Multiple relationships, conflicts of interest and barter

Transcript

RyanIt's a Saturday morning in a small town. A psychologist pulls into the only auto shop for miles to get her oil changed. The mechanic who walks out, wiping his hands on a rag, is her Thursday afternoon client.

SoheeThey both freeze for a second. Then he grins and says, Hey, Doc. And while the car's up on the lift, he adds, You know, money's tight right now. What if I keep your car running, and we call it even for my sessions?

RyanTwo ethics questions before the oil change is done. Welcome to EPPP Prep, the podcast. I'm Ryan.

SoheeI'm Sohee. Today it's multiple relationships, conflicts of interest, and barter. These are some of the most judgment-heavy items in the ethics domain, and the exam rewards knowing the exact test the Code uses.

RyanLet's start with the definition, because it's broader than people expect. Standard 3.05 says a multiple relationship occurs when a psychologist is in a professional role with a person, and one of three things is also true.

SoheeOne, at the same time, the psychologist is in another role with that same person. Two, at the same time, the psychologist is in a relationship with someone closely associated with or related to that person. Think of the client's spouse.

RyanAnd three, the psychologist promises to enter into another relationship in the future, with the person, or with someone close to them.

SoheeThat third one catches people. Nothing has actually happened yet. It's just the promise. Something like, once therapy ends, let's go into business together.

RyanNow, the heart of 3.05. A psychologist refrains from a multiple relationship if it could reasonably be expected to impair the psychologist's objectivity, competence, or effectiveness, or if it otherwise risks exploitation or harm to the client.

SoheeAnd then comes the sentence I'd put on a sticky note above every study desk. Multiple relationships that would not reasonably be expected to cause impairment or risk exploitation or harm are not unethical.

RyanSo the Code does not ban multiple relationships. It bans the ones that could reasonably be expected to impair the psychologist, or that risk exploitation or harm.

SoheeSo, the oil change. Is getting her car serviced by her client unethical?

RyanRun the test. If it stays a routine transaction, with nothing touching the therapy, it poses no reasonably expected threat to her objectivity and no risk of exploitation or harm. Our practice questions treat that kind of routine customer contact, like a client who is one of many cashiers at your supermarket, as not unethical. Same for brief, incidental contact as fellow parents on a sports team, or as members of a large congregation.

SoheeAnd the tempting wrong answers are predictable. The Code prohibits any multiple relationship with a current client? Wrong. It's allowed only if the client signs a waiver? Wrong, a waiver isn't the test. It's allowed only in a rural area with no other provider? Also not the test.

RyanRight. The test is always one question. Could this reasonably be expected to impair the psychologist, or risk exploitation or harm?

SoheeWhat if a harmful multiple relationship sneaks up on you? You didn't create it. It just happened.

RyanStandard 3.05 covers that too. If, due to unforeseen factors, a potentially harmful multiple relationship has arisen, the psychologist takes reasonable steps to resolve it, with due regard for the best interests of the affected person and maximal compliance with the Code.

SoheeNotice whose interests come first there. The affected person's. Not the psychologist's convenience.

RyanThere's a forensic piece as well. When law, institutional policy, or extraordinary circumstances require a psychologist to serve in more than one role in judicial or administrative proceedings, they clarify role expectations and the extent of confidentiality at the outset, and again as changes occur.

SoheeWhich brings us to a cousin standard that people blur with 3.05. Conflict of interest. Standard 3.06.

RyanPsychologists refrain from taking on a professional role when personal, scientific, professional, legal, financial, or other interests or relationships could reasonably be expected to impair their objectivity, competence, or effectiveness, or expose the person or organization they serve to harm or exploitation.

SoheeHere's how I keep them apart. 3.05 is about roles with people. 3.06 is about interests. Money riding on an outcome. A lawsuit against one parent in a custody evaluation. A competing scientific interest in a grant proposal you've been asked to review.

RyanAnd the verb is refrain. Don't take the role. The study notes for our practice questions are crisp on this. Disclosing the interest, feeling sure you'll stay objective, or having a colleague review the conclusions does not replace refraining from the role.

SoheePause and think. A psychologist is asked to do an independent evaluation, and her fee depends on the outcome. She says, No problem, I'll disclose that to everyone at the start. Does disclosure fix it?

RyanNo. Payment that depends on the outcome gives her a financial interest in the findings that could reasonably be expected to impair her objectivity. Under 3.06 she declines the role. Disclosure, confidence and peer review aren't substitutes the Code offers.

SoheeNow, what about when someone else asks for the service? An employer sends an employee. A court orders an evaluation. An agency refers someone.

RyanThat's Standard 3.07, third-party requests. When psychologists agree to provide services at the request of a third party, they attempt to clarify at the outset the nature of the relationship with all the individuals or organizations involved.

SoheeAnd the Code spells out what that clarification includes. The psychologist's role, such as therapist, consultant, diagnostician, or expert witness. Who the client is. The probable uses of the services or the information. And the fact that there may be limits to confidentiality.

RyanWho is the client? That's the question to ask yourself whenever a third party shows up in a stem.

SoheeCouples and family work has its own version of this trap. Standard 10.02 says that if it becomes apparent a psychologist may be called on to perform potentially conflicting roles, such as family therapist and then witness for one party in divorce proceedings...

Ryan...the psychologist takes reasonable steps to clarify and modify, or withdraw from, roles appropriately. It's the same logic again. Spot the role collision early, and deal with it.

SoheeAnd underneath all of this sits Standard 3.08, Exploitative Relationships. Psychologists do not exploit people over whom they have supervisory, evaluative, or other authority, such as clients, students, supervisees, research participants, and employees.

RyanOkay. Back to the mechanic's offer. Car repairs instead of paying for sessions.

SoheeThat's barter. Standard 6.05 defines it as accepting goods, services, or other nonmonetary payment from clients in return for psychological services. So services count, not just goods.

RyanAnd the rule is short. Psychologists may barter only if, one, it is not clinically contraindicated, and two, the resulting arrangement is not exploitative.

SoheeThose are the only two conditions. And the exam loves to offer fake ones.

RyanIt's fine because the client proposed it. Or because it's documented in the record. Or because the work is worth at least the usual fee. Or because the client can't pay any other way.

SoheeNone of those appear in 6.05. The study notes add that local custom doesn't change the rule either. Who offered, how it's documented, the value, local custom, money hardship. None of them decide it.

RyanSo for our mechanic, she asks two questions. Is there a clinical reason against it? And would the arrangement be exploitative? Would trading repairs for therapy tangle up the treatment, or tilt into a deal where he ends up giving more than he gets?

SoheeAnd notice that 6.05 itself points you back to Multiple Relationships, Standard 3.05. A barter deal can add a second role, customer and repairman, on top of psychologist and client.

RyanPause and think, round two. A psychologist's new client turns out to be the husband of her regular tennis partner. Which part of the definition is that?

SoheeThe second part. At the same time, she's in a relationship with someone closely associated with the client. And then the usual test applies. Could it reasonably be expected to impair her, or risk exploitation or harm?

RyanLet's recap.

SoheeA multiple relationship is a second role with the client, a relationship with someone close to the client, or a promise of a future relationship.

RyanIt's unethical only if it could reasonably be expected to impair objectivity, competence or effectiveness, or risk exploitation or harm. Ones that wouldn't are not unethical. Waivers and rural settings aren't the test.

SoheeIf a harmful one arises unexpectedly, take reasonable steps to resolve it, with the affected person's best interests in mind.

RyanA conflict of interest under 3.06 means refrain from the role. Disclosure, confidence, or a colleague's review don't substitute.

SoheeWith third-party requests, clarify at the outset your role, who the client is, how the information will be used, and the limits of confidentiality. And in family work, watch for conflicting roles.

RyanAnd barter needs exactly two things. Not clinically contraindicated, and not exploitative.

SoheeThese questions can feel gray, and that's okay. You don't need a perfect instinct. You need one steady question: could this reasonably be expected to impair me, or risk exploitation or harm? You have that question now.

RyanBring it to your next practice set and see how much clearer these items feel. Thanks for listening to EPPP Prep.

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