Psychotherapy Articles

Psychotherapy Articles

One Dozen Important Actions to Take Now to Practice Ethically and Competently

1. Get out of the office, attend continuing education events and professional association conferences, and interact with colleagues. Don’t isolate yourself. Those who are more isolated professionally are at greater risk of poor decision-making and unethical practice over time (Knapp & VandeCreek, 2012).

2. Create a constellation of colleagues (Johnson, Barnett, Elman, Forrest, & Kaslow, 2012, 2014) and use them actively. This can include joining and actively participating in a peer consultation and support group, meeting regularly with one or more colleagues with whom you participate in a reciprocally supportive relationship, sharing openly and honestly about the challenges and stresses in your life (professional and personal), receiving (and offering) support, and receiving (and providing) candid feedback.

3. Take an aspirational approach to ethics in which you focus not no just doing what you need to do to meet ethics code standards and legal requirements, but in all your decisions and actions actively attempt to do the best you can to achieve the highest ideals of our profession and to do the best you can for those you are own an obligation to professionally (Handelsman, Knapp, & Gottlieb, 2002). Be guided by the aspirationals general principles of your profession’s ethics code and consider these principles in all your decision-making.

4. Actively embrace your fiduciary responsibility to your clients (Jorgenson, Hirsch, & Wahl, 1997). As a fiduciary, your obligation is to only act with your clients’ best interests in mind. Those interests should be your motivation and should guide you in decision making. Honestly assess your motivations and seek consultation from trusted colleagues when it appears that your decision-making may be motivated by getting your own needs met. When your obligations are to more than one person, such as when working with couples, families, and groups, ethical dilemmas and conflicts can easily arise. Clarify your obligations and make a conscious effort to meet your obligations to each party as best you reasonably can (Fisher, 1991).

5. Because so many dilemmas and gray areas exist in psychotherapy practice, learn and utilize a comprehensive ethical decision-making model in your day-to-day professional functioning. For representative examples see Cottone and Claus (2000) and visit Ethics codes, laws, and regulations are important to be familiar with and to follow, but they cannot tell us what to do or provide specific guidance for the “correct” action to take in every possible situation that may arise in the course of your psychotherapy practice. It is essential that you learn to think through ethical dilemmas (after first becoming aware that a dilemma exists) and work through it in a logical manner with the assistance of an ethical decision-making process.

6. Actively practice effective risk management strategies: informed consent, documentation, and consultation (Knapp Younggren, VandeCreek, Harris, & Martin, 2013). Familiarize yourself with the literature on these important issues so that you may practice them in an effective manner. Again, it is important to take an aspirational approach to each of these key risk management strategies, never just trying to do the minimum to get by. Keep in mind how informed consent, documentation, and consultation can assist you to provide the highest possible quality of psychotherapy services to clients, while also assisting you to prevent, and to address when needed, ethical dilemmas and challenges that may arise.

7. Continually work to maintain and improve your clinical competence. Engage in lifelong professional development and learning. Keep in mind your obligation to best meet the needs of any individual referred to you. This does not mean that you will treat everyone referred to you, but that you will ensure they receive the most competent treatment reasonably possible. That might be provided by you or you might appropriately refer this individual to an appropriately trained and credentialed colleague. Continually work to maintain your ongoing competence. When considering expanding your practice into a new area seek consultation from the relevant literature, applicable practice guidelines, and expert to assist you in determining what education, training, and supervised experience are needed before providing these new services independently.

8. Consider and address diversity and individual differences in all you do professionally Hays, 2001) and see it as essential to your overall clinical competence. Do not try to apply assessment and treatment strategies uniformly without consideration of the individual needs of each individual. It is crucial multicultural competence as essential to your clinical competence. For example, consider how you might modify the informed consent process with clients of various diverse backgrounds (Barnett & Sedrak, 2017).

9. Attend to boundary and multiple relationship issues, giving careful consideration of prevailing community standards, your motivations and whose needs are being met, not taking advantage of the client’s dependence and trust, the role of individual differences and diversity issues, the relevance of each decision and action to the client’s treatment needs and best interests, the potential for exploitation to and harm of the client, and the potential for an adverse impact on your objectivity and judgment. Yet, avoid an all-or-nothing approach to boundaries and multiple relationships. They are not inherently all good or all bad. Make individual decisions, keeping in mind your professional role and obligations to each client, knowing that boundary crossings and some multiple relationships may be appropriate and even necessary to best meet your client’s treatment needs (Smith & Fitzpatrick, 1995).

10. Actively practice self-care to promote personal, emotional, physical, relational, and spiritual wellness. Strive for balance between the professional and personal aspects of your life as well as within your professional life. See this as essential for promoting your ability to effectively apply your knowledge, skills, and judgment effectively (Epstein & Hundert, 2002). Remain aware of your functioning and monitor it on an ongoing basis. And, keep in mind that we are notoriously poor at accurately assessing our own functioning and clinical effectiveness (Dunning, Heath, & Suls, 2004; Dunning, Johnson, Ehrlinger, & Kruger, 2003; Eva, Cunningham, Reiter, Keane, & Norman, 2004). Be humble, be honest and realistic about this, consult liberally with trusted colleagues, and don’t just rely on your own self-assessments.

11. Ensure that you provide sufficient oversight and supervision to everyone under your authority, to include those you supervise clinically and administratively. Take this responsibility seriously, actively monitor their functioning, provide ongoing feedback and training, and enforce all policies consistently. As a clinical supervisor, keep in mind that you are responsible for all clinical services provided by your supervisees (Thomas, 2010). Ensure that you provide adequate supervision and keep in mind that supervision is a competency; be sure to obtain ongoing training in this important aspect of psychotherapy practice.

12. When unsure, consult! Do not operate in a vacuum. Openly and honestly utilize expert colleagues to promote good decision-making and ethical practice. You can’t go it alone!

Jeffrey E. Barnett, Psy.D., ABPP is a Professor in the Department of Psychology at Loyola University Maryland and a licensed psychologist who is board certified by the American Board of Professional Psychology in Clinical Psychology and in Clinical Child and Adolescent Psychology. Additionally, he is a Distinguished Practitioner in Psychology of the National Academies of Practice. Among his many professional activities, Dr. Barnett is a past chair of the ethics committees of the American Psychological Association, the American Board of Professional Psychology, and the Maryland Psychological Association. He previously served on the Maryland Board of Examiners of Psychologists and has been a consultant to licensing boards across a range of health professions. His numerous publications and presentations focus on ethics, legal, and professional practice issues in psychology. Dr. Barnett is a recipient of the APA’s outstanding ethics educator award.

Cite This Article

Barnett, J. E. (2018, November). One dozen important actions to take now to practice ethically and competently. [Web article]. Retrieved from:


Barnett, J. E., & Sedrak, M. (2017, March). Individual differences and the process of informed consent. [Web article]. Retrieved from:

Cottone, R. R., & Claus, R. E. (2000). Ethical decision-making models: A review of the literature. Journal of Counseling & Development, 78(3), 275-283.

Dunning, D., Heath, C., & Suls, J. M. (2004). Flawed self-assessment: Implications for health, education, and the workplace. Psychological Science in the Public Interest, 5, 69–106.

Dunning, D., Johnson, K., Ehrlinger, J., & Kruger, J. (2003). Why people fail to recognize their own incompetence. Current Directions in Psychological Science, 12, 83–87.

Epstein, R. M., & Hundert, E. M. (2002). Defining and assessing professional competence. JAMA: Journal of the American Medical Association, 287, 226–235.

Eva, K. W., Cunnington, J. P. W., Reiter, H. I., Keane, D. R., & Norman, G. R. (2004). How can I know what I don’t know? Poor self assessment in a well-defined domain. Advances in Health Sciences Education, 9, 211–224.

Fisher, M. A. (2009). Replacing “who is the client?” with a different ethical question. Professional Psychology: Research and Practice, 40, 1-7.

Gordon, M. J. (1991). A review of the validity and accuracy of self-assessments in health professions training. Academic Medicine, 66, 762–769.

Handelsman, M. M., Knapp, S., & Gottlieb, M. C. (2002). Positive ethics. In C. R. Snyder & S. Lopez (Eds.), Handbook of positive psychology (pp. 731-744). New York: Oxford University Press.

Hays, P. A. (2001). Addressing cultural complexities in practice: A framework for clinicians and counselors. Washington, DC: American Psychological Association.

Knapp, S. & VandeCreek, L. (2012). Disciplinary actions by a state board of psychology: Do gender and association membership matter? An update. In G. J. Neimeyer & J. M. Taylor (Eds.) Continuing professional development and lifelong learning: Issues, impacts and outcomes (pp. 155-158). New York: Nova Science Publishers.

Knapp, S. J., Younggren, J. N., VandeCreek, L., Harris, E., & Martin, J. N. (2013). Assessing and managing risk in psychological practice: An individualized approach (2nd Ed.). Rockville, MD: The Trust.

Johnson, W. B., Barnett, J. E., Elman, N., Forrest, L., & Kaslow, N. J. (2012). The competent community: Toward a vital reformulation of professional ethics. American Psychologist, 67(7), 557-569.

Johnson, W. B., Barnett, J. E., Elman, N., Forrest, L., & Kaslow, N. J. (2013). The competence constellation model: A communitarian approach to support professional competence. Professional Psychology: Research and Practice, 44(5), 343-354. 

Jorgenson, L. M., Hirsch, A. B., & Wahl, K. M. (1997). Fiduciary duty and boundaries: Acting in the client’s best interest. Behavioral Sciences and the Law, 15, 49–62.

Smith, D., & Fitzpatrick, M. (1995). Patient-therapist boundary issues: An integrative review of theory and research. Professional Psychology: Research and Practice, 26(5), 499-506.

Thomas, J. T. (2010). The ethics of supervision and consultation: Practical guidelines for mental Health professionals. Washington, DC: American Psychological Association.



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