APA Ethics Code Standards 3 & 4

Why Standards 3 & 4 Matter for Your Future Practice

You're preparing to become a licensed psychologist, which means you'll be making dozens of ethical decisions every single week. Should you accept a friend's cousin as a client? What do you tell a client's employer who's paying for therapy? When can you break confidentiality? These aren't abstract academic questions. They're real dilemmas that will shape your career and your clients' wellbeing.

Standards 3 and 4 of the APA Ethics Code cover Human Relations and Privacy/Confidentiality. Think of these as your ethical GPS for navigating the complex relationships and sensitive information you'll handle daily. Let's break them down into practical, memorable guidance.

Standard 3: Human Relations (Navigating Professional Boundaries)

Discrimination: When Can You Say No?

Here's what confuses many psychology students: The Ethics Code prohibits discrimination based on age, gender, race, ethnicity, and other protected categories. But that doesn't mean you must accept every single person who contacts you for services.

The distinction is crucial. You cannot refuse services because you don't like someone's race or gender. However, you can refer someone elsewhere when you genuinely believe their situation falls outside your competence or when specific circumstances would prevent you from providing effective care.

{{M}}Think of it like a medical specialist: A cardiologist isn't discriminating when they refer you to an orthopedist for a broken ankle. They're recognizing the limits of their expertise.{{/M}} Similarly, you might refer a prospective client if their values conflict so strongly with yours that you couldn't maintain objectivity, or if they cannot pay your fees and you lack the resources to see them pro bono.

Sexual Harassment: The Two-Part Test

Standard 3.02 defines sexual harassment with crystal clarity. It occurs when sexual conduct meets one of these criteria:

1. The "told you" standard: The behavior is unwelcome or offensive, creates a hostile environment, and you know or have been told this
2. The "reasonable person" standard: The behavior is severe or intense enough that a reasonable person would find it abusive

The key insight? A single severe incident counts as harassment. So does a pattern of less severe behaviors. {{M}}Imagine someone keeps sending you flirty texts after you've said you're not interested. That first rejection creates the line, anything after that crosses it.{{/M}}

The ambiguous situations trip people up on the EPPP. An occasional off-color joke might not constitute harassment initially, but if someone continues after being told it's unwelcome, it absolutely becomes harassment. The Ethics Code is clear: once you're told to stop, you stop.

Multiple Relationships: The Most Complex Standard

Multiple relationships happen when you have a professional relationship with someone and either:

• Simultaneously have another role with them or someone close to them
• Promise a future relationship with them or someone close to them

Not all multiple relationships are prohibited. Only those that "could reasonably be expected to impair objectivity, competence, or effectiveness" or risk exploitation or harm.

Here's the tricky part that appears frequently on the EPPP: post-therapy friendships. Many students think these are fine since therapy has ended. Wrong. These relationships still count as problematic because they prevent the former client from returning to therapy and prevent you from providing other professional services (like court testimony) in the future.

Gottlieb's Decision-Making Model

When considering whether a multiple relationship is acceptable, evaluate three factors:

The greater the power differential, the longer the expected duration, and the more ambiguous the termination, the more problematic the multiple relationship becomes.

{{M}}Picture this scenario: Your regular yoga instructor asks if you'd supervise her practicum hours. You have high power (as supervisor), the relationship will last months (duration), and she'll continue as your instructor afterward (unclear termination). This hits all three red flags.{{/M}}

Special contexts where multiple relationships get extra scrutiny:

• Child custody evaluations: Never conduct evaluations with current or former therapy clients
• Forensic work: Providing both therapeutic and forensic services to the same person impairs objectivity
• When a potentially harmful multiple relationship occurs anyway, you must take reasonable steps to resolve it. Discuss it with those involved, consult colleagues, prioritize the affected person's best interests

Conflict of Interest: Following the Money

Standard 3.06 prohibits accepting roles that impair your objectivity or expose others to harm. This comes up most often with financial conflicts.

{{M}}Imagine you recommend that all your anxiety clients buy a specific meditation app, but you fail to mention you receive a 20% commission on each sale.{{/M}} That's a clear violation. Your financial interest creates pressure to recommend the product regardless of whether it's truly the best option for each client.

Third-Party Requests: Who's Really Your Client?

This concept confuses many students because it challenges assumptions about the therapy relationship. Standard 3.07 requires you to clarify relationships when someone else requests your services.

Key distinction: When an employer pays for an employee's therapy, the employee is typically still your client. When an attorney hires you for a forensic evaluation, the attorney is your client, not the person being evaluated.

Here's the practical guidance:

You must clarify at the outset: your role, who the client is, how information will be used, and any limits to confidentiality.

Informed Consent: More Than Just a Signature

Standard 3.10 requires informed consent using understandable language before providing services, with specific exceptions like court-ordered evaluations.

When Clients Can't Give Consent

Minors: Most people under 18 cannot legally consent to treatment. You must:

• Provide them with an appropriate explanation anyway
• Consider their best interests
• Seek their assent (agreement)
• Obtain permission from a parent or legal guardian

Important exceptions where minors can consent:

• Emancipated minors
• "Mature minors" (varies by state. Those with sufficient maturity and intelligence)
• Minors with certain conditions like substance abuse or STDs (state-dependent)
• Emergency situations where parental consent isn't available and the minor's life is at risk

{{M}}Think of informed consent with minors like a group project at work: the manager (parent) has final authority, but you still explain the project to the junior employee (minor) and get their buy-in for the best outcome.{{/M}}

When parents disagree about treatment: In intact families, consent from one parent usually suffices legally. But getting both parents on board often serves the child's best interests because it improves treatment compliance. When parents are divorced, check the court order. It specifies whose consent is required.

Unaccompanied immigrant children (UIC) present special challenges. These minors enter the U.S. without parents or legal guardians and are in custody of government agencies. The agency holding custody must consent, not the child. You provide informed consent information to both the agency and the child as appropriate.

Court-Ordered Services

When services are mandated by the court, you still discuss the nature of services and confidentiality limits with the person, but you don't need their consent to proceed. If someone refuses a court-ordered evaluation, your options include postponing it, advising them to contact their attorney, and notifying whoever retained you about their refusal.

Documentation Matters

Standard 3.10(d) requires documenting consent appropriately. Sometimes written consent is legally required. Other times, oral consent with documentation is better, like when working with clients from cultures that distrust written documents, clients with limited literacy, or research participants whose anonymity you're protecting.

Interruption of Services: Planning for the Unexpected

Standard 3.12 requires planning for service interruptions due to your illness, death, relocation, retirement, or the client's circumstances.

For foreseeable interruptions: Discuss the situation with clients early, provide pretermination counseling, offer referrals.

For your death: Create a professional will naming a professional executor. Ideally another psychologist who understands ethical obligations. This person contacts your clients and secures their records. According to ASPPB guidelines, don't name a family member as executor due to inherent conflicts of interest.

Standard 4: Privacy and Confidentiality (Protecting What's Shared)

Discussing Confidentiality Limits: The Upfront Conversation

Standard 4.02 requires discussing confidentiality limits at the relationship's outset and whenever circumstances change. This isn't just good practice. It's an ethical mandate.

But different contexts create different confidentiality challenges:

Couples and Family Therapy

You must clarify upfront: Who are the clients? How will information shared privately by one person be handled?

{{M}}Imagine treating a married couple. The husband calls you between sessions to say he's having an affair. Do you keep this secret in couple's sessions, or do you tell the wife?{{/M}} There's no universal answer. But you must establish your policy before this situation arises. Some therapists maintain "no secrets" policies; others keep individual disclosures confidential unless they directly threaten the therapy. Whatever you decide, make it explicit from session one.

Group Therapy

Here's a hard truth: You cannot guarantee confidentiality in group therapy. Why? Because group members aren't bound by professional ethics or legal liability if they breach confidentiality.

Your job is risk reduction:

• Discuss confidentiality importance during screening interviews
• Revisit it in the first session, subsequent sessions as needed, and the final session
• Explain potential consequences of breaches
• Set clear expectations

Minors

Minors generally don't have confidentiality rights unless they're emancipated or legally able to consent to treatment. The parent or legal guardian has rights to information disclosed by the minor.

Best practice: Establish a confidentiality agreement at treatment start. Specify what you will and won't share. Be clear about when you'll contact parents. Typically when the minor is engaging in potentially harmful behavior or when legally required (suspected abuse, suicide risk).

Even when disclosing information to parents, tell the minor beforehand when possible. Including them in conversations with parents often improves outcomes.

Special Contexts

Military settings: Department of Defense rules limit confidentiality more than civilian settings. Provide detailed informed consent stating that confidentiality can never be guaranteed. Document conservatively.

Correctional facilities: Confidentiality ranges from essentially none (court-ordered assessments) to near-typical levels (voluntary therapy). Always clarify limits upfront.

Treatment-driven decisions prioritize the therapeutic relationship. Security-driven decisions prioritize safety of staff and inmates when values conflict. {{M}}If an inmate threatens to harm a guard, that's security-driven. You report it. If an inmate discusses plans to harm someone outside prison but has no means to carry it out, that's different and requires clinical judgment about treatment versus disclosure.{{/M}}

Employee Assistance Programs (EAPs): Confidentiality works the same as in other therapy. Information isn't shared with supervisors or employers without written authorization, even for mandatory referrals. Standard exceptions apply (danger to self/others, mandated reporting).

Telepsychology: Technology introduces new risks. Protect confidentiality through:

• Private, soundproof locations
• Password protection on all devices
• Encryption for emails, texts, documents
• HIPAA-compliant videoconferencing (Zoom for Healthcare, Doxy.me, thera-LINK. But NOT Consumer Skype)
• Updated virus/malware protection
• Discussing with clients how they'll maintain privacy on their end

Disclosing Confidential Information: When Secrets Must Be Broken

Standard 4.05 permits disclosure with appropriate authorization OR without authorization when mandated or permitted by law for valid purposes like protecting people from harm.

Risk for Suicide

When clients are at high risk for suicide, protecting their safety may require breaching confidentiality, contacting family or hospitalizing them.

Important EPPP note: No-suicide contracts (agreements where clients promise not to harm themselves) have no evidence supporting their effectiveness and don't protect you from liability. Don't rely on them as your sole intervention.

Risk for Abuse

Mandatory reporting laws require reporting suspected child abuse or neglect to protective services. Many jurisdictions extend this to elder abuse and abuse of adults with disabilities. You report when you have "reasonable cause to suspect". Not when you're certain.

Risk for Physical Harm: The Tarasoff Duty

Many jurisdictions follow the Tarasoff decision, establishing a duty to protect third parties from client violence. This typically applies when:

• The client communicates a clear and imminent threat
• The threat is of physical harm
• The victim is identifiable
• The client can carry out the threat

Appropriate actions (depending on jurisdiction): warn the intended victim, notify police, or hospitalize the client.

Complex application: HIV-positive clients engaging in risky behaviors. APA's position: legislation shouldn't impose a duty to protect, but if it exists, disclosure should require:

• Knowledge of an identifiable at-risk person
• Reasonable belief the person doesn't know the client's HIV status
• The client has been urged to disclose and refused or is unreliable

Always check your jurisdiction's specific laws and consult with colleagues and attorneys in these situations.

Consultation and Teaching

Standard 4.06 allows consulting with colleagues about clients but requires not disclosing identifying information without authorization. Disclose only what's necessary for the consultation purpose.

Standard 4.07 permits using client information in writings or lectures only if you:

1. Disguise the person adequately (pseudonyms alone aren't enough. Change ages, locations, family composition, timing)
2. Obtain written consent, or
3. Have legal authorization

Client Access to Records: What the Law Says

The Ethics Code doesn't address record access, but HIPAA does. Clients have the right to inspect and obtain copies of their protected health information (PHI).

Exception: You can deny access when you believe it would "reasonably likely endanger" the client or another person.

With minors: Parents typically access their minor children's PHI as legal representatives, unless state law grants the minor consent rights or treatment resulted from a court order.

When minors turn 18: They gain full HIPAA rights over their entire record, including information from when they were minors. Parents lose access without the now-adult child's authorization.

Confidentiality versus Privilege: Understanding the Difference

Many students confuse these terms on the EPPP:

All 50 states recognize some form of psychotherapist-client privilege. You can claim privilege on behalf of a client when asked to disclose information in legal proceedings.

Common exceptions to privilege:

• Court-ordered competency evaluations
• Malpractice suits against the therapist
• Client using mental status as a legal claim or defense

The court determines whether an exception applies.

Common EPPP Misconceptions

Misconception #1: "Post-therapy friendships are fine since therapy ended." Reality: These remain problematic multiple relationships that prevent future professional services.

Misconception #2: "I need both parents' consent to treat a minor." Reality: In intact families, one parent's consent typically suffices legally (though getting both is often clinically preferable).

Misconception #3: "No-suicide contracts protect me legally." Reality: They have no proven effectiveness and provide no legal protection.

Misconception #4: "Confidentiality and privilege are the same thing." Reality: Confidentiality is an ethical duty in all professional contexts; privilege is a legal right in court proceedings.

Misconception #5: "I can't refuse to see someone or I'm discriminating." Reality: You can refer someone when their situation exceeds your competence or when specific circumstances prevent effective treatment.

Practice Tips for the EPPP

Create comparison charts: Make tables comparing different contexts (military vs. civilian confidentiality, minor vs. adult consent rights, confidentiality vs. privilege).

Use the acronym DICTATOR for Tarasoff:

• Duty exists in your jurisdiction
• Identifiable victim
• Clear threat
• Threat is imminent
• Ability to carry it out
• Threat of physical harm
• Only certain actions fulfill duty (warn, notify police, hospitalize)
• Reasonable belief it's serious

Remember "3.10 = Consent" and "4.02 = Confidentiality discussion": These similar-sounding standards trip people up. Standard 3.10 covers obtaining informed consent; Standard 4.02 covers discussing confidentiality limits.

For multiple relationships, think "3-D": Power Differential, Duration, and clarity of termination Determines risk level.

Key Takeaways

• Discrimination prohibition doesn't mean accepting every client. You can refer when appropriate
• Sexual harassment becomes clear once someone is told the behavior is unwelcome
• Multiple relationships aren't always prohibited, but evaluate power, duration, and termination clarity
• Third-party situations require clarifying who the client is and how information will be used
• Informed consent requires age-appropriate explanation for minors, even when they can't legally consent
• Professional wills should name another psychologist as executor, not family members
• Confidentiality limits must be discussed at the relationship's outset and when circumstances change
• Group therapy confidentiality can't be guaranteed. Only managed through education
• Minor clients generally lack confidentiality rights unless emancipated or legally able to consent
• Tarasoff duty requires clear, imminent threat to identifiable victim with means to carry it out
• Confidentiality (ethical duty) and privilege (legal right) are distinct concepts
• Client record access is governed by HIPAA and state law, not the Ethics Code
• HIPAA-compliant platforms are required for telepsychology; consumer versions don't qualify

These standards form the foundation of ethical practice. Master them not just for the EPPP, but for the countless real-world decisions you'll face throughout your career. Your ability to navigate these situations with confidence will protect both your clients and your professional future.