10Stormy “Whethers”: Ethical Challenges of a Clinician in Academia¹

Donald W. Stewart

I never expected my career would become so complicated. My first professional job seemed straightforward enough—I was hired to provide clinical services to students at a university counselling centre. As an added attraction, the position came with a tenure-track academic appointment at the assistant professor rank. However, in working with my clients, I quickly learned that I needed to pay attention to more than their clinical needs. I also needed to understand the complex university system in which they were studying—and in which I was employed. If I were to be successful in my pursuits, I needed to broaden my focus to acknowledge the unique culture of academia in an effort to understand how it influenced all aspects of my clients’ lives and, by extension, my work.

Thus began my developmental journey into the complex web of interrelationships, moving targets, and multiple stakeholders that has characterized all stages of my career to date. In the sections that follow, I will discuss various aspects of these challenges from an ethical standpoint, focusing mainly on issues related to Principle III (Integrity in Relationships), from the Canadian Code of Ethics for Psychologists (Canadian Psychologist Association [CPA], 2017), as this best reflects the character of most of the dilemmas I have encountered in my overlapping roles as a clinician, supervisor, administrator, and regulator. In particular, I will focus on challenges related to establishing and maintaining professional integrity, managing multiple relationships, and avoiding bias in interactions with supervisees and colleagues. I also will touch on challenges in identifying priorities when ethical principles conflict. At the end of the chapter, I include a few questions for reflection intended to help you apply some of the themes in this chapter to your own work in hope that this will deepen your understanding of issues related to maintaining integrity in relationships.

A Chilly Reception: Early-Career Challenges in Maintaining Professional Integrity

When I began my career as a newly-minted Ph.D. in clinical psychology, I was greeted by the senior counselling staff with a healthy dose of skepticism—which I countered with youthful enthusiasm and confusion about how they could see things so differently from me. I knew that most of the counselling staff had studied psychology, even if they were not psychologists, but their humanistic and developmental perspective seemed to frequently conflict with what they considered my “medical model” approach. Rather than being warmly welcomed as a unique resource, I instead felt that I was being pushed to the margins of the department. Adding insult to injury, my department did not support conventional research—which was most unfortunate for a conventional researcher like me (see Stewart & Sheckter, 2001). How was I ever going to secure tenure under these circumstances?

Looking back now, I am sure that I held many unrealistic expectations about what my professional life should be like—and equally certain that these coloured my perceptions of both my colleagues and the culture of my work environment. I think the following depiction of life as a new academic captures much of what I recall about my own expectations during that period:

During my first year as a new faculty member I expected that I would be able to publish several manuscripts, present at multiple conferences, apply for at least one grant, develop working agreements with a number of practicum sites for our new graduate program, direct four to five thesis projects, and excel in all of my other job responsibilities (i.e., teaching, research, service) while still having time to spend with my family and enjoy my hobbies (Zayak, 2013, p. 65).

Not surprisingly, I did not achieve all that I expected during the early days of my career—and, in retrospect, I probably externalized the blame for this to an undue extent. As a new psychologist, it was disappointing to feel I did not have a strong peer group to support my efforts. However, instead of continuing to blame my colleagues for marginalizing me and subverting my work, I eventually began to search for ways in which I could connect with those whose background and perspective aligned more closely with my own. Such efforts went beyond mere attempts at personal validation. Frankly, I was afraid that if I did not take steps to maintain my identity as a psychologist, my professional integrity would begin to suffer as I drifted away from my reference group. I thus began to actively cultivate relationships with other psychologists on campus and in the community, forming productive working relationships, research partnerships, and even friendships with a number of colleagues with whom I had no evaluative connection. Along with this, I also worked hard to clarify my intentions, values, and clinical perspective through dialogue with my counselling centre colleagues, just as I tried equally hard to understand where they were coming from in their professional activities.

Taking responsibility for my own unrealistic expectations was necessary in order for me to begin fulfilling my ethical obligations with respect to maintaining integrity in relationships—even if it was a little tough to see these expectations as “unrealistic” at the outset. In fact, with the benefit of experience, I can see now how there were elements of departmental politics, interdisciplinary rivalries, and perceived encroachment that made difficulties such as those I experienced all but inevitable (cf. Zayak, 2013). But, that notwithstanding, as noted in the Code’s Values Statement for Principle III, psychologists “are expected to understand how their own experiences, attitudes, culture, beliefs, values, individual differences, specific training, external pressures, personal needs, and historical, economic, and political context interact with their activities, to be open and honest about the influence of such factors, and to be as objective and unbiased as possible under the circumstances” (CPA, 2017, para 3).

Reflecting further on this, I can see how my efforts to identify like-minded psychologists in the community helped to provide insight into my own motivations and assumptions, particularly when these contrasted with those of my counselling centre colleagues. I also recall how discussions with some of my outside contacts and mentors were helpful in disentangling what was a real problem from one that I had created by being either unrealistic or impatient. Zayak (2013) similarly outlines the benefits of informal and formal networking as an antidote to some of the stress and isolation young faculty members can feel. It is good advice, and well worth the effort—even (or perhaps especially) for introverts.

Besides building a professional support network, I also recall reading a very helpful article that described 10 principles of success for new psychologists in clinical practice-oriented careers (Plante, 1996). I recall being particularly struck by Principle #10, “Remember, you are a psychologist: You can still be proud of it” (Plante, p. 307). Bolstered by this sage advice, I essentially adopted this as my personal mission statement. This further strengthened my identity as a psychologist, which helped to reduce my defensiveness around my non-psychologist colleagues and increased my openness to their ideas. As a result, I was gradually able to find comfort in my department, develop strong relationships with some colleagues, and continue to do good work clinically. Truth be told, it probably also helped that additional psychologists came on board during the years since I had initially been hired into the department. Whatever the reasons, I eventually was rewarded with the assignment of new duties and responsibilities, which is often how the academy shows that it appreciates you (and, yes, I did secure tenure).

Getting Warmed Up: Initial Encounters in Managing Multiple Roles

Having endured a somewhat cool reception at the outset of my career, once I found my place—and pace—I also began to acquire new responsibilities and, of course, new challenges. One of the first such challenges was my role as a supervisor of practicum students and interns. At that time, there was little training for supervisors, and it was assumed that consuming supervision over a number of years somehow imbued one with the ability to supervise others. As a colleague and I stated some years ago:

The basic deficiency in current efforts to prepare psychologists-in-training for the supervisor role parallels a similar deficiency in the way academics have traditionally been prepared to instruct students. The time-honoured belief that attending university for many years automatically makes one competent to teach is now less commonly accepted, and faculty development initiatives to train new professors in teaching are becoming increasingly prevalent on campuses (Johnson & Stewart, 2000, p. 129).

Although the situation has certainly improved over the years, particularly with respect to availability of coursework in supervision (e.g., Hadjistavropolous et al., 2010), there is still considerable room to grow in terms of providing supervised training in supervision to psychologists (Stewart & Johnson, 2023).

For my part, I did not have any coursework in supervision, but was fortunate in having my early forays into supervision supervised by a senior psychologist. Grateful as I was to have this supervisory oversight, in retrospect I realize that I did not take full advantage of this opportunity. In particular, I recall that the main focus was on whether I was helping my supervisees make progress with their clients. This is obviously a critical aspect of supervision, and I was quite pleased to go along with my supervisor in focusing on the development of my basic supervisory skills. However, the supervision experience could have been substantially enriched if I had been more forthcoming with my supervisor about some of the issues I was facing as a supervisor myself—and also been sufficiently aware of their importance to bring those issues forward for discussion. In fact, as outlined in the Ethical Guidelines for Supervision in Psychology Guideline I.3 (CPA, 2009, 2017), as a supervisee I shared the responsibility for defining the goals and expectations for the supervisory relationship. Acknowledging this lapse in retrospect, what I ought to have discussed with my supervisor were some of the personal issues that my new role as a supervisor was raising for me.

One salient matter that I could have discussed with my supervisor was the obvious fact that most of my early supervisees were also my age contemporaries. Setting aside—for the moment—my insecurities about whether I had the necessary expertise to effectively supervise my peers, our age parity also created the potential for dual relationships given our possible similarities in interests and activities outside of the supervisory relationship. For example, when interns expressed interest in some of the cultural and community activities in which I was also interested, I had the dilemma of whether I should share all of my local knowledge with them, given that this would likely result in their participating in the same events or accessing the same venues that I favoured and thereby increasing the likelihood of a social encounter that I was not yet confident I would know how to manage successfully. However, if I did not share this information, I would feel petty and selfish for putting my interests above theirs. After all, shouldn’t I be doing all that I could to help my supervisees feel at home in their new city?

A helpful way to manage social relationships during internship was developed by Burian and Slimp (2000), who devised a model for evaluating the potential risks associated with such dual relationships. Although they advocate a very formal process that I have yet to follow explicitly, I still find their article helpful as a way of alerting interns to these concerns. I figure that if my supervisees are aware of these issues, it will get them thinking along lines similar to mine. That way, any subsequent discussions about these risks will be anchored in a shared perspective and more clearly oriented toward maintaining integrity in our supervisory relationship. I also believe that Burian and Slimp’s article may serve a prophylactic effect insofar as I do not recall having any social relationship challenges with interns during the 20 years or so in which I have been sharing the article—just as I am sure that our increasing age disparity has had no effect whatsoever on the likelihood that we happen to share similar social interests . . .

There were certainly other things that I could have discussed with my supervisor as well, including my initial fears about not being competent to supervise my supervisees. Harvey and Katz (1985) identified this as the impostor phenomenon, which they describe as a common affliction among young professionals. However, I am comforted by the reassurance that this feeling is most likely to arise within supervisees “when their level of actual competence exceeds that of their felt competence” (Bernard & Goodyear, 2014, p. 97). In any event, as advocated in the Ethical Guidelines for Supervision (CPA, 2009, 2017), I think the take-away message is that I could have and arguably should have done more to share my personal concerns with my supervisor—and that my failure to do so probably led me to struggle more than necessary during a critical developmental period.

This once again highlights the wisdom of the Code and its companion documents, which advocate both proactive and reactive ethics (see “Uses of the Code” from the Code’s Preamble), thereby orienting us toward practices that provide a framework for positive professional behaviour in addition to minimizing the risk of misbehaviour. This is why it never hurts to pull out these documents from time to time to refresh ourselves with them—we should not let them languish simply because we have passed our licensing exams and no longer need to recite them by heart before a panel of our peers.

Feeling the Heat: Muddling Through Mid-Career Multiple Relationships

In addition to the challenges related to my earliest supervisory responsibilities, another substantial challenge occurred a few years later when I took on the role of director of clinical training (DCT) for our then quite recently accredited psychology internship program. As noted by others, entry into this role is initially characterized by excitement and apprehension (Lamb et al., 1986). The excitement stems from the potential contributions to be made to the program, while the apprehension resides in concerns about one’s competence to meet the daunting expectations of this role. Anybody who has served as a DCT can attest to the complexities of this unique leadership position—not the least of which involve creative efforts to fulfill the DCT responsibilities without having any real authority over the program staff, as this usually resides in the office of the department head. In addition, with the exception of very large programs, most DCTs also have direct supervisory responsibilities for interns. In fact, now that I think about it, agreeing to become a DCT can be seen as a choice to enter into multiple role relationships that are entirely avoidable should one decline to become a DCT. As articulated by Sinclair and Pettifor (2017), a role such as this holds many “loss-of-integrity traps” (p. 113) about which one needs to be vigilant.

Fortunately for our profession, we nevertheless are able to find people who can credibly and ethically serve as DCTs despite how fraught with potential difficulties such a role may be. In my own case, one of the most frequently recurring difficulties was dealing equitably with conflicts between supervisors and supervisees. As a beginning DCT, I very quickly became aware of the cognitive biases associated with primacy effects (e.g., Kruglanski & Freund, 1982). In other words, I tried to be cognizant of the temptation to believe the first person who came forward with their version of the conflict, which if not checked would subsequently bias me against the other person’s version of events. In addition to being careful not to violate the standard of objectivity as stated in Ethical Standard III.10, I also needed to be aware of the power imbalance in any dispute involving an intern and a supervisor. As noted in the Ethical Guidelines for Supervision (CPA, 2009, 2017), “the power differential adds to the complexity of the supervisory relationship” (p. 5). Given this, DCTs ought to be mindful that it is always riskier for an intern to bring forward a complaint than it is for a supervisor and, as such, should be sure to acknowledge and validate the supervisee’s courage in bringing forward a complaint whenever possible.

Another source of complication in managing conflict arose from the fact that I knew my colleagues better than I knew my interns. Generally speaking, since I had an enduring relationship with my colleagues, I could very easily be biased in favour of them due to increased exposure and a shared history. However, depending on who the colleague was, and the source and nature of the complaint, this historical knowledge could equally bias me against that person. For example, some supervisors were known to be easily slighted and prone to complain that they were being treated disrespectfully if their supervisory input was not enthusiastically embraced and immediately applied by an intern. This was certainly something that I needed to bear in mind when addressing concerns, most of which were cloudy enough that it was difficult to parse fact from fiction in the competing and equally compelling scenarios each party presented.

I would like to say that I had nothing but success in achieving equitable outcomes for all such dilemmas, but that would not be the case. I struggled through most of these situations and probably made some unwise decisions over the years. However, by following a repeatable step-by-step process in arriving at the decisions, as advised in the Code, I could at least articulate my problem-solving process in tackling these situations. In line with the Code, I also would consult with informed others as necessary to ensure that the process I was following was fair and reasonable, even if I knew that ultimately somebody would be unhappy with the decision I made.

Developing confidence in the problem-solving approach outlined in the Code certainly stood me in good stead as I shimmied further up the administrative ladder and found myself as the head of my department. It seemed that all of the conflicts and dilemmas that I had encountered as a DCT were still there, along with a host of other ones that I was blissfully ignorant about until they landed on my new desk. As we have previously pointed out (Pettifor et al., 2011), ethical supervision as an administrator requires a tricky balancing act among roles and responsibilities, including such things as organizational planning, developing policies and procedures, facilitating case management, conducting program evaluations, monitoring recordkeeping practices, and meeting institutional accountability standards (Borders et al., 1991).

As you might gather from this description, a department head basically has responsibility for everything that goes on in his or her unit, and the potential for multiple relationships increases exponentially when those responsibilities include supervising interns and postdoctoral candidates, as well as managing support staff and providing leadership to the clinical team, including the DCT. As if this weren’t enough, administrators also must take responsibility for the leadership aspects of their position by modelling and maintaining appropriate standards and values in all activities, as well as relying on our discipline’s rules and regulations in carrying out their daily functions. In short, administrators must “scrupulously avoid exploitation, manipulation, or harm, either by themselves or any member of their organization, and take necessary steps to redress any such situations when identified” (Pettifor et al., 2011, p. 204). In so doing, risks related to subjectivity, conflict of interest, and bias will be minimized.

All of this may seem like a tall order, but it really boils down to the simple fact that leaders must set a good example and expect everybody in their purview to do likewise. This expectation is noted in Ethical Standards III.36-37, as part of our “extended responsibility.” Fortunately, there are some helpful sources of advice available in the literature about how to live up to this responsibility. In addition to the article by Pettifor et al. (2011) mentioned above, CPA’s Ethical Guidelines for Supervision (CPA, 2009, 2017) provides some helpful information to guide one’s practices in administration, as does the accompanying Resource Guide for Psychologists (CPA, 2011), which contains practice ethical dilemmas for administrators. Better to spend some time wrestling with these issues in practice dilemmas than to confront them for the first time in your own administrative practice!

Keeping Things Cool: Maintaining Integrity in More Complicated Relationships

So far, I have focused mostly on my developmental trajectory and career milestones, outlining how our ethical guidelines and related materials have been helpful in negotiating a host of challenges primarily related to maintaining integrity in relationships. An important aspect that I have not yet mentioned relates to some of the parallel activities I have been engaged in throughout my career, most notably my role with the professional regulatory body for psychology in my province, which brought with it its own particular set of challenges.

First, a little bit more backstory. While struggling with my early professional identity crisis, I also was working actively toward registration as a psychologist in my province. Through a series of coincidences, on the day I received news that my registration had been approved, I was invited to let my name stand as a nominee for an open position on the council for our provincial regulatory body. As is often the case, there was not a lot of competition for this voluntary position, and I was soon acclaimed as a council member and immersed in regulatory issues about which I knew absolutely nothing.

Undaunted by this, I also volunteered to be the editor of the official publication of our regulatory body, which (fortuitously) proved to be extremely helpful as a way of learning about regulatory issues. As the editor, I received copies of similar publications from jurisdictions across North America, and this allowed me to identify common issues, emerging trends, and various perils and pitfalls that our members could possibly encounter. On this latter point, I always found the practice updates in these publications to be of particular interest and value—and sought where possible to share my excitement about these with the readership. If you have a similar publication in your neck of the woods, you should be sure to check it out; and if you do not have access to something in your own jurisdiction, you can certainly search out similar publications online by exploring websites for the provincial Colleges of Psychologists or their equivalents.

Along with my editorial duties, I attended our bi-weekly council meetings where, among many other topics, we were informed about the status of complaints against our members. This was a real eye-opener for me. I certainly had heard and read about the kinds of things that lead to complaints against psychologists, but (fortunately, I suppose) had no direct experience with such matters. So, to be confronted with news that these incidents were occurring locally—along with the identities of those involved—moved me quickly up a very steep learning curve. In fact, I learned not just about the disciplinary process but also how easy it was for a psychologist to end up on the receiving end of a complaint—even if the complaint was without merit and subsequently dismissed without proceeding to a disciplinary hearing. Since we have a fairly small psychological community, almost all of the psychologists ultimately involved in disciplinary proceedings were known to me either directly or by reputation. To the best of my knowledge, none of these people were evil or stupid. To the contrary, most of them were competent, dedicated, and earnest professionals who made a mistake, went too far, or failed to think through the consequences of their actions. In some cases I actually ended up being pretty impressed with the psychologists subject to sanctioning, especially those who acknowledged the misdeed and accepted responsibility for their actions at an early stage in the proceedings, consistent with Ethical Standard II.3 from the Code.

From this background information, you already might have begun to imagine the sorts of ethical issues that I was now encountering. People whom I knew as colleagues in a range of contexts were now coming onto my radar for professional misconduct of one form or another—and I had to continue interacting with them in our “regular” capacity outside of my “regulatory” one. What about the colleagues who put their self-interest above that of their clients? What about those who practice outside their area of competence? What about the colleagues whose judgement is impaired? Given what I now knew about them, how could I look these people in the eye . . . or make referrals to them? Although the Code’s, Ethical Standards II.43-45 provide some guidance for how to deal with concerns involving colleagues, it focuses mostly on issues related to identifying and addressing concerns as opposed to how one subsequently transacts business with these people.

Turning to the more experienced council members for support was very helpful. They not only helped me overcome the disappointment I felt toward some of my colleagues—they also served as exemplary role models in balancing the dual relationships that emerged from the regulatory role. In observing them, I saw that they had developed a clearer sense of where their roles as council members and disciplinary authorities began and ended with respect to interactions with colleagues and, over time, I was able to develop similar boundaries myself. It was very helpful to understand how some degree of compartmentalization was necessary in order to serve a regulatory role without interfering with one’s ability to function in other professional capacities. Although such a strategy did not obviate all difficulties, such as awkwardness at incidental encounters, it certainly increased my comfort in interacting with colleagues subject to discipline when we had business to transact that was unrelated to the disciplinary process.

Along with this, my fellow council members also helped me to appreciate the importance of avoiding the fundamental attribution error (e.g., Ross, 1977)—that is, being careful that I did not assume infractions were the result of a colleague’s shortcomings without considering relevant situational factors, as well as my own biases (see Ethical Standards III.9-10), when trying to understand another’s actions. Unsurprisingly, things were usually more complicated than they seemed, and the benefits of hindsight were plainly evident during the hearing process, when an opportunity was provided to reconstruct and review events with a fully articulated set of details, timelines, etc. In addition to providing the information necessary to understand the respondent’s actions relevant to the complaint, this exploration of context allowed for evaluation of the extent to which the member relied on the Code as a guide to their practice. In particular, it allowed for an examination of the process the respondent followed in addressing the situation, including such things as acknowledging the conflict and parties affected, consulting with colleagues, and documenting the process invoked to address the dilemma. Although following these steps does not mean that complaints will never arise, such a process will almost certainly play a mitigating role in the eventual outcome of the complaint process.

As stated previously, the Code is a valuable resource that should be consulted frequently in the course of our daily professional activities. Although there is no guarantee that assiduous compliance will prevent complaints, adherence to the Code will reduce the risk of ethical transgressions; and, in cases where it does not prevent the act, it will certainly slow the slide down the slippery slope—allowing for more opportunity to resolve or correct the situation before one finds oneself at the bottom.

Made in the Shade: Striking a Sustainable Balance

At this point in my career, I am identified by my institution primarily as an administrator, but in my heart I remain a clinician. As such, I continue to do clinical work on campus (while also supervising interns and practicum students). The reason I keep my hand in these activities is because it helps to maintain my somewhat hard-won professional skills and, more selfishly, because these activities feel deeply rewarding in ways that many administrative tasks do not (probably something to do with immediate versus delayed gratification, I suspect). Having said that, I do spend a lot of time in administrative activities and continuously encounter new situations in which ethical concerns arise. I certainly recognize that psychologists do not have a monopoly on ethical behaviour, but it is during such administrative challenges that I am heartened by my professional socialization and familiarity with identifying and addressing ethical dilemmas—even as this leads me to worry a bit about those administrators from other disciplines who do not have the benefit of such a solid ethical foundation for their own decision making.

Although my institution classifies me as an academic administrator, our senior administration is definitely pleased to take advantage of my ability to bring a clinical sensibility to the table. One example of this arises in situations where there are concerns expressed about the behaviour of a student or staff member who may pose a safety threat to themselves or others. In many such cases, these concerns are brought to the table for discussion by our institutional threat assessment team, which consists of a diverse group of professionals committed to promoting a safe and respectful work and learning environment for the campus community. As a founding member of our institutional threat assessment team, I am joined by colleagues from a number of other disciplines and backgrounds, including law, human resources, and law enforcement, in deciding how best to respond to such situations. These meetings are rarely dull.

One of the most frequently-occurring issues in these meetings involves balancing the rights of the individual with institutional responsibilities to protect other community members. Savvy readers will immediately see this as an example of weighing aspects of Principle I (Respect for the Dignity of Persons and Peoples) from the Code (e.g., preserving confidentiality, obtaining free and informed consent) against Principle II (Responsible Caring) (e.g., Ethical Standard II.42, which includes the duty to protect or warn others about potential harm).

Because the threat assessment team is interdisciplinary in nature, there are sometimes differences of opinion about priorities at our meetings. To overgeneralize, somewhat unfairly, security personnel tend to focus more on public safety aspects, administrators tend to focus on institutional reputation, and legal counsel tries to ensure that we are acting in accord with all relevant policies to mitigate liability. As a psychologist, I am primarily interested in the mental health and wellness of the people we discuss, including how these aspects both influence and are influenced by the issues that brought these staff members or students to the attention of our team. Although we generally find our priorities aligning, we sometimes have to work through disagreements over competing concerns. When such disagreements arise, I find it helpful to recall the importance of maintaining public trust in our discipline (as noted in Ethical Standards III.10-12) by being accurate, honest, and unbiased in my comments. I also try to communicate respect for the limits of my professional knowledge and honour the competencies of my colleagues in their respective areas of expertise, in line with the Values Statement for Principle IV (Responsibility to Society), which emphasizes the need to work in partnership with others and be open to their suggestions and criticisms. I have found such an approach to be very helpful in maintaining the civil and productive tone that generally characterizes our meetings, even if we do find ourselves disagreeing at times.

In addition to managing occasional differences of opinion among team members because of my many roles on campus, it sometimes occurs that threat assessment discussions involve clients seen by my supervisees or about whom I have been consulted by clinicians in my reporting units. When this happens, I have to be very careful about my role and what I can and cannot say, as this information arose within a confidential context and generally cannot be shared without permission except to prevent harm. I also need to be very clear about who my “client” is in such situations—is it the person of concern, my supervisee or staff member, or the institution itself? The Code again offers some helpful guidance in addressing these complicated matters.

In the most extreme cases, where there is a threat of imminent harm to an identifiable party, the decision to share information without consent is usually made without difficulty. After all, as noted in Ethical Standard II.42, we are obliged to keep people safe by doing “everything reasonably possible to stop or offset the consequences of actions by others when these actions are likely to cause imminent serious bodily harm.” However, only the minimum amount of information necessary to ensure safety should be shared, and then only with those who have a definite need to know. This will help to ensure that confidentiality is preserved to the greatest extent possible, consistent with Ethical Standards I.43 and I.45. So, in the case of a student threatening his roommate with violence for perceived transgressions, providing information about his prior history of mental health problems seems reasonable as a way to activate an optimally supportive response for both the student of concern and his roommate.

Most cases are not so clear, however, and so the decision about whether to share confidential information requires more deliberation. For example, perhaps the mental health of the student above has not deteriorated to the point where he is threatening violence, but instead he stops eating because he believes his roommate is poisoning the food in their fridge. When the threat assessment team discusses this case, ought I to share the information I have about his mental health history? Given that this situation involves a much lower degree of risk (after all, the student can still eat elsewhere), there appears to be no need for immediate action or to break confidentiality. This allows for development of a different sort of response plan, probably involving efforts to get the student to voluntarily access mental health services. In such a case, I would not need to share the information I have regarding his prior mental health history and would simply respond to whatever information was brought forward by others at the meeting. This approach would preserve confidentiality and also facilitate the development of a reasonable response plan. However, as cases like this involve some degree of clinical judgement, it is never a bad idea to consult with colleagues (as the Code advises) to ensure that you have considered all of the relevant factors and are following a defensible course of action.

As you may have gathered from the discussion above, I generally have adopted the default position that my greatest responsibility in these situations is protecting the person of concern—even if I have no clinical relationship with that person myself or through one of my supervisees. I have chosen this most conservative approach as it generally ensures the highest level of protection for the people who are most vulnerable during the threat assessment process, which seems consistent with Principle I (Respect for the Dignity of Persons and Peoples) from the Code, and also does not prevent taking any further steps that may be necessary should an elevated level of risk be identified. To my mind, this seems much more prudent than seeing the institution as my primary responsibility, which would increase the risk of unjustifiable breaches of confidentiality for more routine cases.

Besides having the courage of my convictions (backed up by Ethical Standard III.35), I am also fortunate in having enlightened colleagues who are aware of my position on confidentiality and respect my professional boundaries and priorities, as I do theirs. Like any good team, I suppose, much of our strength comes from our differences. Funny how I can say something like that now, recalling how much I struggled with such professional differences in the early days of my career!

After the Storm: Concluding Comments

When teaching about ethics, I sometimes identify myself as “an ethics geek” to acknowledge that I am more enthusiastic than many about this foundational aspect of our profession and its role as a guide to virtually all aspects of our professional activities. Although I harbour no illusions about successfully recruiting new members for the ranks of ethics geeks, I hope that by sharing my professional journey I have shown you how the Code is flexible and generalizable enough to be widely applied to a host of different types of relationship challenges across a progressively more diverse and demanding set of professional roles and responsibilities.

I further hope that I have helped to persuade you to adopt the Code as a lifelong companion throughout your own professional journey. For my part, I have always appreciated the integral role that the Code has played throughout the various stages of my career. Whether acting as a clinician, supervisor, administrator, or regulator, I have no doubt that the Code will continue to serve me well in the next stage of my career—whatever that might involve—and trust that it will serve you equally well in yours.

Note to readers: As psychologists, we are expected to demonstrate values such as honesty, openness, and objectivity—and to avoid bias and conflicts of interest—in all our professional activities. In so doing, we are more likely to maintain a standard of integrity in our relationships as required by the Code. However, despite their importance, we often do not explicitly think about how these underlying values guide our everyday interactions, be they personal or professional. As such, the Reflection Questions that follow are intended to help you consider your values in more depth and to identify the important (yet often unarticulated) role they play in guiding interactions and influencing the integrity of our relationships.

Questions for Reflection

1. How do you define trust? What makes somebody trustworthy? Is trust a categorical or continuous variable? How do you re-establish trust after it has been damaged?
2. What role did your own biases, assumptions, and self-interest contribute to a disagreement you had with somebody important in your life? Would things have unfolded differently if you had reflected more fully on your own perspective before engaging in the conversation that led to the disagreement? How did you repair the relationship?
3. Is it ever acceptable to misrepresent or “strategically present” information? If so, under what circumstances? Are the “rules” around this different in your personal versus your professional life? Why or why not?
4. To what extent are values absolute versus relative? Think of examples where societal values have changed over time. Identify how your own values have changed. What was the impetus for change? Are your personal and professional values optimally aligned?

note

1. 1 In addition to the obvious parallels between stormy weather and ethical dilemmas, I thought this title was also an apt way to reinforce the notion that ethical practice involves choices about “whether” to pursue one course of action over another. Beyond the title, for the sake of continuity, I have used weather and temperature-related metaphors to identify each section in this chapter as well.

References

Bernard, J. M., & Goodyear, R. K. (2014). Fundamentals of clinical supervision (5th ed.). Pearson.

Borders, L. D., Bernard, J. M., Dye, H. A., Fong, M. L., Henderson, P., & Nance, D. W. (1991). Curriculum guide for training counseling supervisors: Rationale, development, and implementation. Counselor Education & Supervision, 31(1), 58–80. doi:10.1002/j.1556-6978.1991.tb00371.x

Burian, B. K., & Slimp, A. O. (2000). Social dual-role relationships during internship: A decision-making model. Professional Psychology: Research and Practice, 31(3), 332–338.

Canadian Psychological Association. (2009, 2017). Ethical guidelines for supervision in psychology: Teaching, research, practice, and administration. Canadian Psychological Association.

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