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Although formal, assigned supervision is a potent source of learning and guidance for psychotherapy trainees, many beginning psychotherapists use other, informal sources of supervision or consultation for advice and support. Results of an online survey of beginning trainees (N = 146) indicate that other than their formally assigned supervisor, trainees most often consult with colleagues in their program, their own psychotherapist, and their significant other; that they're most likely to seek these other sources of help when they're feeling stuck or feel they've made a clinical mistake; that they do so because they need extra reassurance and suggestions; that they feel the advice given from these sources is helpful; and that they don't especially regret sharing this information. Several case examples are used to illustrate these points. Discussing clinical material with informal sources is, apparently, a great deal more common than typically acknowledged, and as such, has implications for training programs (including discussions of ethics) and formal supervision., (© 2014 Wiley Periodicals, Inc.)

Clinical supervision is an essential aspect of every mental health professional's training. The importance of ensuring that supervision is provided competently, ethically, and legally is explained. The elements of the ethical practice of supervision are described and explained. Specific issues addressed include informed consent and the supervision contract, supervisor and supervisee competence, attention to issues of diversity and multicultural competence, boundaries and multiple relationships in the supervision relationship, documentation and record keeping by both supervisor and supervisee, evaluation and feedback, self-care and the ongoing promotion of wellness, emergency coverage, and the ending of the supervision relationship. Additionally, the role of clinical supervisor as mentor, professional role model, and gatekeeper for the profession are discussed. Specific recommendations are provided for ethically and effectively conducting the supervision relationship and for addressing commonly arising dilemmas that supervisors and supervisees may confront., (© 2014 Wiley Periodicals, Inc.)

Sexual intimacies with clients are inappropriate behaviors under all circumstances. Yet, psychologists who adhere to rigid rules about boundaries and multiple relationships in an ill-guided effort to avoid such occurrences may find that they actually harm clients by acting in ways that are inconsistent with clients' treatment needs and goals. Boundaries and multiple relationships are discussed and strategies for negotiating them effectively are presented. A thoughtful and deliberative process is described for responding to the inevitable feelings of attraction toward clients that at times arise, and steps for addressing psychotherapists' vulnerabilities are presented. Ethics principles and standards as well as decision-making considerations are presented so that psychologists will be better prepared for addressing these important issues in psychotherapy., (© 2013 Wiley Periodicals, Inc.)

Topic: Reparative therapy aims to modify the sexual orientation of lesbian, gay, and bisexual (LGB) people into that of heterosexuals. Although denounced as harmful by most professional organizations, these treatments continue-youth may be particularly vulnerable to the negative consequences., Purpose: The purpose of this article is to discuss reparative therapies, the potential harm LGB youth may experience, clinical and practice issues for psychiatric nurses, and the ethical issues surrounding nurse involvement in reparative therapy., Conclusions: Reparative therapy for adolescents raises important clinical and ethical issues for psychiatric nursing. Further discussion of nurse involvement in these treatments is needed.

The successful termination of the psychotherapy relationship is each psychotherapist's goal. Yet, a number of circumstances may arise that interfere with the successful completion and termination of treatment. This article addresses both termination and abandonment and illustrates the applicable guidelines and standards from the American Psychological Association's (2002) Ethics Code. We conclude with 12 recommendations for proactively addressing termination and abandonment consistent with professional standards and each patient's best interests.

Psychotherapists confront a myriad of ethical dilemmas as they endeavor to provide effective services. This issue of the Journal of Clinical Psychology: In Session on Ethics in Psychotherapy provides psychotherapists with thoughtful reviews, case examples, and practical guidance in the major areas of ethics. Following this brief introduction, the subsequent seven articles cover Informed consent; confidentiality, privilege, and their limits; treatment of minors and their families; business matters of practice (e.g., money, fees, bartering, advertising); clinical competence and scope of practice; boundaries and nonsexual multiple relationships; and termination and abandonment. This issue is designed to promote ethical practice, to provide guidance on common ethical dilemmas, and to prevent ethical challenges before they occur.

Psychotherapists must deal with practical business matters such as advertising, billing, collecting fees, and other practice management topics. We review the enforceable standards of the American Psychological Association's (2002) Ethics Code that deal with advertising, fees, billing, and related business matters in psychotherapy. Using a principle-based perspective, we link each of the standards to overarching ethical values and illustrate the concerns with case vignettes. We argue that understanding the moral foundations of ethical standards helps psychotherapists to implement with greater integrity the spirit and the letter of the standards with regard to advertising and business practices.

Well-implemented informed consent procedures demonstrate psychotherapists' respect for clients' right to self-determination and can initiate meaningful contributions to treatment through enhancing mutual trust, building rapport, and facilitating a sense of ownership. This article details key components of informed consent to psychotherapy by placing them within real-world psychotherapy scenarios. We provide information on client-therapist discussions of the nature and course of therapy, fees and payment policies, the involvement of third parties, confidentiality policies, and new and untested treatments. In addition, this article addresses informed consent procedures for individuals with impaired cognitive capacities and under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations.

Mental health practitioners working with children and families must attend to several ethical concerns that do not typically come into play with adult clients. The challenges for practitioners usually involve attention to four subsets of concerns that all begin with the letter c: competence, consent, confidentiality, and competing interests. Using the 4-C model, this article focuses on ethical aspects of practitioner competence, consent and assent, confidentiality, and the incongruence of interests that occurs when different people organize and set goals for psychological services. After explicating these issues, I provide recommendations for addressing them in the course of clinical practice.

Nonsexual boundary crossings can enrich psychotherapy, serve the treatment plan, and strengthen the therapist-client working relationship. They also can undermine the therapy, disrupt the therapist-patient alliance, and cause harm to clients. Building on T. G. Gutheil and G. O. Gabbard's (1993) conceptualization of boundary crossings and boundary violations, this article discusses and illustrates grounding boundary decisions in a sound approach to ethics. We provides nine useful steps in deciding whether to cross a boundary, describe common cognitive errors in boundary decision making, and offer nine helpful steps to take when a boundary crossing has negative effects.

In this article, I discuss the importance of the psychotherapist's capacities and attributes that go beyond formal education and training as they relate to both readiness for clinical training and continued competence throughout one's professional life. Professional development is essential to the maintenance of professional competence as a psychotherapist. Principles and standards from the American Psychological Association's (2002) Ethics Code are reviewed and illustrated with clinical vignettes. In striving to maintain competence, psychotherapists are strongly encouraged to focus on proactive self-care and professional development in addition to complying with the formal continuing education mandated by most states.

Confidentiality is the secret-keeping duty that arises from the establishment of the professional relationship psychologists develop with their clients. It is a duty created by the professional relationship, it is set forth in the American Psychological Association's (2002) Ethical Principles and Code of Conduct, and it is codified in many state regulations. However, the difference between confidentiality and legal privilege; how, why, and when it can be violated; and the reasons for so doing are not well understood by many practitioners. While on the surface confidentiality might seem to be an easy concept to apply to professional practice, in fact it is quite complex and filled with exceptions that frequently differ from circumstance to circumstance and from state to state. A lack of respect for and a lack of familiarity with the significance of these exceptions could have dire professional consequences. This article reviews the ethical imperative of confidentiality and then provides examples of legal cases that help to better understand its complexity. Then, we offer strategies designed to help metal health practitioners when they are confronted with questions regarding confidentiality and privilege.

Professional and scientific psychology appears to have rediscovered spirituality and religion during recent years, with a large number of conferences, seminars, workshops, books, and special issues in major professional journals on spirituality and psychology integration. The purpose of this commentary is to highlight some of the more compelling ethical principles and issues to consider in spirituality and psychology integration with a focus on psychotherapy. This commentary will use the American Psychological Association's (2002) Ethics Code and more specifically, the RRICC model of ethics that readily applies to various mental health ethics codes across the world. The RRICC model highlights the ethical values of respect, responsibility, integrity, competence, and concern. Being thoughtful about ethical principles and possible dilemmas as well as getting appropriate training and ongoing consultation can greatly help the professional better navigate these challenging waters., ((c) 2007 Wiley Periodicals, Inc.)

This article addresses clinical and ethical directions in treating clients coping with infidelity. Developing competence in this domain requires familiarity with empirical research regarding infidelity, individual and cultural differences involving non-monogamy, and assessment and intervention skills related to treating infidelity. Practical directions will entail distinguishing among responsibilities to individual partners versus their relationship and managing related potential conflicts of interest with other involved parties. Confidentiality assumes increased complexity when confronting undisclosed infidelity in couple therapy and when a client engaging in high-risk behaviors for contracting STDs or testing seropositive for HIV has not informed his or her partner(s). Finally, we discuss therapists' need to concretely articulate their values that influence treatment of infidelity.

Adolescent psychotherapy has only recently taken hold as distinct from either child or adult psychotherapy. This new recognition was born of necessity as practitioners saw that theories and techniques developed for treating children and adults were far less effective for treating adolescents. As necessity is often the mother of invention, new models for treating adolescents have emerged. While these models differ in many respects, they share three characteristics: the unique features of adolescents, psychotherapists requiring specialized knowledge and skills, and the need for adolescent psychotherapy to involve the broader systemic context of the adolescent's life. The articles in this issue of In Session: Journal of Clinical Psychology insist that practitioners recognize and challenge their assumptions about how psychotherapy with adolescents should be conducted. The articles highlight the need for specialized training, the scarcity of evidenced-based research, and the ethical dilemmas that frequently occur when working with this population., (Copyright 2003 Wiley Periodicals, Inc.)

Treating adolescents in psychotherapy presents a number of unique ethical challenges. Because many adolescents who enter treatment have not yet attained the age of majority, reside in families that include other people with emotional difficulties, attend school, become involved with community agencies (e.g., the courts), and must generally take direction from adult authority figures, the role of the therapist becomes particularly complex. The unique dilemmas include developing specialized clinical competence, treatment contracting, choice of treatment modality, direction of the therapeutic process, and confidentiality. This article discusses the range of ethical concerns involved in treating adolescents and suggests strategies for optimal ethical care., (Copyright 2003 Wiley Periodicals, Inc.)