The ethics of psychology as a business: What is a fair return?

Abstract

AbstractIs professional private practice any different than small business? ethical issues associated with establishing fee structure in private practice are addressed based on current trends in Canadian psychology and the existing ethical codes and standards for Canadian psychologists. A number of forces impacting on the delivery and nature of psychological service in Canada are reviewed followed by critique of relevant codes and standards. Recommendations for establishing fee structure in private practice are provided based on the critique, alternative ethical codes, and existing literature. It is suggested that when economic necessity forces Canadian psychologists to turn to private practice as their primary source of income, potential conflict between self interest and public interest may arise. Exploration of this conflict raises many unanswered questions regarding the combination of ethics with the ethics of psychology. To answer these questions and help resolve potential ethical conflicts, further examination and discussion amongst psychologists and their professional associations is recommended.DESCRIPTION OF THE PROBLEMAlthough private practice has been part of Canadian professional psychology for many years, until recently, relatively few Canadian psychologists depended on their private practices as the primary source of their incomes (Hurley & Ritchie, 1995, p. 4). This has begun to change in Canada, but not without a sense of dislocation and considerable anxiety (Hurley & Ritchie, 1995 p. 4; Watkins, Lopez, Campbell, & Himmell, 1986). Many authors have linked these uncomfortable thoughts and feelings to the ethical tension created when combining strategies with psychological practice (Brown, 1990; Buckner, 1992; Dobson, 1995; Parvin & Anderson, 1995; Pettifor, 1996).The titles of recent American books and articles such as: Strategies for Caring Profession: A Practitioner's Guidebook (Yenney, CBY Associates, & American Psychological Association Directorate, 1994), Professional Liability and Risk Management (Bennett, Bryant, VandenBos, & Greenwood, 1990), Maintaining Competitive Edge in Your Private Practice (Wiggins, 1989), Reimbursement Issues For Psychologists in Independent Practice (Bowers & Knapp, 1993), The Ethics of Marketing Private Practice (Sturdivant, 1993) and Issues and the Business of Therapy (Brown, 1990) suggest that such an ethical tension does exist.It has been proposed that operating private professional practice, is in essence, no different that small business (Rapport, 1995, p. 1)-or is it? Could it be that, for psychologists, being part of that involves human pain and despair creates core ethical conflict between earning an income, as is understood in our North American culture, and the value of helping people, as is the mandate of psychology (Brown, 1990; Parvin & Anderson 1995)?The potential ethical conflict between self interest and public interest is explored in this article with special reference to the ethical guidelines and standards of Canadian psychologists. Particular attention is paid to issues associated with establishing fee structure in private practice.Throughout this paper, the terms private practice, profit, and income are utilized based on the following definitions. Private practice is defined here as any privately funded proprietorship that could be owned by solo practising psychologist, partnership or group. Different arrangements exist within group practices, such as: single-specialty, multi-specialty, and multi-disciplinary groups (Yenney et al., 1994). Specifically, the contents of this paper are focussed on proprietorships dedicated to clinical practice. Ethical issues of fee-setting for non-clinical areas of practice are briefly reviewed. Profit is defined as excess of returns over outlay or expenditure (Avis, 1986, p. …