for the use of therapeutic aversive procedures. Melbourne, Australia: Author. Australian Psychological Society. (2014t). Guidelines on confidentiality. Melbourne, Australia: Author. Australian Psychological Society. (2014u). Guidelines on reporting abuse and neglect, and criminal activity. Melbourne, Australia: Author. 15031–0049d-1pass-r03. indd 35 18–04–2016 15:48:47. Australian Psychological Society. (2014v). Guidelines on the prohibition of sexual relationships with clients. Melbourne, Australia: Author. Australian Psychological Society. (2014w). Guidelines regarding financial dealings and fair trading. Melbourne, Australia: Author. Australian Psychological Society. (2018). APS ethical guidelines. Melbourne, Australia: Author. Retrieved from www.psychology.org.au/About-Us/ What-we-do/ethics-and-practice-standards?Redirected=true Australian Psychological Society. (n.d.). APS peer consultation network guidelines. Melbourne, Australia: Author. Retrieved from www.psychology.org.au/ Assets/Files/PeerConsultNetwork.pdf Delany, C. (2008). Decision-making and consent. In R. Kennedy (Ed.), Allied health professionals & the law (pp. 81–107). Sydney, Australia: The Federation Press. Flood, M., & Pelling, N. (Eds.). (2008). The use of technology in mental health [Special Issue]. Counselling, Psychotherapy, and Health Journal, 5(1), 1–328. Greenstone, J., & Leviton, S. (2002). Elements of crisis intervention: Crises and how to respond to them (2nd ed.). Pacific Grove, CA: Brooks/Cole Thomson Learning. Grenyer, B. F., & Lewis, K. L. (2012). Prevalence, prediction, and prevention of psychologist misconduct. Australian Psychologist, 47(2), 68–76. Health Practitioner Regulation National Law (South Australia) Act 2010. (2010). Melbourne, Australia: Government of South Australia. Retrieved from www.legislation.sa.gov.au/lz/c/r/health%20practitioner%20regulation%20 national%20law%20(south%20australia)%20regulations%202010/current/2010.169.auth.pdf

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Ka¨mpf, A., McSherry, B., Ogloff, J., & Rothschild, A. (2009a). Chapter 1: The concept of confidentiality. In Confidentiality for mental health professionals, a guide to ethical and legal principles (pp. 5–10). Bowen Hills, QLD: Australian Academic Press. Ka¨mpf, A., McSherry, B., Ogloff, J., & Rothschild, A. (2009b). Chapter 7: Ethical decisionmaking in confidentiality dilemmas. In Confidentiality for mental health professionals, a guide to ethical and legal principles (pp. 93–116). Bowen Hills, QLD: Australian Academic Press. Kennedy, R., Richards, J., & Leiman, T. (2013). Integrating human service law, ethics and practice (3rd ed.). South Melbourne, Australia: Oxford University Press. Koocher, G. P., & Keith-Spiegel, P. (1998). Ethics in psychology: Professional standards and cases. New York: Oxford University Press. McGlothlin, J. M. (2008). Developing clinical skills in suicide assessment, prevention, and treatment. Alexandria,VA: American Counseling Association. McMahon, M. (2006). Confidentiality, privacy and privilege: Protecting and disclosing information about clients. In S. Morrissey & P. Reddy (Eds.), Ethics & professional practice for psychologists (pp. 74–88). Melbourne, Australia: Thomson: Social Science Press. Mental Health Professional Online Development. (2018). MHPOD home. Retrieved from https://elearning.mhpod.gov.au Miner, M. H. (2006). A proposed comprehensive model for Ethical DecisionMaking (EDM). In S. Morrissey & P. Reddy (Eds.), Ethics & professional practice for psychologists (pp. 25–37). Melbourne, Australia: Thomson Social Science Press. O’Donovan, A., Casey, L., van der Veen, M., & Boschen, M. (2013). Psychotherapy: An Australian perspective. East Hawthorn, Australia: IP Communications. Pelling, N. J. (2017). Addressing supervisee fears in supervision. In N. Pelling & P. Armstrong (Eds.), The practice of clinical supervision (pp. 171–198). Samford Valley, Australia: Australian Academic Press. Pelling, N. J., & Kocarek, C. E. (2003). Beyond knowledge and awareness: Enhancing counselor skills for work with gay, lesbian, and bisexual clients. Journal of Multicultural Counseling and Development, 31(2), 99–112. PRIVACY ACT 1988 – SECT 16A. Retrieved from http://www5.austlii.edu. au/au/legis/cth/consol_act/pa1988108/s16a.html Psychology Board of Australia. (2011a). Area of practice endorsements registration standard. Melbourne, Australia: Australian Health Practitioner Regulation Agency. Retrieved from www.psychologyboard.gov.au/standards-andguidelines/registration-standards.aspx Psychology Board of Australia. (2011b). Guidelines on area of practice endorsements. Melbourne, Australia: Australian Health Practitioner Regulation Agency. Retrieved from www.psychologyboard.gov.au/standards-and-guidelines/ codes-guidelines-policies.aspx

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Psychology Board of Australia. (2011c). Policy for place of practice removal. Melbourne, Australia: Australian Health Practitioner Regulation Agency. Retrieved from www.psychologyboard.gov.au/standards-and-guidelines/ codes-guidelines-policies.aspx Psychology Board of Australia. (2012a). Guideline on professional indemnity insurance for psychologists. Melbourne, Australia: Australian Health Practitioner Regulation Agency. Retrieved from www.psychologyboard.gov.au/ standards-and-guidelines/codes-guidelines-policies.aspx Psychology Board of Australia. (2012b). Policy for the management of notification about single court appointed expert psychologist in family law courts proceedings. Melbourne, Australia: Australian Health Practitioner Regulation Agency. Retrieved from www.psychologyboard.gov.au/standards-and-guidelines/ codes-guidelines-policies.aspx Psychology Board of Australia. (2012c). Professional indemnity insurance arrangements registration standard. Melbourne, Australia: Australian Health Practitioner Regulation Agency. Retrieved from www.psychologyboard.gov.au/ standards-and-guidelines/registration-standards.aspx Psychology Board of Australia. (2013). Guidelines for the 5 + 1 internship program. Melbourne, Australia: Australian Health Practitioner Regulation Agency. Retrieved from www.psychologyboard.gov.au/standards-and-guidelines/ codes-guidelines-policies.aspx Psychology Board of Australia. (2014a). Guidelines for advertising regulated health services. Melbourne, Australia: Australian Health Practitioner Regulation Agency. Retrieved from www.psychologyboard.gov.au/standards-andguidelines/codes-guidelines-policies.aspx Psychology Board of Australia. (2014b). Guidelines for mandatory notifications. Melbourne, Australia: Australian Health Practitioner Regulation Agency. Retrieved from www.psychologyboard.gov.au/standards-and-guidelines/ codes-guidelines-policies.aspx Psychology Board of Australia. (2014c). Public consultation – 28 April 2014 – consultation paper 22: Requirements for general registration, continuing professional development and recency of practice for psychologists. Retrieved from www. psychologyboard.gov.au/search.aspx?q=peer%20consultation Psychology Board of Australia. (2014d). Social media policy. Melbourne, Australia: Australian Health Practitioner Regulation Agency. Retrieved from www.psychologyboard.gov.au/standards-and-guidelines/codes-guidelinespolicies.aspx Psychology Board of Australia. (2015a). Continuing professional development registration standard. Melbourne, Australia: Australian Health Practitioner Regulation Agency. Retrieved from www.psychologyboard.gov.au/ standards-and-guidelines/registration-standards.aspx Psychology Board of Australia. (2015b). Criminal history registration standard. Melbourne, Australia: Australian Health Practitioner Regulation Agency.

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Retrieved from www.psychologyboard.gov.au/Standards-and-Guidelines/ Registration-Standards.aspx Psychology Board of Australia. (2015c). English language skills registration standard. Melbourne, Australia: Australian Health Practitioner Regulation Agency. Retrieved from www.psychologyboard.gov.au/Standards-and-Guidelines/ Registration-Standards.aspx Psychology Board of Australia. (2015d). Guidelines for continuing professional development. Melbourne, Australia: Australian Health Practitioner Regulation Agency. Retrieved from www.psychologyboard.gov.au/Standards-andGuidelines/Registration-Standards.aspx Psychology Board of Australia. (2015e). Policy on working in addition to placements. Melbourne, Australia: Australian Health Practitioner Regulation Agency. Retrieved from www.psychologyboard.gov.au/standards-and-guidelines/ codes-guidelines-policies.aspx Psychology Board of Australia. (2016a). General Registration standard. Melbourne, Australia: Australian Health Practitioner Regulation Agency. Retrieved www. psychologyboard.gov.au/standards-and-guidelines/registration-standards.aspx Psychology Board of Australia. (2016b). Internationalisation of psychology. Connections Newsletter. Retrieved from www.psychologyboard.gov.au/News/ Newsletters/May-2016.aspx Psychology Board of Australia. (2016c). Policy and procedure for candidates who fail the exam three times. Melbourne, Australia: Australian Health Practitioner Regulation Agency. Retrieved from www.psychologyboard.gov.au/ standards-and-guidelines/codes-guidelines-policies.aspx Psychology Board of Australia. (2016d). Policy for higher degree students applying for general registration. Melbourne, Australia: Australian Health Practitioner Regulation Agency. Retrieved from www.psychologyboard.gov.au/standardsand-guidelines/codes-guidelines-policies.aspx Psychology Board of Australia. (2016e). Policy for recency of practice requirements. Melbourne, Australia: Australian Health Practitioner Regulation Agency. Retrieved from www.psychologyboard.gov.au/standards-and-guidelines/ codes-guidelines-policies.aspx Psychology Board of Australia. (2016f). Recency of practice registration standard. Melbourne, Australia: Australian Health Practitioner Regulation Agency. Retrieved from www.psychologyboard.gov.au/standards-and-guidelines/ registration-standards.aspx Psychology Board of Australia. (2017a). Guidelines for the 4 + 2 internship program. Melbourne, Australia: Australian Health Practitioner Regulation Agency. Retrieved from www.psychologyboard.gov.au/standards-and-guidelines/ codes-guidelines-policies.aspx Psychology Board of Australia. (2017b). Guidelines: Transitional programs for overseas qualified applicants. Melbourne, Australia: Australian Health Practi-

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tioner Regulation Agency. Retrieved from www.psychologyboard.gov.au/ standards-and-guidelines/codes-guidelines-policies.aspx Psychology Board of Australia. (2017c). Provisional registration standard. Melbourne, Australia: Australian Health Practitioner Regulation Agency. Retrieved from www.psychologyboard.gov.au/standards-and-guidelines/registrationstandards.aspx Psychology Board of Australia. (2018a). About the board. Melbourne, Australia: Australian Health Practitioner Regulation Agency. Retrieved from www. psychologyboard.gov.au/About/Board.aspx Psychology Board of Australia. (2018b). Codes, guidelines and policies. Retrieved from www.psychologyboard.gov.au/Standards-and-Guidelines/CodesGuidelines-Policies.aspx Psychology Board of Australia. (2018c). Common protocol – informing notifiers about the reasons for national board decisions. Melbourne, Australia: Australian Health Practitioner Regulation Agency. Retrieved from www.psychology board.gov.au/standards-and-guidelines/codes-guidelines-policies.aspx Psychology Board of Australia. (2018d). Guideline – informing a national board about where you practise. Melbourne, Australia: Australian Health Practitioner Regulation Agency. Retrieved from www.psychologyboard.gov.au/ standards-and-guidelines/codes-guidelines-policies.aspx Psychology Board of Australia. (2018e). Guidelines for supervisor training providers. Melbourne, Australia: Australian Health Practitioner Regulation Agency. Retrieved from www.psychologyboard.gov.au/standards-and-guidelines/ codes-guidelines-policies.aspx Psychology Board of Australia. (2018f). Guidelines for supervisors. Melbourne, Australia: Australian Health Practitioner Regulation Agency. Retrieved from www.psychologyboard.gov.au/standards-and-guidelines/codes-guidelinespolicies.aspx Psychology Board of Australia. (2018g). Guidelines for the national psychology examination. Melbourne, Australia: Australian Health Practitioner Regulation Agency. Retrieved from www.psychologyboard.gov.au/standards-andguidelines/codes-guidelines-policies.aspx Psychology Board of Australia. (2018h). National psychology exam. Retrieved from www.psychologyboard.gov.au/Registration/National-psychologyexam.aspx Psychology Board of Australia. (2018i). Overseas applicants. Melbourne, Australia: Australian Health Practitioner Regulation Agency. Retrieved from www. psychologyboard.gov.au/Registration/Overseas-Applicants.aspx Psychology Board of Australia. (2018j). Public consultation March 2018 reducing regulatory burden: Retiring the 4 + 2 internship pathway to general registration. Melbourne, Australia: Author. Retrieved from www.psychologyboard.gov .au/Search.aspx?q=retiring+4%2b2

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Scopelliti, J., Judd, F., Grigg, M., Hodgins, G., Fraser, C., Hulbert, C., . . . Wood, A. (2004). Dual relationships in mental health practice: Issues for clinicians in rural settings. Australian and New Zealand Journal of Psychiatry, 38(11–12), 953–959. doi:10.1111/j.1440-1614.2004 Simpson, S., Richardson, L., & Pelling, N. (2015). Introduction to the special issue telepsychology: Research and practice. The Australian Psychologist, 50(4), 249–251. Trippany, R. L., White Kress,V. E., & Wilcoxon, S. A. (2004). Preventing vicarious trauma: What counsellors should know when working with trauma survivors. Journal of Counseling & Development, 84, 31–37. Wingenfeld-Hammond, S., & Freckelton, I. (2006). Being the subject of a complaint to a regulatory board: Complaints happen. In S. Morrissey & P. Reddy (Eds.), Ethics & professional practice for psychologists (pp. 150–162). Melbourne, Australia: Thomson Social Science Press.

Part B

Ethical dilemmas I. Practice-focused ethical dilemmas

1

Sleepy drivers die When a safety slogan is also an ethical concern Saul Gilbert, Kerry Maxfield, Michael Chia, Jillian Dorrian, Siobhan Banks and Kurt Lushington

Ethical dilemma: reporting obligations regarding fitness-to-drive A female client is seeking treatment for insomnia. She works full-time as an ambulance driver, typically working 12-hour shifts with one week in four on night shift work. You note when taking her history that she snores loudly at night and this has worsened over the past two years. As well, she has also experienced excessive daytime sleepiness. She reports that several times she has nodded off while waiting at traffic lights and that she almost always falls asleep if alone in the ambulance when parked. A review of the client’s personal situation revealed that she is a sole parent. The general practitioner’s (GP) written mental health care plan asks for a follow-up report after the sixth appointment. As part of the case formulation you note that her symptoms are suggestive of obstructive sleep apnoea syndrome (OSA). OSA is known to impair driving performance, which raises your concern especially regarding her fitness-todrive and your responsibilities to the client and the broader community in such a situation. As the treating psychologist, do you encourage the client to take sick leave to seek treatment for their suspected OSA? Do you refer the client back to their GP after the first session rather than waiting until the requested report (after the sixth appointment) based on your clinical concerns? Do you have a duty of care to inform her employer? What actions can you take that are legally and ethically defensible? Do these legal or ethical requirements vary between Australian states? What are the legal requirements on health practitioners regarding fitnessto-drive, and do these legislative requirements also apply to psychologists? What is a psychologist’s duty of care under the Australian Psychology Society’s (APS) Code of Ethics and relevant legislation? These questions will be addressed in the following sections.

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Background information It is reasonable to assume that the client’s daytime sleepiness underlies her propensity to fall asleep while waiting at the traffic lights and when parked (Bioulac et al., 2017). In turn, it is likely that sleep disruption underlies her daytime sleepiness. Several explanations for sleep disruption are evident in this client’s history. A hallmark of modern life is the encroachment of work and social pressures on rest and quality sleep time. Given the client’s work and family responsibilities, then, this could explain the excessive daytime sleepiness and fatigue. Nevertheless, excessive daytime sleepiness is atypical and probably indicates an underlying sleep disorder. A contributing factor could be her insomnia (Hein, Lanquart, Loas, Hubain, & Linkowski, 2017). Alternatively, the symptoms may be secondary to shift work and the resulting circadian disruption to her sleep/ wake rhythm. Shift workers are known to sleep less than non-shift workers especially when attempting to sleep during the day when the circadian system is promoting alertness and not sleep (Åkerstedt, 2003).This is also the case with ambulance workers (Sofianopoulos, Williams, & Archer, 2012). A further possible, but less well-appreciated cause could be OSA. OSA is characterised by repetitive periods of reduced airflow through the upper airways with resultant hypoxia and cyclic arousals from sleep. Clinical features of OSA include habitual snoring, witnessed apnoeic or choking episodes by bed partner, and increased daytime sleepiness. It is now well established that individuals with moderate to severe OSA compared to controls typically have worse cognitive and motor performance (George, 2004). Moreover, individuals with untreated OSA are at 2–7 times greater risk of a motor vehicle accident (MVA) compared to the general population (Howard et al., 2004). In addition, the presence of comorbid sleep disorders is known to exacerbate daytime deficits (Luyster, Buysse, & Strollo, 2010). These factors would place the client at greater risk of a vehicle accident. As well, there is some evidence that people with OSA are also more likely to minimise symptoms including sleepiness, which may place them at great risk for vehicle accidents (Tregear, Reston, Schoelles, & Phillips, 2009). Despite the risk, however, and while the extent of gains is disputed (Vakulin et al., 2011), treatment is reported to reduce the risk of accident in people with OSA (Sassani et al., 2004). Thus, the clinical concern in this case is untreated OSA. This concern is also reflected in the fitness-to-drive legislation where the onus is on reporting untreated but not treated people with OSA.

Fitness-to-drive and the legal obligations of psychologists In recognition of the impact of untreated OSA on alertness, vigilance, and driving performance, Austroads (2017) require a treating health professional to advise drivers suspected of having OSA or excessive daytime sleepiness to

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“avoid or limit driving if they are sleepy, and not to drive if they are at high risk, particularly in the case of commercial vehicle drivers.” Definitions of high-risk drivers include: OO

Those who experience moderate to severe excessive daytime sleepiness1

OO

Those with a history of frequent self-reported sleepiness while driving

OO

Those who have had a motor vehicle crash caused by inattention or sleepiness

In this case, the client meets two of the Austroads criteria. Furthermore, as the client is an ambulance driver there is the reasonable expectation that the level of driver performance would be greater than that for a member of the general population. These factors raise the client’s fitness-to-drive to a higher level of concern. The Austroads guidelines encourage the treating physician not to rely solely on subjective measures or a client’s self-reports to diagnose (or rule out) sleep apnoea. Rather, they suggest that the client should be referred to a sleep physician for overnight polysomnography2 and possibly additional tests of sleepiness such as the Maintenance of Wakefulness Test3 (section 8: Austroads, 2017). In most Australian states and territories, it is left to the discretion of the health professionals to report whether a client may have a diagnosed physical or mental illness, disability or deficiency such that, if the person drove a motor vehicle, they would be likely to endanger the public (ACT Road Transport (General) Act 1999 s. 230 (3) (4), ACT Road Transport (Driver Licencing) Act 1999, s. 28; NSW Road Transport Act 2013. s. 275 (3) & (4), NSW Road Transport (Driver Licencing) Regulation 2008, c. 50; QLD Transport Operations (Road Use Management) Act 1995, s. 142; TAS Vehicle and Traffic Act 1999, ss. 63 (2) & 56, TAS Vehicle and Traffic Act 1999, s. 63 (1); VIC Road Safety Act 1986, s. 27 (4), VIC Road Safety (General) Regulations 2009, r. 68; WA Road Traffic (Administration) Act 2008, s. 136). In contrast, and as based in legislation, health professionals in the Northern Territory (NT) and South Australia (SA) are mandated to report patients at risk (Motor Vehicle Act, 1959 (SA) s.148, Motor Vehicles Act, 1999 NT s.11).4, 5 The health practitioner is also required by law to notify the person in question that this reporting has occurred as well as the reasons for this report. Notably, SA section 148 in the Motor Vehicles Act (1959) states that mandatory reporting applies to “a legally qualified medical practitioner, a registered optician or a registered physiotherapist.” No reference to psychologists is made in this Act for mandatory reporting. The case is the same for the NT under section 11 of the Motor Vehicles Act (1999). Notwithstanding that psychologists are not legally mandated to report clients at driving risk, the APS ethical code refers to circumstances under which

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psychologists are permitted to disclose confidential information. Specifically under section A.5.2 c: if there is an immediate and specified risk of harm to an identifiable person or persons that can be averted only by disclosing information. Further to this, the Privacy Act, 1988 (Cth, section 16A, Item 1) states: that an exception to the Australian Privacy Principles, and allows disclosure of client information if: the entity reasonably believes that the collection, use or disclosure is necessary to lessen or prevent a serious threat to the life, health or safety of any individual, or to public health or safety. Thus, the psychologist in the instance of reporting an individual at driving risk can be effectively placed under the protection of the discretionary reporting category of both the APS Code of Ethics (section A.5.2.c) and the exclusions under the Privacy Act, 1988 (section 16A item 1). It still remains noteworthy that referral of a patient to a treating medical professional or GP in SA and NT will result in that practitioner being subject to mandatory reporting of the patient if a driving risk is identified (SA Motor Vehicle Act, 1959 s. 148, NT Motor Vehicles Act, 1999 s. 11).6

Relevant ethical principles OO

Autonomy

OO

Non-maleficence

OO

Fidelity

Three ethical principles apply to the management of this fitness-to-drive case. First, autonomy, an individual’s right to self-government and their own decision-making, especially if they are not breaking any law. However, when considering this principle the psychologist must balance the right to autonomy against the risks to others that may arise from impaired driving.There is also the expectation that the individual is making an informed decision. Therefore the onus is on the psychologist to ensure that the client has the capacity to understand the risks and that they are sufficiently educated about the driving risks to make an informed decision. Second, non-maleficence, to avoid harming the person receiving treatment and more broadly not harming the general community.When considering this principle the psychologist must balance the impact of notification on the client’s wellbeing versus the psychologist’s obligations to other road users and the community.

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Third, fidelity, that is, the psychologist must maintain a professional relationship and be loyal and supportive. When considering this principle the psychologist must take into account their duty to be honest with the client about their condition and the risks that their condition has to other road users. This includes balancing the client’s right to confidentiality versus the possible need to disclose information to authorities.

Relevant ethical standards In reaching a decision the psychologist must take into account and be conversant with the guiding principles in the APS Code of Ethics (2007) and in particular sections A1.3, A.2.2, A5.2, and B1.2. In addition, section 16A item 1 of the Privacy Act (Cth) 1988. The following ethical decision-making section provides a step-by-step framework for applying the relevant APS ethical principles and standards in such a case.

Ethical decision-making Kämpf, McSherry, Ogloff, and Rothschild (2009) describe an eight-step model for ethical decision-making. This has been applied to the ethical dilemmas surrounding the client and reporting their fitness-to-drive.

Step 1: Identify individuals and groups potentially affected by the decision The client is intimately affected by the decision to report their fitness-todrive. It could result in the loss of employment which as a single parent could be doubly burdensome. The employer may also be affected as they will need to manage the client’s work duties, and, more broadly, it may impact how the organisation manages fitness-to-drive, hours-of-work, shift rosters, and workplace fatigue. The consulting psychologist is also affected as the decision would impact the practitioner-client relationship and, similarly, the GP who is also subject to mandatory reporting requirements. It could also conceivably affect future referral patterns if other clients, or potential clients, hear about the experience of the client in this case and feel uncomfortable discussing sleep disorder symptoms with their health care provider for fear of possible consequences (e.g., reporting and loss of income). Finally, the community is at risk as the client is, firstly, a paramedic with its incumbent clinical demands and, secondly, also an ambulance driver with its incumbent demands for cognitive alertness and a high level of driving skills beyond that of an average driver.

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Step 2: Identify the problem, including the relevant ethical and legal issues and clinical practices The ethical dilemma is whether a client who is not fit-to-drive and therefore a risk to themselves and the community should be reported to the motor licencing authority. Although there is not a legal requirement, the psychologist needs to consider the circumstances under which discretionary reporting may occur taking into account: (a) the nature and severity of risk, (b) the personal consequences for the patient, and (c) the effect on patient-client relationship. In addition, the psychologist needs to consider whether they report to the client’s employer and GP.

Step 3: C  onsider the significance of the context and the settings The context for the client is that they are a paramedic and ambulance driver – demanding occupations which require high levels of functioning. They work in an industry where shift work is common which has accompanying legal obligations on the employer (SafeWorkAustralia, 2011). Finally, they are a single parent with their own personal responsibilities. The context for the psychologist is that they have received a referral with a mental health care plan from a GP who has their own ethical guidelines and, as well, specific obligations under law regarding fitness-to-drive.

Step 4: Identify and use relevant legal, ethical, and professional resources In addition to consultations with colleagues, their insurer, and legal representative, the following resources are available to the psychologist in their decisionmaking: APS Code of Ethics (section A5.1. and A5.2C 2007); the Privacy Act, 1988 (Cth, section 16A, Item 1); and Austroads (2017) (sections 2–5 which includes general information on assessing fitness-to-drive and especially section 3.3.1 regarding confidentiality and section 8 which has information on sleep disorders) (for details see Appendix 1).

Step 5: D  evelop and consider alternative solutions to the problem Alternative A: Advise the client to take sick leave immediately, contact the State motor authority regarding your concerns, and refer them immediately to their GP raising your concerns about suspected OSA Analyse the risks and benefits of this course of action: The risk of alternative A is that a recommendation has been made to the State motor authority before the

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diagnosis has been confirmed by a sleep study. If the study is negative then the failure to undertake a complete and proper clinical assessment prior to making the decision to report may be grounds for professional misconduct.7 To mitigate against this risk the psychologist would need to pay particular attention to note taking, keeping records of all consultations, and to ensure that they have completed a thorough assessment of the person’s condition and history. It would also be beneficial to have consulted with other health colleagues and especially expert specialists on an appropriate course of action. The benefit of following alternative A is increased public safety. Consider how your personal beliefs, values, and biases may affect your decision-making: This is a sympathetic case of a single parent who works in a helping profession. The impact of sleepiness on driving performance is generally under-appreciated and the public perception is that it is not a significant issue and therefore the impact of sleepiness on driving risk may be minimised (Fletcher, McCulloch, Baulk, & Dawson, 2005;Vanlaar, Simpson, Mayhew, & Robertson, 2008).

Alternative B: Take no action other than addressing the reason for the initial GP referral, which was to manage insomnia Analyse the risks and benefits of this course of action: The risk of alternative B is that the psychologist may ignore a potentially important health condition which increases driving risk, namely OSA. There is also a risk to the psychologist if the client does have an accident and they haven’t been informed of the risk associated with OSA or their reporting obligations to State motor authorities. The benefit of alternative B is that the psychologist is simply performing the task requested by the referring GP. Consider how your personal beliefs, values, and biases may affect your decisionmaking: This alternative avoids breaking client confidentiality and prioritises fidelity.These are highly valued practice principles which may unduly influence taking this course of action.

Alternative C: Defer any immediate action until a more accurate and comprehensive assessment of the client’s sleep has been undertaken. This includes a referral to the GP about possible OSA and the need for a sleep study and seeking advice from colleagues/experts. Then work with the patient to educate them of the risks of excessive sleepiness and untreated sleep apnoea as well as educate them as to their obligations under the law as it relates to driving risk, and allow them to determine the best strategy moving forward Analyse the risks and benefits of this course of action: The risk of alternative C is that the client may decide to ignore the recommendation to seek a sleep study.

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A less likely risk is that may have a sleep-related accident while awaiting the sleep study. The benefits of alternative C include: maintenance of client confidentiality, promotion of the therapeutic alliance, and minimisation of driving risk. In the event of a negative outcome, the psychologist would also be able to demonstrate that they were transparent in their instructions to the patient with OSA and the information provided to referring GP about progress, possible outcomes, and the plans they have enacted to mitigate against possible negative outcomes. They can also demonstrate that they sought additional advice when making a case formulation. A treatment plan for alternative C is outlined in Appendix 2. Consider how your personal beliefs, values, and biases may affect your decision-making: Alternative C does require co-joint decision-making and having confidence in that approach.

Step 6: Chose the most appropriate course of action Alternative C is the most appropriate as it can be considered to be a compromise between the first two options but importantly, also acknowledges the complexity of the scenario and the importance of finding out as much as possible about the likely factors that may be contributing to the client’s fatigue and sleepiness before making a decision. In addition, it is consistent with the legislative requirements and recommendations such as are set out in Austroads (2017). It is also the alternative which incorporates the input and advice from professional colleagues and ensures transparency in the actions of the psychologist. It is also the only option that has the client as the driver of the process while using the expertise from the psychologist to direct them and is therefore likely to be the alternative with the best prospect for a sustained and effective outcome.

Step 7: M  onitor and assess the outcome chosen . . . what was the result? The psychologist raises the possible contributing factors to the client’s sleepiness and enacts alternative C. The client is willing to participate in this process and eager to discover the cause of their excessive sleepiness. The obligations of the individual to self-report to the driver licencing authority when they become aware of any factor (related to physical or mental health) that may impair their ability to drive safely is also discussed. This information is conveyed back to the referring GP in a letter after the second visit and the GP, with consent from the client, refers the client to have an overnight sleep study to determine if OSA is a factor. At the same time, the client continues to complete their sleep diary and returns with it and their work roster at the third visit to the psychologist. The psychologist identifies that the client’s work schedule is not a likely contributing factor, but that her

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sleep onset insomnia may be due to stress related to being a single parent.They discuss relaxation techniques prior to bed and the importance of good sleep hygiene. After the fifth visit, the client notices improvement in their sleep and a reduction in their sleepiness. At this time, the sleep study results return with confirmation of moderate sleep apnoea. The client is placed on continuous positive airway pressure therapy (Giles et al., 2006) by the treating sleep physician while they attempt to lose weight. Because the client has observed a reduction in their sleepiness and is on therapy for their OSA, the psychologist and GP determine that reporting to the driver licencing authority is not required. The psychologist ends their sixth session by informing the client to return to them should their insomnia return or if they become aware of any other social or life stresses they wish to discuss. They then send a summary letter back to the referring GP detailing all the steps taken and outcomes of each step.

Step 8: If the situation is resolved, consider the need for a modification to your future practice, and if it is not resolved, repeat steps 5–7 This step includes noting any practice changes that were needed and the reasons for those changes, as well as noting any secondary action taken to resolve the situation. Further, if not already in place as standard practice, this process illustrates the importance of an interim letter back to the referring GP after the second visit. This not only ensures clarity for all parties over the agreed action plan but also transparency if the psychologist is ever called to explain their actions in the event of an adverse event or outcome later on. In the event that the client is unable or unwilling to accept or to understand the significance of the risks associated with leaving their circumstances untreated/unmanaged, then the psychologist may consider that the benefits of some form of discretionary reporting may outweigh the costs of breaching confidentiality. This would be further mitigated if the psychologist has already incorporated their potential need to disclose confidential information should the client pose a risk to themselves or the general community in the informed consent process. A likely scenario in which this may occur would be if the client agrees initially to undertake the action plan described above but simply does not return after the second or third visit. Given the psychologist has already opened channels of communication with the referring GP, a subsequent letter could be written to the GP describing how the client has not returned and to seek clarification on whether the GP has also seen the client regarding their suspected OSA identification and management. The concerns over the risks associated with the client not adhering to the agreed action plan can be clearly articulated and consensus reached with the GP about the need to report the client to the licencing authority.

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Personal reflection For most practising psychologists making a judgement as to whether a client represents a risk to the public is fortunately an uncommon event. Evaluating a client’s fitness-to-drive is even more uncommon.The case scenario presented in this study, however, does highlight some important ethical and legal issues that can arise from what may appear in the first instance to be an innocuous presentation of insomnia. The case study especially highlights the ethical dilemmas that can arise when weighing up duty to the client versus the general community. It also highlights what is probably an under-appreciated legal responsibility for most psychologists, that is, a client’s fitness-to-drive and reporting impairment. When working through the ethical and legal responsibilities of this case study several points affecting good decision-making emerged. These included the importance of communication, history taking, and not making decisions in isolation. Specifically, the importance of talking through the various options and responsibilities with the client and, as well, keeping the GP informed early in the process were underlined. In addition, this case emphasises that when making a diagnosis, the case formulation is based on evidence, and alternate explanations for the client’s problems have been examined. Finally, it is useful to share decision-making with referral sources, peers, and/or experts in the field. The events described in this case study are complex and would require specialist knowledge of sleep disorders to be fully informed as to diagnosis and treatment. Including others in the decision-making can help arrive at an optimal solution.

Details statement The case scenario described in this chapter was created by the authors for educational and research purposes only and does not have any similarities to other cases that the reader may come across.

(b) take reasonable steps to protect the confidentiality of information after they leave a specific work setting, or cease to provide psychological services.

(Continued)

The patient–professional relationship is built on a foundation of trust. Patients disclose highly personal and sensitive information to health professionals because they trust that the information will remain confidential. If such trust is broken, many patients could either forgo examination/treatment and/or modify the information they give to their health professional, thus placing their health at risk.

Section 3.3.1: Health professionals have both an ethical and legal duty to maintain patient confidentiality. The ethical duty is generally expressed through codes issued by professional bodies. The legal duty is expressed through legislative and administrative means and includes measures to protect personal information about a specific individual. The duty to protect confidentiality also applies to driver licencing authorities.

Cth, section 16A, Item 1: an exception to the Australian Privacy Principles, and allows disclosure of client information if: “the entity reasonably believes that the collection, use or disclosure is necessary to lessen or prevent a serious threat to the life, health or safety of any individual, or to public health or safety.”

Section A.5.1: Psychologists safeguard the confidentiality of information obtained during their provision of psychological services. Considering their legal and organisational requirements, psychologists:

(a) m  ake provisions for maintaining confidentiality in the collection, recording, accessing, storage, dissemination, and disposal of information; and

Austroads (2017) sections 2–5 (general information on assessing fitness-to-drive and especially section 3.3.1.) and section 8 (information on sleep disorders)

The Privacy Act, 1988 (Cth, section 16A, Item 1)

APS Code of Ethics concerning confidentiality

Appendix 1: Legal, ethical, and professional resources

Section A.5.2 c: “If there is an immediate and specified risk of harm to an identifiable person or persons that can be averted only by disclosing information.”

APS Code of Ethics concerning confidentiality

Appendix 1:  (Continued) The Privacy Act, 1988 (Cth, section 16A, Item 1)

• Continues driving despite appropriate advice and is likely to endanger the public

• Unable to take notice of the health professional’s recommendations due to cognitive impairment, or

• Unable to appreciate the impact of their condition

The health professional should consider reporting directly to the driver licencing authority in situations where the patient is either:

Although confidentiality is an essential component of the patient–professional relationship, there are, on rare occasions, ethically and/or legally justifiable reasons for breaching confidentiality. With respect to assessing and reporting fitnessto-drive, the duty to maintain confidentiality is legally qualified in certain circumstances in order to protect public safety.

Austroads (2017) sections 2–5 (general information on assessing fitness-to-drive and especially section 3.3.1.) and section 8 (information on sleep disorders)

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Appendix 2: Assessment and treatment plan There are at least four possible causes that may, in isolation or in combination, contribute to the client’s sleepiness: (1) insomnia; (2) OSA; (3) shift work; and (4) given that the client is a sole parent, sleep restriction arising from family responsibilities and social factors. The contribution of these factors can be assessed by taking a detailed history, asking the client to keep a sleep diary, asking the client to keep a time sheet which logs her work schedule, and asking the client to complete questionnaires that assess sleepiness (e.g., the ESS see Footnote 1) and OSA.8 As part of the assessment the psychologist would also need to ascertain if there is a history of sleepiness when driving and related accident history. The psychologists could then discuss with the client where they fall on the spectrum of sleepiness and their potential driving risk. The psychologist could then discuss the potential contributors to sleepiness and treatment options including a referral for a sleep study. They would need to discuss the consequences of a positive sleep study and that notification to the State motor authority may be required, but also that if the OSA is effectively managed that it will not result in a loss of licence or at worst a conditional licence. To ensure that they minimise the legal risks to themselves the psychologist should ensure that in their notes they specifically mention what they said to the client and also record whether they believe that the client understood and, where appropriate, whether the client agreed to a recommended course of action. The client does need to be aware that death caused by driving may result in criminal proceedings.9 Assessing the contribution of the client’s work schedule to her sleepiness may require discussing whether workplace fatigue management policies and procedures are present and their responsibilities under their work agreement to report to their employer any medical conditions which could affect their driving ability (Patterson et al., 2018). The employer has a duty of care to provide working conditions that are safe, which includes appropriate fatigue management (SafeWorkAustralia, 2011), and many industries including emergency services providers have such policies in place (e.g., SA Ambulance, 2008). The client could consider taking steps to report or discuss fatigue with their employer or with workplace Health and Safety Representatives and requesting a roster change to accommodate their fatigue and sleep concerns. After all these discussions, the psychologist can then discuss the possible next steps, and in the first instance, allow the patient to determine what action(s) they would be responsible for and a time frame for those actions to be completed. As part of a comprehensive history and in order to ensure the psychologist has considered as many variables and implications as possible, it would be beneficial to discuss the case with their professional colleagues. In addition, informing the referring GP, via a letter after the second visit, of the issues discussed

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and the proposed action plan in general could also be conducted. While the psychologist would include their concerns over excessive sleepiness, they also would ensure information concerning the ongoing exploration of the likely contributing factors and the willingness of the client to participate in this process. The psychologist would also inform the client of their intent to write this interim letter and also obtain their consent to do so. By following these steps, the psychologist ensures that there is complete transparency in their actions and motives. This not only ensures the client is a participant in the process but also protects the psychologist should an adverse event occur or if there is a deviation in the anticipated action plan (for example, if the client does not attend after the second visit). The Australian Sleep Association provides information on the treatment options for insomnia at www.sleep.org.au/documents/item/355 and shift work sleep disorders at www.sleep.org.au/documents/item/2830.

Notes 1 A commonly used instrument to assess behaviours suggestive of excessive sleepiness is the Epworth Sleepiness Scale (Johns, 1991). Respondents are asked to rate, on a 4-point scale (0–3), their usual chances of dozing off or falling asleep while engaged in eight different activities (e.g., watching TV). A score of 16–24 is indicative of significant daytime sleepiness. 2 This involves the collection of respiratory, electrooccular (EOG), electromylographic (EMG) and electroencephalographic (EEG) parameters to assess for sleep apnoea. 3 A commonly used test is the Maintenance of Wakefulness Test (MWT) (Littner et al., 2005). The MWT is a daytime polysomnographic procedure which quantifies wake tendency by measuring the ability to remain awake during soporific circumstances for a defined period of time (e.g., by assessing the latency to sleep onset while sitting upright in bed under very dim light conditions over a 40-minute period. Typically, an MWT will involve four trials spaced evenly across the day). An MWT trial