Provisions of Ethics for Psychoanalysts and Provisions for Implementation of the Principles of Ethics for Psychoanalysts
Revised by the Board on Professional Standards and the Executive Council April 1983, December 1983.
Preamble. These principles are intended to aid psychoanalysts
individually and collectively in maintaining a high level
of ethical conduct. They are not laws, but standards by which
a psychoanalyst, or one in training to be a psychoanalyst,
may determine the propriety of his conduct in his relationship
with patients, with colleagues, with students, with members
of allied professions, and with the public.
Objectives of the Profession and the Individual Psychoanalyst
Section 1. The principal objective of the profession of psychoanalysis
is to offer a particular contribution to humanity, with full
respect for enhancing the dignity of man. A psychoanalyst
should strive continually to improve psychoanalytic knowledge
and skill. He should make available to his patients and colleagues,
as well as to other physicians, to other qualified professional
persons, and to students, the benefits of his professional
attainments.
Responsibilities to the Individual and to Society
Section 2. The honored ideals of the profession of psychoanalysis
imply that the responsibilities of the psychoanalyst extend
primarily to the individual, but also to society; these secondary
responsibilities deserve his interest and participation in
activities which have the purpose of preserving and improving
both the health and the well-being of the individual and the
community. When the interests of his patient conflict with
the welfare of the community at large, the psychoanalyst must
weigh the consequences of any action and arrive at a judgment
based on all considerations.
Treatment to Have a Scientific Basis
Section 3. A psychoanalyst should practice a method of treatment
founded on a scientific basis; he should not knowingly and
voluntarily endorse anyone who violates this principle.
General Conduct of the Psychoanalyst
Section 4. A psychoanalyst should be courteous, considerate,
professional and ethical in all his relationships. He should
respect all laws, uphold the dignity and honor of the profession,
and accept its self-imposed disciplines. He should accord
members of allied professions the respect due their areas
of competence.
Relationships with Patients and Colleagues
Section 5. A psychoanalyst should not solicit patients; he
may choose whom he will treat. In an emergency, however, he
should render service to the best of his ability unless he
is of the opinion, based on his professional judgment, that
it would be inappropriate or unwise to do so. In all situations,
a psychoanalyst should merit the confidence of patients entrusted
to his care, rendering to each a full measure of service.
Having undertaken the care of a patient, he may not neglect
him; and unless he has been discharged he may discontinue
his services only after giving adequate notice. He should
not render any professional service to the patient of a colleague,
including therapists in allied professions, without the colleague's
knowledge, unless, in his professional judgment, it would
be in the best interests of the patient to do so. When he
becomes aware that his patient is or has recently been in
treatment with another therapist, he should ascertain that
the patient has informed the other therapist of the consultation
or desire for a change of therapists or, if the patient has
not done so, obtain consent, provided this will not interfere
with the treatment, to inform the other therapist himself
as soon as may be practicable. He should, however, recognize
and respect the patient's right to terminate a relationship,
including psychoanalytic treatment, and/or seek consultation
or advice from others. In professional relationships, the
first responsibility of the psychoanalyst is to the patient.
Protection of Confidentiality
Section 6. Except as required by law, a psychoanalyst may
not reveal the confidences entrusted to him in the course
of his professional work, or the particularities that he may
observe in the characters of patients. Should he be required
by a court of law to give testimony relating to the confidences
of his patient, he should make use of all legal means to safeguard
his patient's right to confidentiality.
When a psychoanalyst uses case material in exchanges with
colleagues for scientific, educational or consultative purposes,
he should exercise every precaution to assure that, unless
specifically authorized by the patient, the identity of the
patient is not revealed. When a psychoanalyst learns confidential
information from a source other than the patient involved,
he should, nonetheless, fully and appropriately respect its
confidentiality.
Emoluments for Services
Section 7. A psychoanalyst is entitled to establish and to
receive reasonable fees for his services. When undertaking
the treatment of a patient, the psychoanalyst and the patient
should agree on the fee and the conditions of payment. While
it is expected that these terms will be fulfilled as a requirement
for treatment, a psychoanalyst should implement them tactfully
and humanely and with adequate regard for the realistic and
therapeutic aspects of the fee and its payment. Fees may be
charged for sessions missed by the patient when this policy
has been prearranged. A psychoanalyst should neither pay nor
receive a commission for referral of patients. He must not
exploit the treatment of a patient for his own financial gain
or to promote his personal advantage.
Dispensing of Drugs
Section 8. To the extent permitted by law, drugs or remedies
may be dispensed, supplied, or prescribed by the psychoanalyst
provided he is legally licensed to do so, and such action
is appropriate to the treatment and done in the best interest
of the patient.
Consultation
Section 9. A psychoanalyst should feel free to seek consultation
on his own initiative or at the patient's request whenever
he believes that this action may benefit the treatment. Consultation
should be carefully considered in difficult cases.
Sexual Misconduct in Relation to Patients
Section 10. Sexual relationships between analyst and patient
are antithetic to treatment and unacceptable under any circumstances.
Any sexual activity with a patient constitutes a violation
of this principle of ethics.
Remedial Measures for the Psychoanalyst
Section 11. When disorder within the psychoanalyst, however
evidenced, is threatening or disturbing to the quality of
his work, he should avail himself promptly of remedial measures.
Safeguarding the Public and the Profession
Section 12. To safeguard the public and the profession:
(A) Each psychoanalyst should strive to protect against practice
by psychoanalysts deficient in moral character or professional
competence and should, consistent with the patient's right
to confidentiality, report to the appropriate ethical body
any unethical conduct by fellow members of the profession.
(B) Each psychoanalyst should strive to maintain and improve
his psychoanalytic knowledge and to help his colleagues in
this aim. When he is able, and when circumstances are appropriate,
he should willingly promote knowledge of psychoanalysis and
its derived applications.
(C) Training in the practice of psychoanalysis should reflect
awareness of the special implications for the welfare of present
and future patients and for the standards of psychoanalysis;
the highest ethical and educational standards are required.
While more than ethical standards are involved, the manner
and spirit in which psychoanalytic education is offered clearly
involves ethical issues. The psychoanalyst-teacher has responsibilities
to the public, his students, his profession, and himself.
These responsibilities must be given full attention both by
the individual analyst, and, in the establishment of all training
standards, by the Board on Professional Standards and its
affiliated training programs. Accordingly, the educational
standards and procedures of the Board on Professional Standards
embody these ethical considerations and should be so accepted.
(D) Training in the practice of psychoanalysis, i.e., teaching
courses, or conducting training analyses or providing supervision
of psychoanalytic treatment, should be offered only when the
highest ethical and educational standards are employed, and
when there is careful selection of participants and thorough
evaluation of the training and the progress of those enrolled
in it. No psychoanalyst may claim or imply that training in
psychoanalysis is directly or indirectly connected with or
authorized by the American Psychoanalytic Association unless
the educational standards and procedures of the Board on Professional
Standards are fully observed and the training is conducted
under the auspices of the Board on Professional Standards.
PROVISIONS FOR IMPLEMENTATION OF THE PRINCIPLES OF
ETHICS FOR PSYCHOANALYSIS
1. Committee on Ethics - There shall be a joint standing Committee
Ethics of the Board on Professional Standards and the Executive
Council.
A. Composition
The Committee will consist of five members appointed jointly
by the President of the Association (the President), and the
Chairman of the Board on Professional Standards. Each member,
except for the first appointment, is to serve a term of five
years, with terms overlapping on a staggered basis. One new
member is to be added to this Committee each year as the term
of an outgoing member is completed.
The President and the Chairman of the Board on Professional
Standards will jointly designate one member to act as Chairman
of the Committee on Ethics for a term of two years. Should
vacancies occur on the Committee, the President and the Chairman
of the Board on Professional Standards will jointly appoint
replacement(s) to complete the unexpired term(s) of the member(s)
who is being replaced.
B. Duties
The responsibilities of the Committee on Ethics will be:
1. To consider and respond to communications regarding the
Principles of Ethics and the procedures for implementation
of the Principles, and to make recommendations for appropriate
additions or modifications as indicated by experience. All
recommended changes will be subject to approval by the Board
on Professional Standards and the Executive Council.
2. To issue advisory opinions regarding questions about ethical
conduct submitted to it.
3. To consider complaints concerning any alleged breach of
the Principles of Ethics by a member of the Association referred
to the Committee in accordance with the Procedures outlined,
and to make recommendations concerning the disposition of
such matters.
II. Procedures of the Committee on Ethics and of the
Association in Regard to Questions of Ethical Conduct.
A. Advisory Opinions
1. When there is a complaint or an inquiry, but no alleged
breach of the Principles of Ethics, any communications regarding
the issue, to whomever addressed, may be referred to the Chairman
of the Committee on Ethics, who will respond, with or without
consulting the Committee, as he may deem appropriate. Copies
of such correspondence shall be sent to the President and
the Chairman of the Board on Professional Standards.
2. At appropriate intervals the Committee shall prepare summaries
of advisory opinions and decisions regarding ethical questions.
After approval by the Executive Committee, or by the Board
on Professional Standards and Executive Council if the Executive
Committee so decides, such summaries shall be published and
distributed to the membership.
B. Adjudication: Complaints regarding alleged
breaches of the Principles of Ethics by a member of the Association
may be made to local societies, or to training facilities,
or to the Association.
III. Adjudication at the Local Level
Each local group (Affiliate Societies and Study Groups, Accredited
and provisionally Accredited Training Institutes) should have
a Committee on Ethics or an equivalent thereof for dealing
with complaints. Due process should be observed in the actions
of the local group. Upon recommendation of the Committee on
Ethics, complaints made directly to the Association will be
referred to the local group for evaluation and any necessary
action. In all proceedings involving an alleged breach of
the Principles of Ethics, adequate records must be kept, and
the Association informed of all actions in the matter.
A. When a complaint is made directly or referred to the local
group, every effort should be made to resolve the issue at
that level. The local group shall advise the President or
the Chairman of the Board on Professional Standards of each
complaint and of any action taken with respect thereto.
B. Should the local group fail to deal with the issue to the
satisfaction of all parties, a formal request may be sent
by the complainant, or by the persons charged, or by the local
group to the President, seeking consideration of the matter
at the Association level. Such requests must be made not later
than 60 days after the concerned parties have been notified
of the local group's disposition of the matter.
C. If a member of the Association is suspended or expelled
from a local group as a result of adjudication of complaints
regarding alleged breaches of the Principles of Ethics, a
review of the case by the Association shall promptly be undertaken.
D. The President, at any time, may, in his discretion, refer
a matter for consideration by the Association as described
in IV, B, 4 and 5 below.
IV. Adjudication by the Association
Complaints regarding alleged breaches of the Principles of
Ethics by a member of the Association may be made directly
to the Association (of necessity if there is no appropriate
local group), or may be referred to the Association after
attempt at adjudication at the local level, as provided in
111, B, C and D above.
A. Requirements regarding complaint or request for review
of local action.
1. A complaint, or a request for referral of the matter from
a local group, must be made in writing to the President and
be signed by the party making the complaint or request.
2. The complainant must clearly describe the alleged breach(es),
including the name of the member and any other persons involved,
and the reasons for dissatisfaction with the action, if any,
taken at the local level.
3. In the case of a request for a review of local action by
the person charged with a violation, adequate information
must be provided regarding the charge against him, his defense,
and his reasons for dissatisfaction with the disposition of
the case at the local level.
4. In the case of a referral from the local group, the request
should specify the charge, the persons involved, the action
taken by that group in attempts to resolve the issue, and
the reasons for the referral to the Association.
5. In all cases of a complaint fulfilling the
above conditions, the Association will initiate all necessary
action in accordance with these Provisions of Implementation.
While a complaint will be presumed to be a request for the
Association to take action and to include permission for the
complaint to be shown to those persons whom the President
may designate, the person making the complaint or request
shall provide permission for copies to be sent to the other
local parties and to such other persons as the President may
deem necessary. The complaint or request must also state the
signer's willingness to discuss the matter (with his legal
counsel present, should he so wish) with the President or
with a person or persons designated by the President, including
legal counsel of the Association.
6. No formal action will be taken without due process.
B. Handling of Complaints about Unethical Conduct
1. Communications regarding an alleged breach of the Principles of Ethics
will be sent to the President who will then refer the matter to the Committee
on Ethics. The President will promptly inform the charged analyst of the
full details of the complaint or the request from a local group for consideration
of the matter by the Association.
2. Upon receipt of such referral as described in IV, B, I
above, the Committee on Ethics shall consider all available
information, confer with legal counsel of the Association
and the President, and make whatever inquiries are necessary
to determine if there are sufficient grounds for proceeding
with the matter. Members of the Association may be appointed
as "Fact Finders", as described in IV, B, 5, (a)
to gather information. No judgment of the validity of the
charges will be implied by this determination, except that
if it is determined that there are not sufficient grounds
for proceeding, the charged analyst shall be considered exonerated.
3. If there are sufficient grounds for proceeding and if the
matter has not yet been adjudicated by the appropriate local
group, the matter will be referred to that group for investigation
and any indicated action as described in III above.
4. After adjudication by the local group and in the event
that the charged member has been suspended or expelled from
the local group, or if any of the parties has indicated, as
provided in section III, B above, dissatisfaction with the
disposition of the local group, or, at any time, in the discretion
of the President, the Association shall review the matter.
This review will be undertaken by the Committee on Ethics,
unless in the discretion of the President and the Chairman
of the Board on Professional Standards the Committee on Ethics
cannot perform its duties under the circumstances, in which
case the President and the Chairman of the Board on Professional
Standards will jointly appoint an ad hoc committee consisting
of five members of the Association to deal with the matter.
Such ad hoc committee will be held to the same rules and follow
the same procedures as the Committee on Ethics. The Committee
on Ethics, or the ad hoc committee, will review all pertinent
records, will seek the advice of legal counsel as it deems
appropriate, and will, after consultation with the President,
decide whether sufficient information is available to arrive
at a decision. It may, but shall not be required to, request
written briefs from counsel for the complainant, counsel for
the charged analyst and counsel for the local group. It may,
but it shall not be required to, hold a hearing as described
in IV, 5, (b) below.
When making its decision, the Committee on Ethics or the ad
hoc committee shall vote for one of the following measures:
(a) Exoneration (the accused is cleared from blame where the
evidence shows no unethical conduct by the accused).
(b) Dismissal of complaint (for example, when a determination
on the merits cannot be made because of insufficient reliable
evidence or other procedural defects), without prejudice to
the right of the Committee on Ethics or an ad hoc committee
at a later date to recommend the commencement of new proceedings
with respect to the same charges.
(c) Censure.
(d) Suspension from membership in the Association for a stipulated
period, but for not more than three years.
(e) Separation from the rolls, but with new application for
membership to be entertained in not less than five years.
(f) Permanent expulsion from membership in the Association.
To reach a decision on these measures, at least four members
of the Committee on Ethics, or of the ad hoc committee, must
vote in favor of the measure, with no more than one member
voting against. If this majority is not attained, the charges
shall be considered to be dismissed as in (b) above.
(a) In the event that there is no appropriate local group
to which the matter can be referred, it shall be the responsibility
of the Committee on Ethics, or an ad hoc committee appointed
under circumstances described in IV, B, 4 above, to evaluate
and investigate the charges. It will seek advice of legal
counsel and the President as it deems appropriate. It may
be aided by members of the Association jointly appointed by
the President and the Chairman of the Board on Professional
Standards as "Fact Finders" who will gather preliminary
information. After gathering sufficient information, the Committee
on Ethics or an ad hoc committee may decide to dismiss the
complaint or to proceed with further investigation. In the
event that the decision is to dismiss the complaint, the President
shall notify all parties concerned, and the charged analyst
shall be considered exonerated.
(b) If a hearing is required, or is otherwise considered appropriate
by the Committee on Ethics or by an ad hoc committee, it shall
be held at such reasonable time and place designated by the
Chairman of the Committee. The hearing shall be conducted
by the Committee on Ethics, or an ad hoc committee, unless
in the discretion of the President and the Chairman of the
Board on Professional Standards the Committee on Ethics is
not able to perform its duties under the circumstances, in
which case the President and the Chairman of the Board on
Professional Standards will jointly appoint a "Hearing
Committee" consisting of five members of the Association.
Such "Hearing Committee" shall follow the same rules
and procedures as the Committee on Ethics except as provided
in IV, B, 5, (c) and (d) below. The charged psychoanalyst
shall receive not less than 30 days notice of the hearing.
Attendance at the hearing may be limited to the Committee
members; the charged analyst; the complainant; counsel for
the Association, for the charged analyst and for the complainant,
each of whom may speak on behalf of his client; and witnesses,
if any. Those present shall have such rights as are set forth
below in VIII
(c) If the hearing was conducted by a "Hearing Committee",
it shall send a full report and recommendations to the Committee
on Ethics.
(d) After receiving the report of the "Hearing Committee",
or at the conclusion of the hearing if it has been conducted
by the Committee on Ethics, the Committee on Ethics shall
vote as described in Section IV, B, 4.
(e) If the hearing has been conducted by an ad hoc committee,
the ad hoc committee shall vote as described in IV, B, 4.
V. Executive Council Ratification
The President shall notify all concerned parties of the decision,
pursuant to IV, B, 4 or IV, B, 5, (d), or (e), of the Committee
on Ethics or of the ad hoc committee.* The charged analyst
must indicate in writing within 30 days from the date of mailing
of the notice, either that he accepts the decision, or that
he wishes to appeal it. Unless written notification from the
charged analyst is received within the specified time, the
right to appeal will have been forfeited.
The Chairman of the Committee on Ethics will present a summary
of the matter to the Executive Council sitting in Executive
Session. This summary will include the investigations, if
any, undertaken by the local group as well as that of the
Committee on Ethics, including its decision and the response,
if any, from the charged analyst.
Except in those cases where the charged analyst has indicated
his intention to appeal the decision of the Committee on Ethics,
the Executive Council will then vote to ratify the decision
of the Committee on Ethics, a majority vote being required.
Upon ratification by a majority vote of the Executive Council,
the decision will be considered final.
A. If a majority vote of the Executive Council does not support
ratification, the Council can then refer the matter back to
the Committee on Ethics for further deliberation. A majority
vote of the Executive Council is required for such referral.
The Executive Council may, if it chooses, indicate to the
Committee on Ethics specific questions which it may have concerning
the matter and which it wishes to call to the attention of
the Committee.
When a matter is referred back to the Committee on Ethics
by the Executive Council, the Committee on Ethics will proceed
to gather any fur
*From this point in these "Provisions for Implementation", unless
clearly stated otherwise, the term "Committee on Ethics" will
also be intended to mean an ad hoc committee, should one have been appointed.
the information it deems necessary. It will arrive at its decision following
the same procedures and rules as described in IV, B, 4 and IV, B, 5 above.
The President shall notify all parties concerned of the new decision of
the Committee on Ethics; the charged analyst will then have the same right
to appeal as described above.
If tie charged analyst has not exercised his right to appeal, the matter
will then be presented to the Executive Council, sitting in Executive
Session, for its ratification. A majority vote of the Executive Council
is required for such ratification.
If the charged analyst has not exercised his right to appeal, and if the
Executive Council, by a majority vote, neither ratifies the decision of
the committee on Ethics nor refers the matter back to the Committee on
Ethics, the charges shall be considered "dismissed" as provided
in IV, B, 4 above.
VI Executive Council Appeal
If the charged member exercises his right to appeal the decision of the
committee on Ethics, the President, and the Chairman of the Board on Professional
Standards shall jointly appoint an Executive Council Appeals Committee
consisting of five members of the Executive Council, including at least
two Councilors-at-Large. The appointment of the Appeals Committee must
be confirmed by a majority vote of the Executive Council. The Appeals
Committee is empowered to act on behalf of the Executive Council in adjudicating
the appeal, and its decision will be considered final.
The Executive Council Appeals Committee shall review the record of the
proceedings, but shall not be required, unless it so decides, to hold
additional fact finding hearings. It shall proceed as does the Committee
on Ethics as described in IV, Be 4 and IV, B, 5 above, except that a majority
vote is required for its decision.
VII. Inability to Serve
If, for any reason, a member or members of the Committee on
Ethics or of the Executive Council Appeals Committee or of
an ad hoc committee, or of the Committee on Ethics Hearing
Committee is temporarily unable to serve, the President and
the Chairman of the Board on Professional Standards shall
jointly appoint a member(s) to fill the vacancy during the
time of the original member's incapacity.
VIII. Rights and Privileges of All Parties Come
In all hearings:
(1) The due process rights of all conceserved in implementing these provisions.
(2) The charged member's right of appel
(3) Hearing bodies shall not be bound employed in legal proceedings,
but may a propriate and pertinent.
(4) Should the complainant, the charge appear at any hearing,
the appropriate postpone, dismiss, or proceed with the hearing
(5) A notice of the decision of the Committee, or the relevant decision
of the Executive Council Appeals Committe the charged analyst and the
other parties
