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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.
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.
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.
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.
(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