The ethical conduct of research and the dissemination of its results are essential for the field of psychotherapy and for all psychotherapists. Ongoing research provides us with new insights, and expanding one’s knowledge base directly impacts the clinical services provided to clients. Without ongoing research, the mental health profession would stagnate and the public served would suffer. To provide the best possible treatment services, providers must be able to continually advance understanding of what makes psychotherapy effective, which treatments are most appropriate for which presenting problems, which psychotherapist factors have what effects, which new treatments should be added to one’s armamentarium, and which methods should no longer be used, among many other important issues impacting psychotherapy practice.
The Ethical Principles of Psychologists and Code of Conduct (Ethics Code) of the American Psychological Association (2010a) specifies the professional services psychologists provide should be based on knowledge derived from research, stating, “Psychologists’ work is based upon established scientific and professional knowledge of the discipline” (p. 5). While many different methods of conducting research are seen as legitimate (e.g., randomized controlled clinical trials, practice networks, and qualitative research), the APA has made it clear that psychotherapy should be evidence based. It defines evidence based practice as “the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences” (American Psychological Association Presidential Task Force on Evidence-Based Practice, 2006, p. 271).
Reasons for Concern
The value of evidence-based psychotherapy practice depends upon the quality of the research upon which it is based; thus, how the research is conducted and how its results are disseminated are of great importance and concern. It is essential that both the professionals who utilize research findings to guide their clinical practice and the public served by those professionals have confidence in the findings of research. To accomplish these goals, research must be conducted and disseminated with integrity, free from the influence of bias, conflicts of interest, and political or other agendas adversely impacting the scientific process.
This has been shown to not always be the case. Martinson, Anderson, and de Vries (2005) found that an alarming percentage of researchers they surveyed acknowledged engaging in a range of unethical behaviors in their work, as researchers and scholars. Examples included:
- 0.3% Falsifying or “cooking” data
- 0.3% Not properly disclosing involvement in firms whose products are based on one’s own research
- 1.4% Using another’s ideas without obtaining permission or giving due credit
- 6.0% Failing to present data that contradict one’s own research
- 10.0% Inappropriately assigning authorship credit
- 10.8% withholding details of methodology or results in papers or proposals
- 12.5% Overlooking others’ use of flawed data or questionable interpretation of data
- 15.5% Changing the design, methodology or results of a study in response to pressure from a funding source. (p. 737)
These data raise numerous concerns, to include questions about how such practices could occur. Possible explanations include a lack of ethics education and training, having one’s judgment impacted by emotional distress or burnout, or having one’s objectivity and judgment influenced by conflicts of interest or other pressures. Numerous authors (e.g., Pachter, Fox, Zimbardo, & Antonuccio, 2007) have documented the potentially pernicious effects of financial conflicts of interest, ranging from the influence of simply knowing one’s funding source to the exercise of overt pressure by funding sources. In fact, studies suggest that research funded by the company generating a product or treatment is significantly more likely to yield positive results (e.g., Lexchin, Bero, Djulbegovic, & Clark, 2003).
Additional pressures include competition for research funding that is often performance (i.e., productivity) based, concerns about losing grant funding and contracts if one’s research program does not produce advances as anticipated, productivity requirements for promotion and tenure, and other “career advancement opportunities,” and ego-driven decision-making (Cleary, Usher, & Jackson, 2015, p. 612). And, as Levine and Levine (2014) suggest, one can also add “personal and professional agendas and … human fallibilities” to this list (p. 164).
Such issues raise serious concerns regarding the integrity of the mental health profession and the public’s ability to have confidence in research findings. The fact that important life decisions are made based on published research results further illustrates how important these issues are. An illustrative example is Andrew Wakefield’s now infamous published research linking early childhood vaccinations with the development of autism (CNN, 2011). Despite the later retraction of Wakefield’s research as fraudulent and Wakefield’s subsequent loss of his medical license, among other consequences, many parents of young children decided to withhold vaccinations based on their understanding of Wakefield’s work; some continue to do so, highlighting the potentially profound impact published research findings can have on the lives of those influenced by the research (Haberman, 2015).
Relevant Guidance for Promoting Ethics in Scholarship
Numerous aspects of the research process are addressed in the APA Ethics Code (APA, 2010a), which offers guidance from the planning stages of research through data collection, analysis, and dissemination. Potentially relevant topics include Institutional Approval (Standard 8.01), Informed Consent to Research (Standard 8.02), Informed Consent for Recording Voices and Images in Research (Standard 8.03), Client/Patient, Student, and Subordinate Research Participation (Standard 8.04), Dispensing with Informed Consent (Standard 8.05), Offering Inducements for Research Participation (Standard 8.06) Deception in Research (Standard 8.07), Debriefing (Standard 8.08), and Humane Care and Use of Animals in Research (Standard 8.09), among many others. A comprehensive examination of these topics would be beyond the scope of this brief article, which focuses more narrowly on ethics of scholarship directly pertaining to the dissemination of the results of one’s research. Specific issues to be addressed include authorship credit and order (Standard 8.12), along with the use of ghost authors and guest authors, plagiarism (Standard 8.11), duplicate publication of data (Standard 8.13), and participation in a rigorous peer review process to help ensure the integrity of all published research findings.
In addition to being familiar with the relevant standard of the APA Ethics Code (APA, 2010a), readers are also referred to the APA Publication Manual (APA, 2010b). While this book may be widely used to consult with standards for APA style in one’s manuscripts, such as how to appropriately cite articles with eight or more authors, how to use a running head, and other technical details of preparing a manuscript according to APA style, its use as a resource for guidance on the ethics of scholarship should not be overlooked. Detailed and helpful information is provided on ethical and legal standards in publishing, ensuring the accuracy of scientific knowledge, protecting intellectual property rights, when and how to appropriately credit sources, the editorial process, and author responsibilities in the manuscript submission and publication process. Review of these sections of the APA Publication Manual is strongly recommended for all researchers and scholars.
Authorship issues include authorship credit and authorship order. Researchers and scholars should address such issues from the outset, in a manner similar to the informed consent process. Agreements should be reached about each individual’s anticipated participation and contributions, with appropriate credit given. Agreement should also be reached on the relative importance and value of various contributions to the research project, recognizing that different activities may be of varying importance (Oberlander & Spencer, 2006). If actual contributions differ from what was originally agreed upon, the level of credit given can be changed. As with informed consent, this should be an ongoing process with open discussion among collaborators.
As is highlighted in the APA Ethics Code (APA, 2010a), junior colleagues and students should not be taken advantage of or exploited. Their contributions should be appropriately credited pursuant to Standard 8.12(c), Publication Credit. Further, authorship credit should not be motivated by political factors or conflicts of interest. Guest authorship (i.e., giving authorship credit to an individual who did not earn this credit) and ghost authorship (i.e., not giving authorship credit to an individual who deserves it) are both unethical practices jeopardizing the legitimacy of published research (Barnett & Campbell, 2012).
Clearly Unethical Behaviors
While many issues discussed may represent ethical dilemmas requiring careful attention, several behaviors are so clearly unethical they can be reviewed here together. These include plagiarism, fabricating results, modifying results in response to external pressures, and the duplicate or piecemeal publication of research results (i.e., specifically creating multiple publications out of what would legitimately be considered one study, with the intent of obtaining an increased number of publications). While possible motivations for these practices may be understandable, prevention is of paramount importance.
Research ethics and the overarching goals of legitimate research should be addressed at every possible point in education and training. In addition to a solid grounding in research ethics, future researchers should be specifically trained to avoid each of these unethical practices. For example, learning to spot potential conflicts of interest and motivations potentially leading to impaired decision-making early in one’s career may be helpful in proactively avoiding difficulties later; likewise, training in how to avoid inadvertent or unintentional plagiarism and self-plagiarism, as well as the importance of active oversight throughout each phase of the research process, may assist researchers in avoiding these pitfalls (Roig, 2008; Walker, 2008).
Publication and the Peer Review Process
Assuming the concerns detailed above have been avoided, the next hallmark of scientific integrity in research is the peer review process. Once a manuscript has been submitted to a journal’s editor, if the topic falls within the purview of the journal and meets the journal’s minimum standards based on an initial review by the editor, the usual process is for the manuscript to then be forwarded to an associate editor, who serves as action editor for the manuscript. The action editor selects reviewers who are experts in the areas focused on in the manuscript. The manuscript then undergoes masked review (i.e., no author information is included in the manuscript) by several expert reviewers. Based on feedback provided by the reviewers and action editor, the action editor then makes a decision about the manuscript. This can include rejecting the manuscript, providing detailed feedback, and requesting revisions and subsequent resubmission of the manuscript for further consideration, or acceptance of the manuscript.
One potential challenge might involve a pre-existing relationship between the editor, associate editor, or a reviewer and one or more authors submitting a manuscript. Editors, in this situation, should refer the manuscript to a colleague on the journal’s editorial board, rather than potentially jeopardizing the integrity of the review or decision-making process. Reviewers who suspect (based on the topic, writing style, or some other information) that they may know the author(s) of a submitted manuscript should return it to the action editor and withdraw from the review process. While this system is not perfect, in general it works well and upholds the integrity of the peer review process. Of greater concern is the proliferation of online open access journals and their wide range of standards for peer review.
Understanding Online Open Access Journals
The business model for most journals is to sell subscriptions (print and electronic) to libraries, other institutions, and individual subscribers and to charge a fee to individuals who are not subscribers for the download of individual articles. While this can be a profitable business, these journals also play an important role in the dissemination of high quality research through the rigorous peer review process they generally employ.
In recent years, an alternative model has emerged: the online open access journal. Based on the rationale that restricting access to scientific findings to those who can pay for a subscription or afford download fees limits the wide distribution of research and limits scientific inquiry, these journals charge a publication fee to the researcher who submits the manuscript to the journal for consideration of publication. These fees may be paid by the individual researcher, the researcher’s institution, through grant funding, and the like. Upon publication, the articles are available, free of charge, to all who may be interested in reading them.
Reasons for Concern and Caution
Despite its egalitarian-sounding nature, this system raises a number of challenges and causes for concern. In recent years, there has been a proliferation of online open access journals, not all of which are peer reviewed publication outlets. A large number of these online journals promise a “rapid review” process and quick publication of accepted manuscripts. While there are, in fact, legitimate online open access journals utilizing a rigorous peer review process, as Bohanan (2013) has documented, most are predatory publishing businesses motivated by collecting publication fees. Bohanan (2013) submitted a deeply flawed manuscript with meaningless results to 304 online open access journals, 157 (60%) of which accepted it for publication outright, with no actual peer review process (although a small number of journals did reject the manuscript and provide helpful feedback for improving it).
Researchers and scholars may find publication through legitimate online open access journals to be consistent with their goals of widely disseminating their research, but caution is recommended. Jeffrey Beall (2012a), a librarian at the University of Colorado, Denver, has created criteria for determining predatory open access publishers (available at: https://scholarlyoa.com/2012/11/30/criteria-for-determining-predatory-open-access-publishers-2nd-edition/); Beall (2012b) also provides a comprehensive list of potential, possible, and probable predatory open access journals (available at: https://scholarlyoa.com/publishers/). Use of these and other, similar resources is recommended to help ensure the legitimacy of the peer review and publication processes.
The unethical behaviors highlighted above may occur for a variety of reasons. These may include lack of education on, or awareness of, relevant issues; failure to give adequate attention to ongoing self-care and management of ongoing stresses in one’s life; participating in relationships creating conflicts of interest; and personal motivations. Inadequate attention to each may contribute to impaired objectivity and judgment, potentially resulting in decision-making that is inconsistent with the highest ideals of the mental health profession. In order to maintain the public’s trust and help ensure that research and scholarship are conducted and disseminated with integrity, a range of recommendations can be made. Each of these deserve attention by all researchers and scholars individually, as well as by those who educate, train, and supervise them.
Conflicts of interest and personal motivations. At a minimum, researchers and scholars should endeavor to be aware of conflicts of interest and their likely effects on objectivity and judgment. Mental health providers should also seek to be aware of personal motivations and pressures impacting objectivity, judgment, and decision-making. These are necessary, but insufficient, considerations for ensuring good decision-making in the face of the multiple challenges, stressors, and pressures commonly experienced, as explored below.
Self-care and the promotion of wellness. Mental health professionals face many demands in their professional and personal lives. Attention to these issues, implementing an ongoing practice of self-care, promoting wellness, and striving to develop balance and prevent burnout, are important preventative measures (Baker, 2003; Norcross & Guy, 2007). Further, a focus on self-care should be integrated into each graduate student’s training and should be an ongoing focus in supervision to help promote and adequately address positive career-long habits to help prevent impaired judgment and decision-making (Carter & Barnett, 2014).
Education and self-awareness. An important first step is to include comprehensive education about ethical issues in research and scholarship in each psychotherapist’s training. This should not be limited to ethics courses, but should be integrated into all relevant aspects of training, from research methods courses to supervision, throughout the professional lifespan. Pressures, challenges, and ethical dilemmas should be discussed openly and proactively through group discussions and in ongoing supervision (Pope, Sonne, & Greene, 2006). Rather than emphasizing the memorization of ethics standards and rules, a focus on ethical decision-making is recommended.
The literature on ethics and ethical conduct has emphasized the importance of self-monitoring and self-awareness. These are important, but may not be enough to ensure ethical conduct alone. Research has demonstrated quite clearly that health professionals in general, and mental health professionals in particular, are unable to accurately self-assess competence in professional functioning (Dunning, Heath, & Suls, 2004; Dunning, Johnson, Ehrlinger, & Kruger, 2003). In fact, those with the greatest impairment in their abilities are least effective in self-assessment, resulting in impaired objectivity and placing them at greatest risk of poor decision-making (Kruger & Dunning, 1999). Thus, when one’s objectivity or judgment is impaired, the ability to accurately self-assess is impaired as well.
In its focus on self-awareness and reporting ethics violations after they occur, the APA Ethics Code (APA, 2010a) gives inadequate guidance to researchers, educators, supervisors, and trainers. What is needed is a focus on prevention and an acceptance of responsibility for each other’s ethical conduct. As Johnson and colleagues (Johnson, Barnett, Elman, Forrest, & Kaslow, 2012; Johnson, Barnett, Elman, Forrest, & Kaslow, 2013) recommend, mental health providers need to promote a communitarian culture within the profession, emphasizing support for one another and taking an active interest in each other’s personal and professional functioning, effectiveness, wellness, and conduct. This involves a proactive approach to monitoring and supporting each other, as well as providing honest feedback and assistance in the hope of preventing and avoiding impaired decision-making and unethical conduct.