Is it unethical for a psycholgist to refer a current patient to
his/her own (meaning the psychologist's) spouse/partner for the
purpose of business?  In other words, would this be considered a
"boundary violation"?  If so, are there any exceptions?

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Request for Question Clarification by mvguy-ga on 15 Jan 2003 07:56 PST

The answer may depend on which state or other jurisdiction the
psychologist is practicing in, as formal rules for such things are
usually established at the state level (in the United States, that
is).  So are you looking for a general answer, or an answer for a
specific jurisdiction?

Hi Nerv-ga ~

On the surface it would seem to be a simple question of ethical
considerations in recommending a spouse's business to a current
patient.

While you didn't mention the spouse's business, the concern is valid.
Professionally you do not want to do anything to harm the patient.

The easy answer, and perhaps a solution, is to ensure the patient
understands there is a marital relationship involved. Then, so you
both feel comfortable, offer alternatives as well, so the patient
doesn't feel "obligated".

By way of example, if the psychologist's spouse runs a computer
business and you know the patient needs help the spouse can offer, it
is not unethical to refer the patient to the spouse's business.
Indeed, not referring to it wouldn be unnatural. You can also
recommend one or two other alternate choices.

On the other hand, if the psychologist's spouse were likewise a
psychologist (but you didn't say "practice", you said "business"), it
might be touchier, and still it wouldn't be unethical or a "boundary
violation" if you point out the relationship and again, offer
alternatives.

A check with the APA's Code of Ethics - both the current Code and the
Code which will be in effect June 1st of this year - does not
proscribe such a recommendation.

Further, Dr. Stephen Behnke of the APA's Ethics Office helps to define
the considerations in an article which is located here:

http://www.apa.org/monitor/julaug01/ethics.html

Notice that he defines ethics by stating, "... ethics means thinking
about              reasons in terms of values. This definition has
three elements: a choice to be made, reasons for choosing a particular
course of action and rejecting another, and values that explain why
certain reasons are more compelling and should prevail. Thus, ethics
enters a psychologist's professional life when the psychologist faces
a dilemma and looks to values in deciding what to do."

He helps to answer this question for you by pointing out that the
Preamble "clearly states the Code "has as its primary goal the welfare
and protection of the individuals ..." whom psychologists serve.

Read the rest of the article which makes it fairly easy for you to
answer the question regarding your own values.

So far as directly being in violation, examination of both the old or
new Code would say that it is not a "boundary violation", but only you
can be honest about the values involved here. If your values are
merely helping the patient - without harming him - then the referral
is fine.

If you have any qualms at all, you already know it may not be the best
idea to make the referral.

Good luck in whatever decision you make.
Serenata

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Request for Answer Clarification by nerv-ga on 15 Jan 2003 10:06 PST

Hi Serenata-ga,

Thanks for responding to my question.  I need to ask you a question
regarding your answer, and I need to clarify a few things for you.

Firstly, on what do you base your answer?  Are you a psychologist?  If
not, where did you aquire this info?  Next, to let you know, I am the
patient....and I asked the question because I'm trying  to gain
insight on this issue, so that I can feel more grounded when I discuss
my feelings as to what has happened as a result of the referral.  The
business in question is computer related and I was in need of some aid
in this area.

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Clarification of Answer by serenata-ga on 15 Jan 2003 11:15 PST

Hello again, Nerv-ga.

I based my answer on the American Psychological Association's Code of
Ethics, both the extant Code and the adopted Code which will be
effective June 1st of this year.

The American Psychological Association's website is at:
http://www.apa.org/

The Ethics section is located at:
http://www.apa.org/ethics/

The Ethics section contains the full content of both Codes as well as
additional resources, discussions, articles, etc., about
ethics-related matters.

No, I am not a psychologist, although I earned a baccalaureate degree
in Psychology. I am a retired professional with its own stringent Code
of Ethics, am familiar with the APA Code and with practitioners in the
mental health field.

In addition, my daughter-in-law is a practicing psychologist, and I
casually ran it by her to see if my interpretation was even in the
ballpark.

Due to a lack of information, I erred in assuming it was a
professional who was feeling squeamish about recommending a business,
but the answer is still right so far as ethics is concerned. (And we
know what they say about people who assume.)

There is nothing wrong in such a recommendation unless the patient
felt obligated to use the services recommended.

In your case, as the patient, examine how you felt about the
recommendation - not your actual experience with the business - just
the recommendation.

Did you feel you really "had" to use psychologist's recommendation? If
so, there may be a problem in the recommendation.

Now, if you felt confident in the recommendation and then had an
unfortunate experience, that is something else entirely.

I suspect that we have all at one time or another made a
recommendation we felt was sound, only to discover the person to whom
we made the recommendation had a miserable experience and is now
questioning our faculties for ever making the recommendation in the
first place.

Your question addresses the "ethics" of the recommendation. You are in
a better position to know how you felt about the
recommendation/referral.

1. Did you know and were you aware it was the psychologist's spouse?

2. Were you aware of other businesses you could have chosen instead?

3. Did you feel you "had" to go to the psychologist's spouse because
of your relationship with the psychologist?

4. Do you feel your psychologist took advantage of your position to
further the couse of the spouse's business?

Whatever your feelings now, including whether or not you feel you can
trust the psychologist's judgment again, I do hope you can discuss it
objectively. If you're not comfortable, it will be of benefit to the
psychologist to know this, and good for you to get it out in the open.

I hope this clarifies my answer,
Serenata

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Request for Answer Clarification by nerv-ga on 16 Jan 2003 10:45 PST

Thank you so much for the clarification serenata-ga.  I visited the
APA site and purchased an article on the topic, which along with your
suggestions have  helped me to understand my situation better.

I'm going to throw out one more question to you which is related to my
initial question, but could be seen as a seperate question, so I don't
expect you to answer unless you feel comfortable doing so.

Is it a boundary violation for a psychologist's spouse to be friends
with said psychologist's patient?

Again, thanks much for your input on this matter.

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Clarification of Answer by serenata-ga on 16 Jan 2003 14:41 PST

Each time you've contributed, things get a bit stickier!

Here is another of those "on the surface" answers. By the letter of
the law in the codes - I still see no ethics problem.

From my "favorite shrink's" (my daughter-in-law) - it would depend on
comfort level, both hers and the patient's. There are some friends of
her husband's she wouldn't hesitate to take on as patients and there
would be no problem. There are some she'd never take on as patients
and refer to others.

From a patient's standpoint - I don't want to run in the same circles
as my "shrink", period! And I'd much rather hang on to my friends,
because there are a lot more "shrinks" out there than there are
friends.

I can see that you are looking for an answer to an 'ethics' question,
and I can't answer it for you because I don't know all the facts.
Every clarification contains a bit more information. I really do want
to help your question, too.

You are armed with both the old and new Code of Ethics, which is good
information. You have also ordered another article. With that
information, ask yourself if you feel there was really a question of
ethics then, and if there is a question of ethics now.

Or is this more a question of comfort? If so, whose comfort? Was it
there from the start or did life circumstances change things?

You are the one who is in the best position to answer.

I am loathe to give advice in these impersonal situations, but I'll
offer you what I'd offer my own grown kids in similar circumstances
... "look inside and decide what you've gotta do. Then do it!"

Good luck!
Serenata

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Request for Answer Clarification by nerv-ga on 16 Jan 2003 15:24 PST

Hi Serenata-ga,

Thanks for offering your input on the extra question.  Much
appreciated.  It helps to have input from an objective
source...someone outside of my circle of friends and family.  Thanks
Again.

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Clarification of Answer by serenata-ga on 16 Jan 2003 16:34 PST

I hope it works out,
Serenata

Researcher was very helpful and generous.  Recommended.

This is just my opinion...
but, i think the answer is basically, "no", it would not be unethical;
but it would depend a great deal on the circumstances. Here are some
examples, (obvious as they may be), where i believe this would be an
inappropriate action:
a) the patient is trying to resolve, for example, a sexual difficulty,
and only feels comfortable talking to the same sex
b) the patient has revealed sensitive information that the
psychologist is aware would be difficult and counter-productive for
him/her to reveal again to the new psychologist.
c) if the patient objects, or feels uncomfortable with the notion of a
referral
d) if the psychologist genuinely feels the new psychologist would not
be suitable for the patient
etc...
As long as the current psychologist treating the patient is aware of
the above (which i would hope they would be), then i see no reason why
they could not be referred to another psychologist, even if they are a
spouse, or if it's for the purpose of business. As long as they are
honestly looking out for the patient, and they believe the patient
would receive the same level of treatment without unecessarily causing
him/her inconvenience.
....as i said, just my opinion (as an ex-patient)

Was he referring the patient to her because she was another
psychologist, or for an unrelated business purpose? If the latter,
then I think the pscych would be on very thin ice. A psychologist is
in a unique position of power over a patient, and it would almost
certainly against his professional body's conduct rules to make a
referral such as you describe.

Thank you jackburton-ga and jumpingjoe-ga for your opinions.  The
business in question is computer related and I was in need of aid in
this area.  The psych sincerely thought that her spouse would be of
great help to me in this area.