Are psychotherapy clients entitled to confidentiality?

Yes, both professional ethics and legal provisions entitle patients to confidentiality. In many respects, confidentiality is the bedrock of the psychologist-patient relationship. The APA Ethical Principles of Psychologists and Code of Conduct (2002) states that psychologists have a “primary obligation” to protect confidentiality.

Did Dr. Phil violate Britney Spears’ privacy?

We don’t know all the facts surrounding this situation and therefore cannot comment on it specifically. An important question is the context of the work done by any media psychologist. Psychologists working with the news media are typically sharing information and not providing psychotherapy. The people they interact with are not clients.

From the media accounts, it’s not clear in what capacity Dr. Phil met with Ms. Spears; nevertheless, patients of licensed psychologists are entitled to privacy and confidentiality.

Why do media work if it’s not therapy?

While it is important for all mental health professionals who work with the news media to state that what they do is information-sharing and not therapy, their work, based on the research literature and/or appropriate clinical experience, has value as a means of educating the public about mental health issues. It also has the potential to persuade people to work with a mental health professional for issues affecting their relationships, health and wellness.

For some people, seeking mental health care is a daunting task. They may not be able to afford it or they might believe it is stigmatizing to seek care for mental health problems. For others, there may be mobility barriers. For these people, information about mental health issues delivered via the media may be their only source of such information – or it may encourage them to find the resources (emotional, financial and physical) to access care.

Are psychologists who work in the news media obligated to adhere to a set of ethical standards?

Yes, all psychologists regardless of their work setting are obligated to practice ethically. Members of the American Psychological Association (APA) must follow the APA’s Ethics Code or be subject to possible censure or expulsion by the Association. The APA code includes the requirement that psychologists protect their patient’s confidentiality.

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The American Psychological Association (APA), in Washington, DC, is the largest scientific and professional organization representing psychology in the United States and is the world’s largest association of psychologists. APA’s membership includes more than 150,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting health, education and human welfare.

“Our patients deserve the best health care available, and having full disclosure of research findings – both positive and negative – will help clinicians develop the most effective treatment plans,” said APA President Carolyn Robinowitz, M.D. “Open access to all clinical trial data is necessary to better understand the risks and benefits of treatments.” “Issues involving publication bias are not unique to psychiatry,” obinowitz said.

“Publication bias has been well documented with cardiovascular and anti-inflammatory medications. A clinical trials registry set up and overseen by the federal government would be good for all of medicine.” The study, “Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy,” analyzed 74 FDA-registered studies of 12 antidepressant agents. Researchers found virtually all the studies identified as negative by the FDA were either never published or published in a way that implied a positive outcome. The study found virtually all positive studies were published.

“Selective reporting of clinical trial results may have adverse consequences for researchers, study participants, health care professionals, and patients,” the study authors concluded.

The APA and AACAP were among the first medical specialty groups to call for the establishment of a government-run public registry for all clinical trials, regardless of results. In July 2004, the organizations successfully brought the issue to the forefront of the American Medical Association, the nation’s la rgest physician group, which prompted the AMA to join in the call for a national registry. The APA and AACAP also support federal legislation to provide open access to clinical trials data so physicians and families can make fully informed decisions about treatments.

“Greater transparency in the clinical trials process, particularly including open access to important data, is of significant benefit to the research community, to practitioners in the field, and to our patients,” said AACAP President Robert L. Hendren, M.D. “A national registry will allow patients to have access data on a complete range of treatment options, including medication, to discuss with their physician.”
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About the American Psychiatric Association:
The American Psychiatric Association is a national medical specialty society whose more than 38,000
physician members specialize in the diagnosis, treatment, prevention and research of mental illnesses
including substance use disorders. Visit the APA at www.psych.org and www.HealthyMinds.org.
About the American Academy of Child and Adolescent Psychiatry:
Representing over 8,000 child and adolescent psychiatrists nationwide, the American Academy of Child
and Adolescent Psychiatry is the leading authority on children’s mental health. AACAP members actively
research, diagnose, and treat psychiatric disorders affecting children, adolescents, and their families. Visit
AACAP at www.aacap.org.

Initiated in 2002 by then-APA President Philip Zimbardo, PhD, the task force was charged with reviewing APA policies and practices regarding the acceptance of funding or other material support from private corporations. The group chose to focus on pharmaceutical funding as a case example because its effects on the science and profession of medicine are well-documented “and provide a telling example of the distortions and unintended consequences that can occur when academic centers, scientists and practitioners become overly dependent on for-profit industries,” according to the group’s report.

The 23 unanimous recommendations of the task force are published in the December issue of American Psychologist, the official journal of the American Psychological Association.

“We anticipate that corporate funding will become more of an issue for psychologists in the future for several reasons,” several task force members wrote in the journal. “The increasing influence of large corporations in daily life, the likelihood of increasing numbers of prescribing psychologists, the aging of the population of the United States and the potential increase in markets for pharmaceutical products aimed at behavioral and mental health problems are trends that are likely to bring issues of corporate funding closer to the work of psychologists.”

Task force co-chair Wendy S. Pachter, PhD, JD, lead author of the article, said she hopes the group’s work will stimulate broad discussion of the issues and strengthen the culture of independence and integrity within the sciences and related professions, which could otherwise become vulnerable in the face of corporate challenges and inducements.

“APA and other scientific and professional associations can provide leadership in maintaining scientific and professional integrity in at least two ways,” she said. “First, by example in implementing thoughtful policies with respect to industry funding, and second, through education and continuing education in the basic values of the scientific professions and in how to identify and respond to the challenges posed by corporate funding.”

While noting that corporate funding is currently a tiny portion of the overall APA budget, APA Chief Executive Officer Norman Anderson, PhD, welcomed the report, saying it “raises important issues for the association and for everyone engaged in scientific research, not just psychologists.”

“We all must guard against compromising the integrity of scientific research,” he said. “Vigilance and full disclosure are essential to preserving the independence and credibility of psychological science, practice and education.”

Among the task force’s other recommendations:

• All raw data for any study published in one of APA’s journals should be made available to any qualified scientist for independent review.
• Any financial conflicts of interest must be disclosed for any psychology-sponsored presentation, publication, electronic mailing list, interaction with a research human subject or policy-making public meeting.
• Journals should carry disclaimers about the accuracy of claims in advertisements.
• All initiated clinical trials should be registered in a public registry before trial implementation in order to qualify for publication in any APA journal. Furthermore, APA should consider starting its own clinical trial registry.
• APA members should be advised of potential biases inherent in accepting inducements that could affect the selection of texts, the use of particular tests and/or sponsorship of continuing education courses.
• APA seminars, lectures and continuing education courses presenting commercial products should discuss competing products.
• Continuing education seminar participants should be asked to evaluate the perceived commercial biases in presentations.
• Psychologists should be discouraged from accepting gifts and perquisites from pharmaceutical companies, even when such gifts are of modest value.
• External funds should never be a part of APA’s operating or core budget, including both direct and indirect costs.

Article: “Corporate Funding and Conflicts of Interest,” Wendy S. Pachter, PhD, JD, Washington, DC; Ronald E. Fox, PhD, Human Resources Consultants; Philip Zimbardo, PhD, Stanford University; David O. Antonuccio, PhD, University of Nevada School of Medicine; American Psychologist, Vol. 62, No. 9.

(Full text of the Article is available at: http://www.apa.org/journals/releases/amp6291005.pdf)

Members of the APA Task Force:
Ronald E. Fox, PhD, co-chair
Wendy S. Pachter, PhD, JD, co-chair
David Oliver Antonuccio, PhD
Morgan Sammons, PhD
Charles Roberts Schuster, PhD
Maxine L. Stitzer, PhD
Jalie A. Tucker, PhD, MPH
Philip G. Zimbardo, PhD