APA Ethics Code Standards 5 & 6

Why These Standards Matter More Than You Think

You've probably seen those late-night TV commercials with "life coaches" making wild promises, or stumbled across a therapist's website that feels more like a personal fan page with glowing reviews from current clients. Something feels off, right? That gut feeling exists because these situations violate fundamental ethical principles that protect both clients and the psychology profession itself.

Standards 5 and 6 of the APA Ethics Code govern how psychologists present themselves to the world and manage the business side of practice. These aren't just bureaucratic rules. They're the framework that maintains public trust and protects vulnerable people from exploitation. {{M}}Think of these standards as the operating system that runs in the background of your professional life{{/M}}, making sure every public statement, every financial transaction, and every record you keep meets ethical requirements.

Let's dive into what you need to know for the EPPP and your future practice.

Standard 5: Advertising and Other Public Statements

The Core Principle: Truth in All Forms

Standard 5.01 establishes the foundation: psychologists cannot knowingly make false, deceptive, or fraudulent public statements about their work. This applies to everything. Your website, your LinkedIn profile, what you say in a lecture, your resume, even your listing in a directory.

The key word here is "public." Once you put information out there for others to see, you're accountable for its accuracy. This includes statements about:

• Your training and education
• Your experience and expertise
• Your credentials and licenses
• The services you offer
• Your fees and payment policies
• Your research findings
• The organizations you're affiliated with

The Degree Credential Rule

Here's something that catches many psychology graduates off guard: you can only claim degrees as credentials for mental health services if they meet specific requirements. According to Standard 5.01, acceptable degrees are either:

1. Doctoral degrees in psychology from regionally accredited institutions, OR
2. Degrees (from any institution) that your state licensing board accepted as the basis for your psychology license

{{M}}Imagine you earned a master's degree from a prestigious international university that isn't regionally accredited in the U.S.{{/M}} Even if the program was excellent, you generally cannot advertise that degree as a credential for providing mental health services unless it qualified you for licensure. This protects the public from confusion about what qualifications actually mean.

Who's Responsible for What Others Say About You

Standard 5.02 addresses an increasingly common scenario: you hire someone to help market your practice. Maybe a social media manager or a PR consultant. Here's the deal: you're still responsible for what they say about you.

If you pay someone to create promotional content, you must ensure it's accurate and ethical. This standard also prohibits paying media employees (journalists, producers, etc.) for publicity disguised as news coverage. {{M}}It's like the difference between paying for a clearly labeled Instagram ad versus secretly paying an influencer to recommend your services without disclosing the financial relationship{{/M}}. One is transparent, the other is deceptive.

Additionally, when you do pay for advertising, it must be clearly identified as such. No sneaky product placement allowed in psychology.

Media Appearances and Online Advice

Standard 5.04 governs what you say in media presentations. Podcasts, social media posts, online articles, TV interviews, or any other public commentary. Two critical requirements:

1. Base statements on professional knowledge: Don't just share opinions. Your public statements should reflect actual psychological knowledge, training, or experience.

2. Don't create implied professional relationships: When you respond to someone's comment on your psychology blog or answer a question on social media, you must make it clear that this interaction doesn't establish a therapist-client relationship.

{{M}}Picture yourself scrolling through Reddit and seeing someone describe symptoms of depression in a post. You might want to help, but offering specific advice like "You should try cognitive restructuring exercises" could imply you're providing professional services{{/M}}. Instead, general educational information ("Many people with these experiences benefit from working with a therapist who specializes in depression") maintains appropriate boundaries.

The Testimonial Problem

Standard 5.05 prohibits soliciting testimonials from current therapy clients or other vulnerable individuals. This one's straightforward but important: don't ask your current clients for reviews or testimonials.

Why? Because the therapeutic relationship involves a power imbalance. Clients might feel pressured to provide positive feedback even if that's not their genuine experience. The standard specifically mentions people who "because of their particular circumstances are vulnerable to undue influence."

Here's what's prohibited and what's not:

In-Person Solicitation

Standard 5.06 addresses uninvited in-person solicitation of business from vulnerable individuals. You cannot show up at someone's door or approach them in person to solicit therapy services when they're in vulnerable circumstances.

Important exceptions exist:

• Encouraging family members to participate in a current client's treatment (that's often clinically necessary)
• Providing disaster relief services after a community crisis
• Offering community outreach services

{{M}}Think of it this way: If there's a car accident in your neighborhood, you can't hand out your business cards to traumatized witnesses at the scene{{/M}}. But if you're volunteering with a disaster mental health team at an official relief center, you can offer services there.

Standard 6: Record Keeping and Fees

Creating and Maintaining Records

Standard 6.01 requires psychologists to create, maintain, and eventually dispose of records appropriately. The reasons are practical:

• Facilitating continuity of care if services transfer to another provider
• Ensuring accurate billing and documentation
• Complying with legal requirements
• Protecting both the psychologist and client if disputes arise

Forensic Records Require Extra Attention

If you work in forensic psychology (court evaluations, expert testimony, etc.), your record-keeping standards are even higher. Forensic records should include:

• Detailed notes from all contacts
• All materials reviewed
• All raw test data
• All preliminary notes and drafts
• Documentation of your reasoning process

Why so thorough? Because in forensic work, your records can be subpoenaed and scrutinized by opposing counsel. Everything you created or used to form your opinion is potentially subject to legal discovery (except what's protected by privilege).

Protecting Confidentiality in Records

Standard 6.02 provides guidelines for maintaining confidentiality, which gets complicated in our digital age.

Standard 6.02(b) requires using coding or other techniques to protect personal identifiers when entering confidential information into databases that unauthorized people might access.

Modern protection strategies include:

{{M}}Using your personal Gmail to email session notes to yourself would be like shouting client information across a crowded coffee shop{{/M}}. Even if no one's actively listening, you're exposing confidential information unnecessarily.

Planning for Unexpected Withdrawal from Practice

Standard 6.02(c) requires having a plan for what happens to client records if you can no longer practice. Whether due to retirement, illness, disability, or death. This is called a "professional will."

Your plan might include:

• Designating a trusted colleague to manage records
• Providing instructions to your spouse or executor about seeking professional guidance
• Arranging with a professional association to handle record management
• Creating detailed written procedures for contacting current clients

How Long to Keep Records

While not in the Ethics Code itself, APA's Record Keeping Guidelines recommend maintaining full records:

• For adults: 7 years after the last service date
• For minors: Until 3 years after they reach the age of majority (typically 21 in most states)

These are minimums. Many psychologists keep records longer because:

• State laws may require longer retention
• Insurance or institutional policies may differ
• The nature of services may warrant longer retention (like forensic work)

The Money Talk: Fees and Financial Arrangements

Discussing Fees Early

Standard 6.04 requires reaching agreement with clients about fees "as early as feasible". Ideally during your initial contact or first session. This conversation should cover:

• Fees for different types of sessions (individual, couples, family, etc.)
• Billing and payment schedules
• Charges for missed appointments or late cancellations
• How third-party insurance works
• Your policy for unpaid fees and collections

Being upfront about money prevents misunderstandings and allows clients to make informed decisions about services they can afford.

The Collections Process

If a client doesn't pay, Standard 6.04(e) allows using collection agencies or legal measures, but only after:

1. Informing the person you'll take such measures
2. Providing opportunity for prompt payment

When you do involve a collection agency, share only the minimum necessary information: the client's name, contact information, service dates, and amount owed. No clinical information.

Sliding Fee Scales

Though not explicitly addressed in the Ethics Code, sliding fee scales based on income are generally considered acceptable when:

• Applied consistently and equitably
• Compliant with state laws and insurance contracts
• Clearly explained to clients

Free First Sessions

Some psychologists offer free initial consultations. This isn't explicitly prohibited, but requires caution:

• Clearly explain the limited purpose (helping both parties determine if it's a good fit)
• Inform the person of future session fees beforehand
• Document the agreement
• Be cautious about creating expectations you can't meet

Emergency Records Access

Standard 6.03 prohibits withholding records needed for emergency treatment solely because of unpaid fees. Note the specifics:

• This applies to treatment, not assessment reports or educational records
• The need must be for emergency care
• You can't withhold records solely due to nonpayment

{{M}}If a client who owes you money shows up at an emergency room in crisis{{/M}}, and the ER doctor needs treatment records, you must provide them. The person's safety trumps payment disputes.

Also important: HIPAA generally doesn't allow refusing to let patients inspect or obtain copies of their health records due to nonpayment, so withholding records for billing reasons may violate federal law regardless of ethics.

Barter Arrangements

Standard 6.05 defines barter as accepting goods, services, or other non-monetary payment for psychological services. It's allowed when:

• Not clinically contraindicated
• Not exploitative

However, most experts strongly discourage bartering because:

• It creates boundary complications
• The value of bartered goods/services may be unclear
• It can lead to conflicts and resentment
• It may create dual relationships

If you do accept barter (perhaps in rural areas with limited resources), bartering goods is generally less risky than bartering services. {{M}}Accepting homemade jam in exchange for therapy is less complicated than accepting home repairs{{/M}}, where ongoing contact and quality disputes could damage the therapeutic relationship.

Accurate Billing

Standard 6.06 requires providing accurate information to whoever pays for services. Whether that's the client, an insurance company, or another third party. This means accurately reporting:

• Diagnosis codes
• Types of services provided
• Who provided the services
• Fees charged

Common Billing Violations

These practices are both unethical and illegal (fraud):

Referral Fees

Standard 6.07 states that referral fees must be "based on the services provided" and not "on the referral itself."

Prohibited: Paying a colleague $50 for each client they refer to you, regardless of what they did.

Acceptable: Paying a colleague for actual time and costs associated with making the referral (reviewing records, consulting with you about the case, copying files).

This standard doesn't prohibit:

• Paying legitimate psychology referral services
• Fee-splitting when multiple professionals provide services to the same client
• Paying employees a percentage of fees as part of their compensation

Common Misconceptions and EPPP Traps

Misconception 1: "I can use any degree I've earned in my advertisements."

Reality: Only degrees from regionally accredited institutions or degrees that qualified you for licensure can be used as mental health service credentials.

Misconception 2: "If a former client voluntarily writes a positive review online, I can feature it prominently on my website."

Reality: While unsolicited testimonials aren't explicitly prohibited, using them raises ethical concerns about confidentiality and could suggest solicitation. Many experts recommend against featuring client testimonials regardless of how they were obtained.

Misconception 3: "I can't collect on unpaid fees ethically."

Reality: You can use collection agencies and legal measures, but only after warning the client and giving them opportunity to pay. You must share minimal information with collectors.

Misconception 4: "HIPAA and ethics codes say the same thing about records."

Reality: HIPAA is federal law with specific requirements that sometimes exceed ethics code standards. For example, HIPAA's patient access rules are broader than what the Ethics Code requires.

Misconception 5: "I should keep all records forever to protect myself legally."

Reality: While longer retention has benefits, indefinite retention creates its own risks (data breaches, confidentiality violations, storage burden). Follow the 7-year guideline unless specific circumstances warrant longer retention.

Practical Memory Aids for the EPPP

For Standard 5 (Public Statements), remember the acronym FALSE:

• Fraudulent statements are prohibited
• Advertisements must be clearly identified
• Limitations on soliciting testimonials from current/vulnerable clients
• Statements in media must be based on professional knowledge
• Employees' statements about you are still your responsibility

For Standard 6 (Records and Fees), remember PRICED:

• Protect confidentiality in records (encryption, coding)
• Records must be maintained appropriately
• Insurance billing must be accurate
• Collections require warning first
• Emergency treatment records can't be withheld for payment
• Discuss fees early

For remembering what makes degrees acceptable credentials: "Regional OR basis for licensure". It's an OR statement, not AND. Either condition makes the degree usable.

For testimonial rules: "Current = Can't ask." Current clients and vulnerable people cannot be solicited for testimonials.

Real-World Application Scenarios

Scenario 1: You're launching a private practice website. A web designer suggests featuring quotes from your current therapy clients about how much you've helped them.

Ethical response: Decline. You cannot solicit testimonials from current therapy clients (Standard 5.05). If former clients voluntarily provide testimonials, use them cautiously and consider the confidentiality implications.

Scenario 2: A client who owes you $800 for previous sessions requests their records to transfer to a new therapist.

Ethical response: Provide the records. While you can pursue payment through other means (after warning them first), you cannot withhold records needed for continued care solely due to nonpayment. HIPAA also requires providing access to health records regardless of payment status.

Scenario 3: You're interviewed for a podcast about anxiety disorders. A listener emails asking if her symptoms sound like panic disorder and what she should do.

Ethical response: Provide general educational information about panic disorder and recommend she consult with a local mental health professional. Make it clear that your response doesn't establish a professional relationship or constitute an evaluation (Standard 5.04).

Scenario 4: A client offers to build you a website in exchange for six therapy sessions.

Ethical response: Carefully consider whether this arrangement is clinically appropriate and non-exploitative (Standard 6.05). Most experts would discourage this because ongoing website issues could complicate the therapeutic relationship. If you do proceed, document the agreement thoroughly, including the value assigned to both services.

Scenario 5: An insurance company routinely denies claims for one type of diagnosis. You're tempted to assign a different diagnosis that you know will be covered, even though it's not quite accurate.

Ethical response: Don't do it. This violates Standard 6.06 (accurate billing) and constitutes insurance fraud. Instead, appeal denied claims, provide additional documentation, or discuss out-of-pocket payment options with the client.

Key Takeaways

• Public statements (ads, websites, social media, lectures) must be truthful and based on actual qualifications from accredited institutions or degrees that qualified you for licensure
• You're responsible for statements others make on your behalf when you've hired them for promotion
• Current therapy clients and vulnerable people cannot be solicited for testimonials
• Media statements must be based on professional knowledge and must not create implied professional relationships
• Records must be protected through encryption, secure storage, and careful confidentiality practices
• Plan ahead for what happens to records if you can no longer practice (professional will)
• Keep adult records for 7 years; keep minor records until 3 years after they reach majority age
• Discuss fees early in the relationship, covering sessions, missed appointments, insurance, and collection policies
• Emergency treatment records cannot be withheld solely for nonpayment
• Warn clients before using collection agencies and share only minimal necessary information with collectors
• Barter is allowed but discouraged due to complications it creates
• All billing must be accurate. Never misrepresent diagnoses, services, or providers for insurance coverage
• Referral fees can only compensate for actual services provided, not for the referral itself

These standards protect both clients and the profession. They ensure transparency, maintain public trust, and prevent exploitation of vulnerable individuals. Master these for the EPPP, but more importantly, internalize them for ethical practice throughout your career.