Bruce Dennis Sales (Auth.), Bruce Dennis Sales J.D., Ph.D. (Eds.) - The Professional Psychologist's Handbook (1983, Springer US)

The Professional
Psychologist's Handbook
The Professional
Psychologist's Handbook
Edited by
Bruce Dennis Sales
University of Arizona
Tucson, Arizona
Springer Science+ Business Media, LLC

Library of Congress Cataloging in Publication Data
Main entry under title:
The Professional psychologist's handbook.
Bibliography: p.
Includes index.
1. Psychology—United States—Practice. 2. Psychology—Standards—United States.
3. Psychologists—Legal status, laws, etc.—United States. I. Sales, Bruce Dennis.
[DNLM: 1. Psychology—United States—Handbooks. BF 38 P964]
BF75.P72 1983 150 .23 73
/ /
83-4038
ISBN 978-1-4899-1027-1
ISBN 978-1-4899-1027-1 ISBN 978-1-4899-1025-7 (eBook)

DOI 10.1007/978-1-4899-1025-7
© 1983 Springer Science+Business Media New York

Originally published by Plenum Press, New York in 1983
Softcover reprint of the hardcover 1st edition 1983
All rights reserved
N o part of this book may be reproduced, stored in a retrieval system, or transmitted

in any form or by any means, electronic, mechanical, photocopying, microfilming,
recording, or otherwise, without written permission from the Publisher
To my colleagues and students,
who asked the seemingly endless questions
that provided the impetus for this book
Contributors
PATRICK H. DeLEON, J.D., Ph.D., M.P.H., is Executive Assistant to U.S.

Senator Daniel K. Inouye. A Diplomate in Clinical Psychology (Amer-
ican Board of Professional Psychology), he is former Chairman of the
American Psychological Association's Board of Professional Affairs and
current Chairman of its ad hoc Committee on Legal Issues. He is on the
clinical faculty of the University of Hawaii's School of Public Health
and Department of Psychology. He is also Legislative Committee
Chairman for Division 12 (Clinical) and Division 38 (Health Psychol-
ogy), and Consultant to the Division 12,29,31, and 39 newsletters, as
well as Professional Psychology and the American Psychologist.
HERBERT DORKEN, Ph.D., is former adjunct Professor and Research Psy-

chologist at the Langley Porter Neuropsychiatric Institute, University
of California, San Francisco. He is presently Health Services Consultant
for the California State Psychological Association (CSPA), where he is
closely involved in its health care legislation, insurance, and related
practice issues. Previously, he represented the Division of Clinical Psy-
chology on the American Psychological Association's Council of Rep-
resentatives and was reelected for another term to represent the CSPA.
A former member of the APA Committee on Health Insurance, which
is now the Committee on Professional Practice, he was reappointed to
a second term. He was also elected to the Board of Trustees of the Asso-
ciation for the Advancement of Psychology (AAP) and is a member of
its Special Projects Advisory Committee. In 1980, he was elected to the
AAP's Executive Operations Committee. In 1979, he received from the
APA the first Distinguished Professional Contributions Award for
Applied Psychology as a Professional Practice. Dr. Dorken is the sole
editor and senior author of The Professional Psychologist Today: New
Developments in Law, Health Insurance and Health Practice.
R. KIRKLAND GABLE, J.D., Ed.D., currently Associate Professor of Psy-

chology at California Lutheran College, was previously Assistant Pro-
fessor of Psychology in the Department of Psychiatry at Harvard Med-
vii
viii CONTRIBUTORS
ical School. He has been a member of the Board of Directors of the

Association for the Advancement of Behavior Therapy, an assistant edi-
tor of the International Journal of Psychiatry and Criminology, and a staff
member of the Harvard Civil Rights-Civil Liberties Law Review. He is cur-
rently a member of the Editorial and Advisory Board of the journal Law
and Human Behavior. He has served as Chair of the National Institute of
Mental Health's Crime and Delinquency Review Committee and the
American Psychological Association's Committee on Scientific and
Professional Ethics and Conduct. Currently, he is a member of the APA
Task Force on Psychologists' Use of Physical Interventions.
ROBERT M. GUION, Ph.D., is Professor of Psychology at Bowling Green

State University, where he teaches and does research in the field of
industrial psychology. He has had various roles in the American Psy-
chological Association including being a member of the APA Accre-
ditation Committee, current Chair of the Board of Scientific Affairs, and
former President of the Division of Industrial and Organizational Psy-
chology. He authored the book Personnel Testing; with Mary Tenopyr,
he wrote Principles For the Validation and Use of Personnel Selection Tech-
niques, an official document of the Division. Professor Guion is identi-
fied as the principal author of Standards For Educational and Psychological
Tests. He was a member of an advisory committee to the Office of Fed-
eral Contract Compliance. This committee prepared the forerunner of
the current uniform guidelines for personnel selection procedures.
DURAND F. JACOBS, Ph.D., Chief of Psychological Services at Jerry L. Pet-

tis Memorial Veterans Hospital, Loma Linda, California, holds aca-
demic appointments as Professor of Psychiatry at Lorna Linda Univer-
sity Medical School, Clinical Professor of Psychology, Fuller
Professional Graduate School of Psychology, and Visiting Research
Psychologist, University of California at Riverside. He is a Diplomate
in Clinical Psychology of the American Board of Professional Psychol-
ogy, and has been licensed for practice in Ohio and California. Within
the American Psychological Association, he has served as a member of
the Council of Representatives, President of Division 22 (Rehabilitation
Psychology) and Division 18 (Psychologists in Public Service), and has
been associated with the development of each of the APA's major pol-
icy statements affecting professional practice, including the Standards
for Providers of Psychological Services and the Speciality Guidelines for the
delivery of psychological services. During 1979-80, he was a member
of a task force that defined the characteristics and criteria for recogniz-
ing emerging specialities in professional psychology. Dr. Jacobs has
also cochaired the APA task force that formulated the profession's first
"model criteria sets" for use in peer review activities conducted by gov-
ernmental and private third party payers. During 1976-77 he was a
CONTRIBUTORS ix
member of the Conference on Training and Credentialing in Psychol-

ogy; the recommendations of that group led to major revisions in the
criteria for accrediting doctoral training programs in professional psy-
chology. More recently, he served on the task force established to rec-
ommend means for implementing the APA's policy statement regard-
ing practice. Dr. Jacobs was awarded the Citation for Outstanding
Service from the President's Committee on the Handicapped, and was
selected as the 1979 Mary E. Switzer Fellow by the National Rehabili-
tation Association. He currently is a member of the Board of Directors
of the California State Psychological Association, chairs the Standards
and Quality Assurance Committee of the Association, and is codirect-
ing a major federal study aimed at enhancing accountability in reha-
bilitation programs.
RICHARD R. KILBURG, Ph.D., is presently Administrative Officer for

Professional Affairs with the Americal Psychological Association. His
responsibilities include overall supervision of the Quality Assurance
Program, Professional Practice Program, and State Association Pro-
gram. He has held positions as the director of a rural community men-
tal health center and as Assistant Professor at the University of Pitts-
burgh School of Medicine. He also has worked with a wide variety of
community organizations and taught at Carnegie-Mellon University.
He is currently coauthoring a book on the managing of one's profes-
sional career.
MICHAEL KINDRED, J.D., is Professor of Law and former Associate Dean

at Ohio State University College of Law, where he teaches courses in
Mental Disability and the Law, Criminal Law, and Interprofessional
Practice. He is the principal editor and a contributing author of The
Mentally Retarded Citizen and the Law. This work stands as a landmark
in the exploration of the relationship between law and mental retar-
dation. Professor Kindred also has been very active in the movement
to assure the legal rights of disabled citizens including serving at the
local level as President of the Board of Directors of the Association for
the Developmentally Disabled, a nonprofit agency in Ohio operating
fifteen group homes, in addition to providing respite, day care, and
counseling services. He is also Cochairman of the American Bar Asso-
ciation's subsection on Mental Retardation/Handicapped and the Law
and Chairman of the Legal Advocacy Committee of United Cerebral
Palsy Associations.
GERALD P. KOOCHER, Ph.D., Unit Chief for Inpatient Psychological Ser-

vices at Boston's Children's Hospital Medical Center and Assistant Pro-
fessor of Psychology at Harvard Medical School, is a Clinical Diplomate
of the American Board of Professional Psychology. He has served as
x CONTRIBUTORS
Vice-Chair and member of the American Psychological Association's

Committee on Scientific and Professional Ethics and Conduct, and is
current President of the Massachusetts Psychological Association. He
has written widely on client rights, therapeutic practices, and ethical
problems in psychological service delivery.
RONALD B. KURZ, Ph.D., is Chairman of the Department of Pediatric Psy-

chology and Director of Psychology Services and Training at the Chil-
dren's Hospital National Medical Center, Washington, D.C., and Pro-
fessor of Psychiatry and Behavioral Sciences, and Child Health and
Development at George Washington University. Formerly employed
by the American Psychological Association as the staff person in charge
of accreditation and professional training, he continues to be heavily
involved in accreditation and training review activities, serving as an
accreditation site visitor, adviSOry consultant to training programs, and
member of the Psychology Education Review Committee of the
National Institute of Mental Health. He is currently directory editor for
the Association of Psychology Internship Centers and serves on its
executive committee.
STEPHEN J. MORSE, J.D., Ph.D., is Orrin B. Evans Professor of Law at the

University of Southern California Law Center and Professor of Psy-
chiatry and Behavioral Sciences at the University of Southern Califor-
nia School of Medicine. Dr. Morse has been President of the American
Psychology-Law Society and a member of the American Psychological
Association's Task Force on Legal Action. He is a Diplomate of the
American Board of Forensic Psychology and an active consultant in
forensic psychological matters. Dr. Morse is currently completing two
books on mental health law, Cases and Materials on Mental Health Law
(West Publishing Co.) and The Jurisprudence of Craziness (Oxford Uni-
versity Press).
MICHAEL S. PALLAK, Ph.D., is currently Executive Officer of the Ameri-

can Psychological Association. Prior to this appointment in September
1979, he served as Deputy Executive Officer of the APA. In his capacity
as Executive Officer he serves as editor of the American Psychologist (the
official archival journal of the American Psychological Association). He
is psychology'S liaison to the National Advisory Mental Health Council
and frequently interacts with the Veterans Administration, National
Institute of Mental Health, National Science Foundation, and other
professional associations concerned with science and training policy-
in which psychology has a vital role. He also routinely meets with
members of Congress and their staff regarding funding in the social
and behavioral sciences. Prior to coming to AP A he was Associate Pro-
fessor of Psychology at the University of Iowa. His research and writ-
ing have focused on energy conservation and attitude change.
CONTRIBUTORS xi
BRUCE DENNIS SALES, J.D., Ph.D., is Professor of Psychology and Head

of the Law-Psychology Program at the University of Arizona. Previ-
ously, he was Professor of Psychology and Law at the University of
Nebraska-Lincoln where he founded and directed the first integrated
J.D.-Ph.D. and postdoctoral training program in psychology and law.
He has served as President and a member of the Board of Directors of
the American Psychology-Law Society; Chair and member of the
American Psychological Association's Committee on State Legislation,
Committee on Tests and Assessment, and ad hoc Committee on Patient
Advocacy; member of the APA's Task Force on Legal Action, and Board
of Professional Affairs. He currently serves on the APA's ad hoc Com-
mittee on Legal Issues and chairs their Subcommittee on Specialty Cri-
teria; and the American Bar Association's Commission on the Mentally
Disabled and the Committee on Law and Behavioral Sciences (as chair).
Dr. Sales is editor of the book series Perspectives in Law and Pschology,
and the journal Law and Human Behavior; coeditor of the book series
Law, Society and Policy; Chair of the Editorial Advisory Board of the
Mental Disability Law Reporter; and a member of the editorial boards of
several journals including Professional Psychology. He is author or editor
of nine books relating to the psychology-law interface, and profes-
sional psychology, and coeditor of a special issue of Professional Psy-
chology on 'Law and Professional Psychology.'
GOTTLIEB C. SIMON, Ph.D., is currently the director of a neighborhood

citizen participation organization in Washington, D.C. He has served
as a consultant to Ralph Nader's Center for the Study of Responsive
Law, and as Associate Administrative Officer for Professional Affairs at
the American Psychological Association. He helped to establish the
APA's ad hoc Committee on Promoting Public Interest Activities which
he chaired from 1974 to 1978. Active in the treatment rights movement,
he served for several years as the APA's representative to the Mental
Health Law Project in several right-to-treatment cases, including the
landmark Wyatt v. Stickney, and was a member of the APA Task Force
on Patient Advocacy in Mental Institutions. Former Chair of the Dis-
trict of Columbia State Mental Health Advisory Council, he is now a
member of the D.C. Statewide Health Coordinating Council. Previ-
ously on the faculty of New York University, he has taught at George
Washington University, and the University of the District of Columbia.
C. PAUL SPARKS is former President of the Division of Industrial-Orga-

nizational Psychology of the American Psychological AssQciation. As
President, he selected the editors and an advisory panel for a revision
of the Division's Principles for the Validation and Use of Personnel Selection
Procedures. He is currently a member of the APA's Committee on Tests
and Assessment and the Board of Professional Affairs' Task Force on
Competency Assessment in Professional Psychology. He was a member
xii CONTRIBUTORS
of an advisory committee to the Secretary of Labor during preparation

of the Office of Federal Compliance 1971 Order on selection and test-
ing. Since 1964 he has supervised research and application in a wide
variety of behavioral science areas as Coordinator of Personnel
Research for Exxon Company, in Houston, Texas. He is also an Adjunct
Professor of Psychology in the Graduate Studies Division of the Uni-
versity of Houston. Prior to that he was President of the consulting
firm of Richardson, Bellows, Henry, & Co., Inc.
TOMMY T. STIGALL, Ph.D., is Manager of Psychology and Training for the

State Office of Mental Health and Substance Abuse, Louisiana Depart-
ment of Health and Human Resources, Baton Rouge, and formerly was
Chief Psychologist at the Baton Rouge Mental Health Center. He also
maintains an active private clinical practice in Baton Rouge. He served
as a member of the American Psychological Association's Committee
on State Legislation from 1974 to 1979, and was Chairman of that com-
mittee during 1977. He was an invited participant at two national con-
ferences on Education and Credentialing in Psychology held in 1976
and 1977. In 1977 he joined the Steering Committee for the proposed
National Commission on Education and Credentialing in Psychology.
Active in professional affairs at both the state and national level, Dr.
Stigall is a former member and Chair of the Louisiana State Board of
Examiners of Psychologists and former president of the American
Association of State Psychology Boards. He is past President of the Lou-
isiana Psychological Association and, for a number of years, has been
Chair of its Legislation and Social Issues Committee. He currently
serves as a member of the APA Board of Professional Affairs. In 1979
he was the recipient of the Division 31 Award in Recognition of Out-
standing Contributions to State Psychological Affairs.
GEORGE STRICKER, Ph.D., Professor and Assistant Dean of the Institute of

Advanced Psychological Studies at Adelphi University, Garden City,
New York, is a Diplomate in Clinical Psychology (American Board of
Professional Psychology). He is currently Chair of the National Advi-
sory Panel for the American Psychological Association/CHAMPUS
project, and has served as a member of the APA's Task Group on Model
Criteria Sets and as Chair of the Committee on Professional Standards
Review. He has been President of the New York State Psychological
Association, Chair of its Ethics Committee, and a member of its Profes-
sional Standards Review Committee. He is currently on the New York
State Board for Psychology.
ALFRED M. WELLNER, Ph.D., is Executive Officer for the Council for the
National Register of Health Service Providers in Psychology, and a
Diplomate in Clinical Psychology (American Board of Professional Psy-
chology). Previously, he was in full-time private practice and consult-
CONTRIBUTORS xiii
ing work. Dr. Wellner is a former Chair and member of the American
Psychological Association's Committee on Accreditation, a member of
the AP A Commission on Accreditation, served on the task force
responsible for drafting the current Accreditation Criteria, and the first
Chair of the APA Task Force on Standards for Providers of Psycholog-
ical Service. A member of the interorganizational Steering Committee
on Education and Credentialing in Psychology, Wellner helped plan
two national conferences (1976 and 1977) and edited the committee's
reports and publications. He also served as President of the Maryland
Psychological Association, a member of the Maryland State Board of
Examiners of Psychology, and served on the APA Council of Represen-
tatives. He is immediate past President of the District of Columbia Psy-
chological Association.
CARL N. ZIMET, Ph.D., is Professor of Clinical Psychology and Head of the

Division of Clinical Psychology at the University of Colorado Health
Services Center in Denver. He has served on the Board of Trustees of
the American Board of Professional Psychology, a role which led him
to help develop the concept of a National Register of Health Service
Providers, and has been Chair of the National Register since its incep-
tion in 1974. He also has served as Executive Officer for the National
Conference on the Professional Preparation of Clinical Psychologists
sponsored by the American Psychological Association in 1965, was a
member of the Steering Committee on Education and Credentialing in
Psychology, and former President of the APA Division of Psychother-
apy, and the Society for Personality Assessment. He is currently a
member of the National Institute of Mental Health's Psychology Edu-
cation Committee, and serves on the APA Council of Representatives.
In 1974, he received the Distinguished Service Award from the Colo-
rado Psychological Association.
Acknowledgments
The editor is grateful to the American Psychological Association for grant-

ing permission to reprint in the Appendixes the following copyrighted
material:
From "Standards for Providers of Psychological Services." Copyright

1975 by the American Psychological Association, Inc.
From "Specialty Guidelines for the Delivery of Services" by the Com-

mittee on Professional Standards, American Psychologist, 1981, 36(6), 639-
681. Copyright 1981 by the American Psychological Association, Inc.
From "Ethical Principles of Psychologists," American Psychologist, 1981,

36(6),633-638. Copyright 1981 by the American Psychological Association,
Inc.
From "Standards for Educational & Psychological Tests" prepared by a

joint committee of the American Psychological Association, the American
Educational Research Association, and the National Council on Measure-
ment in Education, Frederick B. Davis, Chair. Copyright © 1974 by the
American Psychological Association, Inc.
xv
Contents
I. INTRODUCTION
1. The Context of Professional Psychology 3

Bruce Dennis Sales
II. STANDARDS OF PROFESSIONAL PRACTICE
2. The Development and Application of Standards of Practice for

Professional Psychologists 19
Durand F. Jacobs
3. Ethical and Professional Standards in Psychology 77
Gerald P. Koocher
4. Standards for Psychological Measurement 111
Robert M. Guion
5. Specialty Standards for Industrial-Organizational Psychologists 141
C. Paul Sparks
III. PROFESSIONAL ORGANIZATIONS
6. A Professional's Guide to the American Psychological

Association 157
Richard R. Kilburg and Michael S. Pallak
7. The National Register of Health Service Providers in Psychology 185
Alfred M. Wellner and Carl N. Zirnet
IV. OTHER PROFESSIONAL DEVELOPMENTS
8. Accreditation of Professional Training Programs in Psychology 203

Ronald B. Kurz and Alfred M. Wellner
9. Peer Review Systems in Psychology 223
George Stricker
xvii
xviii CONTENTS
V. LAWS AFFECTING PROFESSIONAL PRACTICE
10. Health Insurance and Third-Party Reimbursement 249

Herbert Diirken
11. Licensing and Certification 285
Tommy T. Stigall
12. Mental Health Law: Governmental Regulation of Disordered Persons
and the Role of the Professional Psychologist 339
Stephen J. Morse
13. Developmental Disabilities Law and the Roles of Psychologists 423
Michael Kindred
14. Malpractice Liability of Psychologists 457
R. Kirkland Gable
VI. MANAGERIAL AND BUSINESS SKILLS
15. The Psychologist as a Manager 495

Richard R. Kilburg
VII. VALUES AND INTERESTS AFFECTING PROFESSIONAL

DECISION-MAKING
16. Psychology, Professional Practice, and the Public Interest 541

Gottlieb C. Simon
VIII. POLITICAL AND REGULATORY PROCESSES
17. The Changing and Creating of Legislation: The Political Process 601
Patrick H. DeLeon
IX. APPENDIXES
A. Standards for Providers of Psychological Services 623

B. Specialty Guidelines for the Delivery of Services 639
C. Ethical PrinCiples of Psychologists 683
D. Standards for Educational & Psychological Tests 689
Index 767
I
INTRODUCTION
1
The Context of Professional Psychology
BRUCE DENNIS SALES
From the time we start as undergraduate majors in psychology, we are

taught the theories, methods, and findings that are the substance of the sci-
ence of psychology. As graduate students, we learn of the professional
aspects of this substance and become proficient in the assessment, diagnosis,
and treatment of mental disorder if clinical is our specialty. The pattern is
similar for the other recognized specialties-counseling, industrial-organi-
zational, and school psychology. Thus, as professional psychologists,! we
are typically very well trained in how to best provide primary psychologi-
cal services to our clients.
But is such preparation sufficient to make a psychologist a competent
professional? Stated another way, is there more to being a professional than
knowledge and skills in the primary delivery of one's services? For exam-
ple, consider the clinician working in private practice. He or she is superb
in treating clients, but what is the best way to attract clients when starting
a practice? Once a client does come to the door, how much information
should the professional present about the services that will be provided,
their potential limits and risks, the limits of confidentiality, and so on?
What if the patient's symptomatology is such that the clinician would like
to try a radical approach to therapy? Is the therapist exposing him or herself
to potential liability? And if the professional attracts clients and starts to
become successful, should the psychologist incorporate? Should a partner
be sought? What if a law is passed by the state legislature that the profes-
sional feels is absurd or even dangerous to the clients' welfare? What can
IThe term professional psychologist, although typically applied to practitioners in one of the
four recognized specialties in psychology, should also include all other psychologists who
deliver their services in applied settings. The materials discussed in this chapter are equally
applicable to these persons.
BRUCE DENNIS SALES. Department of Psychology, University of Arizona, Tucson, Ari-

zona 85721.
3
4 BRUCE DENNIS SALES
be done? In fact, what is the client's welfare? Who determines whether we

as professionals are acting in the client's best interests or in our guild inter-
ests? These questions are representative of a much larger set that often are
never raised in our training and, if raised, are never fully or adequately
explored.
Similar questions are in need of asking and answering for many profes-
sionals intending to work in the public sector. For example, although such
a professional would not need to know about what form of business he or
she should legally practice as, if the individual is a clinical, counseling, or
school psychologist, it would be necessary to understand the laws affecting
right to treatment and right to refuse treatment. The therapist also will have
to be at least as sensitive, and possibly more sensitive, than private practi-
tioners to ethical and professional standards relating to working with invol-
untary patients. And he or she still will need to know about the political
process since it creates, among other things, laws that often establish public
institutions that are grossly underfunded and understaffed. If clients are to
be better served, the professional will need to advocate effectively for and
represent the clients' needs before the legislature and in the political
process.
Thus, to answer the question posed earlier, knowledge of how to
deliver one's primary psychological service is not sufficient today to make
one a competent professional-whatever your specialty or area of expertise.
But what types of knowledge and skills are necessary to ensure professional
competence and success?
THE NEEDED SKILLS AND KNOWLEDGE BASES
SUBSTANTIVE'pSYCHOLOGICAL KNOWLEDGE AND SKILLS
Clearly, the basis for profeSSional practice in psychology is a thorough

knowledge of its substantive core and the specialty area of practice. This
core includes knowledge of biological, cognitive-affective, and social bases
of behavior; individual differences; statistics and psychometrics; and history
and systems (American Psychological Association, 1979; see Chapter 11). To
the knowledge base is added skill training through practice experiences
during graduate training, which in the case of many professional psychol-
ogists includes participation in a one- or two-year internship training
program.
In fact, such knowledge is not only logically required to be a competent
professional but also is mandated by the standards of the American Psycho-
logical Association (APA) that govern professional practice (see Principle 2
of the Ethical principles of psychologists, 1981; Section 1.5 of the Standards for
providers of psychological services, 1977; and Guideline 1 of each of the Spe-
cialty guidelines for the delivery of services, 1981).
But what then? Have we acquired enough substantive knowledge or
THE CONTEXT OF PROFESSIONAL PSYCHOLOGY 5
have we just begun our education? Professionals cannot afford to terminate

their training with graduation or shortly thereafter. Competent and ethical
professional practice requires that one constantly stay abreast of recent
developments in the field to ensure the best services to the public which,
in turn, satisfies our obligation to serve the public interest (see Chapter 16);
to satisfy our ethical (see Chapter 3), and legal (see Chapter 14) obligations
to our clients; and to satisfy our obligations to our profession and peers by
maintaining the highest standards of practice (see Chapters 2, 4, 5, and 9).
For this information, the professional must turn to the relevant journals,
books, conferences, and continuing education programs that are available
in psychology.
This volume is not intended to fulfill this need. We have explicitly
avoided providing updates on the current substantive knowledge of profes-
sional psychology since it is readily available elsewhere. Our focus instead
is on those other areas of knowledge that might best be labeled the context
of professional pra~tice that regretfully is often underrepresented in our
training and in our literature.
KNOWLEDGE OF STANDARDS OF PROFESSIONAL PRACTICE
According to APA and the American Association of State Psychology

Boards (AASPB), the association that represents the state licensure/certifi-
cation boards in psychology, a knowledge of the professional standards that
regulate one's practice is essential. For example, consider APA's Standards
for providers of psychological services (1977; see Chapter 2). Section 1.5 states
that, "Psychologists shall maintain current knowledge of ... professional
developments that are directly related to the services they render." Since
standards for practitioner behavior developed by our representative orga-
nization/s (the prime one clearly being APA) will affect the services we
render, knowledge of these standards becomes mandatory for competent
professional practice. The Standards are explicit on this fact in Section 2.2.3.
It states: "All providers within a psychological service unit shall be familiar
with and adhere to the American Psychological Association's Ethical Stan-
dards of Psychologists, Psychology as a Profession, Standards for Educational and
Psychological Tests and other official policy statements relevant to standards
for professional services issued by the Association." This same point is con-
tained within the Specialty guidelines for the delivery of services (Committee on
Professional Standards, 1981).
Knowledge of these professional regulations forms the first part of the
context and is not only essential for the maintenance of a competent prac-
tice but for an ethical one as well. Consider Principle 3d. of the Ethical prin-
ciples of psychologists (American Psychological Association, 1981) which
states, "As practitioners . . . psychologists act in accord with Association
standards and guidelines related to practice." Thus, there can be no doubt
that one part of the context of a competent and ethical professional practice
is a firm understanding of the organizational standards that regulate our

behavior.
These standards include the Standards for providers of psychological ser-
vices (American Psychological Association, 1977). Their goal is "to codify a
uniform set of standards for psychological practice that would serve the
respective needs of users, providers, and third party purchasers and sanc-
tioners of psychological services" (p. 1). These standards govern all service
functions regardless of psychological specialty. They establish minimally
acceptable levels of training and experience and assure the consumer
accountability for the type and quality of the services provided. Related to
these standards are the Specialty guidelines for the delivery of services (Ameri-
can Psychological Association, Committee on Professional Standards, 1981).
They were developed to complement the generic standards and are
intended "to educate the public, the profession, and other interested parties
regarding specialty professional practices ... and to facilitate the continued
systematic development of the profeSSion" (p. 639). Both the generic and
specialty standards are discussed by Durand F. Jacobs in Chapter 2.
As noted in the Specialty Guidelines, part of its function is to define the
ethical practice of each specialty. Such definition is predicated upon a
generic set of ethical principles for all psychologists. Indeed, as already
noted, Principle 3d. of the Ethical principles of psychologists (American Psy-
chological Association, 1981) mandates that psychologists conform their
behavior to these ethical and professional standards. The ethical principles
are intended to ensure that psychologists accept the responSibility for "com-
petence, objectivity in the application of skills, and concern for the best
interests of clients, colleagues, students, research participants, and society"
(p. 633). Gerald P. Koocher discusses these principles in Chapter 3.
Perhaps more specific in reference than any of the other standards is
the Standards for educational and psychological tests (American Psychological
Association, 1974). This document, the product of a joint committee of APA,
the American Educational Research Association, and the National Council
on Measurement in Education, is intended to provide guidance to both test
developers and test users. According to the manual, "These standards apply
to any assessment procedure, assessment device, or assessment aid; that is,
to any systematic basis for making inferences about characteristics of peo-
ple" (p. 2). Because members of each of the professional specialties in psy-
chology (Le., clinical, counseling, industrial-organizational, and school)
engage in assessment for various purposes, knowledge of these standards
becomes of critical importance. Especially today in an era of increased liti-
giousness and growing concern over test unfairness, knowledge of these
standards is mandatory for legal as well as professional/ethical reasons.
Robert M. Guion discusses these standards in Chapter 4.
Because some industrial-organizational psychologists are regularly
involved in the creation of tests for personnel selection and other business
purposes, they must be conversant not only with the above APA standards
but also with governmental documents that relate to employee selection
(U.S. Equal Employment Opportunity Commission et a1., 1978; U.S. Depart-

ment of Labor, 1979), and APA's Division of Industrial-Organizational Psy-
chology's Principles for the validation and use of personnel selection procedures
(1980). c. Paul Sparks discusses these standards and all others that the
industrial-organizational psychologists need to be familiar with for com-
petent practice in Chapter 5.
KNOWLEDGE of PROFESSIONAL ORGANIZATIONS
A second area that forms part of the context of professional psychology

is knowledge of the operation of professional organizations. For instance,
given the importance of the above-mentioned standards, it should be clear
that the promulgating professional organization for most of them, APA,
plays a critical and substantial role in professional practice and develop-
ment. Unfortunately, however, much like a representative government,
many of us pay our taxes (annual dues) to it but often do not take the time
to learn about how it functions, how it directly benefits us, and how it can
be extremely responsive to our needs. As professionals we should correct
this oversight. As Kilburg and Pallak note in Chapter 6, APA is 90 years
old; has over 50,000 fellows, members, and associates; has 14 million dollars
in assets; and spends 12 million dollars per year. Clearly our major repre-
sentative professional organization has the financial and constituent
resources to forcefully and effectively represent our interests. In fact a care-
ful reading of Chapter 6 will demonstrate that APA has a highly complex
and efficient organizational structure for enunciating policy and for achiev-
ing our collective goals.
The fact that the time is past where American psychology can afford to
be individuals loosely banded together is also reflected in the existence of
the National Register for Health Service Providers in Psychology (see Wellner and
Zimet's discussion in Chapter 7). The Register, a publication that lists inde-
pendent practice-level health service providers in psychology, has become
an essential source for identifying those psychologists who should qualify
for direct reimbursement by third-party health reimbursement programs.
Without this listing, many insurers would refuse to reimburse psychologists
because of the companies' inability to identify which psychologists are
qualified to provide health services. This resource also will allow for the
specification of the geographic distribution of health service providers in
psychology, thereby aiding in health policy decision making.
KNOWLEDGE OF PROFESSIONAL DEVELOPMENTS
An understanding of the operation of professional organizations will

naturally lead to the identification of professional developments, other than
standard setting, that are critical for the growth of and successful operation
of a profession. Knowledge of these developments comprises the third

aspect of the context. For instance, development of professional expertise is
obviously dependent upon appropriate training. But how do we insure the
existence of such programs? One avenue is through the promulgation and
implementation of criteria for the accreditation of professional training pro-
grams in psychology. As Ronald B. Kurz and Alfred M. Wellner note in
Chapter 8, APA has implemented such a system for clinical, counseling, and
school psychology and predoctoral internships in clinical and counseling
psychology. Understanding the accreditation process is important for
professional psychologists since it, by labeling what is accepted training in
our field, influences the development of future professionals and ultimately
the growth and direction of the profession.
Another professional development that psychologists who provide
health services must be familiar with is the existence and growth of peer
review. As George Stricker notes in Chapter 9, peer review is one method
of quality assurance, and occurs when a review of the quality of one profes-
sional's performance is made by a co-professional. Peer review, an approach
the APA has helped implement and develop, already exists at the state and
national level and is a logical complement to the standards of professional
behavior that are promulgated by APA and state licensing and certifying
boards (see Chapter 11).
Although peer review is a development implemented by the profes-
sion, it often is tied, like the use of the National Register, to the operation of
a particular law or set of laws. For example, the use of a peer review mech-
anism to assure accountability in the delivery of health services at the fed-
eral level was mandated in 1972 as part of the amendments to the Social
Security Act (see Chapter 9). The National Register is directly related to the
operation of freedom of choice legislation which requires health insurers
to directly recognize and reimburse health service providers in psychology
(see Chapter 10). The importance of knowing about and understanding how
these laws operate, as well as all others that affect professional practice, is
the focus of the next section, and the fourth part of the context of profes-
sional psychology.
KNOWLEDGE OF THE LAWS AFFECTING PROFESSIONAL PRACTICE
The major standards controlling professional practice dictate that psy-

chologists not only stay abreast of current professional standards but of cur-
rent legal developments as well (see Principle 3 of the Ethical principles of
psychologists, APA, 1981; Standards 2.2.2 and 2.2.4. of the Standards for pro-
viders of psychological services, APA, 1977; and Guideline 2 of the Specialty
guidelines for the delivery of services, APA Committee on Professional Stan-
dards, 1981). But there are two other reasons why we must stay informed.
First, since laws regulating our practice enjoy the sanctioning power of the
state, we do not have the option of ignoring them. Ignorance of the law, or
an intentional violation of it for even the best of reasons, can lead to a fine,
loss of license, or prison term, and equally severe consequences for our
clients. We will return to this point later. Second, laws often confer very
important benefits, but only if those laws are properly invoked.
But what are those laws? They can be categorized into three broad top-
ics-those that regulate the organization and administration of professional
business enterprises, those that regulate the delivery of our professional
services, and those that regulate the way our clients enter into the service
system and are processed through that system. Let us consider each of these
categories in turn.
Regulation of the Business

Whatever our conception of a professional psychologist was when we
entered graduate school, practice after graduation quickly teaches us that
we, like all other persons, must earn money to survive. In fact, our ability
to provide a professional service is the key to solving this dilemma. Yet,
how often have we thought that our goal should be to help others and not
to strive for financial rewards, and how often have we felt guilty when
confronted with the fact that as professionals we would have the opportu-
nity to earn a substantial return for our services? Providing professional
services while operating like a business should not be antithetical concepts.
As long as the service is skillfully performed and within the bounds of the
ethical and other professional codes, the practitioner has the right to charge
a fair price. Our society is so complex, however, that determining what to
charge a client only scratches the surface of the knowledge base that must
be acquired and the types of decisions that must be made in order to be
successful in business today. Later in this chapter we will consider the
acquisition of managerial and business skills. Of importance at this point
are the laws that regulate our business.
A prime example of direct concern to health service providers is the
law affecting whether health insurers will have to pay psychologists for
their independent provision of service to the client/purchaser of the insur-
ance. Prior to state laws (known as freedom of choice laws) mandating that
these insurers pay psychologists directly, many insurers kept their coverage
narrow, reimbursing only psychiatrists or psychologists who were super-
vised by psychiatrists. Clearly a knowledge of this law and its requirements
is essential to professional psychologists who provide health services. Her-
bert Dorken discusses those federal and state laws that affect health insur-
ance and third-party reimbursers in Chapter 10.
Regulation of the Professional

Another category of laws that are of critical importance to the profes-
sional are those that regulate the practitioner. This volume contains four
chapters that review some of the most important aspects of this law. Tommy
T. Stigall, in Chapter 11, describes in detail the licensure and certification

laws in this country that regulate the title and practice of psychology. His
chapter meticulously analyzes the components of the laws in all states so
that the reader will understand all of the issues relating to this body of law
and how they operate in each state.
Once licensed or certified, the mental health professional will typi-
cally, at some point in his or her career, if not periodically and regularly,
be involved with mentally disordered persons who are being processed
under some state or federal law. These laws include such things as deter-
mining whether a person meets the legal criteria for involuntary civil com-
mitment, guardianship or conservatorship, competency to stand trial, or
nonresponsibility for the commission of an otherwise criminal act. In order
for the psychologist to successfully provide service, the legal context for
these services must be understood. For example, when the psychologist is
asked to evaluate an individual to determine if the person is competent to
stand trial, the psychologist is not being asked to determine whether the
person is mentally ill. Rather, the law sets its own definition that the profes-
sional must assess for. The application of an incorrect standard for assess-
ment can lead the judge to disregard the psychologist'S testimony and
potentially yield serious consequences for the client. A discussion of these
standards and other legal and policy issues that form the context of profes-
sional psychology when dealing with mental health law are explored in
Chapter 12 by Stephen J. Morse.
Whereas most psychologists have at least some familiarity with aspects
of mental health law, they usually do not have any when the topic is devel-
opmental disabilities law. Yet the federal and state law affecting persons
who have a developmental disability is already extensive (Sales, Powell,
Van Duizend, & Associates, 1982). As Michael Kindred notes in Chapter 13,
the roles psychologists should play under this law are many, and thus
familiarity with this aspect of the legal context is important. Some of these
roles are very similar to that required under mental health law-assess-
ment, diagnosis, testimony, preparation of a treatment plan, therapy, and
habilitation. But other roles such as advocacy for the client at the case,
agency, or systemic levels, or the serving on adviSOry boards within the
service system have also received substantial attention because of the writ-
ings of scholars and professionals, and the requirements of state and federal
law concerned with securing and protecting the rights of developmentally
disabled persons. Moreover, the reading of both the Morse and Kindred
chapters will give the reader a firm understanding of the psychologist'S
roles and functions as defined by the law affecting both mentally and phys-
ically handicapped persons.
Finally, when discussing the legal regulation of the professional it
would be impossible to ignore the liability of psychologists for their illegal
actions. Traditionally known as malpractice law, which refers to negligent
actions, liability may in fact ensue from other legal theories such as breach
of contract. Knowledge of this law is essential since, like professional stan-
dards, it sets guideposts for professionals by alerting them to what behav-

iors exceed the bounds of proper professional care and to what principles
they should use in regularly evaluating their professional conduct. R. Kirk-
land Gable (formerly Schwitzgebel), discusses these issues and provides the
information necessary for the psychologist to maintain appropriate profes-
sional behavior in Chapter 14.
Regulation of the Client

The third area of legal regulation involves those laws that dictate the
rights of clients and the way they must be processed through the service
system. In some cases, these are the same laws that regulate the profes-
sional, with some parts of the law referring to the client and other parts to
the professional. Regardless of the independence of the source of the reg-
ulation, it is important that the professional understand how the law con-
trols that behavior of the client that is related to the professional's services.
For example, a civil commitment statute will specify what behaviors must
be present before the individual will be subject to commitment, what pro-
cedures must be followed for commitment to take place, where the person
will go once committed, and what rights the person has during each stage
of the process. For the health service provider in psychology such knowl-
edge is critical since that professional may wish to initiate such proceedings
on behalf of a client or may be asked to assess, testify about, or treat such
an individual. Thus, the law regulating the client becomes part of the con-
text circumscribing the professional's behavior. Both Morse's chapter on
mental health law and Kindred's chapter on developmental disabilities law
provide good examples of this law.
KNOWLEDGE OF THE MANAGERIAL AND BUSINESS SKILLS
By this point the reader may be shaking his or her head and feeling
overwhelmed by the amount of information that apparently has to be mas-
tered. To some extent the reaction is justified. Being a competent profes-
sional requires the acquisition and retention of more information than you
might have initially anticipated. Yet, reading stacks of materials is nothing
new to the doctoral candidate. On the contrary, it is the regular fare of grad-
uate studies. Yet it is not the status of being a graduate student that enables
one to master large amounts of reading, regularly attend classes, and sched-
ule research and practice on a weekly basis while maintaining a personal
life. Rather it is the exercise of appropriate managerial skills. Unfortunately
we usually are left to our own devices to acquire them.
These skills, as well as other business skills, are equally if not more
essential during one's professional career and constitute the fifth compo-
nent of the context. For example, how often should appointments be sched-
uled? How much responsibility should be delegated to staff. Should you
make time to participate in the activities of your local professional associa-
tion? Questions such as these should not be raised and answered on a piece-
meal basis. Rather, they should be approached with the same systematic
rigor that we apply to learning our substantive skills. In fact, there is no
reason why the acquisition of this knowledge should be approached as a
foreign task. Psychology has provided a rich scientific base for understand-
ing managerial and business behavior. In addition, not to master these skills
may very well lead to major problems in the operation of your practice or
to a successful practice with no time left for a personal life. The chapter by
Richard R. Kilburg (Chapter 15) introduces the reader to the issues and
concepts involved in successful managerial behavior.
KNOWLEDGE OF THE VALUES AND INTERESTS AFFECTING PROFESSIONAL DECISION

MAKING
A knowledge of managerial and other business skills is typically

equated with ones self or guild interest. In fact, this should not be the case
for psychologists. We should be managing our professional resources so
that the public good is served at the same time as we are earning our living.
As noted in the Standards for providers of pyschological services (American Psy-
chological Association, 1977), "Psychologists' professional activity shall be
primarily guided by the principle of promoting human welfare" (Standard
3; also see guideline 3 in the Specialty guidelines for the delivery of services,
APA Committee on Professional Standards, 1981). Similarly, the Preamble
to the Ethical principles of psychologists (American Psychological Association,
1981) states that "Psychologists respect the dignity and worth of the indi-
vidual and ... are committed to increasing knowledge of human behavior
and ... to the utilization of such knowledge for the promotion of human
welfare." (See also Principles 6 and 9.)
We are really dealing with multiple issues here-client welfare, public
welfare, profeSSional self-interest, guild interest. What is the client's wel-
fare? Who decides it? Since the client who may need a profeSSional's service
is typically not conversant with all of the implications of that service, can
that person make the decision as to whether to enter into a service contract?
Should the professional make the decision for the person? What conflicts
of interest arise in that case? Is an understanding of client welfare and inter-
est the same as public welfare and interest? Who decides what is in the
public interest? How does the professional's interest differ from the guild
interest? Must the guild or professional interest compete with the public or
client interests? These are but some of the questions that require the same
level of rigorous analysis as substantive ones relating to the primary deliv-
ery of ones service. For example, Simon (Chapter 16) presents eight differ-
ent definitions of the public interest, with the acceptance of anyone over
another potentially leading to different professional actions in a given
situation.
Thus, knowledge of these issues form the sixth part of the context of
professional psychology. But as with the other categories that are included
within the context, our training in the knowledge base on the values and
interests that guide our professional decision making is typically woefully
inadequate. In Chapter 16 Gottlieb C. Simon presents an introduction to
this important area of professional concern.
KNOWLEDGE OF THE POLITICAL AND REGULATORY PROCESSES
Once the psychologist has mastered the above knowledge bases, he or

she is in a unique position to contribute to the political and regulatory pro-
cesses. For example, given professionals' specialized expertise and genuine
sense of client interests, their views are important for legislators to hear.
Indeed, advocating for the client often is necessary since they do not have
a constituency to otherwise advocate on their behalf (see Chapters 13 and
16). Even where they do, the specialized expertise of the professional can
be invaluable for helping shape a law or public policy that will reflect the
state of the art rather than the state of popular misconceptions and fears.
It is also important that we advocate for laws, regulations, and public
policies that legitimately recognize the needs of profeSSional psychologists.
Too often, for example, rules are drafted recognizing the rights of one
professional group to perform services while excluding others. Clearly this
is a "turf" issue and involves guild and professional self-interest. But it is
also a public interest issue if the excluded professions can deliver services
of equal quality while eliminating restraint of trade, promoting freedom of
choice, and lowering costs by increasing the availability of providers. A
related problem occurs with rules inappropriately circumscribing profes-
sional behavior. If we do not advocate for American psychology, we cannot
expect others to do it for us.
Yet getting involved in the political and regulatory processes is often
a mystery to us both as profeSSionals and as scientists (Massad, Sales, &
Acosta, 1983). In Chapter 17 Patrick H. DeLeon introduces us to this seventh
and final component of the context and unravels some of this mystery as
he takes the reader through the steps a professional would need to take to
get legislation introduced and passed.
RELATIONSHIP OF THIS ANALYSIS TO THIS VOLUME
Within this chapter, we have identified seven areas of knowledge that

form the context of professional psychology and have argued that psychol-
ogists must be aware of and knowledgeable about this information if they
are to be competent, ethical, and successful practitioners. Although exam-
ples of topics that would fall within each category are presented, and
although they are central to each category, they are by no means exhaustive
of all topics within that part of the context. For example, under professional
organizations, a professional should also be knowledgeable about the Asso-
ciation for the Advancement of Psychology, the American Board of Profes-

sional Psychology, and many other specialty organizations. Relatedly, the
section discussing the need for knowledge about the laws affecting profes-
sional practice discusses key legal areas as a justification for the identifica-
tion of the category but leaves out other topics that a professional would
want to be aware of (e.g., child abuse laws).
The use of selective examples was intentional in that the goal of this
chapter has been to provide a tentative map of the forest rather than to list
each tree. To some extent, however, this was a practical necessity. Since psy-
chologists and other scholars have not spent time determining what con-
stitutes the context of professional practice, few of the topics or categories
have been previously identified. It is hoped that this chapter will stimulate
further research and writing on these issues. In fact, as further refinement
takes place in thinking about what constitutes the context, it is likely that
some of the conceptual categories listed here will need to be modified. For
example, as the "laws" category was divided into subareas, this same pro-
cess might also make sense for other categories in the future. In addition,
new categories also may emerge. For example, activities of federal agencies
that directly affect professional practice deserve future attention but should
it be as a new category or as part of an existing one or ones?
On the other hand, the categories and examples chosen were not hap-
hazard; they represented the product of a careful search for issues. From
that point we tried to select from the issues within each category ones that
were central for both practitioners and graduate students to learn about.
The chapters in this book represent the end product of this process.
Attempting to serve multiple audiences-both practitioners in public
and private settings and students, as well as practitioners from the various
areas within professional psychology-created other problems for the
development of this volume. For example, how much information should
be included in each chapter? We have tried to solve this problem by having
each author organize his chapter around three topics: the history of the
issue under consideration, an overview and analysis of how it currently
operates, and a consideration of future issues, directions, and needs. Thus
the chapters should be informative to both the novice and those who have
some prior knowledge about the topic. However, given that this volume
was partially intended to serve a student audience, potentially through a
one-semester course on the topic, volume length constrained covering all
appropriate topics or equally serving each of the professional areas. For
example, it is likely that clinical and counseling people will find this vol-
ume more comprehensive and useful than school or industrial-organiza-
tional psychologists, although there is much information that is relevant to
all groups.
To a great extent this deficiency will be remediated if readers find this
volume as useful as we hope and expect it will be. Their positive reaction
will provide the impetus for the initiation of work on the updating and
revision of this volume and the addition of a second volume composed of
chapters that, although not essential for individuals to learn while as grad-
uate students, would be very valuable for practitioners to have access to.
Thus, we welcome your comments.
Finally, one last caveat deserves mention. The very nature of some
parts of the context is one of constant change. For example, laws are subject
to legislative or judicial revision. Professional standards are usually scruti-
nized annually and periodically revised. Professional organizations period-
ically revise their organizational structure to deliver services to the mem-
bership more effectively or to deliver new services. For this reason, the
reader should not use this book as the final authority on each issue. Rather
it is intended as the resource for building the contextual knowledge bases
that are needed in being a competent, ethical, and successful professional.
REFERENCES
American Psychological Association. Standards for providers of pyschological services. Washing-

ton, D.C.: Author, 1977.
American Psychological Association. Criteria for accreditation of doctoral training programs and
internships in professional psychology. Washington, D.C.: Author, 1979.
American Psychological Association. Ethical principles of psychologists. American Psycholo-
gist, 1981,36,633-638.
American Psychological Association, American Educational Research Association, & National
Council on Measurement in Education. Standards for educational and psychological tests.
Washington, D.C.: American Psychological Association, 1974.
American Psychological Association, Committee on Professional Practice. Specialty guide-
lines for the delivery of services. American Psychologist, 1981, 36, 639-681.
American Psychological Association, Division of Industrial-Organizational Psychology. Prin-
ciples for the validation and use of personnel selection procedures. Dayton, Ohio: Author, 1975.
Massad, P., Sales, B. D., & Acosta, E. Utilizing social science information in the policy process:
Can psychologists help? In R. F. Kidd & M. Saks (Eds.), Advances in applied social psy-
chology (Vol. 2). Hillsdale, N.J.: Erlbaum, 1983.
Sales, B. D., Powell, D. M., Van Duizend, R., & Associates. Disabled persons and the law: State
legislative issues. New York: Plenum Press, 1982.
U.S. Department of Labor, Employment Standards Administration, Office of Federal Contract
Compliance Programs. Federal contract compliance manual. Washington, D.C.: u.s. Govern-
ment Printing Office, 1979.
U.s. Equal Employment Opportunity Commission, Civil Service Commission, Department of
Labor, & Department of Justice. Adoption by four agencies of uniform guidelines on
employee selection procedures. Federal Register, 1978,43,38290-38315.
II
STANDARDS OF PROFESSIONAL
PRACTICE
2
The Development and Application of
Standards of Practice for Professional
Psychologists
DURAND F. JACOBS
This chapter attempts to condense into a relatively small space the long and
complicated history of how standards of practice evolved and the implica-
tions they have for American Psychology (Jacobs, 1976, 1977). It outlines
the rationale and the basic parameters of a standards document. The first
major section reviews the history of standard-setting attempts by the Amer-
ican Psychological Association (APA). It traces a series of events over the
past 25 years that set the stage for six major policy statements on practice
promulgated by the Association between 1974 and 1980.
The second section discusses the original Standards for Providers of
Psychological Services published in September 1974. This is followed by an
examination of critical portions of the revised Standards that were pub-
lished under the same title in January 1977. Essential similarities and dif-
ferences between the original and the revision are noted. A review of
events that prompted APA to supplement the 1977 standards with four sep-
arate specialty guidelines published in 1980 follows. These present the most
recent APA policy covering the delivery of services by clinical, counseling,
industrial/organizational, and school psychologists. The intent of the spe-
cialty guidelines is "to educate the public, the profession, and other inter-
ested parties regarding specialty professional practices ... and to facilitate
the continued systematic development of the profession." The discussion of
DURAND F. JACOBS. Jerry L. Pettis Memorial Veterans Hospital, Loma Linda, California
92357.
19
20 DURAND F. JACOBS
the guidelines points out important differences among them and pinpoints
key differences between them and the 1977 standards.
The third section compares and contrasts the purposes and differential
utility of standards of practice, ethical standards, and state licensing laws.
It points out how each in its own way attempts to protect the user of psy-
chological services.
The fourth section, "On-going Concerns," alerts the reader to several
key issues that were addressed in APA's policy statements on practice, but
which continue to challenge the profession as unfinished business. Central
among them is the question of how best to implement APA's several policy
statements.
The fifth and final section surveys the road ahead with regard to future
prospects, problems, and opportunities awaiting professional psychologists.
It predicts continuation of the trend toward more rigorous quality control
of psychological services. Psychologists can expect to feel the weight of
closer regulation of their practice, emanating from within the profession as
well as from statutory and other interest groups outside it. It looks forward
to major research efforts being initiated to develop criteria for defining
professional competence on the basis of practice outcomes. Greater use of
paraprofessionals in the delivery of psychological services is anticipated.
There will be increased demands for more fully documented case records.
Unrelenting pressures will goad the profession to demonstrate convinc-
ingly its commitment to the public welfare. The chapter closes with a
description of the preparations being made by APA to meet the anticipated
onslaught of requests from groups of psychologists who believe that their
respective practices warrant formal recognition as new specialties. In gen-
eral, this writer's view of the road ahead suggests substantially increased
benefits for those who receive psychological services and greater rewards
for those who provide them.
RIGHTS AND RESPONSIBILITIES OF AN INDEPENDENT PROFESSION
Historically, there are three basic rights that assure the functional
integrity and continued survival of any independent profession:
1. Self-determination of the qualifications of candidates for entry into
the profession
2. Autonomy of professional functioning within the bounds estab-
lished by social, moral, and legal responsibilities
3. Self-regulation, exercised through peer review and based on a self-
promulgated code of ethics, as well as self-promulgated standards of
practice
Standards of practice are the hallmark of a profession dedicated to pub-
lic service. Their existence serves notice to all interested parties that the
THE DEVELOPMENT AND ApPLICATION OF STANDARDS 21
profession is both capable and sufficiently well-established to define, direct,

and review its own areas of practice.
STRUCTURAL DIMENSIONS OF STANDARDS OF PRACTICE
There are 10 features that distinguish standards and guidelines for the
delivery of professional services:
1. They define the education and training required to become a qual-

ified professional service provider.
2. They define the supervisory controls that qualified providers are
responsible for maintaining over supporting professional and tech-
nical staff who function under their direction.
3. They describe the types of services offered and outline the essential
organizational elements of the profession's service delivery system.
4. They describe specific functions and organizational procedures
that are expected to be maintained at or above given levels. Stan-
dards represent a commitment to improved services, and tend to
float at least one notch above common practices.
5. They define the profession's relationship to governance of the set-
ting where services are provided. In larger and in multidisciplinary
organizations such matters as the extent of the profession's respon-
sibility and authOrity, staff privileges, voting status on key com-
mittees, and so on, are specified in standards and guidelines.
6. They define the nature of relationships with other professional or
administrative staff with whom the professional interacts.
7. They define safeguards for protecting human and civil rights of
recipients of services.
8. They define the methods by which the professional's services are
evaluated by local peers and/or by those removed from the local
setting, such as professional standards review organizations.
9. The have a built-in mechanism for periodic review and revision.
All standards are living documents. They require updating as the
knowledge and skill base of the profession changes, and as other
circumstances change, either within or outside the profession, that
influence service delivery.
10. Standards and guidelines must be wedded to some mechanism for
their implementation. They are academic unless there are proce-
dures in place for assuring their widespread application and
enforcement.
Each of the policy statements on standards of practice promulgated by

the American Psychological Association between 1974 and 1980 incorpo-
rated the above dimensions.
22 DURAND F. JACOBS
HISTORY OF APA'S STANDARD-SETTING ATTEMPTS
DEVELOPMENT OF THE FIRST STANDARDS OF PRACTICE
Efforts by the APA to formulate standards of practice date back over 30

years. The first in a series of ill-fated attempts began in 1952. This evolved
under the aegis of the APA Committee on a Directory of Psychological Ser-
vice Centers. The goal of the committee was to publish for public consump-
tion a listing of settings where "qualified" psychologists were employed.
The committee completed its organizational activities in 1954 and recom-
mended that its work be continued through the creation of the American
Board of Psychological Services, Inc. (American Psychological Association
1953). The board proposed to enhance the public image of professional psy-
chology by publishing a directory of individuals and agencies that had vol-
untarily requested evaluation and were found to meet the board's criteria
for providing high quality psychological services. The standards they pro-
posed were essentially: (1) that independent private practitioners hold a
diploma from the American Board of Examiners in Professional Psychology
and, (2) that the ranking psychologist in an agency hold a PhD and have
had at least three postdoctoral years of appropriate supervised experience.
Beyond this, virtually nothing was said about what services psychologists
were expected to provide or what would constitute acceptable areas of per-
formance. The board's work continued sporadically until 1960 when its
operation became defunct. Subsequent attempts to establish standards
(American Psychological Association 1960) likewise were limited to defin-
ing the academic and experiential background required before a psycholo-
gist was considered qualified to offer independent professional services in
a community-based fee-for-service setting.
The initial impetus toward creating standards covering institutional
practice (in distinction to private practice) emerged from an executive board
meeting of APA Division 22 (rehabilitation psychology) in 1966. This group
was aware that recent landmark federal legislation (Le., the Rehabilitation
Act of 1965) had stimulated unprecedented expansion of rehabilitation ser-
vices. Following the influx of federal money for new buildings and pro-
grams, there appeared a spate of equally unprecedented standard-setting
and accreditation manuals to guide the proper staffing and operation of the
new and expanded facilities. These manuals were published by the federal
government and by private groups whose purpose was to survey health and
rehabilitation settings and to accredit formally those that met criteria estab-
lished by these groups for safety, organization and procedures, record keep-
ing, and staffing. Some manuals referred to the "qualified psychologist" as
one defined as such by the American Psychological Association. However,
the APA had not yet spoken about training level or mode of functioning
for psychologists in institutional practice. As a result, two very influential
government and private groups, acting on their own initiative, published
manuals that described the psychologist (minimally) qualified to practice in
institutional settings as one "with a master's degree from an accredited uni-

versity" (U.S. Department of Health, Education, and Welfare, 1967, p. 12;
Commission on Accreditation of Rehabilitation Facilities, 1973, p. 15).
The Division 22 executive board concluded that if this situation pre-
vailed, psychology's intent to become an independent profession would be
seriously curtailed. It decided it would not stand idly by while governmen-
tal and private groups outside of psychology proceeded to define what
would be acceptable training for the thousands of psychologists in institu-
tional practice. The board therefore took action to affirm the profession's
right to set its own standards for how psychologists would function in facil-
ities such as hospitals, rehabilitation centers, schools for the retarded, shel-
tered workshops, and related institutional settings. (It would be almost a
decade before APA would formally challenge and initiate attempts to
remove constraints imposed on psychologists in hospital and other insti-
tutional practice by one of the most powerful of these early standard-setting
groups, the Joint Commission on Accreditation of Hospitals.)
In the fall of 1966, Division 22 created its own Committee on Standards.
It charged the committee to establish liaison with national standard-setting
and accrediting organizations, learn more of their plans, and influence their
actions in a manner that would enhance the quality and impact of psycho-
logical services in rehabilitation and other types of institutional settings.
The committee's first report concluded on an ominous note:
If psychologists do not take the initiative in recommending how their services
might best be utilized ... others will certainly make those decisions for us in a
manner which may not be in the best interests of the client, the public who
pays, or the profession that trains and reviews the contributions of its members.
(Jacobs, February 1967, p. 4)
When informed of these findings, the professional affairs officer for

APA responded:
The Board of Professional Affairs certainly shares your concern about the estab-
lishment of standards for psychologists by other groups. As you know, APA has
done a great deal during the past to clarify and make more uniform the minimal
professional standards for fee-for-services activities of psychologists. This, in
my judgment, is real advance. However, standards for institutional employment
in service roles are still very much up in the air, as the Association has never
really gone into this aspect of standards in any thorough or definitive way. In
fact, there has been a tendency to side step this by exempting institutions from
standards required for independent service roles. This area certainly constitutes
a very important piece of unfinished business to which APA-probably
through BPA [Board of Professional Affairs]-must come to grips. (McMillan,
1968, p. 1)
For the next two years the Division 22 Committee on Standards con-
ducted surveys of types and numbers of psychological manpower in reha-
bilitation facilities. Their intent was to use this data to influence statements
regarding psychologists and psychological practices that would appear in
standards manuals published by non-AP A groups. During this time, addi-
24 DURAND F. JACOBS
tional federal legislation fostered similar explosive growth in the fields of

mental health and retardation. By August 1969, the committee had consol-
idated its findings and urgently recommended that APA initiate action to
promulgate "Standards for Psychologists in Institutional Practice." In Feb-
ruary 1970, the Division 22 executive board formally petitioned APA gov-
ernance to act favorably on the committee's report. Their position included
the following statement:
While recognizing the broad and profound implications that recommendations
such as these have for the profession of Psychology, it is our firm conviction
that APA must act to discharge its long delayed responsibility for establishing
standards for the large segment of its membership who practice in institutional
settings. Although it is understood that the final form and content of such APA
standards may be properly modified from those herein submitted as a result of
further study, there can be no justification for further delay. The APA in our
opinion must quickly take a definitive and public position on the matter of stan-
dards for psychologists in institutional settings, since other governmental and
private groups have already begun to suggest their own standards in the
absence of such guidelines from APA. There are, however, even more compel-
ling positive reasons for APA to take prompt action in this matter. Supple-
menting existing standards for psychologists in independent practice (Le., "A
Model for State Legislation Affecting the Practice of Psychology," American
Psychological Association, 1967) by a comparable set for those in institutional
practice will significantly influence the content and direction of university
training for the profession of Psychology, and also will provide meaningful
objectives for those training subprofessional technical personnel to assist
professional psychologists in their work. The recommended extension of stan-
dards will better meet the profession's ethical obligation to insure competent
assistance to consumers of psychological services. Finally, the proposed exten-
sion in standards will provide a set of authoritative, national guidelines for
those involved in statutory and accreditation efforts. (Jacobs, 1970, pp. 3-4)
As a direct result of these initiatives by Division 22, APA's Board of
Professional Affairs (BPA) established the Task Force on Standards for Psy-
chologists in Service Facilities in March 1970. Its charge was "to plan and
implement activities contributing to the formulation and publication of
standards that would serve to improve the quality and accessibility of psy-
chological services to all in need of them."
At its first meeting in Washington, D.C., the task force was joined by a
delegation from the Joint Commission on Accreditation of Hospitals
(JCAH) which was then planning the first revision of its Standards for Psy-
chiatric Facilities (Joint Commission on Accreditation of Hospitals 1969). It
is notable that the JCAH had never before met with a professional group
other than physicians to seek their prior input. Thus, almost immediately,
the task force was delegated authority to represent the position of the APA's
Board of Professional Affairs (BPA) on matters affecting the qualifications
and functions of psychologists practicing in institutional settings. In similar
action-oriented contacts over the next four years the task force contributed
much of the actual wording regarding psychological services that subse-
quently appeared in the standards published by the JCAH Accreditation
Council for Facilities for the Mentally Retarded (1971) and in the JCAH
Accreditation Manual for Psychiatric Facilities (1972). Two task force mem-
bers represented APA's "amicus" position in the Wyatt v. Stickney judgment
(establishing the first standards for professionals in mental hospitals) issued
by the U.S. District Court in Alabama in 1972. In 1973 and 1974, the chair
of the task force collaborated with members of BPA's Committee on Health
Insurance to define the qualified psychologist in national level delibera-
tions with public and private insurance carriers. Early drafts of the task
force's statement on standards of practice contributed directly to federal leg-
islation specifying definitional and quality control guidelines for psychol-
ogists qualified to provide health services for civilian dependents of U.S.
military personnel (CHAMPUS). Task force members also were appointed
to the first APA committee organized to produce "model sets criteria" for
peer review of psychological services under the federally directed Profes-
sional Standards Review Organizations (U.s. Department of Health, Edu-
cation, and Welfare, 1974).
These interim outcomes were gratifying because they represented
increased participation by APA instrumentalites in decisions being made
by others about psychology'S professional identity and functioning. They
did not, however, replace the prime objective of formulating a set of stan-
dards through which American psychology could speak out directly and
decisively on the proper qualifications, functions, styles of operation, and
accountabilities of practicing psychologists. This finally materialized on
September 2,1974, when the APA Council of Representatives overwhelm-
ingly approved the Standards for Providers of Psychological Services as its
basic and most comprehensive policy statement on professional practice
covering both private and institutional settings (American Psychological
Association, 1974b). A detailed review of the content of the standards will
be presented later in this chapter.
Concurrent with their approval of the original standards, the APA
council voted to create the first Committee on Standards for Providers of
Psychological Services (COSPOPS) to carry on the work begun by the Task
Force on Standards for Psychologists in Service Facilities. The initial charge
to the new committee was to update and revise the standards, taking into
consideration reports of experience obtained from the membership and the
using community outside of APA. In January 1976, the APA Council of Rep-
resentatives further charged the committee to limit the scope of the revised
standards to activities ordinarily associated with the practice of clinical,
counseling, industrial-organizational, and school psychology. Membership
on the 1976 committee was rearranged so that there was one representative
from each of the four applied specialties, one member (the chair) to repre-
sent institutional practice and one to represent the public interest. It is note-
worthy that the original APA Task Force on Standards and later committees
similarly charged with developing standards of practice each sought input
from user and sanctioner groups.
26 DURAND F. JACOBS
THE 1977 REVISION of the STANDARDS
In January 1977, the APA Council of Representatives voted to adopt

the first revision of the original standards (American Psychological Asso-
ciation, 1977b). In the prologue to that document the Association reaffirmed
its commitment to improving "the quality, effectiveness, and accessibility
of psychological services to all who require them" (p. 1). The revised stan-
dards were offered to serve the respective needs of users, providers, third-
party purchasers, and sanctioners of psychological services. They also made
it clear that psychologists intended to regulate themselves in their efforts
to serve the public interest. In taking this position, APA invoked the pre-
rogatives of psychologists as experts best equipped to judge the extent to
which professional standards were being maintained in the conduct of psy-
chological practices. The standards specified: "It is to be understood that
fulfillment of the requirements to meet these Standards shall be judged by
peers in relation to the capabilities for evaluation and the circumstances
that prevail in the setting at the time the program or service is evaluated"
(p.2).
Self-regulation within a professional group has well established prec-
edents. A number of state level legal decisions and definitive action in 1978
by the U.S. Supreme Court have relegated the lion's share of the regulation
of professions to their respective professional organizations. Traditionally,
such self-monitoring has been premised upon the ethical codes of these
professional groups. The APA made a bold and unprecedented advance on
the public's behalf when it first promulgated standards of practice for psy-
chologists that went well beyond ethical constraints. At that time, no other
professional organization had voluntarily assumed this additional measure
of accountability to the public. The revised standards went even further.
They expressed APA's intention to extend its influence and good offices
beyond its own members:
Any persons representing themselves as psychologists, when providing any of
the covered psychological service functions at any time and in any setting,
whether public or private, profit or nonprofit, are required to observe these
standards of practice in order to promote the best interests and welfare of the
users of such services. (American Psychological Association, 1977b, pp. 1-2)
A detailed review of the similarities and differences between the orig-

inal and the revised standards will be presented later in this chapter.
APA's FIRST STANDARDS FOR SPECIALTY PRACTICE PUBLISHED IN 1980
Even as council debated and finally voted overwhelmingly to adopt the

1977 revision of what have come to be known as the "generic" standards,
they made their action conditional on the understanding that representa-
tives from the four major specialty areas would be given the opportunity to
participate in developing specialty standards of practice. This action was

intended to answer the concerns of many psychologists that the "generic"
standards obscured and even distorted certain essential differences in
professional orientation and modus operandi among the specialty groups.
This compromise served on the one hand to acknowledge the common
responsibilities of all types of professional psychologists by endorsing the
revised standards as basic policy. On the other hand, it permitted APA's
basic policy to be appropriately focused and elaborated through separate
and distinct specialty standards that would make prospective users aware
of salient features that differentiated one specialist from another. Conse-
quently, COSPOPS was charged not only to implement the "generic" stan-
dards, but to proceed with all reasonable speed to develop specialty stan-
dards for providers of clinical, counseling, industrial-organizational, and
school psychology.
The formulation of specialty standards entailed more active and far-
reaching attempts to involve concerned constituent groups than had
attended the preparation of any other APA policy statement. Hundreds of
persons identified with each of the four specialty areas, acting individually
or as members of divisional executive boards and professional affairs com-
mittees, ad hoc groups, and councils of educators and trainers contributed
directly to the content of the many successive drafts. Their ranks included
primarily practitioners, but also academicians, researchers, trainers, and stu-
dents. Additional input was received from psychologists outside these spe-
cialty areas who represented special interests both within and outside the
Association. Valuable feedback also was received from nonpsychologists
representing legislative, statutory, service agency, and public interest view-
points. Over a two-year period, successive drafts of the four sets of specialty
standards were distributed for review to literally thousands of persons both
within and outside APA. Each criticism and suggestion received from the
field was carefully considered by the committee. These, along with recom-
mendations from APA boards and committees, provided the major stimuli
for numerous content changes.
It quickly became apparent that there was extensive variability among
senior members of each speciality group about what constituted their typ-
ical pattern of practice. These "within" differences exceeded both in range
and intensity the polite, but firm, territorial disputes over areas of overlap-
ping functions that surfaced between representatives of COSPOPS from the
respective specialty groups.
By the fall of 1978, it became obvious to COSPOPS that sufficient con-
sensus had not yet been achieved to recommend then current drafts of the
specialty standards for action by APA governance. Meanwhile, COSPOPS
requested and was granted permission to obtain a reading from APA attor-
neys on legal considerations relating to essential content, phraseology,
grandparenting, plan for adoption, and means for implementation before
submitting their final proposals. The original plan to have final drafts of
specialty standards available for action by the APA Council of Representa-
28 DURAND F. JACOBS
tives in January 1979 went by the board. The deadline for council action
was delayed one full year. Council action was taken at the January 31,1980
meeting. Following some revisions, the documents were approved and
accepted as policy at this meeting.
The move toward specialty standards touched some unresolved and
tender pressure points within professional and scientific psychology. A
number of (often rhetorical) questions were raised. Is there evidence show-
ing that psychologists designated as specialists are more successful in
achieving desired client outcomes than psychologists not so deSignated?
What differences in education and training justify claims of special com-
petence to practice a specialty? Are there uniform sets of specialty criteria
that APA uses when it accredits training programs in clinical, counseling,
and school psychology? Does the American Board of Professional Psy-
chology apply a uniform set of training and experiential criteria when
recognizing individual excellence as clinical, counseling, school, or indus-
trial-organizational psychologists? Is this the appropriate time to define spe-
cialties on a uniform national scale? Will the publication of specialty stan-
dards establish role models that will prematurely freeze the potential for
growth and differentiation within designated specialties? Will specialty
deSignation of some psychologists prevent general providers of psycholog-
ical services from using the methods or dealing with the populations of a
specialty? Will the publication of specialty standards make psychologists
more vulnerable to malpractice suits should they fail to meet a given stan-
dard? What is the best way to integrate less than doctoral level providers
into multilevel psychological service delivery systems? What constitutes
adequate supervisory controls over supporting staff? What are reasonable
staffing standards for various settings? Will specialty standards aggravate
existing disagreements among professional psychologists about who is
qualified to do what? Will specialty standards concretize a "pecking order"
of recognized specialties or stifle the emergence of new applied specialties?
A REVIEW OF THE CONTENT OF STANDARDS
The material that follows provides an overview of the format and con-
tent of each of APA's major policy statements on standards of practice for
professional psychologists. Documents currently in force are reproduced in
full in the Appendix of this book. The limited aim here is to familiarize the
reader with key aspects of each document, and to point out important
changes that have evolved with each successive publication. The original
Standards for Providers of Psychological Services were published in Sep-
tember 1974. Preparation of this document offered APA a long-overdue
opportunity to consolidate references from all its previous policy statements
about profeSSional practice into a single authoritative and up-to-date source.
As a result, the standards served to resolve inconsistencies, bridge gaps, and
extend former statements of policy and principle in order to interface them
with current concerns of the public and to demonstrate the Association's

resolve to speak out dearly on what it viewed as minimally acceptable con-
ditions for the provision of psychological services.
FORMAT OF THE 1974 STANDARDS
Introduction. The Standards opened with a three page introduction. This

presented an historical summary of events leading to APA' s decision to pro-
mulgate standards of practice. Then followed a statement of the basic prin-
ciples that guided the development of standards and a listing of major
implications that the completed work was expected to have for the future
of Psychology. In essence the five guiding principles held that:
1. There should be a single set of standards covering all psychologists

regardless of their specialty, and regardless of the populations they
served or the settings in which they practiced.
2. This single set of standards should be equally applicable in both the
private and public sectors. This principle explicitly rejected the pre-
vailing double standard whereby psychologists who provided pri-
vate fee-based services were subject to statutory regulation, while
those who provided similar psychological services under govern-
mental auspices were exempt from such control. This circumstance
was held to afford greater protection under the law for those receiv-
ing psychological services on a fee-for-service basis. On the other
hand, recipients of psychological services in the private sector were
seen as lacking many of the quality control safeguards that were
available in governmental settings, such as consultation, peer
review, and records audit.
3. Psychologists qualified to provide autonomous services in any set-
ting should have earned a doctoral degree, based on appropriate
psychological training. Those providing psychological services who
had lesser (or other) levels of training should be supervised by a
psychologist with a doctoral degree.
4. While assuring some orthodoxy in the organization and functioning
of psychological service systems, the standards must recognize and
provide for innovative methods and flexible use of support
personnel.
5. The standards should anticipate and support emerging service
delivery patterns both in solo independent practice and in more
complex multilevel psychology services.
Then noted were the implications that the publication of standards

likely would have on all those touched by them (e.g., providers; consumers;
employers; legislative, regulatory, and accreditation groups; trainers and
students; and the APA itself). It was anticipated that:
30 DURAND F. JACOBS
1. The standards would provide a firmer set of expectations between

provider and consumer and facilitate more objective evaluation of
services provided and outcomes achieved.
2. The standards would provide a necessary step toward more uniform
legislative and regulatory actions involving psychologists.
3. The standards would have a significant impact on future training
models for both professional and support personnel in psychology.
4. The standards would directly influence what would be considered
as an acceptable guide for operational structure, staffing, and func-
tioning of the Psychology Service in all manner of settings.
5. Initiation of the standard-setting process would involve the APA in
periodic review and revision of the Standards.
The introductory section closed with a summary statement of the three
major objectives that publication of the standards intended to achieve:
1. To establish a uniform, nationwide set of minimally acceptable cri-
teria for the organizational structure, operating procedures and pro-
vider-consumer relationships attending the delivery of psycholog-
ical services
2. To provide an objective basis for evaluating the performance of
those furnishing psychological services
3. To provide an authoritative model for those wishing to establish (or
upgrade) a psychology service
DEFINITIONS
This section described the persons, services, organizational frameworks

and settings involved in the delivery of psychological services.
1. Providers (Le., the "qualified psychologist" and others who offered
psychological services under the supervision of a qualified
psychologist) .
2. The Psychology service (Le., the various organizational modalities
through which psychological services might be provided).
3. Psychological services (i.e., evaluation, intervention, program devel-
opment, and consultation). The "teaching of psychology" was spe-
cifically exempted as a psychological service covered by these
standards.
4. Settings (i.e., the types of facilities in which services might be pro-
vided, including educational, health, correctional, industrial, etc.).
5. Consumers (i.e., direct and indirect recipients of psychological ser-
vices such as individual clients, organizations, employers, and third-
party payers).
6. Sanctioners (Le., those persons or groups once removed from the
direct recipient of services who shared a vital interest in the quality
or nature of services prOvided).
CONTENT OF THE INDIVIDUAL STANDARDS
These were grouped into four topical areas: providers; programs, policies,
and procedures; accountability; and environment. The section on providers con-
tained four separate standards addressed to staffing, supervision, adminis-
trative direction of the psychology service, and the involvement of psy-
chologists in the governance of the setting. The section on programs
contained three standards stipulating major parameters for the internal
organization of the psychology service. The section on policies was com-
prised of seven standards. These specified how providers of psychological
services were expected to operate within established statutes, agency, and
professional guidelines; observe the legal and civil rights of the recipients
of their services; keep abreast of new knowledge and scientific advances in
their area of application; and utilize professional persons and resources out-
side the immediate setting that may be of benefit to their consumers. The
section on procedures included four standards. Each required a particular
aspect of written documentation that portrayed in toto the plans, proce-
dures, and methods utilized to pursue the objectives sought by the provi-
sion of psychological services, while insuring the confidentiality of infor-
mation about consumers. The section on accountability contained four
standards. These specified psychologists' concurrent responsibilities and
accountabilities to consumers, to the profession of psychology, and to others
concerned with maintenance of readily accessible, effective, economical,
and high quality psychological services.
The single standard comprising the final section on environment
required that psychologists act to promote physical and social attributes in
the work setting that facilitated the delivery of humane and effective psy-
chological services.
Immediately following the body of the standards was a set of 21 foot-
notes. They not only elaborated on specific content, but also provided the
reader with an historical commentary on how a given standard had been
influenced by previous policy statements or positions of APA. The stan-
dards ended with a bibliography of 10 key references to APA policy state-
ments concerning the practice of psychology.
FORMAT OF THE 1977 (REVISED) STANDARDS
The introductory section of the revised standards closely followed the

format of the 1974 publication. However, the content differed from that of
the original policy statement in several important respects:
• The 1977 revision prominently stated that "functions and activities
related to the teaching of psychology, the writing or editing of schol-
arly or scientific manuscripts, and the conduct of scientific research
do not fall within the purview of the present Standards" (American
Psychological Association, 1977b, p. 2). This expanded the statement
32 DURAND F. JACOBS
in the original standards that simply exempted "the teaching of psy-

chology" from the list of psychological services that should require
state licensure or certification (American Psychological Association,
1974b, p. 4).
• They eliminated an ambiguity in the original standards that left
unresolved whether they represented "minimally acceptable" crite-
ria for present levels of psychological services or were projecting
future "goals" to be pursued (American Psychological Association,
1974b, p. 3). The revised standards made it clear that they established
"the minimally-acceptable levels of quality assurance and performance
that providers of those psychological services covered by the Stan-
dards must reach or exceed" at the time they were reviewed (p. 1).
• While the original standards were designed to cover all manner of
applied psychologists, the 1977 revision explicitly restricted its
impact to functions "ordinarily involved in the practice of clinical,
counseling, industrial-organizational, and school psychology" (p. 1).
• The 1977 standards were more stringent in requiring that, "any per-
sons representing themselves as psychologists, when providing any
of the covered psychological service functions at any time and in any
setting, whether public or private, profit or nonprofit, are required
to observe these standards of practice in order to promote the best
interest and welfare of the users of such services (1977b, pp. 1-2).
• A caveat also was included in the 1977 revision that underscored the
self-regulatory intent of the standards and the latitude given to
reviewers when judging compliance: "It is to be understood that ful-
fillment of the requirements to meet these Standards shall be judged
by peers in relation to the capabilities for evaluation and the circum-
stances that prevail in the setting at the time the program or service
is evaluated" (p. 2).
DEFINITIONS
This section essentially followed that of the original standards. How-

ever, three noteworthy changes were made in the provider definition. First,
the term qualified psychologist was replaced by professional psychologist. Sec-
ond, the component in the earlier definition of the psychologist that
required state licensure or certificate was dropped. (The rationale for this
change was that, while APA should define psychologists in terms of the
education and training required for entry to professional practice, it was
inappropriate for the Association to incorporate a statutory requirement
within its definition). Third, the revised standards included a grandparent-
ing clause:
For the purpose of transition, persons who met the following criteria on or
before the date of adoption of the original Standards on September 4, 1974, shall
also be considerd professional psychologists: (a) a master's degree from a pro-
gram primarily psychological in content from a regionally accredited university

or professional school; (b) appropriate education, training, and experience in
the area of service offered; (c) a license or certificate in the state in which they
practice, conferred by a state board of psychological examiners, or the endorse-
ment of the state psychological association through voluntary certification, or,
for practice in primary and secondary schools, a state department of education
certificate as a school psychologist provided that the certificate required at least
two graduate years. (footnote 4, p. 11)
Some minor changes also were made. For instance, "supervision" was
added to the listing of psychological services; the former organizational
title Psychology Service was changed to Psychological Service Unit; and the
term consumers was replaced by users.
CONTENT OF THE INDIVIDUAL STANDARDS
The standards, themselves, continued to be organized within the same

four topical sections. However, the following important changes were made
in the content of various standards within these sections. The 1977 revision
expanded the number of standards in the providers section from the original
four to seven. Two new standards were added. Standard 1.6 stated that
"psychologists shall limit their practice to their demonstrated areas of
professional competence" (p. 5). Standard 1.7 closely followed a resolution
passed by the APA Council of Representatives in January 1976. It stated,
"psychologists who wish to change their service specialty or to add an addi-
tional area of applied specialization must meet the same requirements with
respect to subject matter and professional skills that apply to doctoral train-
ing in the new specialty" (p. 6). The third addition (Standard 1.5) was essen-
tially the same requirement that appeared as Standard 3.2.6 under the
policies section of the 1974 publication.
The programs section of the 1977 revision contained the same three
standards as appeared in the original publication. The policies section also
included the same standards as appeared in the 1974 publication, apart from
the original Standard 3.2.6 which was shifted to the provider section in the
1977 revision. The procedures section of the 1977 revision established Stan-
dard 2.3.3 for the first time. This required that "there shall be a mutually
acceptable understanding between the provider and user or responsible
agent regarding the delivery of service." The original Standard 3.3.2 man-
dating a "written service delivery plan" was softened somewhat in the 1977
revision to read: "Providers shall develop a plan appropriate to the provid-
er's professional strategy of practice and to the problems presented by the
user" (Standard 2.3.2, p. 8). The interpretation that elaborated this standard
further limited the necessity for a written plan to "whenever appropriate
or mandated in the setting."
The section on accountability remained basically unchanged from the
original document. However, the requirement for periodic evaluations of
psychological services (Standard 3.3, p. 10) added a cautionary note:
34 DURAND F. JACOBS
It is highly desirable that there be a periodic reexamination of review mecha-

nisms to insure that these attempts at public safeguards are effective and cost
efficient and do not place unnecessary encumbrances on the provider or unnec-
essary additional expense to users or sanctioners for services rendered.
The final section on environment was essentially the same as that of the
original standards. Several new footnotes and references appeared in the
1977 revision that reflected recent changes in APA policies and publica-
tions. When the APA Council of Representatives approved the revised stan-
dards in January 1977, the original 1974 standards became history.
COMMENT
The phrase where appropriate had been inserted in several standards

throughout the 1977 revision to recognize that procedures that would be
useful in one setting (e.g., health) would be inappropriate in another (e.g.,
school and industry). These changes were intended to offset the bias toward
health and rehabilitation settings that was evident in the original standards.
Despite such efforts, the revised standards still retained a definite tilt
toward institutional settings, rather than presenting a more balanced
approach to circumstances prevailing in each of the several major areas
where psychologists practice. The APA specialty guidelines published in
1980 attempted to resolve this problem. They focused common concerns
about maintaining good practice standards upon those activities, users, and
settings associated with the four specialties of clinical, counseling, indus-
trial-organizational, and school psychology.
FORMAT OF THE 1980 SPECIALTY GUIDELINES
It was understood at the outset that the specialty standards! would be

rooted in the Association's basic policy statement on professional practice
that had been established in the "generic" standards (American Psycholog-
ical Association, 1977b). COSPOPS was charged to extend and, as appropri-
ate, to tailor these new policy statements so that they addressed the differ-
ing orientation, delivery style, populations, and settings associated with
each form of specialty practice. To accomplish this task the membership of
COS POPS was reconstituted once again. Appointments were made by the
APA's Board of Professional Affairs so that there was one representative
from each of the four applied specialty groups, one to represent the public
interest, and one to represent institutional practice. The executive boards of
each of the four parent APA divisions (12, 14, 16, and 17) were asked to
'The term Specialty Standards was replaced by Specialty Guidelines when the APA Council of
Representatives approved these documents in 1980. The rationale for this change is dis-
cussed later in this chapter.
consider establishing a Professional Affairs Committee to provide consul-

tation and direction to their COSPOPS' representative and to keep the
membership of the division closely informed on progress being made. This
was done. It did much to advance the process by assuring improved com-
munications between COSPOPS and the broad constituencies of profes-
sional psychology. Each change in division leadership introduced some
new cooks into the kitchen, however, which sometimes produced some
wrenching shifts in the evolution of successive drafts. Nonetheless, the
decision to encourage the fullest measure of participation from those who
would be most affected by the final products did much to enhance trust in
COSPOPS' work and to marshall support for its final recommendations.
The process of developing standards for the major specialties continued
for almost three years. During that time the pursuit of acceptable consensus
within constituent groups (as well as agreement between members of COS-
POPS) necessitated 7 drafts of the document for clinical, 9 for counseling,
12 for industrial-organizational, and 11 for school psychologists. Largely
because most objections had been progressively answered in earlier drafts,
the final proposals moved through APA governance without major changes
and were ready for review and action by the Council of Representatives at
their January 1980 meeting in Washington, D.C.
However, on the day preceding their scheduled appearance as an
agenda item, several caucuses of Council representatives made up of both
professional and academic groups mounted a determined groundswell to
resist passage of the impending policy statements. Their common concerns
centered on the negative consequences that might attend the publishing of
these documents under APA's imprimatur as "minimally acceptable" stan-
dards of practice. They feared that such action possibly could place psy-
chologists at risk of ethical charges or even malpractice suits should they
fall short of performance stipulated in the specialty standards. These feel-
ings persisted even though the groups were reminded of opinions to the
contrary that had been offered by APA's legal counsel several months ear-
lier. The likelihood of a major floor battle was averted literally moments
before the Specialty Standards were scheduled for action by Council. Con-
tending groups agreed to support them, provided the following modifica-
tions were made:
1. The phrase "minimally acceptable levels" and other obligatory lan-
guage would be dropped wherever it appeared in the document.
2. The connotation of "standards" would be removed, and the titles of
each of the documents would be altered to read "Specialty Guide-
lines for the Delivery of Services by (Clinical, Counseling, Indus-
trial-Organizational, School) Psychologists."
The council accepted amendments to this effect with little debate. After
some additional clarification on minor content questions, it voted over-
whelming approval for the new Specialty Guidelines as amended. In addi-
tion it instructed that the next revision of the generic standards (scheduled
36 DURAND F. JACOBS
for the early 1980s) include modifications in the spirit of the above in order
to maintain the Association's commitment to quality assurance for the pub-
lic without running the risk of unduly compromising its practitioners.
The specialty guidelines were designed to follow the format and,
whenever applicable, the wording of the generic standards. Therefore,
there are many similarities among them. Four separate free-standing pub-
lications were issued, because each would be used by a different pUblic,
receiving psychological services in a different setting. To expedite this
review of their content the clinical, counseling, and school documents will
be discussed together. This will be followed by a review of specific depar-
tures in format and content that appear in the specialty guidelines for
industrial-organizational psychologists.
INTRODUCTION
The introductory sections of all four specialty guidelines are essentially

similar. Each notes the intimate relationship between the generic standards
(American Psychological Association, 1977b) and the specialty guidelines.
Each alerts the reader that publication of the guidelines does not alter
APA's basic position that state licensure/certification should be based on
generic and not specialty qualifications for practice. Each goes on to explain
that specialty guidelines are meant to serve the public interest in an added
fashion by providing potential users and other interested groups with
essential information about additional qualifications and particular kinds of
services available from specialists in professional psychology.
The rationale for the development of the guidelines is then presented.
It notes that there has been sufficient growth in the field to warrant recog-
nition of specialists and that such recognition will facilitate continued
development of professional psychology. It is observed that all learned dis-
ciplines have regarded specialty practice as the outcome of increased prep-
aration in a particular set of knowledge and skills together with a voluntary
limiting of service to a restricted area of practice. Consequently, the guide-
lines are intended to apply only to those psychologists who voluntarily wish
to be designated as specialists. They do not apply to other professional psy-
chologists. An explicit caveat states:
Lack of specialty designation shall not preclude general providers of psycho-

logical services from using the methods or dealing with the populations of any
specialty, except insofar as psychologists voluntarily refrain from providing ser-
vices that they are not trained to render. (p. 1)
APA serves notice, however, that "following the grandparenting

period, psychologists do not put themselves forward as specialists in a given
area of practice unless they meet the qualifications" noted in the guidelines
for that particular specialty.
Each set of guidelines pledges the Association's intent to encourage
and participate in "efforts to identify professional practitioner behaviors

and job functions, and to validate the relationship between these and
desired client outcomes." This is the first time that APA (or any professional
organization) has publicly committed itself to developing competency criteria
based on measured proficiency in obtaining specified client outcomes,
rather than relying exclusively on a priori training credentials. The intro-
ductory section of each document reaffirms APA's previous position (1977b)
that the guidelines have been established as a means of self-regulation to
protect the public interest. Each relates that a new APA Committee on
Professional Standards was established in January 1980 and charged with
keeping the generic standards and the specialty guidelines responsive to
the needs of the public and the profession through periodic systematic
review and revision.
The introduction to each of the specialty guidelines incorporates the
set of principles and implications found in the generic standards (1977b). Two
new principles have been added. The first reiterates APA's position favor-
ing generic licensure. The second recommends the specialty guidelines as
"an authoritative reference for use in credentialing specialty providers by
such groups as divisions of the APA and state associations, and boards and
agencies that find such criteria useful for quality assurance." It is anticipated
that the latter groups may include state licenSing boards and major employ-
ers of psychologists at the state and federal level. .
DEFINITIONS
Each set of guidelines includes a definitions section similar to that in the

generic standards. It describes providers of (specialty) psychological service;
types of specialty services offered; alternate organizational styles for consti-
tuting the specialty's service delivery unit, and typical users of that special-
ty's services.
Providers. In each guideline the definition of the professional (special-
ist) psychologist has been expanded significantly beyond what appeared in
the generic standards. The brief phrase describing the doctoral degree as
one earned "in a program that is primarily psychological" has been
replaced by a detailed listing of the revised criteria (American Psychological
Association, 1979) required by the APA Education and Training Board
when accrediting specialty programs in clinical, counseling, and school
psychology. Historically, I-a programs have not been accredited by APA.
Therefore, to lay a foundation for future accreditation the definition of the
"fully qualified I-a psychologist" includes a statement specifying the edu-
cational and training content of an acceptable I-a program.
Initially, the definitions section of each draft of the four specialty
guidelines had contained a detailed statement of the educational and train-
ing qualifications for each type of specialist. These unprecedented descrip-
tions of the content of specialty education and training developed by COS-
POPS were deleted from the final drafts of the clinical and counseling
38 DURAND F. JACOBS
guidelines at the insistence of the APA Education and Training Board. An

exception for 1-0 was allowed because this group lacked any other author-
itative consensual statement regarding its educational and training require-
ments. A compromise was agreed upon in the case of the guidelines for
school psychologists that led to their education and training requirements
being retained in a footnote. This was permitted so that APA would have
an official referent to apply for accrediting school psychology programs,
while carrying on then current negotiations with the National Association
of School Psychologists about the respective prerogatives of the two asso-
ciations on this matter.
The definitions section specifies a group of providers who are not profes-
sional psychologists but who participate in the delivery of psychological
services under the supervision of a specialist. In general these are called
psychological aides or technicians. The school guidelines go much further
than the others in defining specific levels of supporting personnel. They
identify an intermediate-level support person called a "specialist in school
psychology," who "has successfully completed at least two years of gradu-
ate education in school psychology and a training program that includes at
least 1,000 hours of experience supervised by a professional school psy-
chologist, of which at least 500 hours must be in school settings. Specialists
in school psychology provide services under the supervision of a profes-
sional school psychologist." Other less well-trained persons are noted who
also provide school psychological services under the supervision of a
professional school psychologist. These may include a "school psychologi-
cal examiner," "school psychological technician," "school psychological
assistant," "school psychometrist," or "school psychometric assistant."
Inclusion of the intermediate master's level person in the guidelines rec-
ognized the current manpower situation in school systems throughout the
country wherein doctoral-level school psychologists are in short supply. In
such circumstances the "specialist in school psychology" is designated as
the local director or coordinator of school psychological services and is
supervised by a professional school psychologist employed on a part-time
basis by the local setting. The specialist in school psychology in turn would
supervise the work of lesser trained personnel. In this manner the guide-
lines offer a balanced combination of ready accessibility and quality control
to users of school psychological services.
Psychological Services. Although each retains its unique theoretical and
methodological approaches, each of the specialty guidelines follows the for-
mat of the generic standards in listing a common set of six generic services.
In the clinical, counseling, and school guidelines these are: assessment and
evaluation, intervention, consultation, program development, evaluation,
and supervision. The 1-0 guidelines specify a different set of services: selec-
tion and placement of employees, organization development, training and
development of employees, personnel research, improving employee moti-
vation, and design and optimization of work environments.
The Psychological Service Unit. The clinical, counseling, and school

guidelines closely follow the format and content of the generic standards
in describing the several functional units through which specialty psycho-
logical services are provided. The 1-0 guidelines do not contain a separate
section of this type, thereby leaving the organizational framework for the
delivery of services open to the requirements of each occupational setting.
Users of Psychological Services. The clinical, counseling, and school
guidelines again closely follow the format and content of the generic stan-
dards in this section. The 1-0 guidelines omit this as a separate section, but
identify their typical users (e.g., individuals, groups, or organizations) in
the section describing the services they provide. The clinical, counseling,
and school guidelines subsume under users of psychological services a spe-
cial group termed "sanctioners." These might include family members,
third-party payers, peer reviewers, governmental or private accreditation
bodies; in fact anyone who shares a legitimate concern about the content
and quality of psychological services and how they are provided.
Content of the Individual Guidelines

Apart from some variations in the 1-0 document, the content of each
specialty guideline addresses the same issues and closely follows the format
of the generic standards. They differ one from the other in terms of how
these common concerns are modified to reflect the special interests, typical
work sites, and usual clients of each group of specialty practitioners.
One significant change, however, has been made uniformly through-
out all four documents. Each guideline is presented as a simple declarative
statement. The mandate "shall" and other obligatory language used in the
generic standards has been carefully omitted from the specialty guidelines.
The guidelines for clinical, counseling, and school psychology are
organized into the same four topical areas that appeared in the generic stan-
dards. Because the 1-0 guidelines adopted a somewhat different format,
they will be discussed separately at the end of this section.
The Providers Section. In the clinical, counseling, and school documents
the section on providers covers the same seven basic content areas that
appeared in the generic standards. An eighth guideline is added that states
that psychologists in each of these three specialties "are encouraged to
develop innovative theories and procedures and to provide appropriate the-
oretical and/or empirical support for their innovations."
There also are several noteworthy elaborations on the generic stan-
dards that appear in the providers section. For instance, the school psychol-
ogy guidelines present several options for school districts to consider when
acquiring services from a professional school psychologist (Guideline 1.1).
In each of the specialty guidelines conditions for supervising technical sup-
port staff are spelled out in much more detail than was so in the generic
standards. The guidelines specify a written delegation of authority from the
40 DURAND F. JACOBS
supervising professional psychologist that spells out the range and type of
services to be provided by the support person, the manner in which face-
to-face supervision is to be provided, the limits of independent action and
decision making accorded the support person, and the means by which the
supervised person will contact the psychologist in the event of an emer-
gency or crisis (Guideline 1.2). Guideline 1.2 also recognizes that under cer-
tain circumstances a professional psychologist of another specialty or even
a professional from another discipline may appropriately provide supervi-
sion or training in a special proficiency area.
In Guideline 1.3 the clinical and counseling documents indicate that
when two or more different specialties are integrated within a single con-
solidated psychological service unit, anyone of the involved professional
psychologists may serve as administrative head of the unit.
Guideline 1.7 sets forth the conditions under which a professional psy-
chologist may acquire specialty recognition. Unlike the counseling and
school documents which limit their requirements to acquiring necessary
supplementary specialty education and training within the doctoral train-
ing program, the clinical guidelines require an additional year of postdoc-
toral experience obtained under the supervision of a clinical psychologist.
Grandparenting Provisions. Each of the specialty guidelines contains an
extended footnote specifying the grandparenting criteria for established
psychologists who wish to seek recognition as specialists. Two broad cate-
gories of psychologists who did not obtain their original graduate training
in the specialty area where recognition is sought may be grandparented as
specialists. Category 1 accepts as specialists those persons who had com-
pleted doctoral level training in a regionally accredited program and had
acquired three postdoctoral years of "appropriate education, training, and
experience" in providing given specialty services, including a minimum of
one year in a recognized clinical, counseling, or school setting, as the case
may be. Category 2 recognizes as specialists those who on or before Septem-
ber 4, 1974, had completed a master's degree program in psychology at a
regionally approved institution, held a license or certificate granted by the
state in which they practiced, and had obtained five post-master's years of
appropriate education, training, and experience in the specialty area,
including a minimum of two years in a work setting identified with practice
in the given specialty.
The school psychology guidelines recognize a third category of persons
who would qualify as specialists under their grandparenting rules. Eligi-
bility for this third category is based on the 1977 Resolution passed by the
APA Council of Representatives acknowledging a "transition period" for
the use of the title school psychologist. Thus, persons in Category 3 may rep-
resent themselves as school psychologists so long as they restrict their prac-
tice to elementary or secondary school settings. This category is open to
persons who meet the following criteria on or before January 31, 1985: They
must (a) possess a master's degree involving at least two years of full-time
graduate study in school psychology at a regionally accredited institution,
(b) have acquired at least three additional years of training and experience
in school psychological services, including a minimum of one school year
in school settings, and (c) have obtained a license or certificate conferred by
the state for practice in elementary or secondary schools.
The Programs Subsection. The guidelines comprising the programs sub-
section of the clinical, counseling, and school documents include all but one
of the substantive items that appeared in the generic standards. Former
Standard 2.3.3 was dropped, since it was viewed as less appropriate than
the delivery of service model described in Guideline 2.3.2. An entirely new
guideline (2.3.4) has been added that specifies the conditions for retention
and disposition of client records. The clinical and counseling guidelines go
further than the generic standards in the section dealing with confidential-
ity of case records (Guideline 2.3.5). This elaboration builds upon experi-
ence obtained in recent years and addresses the legal issue of who "owns"
the information in the case record. It reads:
Users have the right to information in their psychological records. However,
the records (themselves) are the property of the psychologist or of the facility
in which the psychologist works and are, therefore, the responsibility of the
psychologist and subject to his or her control. (American Psychological Asso-
ciation, 1980c, p. 12)
The Accountability Section. This section of the clinical, counseling, and

school guidelines closely follows the format of the generic standards. A
somewhat higher level of accountability to clients is included in Guideline
3.1. This states that specialists in psychology "seek to ameliorate through
peer review, consultation, or other personal therapeutic procedures those
factors that inhibit the provision of services to particular users," and as nec-
essary assist clients to obtain required services from other sources.
The Environment Section. This final section of the clinical, counseling,
and school guidelines differentially applies the generic standard to the
respective work sites of the specialty practitioners.
Content of the 1-0 Guidelines.

As noted earlier, the 1-0 guidelines depart rather markedly from the
categorical content and format adopted by the other specialties. Their state-
ment is considerably more compact, since many of the concerns shared by
clinical, counseling, and school groups were not viewed as relevant for 1-0
psychologists. Other important differences between the 1-0 guidelines and
the other specialty documents are identified below, as are differences
between the 1-0 guidelines and the generic standards.
The providers section of the 1-0 document is subtitled "Staffing and
Qualifications of Staff." Together with material included in their definitions
section, it incorporates the general content of six of the eight guidelines
present in the other specialty documents. (The two that were omitted were
not seen as relevant to 1-0 settings.) The guideline dealing with profes-
sional psychologists who wish to be recognized as 1-0 specialists is more
42 DURAND F. JACOBS
permissive than the generic standards or the requirements of the other spe-
cialty groups. It allows for individual psychologists to be recognized as 1-0
specialists after completing "continuing education courses and workshops
in 1-0 psychology, combined with supervised experience as an 1-0
psychologist."
The second section of the 1-0 document is titled "Professional Consid-
erations." It covers the kinds of items that are incorporated in the "pro-
grams" subsections of both the generic standards and the other specialty
documents. It omits any mention of the composition and organization of an
1-0 psychological service unit and focuses directly on guidelines that pro-
tect the user of psychological services. The second subsection, "Planning
Organizational Goals," reflects the content of two of the five generic stan-
dards. The first of these presents a guideline for establishing a mutually
acceptable understanding between the provider and user regarding mar-
keting of 1-0 psychological services. The second closely follows the generic
standard establishing a system to protect confidentiality of information
about users of services. In this section one finds two guidelines unique to
their specialty. These state:
• The 1-0 psychologist does not seek to gain competitive advantage
through the use of privileged information (Guideline 2.5) .
• The 1-0 psychologist who purchases the services of another psy-
chologist provides a clear statement of the role of the purchaser
(Guideline 2.6).
The accountability section of the 1-0 document includes two of the four
items that appear in the generic standards and in the other specialty guide-
lines. Those deleted were not seen as relevant to 1-0 settings. Of those
retained, the first reaffirms that professional activities of 1-0 psychOlogists
are guided primarily by the principle of promoting human welfare. The
second calls for periodic evaluation of the extent to which 1-0 services are
meeting identified needs and achieving projected goals. The 1-0 guidelines
do not contain an environment section. The grandparenting requirements for
recognition as an 1-0 psychologist list the same two categories as were
noted in the clinical and counseling statements.
RELATION OF STANDARDS OF PRACTICE TO ETHICS AND LAW
Standards and guidelines of practice serve to bridge the gap between a

profession's ethical code and the requirements set by law for the delivery
of its professional services.
STANDARDS AND ETHICS
Standards of practice attempt to translate the profession's ethical values

into measurable dimensions and apply them to day-to-day practices. Unlike
its ethical standards, which are limited in their impact to members of APA,
the Association's standards of practice represent the most authoritative
statement available to the public at large on matters affecting quality control
of psychological services. As such, they are addressed to all who are party
to them. In addition to those representing themselves as professional psy-
chologists, this includes technical support staff, users, employers, third-
party payers, and sanctioners. As a result, standards of practice exercise
influence that extends considerably beyond that of a code of ethics.
In his treatise on Accountability Among Providers of Psychological
II
Services" McMillan (1976) illuminates several important distinctions

between standards dealing with ethics and those addressing practice. He
makes special reference to the section titled "Accountability" in the APA
Standards for Providers of Psychological Services (American Psychological Asso-
ciation, 1974b ):
Accountability calls for making the work of the practicing psychologist acces-
sible to evaluation or inspection by some outside body or person. Webster
defines the term as "furnishing a justifying analysis or explanation." For our
purpose, what is being accounted for is the nature and quality of service pro-
vided to a patient or client .... Accountability is here, probably for keeps and
desirably so, and it behooves us to consider what may be implied in the part it
plays in monitoring quality control in our professional work. To whom should
we be accountable in our professional services? Adapting my remarks from the
APA statement, I think we can identify three groups: the client himself, the
sanctioners of services (those significant others who have a stake in the services
rendered, such as family or employers), and our professional colleagues. (p. 7)
McMillan applauds this readiness of psychologists to subject them-

selves and their activities to open and available accountability, particularly
to clients and others who share an interest in how services are provided.
This is the unique hallmark of the APA Standards. Prior to them, no profes-
sion had ventured to do this. He views this as a significant advance in qual-
ity control, well beyond what had been done previously in the APA Ethical
Standards. He concludes:
Now, how do accountability and ethics relate to each other? They may be seen
as two sides of the coin of quality control in professional behavior: ethical stan-
dards provide the value system guiding the psychologist, while accountability
provides the mechanism for activation of the value system in the real world of
professional practice. Some other comparisons may be helpful here. The ethics
code is the quieter, more passive mode. It comes alive only when there is a
complaint, if you will; even then its operations are more covert and silent.
Accountability is more overt, and active, and demanding of regular usage. For
example, it may well be that there will be a requirement of regular and periodic
review of psychological services as provided by both individuals and groups.
Indeed, the APA Standards statement calls for just that in its Standard 4.3 as
follows: "There shall be periodic, systematic, and objective evaluation of psy-
chological services." (American Psychological Association, 1974b, p. 10)
Interpretation: "Regular assessment of progress in achieving goals shall be pro-

vided in the service delivery plan, including consideration of the effectiveness
of the psychological services relative to costs in terms of time, money, and the
44 DURAND F. JACOBS
availability of professional and support personnel. Evaluation of the efficiency

and effectiveness of the psychological service delivery system would be con-
ducted both internally and under independent auspices." (American Psycho-
logical Association, 1974b, p. 10)
I am not necessarily making a case for accountability being the more desirable
or important side of the coin. I believe that both are essential for the successful
development and maturation of a profession. (McMillan, 1968, p. 13)
Thus, standards of practice complement the Association's ethical code

by adding specific operational content to the profession's concept of ethical
practice, and by providing the profession's first proactive means to maintain
surveillance over practice.
STANDARDS AND THE LAW
Standards of practice differ from statutory requirements in several

ways. Legislative actions constitute attempts by persons outside the profes-
sion to define and regulate the conduct of professional activities so that they
serve the public interest. Standards of practice pursue the same goal
through self-regulation within the profession. State statutes dealing with
profeSSions usually define the title, specify minimal educational qualifica-
tions of service providers, and authorize a set of functions that can be pro-
vided only by those specified in the statute. Standards also address these
matters. Qualifications proposed by profeSSional organizations, however,
tend to float a notch or two higher than those established by governmental
groups. The reason for this is the political process itself, wherein those pro-
posing legal controls often include a far broader and more heterogeneous
mix of interested parties than are found within the organized professional
group alone. As a result, legislative decisions tend to favor recognition of
the greatest number of service providers who would be accessible to the
public within the constraints of certain quality control considerations. This
tends to produce statutes with lower requirements for entry qualifications
and for maintenance of competence than those proposed by the profes-
sional organization. Another difference is the relative ease with which
profeSSional standards can be revised and upgraded over time, as compared
to the far more difficult (and often chancy) activity of amending a legisla-
tive action.
In recent years a backlash has occurred against the considerable influ-
ence that professional groups have exercised in shaping legislative require-
ments for practice. The charge made (Hogan, 1979) is that laws and statutes
serve the interests of the profession more than those of the public by
restricting accessibility to qualified providers and, thereby, increase cost of
service as well. Criticism also has been leveled that state examining boards
have been less than diligent in monitoring and prosecuting violations of
statutes affecting practice. These circumstances have given impetus to a
wave of new legislation called "Sunset Laws." In several states such actions
have provisionally repealed licensing laws affecting psychologists and

other professions. This means that unless the affected professions can rec-
ommend improved legislation that clearly is more protective of the public
interest, their statutory privilege of exclusive practice will be revoked. In
these times when professionals and their practices are suspect and under
critical review by consumer groups, state legislatures, the Federal Trade
Commission, third-party payers, etc., it is well that APA had the foresight
to make itself publicly accountable through wide dissemination of its stan-
dards and guidelines.
Unlike legal codes, the standards and specialty guidelines have been
written in a manner that is easily understood by all parties involved. Both
were designed to alert users to their rights and privileges and to afford them
an opportunity to anticipate and assess the services they receive. The stan-
dards go much further than any legislative mandate or ethical code by pro-
viding facility directors, agency heads, and corporate officers with a blue-
print for organizing and staffing psychological service units in their
respective settings. In a similar manner, the standards and guidelines pro-
vide a heretofore unavailable basis for third-party payers and others to
share a set of reasonable, objective, and essentially measurable criteria for
identifying qualified service providers and their support personnel, for
assessing the adequacy of recordkeeping procedures, and for reviewing
documented progress toward service goals. Professional groups, including
psychology, have been placed very much on their mettle to demonstrate
that high entry qualifications and rigorous demands for maintaining com-
petence through continuing education are to the public's advantage and
worth the additional costs and inconveniences entailed.
The professions also are devising multilevel delivery systems that com-
bine the best features of ready accessibility of services and lower unit costs
with high levels of professional accountability and quality control. The his-
torically dominant dyadic model for the delivery of professional services is
giving ground to alternative models involving extensive use of paraprofes-
sional support personnel (Jacobs, 1974).
For all the above reasons, standards of practice have come to fill an
essential need not fully met by the profession's or society's previous meth-
ods to insure safety, quality, orthodoxy, effectiveness, accessibility, econ-
omy, and accountability to potential users of psychological services.
ON-GOING CONCERNS
A sizable array of seminal issues affecting the future of American psy-

chology were carefully addressed in APA's policy statements on profes-
sional practices. Many of these remain unresolved, however, and continue
to command the profession's attention as urgent unfinished business. First
and foremost are continuing attempts to formalize an operational definition
of the profeSSional psychologist that will serve the best interests of both the
46 DURAND F. JACOBS
public and the profession. Inseparably intertwined with this are attempts
to arrive at a balanced solution for what has come to be called "resolution
of the master's issue," i.e., how best to incorporate those with less than doc-
toral training into the profession's service delivery systems.
The second consideration is how the Association will advance its stated
intention to support scientific studies that will test, and hopefully validate,
APA's position that doctoral training and related quality control measures
can assure the public of competent practitioners. The third continuing con-
cern deals with training psychologists to maintain systematic case records
in order to meet increasing demands for peer review. A fourth issue stems
from the expanding use of support personnel in the delivery of psycholog-
ical services, and the need to elaborate further the professional and legal
responsibilities of psychologists who must provide effective direction and
supervision of these paraprofessional "extenders." The fifth item requiring
corrective action is how to pursue the limited alternatives open to the help-
ing professions in order to rekindle the public's faltering trust in the
motives and skills of its helpers. This crisis in trust has reached the point
where each professional group either must institute its own highly visible
and effective regulatory mechanisms or prepare itself for the consequences
that will come when others outside the profession take regulation into their
own hands. The sixth issue urgently awaiting resolution is closely related
to the problem of improving the profession's public image. It pertains to
the need for APA to chart a course for implementing its policy statements
on practice and to do so in an even-handed manner that protects users of
psychological services while not placing unreasonable demands on the
practitioner.
THE DEFINITION OF THE PROFESSIONAL PSYCHOLOGIST
The single topic that has generated the most controversy throughout
the development of standards has been APA's decision to define the
"professional psychologist" in any and all settings as one holding "a doctoral
degree from a regionally accredited university or professional school in a
program that is primarily psychological, and appropriate training and expe-
rience in the area of service offered" (American Psychological Association,
1977b, p. 4). To fully appreciate the significance of this action necessitates
an understanding of the somewhat checkered history of how the double
standard for defining the (professional) psycholgist had evolved in federal
regulations and state statutes and how these events were abetted by the
default of organized psychology.
APA played sequential roles of passive observer (1945-1954) and later
(1955-1978) active endorser of an amazing series of damaging statutory
actions that began with passage of the first psychology licensing law of 1945
and continued through 1978 when the 50th statute governing psychological
practice was passed. The upshot of all this was that the great majority of
persons representing themselves as psychologists had been systematically

exempted from the requirements of licensure in virtually all state statutes
regulating the practice of psychology. Those exempted were persons
employed as "psychologists" in tax-supported institutions and agencies
such as universities, state and federal hospitals, schools for the mentally
retarded, mental hygiene clinics, and correctional facilities.
Independent surveys conducted by Benoit (1968) and by Arnhoff and
Jenkins (1969), verified that the great majority of the applied clinical, coun-
seling, and rehabilitation psychologists in the United States, then as now,
were employed in tax-supported settings. These settings included mental
hospitals, residential and training schools for the retarded, rehabilitation
facilities, secondary schools and colleges, correctional institutions, com-
munity mental health and family service clinics, and additional types of
human service facilities supported by state and federal agencies. Then as
now, persons employed as "psychologists" in these settings serve the over-
whelming majority of users of psychological services in the United States.
Yet, less than half of those functioning as "psychologists" had completed
doctoral level training. Despite these facts, APA's official position on licens-
ing did not contest legislative actions exempting this huge group of provid-
ers of psychological services from licensure requirements. It read:
(Recommendation) 8. Persons employed as psychologists by accredited aca-
demic institutions, governmental agencies, research laboratories, and business
corporations should be exempted, provided such employees are performing
those duties for which they are employed by such organizations, and within
the confines of such organizations. (American Psychological Association, 1967,
p.1100)
The APA guidelines for state legislation affecting the practice of psy-
chology (American Psychological Association, 1967) went on to recommend
that when the same persons provided similar professional services to the
public for a fee they should meet licensure requirements that mandated
doctoral level training:
(Recommendation) 10. Persons employed as psychologists who offer or provide

psychological services to the public for a fee, over and above the salary that they
receive for the performance of their regular duties, should not be exempted.
(Recommendation) 11. Persons employed as psychologists by organizations that
sell psychological services to the public should be exempted. (pp. 1100-1101)
It would be difficult to find a more flagrant example of a double stan-

dard regarding provision of services to citizens of a given state. Inadver-
tently, APA had placed itself in a position that tacitly supported the practice
of tax-supported agencies that deliberately hired less well trained persons
as psychologists because they were less expensive. Those reading the above
excerpts are reminded that the prime stimulus that provoked the creation
of the original APA standards of practice was the limited coverage and
unsatisfactory quality of psychological services available to persons served
in tax-supported institutional settings. Not only were these services pro-
48 DURAND F. JACOBS
vided by too few and often poorly trained personnel, but the status quo had
been maintained by statutory decree. To make matters worse, there were
clear indications in the late 1960s that, barring effective action by APA,
those conditions were about to be concretized by imminent actions of reg-
ulatory, standard-setting, and accreditation groups. Seen within this histor-
ical context, the standards are revealed (1) as a strong public statement of
dissent against this wholly unacceptable state of affairs and, (2) as an
unprecedented move by APA to improve the quality, effectiveness, and
accessibility of psychological services to all who required them.
With publication of the original standards for providers of psycholog-
ical services in 1974 APA finally resolved its long-standing dilemma over
what would be the minimally-acceptable qualifications for all those who
bore the title psychologist. For the first time in its history APA took the posi-
tion that the doctoral degree was the uniform training requirement for any
psychologist offering professional services in any setting, whether public or
private. Even as APA announced its higher standard, it acknowledged what
had happened in the past:
It is recognized that some statutes or regulations presently define and permit
autonomous provision of psychological services by persons with training and
experience other than that noted in Standard 2.1. Therefore, at the present time,
persons holding less than a doctoral degree from an accredited university in a
program primarily psychological in content shall also be considered as qualified
psychologists in the state in which they practice provided that they have (a)
appropriate experience in the area of service offered and (b) a license or certif-
icate from a state examining board under a "grandfather clause," or endorse-
ment by a state psychological association through voluntary certification in
states without statutory provisions. (p. 5)
The 1977 revision of the standards modified this grandparenting clause

in two ways. First, it was expanded. Principally, this addressed special prob-
lems posed by school psychologists. Second, the updated conditions were
made more stringent. The revised statement read:
For the purpose of transition, persons who met the following criteria on or
before the date of adoption of the original Standards on September 4, 1974, shall
also be considered professional Psychologists: (a) a master's degree from a pro-
gram primarily psychological in content from a regionally accredited university
or professional school; (b) appropriate education, training, and experience in
the area of service offered; (c) a license or certificate in the state in which they
practice, conferred by a state board of psychological examiners, or the endorse-
ment of the state psychological association through voluntary certification, or,
for practice in primary and secondary schools, a state department of education
certificate as a school psychologist provided that the certificate required at least
two graduate years. (p. 11)
Note that the looseness of the introductory phase, "Therefore, at the

present time," in the 1974 version was focused sharply to read: "For the
purpose of transition." This served notice that exceptions to the doctoral
requirement were limited to those who met the criteria "on or before the
date of adoption of the original Standards on September 4, 1974," but no
later. A stricter interpretation also is seen in the 1977 grandparenting state-

ment which interposed an educational floor of "a master's degree" (line 4).
This upgraded the open-ended phrase "less than a doctoral degree" that
appeared in the 1974 statement.
A similar commitment to tighter requirements is evidenced in the 1977
addendum in Section C referring to school psychologists. To qualify for
this exception school psychologists who had not earned a doctoral degree
had to (a) confine their practice to primary and secondary school settings,
(b) possess a certificate issued by the state department of education (since
most states do not license school psychologists), and (c) meet the higher
master's degree requirement of at least two years of graduate training (the
mode among training centers that granted degrees after as little as one or
as much as three years of study).
As earlier noted, the grandparenting statement in the 1977 revised
standards was motivated by the APA's intent to limit the influx of literally
thousands of persons representing themselves as psychologists who had
been trained to a master's level in programs outside the influence of APA's
accreditation system. The overwhelming majority of this group were school
psychologists. If this situation were not corrected it would stand as a living
contradiction to the APA policy requiring the doctoral degree as the sole
entry level for use of the title psychologist. Worse, it could be used as a prec-
edent for accepting master's level graduates as independent practitioners in
other applied specialties of psychology. In the floor jockeying at the APA
Council of Representatives meeting in January 1977 it was found prudent
to reverse the order of two items of business on the council's agenda. Orig-
inally scheduled for earlier consideration was final action on the revised
Standards for Providers of Psychological Services. Moved ahead of it at the
last moment was an item titled "Resolution of the Master's Level Issue." The
first section stated:
The title "Professional Psychologist" has been used so Widely and by persons
with such a wide variety of training and experience that it does not provide the
guidance the public deserves. A1l a consequence, the APA takes the position and
makes it a part of its policy that the use of the title, "Professional Psychologist,"
and its variations such as "Clinical Psychologist," "Counseling Psychologist,"
"School Psychologist," and "Industrial Psychologist" are reserved for those
who have completed a Doctoral Training Program in Psychology in a univer-
sity, college, or professional school of psychology that is APA or regionally
accredited. In order to meet this standard, a transition period will be acknowl-
edged for the use of the title, "School Psychologist," so that ways may be sought
to increase opportunities for doctoral training and to improve the level of edu-
cational codes pertaining to the title. The APA further takes the position and
makes it part of its policy that only those who have completed a Doctoral Train-
ing Program in Professional Psychology in a university, college, or professional
school of psychology that is APA or regionally accredited are qualified 1nde-
pendently to provide unsupervised direct delivery of professional services
including preventive, assessment, and therapeutic services. The exclusions
mentioned above pertaining to school psychologists do not apply to the inde-
pendent, unsupervised, direct delivery of professional services discussed in this
paragraph. (Conger, 1977, p. 426)
50 DURAND F. JACOBS
Thus, key changes in the revised 1977 standards represent a kind of

shadowscape of the ongoing struggles of American Psychology to find firm
footing, integrate its many and diverse constituent groups, and grope
toward maturity as a unitary profession and science. While the nonresolu-
tion of the master's issue persists within APA, the National Association of
School Psychologists (NASP) is waging an aggressive compaign to obtain
statutory recognition of "school psychology" as an independent profession,
separate and distinct from the remainder of professional psychology. NASP
proposes a master's degree in education as the entry level for autonomous
practice of school psychologists in any setting. The development of spe-
cialty standards during 1977-79 offered several opportunities for "summit
conferences" between APA and NASP leaders and members of COSPOPS.
These resolved many problems that previously had separated the two
groups. However, the single issue that remains is the same that has per-
sisted for over three decades: what level of training shall provide entry to
the title and role of psychologist? The view of this observer is that organized
psychology has little choice but to hew to its now established policy that
doctoral level training is required for entry to the profession. This means
APA must, if necessary, fight all comers to retain ownership of the generic
title psychologist with or without specialty modifiers. APA has been tardy in
reaching this decision, but it appears that its resolve is hardening on this
position. In a related action in August 1979, the Council of Representatives
voted to upgrade APA's 1963 criteria for accrediting doctoral programs in
psychology. The intent was to add badly needed substantive dimensions to
the vague description of the structure and content of doctoral training as
being "primarily psychological in nature."
However, even as consensus was reached on what constituted accept-
able training for entry into practice, voices from within and outside psy-
chology were asking if that was the key issue, after all. Demonstrated com-
petence, not educational preparation alone, had become the new rallying cry
for certifying the qualified professional psychologist in the 1980s.
STRUCTURED TRAINING VERSUS COMPETENCY MEASURES
Transcending the issue of entry level of training for the professional

psychologist is the question of whether or not the standards and specialty
guidelines contribute measurably to assuring that service providers will be
competent in their practices. Asserting that a provider is qualified to prac-
tice solely on the basis of prior formal education and supervised training
has troubled those responsible for quality control in each of the human ser-
vice professions. HistOrically, the public has accepted the premise that the
leadership of an organized profession were in the best position to decide
about what combination of corpus of knowledge and skills would reason-
ably assure the preparation of a competent practitioner. These prerequisites
are then packaged into accredited education and training programs of given
content and duration, topped by a specified terminal degree that ordinarily

has been accepted by state licensing boards as sufficient evidence for com-
pletion of entry to practice requirements. This train of events is premised
on the assumption that the means of training will produce the desired out-
comes in practice. It is further buttressed by faith that careful selection of
students, good faculty and facilities, diligent study, and rigorous supervi-
sion during training will produce knowledgeable and skillful (Le., compe-
tent) practitioners when they move into independent practice. No profes-
sion has yet assembled scientific data based on practice outcomes to support
these assumptions. Nor has agreement been reached about what crucial out-
come criteria should be utilized for evaluating proficient performance.
Until early 1980 the position of American psychology on this issue had not
advanced beyond what the Task Force on Standards for Service Facilities
had offered in 1971 as the rationale for requiring doctoral training as the
entry level for providers of psychological services:
The task force is also aware of the imperfect correlation between academic cre-
dentials and service capability. However, the alternative methods of assessing
competence are also imperfect and require use of equally vulnerable indices of
excellence. Moreover, the professional's roots in scientific psychology and aca-
demic preparation make academic credentials an appropriate means of estab-
lishing minimal standards. (American Psychological Association, 1971c, p. 2)
It was in the foreword to the specialty guidelines that APA first

announced its intention to develop operational criteria for evaluating com-
petent performance by psychologists:
These Guidelines represent the profession's current best judgment of the con-
ditions, credentials, and experience which contribute to acceptable professional
practice. The APA strongly encourages, and plans to participate in efforts to identify
professional practitioner behaviors and job functions, and to validate the relation between
these and desired client outcomes. Thus, future revisions of these Guidelines will increas-
ingly reflect the results of such efforts. (italics added) (American Psychological
Association, 1981, p. 640) .
Critics had argued that standards of practice should not have been
issued until they included proven competency criteria. Such critics failed to
recognize that standards affecting practice may include other useful quality
control indices. The absence of a preferred class of criteria (Le., competency
indicators) did not dissuade APA from taking steps to assure the public of
its concern for their welfare and to show its willingness to hold psycholo-
gists accountable for quality performance on the basis of presently available
indices that providers, users, and sanctioners agreed were relevant to (if not
yet demonstrably predictive of) desired service outcomes.
WRITTEN REPORTS
The pressure point among professionals that is most sensitive to the

public's demand for increased accountability is the requirement for system-
52 DURAND F. JACOBS
atic recordkeeping. This matter is addressed in both the generic standards

and the specialty guidelines. Except for slight differences in presentation,
the specialty guidelines closely follow the procedures enumerated in the
generic standards. These require five kinds of written documentation:
1. An organizational chart (Standard 2.1.2). This shows lines of respon-

sibility and accountability for each person who provides psycholog-
ical services with supervisory relationships delineated.
2. A current statement of the objectives and scope of the psychological
service unit (Standard 2.2.1). This implies that the services offered
are consistent with staff competencies and accepted practices.
3. A set of procedural guidelines for the delivery of the psychological
services (Standard 2.3.1). This describes the methods, forms, proce-
dures, and techniques currently being used to support the objectives
of the unit.
4. An individual service delivery plan (Standard 2.3.2). This docu-
ments the user's and provider's mutual understanding of objectives
of psychological services to be offered and the manner in which
they will be provided. It also may specify the respective accounta-
bilities of persons who are party to the plan.
5. Continuing documentation of services provided (Standard 2.3.4).
The specialty guidelines added a brand new component to record-
keeping; namely, a "records retention and disposition policy"
appropriate to the setting of each specialty.
All the above records are intended to be available upon request to users
and (with proper safeguards of confidentiality) to sanctioners as well. These
written records, particularly those containing documentation of profes-
sional intervention, constitute the core material essential for peer review.
The first three types of records provide the information necessary for
effective administrative review. An addition~l standard (3.3) applies when
the psychological service unit is a component of a large organization (e.g.,
school, agency, hospital, corporation, etc.). This standard calls for periodic
evaluations of the effectiveness of the unit relative to accessibility of profes-
sional and support personnel and similar operational considerations.
The mandate for specific kinds of written records is seldom applauded
by professionals. It is time-consuming and it often replaces a more person-
alized and flexible style of records management. One hopes that such prob-
lems are offset by the advantages obtained through better informed users
and sanctioners and more assured accountability of psychologists for the
services they provide and supervise. Parenthetically, the writers of the stan-
dards were not insensitive to the risks posed by mandated records and
review procedures. They added the following precaution to Standard 3.3:
It is highly desirable that there be a periodiC reexamination of review mecha-
nisms to ensure that these attempts at public safeguards are effective and cost
efficient and do not place unnecessary encumbrances on the provider or unnec-
essary additional expense to users or sanctioners for services rendered. (p. 10)
SUPERVISION
The issue of supervision was touched only lightly in the original 1974
standards. It stated that providers of psychological services who did not
meet the requirements for the qualified psychologist (e.g., psychological
associates, assistants, technicians) "shall work under the supervision of a
qualified psychologist" (Standard 2.2, p. 5). The 1977 revision went consid-
erably further. It elevated the status of supervision to the level of a formal
"Psychological Service" (p. 4) and added that the supervising psychologist
"shall assume professional responsibility and accountability for the services
provided. The level and extent of supervision may vary from task to task so
long as the supervising psychologist retains a sufficiently close supervisory
relationship to meet this standard" (Standard 1.2, p. 5).
Subsequent experience has revealed that merely specifying the locus of
control is not sufficient to assure either the user or the person being super-
vised of adequate professional guidance for services being provided. For
instance, a widely cited case (Brown and Associates Psychological Clinic v. Geor-
gia State Board of Examiners of Psychologists, 1970) decided by the Georgia
State Board of Examiners of Psychologists held the psychologist at fault
because services were being provided by a technician without prior direc-
tion and without adequate review of results of evaluation and therapy activ-
ities. Moreover, the board found violations of their standard requiring that
professional-related "activities of the 'technician,' 'assistant,' or 'intern'
must be conducted in a setting whereby the professional supervisor could
personally intervene in a crisis situation requiring his immediate attention"
(p. 10).
In response to such demands for increased accountability in the psy-
chologist's supervisory role, the specialty guidelines enumerated key com-
ponents of the supervisory process. These were discussed earlier in this
chapter. As presented in the specialty guidelines, supervision has become a
function that now is readily assessable for review and evaluation by peers,
users, accreditation groups, and third-party payers alike. This anticipates
the expanded use of paraprofessional support staff within multilevel deliv-
ery of psychological service systems in all manner of settings. The trend is
toward even more rigorous and explicit controls by professionals over tech-
nical support personnel, including formal certification for specific activities
(e.g., biofeedback technician). It also is reasonable to expect that the func-
tions of support personnel and the manner of supervisory controls applied
within the profession will be augmented by statutory action and by require-
ments included in operations manuals issued by third-party payers.
THE PUBLIC'S CONCERN WITH ACCOUNTABILITY
Pent-up public indignation and outrage at shabby governmental, busi-

ness, and professional practices emerged as a political force in the late
1960s. This crisis in trust has continued to gain momentum over the past
54 DURAND F. JACOBS
decade and a half. It has produced mounting demands for tough policing
of product quality and safety, elimination of environmental pollutants,
clearly explained lending and labeling practices, and an end to "rip-offs"
by large corporations and professional groups acting in arrogant self-
interest.
An accompanying loss of faith in society's established institutions to
treat the "little guy" with consideration has produced an accelerated move-
ment to guarantee explicitly human dignity and personal rights through
new legislative and statutory initiatives and through landmark decisions by
state and federal courts (Jacobs, 1974b). Matters have reached the point
where consumers and their advocates have successfully challenged the
professional's presumptive right to decide alone the content, staffing, man-
ner of and site for service delivery. Nowhere on the current scene to do
these two movements, i.e., to seek recourse for past wrongs and to demand
assurances for future good treatment, converge and complement one
another more strongly than in the concern for adequate human services
(Jacobs, 1975).
It was neither providers nor consumers, but those at least once
removed from direct service delivery who first developed means for
enhancing conditions believed to contribute to improved service delivery.
The first kind of standards that evolved were promulgated by governmental
and private accreditation groups. The standards compiled by these groups
addressed matters such as requirements for basic staffing, organizational
structure, range and type of services and procedures, and a safe environ-
ment. They required a trail of documents that recorded the need, goals, and
process of service delivery. Such standards assumed that consumers would
stand to benefit if service providers were well trained, well organized, kept
good records of what transpired in their work, engaged in peer review,
remained abreast of new information in their field, and had adequate staff
and supporting resources.
Criteria for the evaluation of professional judgment and competence in
performance were not included in the first type of standards. Such matters
were seen as properly the domain of the concerned profession to be ascer-
tained through peer review and improved continuing education programs.
The early standards required only that the structure for review of such activ-
ities be in place and operable. The underlying rationale for this approach
was that, while quality of service is not directly measurable, its level can be
accurately estimated by direct observation of selected structural and proce-
dural components of the service delivery system.
The AP A standards were based on the same line of thinking. They
addressed most of the dimensions covered by standards issued by major
educational, health, and environmental groups. The unique features of the
APA standards were: (a) they were initiated and written by and for the pro-
viders themselves as a means for self-regulation and (b) their scope was
greater in that it aimed to "serve the respective needs of users, providers,
and third-party payers and sanctioners of psychological services" (Ameri-
can Psychological Association, 1977b, p. 1). Viewed in this light, the stan-
dards and the specialty guidelines that followed provided an unprece-

dented method for exercising quality control. APA's 1977 standards were
enthusiastically received by governmental, voluntary, and private groups
who recommended them to other disciplines as a model to emulate. Two
professional organizations already have paid APA the highest compliment
by closely modeling their own Standards for the Provision of School Psy-
chological Services (National Association of School Psychologists, 1978) and
Standards for Health Care Providers in Clinical Social Work Services
(National Federation of Societies for Clinical Social Work, 1976) after those
originated by the APA. This suggests that APA and other professions will
continue to generate practice standards in response to the public outcry for
increased monitoring and accountability of service providers. Indeed,
professional organizations have extremely limited options in this matter:
either they may seize the initiative by writing standards for their own
members or expect others outside the profession to write standards for
them.
In promulgating specialty guidelines for clinical, counseling, indus-
trial~organizational, and school psychologists, APA has struck an irreversi-
ble course of action for the foreseeable future. Emerging specialties will
have to present their respective guidelines for practice. Moreover, as new
specialty groups seek to gain recognition from APA and from the public,
they will face even more stringent demands for demonstrated competence
and assurances of quality control in their practices.
IMPLEMENTATION OF THE STANDARDS AND SPECIALTY GUIDELINES
The original charge to the Committee on Standards for Providers of

Psychological Services (COSPOPS) was to revise the 1974 standards and to
suggest means to implement them, including their application by relevant
governmental and private accreditation groups. In October 1975, COSPOPS
proposed an "Implementation Grid." This identified four groups that had
some responsibility for exercising quality control over the delivery of psy-
chological services. These were: the profession itself, governmental agen-
cies that employ or contract for services from psychologists, voluntary
groups concerned with the public interest, and private groups who pur-
chase psychological services.
The profession'S responSibility for maintaining quality control is dis-
charged by the APA and state psychological associations through their com-
mittees on standards, ethics, and legislation, conditions of employment for
psychologists, and professional standards review. The profession's advocate
arm, (i.e., the Association for the Advancement of Psychology) represents
the guild's self-interest by attempting to educate legislators and users of
psychological services about when, how, by whom, and under what circum-
stances psychological services may be provided in an effective and efficient
manner.
Major federal governmental groups responsible for assuring quality
56 DURAND F. JACOBS
control, accessibility, and economy in the delivery of psychological services

include regional Professional Standards Review Organizations (PSRO);
agencies administering health insurance programs for federal civilian
employees and for dependents of military personnel (e.g., CHAMPUS); and
agencies responsible for hiring personnel to provide psychological services,
such as the Civil Service Commission, the military, and the Veterans
Administration. Included in the federal sector are those charged with writ-
ing regulations to implement laws dealing with health, safety, and rehabil-
itation that contain provisions for psychological services.
State and local governmental groups that have responsibility for main-
taining quality control of psychological services are licensing boards in psy-
chology, as well as state departments of rehabilitation, education, health
and mental health, and their counterparts at the county and municipal
level. State and county personnel boards would be concerned with imple-
menting standards of practice in connection with their roles in staffing psy-
chological services. Also involved are those charged with writing imple-
menting statutes or regulations that contain provisions for psychological
services.
The voluntary sector includes national organizations that have
assumed the role of watchdog over the public interest, mainly in matters of
health and rehabilitation. Prominent among these are the Joint Commission
on Accreditation of Hospitals (JCAH), the Commission on Accreditation of
Rehabilitation Facilities (CARF), and various organizations representing
consumer groups. Such groups might be expected to incorporate all or parts
of APA's standards within their own accreditation manuals.
Most notable among those in the private sector with a vested interest
in implementing quality control, acceSSibility, and economy (i.e., cost-con-
tainment) of psychological services are insurance companies that have a
role as third-party payers. Also interested would be independent agencies
and corporate groups that hire psychologists or otherwise purchase psycho-
logical services.
Yet to be determined are the means by which each of these four groups
might choose to implement APA's standards and guidelines of practice.
Implementation could take many forms. For those outside the profession,
these could range from public education activities such as official recogni-
tion, citation, and dissemination of the APA policy statements (which has
occurred) to acknowledging formally and incorporating the standards or
portions thereof in accreditation, employment, and regulatory procedures
(which to date has not happened in the United States). The latter approach
would necessitate a superstructure of procedures for investigating and pass-
ing judgment on a provider or a facility unable or unwilling to comply with
APA standards and guidelines. While APA does have procedures in place
for dealing with violations of its ethical standards, the Association has not
established formal mechanisms for the express purpose of enforcing any of
its policy statements dealing with standards of practice, use of psychological
tests, or research with human and animal subjects.
In the course of developing the revised standards COSPOPS had rec-
ommended that they "include an explanation of the modalities through

which the standards will be implemented and how deficiencies will be
dealt with within each major setting" (American Psychological Association,
1975a). The 1977 Standards, as finally approved, did not contain this infor-
mation. The Standards did pave the way for future action, however, by
observing that it was APA's responsibility "to determine how psychologists
would be held accountable should their practice fail to meet quality stan-
dards" (p. 2). Prominently placed in the introductory section was the fol-
lowing statement: "Care has been taken to assure that each standard is
clearly stated, readily measurable, realistic, and implement able" (p. I, italics
added).
Since the publication of the revised standards, there has been mount-
ing concern and some dissension within the Association about how best to
implement them. In early 1978 this stimulated appointment of a Task Force
to review all of APA's current standards, guidelines, and principles.
Appointed as members were the chairs of COSPOPS, CSPEC, CAFCOE, the
Committee on Professional Standard Review (COSPR), and a representative
from the APA board of directors. The task force was charged to review the
prevailing lack of coordination regarding enforcement and to consider pro-
cedures that would produce more effective utilization of these policy state-
ments. It proceeded on the assumption that the Association has a vital and
unique responsibility to promulgate and implement its own scientific and
professional guidelines, principles, and standards in the public interest. The
task force studied 10 policy statements issued by APA that were then in
effect, and noted how each was enforced. These were:
1. Guidelines for telephone directory listings (Committee on Scien-
tific and Professional Ethics and Conduct, 1969)
2. Principles for the care and use of animals (American Psychological
Association, 1971 b )
3. Guidelines for psychologists for the use of drugs in research
(American Psychological Association, 1971a)
4. Guidelines for conditions of employment of psychologists (Amer-
ican Psychological Association, 1972)
5. Ethical principles in the conduct of research with human partici-
pants (American Psychological Association, 1973b)
6. Guidelines for psychologists conducting growth groups (American
Psychological Association, 1973b)
7. Standards for educational and psychological tests (American Psy-
chological Association, 1974a)
8. Statement of principles on academic freedom and tenure (Ameri-
can Association of University Professors, 1977)
9. Standards for providers of psychological services (American Psy-
chological Association, 1977b)
10. Ethical standards of psychologists (American Psychological Asso-
ciation, 1977c).
With the exception of direct interventions that can be completed by
58 DURAND F. JACOBS
CAFCOE (items 4 and 8), it was confirmed that to the extent an APA policy
statement was enforced at all, only CSPEC (i.e., the APA Ethics Committee)
can exercise this power. Such enforcement in turn is limited to psycholo-
gists who are members of APA.
The report of the task force commented on the extreme diversity
among the policy statements. Several had never been formally reviewed by
the membership nor approved by the Association's governance. Yet all had
been endorsed by APA. The policy statements revealed no consistent for-
mat. They ranged in length from 1 page (item 3) to 104 pages (item 5). There
was considerable overlap and a obvious lack of coordination among them.
Each seemed to be the product of an isolated action. For instance, there were
broad ethical principles contained in the standards for providers and
detailed standards of practice contained in the ethical standards. In no
instance had APA articulated a program for systematically disseminating its
policy statements to the consuming public or to the scientific and profes-
sional communities for whom they were designed. Finally, APA had not
specified a course of action for informing the public, the profession, and
others with a need to know about the manner in which the policy state-
ments were to be enforced.
To ameliorate the foregoing difficulties the task force recommended
that:
1. Once a policy statement is promulgated, an explicit mechanism
should be established for implementing and, where appropriate, for
enforcing it.
2. APA should develop a mechanism for periodically evaluating the
manner in which each policy statement has been disseminated, uti-
lized, and enforced.
The recommendations of the task force were accepted with thanks but,
as of this writing, no action to apply them has been taken.
There are two broad avenues open for implementing the standards and
specialty guidelines. The first is to increase general awareness of the pur-
pose and content of these policy statements through a program of educating
providers, potential users, and others with a need to know. The second is
to establish procedures for direct regulation and enforcement of the policy
statements by way of peer or other review. Either or both of these methods
could be exercised by the profession, by governmental entities, or by orga-
nizations in the voluntary or the private sector, acting independently or in
concert.
Implementation through Voluntary Self-regulation

Experience has shown that providers are generally well intentioned
and will strive to conform to professional standards and guidelines issued
by their parent organization once they are made aware of the purpose and
content of these policies. For the great majority any form of coercion is
unnecessary. They can be expected to respond affirmatively simply because

they identify with the mores and objectives adopted by their professional
peers and leaders. By the same token, facility directors and employers of
psychologists have commented favorably upon receiving copies of APA's
standards and with few exceptions have enthusiastically endorsed them.
This suggests that these groups regard the standards as reasonable and as
an honest attempt by the profeSSion to improve the quality of psychological
services offered to the public. Supporting evidence for this interpretation
has come from APA's Committee on Academic Freedom and Conditions of
Employment (CAFCOE). Their rather extensive experience has been that
conflicts between psychologists and their employers usually have been
resolved when the contesting parties were persuaded to abide with those
portions of the standards that related to the matter in question. Indeed, this
has proceeded so well that APA plans to compile a casebook to illustrate
how each standard has been applied to actual situations in various settings.
The first sampling of cases appeared in the June 1981 and June 1982 issues
of the American Psychologist.
Considerable progress along the educational path has been made by
APA in disseminating copies of the standards to providers, consumers,
national accrediting organizations, federal and state civil service commis-
sions, state licensing boards, military personnel offices, and major employ-
ers of psychologists. Since the generic standards were published in January
1977, it has been APA's policy to provide a free single copy upon request
and to make bulk sales at a modest price (the same policy is in effect for
those requesting the specialty guidelines). As of June I, 1980, over 20,000
copies of the standards had been distributed. Of this total almost 10,000
were shipped in bulk orders and over 11,000 single copies were distributed
free of charge. To further inform psychologists, students, and others about
the existence of the revised standards, APA published them in the American
Psychologist in 1977 and in the preface of its 1978 Directory and in those that
have appeared since then. A free copy is routinely enclosed in the dues
statements of new members and associates of the Association. Another
means used to increase the visibility and guide the application of the stan-
dards has been to cross-reference them in other APA policy statements and
publications. The specialty guidelines were published in the June 1981
issue of the American Psychologist.
Self-regulation through Intramural Implementation

The second major avenue open for implementing APA's policy state-
ments on professional practice is for APA or state psychological associations
to establish peer review procedures for enforcing them. Naturally, this is
more involved and much more controversial than self-imposed or privately
negotiated local applications of the standards and specialty guidelines to
improve practice methods or working conditions.
Resistance to any move to enforce the generic standards or specialty
guidelines revolves around the fear that this might invoke ethical charges
60 DURAND F. JACOBS
or legal actions against psychologists who do not meet a given standard or

guideline. This antipathy has no basis in fact. Most psychologists fail to rec-
ognize that, since its original publication in 1974, the APA policy statement
on Standards for Providers has been binding on members of APA, and,
thereby, technically enforceable. The APA ethical code enjoins members of
the Association to observe "association standards of practice concerning the
conduct of their practice" (Principle 3c). Although no such issue has ever
been raised, one could expect that a complaint against a member of the
Association verifying that he or she had persisted in willful and flagrant
noncompliance undoubtedly would result in some sanction being applied
under the Ethical Standards.
Implementation through Non-APA Accreditation Procedures

The most relevant information relating to application of quality control
standards in human service facilities comes from the experience acquired
by those who have applied the accreditation standards of the JCAH and
CARF. What follows is a extrapolation from that history to anticipate the
conditions that likely would prevail if the standards and specialty guide-
lines were implemented by peers through being incorporated in the accre-
ditation manuals of other agencies.
Basically, standards are designed to obtain and maintain a satisfactory
pattern of practice. Some psychologists erroneously fear that their entire
practice would be in jeopardy should they fail to comply with anyone or
another of the standards or guidelines. The history of standard-setting and
implementation shows that evaluation of performance relative to a given
standard is neither an isolated nor an all-or-nothing decision. Typically,
performance in each major area under review is rated on an ordinal scale
ranging from "substantial compliance" to "noncompliance." Usually, sev-
eral individual standards comprise a subsection. The provider is evaluated
on the basis of the level of overall compliance across the several items in the
subsection. Providers are not rated on those individual standards or subsec-
tions that are irrelevant to their particular setting, specialty, client popula-
tion, or mode of service delivery. Nor are they held accountable for failure
to meet a standard when doing so would cause them to violate a local stat-
ute, ethical principle, or condition of employment. Neither are they held
accountable when they are prevented from meeting a standard (e.g., Stan-
dard 3.2) because of circumstances beyond their personal control or reason-
able influence.
Full compliance with every standard or subsection is not reqUired. A
rating of "substantial compliance" indicates that the activities under review
met the intent of the standard(s) as evidenced by direct observation and/or
documentation. A rating of "partial compliance" indicates that the ongoing
activities were found to address the intent of the standard(s) but that there
is a need to upgrade certain aspects of activity and/or its documentation to
reach the level of "substantial compliance." A rating of "noncompliance"
THE DEVEWPMENT AND APPLICATION OF STANDARDS 61
indicates that the activity under review failed to meet the intent of the stan-
dard(s) as evidenced by direct observation and/or documentation.
Following this type of section-by-section review, providers typically
receive an overall rating that remains in effect until their next accreditation
review. A written summary statement noting the strengths and weaknesses
in various aspects of their professional activities is appended. Characteris-
tically, there is opportunity to discuss one's ratings with the rater and to
offer an explanation of extenuating circumstances that are beyond the con-
trol of the person being evaluated. In this regard, the reader is reminded
that the generic standards (p. 2) hold that "fulfillment of the requirements
to meet these standards shall be judged by peers in relation to ... the cir-
cumstances that prevail in the setting at the time the program or service is
evaluated." Traditionally, those involved in peer review activities are per-
mitted a limited grace period wherein major deficiencies can be corrected
without prejudice. Those found in partial compliance typically are given a
time-definite (e.g., six months to one year) during which they may upgrade
their activities to a level of substantial compliance and, thereby, avoid sanc-
tions entirely. The cost for APA independently to administer a peer review
system based on the accreditation model clearly would be prohibitive.
Therefore, APA has considered having its standards of practice imple-
mented by having them included as part of the review of psychological
services already being conducted by national accreditation groups such as
the JCAH.
Frequently eclipsed by the stress engendered in most people when
subjected to a performance review are the advantages that accrue by virtue
of the feedback received from the reviewer. Indeed, the primary purpose
of accreditation through peer review is educational. Therefore, the potential
for enforcement of a set of standards acts more to gain and hold the atten-
tion of the person being reviewed than to constitute any real threat to the
income or position of the well intentioned practitioner. The limited expe-
rience acquired by APA over the past few years through peer review of case
records under the CHAMPUS and AETNA insurance plans has been
enlightening. It was reported that being subject to review served to encour-
age psychologists to firmly and successfully defend their procedures and,
particularly, to upgrade their documentation. Even in the absence of immi-
nent peer review, APA's standards and specialty guidelines provide the
well intentioned practitioner with an excellent self-evaluation tool.
The specialty guidelines offer a somewhat more benign approach to
potential enforcement than do the generic standards. This is so because all
references to "minimally acceptable" levels of performance have been
dropped, along with other obligatory language that appeared in the stan-
dards. Nonetheless, the guidelines reaffirm that they have been developed
"as a means of self-regulation to protect the public interest." They go fur-
ther than the standards in volunteering that guidelines may be used inde-
pendently ''by boards and agencies that find such criteria useful for quality
assurance."
62 DURAND F. JACOBS
IMPLEMENTATION THROUGH STATUTORY MEANS
Virtually all state regulatory boards in psychology formally incorporate

the APA code of ethics when exercising their own responsibilities to reg-
ulate and discipline practitioners. Statutory language frequently is broad
and general. Without explicit guidelines boards often are hard pressed to
administer the law in a fair and consistent manner. The APA standards and
specialty guidelines constitute the most comprehensive and relevant doc-
uments available for licensing boards to use in evaluating profeSSional con-
duct, particularly if they are applied in combination with the Ethical Stan-
dards of Psychologists. As of this writing, APA has taken no direct action
to encourage state regulatory boards to adopt its policy statements regard-
ing practice. Nor has any state examining board exercised its independent
prerogative to do so. There is a precedent, however, for utilizing APA's
standards of practice in this manner. This was established in Canada by the
Ontario Board of Examiners in Psychology in December 1978. Their ratio-
nale for doing so is set forth under the section "Professional Standards" in
the regulations manual published to implement the Psychologists Registration
Act (Ontario Board of Examiners in Psychology, 1980), This section states:
For the benefit of psychologists and members of the public who are in doubt as
to the formal bases for its evaluation of acceptable professional behaviour, The
Ontario Board of Examiners in Psychology announces that it had formally
adopted and makes broad use of the Ethical Standards of Psychologists (1977
Revision), Standards for Providers of Psychological Services (1977 Revision),
Ethical Principles in the Conduct of Research with Human Participants and
Standards for Educational and Psychological Tests and Manuals. The documents
are published by the American Psychological Association and are available from
its office at 1200 Seventeenth Street, N.W., Washington, D.C. or directly from
the Board.
In addition, the Board has adopted a set of Standards for Professional Con-
duct (OntariO Board of Examiners in Psychology, 1978) which outlines in spe-
cific terms standards of professional practice. Copies have been sent to all psy-
chologists registered in Ontario. Extra copies are available from the Board office
at cost. (p. 27)
The Ontario Board's "Standards for Professional Conduct" referred to

above are based on an adaptation of APA's 1977 revised standards. At the
time of this writing no other Canadian province had followed this example.
LEGAL CONSIDERATIONS
Shortly before the four proposals for specialty guidelines were for-
warded to APA governance for final action, they were subjected to inten-
sive scrutiny by APA's legal advisors. (Although the review that follows
focuses on the content of the specialty documents, the attorneys' comments
may be interpreted to apply equally to the generic standards.) Among the
matters under consideration were: (a) the extent to which APA might
encounter possible antitrust problems in promulgating its policy statements

on specialty practice and (b) whether APA would be subject to legal action
for not implementing the guidelines after establishing them. The attorneys
were of the opinion that, if evenly and fairly applied with appropriate
advance notice to members, the guidelines would not raise antitrust issues
that heretofore had attracted the attention of the Federal Trade Commission
or that had been litigated in the courts. Their search found no st(!.tutes or
cases that held professional associations liable for failing to implement stan-
dards of performance that they had established for their members.
The attorneys identified six factors that they believed courts might con-
sider should a challenge arise regarding the legality of any particular guide-
line. These were:
1. Whether the guideline itself is violative of the law or requires a
member to be so
2. Whether the guideline interferes with a public policy or function
3. Whether there is a reasonable relationship between the guideline
and the purposes of the association
4. Whether the guideline is reasonable, just, and fair
5. Whether the association provided the members, groups of members,
and others with adequate notice of the intended implementation of
the guidelines
6. Whether the procedures employed in the enforcement of the guide-
lines are fair
The attorneys concluded that in their opinion none of the individual
guidelines were themselves illegal or required members to perform illegal
acts, nor did they appear to interfere with any known public policy or
function.
In a second set of inquiries APA's attorneys were asked to determine
which, if any, specialty guidelines (or standards) might generate a risk of
legal liability for APA members. The attorneys foresaw no risk of legallia-
bility to a practicing psychologist for simple failure to adhere to the APA
policy statements. The attorneys did observe, however, that courts have
relied on professional codes to establish a standard of care by which to
judge the performance of professionals. In so dOing, they have treated
professional codes as impliedly incorporated into the contracts of service
between profeSSionals and their clients (See, e.g., Hammonds v. Aetna Cas-
ualty and Surety Co., 1967). Therefore, one might logically assume that it
would not be in the best interests of a psychologist already named as a
defendant in a malpractice suit if it also could be shown that the psychol-
ogist had failed to adhere to APA standards or guidelines that were ger-
mane to the matter under litigation.
The guidelines were considered to have a reasonable relationship to
the purposes and principles of APA (as set out in its bylaws and other rel-
evant documents). In light of the extensive review procedures and input
from authoritative groups of psychologists, the attorneys assumed that
there was sufficient reason to believe that the statements were reasonable,
64 DURAND F. JACOBS
just, and fair. They pointed out that this judgment could be made only by
peers. The wide distribution of preliminary drafts of the documents and
their repeated reviews by divisional professional standards committees and
approval by elected representatives to the Council of Representatives
appeared to satisfy the consideration regarding adequate notice of publi-
cation and implementation of the policy statements. The attorneys were of
the opinion that if APA decided to enforce the specialty guidelines in a
manner consistent with the procedures used by the APA Ethics Committee,
this would satisfy the due process requirement.
The attorneys also concluded that for the most part the specialty guide-
lines "appear to provide a clear guide to psychologists as to the conduct
which their profession expects of them." It was their considered opinion,
however, that APA could anticipate certain problems should it attempt to
enforce each and every guideline in a similar manner. Examples of possibly
troublesome items where precise measures of compliance might be difficult
to ascertain included those that referred to psychologists maintaining cur-
rent knowledge of scientific and professional developments that are related
to the services they render; those encouraging psychologists to develop
innovative theories and procedures that they would be prepared to support
on an appropriate theoretical or empirical basis; those that stipulated that
psychologists maintain a continuing cooperative relationship with col-
leagues and co-workers; and the item specifying that psychologists promote
the development of a physical, organizational, and social environment that
facilitates optimal human functioning. This was not meant to imply that
such guidelines could not be enforced. Indeed, it was the attorneys' opinion
that all the guidelines were technically enforceable. What concerned them
was the enormous potential burden that administering an enforcement
mechanism might have on APA staff and financial resources. They raised
the questions as to whether a voluntary professional association should
itself assume the task of policing the conduct of its members to the extent
envisioned by the standards and specialty guidelines. Or should it instead
present its policy statements on practice in a manner that prOVided clear
guidance to the profession and the public while leaVing the job of enforce.:
ment to state licensing authorities? They concluded with the observation
that, should the profession ultimately decide to enforce some or all of the
standards and guidelines of practice, they highly recommended the peer
review mechanism outlined in the Professional Standards Review Committee
Procedure Manual (American Psychological Association, 1975).
SUMMARY
APA has several major options to consider when deciding about future
implementation of its policy statements on practice. At one extreme it could
decide that it would be sufficient to offer its policy statements as guidance
to its members, the profession at large, and the public, and leave the task
of enforcement entirely to others. At the other extreme it could decide to
enforce its policy statements on practice wholly and independently, as it

presently enforces its ethical standards. A more likely outcome lies in the
middle ground between these extremes. For instance, the organized profes-
sion might use its presently established national resources (e.g., CAFCOE)
or state level resources (e.g., PSRCs) actively to influence specific local deci-
sions affecting practice, but to do so in a manner short of direct regulation
or enforcement. The most attractive and readily available means would
appear to be utilization of the state PSRCs in an advisory capacity to all con-
cerned parties. Reviews could be done on either a proactive or reactive
basis. Voluntary compliance with a recommendation of their peers would
be expected of psychologists under either type of review.
The special advantage of the PSRCs is that they could be utilized for
any practice issue involving a psychologist, whether or not that individual
was a member of the national or state psychological association. This would
greatly expand the influence of APA's policy statements, since any direct
enforcement of its policy statements by APA would be limited in scope to
its members. Although they have no direct enforcement powers, each state
PSRC, acting as a responsible representative of the profession, is obligated
to refer suspected violations of professional ethics or local statutes to other
appropriate bodies, e.g., the state or national ethics committee, or to the
licensing board.
Another advantage of using the PSRCs for implementation of the stan-
dards and specialty guidelines is that these committees are already func-
tioning to one degree or another in every state. This not only would serve
to divide and distribute the workload and responsibility for administration
of oversight procedures, but also would greatly lessen the cost to all con-
cerned parties by permitting quality control activities to be conducted at the
local level. The proposed expansion of PSRC functions would provide law-
makers with convincing evidence that the profession intends to invoke its
special obligation to protect the public welfare and to correct improper
practices of psychologists.
THE ROAD AHEAD
In forecasting what the next five years will bring to affect the content
and application of standards and guidelines of practice, one can anticipate
important developments in at least five areas. These are: competency assess-
ment, written documentation of service activities, use of paraprofessionals,
new moves toward regulation of practice, and the emergence of new spe-
cialties in professional psychology.
COMPETENCY ASSESSMENT
To an unprecedented degree major research efforts will be mounted on

a national scale to assemble criteria that ultimately will be applied to rec-
66 DURAND F. JACOBS
ognize competent psychologists on the basis of their practice outcomes.

There is no doubt that APA will pursue actively the promise made in the
1980 specialty guidelines "to identify professional practitioners' behaviors
and job functions, and to validate the relation between these and desired
client outcomes." To the extent that these efforts are successful, levels of
competence could be evaluated directly in terms of demonstrable changes
achieved in a client's condition, performance, or circumstances. In time this
operational method would replace the present inferential basis for evalu-
ating competence, i.e., that successful outcomes can be expected of those
with doctoral degrees in psychology from accredited institutions of higher
learning who have demonstrated to peers that they possess the requisite
knowledge and appropriate technical skills deemed necessary for profes-
sional practice. Likely applications of the competency criteria evolving
from field investigations would be to judge entry level capabilities of new
practitioners and to periodically assess the proficiency of those in practice.
The scope of competency assessment can be expected to extend over the
entire range of applied professional activities. For instance, one set of stud-
ies might probe the reliability and utility of conclusions reached by psy-
chologists on the basis of formal psychological examinations. Indepen-
dently verified client outcomes would be the touchstone for evaluating the
efficacy of recommendations made by psychologists for school or occupa-
tional placements, for assessing the validity of recommendations concern-
ing product developments, treatment, or rehabilitation planning, parole,
eligibility for compensation, competency to stand trial, suitability to retain
custody of a child, etc.
A second group of studies might be directed to evaluate outcomes of
psychological interventions designed to facilitate improved functioning of
individuals and groups. Outcome studies of this type would examine the
relationships between receiving specified psychological services and direct
changes in the client's presenting problem, as well as subsequent modifi-
cations in the client's ability to function in desired self-directed activities,
or in interpersonal relationships, or in targeted occupational, school, or rec-
reational pursuits. Naturally, the kinds of client outcomes selected as
dependent variables would differ as a function of the populations, settings;
and specialty practices to be evaluated. Many practical questions remain
unanswered about who will design and direct such studies, how they will
be supported, and who will voluntarily participate in them. Preliminary
research will be required to determine baseline expectancies for stipulated
outcome criteria as well as to parcel out the effects of a host of contributing
independent variables. Early starts in this direction will doubtless uncover
that even more perplexing problems need to be solved before substantial
progress can be made on this wholly unprecedented course for assessing
the competence of professional psychologists. What is quite clear, however,
is that the die has been cast irrevocably to redefine eventually the quality
of services in terms of results obtained. Psychology's initiatives in this area
will have profound reverberations for other human service professions.
DOCUMENTATION of SERVICES
Movement toward validating the relationships between client out-

comes and psychological services received will necessitate systematic
recordkeeping, particularly documentation of the need and plan for service,
types of interventions used, progress made, and specific outcomes obtained.
The same kind of information is required for the conduct of most peer
review and related quality control activities. Increasing demands from both
these quarters will constitute the most immediate prod for greater docu-
mentation of psychological services. Requirements for documentation can
be expected to be greater and more stringent for psychologists employed in
health, education, and rehabilitation settings, particularly in those facilities
that choose to seek accreditation through external review procedures. Prac-
titioners in the private sector will not escape more frequent review of their
records, particularly those whose clients are members of prepaid health care
plans or whose care is supported by tax dollars. Even that minority of psy-
chologists whose case files remain untouched by peer reviewers can expect
to be confronted by increasingly knowledgeable clients exercising their
right to examine their own records. APA has already initiated collaborative
projects with CHAMPUS and the AETNA Life and Casualty Insurance
Company to establish model peer review procedures to process the rapidly
increasing number of claims being submitted by psychologists. APA's pol-
icy statements on standards and guidelines of practice will be utilized to an
increasing extent by those conducting peer review activities in the years
ahead.
USE OF PARAPROFESSIONALS
Pressures to reduce unit costs of psychological services coupled with

increased demands to make such services more accessible to greater num-
bers of users will stimulate more utilization of paraprofessionals by psy-
chologists practicing in most settings. While multilevel delivery of service
systems may add to psychologists' personal status and material rewards, the
prospect of bringing in paraprofessionals has received a mixed reception. It
has provoked fears in some psychologists about loss of professional auton-
omy and control, raised concerns about increased client vulnerability, and
posed questions about whether such changes will produce watered-down
quality of services. Actual experience, however, has demonstrated that well
trained and properly supervised paraprofessionals contribute effectively to
many aspects of psychological service activities (Jacobs, 1974).
Utilizing paraprofessionals for more routine tasks has freed psycholo-
gists to apply their unique skills and knowledge to more demanding profes-
sional problems. Experience also has shown that the client needs to be care-
fully informed about the identity and particular functions of each member
of the psychological team. In the future support personnel must be trained
68 DURAND F. JACOBS
to better understand their limits and to hew to defined functions and scope
of operations. On the other hand, psychologists must become more sensi-
tive to their professional accountabilities for the activities of those they
direct and supervise in the course of providing psychological services.
More pervasive and profound than these workaday adjustments are the
professional role changes that will evolve for psychologists as they make
more use of paraprofessionals. These go considerably beyond the pragmatic
question of who will do what for whom, and subsequent division of labor
among the two groups (Jacobs, 1972, 1974). As the broad service functions
that comprise professional practice are systematically subdivided to identify
those methods that can be applied by trained paraprofessionals, the "laity"
acquires skills that previously had been the exclusive prerogative of the
professional. A critical indicator of professionalism is the high degree of
autonomy and exclusiveness that professionals enjoy in the performance of
their work. A potential source of strained relations between professionals
and their paraprofessional assistants is concern that the latter group may
usurp a measure of this independence, thereby blurring the professional's
role and status. This problem will become more acute as the overlap
between historical professional functions and delegated paraprofessional
duties increases. One can expect future revisions of APA standards and
guidelines for practice to show expansion of those sections dealing with the
three-cornered relationship between the professional, the paraprofessional,
and the client. State statues (e.g., in California) have already begun to
address these issues. While organized psychology must wait for accumu-
lated experience to cast more light on these matters, in the final analysis the
key factor determining future use of paraprofessionals will be whether or
not the client has benefited.
REGULATION OF PRACTICE
The entire professional community, including psychologists, can

expect no immediate relief from demands for strict accoul'!tability and qual-
ity control of the services they provide. Practicing psychologists may expect
their credentials and service,s to be scrutinized by several different groups:
the direct users of services, third-party payers, employers, deSignated peer
review groups, and state licensing boards. The best strategem for reducing
the weight of review from those outside the profession is to increase the
visibility, credibility and effectiveness of self-regulation within the profes-
sion. Consequently, one confidently can predict that the immediate future
will witness an acceleration of APA's efforts to implement its policy state-
ments. Having promulgated them, the Association has no other credible
course to take. It is very much to a profession's advantage to retain the ini-
tiative in specifying the criteria for regulation of its members. Such action
has been recognized by the U.S. Supreme Court as an appropriate respon-
sibility of a professional association. Even if licensing boards, third-party
payers, employers, consumer groups, and/or legislators choose to expand
their own roles in exercising greater control over psychological (and other
professional) services, they likely will give cognizance to the profession's
efforts to do likewise. What is certain is that in the absence of meaningful
and effective self-regulatory actions conducted by the profession, psychol-
ogists are much more vulnerable to controls promulgated by others.
EMERGING SPECIALTIES IN PROFESSIONAL PSYCHOLOGY
Professional psychology, along with other human service professions,

has been caught up in the boomlet of credentialing of specialized functions
that has accelerated progressively since the early 1970s. The public has
shown a growing interest in obtaining more explicit information about
what specialties are recognized in professional psychology and how to con-
tact individuals who are qualified in them. For instance, at this writing con-
sumers seeking a specialist to help them with a given problem are at a loss
to ascertain who is qualified either by knowing that the psychologist is
licensed or by the nature of the psychologist's listing in the local telephone
directory. A number of state licensing boards have indicated that, as a sup-
plement to generic licensing of psychologists, specialty credentialing
would afford the public an added measure of protection by identifying
practitioners who are particularly well qualified to utilize specialized skills
or to work with particular problems or populations. The Federal Trade
Commission (FTC) already has forced some professions (i.e., optometrists,
dentists) to break their historical pattern of aloof silence and to provide the
public with relevant information regarding their special skills, unique ser-
vices, fees, and so forth. This information is needed before consumers can
make an informed choice of a service provider. Having made a successful
start, the FTC is now stalking the "big game" of medicine and law. Even-
tually all professions, including psychology, can expect to be held to a much
higher standard of open and candid communication with the public about
the services they offer. This will spur a level of healthy competition never
before seen among individual professionals and between different profes-
sionals offering similar services.
Until APA' s policy statements outlining the parameters of specialty
practice were published in 1980, the courts had no recourse but to consider
the views of individual experts when reaching decisions about such mat-
ters. For instance, when reviewing a lower court's decision in the case of
Midwestern Psychological Services, Inc. et al. v. Potts and Potts (1979), the
appeals panel observed: "Generally, one who undertakes to practice in a
given specialty, even on a part-time or limited basis, is held to the standard
of care of the specialty while practicing it." While this statement contains a
certain logic, it is not fully consistent with AP A's policy as set forth in the
specialty guidelines (p. 1). Employers as well as governmental and private
health insurance underwriters also have sought guidance from the profes-
sion to identify psychologists qualified to provide health care services. In
1975, because APA was not prepared to offer such information, a free-stand-
70 DURAND F. JACOBS
ing group of psychologists was organized to do so. Called the Council for
the National Register of Health Service Providers in Psychology, it devel-
oped criteria to screen voluntary candidates and has published a recurring
directory listing psychologists qualified to provide health services.
Impressed by the success of the National Register, other groups of psychol-
ogists have become convinced that specialty credentialing of this sort
would help them compete with their noncredentialed peers and with spe-
cialists in other professions who were providing similar services to the pub-
lic. These groups included psychologists whose practice had come to be
concentrated on select problems, settings, or populations, e.g., rehabilita-
tion, forensics, mental retardation, gerontology, alcoholism, psychoanaly-
sis, neuropsychology, women, and child clinical. In recent years each of
these groups has petitioned APA for recognition as a specialty of
psychology.
By late 1978 the sum of these pressures from within and outside of APA
prompted the Board of Professional Affairs to convene a Task Force on Spe-
cialty Criteria, charged with reviewing this matter in depth and returning
definitive recommendations for action. In May 1980, the task force submit-
ted its final report, "Characteristics and Criteria of a Specialty in Psychol-
ogy." Sections of that report are quoted below:
Specialties grow out of a history and tradition of service, research and scholar-
ship which identify a relationship between an area of need and a body of rel-
evant knowledge and skills within the profession. The Task Force on Specialty
Criteria recommends creation of a committee, to be called the Committee on
Specialty Designation (CSD), which will recognize specialties in psychology
using the following criteria. All of the criteria must be met by any group wishing
recognition for a specialty in psychology.
I. Criteria for Identification of a Specialty
In order to be designated as a Specialty in psychology, a group applying to
the Committee on Specialty Designation must:
A. Define the specialty in terms of a body of knowledge and a set of skills
related to the knowledge base. The skills of this specialty must have dem-
onstrated efficacy for dealing with particular problems, service populations,
and settings. This demonstration of efficacy would not be restricted to out-
come studies, but would include a variety of research designs and methods.
B. Specify the knowledge and skills of the specialty to be acquired through a
sequential academic curriculum and a professional training program which
include the core knowledge of psychology but go well beyond it. The spe-
cialty academic courses and training may overlap those of other specialties.
However, it is expected that a significant portion of the predoctoral educa-
tion and training of one specialty will be different from the education and
training of another specialty. Ordinarily this entails at least one year of
coursework and supervised training in the specialty predoctoral program
and may require additional postdoctoral specialty training. Psychologists
who wish to "add an additional area of applied specialization must meet
the same requirements with respect to subject matter and professional skills
that apply to doctoral (and post-doctoral) training in the new specialty."
(Standards for Providers of Psychological Services, American Psychological
Association, 1977b)
C. Show the pattern of specialty practice to be discriminably different in the

aggregate from the pattern of practice in other specialties. It is recognized
that specialties may be partially overlapping in academic background and
practice.
D. Identify doctoral programs in regionally accredited institutions in several
geographic locations which offer programs in the specialty area. These pro-
grams must offer the specialty curriculum and related supervised training,
and must have produced graduates.
E. Present Standards of Practices which define clearly the range of services
and practices for members of that specialty (e.g., Specialty Guidelines for the
Delivery of Services by (Clinical Counseling, School, Industrial/Organizational)
Psychologists. (American Psychological Association, 1980, a, b, c, d)
II. Criteria for Continued Recognition of a Specialty
Continued recognition of an area of specialty practice assumes there will
be:
A. Evidence that the specialty is responsive to an identified public need and
that the specialty practice (knowledge and skills) is relevant to the need.
B. Evidence that the specialty is engaged in ongoing investigations designed
to evaluate and increase the usefulness of its skills and services.
C. Administrative procedures for identifying those who are qualified to prac-
tice the specialty, to include:
1. mechanism(s) for certification and recertification,
2. method(s) for assessing competent performance, and
3. plan(s) for continuing education.
The preceding criteria are provided as a response to the public's need for assur-
ance that their service providers have verifiable training and experience in par-
ticular specialty areas. The above criteria are intended to establish formal guide-
lines for recognition of a specialty. Once a specialty has been deSignated by
APA, individual psychologists trained in that specialty then may be identified
as specialists. (p. 8)
Two preliminary drafts of the criteria proposed above stimulated a

mixed reaction from APA members. The most vociferous concerns were
voiced by those who feared that, once begun, specialty recognition would
snowball and lead to fragmentation of the profession, regressive educa-
tional and training practices, and a loss of credibility in the eyes of the pub-
lic. The prevailing view, however, was to the contrary. Self-proclaimed spe-
cialties already were emerging at such a rate that formal criteria for
specialty recognition were essential if APA was to maintain orderly and
responsible growth of the profession and, thereby, control fractionation.
Perhaps the most critical decision made by the task force to stay the
threat of progressively refined specialization to the point of absurdity was
to draw an initial distinction between what was a specialty in professional
psychology and what was a "special proficiency" in practice. Typically,
when organizations other than APA certify a practitioner as trained to offer
a specific service, they are designating persons who possess a special pro-
ficiency. Organizations created for this purpose include the American Asso-
ciation of Marriage and Family Counselors, the National Association for
Accreditation in Psychoanalysis, state and national biofeedback societies,
the Council for the National Register of Health Service Providers in Psy-
72 DURAND F. JACOBS
chology, and the American Society for Clinical Hypnosis. The task force
recommended that APA adopt the term special proficiency to recognize the
mastery of a special skill, special technique, or indepth knowledge of the
needs of a specific population or problems of a specific setting. A special
proficiency is not bound to anyone specialty of psychology. Some are not
even unique to the profession of psychology. Working with certain popu-
lations (e.g., the aged, children, women, or the developmentally disabled)
or in some settings (e.g., schools or prisons) may require one or more special
proficiencies. The task force noted examples of special proficiencies com-
monly utilized in three major areas of psychological practice:
1. Behavior change (e.g., psychoanalysis, hypnosis, group therapy, bio-
feedback, behavior modification, marriage and family therapy, sex
therapy, vocational counseling)
2. Evaluation or assessment (e.g., neuropsychological assessment, com-
petency evaluation, program evaluation, market surveys, consumer
research and product evaluation)
3. Consultation (e.g., management consultation, organizational devel-
opment, and consultation to organizations such as police, schools,
military, community agencies, industries, courts and health
facilities)
The criteria finally proposed by the task force emphasized that a spe-
cialty of psychology represented an integration of basic knowledge ,and
skills, acquired during doctoral preparation for practice within a broad sub-
ject matter area of psychology. Many special proficiencies could be sub-
sumed within a given specialty area. The task force endorsed APA's posi-
tion that general providers of psychological services should not be
prevented from using the methods or dealing with the populations of any
specialty except insofar as they voluntarily refrained from prOviding ser-
vices that they were not competent to render. (American Psychological
Association, 1980c, p. 1)
EPILOGUE
One might conclude from the above discussion that the road ahead for
professional psychology is beset with challenges on all sides. Although lit-
erally true, such a conclusion would fail to recognize that the issues asso-
ciated with the development and implementation of standards and guid-
lines for practice are but necessary stepping stones on the way to full
maturation of the profession. Psychologists are not alone in being held
increasingly accountable for the efficacy and quality of the services they
provide and for the adequacy of outcomes obtained by virtue of their inter-
ventions. This reflects the tenor of the times. It represents the new relation-
ship that a much more sophisticated public is demanding between itself and
each of the helping professions. APA's continuing commitment to develop
and revise its standards and guidelines for practice is the hallmark of a
responsible profession. It reflects the high ideals of American psychology
and the confidence it has in its own vitality and ability to achieve the goals
it has set. For these reasons, the road ahead should lead to substantial
rewards both for those who will receive psychological services and for
those who will provide them.
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3
Ethical and Professional Standards in
Psychology1
GERALD P. KOOCHER
The prerequisites for conducting an ethical practice in psychology go far

beyond professional competence and good intentions. They include, at the
very least, a degree of professional sophistication, a solid measure of com-
mon sense, a high level of personal integrity, the exercise of careful plan-
ning, and the ability to establish good interpersonal rapport. While these
may seem to belabor the obvious, it is worth noting that a substantial minor-
ity of those judged guilty of violating the Ethical Standards of Psychologists
(American Psychological Association, 1977a) appear to have done so with-
out intent or awareness (Keith-Spiegel, 1977). Given this reality, this chap-
ter will address three basic concerns. First, the evolution of the Ethical Stan-
dards of Psychologists (American Psychological Association, 1977a) will be
reviewed from a historical perspective. Second, the extant organizational
and procedural structures for refining and enforcing ethical standards in
professional psychology will be addressed. Finally, a condensed series of
topics relevant to day-to-day professional practice issues will be discussed
with the ultimate goal of making it possible for the reader to anticipate and
prevent many types of ethical problems.
IThis chapter was completed early in 1979, shortly after the APA Council of Representatives
approved the revisions of the 1979 Ethical Standards of Psychologists. Unforeseen delays by
other authors of this volume postponed submission of the manuscript to the publisher until
mid-1981. On January 24,1981, the APA Council of Representatives adopted a new revision
retitled: Ethical Principles of Psychologists. This document was published in the June, 1981,
issue of the American Psychologist (36, 6, 633-638).
The 1981 revision includes both substantive and grammatical changes over the 1979
version. The basic principles and thrusts of the ethics code as discussed in this chapter, how-
ever, remain unchanged. Behavior considered problematic in 1979 is not suddenly approved
and this chapter is by no means obsolete. The changes basically revolve around which issues
GERALD P. KOOCHER • Department of Psychiatry, Children's Hospital Medical Center,

Boston, Massachusetts 02115.
77
78 GERALD P. KOOCHER
HISTORICAL PERSPECTIVES
The development of ethical standards parallels to a substantial degree

the development of psychology as a profession. A detailed review of this
progress over a 30-year period is well presented by Golann (1970), begin-
ning in 1938 when the total membership of the American Psychological
Association was 2,318. In that year the APA formed a special committee to
consider the advisability of an ethical code. Although the committee was
able to resolve many ethical complaints informally, it was not empowered
to receive or investigate such complaints formally. As a result, a standing
committee of the AP A designated the Committee on Scientific and Profes-
sional Ethics and Conduct (CSPEC) was created in 1940 to consider com-
plaints of unethical conduct. Work on a formal code of ethics was begun in
1947, with the goal of applying an incident collection technique to develop
the standards. In 1948 the 7,500 members of the APA were asked to submit
incident or case reports detailing ethical problems, and more than 1,000
were received. These reports were classified into six categories:
1. Public Responsibility
2. Client Relationships
3. Teaching
4. Research
5. Writing and Publishing
6. Professional Relationships
During the next 4 years these data were used to prepare drafts of an
ethical code, which were in turn shared and debated in departments of psy-
chology and at local, regional, and national professional meetings (APA
were of most current concern to the governance of the APA. There are, however, four new
twists that are deserving of the reader's notice.
First, a 10th principle, "Care and Use of Animals," has been added. This was drafted by
a special subcommittee and was intended to formalize in the ethics code what had hereto-
fore been less explicit guidelines without substantial enforcement mechanisms. Principle
nine, "Research with Human Participants," was also reworked substantially in keeping with
federal guidelines and current practices. Principle seven, "Professional Relationships," was
also made more explicit. This is especially true of section 7c which defines "sexual harass-
ment" as a specific ethical violation. Finally, and perhaps most reflective of recent changes
in American culture, Principle four, "Public Statements," has been rewritten in much more
explicit fashion. Advertising in the broadcast media and participation in broadcast talk
shows are among the areas impacted. In general the new principle is based on the concept
that relevant consumer information may be communicated via the media. So long as adver-
tisements are now explicitly announced as such and are not false, deceptive, based on mis-
interpretation, testimonials, appeals to fear, exaggerated claims, or direct individual solici-
tations, they may be appropriate. In the past there was also a prohibition against the giving
of "personal advice" by means of the public media. This blanket ban is now lifted on the
basis that such advice is likely to be demanded in a variety of quarters and it is preferable
that it come from well-trained colleagues rather than from others who might not meet the
standards of adherence to the ethics code. Psychologists who choose to provide such advice,
however, are enjoined to exercise the highest standards of professional judgment.
ETHICAL AND PROFESSIONAL STANDARDS IN PSYCHOLOGY 79
Committee on Ethical Standards for Psychology, 1951a, 1951b). The code

was adopted first in 1953, and subsequently a refined version with 18 gen-
eral principles was promulgated in 1959 on a trial basis for 3 years prior to
its formal adoption. Several revisions later the most recent Ethical Standards
of Psychologists was adopted in 1977 (American Psychological Association
1977a) when the APA's membership had reached 44,650. Continuous
refinement of the ethical code is likely as the profession continues to
develop. The process involves drafting of revisions by CSPEC or ad hoc task
forces on its behalf, presentation of the proposed changes to the member-
ship for comment, and finally a vote on formal adoption by the APA gov-
ernance structure. The revised standards continue to rest on the original
empirical foundations of the ethical code in the sense that changes evolve
as a function of the number and sorts of incidents called to CSPEC's atten-
tion. The most recent version is the end product of 9 years of work by sev-
eral task forces and CSPEC and passed through 12 draft versions prior to its
formal adoption in January, 1977. Some areas of controversy still remain,
especially those dealing with announcement of services to the public (i.e.,
advertising) and issues related to confidentiality. While these are to be dis-
cussed later in this chapter, the reader can anticipate continued evolution
of those portions of the Standards.
ETHICAL STANDARDS AND RELATED DOCUMENTS
In addition to the Standards themselves the CSPEC operates by a formal

set of Rules and Procedures and the directives of the APA Bylaws (Committee
on Scientific and Professional Ethics and Conduct, 1974, and American Psy-
chological Association 1978, respectively). In addition, eight policy state-
ments covering topics such as the care and use of animals, guidelines for
conducting growth groups, guidelines for telephone directory listings, and
standards for providers of psychological services are referenced in the Eth-
ical Standards. While these documents are not considered a part of the Stan-
dards per se, psychologists should be familiar with them and especially to
those related to one's specific areas of practice.
Professional psychologists will be particularly interested in the guide-
lines for conducting growth groups (American Psychological Association,
1973a), standards related to educational and psychological tests (American
Psychological Association, 1974), and standards related to provision of psy-
chological services (American Psychological Association, 1977b). The policy
statements of more direct interest to academic and research psychologists
are omitted from this listing, as is the statement on telephone directory list-
ings. The former documents should be sought out as needed, but the latter
is out of date and revision is pending in the face of changing advertising
standards for psychologists which will be discussed later in this chapter.
In an effort to maximize its educative functions and establish an archi-
val record of case precedents CSPEC recently decided to make detailed
annual reports available to the APA membership. The reports appear in the
December issues of the American Psychologist beginning with the 1979 vol-
ume. In addition to reporting on the types of cases investigated these
reports will include suitably disguised descriptions of different or recalci-
trant cases in a fashion that hopefully will prove useful in guiding psy-
chologists and preventing similar problems in the future.
Whereas the Ethical Standards and Rules and Procedures are generated by
CSPEC, many other boards and committees of the APA are concerned with
professional and scientific ethics and standards. Thus, although CSPEC is
the main organizational structure for dealing with ethical infractions, the
various policy statements noted previously are products of other boards,
committees, or task forces. Given this level of complexity it is important to
recognize how these different groups, and policy statements they evolve,
interact. When it comes to drafting policy statements, the board or commit-
tee initiating the project invariably will circulate draft copies to the mem-
bers of the other panels for comment. Each board or committee has staff
member liaison at the APA central office, thus making it possible for coop-
erative sharing of policy formulations between the different groups whose
members may meet formally only a few times per year.
THREE INTERACTING COMMITTEES
Within the APA there are at least three different standing boards or
committees empowered to receive and investigate various complaints on
ethical matters-CSPEC and two other groups known by the acronyms
BSERP and CAFCOE.
CSPEC currently consists of seven APA members elected for staggered
3-year terms by the Council of Representatives. The members must be cho-
sen to reflect the range of interests characteristic of psychology in all of its
aspects and be drawn from different geographical areas (American Psycho-
logical Association, 1976). In addition to being the point of origin for
amendments to the Ethical Standards, this body is broadly empowered to
receive complaints against individual members, investigate those complaints,
and take a wide range of disciplinary actions (Committee on Scientific and
Professional Ethics and Conduct, 1974). CSPEC meets at least three times a
year in Washington, D.C., to review cases and issues, but between meetings
correspondence and coordination is managed by the administrative officer
for ethics, who is a doctoral-level psychologist on the senior staff of the
APA. All investigations of CSPEC are confidential and focused on individual
members.
CSPEC has wide discretion in decisions about actions to be taken when
charges of an ethical infraction are sustained. These may range from a "cen-
sure" or "reprimand," which are confidential admonitions to the member
psychologist from CSPEC, to a recommendation of expulsion to the board
of directors of APA.
Another body within the AP A governance structure that is empowered

to receive and investigate ethical grievances is the Board of Social and Eth-
ical Responsibility (BSERP [sic]). This body currently consists of 10 members
chosen for staggered 3-year terms similarly to CSPEC. The mandate of
BSERP is broader and more oriented toward social policy at large than is
CSPEC's mandate. BSERP has "general concern for those aspects of psy-
chology that involve solutions to the fundamental problems of human jus-
tice," especially involving "the internal operations of the Association" and
"the roles of psychologists in society" (American Psychological Association,
1978). While BSERP has limited investigatory authority and may propose
policy actions to the APA governance structures, it lacks the capacity to take
disciplinary action against members. It also differs from CSPEC in that it
need not limit its role to complaints against individuals who are members
of APA. Its mandate permits examination of problems related to organiza-
tions and roles having interface with psychology in a broad sense.
Another body with limited investigatory powers is the Committee on
Academic Freedom and Conditions of Employment (CAFCOE [sic]). This
group has a broad mandate for receiving and investigating complaints rel-
ative to employment conditions and academic freedom. It has often been
an effective body for resolving disputes between psychologists and their
employers, a task that CSPEC is often unable to engage in because of its
focus on individuals and the constraints placed on it by confidentiality.
While CAFCOE has no disciplinary authority, it can act as a third-party
negotiator to assist in the resolution of disputes. At times the negotiations
may call for an arbitrator's role, while in some circumstances CAFCOE may
act more as an advocacy group in response to a complaint.
Cases sent to one or another of these groups are occasionally referred
back and forth for action as events warrant. A psychologist frequently may
contact one group with an inquiry or complaint more appropriate to the
functions of another. On other occasions the initial investigation conducted
by a committee might produce evidence that could more effectively be dealt
with under the procedures used elsewhere.
ApPLICATION AND ENFORCEMENT OF ETHICAL STANDARDS
Up to now this chapter has focused on the various ethical codes and
related policies of the American Psychological Association. Although all
APA members, nearly 50,000 as of this writing, are bound by the organi-
zation's Ethical Standards of Psychologists, they have chosen to abide by them
voluntarily. That is to say, they choose to uphold these standards as a func-
tion of organizational membership. Since many psychologists do not
belong to APA, it would seem that they are not bound by the same stan-
dards. In the jurisdictional sense that is quite true, although technically
most licensed psychologists in the United States ultimately become respon-
sible for upholding the same standards or very similar analogues.
All 50 states and the District of Columbia have statutory licensure or

certification laws influencing the practice of psychology (see Chapter 11).
The same 51 jurisdictions have state psychological associations affiliated
with the APA. All of the state associations and many smaller local psycho-
logical associations require their members, some of whom are not APA
members, to adhere to the Ethical Standards and enforce this through orga-
nizational ethics committees. Virtually all of the statutory licensing author-
ities have adopted rules of practice with some adopting the APA standards
by name, others adopting a modified version, and still others requiring
licensees to pledge to uphold either the APA standards or those of the
American Personnel and Guidance Association (APGA). As a result, a per-
son who wishes to practice as a psychologist generally will end up being
accountable to the APA standards or some similar code even if he or she
chooses not to join a voluntary professional organization.
In addition to the organizations and statutory licensing authorities that
may require adherence to ethical standards, professional standards review
committees are playing an increasingly important role in this respect when
service delivery is involved. As noted elsewhere in this volume (see Chap-
ters 2 and 9), peer review systems are becoming increasingly more impor-
tant as a means of evaluating professional services and assuring adherence
to the Ethical Standards. In the foreseeable future virtually every health ser-
vice provider will be accountable to some peer review group except those
in some jurisdictions that exempt governmental employees or those work-
ing for certain nonprofit agencies from statutory licensing or peer review
requirements.
WHAT SHOULD I Do WHEN CONFRONTED WITH AN ETHICAL PROBLEM?
The ideal manner for coping with ethical dilemmas is preventive antic-
ipation, and that is the main purpose of this chapter. By giving careful con-
sideration to the sorts of problems that may confront the professional psy-
chologist from time to time, it should be possible to avoid many common
pitfalls, especially since, as noted earlier, many ethical violations result
without malicious intent or awareness on the part of the psychologist
(Keith-Spiegel,1977).
For the purposes of this chapter, ethics are defined as the principles of
conduct governing an individual or group, including the specific duties and
obligations that are a part of the professional psychologist's role. These will
be discussed in more explicit detail later in the chapter. First, consider the
circumstances wherein the psychologist is faced with a situation recognized
as posing some ethical questions. An initial step would be to seek consul-
tation with colleagues about the problem and discuss the ethical issues and
alternatives. When colleagues are not readily available for such discussions,
state association ethics committees can generally be quite helpful. Often the
chair of such committees will be willing to offer informal consultation
about professional practice issues or hypothetical case situations and some-

times the full committee may be able to respond. The APA committees
involved in such issues are willing to perform similar advisory tasks. Often
questions can be answered simply by a phone call to the secretary of CSPEC
at the APA central office, but if the question can wait until the next com-
mittee meeting a response from the full committee is also obtainable. Some
examples of questions posed to CSPEC in recent years include: "Is this sam-
ple advertisement ethically permissable?" "What should I do if I think my
psychologist-employer-supervisor is behaving unethically?" "Is it okay to
pay a percentage of my private practice to the person whose office I share
or is that fee-splitting?" and "Am I exempt from the APA ethical code
because I am a federal employee?" While these specific issues will be
addressed later in this chapter, the point to be made here is that anticipation
of problems and seeking consultation with peers is the first line of defense
against later being accused of ethical misconduct. To paraphrase the famous
proverb, an ounce of education is worth a pound of disciplinary remedy.
Unfortunately, there are many problems that will come to the psy-
chologist's attention wherein prevention is no longer the issue. How, then,
is one to respond when the potentially unethical behavior is in progress or
recently completed? Again, the best first step is informal educative contact.
Whenever possible it would be desirable to make informal contact with the
colleague in question on a confidential basis in order to share your concerns
about the ethical problem that has come to your attention. There are indeed
some risks involved since this is a sensitive area of concern to most psy-
chologists. Ideally, the colleague will respond to a polite, tactful, educative
intervention by either modifying the problem behavior, offering remedy
where necessary, or seeking additional consultation with others, if the indi-
vidual disagrees with your views. Should you receive a hostile or nonsub-
stantive response in the face of persistent problematic behavior, you regret-
tably may find it necessary to make a more formal attempt at resolving the
problem.
When enforcement of the Ethical Standards becomes an issue, a critical
first step is defining the jurisdictional authority. If the psychologist in ques-
tion is licensed, or unlicensed and acting in violation of a state statute, one
may consider a complaint to the state authorities. In some situations the
nature of the ethical problem may not be of a practice nature or may not
fall within the state authority's sphere of interest. If the psychologist who
is alleged to be guilty of an ethical violation is a member of a state associ-
ation, one might contact the chair of the group's ethics committee. Likewise,
if the psychologist is a member of the APA, one might choose to contact
CSPEC. When there is a jurisdictional overlap, it is usually preferable to
attempt a resolution at the local level. However, when there is some reason
to believe that local handling is unworkable the national organization gen-
erally will be willing to assume jurisdiction. One must remember, however,
that APA, state, and local psychological associations may act only to inves-
tigate their members, having no enforcement authority over nonmembers.
For this reason APA and most state associations permit resignations to be
accepted only by their boards of directors and such boards will not permit
resignation by members under investigation for ethical infractions until the
investigation is completed. Otherwise, a member being investigated for an
ethical infraction could choose to resign, thereby dropping out of the orga-
nization's jurisdiction.
For the sake of illustrating the process, I shall assume that is has
become necessary to pursue a complaint against an APA member by com-
plaining to CSPEC. The complainant should write a confidential letter to
the administrative officer for ethics including the following information:
the name of the member psychologist being complained against, the spe-
cific behavior found objectionable, and the reasons why this was considered
to be unethical. Information about unsuccessful attempts to resolve the mat-
ter informally or reasons why this was not attempted also would be helpful,
as would any documentary evidence supporting the complaint. The admin-
istrative officer will share this information with the chair of CSPEC in order
to determine whether the behavior described would, if true, constitute an
ethical infraction. If there seems to be some doubt about this, the full com-
mittee is asked for an opinion. Once it is determined that the matter could
fall within the committee's purview the complainant will be asked to
authorize the use of his or her name in contacting the psychologist com-
plained against. The complainant also will be provided with documents
outlining the procedures to be followed in the investigation (Committee on
Scientific and Professional Ethics and Conduct, 1974; APA, 1977a). This per-
mission is required because a person has a right to know the name of the
accuser, and unless such permission is granted the case cannot go forward.
One exception to this rule is that the CSPEC may act sua sponte (i.e., without
a specific complainant) when it has information available from a public
source (e.g., a newspaper report of a psychologist who has pleaded guilty
to insurance fraud, a questionable advertisement that was sent through the
mail, or questionable public statements reported over the broadcast media
that are called to CSPEC's attention). In such cases, however, the party com-
plained against may be told the source of the data (e.g., newspaper clipping,
pamphlet, or broadcast) on which the complaint is based.
When a case is opened, the secretary writes to the psychologist con-
cerned requesting a written response to the ethical concerns in question.
CSPEC need not share all the data it has available with the party com-
plained against, but does detail in the· inquiry letter all of the potential eth-
ical issues it is concerned with and provides copies of the same procedural
documents sent to complainants. Inquiry letters generally are sent by cer-
tified mail, are considered confidential correspondence between the party
complained against and CSPEC, and usually require a response within 30
days. It is not unusual, however, for extensions of time to be granted for
reply when extenuating circumstances require it.
Occasionally CSPEC will receive a response from an attorney rather
than the psychologist member or will be notified that litigation is pending
on matters related to the case. While responses from the attorney of the
psychologist being complained against are often substantive, CSPEC gen-
erally requires a personal response from the psychologist in recognition of
the fact that professional ethics revolve on the cornerstone of peer review
rather than legal process per se. If litigation is pending on a matter that
CSPEC is investigating the case will be opened and tabled pending the out-
come of the litigation. Although every effort is made to ensure fairness and
due process to all parties involved in an ethics inquiry, strict legal rules of
evidence do not apply. In one recent case, for example, a psychologist who
was convicted of a misdemeanor involving an assault on a patient admitted
committing the act but expressed the opinion that an ethics charge should
not be sustained against him since the evidence presented at his court hear-
ing on the charge was obtained illegally. While a court of law may ulti-
mately clear the psychologist of the charge on that technicality, CSPEC
determined that the behavior was unethical regardless of the circumstances
under which the charge of assault was brought.
Only rarely is it necessary to proceed with a formal hearing or fact-
finding panel as discussed in the rules and procedures of CSPEC (1974).
Such hearings are convened chiefly when CSPEC determines that the accu-
sations against the member psychologist might warrant, if true, expulsion
from the APA. In such cases the member psychologist may be asked to
appear before CSPEC sitting as a hearing panel in Washington, D.C., or par-
ticipate in an ad hoc fact-finding procedure arranged locally for the con-
venience of the member and witnesses. Often CSPEC is able to reach a deci-
sion on the basis of evidence collected through correspondence, court
transcripts, or other documentary materials.
Formal sanctions are rarely needed since most ethics panels consider
themselves to be educative first and punitive only when absolutely neces-
sary. In many instances psychologists simply may consent to change certain
questionable practices, desist from others, obtain supervision or consulta-
tion in the community, take some remedial actions, or otherwise improve
the circumstances that led to the initial complaint. When a spirit of coop-
erative colleagiality is demonstrated, ethics panels are generally inclined to
avoid a formal fault-finding process. The critical variable is generally
whether or not a client has been harmed and the extent to which that can
be remedied or prevented in the future. The word client as used above also
may be interchanged with student, patient, colleague, or any other person
or group with whom the psychologist interacts in a professional capacity.
It should be noted that any person may complain to CSPEC, not simply
APA members. This causes difficulty from time to time when, for example,
a person who seems to be psychotic or otherwise severely disturbed issues
a rambling complaint against a member psychologist. The investigation
proceeds in exactly the same sequence as if the complaint came from a lead-
ing colleague in the profession. CSPEC members obviously may take the
bizarreness of the complaints into account in reaching a decision as to
whether an ethical violation has in fact occurred, but every potential com-
plainant is given a fair hearing. CSPEC members realize that the nature of
our profession is such that not all of our clients (and colleagues) are fully
rational at all times.
The most difficult cases facing CSPEC are those in which the parties
involved exchange claims and counterclaims while presenting little palpa-
ble evidence. Often such claims come down to being the word of one per-
son against another, and CSPEC has no choice but to close the case with no
finding. It is also not unusual for some cases to drag on for years because
they are interrupted by litigation, delays in obtaining information, and the
fact that the full CSPEC meets just three times per year. Both sides in the
dispute may become angry at the committee members for the long time
needed to collect all the data, and angrier still when their particular views
are not upheld.
There are certain circumstances when CSPEC acts more swiftly than
usual. For example, when APA is notified that a member psychologist has
been expelled from a state psychological association or has been convicted
of a felony related to his or her practice as a psychologist, the administrative
officer for ethics and chair of the CSPEC may act immediately upon a review
of the hearing or court transcript to suspend temporarily the member's APA
membership and send a "show cause" letter. This letter asks the member to,
"show cause why you should not be expelled from the American Psycho-
logical Association" for the same reasons that led to the precipitating action
at the state level. The full CSPEC will then proceed to evaluate the case as
outlined above.
As noted earlier, the most severe penalty that CSPEC can recommend
is expulsion from the APA, just as the most severe penalties at local levels
may involve expulsion from a state association or suspension of licensure.
While loss of license to practice has clear economic impact, the impact of
disciplinary action by a professional association may be less obvious, but
still substantial. To begin with, APA and most state associations are permit-
ted by their by-laws to notify each other, relevant state licensing boards,
and the American Board of Professional Psychology regarding any ethical
charges that have been sustained against a member. Therefore, even if a
psychologist is simply censured in a confidential letter from the local or
national ethics committee, this information may be shared with other rel-
evant bodies at the discretion of the originating group. In some cases the
psychologist must report being found guilty of an ethical infraction since a
question aimed at this point is asked on virtually every license application,
license renewal form, professional association membership form, and mal-
practice insurance application. Giving false information on such forms after
one has already been found guilty of a prior infraction would be viewed
very harshly by ethical review panels. When the ultimate sanction of a
professional association, expulsion, is invoked, the members of the associ-
ation often are sent a confidential notice of that action. This may make it
very difficult for an expelled psychologist to work effectively in the profes-
sional community.
KEY AREAS OF CONCERN
With the foregoing information in mind, the remaining portions of

this chapter will be devoted to a discussion of specific ethical principles that
bear most directly on the practice of the professional psychologist. For this
purpose I have made an effort to summarize and combine categories from
the current Ethical Standards of Psychologists (American Psychological Asso-
ciation, 1977a). I shall try to highlight the key issues that the professional
psychologist must attend to in order to maintain high ethical standards in
his or her practice. At the same time, I shall endeavor to call attention to
those issues where controversy exists so that the reader may consider these
issues prospectively. The unifying theme of the entire presentation is that
anticipation of problem areas is the most constructive and ethically defen-
sive posture for the professional psychologist to assume. The five problem
areas to be considered include: responsibility: competence, moral, and legal
standards; public statements; confidentiality and consumer welfare; profes-
sional relationships; assessment techniques and research.
RESPONSIBILITY: COMPETENCE, MORAL, AND LEGAL STANDARDS
Accepting personal responsibility for all of one's actions as a psychologist

is the most basic aspect of having ethical sensitivity in this area. When a
psychologist works in a large organization, institution, or practice the same
diffusion of responsibility well described in the social psychological litera-
ture (e.g., Darley & Latane, 1968) is a potential risk. This personal respon-
sibility extends from attending to the needs of clients at risk, providing
proper supervision to trainees, maintaining proper records, and so forth
down to checking reports and insurance forms for accuracy prior to signing
them. Occasional carelessness may lead to a pattern or chain of events that
erodes the ethical quality of one's practice.
Example: A psychologist was convicted of insurance fraud when it was deter-
mined that he had submitted service claims for clients he had never treated.
When called before an ethics panel, his defense was essentially that he had been
careless. He stated that he had signed blank insurance forms for the adminis-
trative convenience of the facility where he was employed and claimed that the
forms were fraudulently completed after they left his hands. He pleaded guilty
to one count of fraud and was given a suspended sentence in exchange for pro-
viding evidence against those who allegedly altered the forms. The ethics panel
found that he had not exercised sufficient professional care in this situation and
required him to obtain some supervision relative to the management of such
matters for a period of one year.
Recognizing the limits of one's competence is another key aspect of exercis-

ing professional responsibility. In addition to accurately representing their
earned credentials, psychologists are expected to practice within the bounds
of activities they are qualified to conduct. The public is often not aware of
nuances in training and may assume that the practitioner skilled in indi-
vidual psychotherapy also is competent in group therapy practice or that
any licensed psychologist automatically has been qualified to work with
child clients. Unfortunately, some psychologists make the same mistake and
treat their degree(s) as license to practice in any aspect of applied psychol-
ogy whether or not they have had specific training with the technqiues or
special client populations concerned. It is essential that the ethical psychol-
ogist be self-limiting in this respect, since the public at large will generally
be unable to do so.
Example: A licensed psychologist whose practice was limited to psychotherapy
with adults was asked to give testimony in a child custody hearing in support
of the child's father who was the psychologist's client. During the course of the
hearing an attorney and the judge asked specific questions about the emotional
status of the child, with whom the psychologist had only had transitory contact.
The psychologist proceeded to give his opinions which were accepted by the
court as "expert" testimony. The psychologist who actually had treated and
evaluated the child called the matter to the attention of an ethics panel. After a
careful review of the trial transcripts the panel concluded that the father's psy-
chologist had gone well beyond the bounds of his professional competence in
offering his opinions when he should have advised the court that he was not
competent to address those issues.
The concept of knowing oneself in terms of profeSSional competence

also extends into the personal life of the psychologist, when she or he is
experiencing enduring aberrations of personality or mental status that may
interfere with optimal service to clients. This "sick doctor" phenomenon
effects all human service professions and is particularly agonizing for men-
tal health professionals since it is obviously not unethical to be emotionally
disturbed per se (Keith-Spiegel, 1977). While most ethics panels would
attempt to be educative and sensitive to the needs of the practitioner with
personal emotional problems, the consumers of psychological services must
be protected. A psychologist should suspend himself or herself from prac-
tice when there is any doubt about interference from emotional issues in
his or her private life. When practitioners are blind to their weaknesses in
this regard, colleagues should step in to assist them in seeing the matter
from another frame of reference. The same holds true for the colleague in
need of training, supervision, or personal therapy even when the situation
does not warrant total cessation of professional practice.
Refusal to be a party to questionable practices must also be considered an
important aspect of one's professional responSibility. A psychologist should
not condone practices inconsistent with legal, moral, or ethical standards
for respecting colleagues, clients, or employees. This might include speak-
ing out against discriminatory hiring or promotion practices or violation of
the rights of patients in a facility where one is employed. Certainly a psy-
chologist should not be a party to any activities that are illegal or aimed at
avoiding regulations promulgated in the public interest.
Example: A psychologist-director at a community mental health center inter-
viewed and offered a position to a recent graduate of a distant doctoral program,
indicating that formal hiring by the governing board of the center was a mere
technicality. When the latter psychologist and her spouse visited the town for
a final interview, some local eyebrows were raised by virtue of the now evident
fact that theirs was an interracial marriage. Following the visit, the psycholo-
gist-director responded to the wishes of those on the governing board by with-
drawing the job offer. He told the applicant, "Your values are clearly out of line
with community standards and you just wouldn't fit in well," thereby condon-
ing and supporting unethical and illegal discriminatory practices.
It is also important to note that a psychologist cannot justify violation

of the ethical standards on the basis of one's employment status. If, for
example, a trainee is ordered by a supervisor to deliver services beyond his
or her range of competence without proper supervision, the trainee should
refuse to do so. In such a situation it would be the supervisor who was not
behaving appropriately, and the trainee should not condone or otherwise
be a party to this. By the same token one cannot claim immunity from the
obligation to behave ethically because one happens to be serving in the
military, as a government employee, or as the junior member of a large pri-
vate practice.
Example: The director of a governmental agency objected to an ethics inquiry
into her behavior initiated at the complaint of a subordinate. She claimed that,
while still a psychological association member, she was now primarily a poli-
cymaker/administrator rather than a psychologist. As such, she claimed, she
could not be held accountable to the ethical standards of psychologists. The
ethics panel disagreed and noted that so long as she retained membership in
the organization, she was responsible to uphold the same standards of conduct
expected of any other member.
Remaining abreast of current developments is a must for the psychologist

who hopes to deliver competent and ethical services. This would include
being aware of current scientific, professional, and legal developments rel-
evant to one's practice of psychology. Professional standards and legal
codes are constantly changing documents that evolve as a function of
changes in society and human needs. Psychologists must stay in touch with
legal and professional developments that bear on their practice in order to
deliver the most effective and appropriate services to clients. Membership
in professional organizations, participation in continuing education pro-
grams, reading relevant journals or textbooks in one's fields of interest, and
attendance at scientific meetings are but a few of the means available to
assure this. Intervention and assessment techniques, the basic tools of the
professional psychologist, also are subject to revision, refinement, and evo-
lution. In order best to serve the public interest it is critical for psychologists
to keep abreast of these developments and secure whatever training is nec-
essary to keep their skills current.
PUBLIC STATEMENTS
In presenting oneself to the general public, whether through adver-

tisements, public speaking, or presentations in the media, a psychologist
should strive for honesty, modesty, and the scientific caution appropriate to
the context. In some ways the issue of public statements in general relates
quite closely to the general issue of responsibility as discussed previously.
That is to say, the psychologist must be especially careful not to mislead the
public using his or her role as a professional in the community. This
includes not only the statements made by the psychologist her/himself, but
also statements made in the psychologist's name by advertising agencies,
talk-show hosts, magazine editors, or others. As with many types of poten-
tial ethical problems, a bit of forethought can forestall considerable diffi-
culty later on.
Maintaining control of how one's name is used will be a critical point to
remember. If a psychologist is involved in helping to devise a new instru-
ment, a textbook, or similar product, it would be wise to insist on the right
to review advertising copy in advance. If an article is written for a popular
magazine with the understanding that the editors "reserve the right to edit
for style," the psychologist should in turn insist on reviewing the final copy
for accuracy. In granting interviews, especially on live broadcast programs,
it is a good idea to meet with the interviewer and discuss the topic material
in advance. The same holds true for granting interviews with the writing
press. If you cannot fully trust the accuracy and judgement of those who
will be reporting on the interview, it might be best not to grant it.
Colleagues and members of the public frequently will call bizarre or
outrageous media "comments" by psychologists to the attention of ethics
panels. Often an investigation reveals that the psychologist who was
"quoted" or interviewed is equally shocked or embarrassed by the context
in which the comments were misinterpreted or reported. Whenever a psy-
chologist suspects that his or her name may be used in public, especially
when linked to a product or potentially sensational story, the thought
"How can I ensure accuracy?" should come to mind.
Advertising by psychologists has become an issue of considerable interest
since the Federal Trade Commission began taking steps to remove barriers
to public advertising that professional associations had tended to erect
(Koocher, 1977). Essentially, advertising by psychologists will probably be
considered "ethical" if the material uses appropriate modesty, due scientific
caution, and full respect for the limitations of our current state of knowl-
edge and represents the psychologist's qualifications and credentials accu-
rately. In that light, most simple factual statements about services being
offered to the public are probably reasonable. Advertising by psychologists
should avoid direct solicitation of individual clients, except that industrial
and organizational psychologists whose clients usually are corporations are
generally permitted to solicit these clients directly.
Example: The industrial/organizational psychologist who has designed an
assessment center program (e.g., Bray, 1976, 1977) for evaluating potential can-
didates for corporate executive positions would not be out of line by sending
pamphlets about the program to personnel managers at potential client corpo-
rations (assuming that the material in the pamphlets was accurate and not mis-
leading). On the other hand, a clinical psychologist would be considered uneth-

ical in soliciting clients were he or she to send letters describing professional
services offered to persons listed in the telephone directory. The assumption
underlying this distinction is that the corporate client is in a better position to
evaluate critically the services being offered than is the member of the public
at large. On the other hand, it would be entirely appropriate for the clinician
to send his or her detailed announcement of services to other professionals on
a person-to-person basis (again assuming that the material is accurate and not
misleading).
Aside from the issue of direct solicitation of clients, other points to

avoid in advertising services to the public would include exaggeration of
the efficacy of one's services, presentation of testimonials from "satisfied
users," or evaluative comments regarding the nature of one's services
(Koocher, 1977). Unless highly reliable and valid scientific data exist, one
should not imply that unique or special quality characterizes the services
available from any practitioner. Such statements as, "nationally known
expert," "I have helped millions," or "mind strengthening techniques
used," are examples of some claims that have been used inappropriately.
Testimonials are obviously subject to selective reporting, removal from con-
text, and other problems that make them totally out of place in advertising
psychological services.
In the past, psychologists have been strictly limited in terms of the fac-
tual material they were ethically permitted to list in public advertising. That
is in the process of change, even as this chapter is being written. A task
force on advertising developed some revised guidelines and case examples
during 1978. The interested reader should be able to obtain a copy of the
report, as long as copies last, by writing to the APA Ethics Office in Wash-
ington, D.C. The new standards permit broad listing of factual material in
advertising.
Example: Harrison Q. Troll, Ph.D.
-Licensed Psychologist
-Ph.D. granted by Jones State University in Clinical Psychology, 1974
-Specializing in treatment of children and adolescents
-Convenient office hours
-Sliding fee scale
-Health insurance accepted
-Family therapy available
-24-hour answering service
Call 555-5555 for an appointment
Assuming that this advertisement is accurate and truthful, and assuming

that Dr. Troll is indeed qualified to practice in the areas indicated, there are
no ethical violations involved. Although some might be inclined to regard
frequent insertion of this ad in the printed media or the use of boldface
type to be stylistically inappropriate, most ethics panels would probably not
be concerned. Ethics bodies are most concerned for the clients' interests and
as long as the content of the ad is appropriate the size of the letters, type
style, or frequency of appearance probably would be of little concern.
Two common problems with advertisements have to do with subtle

inaccuracies in presenting one's skills and credentials to the public. First, it
is more appropriate to list one's degree after one's name (i.e., Ph.D., Ed.D.,
Psy.D., or whatever) rather than to announce oneself simply as Dr. Harrison
Troll in an advertisement. Many professionals other than psychologists may
use the title Dr., leaving room for possible misinterpretation. By the same
token, it is unethical to list unearned degrees or degrees not conferred by
a regionally accredited educational institution when presenting oneself as
a psychologist. If a master's level psychologist holds a doctorate in another
field such as law, sociology, or English literature, only the master's degree
should be cited in any literature portraying that person as a psychologist
since the other degrees are not relevant to psychological practice. Second,
care should be taken not to exceed the bounds of one's training and com-
petence in announcing services. It would probably be unethical, for exam-
ple, to state that one provides "all types of psychological services." It is the
rare psychologist indeed who is qualified to deliver every possible type of
service from industrial consulting to individual psychoanalysis. Typically,
the individual who would run such an ad might mean that she or he pro-
vides "psychological assessment and psychotherapy for children, adoles-
cents, adults, and families." If that is the case, it is best to be specific rather
than too general.
Two sorts of controversies in this regard have come to the fore in recent
years, and I call them to the reader's attention with full honesty about their
controversial nature. Specifically, I refer to the issue of whether one may
mention APA membership status, listing in the National Register of Health
Service Providers in Psychology, or membership in other professional organi-
zations in advertisements. With regard to AP A membership, it was long
considered that membership in a scientific or professional organization that
has no individual credentialing function is meaningless for purposes of a
public advertisement. Others contended that permitting the listing of APA
membership in ads would imply APA approval of the psychologist in ques-
tion. Still others have noted that APA members are accountable to the Eth-
ical Standards of Psychologists (1977a) and the enforcement pf those Standards
through CSPEC (1974). As a result, these psychologists would assert that
APA membership is indeed a special qualification that one ought to be per-
mitted to call to public attention. In apparent recognition of that viewpoint,
CSPEC voted in October 1978 to recommend that members are permitted to
list their "APA membership status" in public advertiSing if they wish. This
was adopted as official organizational' policy by the Council of Representa-
tives in January 1979.
The controversy regarding mention of the National Register is not quite
so easily dealt with. The function and scope of that organization are dis-
cussed earlier in this volume (see Chapter 7). Applicants are required to
document that they have earned certain credentials and have had certain
specified experience prior to being "listed" in the register. The matter
became somewhat complicated in 1975, when the organization began to

send numbered certificates with gold-embossed seals to psychologists who
were approved for listing in the National Register. Many such registrants
assumed that this meant that they had earned a special credential that was
appropriate for listing on stationery and in advertising copy. As recently as
October 1978 CSPEC had noted that such use of a psychologist's listing in
the National Register was not appropriate. The rationale for discouraging the
fact of one's entry in the National Register in public advertisements or on
professional stationery had several bases. First, listing in the National Reg-
ister is based solely on verification of other credentials. Second, the National
Register does not enforce professional accountability on those registered
with it in any direct fashion. Third, listing in the National Register does not
imply competence, but the public may not adequately understand what it
means, hence there is little to be gained for the consumer by reading about
it in a psychologist's advertisement. After reviewing the screening proce-
dures used by the National Register CSPEC reversed its position in April
1979. The rationale for this reversal involved recognition of the care with
which the credentials of applicants are evaluated and a sense that this pro-
cess provides a means of helping the consumer to locate psychologists who
are at least minimally qualified to deliver direct health services. Thus, inclu-
sion in the National Register and APA membership status may now ethically
be listed on stationery or in advertising by psychologists. For guidance with
regard to the propriety of listing other organizational memberships psy-
chologists should consult directly with the groups in question.
Product endorsements by psychologists are not considered appropriate,
especially when the psychologist is rewarded or compensated in some way
for the endorsement. The rationale is twofold. First, if the product is psy-
chological in nature (e.g., a relaxation tape, biofeedback apparatus, assess-
ment technique, etc.) it should stand as a product on a foundation of empir-
ical research rather than personal testimony. Second, if the product is not
psychological in nature (e.g., a brand of toothpaste, pasta, or alcoholic bev-
erage) the psychologist is using his or her professional stature in an irrele-
vant realm to endorse a product in a way that may be deceptive and mis-
leading to the public. If a psychologist were to have a dual career,
performing psychotherapy by day and announcing television commercials
in the evening, the circumstance theoretically might be ethically appropri-
ate so long as the psychologist's role (i.e., by day) was not mentioned or
otherwise employed in the evening as a means of influencing the public to
buy products.
As noted earlier, this principle holds true especially when the psy-
chologist has played a major role in the development of a particular device,
book, or other product. Often, one may be blind to difficulties of this sort
when personal involvement is substantial. Nonetheless, every effort should
be made to assure that commercial products offered for public sale are pre-
sented in a professional, scientifically acceptable, and factually informative
manner. The use of due caution, scientific modesty, and avoidance of sen-
sationalism or undocumented claims will go far in preventing careless eth-
ical infractions.
CONFIDENTIALITY AND CONSUMER WELFARE
In general, ethics review panels probably consider behavior that

endangers the welfare of a client as the most serious sort of violation. The
consumers of psychologists' services are particularly vulnerable since they
often take considerable emotional risks in seeking help and routinely
develop a special dependency on the professional expertise of the person
delivering services. If there is a single canon of ethics that should be most
salient to all professional psychologists it is that the welfare of the client is
paramount.
Obviously the client of a psychologist is not always an individual. It
may be a health service organization, a private corporation, a school system,
or other entity to which the psychologist consults. In such instances the
client-organization enjoys the same rights and considerations due to indi-
viduals who are clients of a psychologist. The use of the word client in this
chapter generally may be interpreted to refer to both organizations and
individuals who use the services of the professional psychologist. There
may be times when the psychologist serving a client-institution will
encounter a situation that seems to present a conflict between the welfare
of that institution and the welfare of individual employees, patients, or
clients of the institution with whom the psychologist works as a consultant
or agent of the organization. Although there is no universal answer to such
dilemmas, the psychologist generally should act to protect the welfare of
the individual. In no case, however, is the psychologist excused from
attending to the welfare of individuals simply by virtue of being an orga-
nizational employee or consultant. Professional ethics transcend organiza-
tional policy when human welfare is at issue.
Example: A senior-level civil servant in a government agency is required to
undergo a psychological evaluation prior to an assignment to a sensitive poli-
cymaking position. A psychologist in private practice who regularly consults
with the government agency conducts the evaluation, and subsequently the
government employee is reassigned to less responsible duties. The employee
seeks feedback from the psychologist, either directly or through another profes-
sional, but the consultant psychologist refuses to cooperate, noting that his
client was the government agency rather than the employee of the agency and
claiming that the agency is responsible for providing any feedback to its
employee. The ethics panel disagreed, noting that the employee had a right to
know the nature of the evaluation findings that influenced his career adversely,
and further stating that the psychologist who rendered the initial service must
be prepared to follow-up on such inquiries. The agency involved gave the
employee a copy of the actual psychologist's report under the provisions of the
Freedom of Information Act, but the psychologist should still have been avail-
able to share this information with the employee whose welfare was at risk.
Counterproductive relationships may exist between psychologist and

client from time to time. When this occurs the ethical psychologist needs to
remedy the situation or terminate the relationship. When a psychologist
determines that his or her services are being used by an employer in ways
that are not beneficial to employees or significant others in the community,
the ethical psychologist will attempt to remedy the situation by discussing
the problem along with proposed modification with responsible persons.
Should this fail, the relationship should be terminated.
Example: A psychologist who was treating a woman in individual psychother-

apy became concerned when the client appeared to be decompensating. The
psychologist suggested hospitalization at an inpatient facility, but this only
increased the woman's level of agitation. Subsequently, the client began to har-
ass the psychologist by means of obscene phone calls, minor damage to the psy-
chologist's office, and personal threats. Under such circumstances it became evi-
dent that the psychologist could no longer effectively treat the client who still
wished to maintain the "therapeutic" relationship. The psychologist provided
the names of several other therapists who had expressed a willingness to treat
such a client and firmly terminated the relationship.
The example cited above was a blatant instance of a situation in which

the client and therapist could not salvage what had become a counterpro-
ductive relationship. Unfortunately, however, there are other more subtle
situations that the professional psychologist should take care to avoid. Dual
relationships constitute a prime example of this problem. The extreme
example would be a sexual relationship between client and psychologist. In
such cases, as in the case of service delivery to friends, relatives, etc., the
personal aspects of the relationship cannot help but impair the ability of
the psychologist to function in an effective professional manner. How then
should a psychologist react when personal feelings intrude on a profes-
sional relationship? The first step is recognition that such an intrusion has
occurred. The second step is to effect the transfer of the client to another
service provider with the least possible distress. The final step is to seek
professional assistance to determine the nature of the problem that led to
the loss of professional objectivity and work toward its resolution. Sexual
intimacies with clients are clearly unethical, and relationships that might
tend to create other sorts of dual relationships ought to be carefully
avoided. By way of prevention, a psychologist should very carefully con-
sider at the outset of the relationship any potential conflicts of interest or
contraindications to accepting the client, whether these difficulties arise
within the psychologist or elsewhere.
Contracting for services is a highly effective strategy for clarifying the
nature of the psychologist-client relationship to the mutual satisfaction of
all concerned. The concept of arriving at a verbal or written agreement
about therapeutic goals, hourly fees, and other variables involved in human
service delivery is not new to psychology (Schwitzgebel, 1975, 1976). It has
been adequately demonstrated that the actual procedure of clarifying a rela-
tionship with clients through careful discussion and contracting in a quasi-
legal fashion may actually enhance the emotional climate of the relation-
ship by involving the client actively and helping the psychologist to con-
sider the client's welfare in greater detail. Specific illustrations of ways in
which psychologists can use contracting to provide clients with informa-
tion needed to make informed decisions, to respond to challenges to one's
competence by clients, and to handle client's complaints may be found in
a recent paper by Hare-Mustin and her colleagues (1979). Their article is
based on an open-communication model that attempts to foster more effec-
tive client-psychologist interactions by modeling techniques. A sample
contract and client-psychotherapist dialogue are provided to illustrate ways
in which ethical standards can be applied in an effective fashion.
Privilege and confidentiality are frequently confused concepts presenting
controversies to which the professional psychologist should be sensitive.
Privilege (or privileged communication) is a legal term characterizing the
quality of specific types of relationships that prevent information learned
as part of such relationships from being disclosed in court or other legal
proceedings. Privilege is granted by law and belongs to the client in the
relationship. Where privilege exists the client is protected from having his
or her communications revealed without explicit permission. If the client
waives this privilege, the professional may be compelled to testify on the
nature and specifics of material discussed. Traditionally, such privilege has
been extended to the attorney-client, husband-wife, physician-patient,
and priest-penitent relationships. Some jurisdictions now extend privilege
to psychologist-client or psychotherapist-client relationships, but the
actual laws vary widely, and it is incumbent on each practitioner to inves-
tigate the status of communications with clients locally. Privilege is also not
absolute, as in the case when a professional may be legally obligated to
report child abuse, gunshot wounds, or communicable diseases (Siegel,
1979; Swoboda et al., 1978).
In contrast with privilege, confidentiality refers to a general standard
of conduct that obliges a professional not to discuss information about a
client with anyone. Confidentiality also may be based in law (Swoboda et
al., 1978) but, as far as this chapter is concerned, focuses on ethics instead
of law and implies an explicit contract or promise not to reveal anything
about a client, except under certain circumstances agreed to by both source
and subject. Although confidentiality began as an ethical principle, it does
have legal recognition. For example, a client could sue a psychologist in a
civil action for breach of contract based upon a violation of confidentiality.
The controversy comes into play chiefly around the issue of whether
or not a psychologist may be ethically permitted to breach confidentiality
under certain circumstances. The focus of the controversy is centered on the
"clear and imminent danger" clause of the Ethical Standards (American Psy-
chological Association, 1977a, p. 4). This refers to the consideration of risks
posed by the client of psychologists to themselves or to other persons.
Essentially, the point is that a psychologist is not considered unethical for
a limited disclosure of confidential material (without consent of the client)
to the extent that such disclosure was necessary to prevent harm in the face
of a clear and imminent danger.
Example: The client of a psychologist telephoned his office "to say goodbye" and
related that she had just ingested a quantity of sleeping pills. She lived alone
and had sought help in dealing with a number of depressive issues. She related
that she was now feeling "too helpless and tired to go on and am going to sleep
permanently," hanging up before the psychologist could engage her in a dia-
logue. The psychologist immediately dialed the client's number and got a "busy
signal." A call to the telephone operator led to information that the phone was
"off the hook," so the psychologist immediately telephoned the police. He
informed the police of the client's name, address, ana his concern that she was
attempting suicide at the moment. When the police arrived at the client's apart-
ment she was discovered to be well and unharmed, although depressed and
overtly angry at the psychologist for sending them to "check up on me." She
subsequently filed an ethics complaint against the psychologist in question.
Given the very real risk of possible suicide, the limited nature of the psychol-
ogist's disclosure, and the potential danger of inaction, the ethics panel deter-
mined that the psychologist'S response was entirely appropriate given the
circumstances.
Not all psychologists agree with the "imminent danger" concept, and
some assert that a psychologist should never disclose confidential informa-
tion, without the informed consent of the client (Dubey, 1974; Sigel, 1976,
1979). Siegel in particular argues that one should strive at all costs to keep
the therapeutic relationship intact and use it as a means to reduce the immi-
nent danger or risk, claiming that this is almost invariably possible (1976).
This extreme position could easily land a psychologist in jail because it may
be in direct violation of the law in some cases. Although this position is
clearly a minority viewpoint, it has its share of proponents. The reader with
strong interests in this dilemma will want to read the American Psycholog-
ical Association Task Force on Privacy and Confidentiality Final Report
(1977) for an overview of recent developments.
When law and ethical principles diverge (e.g., when a confidential
communication is not privileged in the eyes of the law) the situation
becomes extremely complex, but it would be difficult to fault a psychologist
ethically for divulging confidential material if ordered to do so by a court
of competent authority after exhausting appropriate appeals. On the other
hand, is it unethical to be in violation of the law if you believe that you are
behaving ethically by violating it? Students of ethical philosophy will
immediately recognize a modern version of the controversy developed in
the writings of Immanuel Kant and John Stuart Mill. Is it the intention of
the actor that should be judged or solely the final outcome of the behavior
that matters? Clearly, the answer will not be found in these pages. Each
situation is different but the most appropriate approach to evaluating a case
would be to consider the impact of alternative courses of action and choose
in terms of what outcomes might reasonably be expected. In general, how-
ever, it will be an extremely rare situation that justifies violating the law in
order to behave ethically.
No discussion of confidentiality in the mental health fields can be com-

plete without reference to the Tarasoff case (Tarasoff v. Regents of University
of California, 1974, 1976). Detailed analysis of the legal case has been pro-
vided by Stone (1976) and Leonard (1977), but a brief summary follows for
those unfamiliar with the facts. In the fall of 1969 Prosenjit Poddar, a citizen
of India and naval architecture student at the University of California's
Berkeley campus, shot and stabbed to death Tatiana Tarasoff, a young
woman who had spurned his affections. Poddar had been in psychotherapy
with a psychologist at the university's student health facility, and the psy-
chologist had concluded that he was quite dangerous. This conclusion
stemmed from an assessment of Poddar's pathological attachment to Tara-
soff and evidence that he intended to purchase a gun. After consultation
with appropriate colleagues at the student health facility the psychologist
in question notified police both orally and in writing that Poddar was dan-
gerous. He requested that Poddar be taken to a facility to be evaluated for
civil commitment under California civil commitment statutes. The police
allegedly interrogated Poddar and found him to be rational. They con-
cluded that he was not really dangerous and secured a promise that he
would stay away from Ms. Tarasoff. After his release by the police Poddar
naturally never returned for further psychotherapy and two months later
actually killed Ms. Tarasoff as noted above (Stone, 1976).
Subsequently, Ms. Tarasoff's parents attempted to sue the Regents of
the University of California, the student health center staff members
involved, and the police. Both trial and appeals courts dismissed the com-
plaint, holding that despite the tragedy there was no legal basis in Califor-
nia law for the claim against them. The Tarasoff family appealed to the
Supreme Court of California asserting that the defendants had a duty to
warn Ms. Tarasoff or her family of the danger and that they should have
persisted to assure his ultimate confinement. In its first ruling (Tarasoff,
1974) the court held that the therapists indeed did have a duty to warn Ms.
Tarasoff. When the defendants and several amici curiae petitioned for a
rehearing the court took the unusual step of granting one. In their second
ruling (Tarasoff, 1976) the court released the police from liability without
explanation and more broadly formulated the duty of therapists imposing
a duty to use reasonable care to protect third parties against dangers posed
by patients.
While the impact of this decision outside of California is not immedi-
ately clear the issue of whether or not psychologists must be police, protec-
tors, or otherwise have a "duty to protect" has become a national concern
(Bersoff, 1976; Leonard, 1977; Paul, 1977). Siegel (1979) takes the view that,
if Poddar's psychologist had accepted the absolute and inviolate confiden-
tiality position, Poddar could have been kept in psychotherapy and the life
of Tatiana Tarasoff might have been saved. Siegel notes that in his opinion
the therapist "betrayed" his client and observes that if the psychologist had
not considered Poddar "dangerous," he could not have been held liable for
"failure to warn." Again, this may be a valid position; however, many psy-
chologists would argue the need to protect the public welfare with direct
action. There may be no single ethically correct answer in such cases, but
the psychologist also must consider what is required by law.
Perhaps the ultimate irony of the Tarasoff case in terms of outcome is
what happened to Poddar. His original conviction for second degree mur-
der was reversed because the judge had failed to give adequate instructions
to the jury concerning the defense of "diminished capacity" (People v. Pod-
dar, 1974). He was convicted of voluntary manslaughter and confined to the
Vacaville medical facility in California. He has since been released from
confinement and "has returned to India, and by his own account is now
happily married" (Stone, 1976, p. 358).
If there is a prospective means to avoid such dilemmas in one's practice,
three separate aspects are probably involved. First, each psychologist must
come to terms with the circumstances under which she or he will breach
confidentiality or privilege. Consultation with an attorney about the law in
the jurisdiction where the psychologist practices would be a very helpful
part of this process. Second, the psychologist should make these conditions
or limitations clear to potential clients from the outset of any professional
relationship either orally or in written form (Hare-Mustin et ai., 1979).
Finally, should an actual circumstance arise bearing on these issues, a con-
sultation with colleagues to sort out alternatives that may not have come to
mind initially might be appropriate. These steps will not solve all such
problems but might reasonably be expected to reduce their potential
occurrence.
Third-party access to confidential information is a relatively recent problem
as far as the profession of psychology is concerned, but as insurance cov-
erage to psychologists as health care providers increases, so will the poten-
tial dangers. When insurance coverage is used to pay the psychologist's bill
a claim form must be filed listing dates and types of services rendered along
with a diagnosis. Insurance companies routinely exchange personal data on
policyholders with central records facilities, and the claim forms pass
through the hands of secretaries, clerks, computer programmers, and insur-
ance agents. Such individuals are not accountable to a code of professional
ethics and few people know how carefully or carelessly such confidential
information is handled once it leaves the psychologist's office. While it may
seem that the stigma has gone out of seeking mental health care, that is
often not the case. For example, Senator Thomas Eagleton was forced to
resign as a vice-presidential nominee when his past history of treatment for
depression became public knowledge.
Some psychologists believe that they are helping their clients in this
respect by submitting claim forms with diagnoses of "adjustment reaction."
Aside from the potential fraud inherent in listing a false diagnosis, the prac-
tice of using such benign diagnoses to protect the client may result in a
hearing before a professional standards review committee (see Chapters 9
and 10). For example, an insurance company may become suspicious when
a patient requires hospitalization or months of protracted psychotherapy
for the treatment of an "adjustment reaction."
The whole question of providing information on clients to third parties
is a controversial one (Jagim et al., 1978), but it seems wise to let the client
make an informed choice whenever possible.
Example: Part of the dialogue with a new client may go something like this: "As
you know, your health insurance company will help to cover the cost of psy-
chological services for you. In order for me to collect my fees from them, I shall
have to complete some insurance forms that will create a record in the insurance
company's files that I treated you, including the dates of our appointments and
the diagnosis or name of the problems I treated you for. Insurance companies
usually claim to keep such information confidential, but once it is in their hands
I have no control over what they do with it or who may see it. If you are con-
cerned about that you may want to check with your insurance company before
authorizing me to bill them. You have the option of paying me directly, if you
wish, rather than using your insurance coverage and creating a record outside
of this office."
It is also clearly important for psychologists to supervise the work of

secretaries, clerks, assistants, or others in their employ in order to ensure
the security of clients' records. For many clients this will not be a matter of
substantial concern, but the fact that it is discussed with them serves to
demonstrate the psychologist'S concern for their best interests. This should
also be kept in mind in settings where management information systems
are in operation for similar reasons (Koocher & Broskowski, 1977).
When special subpopulations of clients, such as children, are involved
the practitioner will also have to weigh the context carefully in assessing
what limits need to be placed on information to be shared with parents,
schools, and others (Koocher, 1976; Ross, 1966). Many professional psy-
chologists today treat children individually, while also counseling their
parents (Koocher & Pedulla, 1977), and some care must be taken to do so
effectively while respecting necessary confidences of all parties. Often this
is not difficult, so long as the psychologist has given careful thought to the
potential problems in advance of beginning work.
The death of the professional psychologist can also raise a complex set of
questions in relation to the confidential nature of client records. It is impor-
tant to have a will for many reasons, but a psychologist's will should specify
the disposition of his or her records in the event of death. One alternative
is to arrange with a professionally responsible colleague for the care and
management of the records, so designating in the will. An alternative
arrangement would be to arrange for one's spouse or executor to have the
records incinerated. The actual plan is not so important as the central theme
of protecting the privacy of one's clients.
Avoiding a casual attitude toward confidential case material is also quite
important in respecting the clients one serves. It has become something of
a cliche to note that the world is a small place when it comes to people
knowing people who know people. One should not discuss one client in
front of another client, a family member, friends, or anyone. When it is
necessary to seek colleagial advice in the handling of a difficult case or prob-
lem, a psychologist should be careful not to reveal the identity of the
patient or disclose more confidential data than is actually necessary. Keith-
Spiegel (1977) notes that a secret shared in confidence may seem quite mun-
dane to many but be extremely important or embarrassing to the client. She
also observes that sharing someone else's secret with a third party has the
effect of reducing its impact. That is to say, it is easier to pass on a once-
removed secret than a secret received directly from the source.
Example: A psychologist in a small town let out information about a client's
physical illness to another psychologist in the course of conversing about that
illness in general. While most people would agree that the illness in question
was no cause for shame, the client suffered considerable anguish at having been
"discovered." The psychologist who was told the information let it out to a
more general audience at a cocktail party attended by one of the client's friends.
The client brought ethical charges against the first psychologist. He was deeply
regretful over the incident and fortunately was able to resolve the matter infor-
mally apologizing to the client, who graciously accepted it. Unfortunately other
psychologists too often learn their "keep-your-mouth-shut" lesson with consid-
erably more agony. (Keith-Spiegel, 1977)
PROFESSIONAL RELATIONSHIPS
Inter- and intra-professional relationship problems are the source of

many ethical difficulties that, as with other such problems, often can be
short-circuited with a bit of forethought. One should approach colleagues
with a basic spirit of cooperation rather than competitiveness or skepticism
whenever possible. When undertaking jOint endeavors, whether they be
publications or a group practice, clear understandings should be agreed
upon at the outset regarding all roles and responsiblities. It is wise to have
such understandings in writing, even if this simply takes the form of an
exchange of memos. The written form of such understandings on collabo-
rative projects can go far to enhanCE: communication and call misunder-
standings to mutual attention early enough to remedy them without alien-
ation of anyone.
The problem of multiple therapists occurs frequently enough to deserve
some consideration. By this I mean the situation wherein a client seeks ser-
vices or consultation from one professional while already engaged in sim-
ilar services with another. Clearly, there are cases where such relationships
are quite appropriate: the client seeks a second opinion, the client seeks
group therapy to complement individual psychotherapy, or the client seeks
some additional service not within the scope of the extant provider-client
relationship. On the other hand, some clients have been known to seek sim-
ilar services from two or more providers simultaneously. In other circum-
stances a client could conceivably flee from one therapeutic relationship to
another to avoid confronting certain feelings, while projecting the difficul-
ties onto the service providers. Obviously, this is a complex matter deserv-
ing careful analysis in each individual case. The point is that the profes-
sional psychologist should be fully informed about such relationships in
order to deliver efficient and effective services.
Along these lines, it is important to ask clients about other professional

relationships at the outset of any initial meeting. One should seek written
consent to obtain relevant information from prior or concurrent service
providers and clarify the purpose of one's contact with the client. If the
client has terminated other relationships, one needs only to clarify issues
with the client. If, however, the client is being treated simultaneously by
another professional along parallel lines, it will be important to consult
with both parties. At the same time, a psychologist should support the
client's right to seek alternatives. It is appropriate to discuss disagreements
with clients when the goals or conduct of a professional relationship
become problematic, but a psychologist should never refuse to send reports
or discuss the case with a new service provider of the client's choice pro-
vided that proper consent has been obtained.
Handling possible ethical violations uncovered in the course of work with
clients who have been treated by others is unfortunately not a rare occur-
rence. One is faced with a dual dilemma in the sense that ethical standards
encourage the reporting of such events, while simultaneously requiring
confidentiality to one's client.
Example: A psychologist begins work with a young woman who had abruptly
terminated psychotherapy with another psychologist. She refuses to grant per-
mission for her new therapist to contact the former therapist, and subsequently
reveals to the new therapist that she had been sexually assaulted by the other
psychologist. If one assumes that the client's reality testing is not impaired and
that her report is accurate, the prior therapist was clearly unethical and may be
a potential danger to other clients. In this situation, however, the new thera-
pist's responsibility to the client and her welfare should outweigh responsibil-
ity to take some action regarding the other psychologist. The client has been
injured and the therapist must focus on providing her the help she has sought
in overcoming the trauma of the prior relationship. Perhaps the client herself
will come to her own decision about some form of action against the former
therapist, but the new therapist should respect her right to privacy and confi-
dentiality even if this precludes informal contact with the other colleague.
In some circumstances the case cited above may lead the psychologist
into a double bind situation. Some jurisdictions may have laws that require
the reporting of felonies. In this case the behavior of the former therapist
may constitute felonious assault and there may be a risk to future patients
who seek him out. I would argue that even if the law reqUired reporting
the felony "for the greater good of society," this could cause substantial
emotional stress for the client who has come seeking confidential treatment.
To violate her wishes in favor of the more diffuse "public good" would be
tantamount to inflicting a second emotional assault to a specific victim in
the hope of preventing harm to persons unknown. I would therefore favor
respecting and protecting the vulnerable client, even if that meant com-
mitting a technical violation of the law. I would encourage and support her
in reporting the situation, if she felt able to do so, but I would not undertake
this myself without her full informed consent.
In other situations where possible ethical violations come to the atten-
tion of psychologists the steps outlined earlier in this chapter should be

followed. This would include informal colleagial attempts to educate the
psychologist about potential ethical problems associated with the behavior
in question prior to filing of a formal complaint. Peer pressure has long
been recognized as a powerful motivating force, and most colleagues will
be at least somewhat receptive to tactfully offered professional advice along
these lines. In any case, turning a blind eye to unethical behavior does not
help the colleague, the profession, or the consuming public. While it is true
that anger and hostility may sometimes be the reward for raising such ques-
tions, however tactfully, it may be helpful to recall the comment attributed
to Confucious, "To see what is right and not do it is want of courage."
Supervisor-supervisee relationships are another area for careful concern
under the headings of both client welfare and professional relationships.
On the one hand, supervisees may be colleagues serving clients for whom
the supervisor also holds a measure of responsibility. On the other hand,
the supervisee may also be seen as the client of the supervisor in many
ways. Timely feedback or lack thereof is probably at the root of most ethical
complaints growing out of such relationships. This is especially true when
supervisees are abruptly notified that they are not to be rehired or given an
anticipated raise or promotion. Routine feedback sessions should be built
into all supervisory relationships, and when serious criticisms are discussed
with supervisees they should invariably be put in writing as well as being
followed or accompanied with a dialogue about expected changes. This is
not a one-way process. Although supervisees are generally considered "one
down" in any hierarchial structure, they should routinely communicate
professional concerns with supervisory colleagues both orally and in
writing.
When a client is receiving services from a psychologist who is in turn
being supervised, the client has the right to know this. Indeed, many clients
would be pleased to know that the psychologist serving them has consulted
a senior colleague on their case. This should not come to a client's attention
at a sensitive moment, however, and is best presented factually as a part of
the initial contract formed between client and psychologist.
Fee-splitting is generally considered unethical. By fee-splitting I refer to
the practice of paying a fee or percentage of one's income to another in
exchange for referring clients. Clients ought to be referred because of a fit
between their needs and the practitioner's skills or competencies rather
than a commission arrangement. In some settings, however, an arrange-
ment is concluded whereby a psychologist pays a certain percentage of his
or her earnings to another practitioner or corporation in exchange for ser-
vices rendered, such as office space rental, secretarial services, telephone
answering, etc. This sort of arrangement may well occur within a group
practice setting, but it would not be considered fee-splitting so long as the
fee paid by the psychologist is on all patients for whom the services (e.g.,
office space) are used and not simply on those patients referred from other
group members. So long as the fee represents compensation for actual ser-
vices rendered, not simply a "finder's fee," it would not be regarded as

unethical.
"May I take my clients with me?" is a question often asked by psycholo-
gists as they prepare to change jobs while remaining in the same geographic
area. Examples include the industrial psychologist who decides to set up her
or his own consulting service after working for years with another com-
pany or the psychotherapist who plans to move from a clinic or group prac-
tice to a private office. From the viewpoint of the therapist who is seeking
to take the clients along the matter is one of convenience for both the ther-
apist and the client. The issues of termination and transfer do not have to
be worked through, no one has to start from the beginning in getting to
know a new service provider (or client), and the ongoing therapeutic or
consulting process suffers little interruption. From the standpoint of the
organization, the clients are their own, in that they sought out the organi-
zation and not a particular psychologist, and thus they should continue to
receive these services in the same setting. The psychologist may be
regarded simply as one of many organizational employees who come and
go, with no rights or duties to the clients once they have ceased to be
employed. In sorting out this potential ethical dilemma two separate issues
must be considered in the following priority sequence: First, what does the
client's welfare dictate? Second, what is the nature of the contract between
employer and employee?
When it comes to evaluating the client's welfare, the client is often in
the best position to make a decision so long as the choice is not presented
in an emotionally loaded context. Ideally, the choice should be offered in
much the same fashion that an ethical researcher would obtain informed
consent from a potential subject. That is to say, the client should be pre-
sented with all of the facts that might reasonably influence his or her will-
ingness to participate (or continue to be served) in an evenhanded and
straightforward fashion. Factors that might be of concern to therapy clients
could include: availability of 24-hour coverage, possibility for inpatient
treatment if needed, fees to be charged, convenience of office location and
appointment times, and many similar items in addition to the therapist-
client relationship that has preexisted. In making such a presentation to the
client the therapist should not attempt to belittle the quality of services,
raise questions about the organizational leadership, or otherwise provide
the client with personal adverse opinions that may have contributed to the
anticipated termination of the relationship between the psychologist and
the organization. Obviously, such options do not become an issue for many
clients, such as those requiring inpatient hospitalization or service within
a specialized setting utilizing a treatment team approach.
In the ideal circumstance the employer and employee will consider this
potential problem at the start of their professional association and come to
some agreement about how these issues are to be handled as part of the
employment contract. The nature of the employer-employee contract, how-
ever, does not obviate the need to consider the welfare and best interests of
the organization's clients. It is obvious that employer, employee, and client

may have three quite different viewpoints about what constitutes the
client's "best interests." The problem that leads to most ethical complaints
revolving around such issues is basically an enmity between employer and
employee concerning the termination of their relationship. The wisest pre-
ventive step that can be taken in this regard is formulation of a basic under-
standing between the two parties at the time of initial hiring. Ideally, this
could take written form and discuss a means for jointly resolving the prob-
lem of ongoing clients' welfare at the termination of the employer-
employee relationship. Should there later be some legitimate difference of
opinion regarding the welfare of specific clients, colleagues of sincere good
faith generally can call upon members of a local ethics panel or professional
standards group for an outside consultative opinion. The most unethical
behavior possible in such a situation would be for either party to indepen-
dently attempt to alienate the client from the other, for whatever motive.
In the case of organizational clients the situation is typical of the one
that obtains in the corporate world at large. If one company regards its best
services as coming from a single employee of another firm, who then strikes
out in a new venture to provide similar services through his or her own
firm, the choice of which services to use belongs to the client organization.
If this is a possibility, industrial consulting organizations (or similar enti-
ties) may include "noncompetitor" assurances in their contracts. In such
instances the employee essentially promises not to compete with the
employer-organization for a period of time following termination of their
contract, although such restrictions may be subject to geographic limita-
tions. Such a clause would probably be unreasonable if the clients were
individuals in need of mental health services, as opposed to organizational
or corporate clients.
Responsiveness to appropriate inquiries in a cooperative spirit is an impor-
tant aspect of professional psychology, whether the inquiry originates with
an ethics panel, a professional standards review committee, or a colleague.
Refusal to respond to duly constituted ethics or professional standards
review groups may be considered unethical behavior per se. The APA Eth-
ical Standards of Psychologists (American Psychological Association, 1977a)
specify the duty to respond with "reasonable promptness" (p. 6) to inquiries
from duly constituted committees of the APA and state psychological asso-
ciations. A member could conceivably be expelled for failure to respond to
an appropriate organizational inquiry.
Although the same force does not apply when one colleague questions
another as to the ethicalness of the second colleague's practice, failure to
respond to such inquiries might force a colleague into filing a formal ethics
inquiry with the appropriate body. In any case, threats or untoward public
comments directed at colleagues who attempt such informal inquiry are
totally inappropriate. The correct response to such an inquiry, if one con-
sidered the colleague to be out of line, would be to suggest simply and
politely that he or she file a formal complaint while declining to discuss the
matter with the questioner. Ideally, however, such a step should rarely be
necessary.
TECHNIQUES: ASSESSMENT AND RESEARCH
Many of the basic principles to be addressed in this section of the chap-

ter are essentially elaborations of principles discussed earlier. The focus
here, however, is on the specific techniques of the professional psychologist
and the manner in which they may contribute to ethical dilemmas in the
course of one's practice.
Proper use and reporting of test and research data is one such example. Ear-
lier in the chapter a psychologist's responsibility for keeping up to date on
professional developments and for making sure that her or his services are
properly utilized were discussed. When standardized tests are utilized they
should be applied judiciously and appropriately in the context of proper
norms and valid applications. When revisions in norms or standards are
published, psychologists should be aware of them. When efforts to make
inappropriate use of one's assessment reports or techniques comes to the
attention of a psychologist, remedial or corrective action should be taken.
By the same token, when a psychologist devises a new technique or assess-
ment instrument, (s)he is responsible to assure that appropriate standards
are met (American Psychological Association, 1974). The same principles
apply to the application and interpretation of research data, whether in the
context of work with a single patient or presented in a public forum. Accu-
racy and appropriate scientific caution must be conSistently applied.
Safeguarding confidential test material and confidential research data is also
an important concern. Psychologists should not disclose "correct answers"
or otherwise reveal confidential test stimuli to nonprofessionals outside of
proper contexts. When, for example, a client replies, "I don't know, what is
the right answer?" to a question on the WAIS, the appropriate response
would be, "I'm not permitted to tell you." This avoids disclosing informa-
tion that might unnecessarily compromise test security or invalidate the
same client's future performance. When a person provides test or interview
data as part of a research project an explicit statement in the signed consent
form should state how the data will be handled and who may have access
to the data of identifiable subjects. When this data is of a sensitive nature
the psychologist may wish to consult an attorney in advance to clarify the
laws that may apply.
Safeguarding the rights of the client in assessment and research is the final
and most important concern under this heading. The need for proper safe-
guards is implicit in all that has been discussed before. Openness and hon-
esty should be a part of this entire process. Clients have a right to know the
nature and purpose of assessment techniques in language that they are
capable of understanding. They also have a right to appropriate and timely
feedback on the results unless, as in some settings (e.g., employment situ-

ations), an explicit exception to this right is agreed upon in advance. When
such feedback is to be provided by others the psychologist must assure that
the processes and procedures for rendering feedback are adequate. This is
especially critical when test scoring or interpretation services are available
at a site distant from the actual client-care setting.
When any reasons exist to doubt the reliability or validity of a given
set of test or research data, the psychologist in charge is responsible for
clearly indicating these facts in any reports or recommendations relative to
applying the data. The effort to assure that psychological data is not misused
by others also extends to client's files. When test data in one's own files
becomes obsolete it should be destroyed. The same is true for data held in
the files of clinics or other agencies where a psychologist supervises test or
research data files. The basic concern here is that information that might be
harmful to a client if disclosed is destroyed when retention of such data
serves no useful purpose on the client's behalf.
Although general recommendations regarding appropriate treatment
of participants in psychological research exist (American Psychological
Association, 1973b), psychologists whose research has particular application
to client or employee populations must exercise special care to assure that
the data are not misused. The psychologist must be prepared to monitor the
use or application of the data he or she generates, so long as it can be linked
to individuals or potentially misused.
CONCLUSION
By this point I hope that the reader is left with at least four principal
strategies for maintaining a practice with high ethical standards. First, be
informed. Be familiar with the policies, techniques, practices, and issues that
can be expected to crop up as a part of delivering psychological services.
Keep abreast of current developments and be aware of the changing nature
of professional psychology. Second, be sensible. Common sense, a cooperative
spirit, openness, and honesty will go far to enhance relationships with
clients and fellow professionals alike. Third, think preventively. Attempt to
identify potential ethical dilemmas before confronting a crisis situation.
Formulate the best approach to the problems based on the nature of your
own skills and the nature of your practice. Take anticipatory steps to min-
imize the likelihood of ethical infractions and potential related conflicts. Do
not be afraid to use written agreements or understandings to clarify rela-
tionships with clients and colleagues and by all means do not presume that
your own assumptions about the nature of your relationships with others
automatically will be understood and supported by them. Finally, ask for
advice. Seeking guidance from colleagues, ethics panels, professional stan-
dards review committees, and others is an important means of validating
your opinions regarding effective and ethical service delivery. It is also a

means of discovering issues and alternatives you may not have considered
previously. A second opinion never hurts.
ACKNOWLEDGMENTS
The author gratefully acknowledges the detailed constructive criticism

of R. Kirkland Gable (formerly Schwitzgebel), Patricia Keith-Spiegel, and
the editors in response to an earlier draft of this chapter.
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4
Standards for Psychological Measurement
ROBERT M. GUION
Three generations of the documents informally known as "testing stan-

dards" have been published (American Psychological Association, Ameri-
can Educational Research Association, & National Council on Measurement
in Education, 1954, 1966, 1974). The first two documents described the
proper content of manuals provided by publishers to accompany tests; they
were primarily standards of information. The third added requirements for
test users.
At one time, nearly every psychologist in some form of professional
practice included the development and use of psychological tests as part of
the typical, expected practice of psychology. Clinical psychologists were
routinely expected to give Rorschach or Thematic Aperception tests to their
clients; educational psychologists were known mainly as testers in the
school systems; vocational counselors advised their clients on the basis of
profiles on interest and aptitude tests; industrial psychologists were known
primarily as employment testers. None of these is currently an automatic
characteristic of these professional roles. After a period of great enthusiasm
and hope-and even an excess of faith-in the use of tests, a certain disil-
lusionment has followed both within the general public and within the
psychological profession. Not only is there less reliance on tests than in
former years, but more and more psychologists actively eschew the use of
formal tests. Fewer psychologists see themselves as testers who need to
know and understand the testing standards.
Nevertheless, professional practice does not avoid quantitative ideas.
One client is more deviant than another. One candidate for promotion to
management is more promising than another. One child in a schoolroom is
more introverted than another. Such quantitative ideas require some
method of assessment. At the very least, professional practice often requires
ROBERT M. GUION. Department of Psychology, Bowling Green State University, Bowling

Green, Ohio 43403.
111
112 ROBERT M. GUION
the classification of clients or research subjects into broad categories. As

practitioners have turned away from formal, standardized tests, they have
retained the necessity for making quantitative statements, but many of
them have moved to less standard, more subjective techniques of assess-
ment. They do interviewing and either rate characteristics of interviewees
or have ratings made by a reader of the interview protocol. Candidates for
management positions are run through a series of exercises during which
their behavior is observed and rated by assessors. Attributes such as
achievement motivation are inferred from background events that have
been deemed by individual advisors to be signs of such motivation. Clini-
cians who seek to assess certain attributes use "homemade" sets of inter-
view questions to determine quantitatively various characteristics ranging
from assertiveness to sexual deviancy.
All of these are in fact tests, at least in the broad sense in which the
1974 Standards defines the word. They are included as tests because they are
techniques of making inferences about quantitative characteristics of peo-
ple; they are therefore subject to the testing standards (APA, AERA, NCME,
1974, p. 2). The use of the word test should be recognized as a convenient
shorthand. It can refer to a formal standardized technique for making quan-
titative inferences, developed through careful research and providing a
model or paradigm that can be used as a point of comparison for all of the
other assessment procedures; or it can refer to an informal, ad hoc proce-
dure used by a particular practitioner in a unique situation. The kinds of
measurements that can fit this definition of test include ratings using var-
ious types of rating scales; scores on simulation exercises, work samples, or
attitude scales; index numbers based on answers to interview questions; and
many other forms of assessment.
Who should follow the Standards? Many psychologists believe that the
Standards were developed only for test publishers and that no one else need
be very much concerned with them. The 1974 Standards attempted to dis-
courage that point of view by establishing the section for test users. This
document was intended to apply not only to those who develop assessment
procedures for publication, dissemination, and possible profit, but also to
those who use such procedures or who develop their own private assess-
ment procedures. The Standards are necessarily applicable in different
degrees to different people. It is more serious to be in violation of the Stan-
dards if one is developing an instrument for commercial publication or wide
use than if one is developing an instrument that is to be used only once
and in a very limited setting. People with extensive research capabilities
can follow the Standards more closely than those who lack such opportu-
nities. In any case, however, the underlying principles apply even where
total and rigid adherance to them is not feasible, practical, or possible.
The authors of all of the generations of the Standards described the
information that a test developer or publisher is expected to provide for any
test distributed for general use. One must infer from these informational
requirements what the authors expected to hold true in development of that
STANDARDS FOR PSYCHOLOGICAL MEASUREMENT 113
information. This chapter, unlike the Standards, will place the emphasis on
the development of measurement instruments, if for no reason other than
the seemingly widespread use of individualized, personalized measures by
individual practitioners. What will be presented is a set of principles for the
development and use of techniques for making quantitative inferences,
whether the techniques are to be widely distributed or retained for the pri-
vate use of the developer. As in the Standards from which they are derived,
the principles can be adhered to fairly rigidly if one is developing a paper-
and-pencil test of an attribute that has been well defined in the research
literature and measured successfully in the past. If, however, one is devel-
oping a novel technique for assessing characteristics less well established,
or if one is required to use measurement techniques that must be developed
quickly for an immediate need, one cannot follow these principles at all
closely. In the latter case, however, one can examine the Standards and these
principles and use them as a guide to the best professional practice circum-
stances will permit. They identify the questions that one ought to be asking
when setting out to develop even an informal approach to assessment-
even if the questions prove unanswerable.
This chapter builds on the official documents, particularly on the 1974
version, plus the experiences of the author over the years subsequent to the
publication of that document. A brief demurral is needed. Since this author
was identified in the foreword of the 1974 Standards as its principal author,
some readers might confuse the statements here with the official positions
of the three sponsoring organizations. This would be unwise. In the first
place, this author was only one member of the joint committee, even
though a recording member. The document is the result of long delibera-
tions, arguments sometimes bordering on the acrimonious, and compro-
mise. It is more than likely that different members of the committee would
still interpret specific provisions in different ways. Moreover, the choice of
principles to be emphasized and the inferences about principles of test
development are based on this author's opinions and points of view that in
many cases have been developed subsequent to the publication of the 1974
Standards. This chapter, then, must be recognized as solely the expressions
of this one author, not those of the committee that developed the 1974
Standards.
PROCEDURES IN TEST CONSTRUCTION
A brief overview of procedures of test construction and of their appli-

cability to other forms of measurement may provide a context for the state-
ments of principle to follow. This section is not intended to be comprehen-
sive; more detailed advice on test construction can be obtained from
Anastasi (1976), Brown (1976), Cronbach (1970), Ebel (1972), Horst (1966),
Messick and Ross (1962), Nunnally (1978), and Wiggins (1973).
The development of a new test begins with a need or with an idea. This
114 ROBERT M. GUION
beginning may come from theoretical literature introducing terms requir-

ing measurement. Examples in recent years have included concepts of
androgeny, assertiveness, or organizational climate. The ideas may emerge
from needs for the evaluation of the outcomes of psychological practice: a
need for measurement of performance, of learning, or of recidivism. What-
ever the source, an idea emerges of an attribute of human beings or of
human behavior that, for purposes of professional practice, needs to be
quantified.
Psychologists rarely like to base judgments of anything on siIi.gle
observations. The paradigm of test construction has, therefore, been based
on the use of many different observations of the same attribute. In a test,
these observations are called items. In ratings of performance, the different
observations or items may be different raters, or they may include both dif-
ferent raters and different examples of behavior to be rated. Whatever the
nature of the item, measurement practice usually calls for the invention,
writing, or creation of many different items, each of which is to provide at
least some small piece of information relative to the attribute to be
measured.
One should not fall into the habit of thinking of all test items as the
ubiquitous multiple-choice test. Items may, of course, be conventional test
questions requiring multiple-choice, true-false, or written answers. The
items may be questions with either right or wrong answers or they may be
statements of belief that a respondent is to endorse or repudiate to some
degree. They may involve continuous responses, such as reaction times;
items may consist of different stimuli to which the latency of response can
be determined.
Once the items have been devised, they are presented to a sample of
people who respond to them according to instructions; their responses pro-
vide a data base. From these responses, some procedures known as item
analyses are carried out. The most conventional form of item analysis con-
sists of computing two statistics for each item. One statistic is a value on a
scale of the difficulty or easiness of the item (as simple as the percentage of
people who give the right answer); the other is a discrimination index to
show how well the responses to the item distinguish between people with
a great deal and people with very little of the attribute being measured
(often a point-biserial correlation coefficient relating item responses to total
scores). The general purpose of item analysis is to delete poor items so that
the measure that results will have some homogeneity; items that are too
easy or too difficult to distinguish different levels of the attribute are gen-
erally deleted, as are those that do not fit the pattern of the total score.
If one's purpose is to develop an educational test to cover a broad, het-
erogeneous array of information, one would not want to delete items that
do not correlate well with the total set. Item analysis procedures in such
cases may be based more on questions of judgment of the appropriateness
or relevance of the items. These judgments need not be merely the judg-
ments of the test developer; they may be the pooled judgments of a body
of subject matter experts.
Even where homogeneity is sought, the conventional item statistics

may not be the procedures used. In recent years, latent trait theory has been
developed as a means of providing information about items that may be
invariant across different samples of people from the same population. In
any case, however, item analysis procedures are used to select items for
inclusion or to identify items that will be purged from the item pool; ide-
ally, the item pool will be large enough that item analysis procedures can
be used to identify the very best items in the pool to comprise the final
measuring instrument.
The development of a test is in part the development of the particular
set of items that will go into the test (and perhaps into alternate forms of
it). It also consists of the development of standard procedures for adminis-
tering and scoring the resulting test forms. When these procedures have
been firmly established, the test in its shortened form is administered to a
new group of people. From their responses, information is obtained about
the validity and reliability of the test. On the basis of such research, docu-
ments are prepared, such as test manuals or research memoranda, for guid-
ance in future use.
This has been an obviously brief account of the procedures, ideas, and
computations involved in building techniques for making quantitative
inferences about characteristics of people (Le., tests). It may serve, however,
as a general context in which more details can be fit. The statements of prin-
ciples that comprise the bulk of this chapter are intended to provide guid-
ance for defining the details in applications to specific measurement
problems.
STANDARDS FOR PLANNING
1. The attribute to be measured should be defined and stated clearly. One does
not measure people; one measures attributes of people. A measurable attrib-
ute is considered to exist in differing degrees; that is, it is a variable or a
dimension. Measurement should result in a numerical designation or score
that will be taken as a measure of that variable. The person who develops
the methods of arriving at that number should have fairly clearly in mind
what that number is supposed to mean. The measurement should be
planned and articulated well enough that the resulting measurement can
be used by other people without likelihood of misinterpretation.
It is helpful to distinguish between the operational definition of a var-
iable and a conceptual definition of that same variable. A conceptual defi-
nition can be stated in words. These words describe, as well as the devel-
oper can, the nature of the attribute and, perhaps, defining relationships of
that attribute to other dimensions. Operational definitions are the proce-
dures by which the attribute is actually measured. There ought to be some
congruence or agreement between the operational and the conceptual def-
initions. Informed people should be able to examine a set of operations and
reach an informed agreement that these operations lead to numbers that
116 ROBERT M. GUION
reasonably can be expected to reflect the concept to be measured. While a

strict operationist point of view would argue that an operational definition
is its own standard, there are very few strict operationists in professional
psychology who would accept numbers simply as the outcome of a set of
operations, without reference to a more general, semantic expression of the
interpretation of those numbers (Underwood, 1957). The determination of
that congruence is ultimately an empirical question bearing on the con-
struct validity of the resulting measure. In the planning stages, however, it
is necessary to recognize that careful and complete logic and articulation in
conceptualizing the variable and in matching operations to the concept will
result in measuring instruments more likely to pass the tests of construct
validity. (Note particularly Standards B2, B3, and B3.1).1
2. Acceptable methods and conditions of observation should be specified. Psy-
chological measurement is based on the responses people make to standard
stimulus materials. The possible combinations of stimuli and expected
responses and the circumstances in which they may occur define the pos-
sible conditions of observation. Within these boundaries, the nature of the
responses to be scored as a basis for measurement, the methods of scoring,
the types of stimulus materials that are appropriate for eliciting these
responses, and the populations from which the people are drawn should be
clearly specified. These specifications imply certain kinds of hypotheses or
assumptions that, given the objectives of measurement, one method of
observation, scored in one particular way, under one set of conditions, for
one group of people, is likely to prove superior to alternatives. In defining
these components of measurement, one need not rely exclusively on con-
ventional approaches to test construction. A conventional test poses ques-
tions as the stimulus materials to people who, as a group, may be presumed
to know the answers to those questions, and most commonly requires these
people to respond by choosing one of a series of optional answers. There
are, of course, other response modes of conventional tests: indicating
whether a statement is true or not, recalling the answer to the question
without any further stimulus material to be recognized, or even writing out
essays in response to the question.
Other conditions of observation may, in many cases, be far superior. In
attitude measurement, for example, statements of belief are presented as
stimulus materials and the response is an indication of endorsement or
nonendorsement of these beliefs. In the measurement of performance, the
stimulus is the actual task to be performed the response is the performance,
which is in turn a stimulus that an observer of that performance may
1 References in this chapter to particular statements of Standards are to the numbered state-
ments in Standards for Educational and Psychological Tests, APA et al., 1974. Since the chapter
is written largely as a summary or precis of that document, it should be close at hand while
one is reading this chapter. Even after a subsequent revision is prepared, which seems inev-
itable, the reader should try to identify its relevant provisions and see how the most current
version of the Standards treats these principles.
respond to by entering a judgment of its quality at an appropriate position

along a scale. In measuring the ability to process certain kinds of informa-
tion, one might present tachistoscopically stimulus materials containing
that information, call for a button to be pressed in response, and score it by
measuring the latency of the response.
The choice of a method depends on the goals of the developer or user
of the measuring instrument and on the methods that are considered best
in matching these goals. Obviously, then, this principle also implies a
requirement that the goals of measurement be dearly defined. (For an elab-
oration of this principle, note particularly Standards HI, Hl.l, H1.2, H2.I,
H3, and H.4.)
Methods of measurement may vary substantially in the degree of math-
ematical formality of the measurement technique. For some attributes, there
is a more or less well-developed body of psychological theory of the rela-
tionships between relevant stimuli and expected responses. For example, in
signal detection theory, the likelihood ratio is computed on a theoretical
basis. Likewise, the amount of information in the message one person com-
municates to another can be measured in accordance with the mathematics
of information theory. In such examples as these, the units of measurement
are defined by the theory; the meaning of an obtained likelihood ratio or
information measure is the same whether it is obtained under strong signal
or powerful noise conditions, or whether the set of messages examined are
simple and highly redundant or tightly packed with information.
In contrast, most (although not all) test development proceeds without
a theoretical model of the relationships between stimuli and responses. The
unit of measurement, instead of being defined by a theory, is defined by
the distribution of the attribute in the sample of people studied in devel-
oping or standardizing the test; the unit of measurement is the standard
deviation of that sample. The score obtained by some later examinee, some-
one who may not have been part of that original group of people, is inter-
preted as being so many standard deviations above or below the mean of
that earlier distribution.
If one is measuring an attribute that can be measured more or less for-
mally, the method of measurement will apply to a range of conditions
implied by the theory. Measures of certain perceptions, utilities, and infor-
mation are among the very few formally measured attributes. Attitudes,
personality traits, stylistic habits, or cognitive skills are measured by scales
that, despite some formal properties, tend to be more intuitively developed.
The developer of these intuitive measures must take special care to define
the circumstances of measurement: the content and form of stimulus mate-
rials serving as items (or independent observations), the number of items,
the appropriate population of study and the rules for sampling from it, any
important conditions such as lighting or time limits or instructions, and the
psychometric properties sought or accepted. What kinds of items, how
many, consisting of what content, presented to whom under what kinds of
conditions? Answers to these and related questions should be induded in
118 ROBERT M. GUION
the planning of any measurement procedure not explicitly derived from a

formal mathematical model.
3. Probable modes of interpretations should be specified. The 1974 Standards
distinguished between norm-referenced interpretations, content-refer-
enced interpretations, and criterion-referenced interpretations. Norm-ref-
erenced interpretations interpret scores in terms of locations within a dis-
tribution of scores; that is, a score obtained by one individual is compared
to those made by other individuals, using centiles or standard scores. Con-
tent-referenced interpretations interpret scores in terms of performance at
different points on a continuum defined by the instrument itself. For exam-
ple, a score might be interpreted as being 75% of the total possible score.
Criterion-referenced interpretations were defined, in the 1974 Standards, as
those that interpret scores in terms of an external variable. This definition,
which is consistent with the typical use of the term criterion in psychometric
history, has not been widely accepted. In educational measurement, the lit-
erature on criterion-referenced testing is well established as meaning sev-
eral things, none of which is the definition in the Standards. In general, it
refers to a criterion or standard level of performance on an achievement
test. For example, many civil service laws set an arbitrary standard of 70%
as a "passing" score on any examination, without reference to the psycho-
metric properties of the examination. Such a standard is in a dictionary
sense a criterion and scores are interpreted as being at, above, or below that
criterion. Sometimes no such specific standard is set and the term criterion-
referenced interpretation means something very much like the definition
of content-referenced interpretations in the Standards. Although this vari-
ation in meanings is somewhat confusing, it exists and is so well
entrenched that it is unlikely to be changed (Hambleton, Swaminathan,
Algina, & Coulson, 1978).
On one point there is no confusion: whether it be called content-ref-
erenced, standards-referenced, criterion-referenced, or domain-referenced
(to add just two more of the many terms that have been used), the intent is
to describe a type of test score interpretation that is entirely different from
the conventional norm-referenced interpretations. Instead of interpreting
the score an individual makes relative to scores made by other people, one
may intend to interpret a score in more nearly absolute terms-that is, in
terms of the measurement scale itself. These are quite different kinds of
interpretations, and the decision should be made in planning the devel-
opment of a measurement technique.
In fact, some authorities believe that the difference is more fundamen-
tal than a mere difference in the interpretation of scores; some would argue
that there are substantial differences in the manner of constructing and
evaluating norm-referenced and content-referenced tests. For example, spe-
cial approaches to reliability estimation have been suggested by Livingston
(1972), Huynh (1976), and Brennan and Kane (1977), among others. Each of
these, however, is concerned primarily with the reliability of classification
using a specified cutting score. Linn (1977) argued that the reliability of
scores along a total scale can be estimated by conventional means, even

where content-referenced interpretations are intended.
Where interpretations of scores are intended to be free of the reference
to specific samples of people with their own specific distributions, recent
advances in psychometric theory may provide more profitable approaches.
Most of the latent trait models provide a scale of measurement that, despite
the fact that both the zero point and the units of measurement may be arbi-
trary, gives scores that can be interpreted without reference to normative
characteristics of a particular sample (Hambleton & Cook, 1977).
The distinction needs to be made in planning a measurement tech-
nique. If comparison with different kinds of norm groups is not going to
be meaningful in the context of the intended uses, then some more formal
method of measurement (such as mathematical scaling techniques, latent
trait scales, or other mathematical models) will be helpful. The emphasis is
on the intended interpretation, but the intended interpretation generally
influences the way a measuring technique is constructed.
STANDARDS FOR CONSTRUCTION
1. A test developer should define and sample from an unambiguous content

domain. Although all three generations of Standards have incorporated the
term content validity, it is more appropriate and descriptive to refer to con-
telLt-oriented test development (Guion, 1978; Messick, 1975; Tenopyr, 1977).
The latter term places at least as much emphasis on how one decides what
to put into a test as on how one might evaluate a finished product.
The notion of content-oriented test development has its origins in edu-
cational measurement, in which the content is determined by the content
of a curriculum. If a system-wide test of eighth-grade English grammar is
desired, teachers and curriculum coordinators identify the objectives, in
terms of the desired learning, of such a course of study; a content domain
is thus defined by the curriculum objectives. A valid sample of that content
would be representative in some way, perhaps by allocating test items or
points to various grammatical topics in proportion to the time allocations
given to them in the classroom.
Content sampling is broader than curriculum sampling, however,
Schimmel (1975, cited in Guion, 1977), defined a content domain of differ-
ent kinds of assertive behaviors in developing a scale of assertiveness.
Other examples can be offered. Different kinds of behavior of children at
play can be organized as a content domain from which observers' checklists
can be developed for measuring such attributes as socialization level or
aggressiveness. A cognitive test of problem-solving ability may be more
easily constructed if one first develops, if not an explicit catalog of all kinds
of problems fitting a content domain, a set of rules for deciding whether a
particular problem does or does not fit within a defined content domain.
Even a factorial test, such as a test of visualization ability, is defined by a
120 ROBERT M. GUION
variety of item types. A test developer can specify these and, perhaps, limit
the test content domain to one or two types of items that have been espe-
cially effective in defining the factor. In short, in developing any test,
checklist, or inventory, a test developer should be able to specify the kinds
of items that best reflect the attribute being measured.
If there are several categories of items fitting the domain, then relative
frequency, relative importance, or relative complexity of the categories
could be invoked in setting rules for sampling from the more general con-
tent domain. The rules or procedures for sampling should be so well spec-
ified that other observers or test developers, including those who may pre-
fer a different domain definition, can judge whether the domain as defined
has been adequately sampled.
Special effort should be taken in test construction to avoid inappro-
priate bias in selecting or creating items. Two kinds of bias should be mat-
ters of concern. One is content bias, in which some content areas have a
representation in the test that is inconsistent with the rules for domain sam-
pling. The other consists of an interaction of response tendencies to indi-
vidual items with subgroup identification.
Relevant Standards include E9, E12, E12.2, E12.1.2, and E12.4. While
most of these Standards were written explicitly for evaluating measures in
terms of so-called content validity, the test developer should recognize that
the validity of any measure depends in part on how well the content of the
measuring instrument can be justified in terms of the purposes of
measurement.
2. Items and item responses should be analyzed so that contaminating items
may be eliminated. Conventional item analysis consists of using a set of
responses to items to compute item difficulty and item discrimination sta-
tistics. A more complex item analysis might estimate the parameters of item
characteristic curves relating the probability of a correct response to level
of latent ability (Hambleton & Cook, 1977). In either case, the intent is to
identify items that will arrange themselves along a Single continuum. That
is, the intent of such item analysis is partly to select items for inclusion in
a final form to assure that the measuring instrument will distinguish
between people with varying degrees of a single homogeneous attribute.
The requirement of homogeneity has often been misunderstood.
Homogeneity might be synonymous with factorial purity, but it need not
be. Homogeneity refers simply to unidimensionality, the notion that a
dimension can be identified in which transitive relationships constitute the
rule. A transitive relationship is one in which b > a, c > b, and therefore
and necessarily, c > a (Coombs, Dawes, & Tversky, 1970). If these relation-
ships are not consistent, then the fundamental measurement requirement
of transitivity has not been met, and the numbers used to imply measures
are influenced by various competing dimensions (or contain unacceptable
error).
Transitivity may occur in any combination of variables where there is
a functional unity binding them together. In physical measurement, a use-
ful example is the measurement of volume, which may be analysed into the
three component dimensions of length, width, and depth. Nevertheless, if
Box B has a greater volume than Box A, and Box C has a greater volume
than Box B, then unarguably Box C is greater in volume that is Box A. The
requirement of transitivity has been satisfied and a unidimensional scale
exists.
Items that reflect an overarching unity in such a case can be assembled
to create a homogeneous set of items. Items that may represent a "factorially
pure" measure of one of the component dimensions may fail to contribute
to that homogeneity; if so, the fact can be identified through item analysis.
If most of the items in a pool of items tend to measure a single dimension,
then any other items measuring any other aspect of that overall unity will
probably be excluded as a result of item analysis.
There have occasionally been arguments over the need for homoge-
neity in measurement. Cronbach (1971) has argued that homogeneity is not
an essential component of a measuring instrument intended to lead to
inferences of degree of mastery in an overall content domain. If this point
of view is accepted, a different form of item analysis is necessary: an anal-
ysis of each component item for its relevance to the content domain. This
is done through expert judgments. One statistical approach to the quanti-
fication of such judgments has been the content validity ratio proposed by
Lawshe (1975):
n, - N/2
CVR = N/2
in which n, equals the number of judges who identify the item as essential
to a representation of the domain, and N is the number of judges.
The purpose of either of these kinds of item analyses is to identify item
contaminants, either as sources of heterogeneity (items measuring attri-
butes other than the one intended) or as outside of the defined content
domain. A different kind of analysis may be necessary to identify biased
items, those involving an interaction between responses to the item and
attributes external to the measuring instrument. External attributes include
race or sex or age bias, but many other kinds of potential interactions
deserve investigation. There has not been enough experience with item bias
studies to justify a requirement that such investigations be conducted, but
investigations of item bias are certainly among the kinds of item analyses
worth considering (Ironson, 1977; Rudner, 1977).
3. Adequacy of content sampling should be based on the competent, indepen-
dent judgments of people who are genuinely qualified to make them. The principle
here has been described as providing a paper trail of the judgment process.
Such a record is necessary to whatever extent the finished measuring instru-
ment will be evaluated in terms of the adequacy of its content sampling.
Where this is important (for example, where there is a possibility of litiga-
tion), conventional practice calls for the convening of a panel of experts on
the content area; they make judgments about the value or appropriateness
122 ROBERT M. GUION
of individual items in the test. The qualifications of such judges or experts

should be substantial and should be carefully documented. The processes
by which the judgments are reached should be independent so as to pro-
vide maximum reliability and freedom from the undue influence of a sin-
gle, perhaps overbearing person. (See Standards E12.1 and EI2.1.1.)
4. Standard procedures of test use, administration, and scoring should be estab-
lished. Decisions have to be made about a test as a whole before it exists in
its final form. Will it be administered with or without a time limit? If a time
limit is to be established, what shall it be? Will the instructions be given in
printed form or orally? What kinds of prior practice or other exposure to
the item type will be included in the administration of the test? If it is a
paper-and-pencil test, what color of paper will be used, what size and style
of type, and what sort of answer sheet?
In standardizing a test, it is useful to return to the old-fashioned notion
of a test as an experiment. It used to be said that, each time the test is given
to another person, it represents a replication of an experiment (Yerkes,
1921). Experiments, however, cannot be replicated satisfactorily unless the
new experimenters know precisely the conditions and circumstances of the
original study. By the same token, the test score obtained by a new admin-
istrator is not truly comparable to test scores obtained by an earlier admin-
istrator unless they both follow the same procedures.
The principle of standardization is very well established in ability test-
ing. It seems to be rarely observed in other forms of measurement, and it is
particularly rarely observed in measurement by getting ratings of observed
performance. It is, nevertheless, essential-perhaps more so for these than
for the ability tests-that measurement procedures be carefully standard-
ized. Rating systems, after all, are subject to additional sources of error.
Some errors of measurement stem from random variations in the behavior
of the people being measured, and still others from random variations in
the behavior of the people doing the rating. The more the rating task is
clearly structured and standardized, the fewer such sources of extraneous
and unreliable variance will exist. (See principles in Section C of Standards.)
STANDARDS FOR EVALUATION OF MEASUREMENT
1. Carefully planned research should be conducted for the evaluation of any

intended interpretations of scores. Test development cannot be considered com-
plete until empirical studies have been done demonstrating the validity of
the intended interpretations from test scores. Studies investigating the prac-
tical usefulness of a test, such as its practical predictive validity, may sup-
port or refute not only the interpretation of scores as predictors but also
their interpretations as reflections of intended attributes. If one claims to
have measured a particular attribute, some empirical study, not necessarily
concerned with usefulness, should be done to show whether the instru-
ment does indeed measure the attribute intended and whether its scores are
or are not contaminated by irrelevant attributes. That is, evidence of con-
struct validity is an essential part of test development. (See especially Stan-

dards E13, E13.1, and E13.2.)
This principle can be stated better, perhaps, in the negative: one should
not assume that one has measured an attribute satisfactorily simply because
the method of measurement seems right. A colleague once described such
practice as the "seem-y" side of psychology. Experience is said to be a good
teacher, but sometimes it teaches falsely. Many a professional psychologist
has developed the habit of inserting certain kinds of questions into inter-
view procedures because they seem intuitively right. On rare occasions, one
finds opportunities to test assumptions derived through experience-and
the results are often disappointing. Nevertheless, many people, including
professional psychologists, who have avoided the use of formal, standard-
ized tests because they lack face validity are perfectly willing to use such
experientially-based myths of effective assessment.
Stating the principle positively, however, provides more guidance. For
one thing, the positive statement suggests guidelines to consider in
attempting to evaluate proposed methods of measurement. Some of these
are very general. Sound, carefully planned research is, first of all, based on
an adequate number of cases-although the number of cases traditionally
accepted may be quite inadequate. Schmidt, Hunter, and Urry (1976)
showed that there is an unacceptable probability of falsely accepting null
hypotheses when the number of cases is small, and they provided guidance
for determining the number of cases needed under different assumptions
of range restriction and criterion unreliability. Sound research also includes
precautions to avoid criterion contamination. In educational or personnel
research, it is not at all uncommon for people who have made decisions on
the basis of test scores to be asked later-often not very much later-to
provide criterion data. Sound research will avoid the opportunity of artifi-
cially inducing correlations between the test and its criterion because of
such lack of independence in the measurement. More specific principles of
effective research must be followed consistent with the specific kinds of
information sought.
Not all research designs involve the relationship between test mea-
sures and criteria, but most guidance for validation research is for correla-
tional studies. Nothing appears in the various generations of the Standards
concerning the utility of quasi-experimental designs (Cook & Campbell,
1979) or of the kinds of research that might be particularly useful for eval-
uating the outcome of content-oriented test development. Cronbach (1971)
suggested for the latter case that two forms of a test be constructed inde-
pendently, using independent judges, to conform to an original set of spec-
ifications for defining and sampling from a content domain. He suggested
that the correlation between the two forms could be taken as an indication
of content validity. Here, too, principles such as assuring an adequate num-
ber of judges, an adequate number of people to take the two forms of the
test, and the assurance of independence in following instructions are essen-
tial ingredients of an effective research design.
The statement of this particular principle is not intended to specify cor-
124 ROBERT M. GUION
rect designs, to retain the emphasis on traditional methods of validation,

nor even to insist on the necessity of formal research; after all, good judg-
ment is superior to poor research, and the choice is often between poor
research or none at all. Rather, the purpose is to emphasize the need for
careful planning of the best ways available to gather evaluative data. To
revert to the negative expression, efforts to evaluate interpretations based
on measuring instruments should not be haphazard. (See in particular Stan-
dards E4.1, E6.2, E7, E7.2, and E7.3.)
2. The source and extent of measurement errors should be empirically identified.
This is more than simply saying that reliability should be estimated. Section
F of the Standards, in discussing at some length the problem of reliability
estimation, clearly points out that the different methods of estimating reli-
ability differ mainly in the sources of error considered. Internal consistency
coefficients are computed when the error variance of concern is due pri-
marily to heterogeneity in the attributes measured. Coefficients of stability
are computed when the error is due to changes in responses over time. Coef-
ficients of equivalence are computed when one is primarily concerned with
domain sampling errors as sources of error variance.
Far superior to these conventional estimates of reliability are the gen-
eralizability coefficients that can be obtained from multiple-facet analysis,
known also as generalizability theory (Cronbach, GIeser, Nanda, & Rajar-
atnam, 1972). These procedures allow the total measurement error to be
analyzed into identifiable components. For example, different facets or com-
ponents of error might be attributable to heterogeneity of content, differ-
ences among administrators, errors in scoring, use of different pieces of
appartus, differences in time of day, and the like. The methods of general-
izability theory were, of course, known at the time the 1974 Standards revi-
sion was developed, but there seemed to be problems of feasibility that
often make generalizability analyses difficult to conduct. For that reason,
the approach, which is essentially the recommendation of Standard Fl.l,
was listed simply as desirable. The most important aspect of generalizability
theory seems to be not the specific research design but the fact that gener-
alizability theory forces one to raise questions that might not otherwise be
considered (Cronbach, 1976).
Standard F2.3.2, a further recognition of advances in psychometric the-
ory, requires investigators to report standard errors of measurement at dif-
ferent score levels. Again, this is listed as a desirable recommendation
rather than an essential requirement. Too often, the number of cases is too
small to compute standard errors independently for different score ranges.
The most efficient way of determining the precision of measurement at dif-
ferent levels is through the use of the information curves derived through
latent trait analysis (Hambleton & Cook, 1977).
Both generalizability theory and latent trait analysis can remind profes-
sional psychologists that classical psychometric theory is often a severe
oversimplification of the measurement logic. A single reliability estimate
considers only a single source of error variance; a single standard error of
measurement ignores the fact that a particular test, attitude scale, or other
psychological measurement is typically designed to be most effective in a

limited score range and, therefore, is not uniformly effective at all score
levels.
3. Studies intending to investigate either the construct validity or the practical
usefulness of a measuring instrument should be conducted using samples from the
population of intended use. An appalling tendency in psychometrics is to use
a sample from an available population, usually a captive one (such as stu-
dents in an introductory psychology class), to develop a measuring instru-
ment intended for subsequent use in totally unrelated populations. For
example, a personality measure might be developed on the basis of
responses from college students, friends, or members of a local service club
or church, even though it is intended to be used with juvenile delinquents
or hospital patients. This practice, although rather widespread, is so obvi-
ously inappropriate that no extended comment seems needed. Neverthe-
less, the Standards have identified some cautions to be observed in selecting
a sample for research.
For example, Standard E6.1.1 requires research subjects to be of the
same age, have the same educational status, or be in the same occupation as
the persons for whom use of the test is recommended. There should also be
some similarity of expected motivational level; a test intended to be used
among candidates for a position, educational program, or other opportunity
should not be validated on samples of people who have already received
that opportunity and therefore approach the test with quite different moti-
vation. Some judgment is always required in these matters; if the difference
between the populations is simply one of motivation, and if motivational
variables are deemed to have little to do with the actual responses people
make, then the distinction between candidates and incumbents may be
trivial.
4. Criterion measures or dependent variables should be selected for criterion-
related validation with care and judgment. Criterion-related validities are
important in both the assessment of construct validities and of practical use-
fulness. For either purpose, it is customary and desirable to decry the ten-
dency to use whatever criterion measure happens to be readily available
regardless of its appropriateness.
A criterion is itself a measure of something, and it should be planned,
developed, and evaluated according to the principles applicable to other
measures. The validity of a criterion measure should itself be investigated,
not merely assumed (Standard E4). It should be evaluated either as a sample
of important behavioral content or as an adequate measure of a criterion
construct.
A criterion-related validity study is best understood as hypothesis-test-
ing research. One measure, called a predictor, is hypothesized to be related
in some functional way to a dependent variable called a criterion. Funda-
mentally, the hypothesis concerns the relationships between one attribute
in the role of predictor and another cast as the criterion. Alternatively, the
hypothesis is that the same attribute can be measured in independent ways.
Suppose, for example, that one has developed an inventory intended
126 ROBERT M. GUION
to provide a measure of interpersonal competence. One might evaluate the

resulting measurement in either of two ways. One might look for an alter-
native way of measuring interpersonal competence. If the test is intended
to be used with school children, teachers might be asked to rate children in
their classes on interpersonal competence, and the evidence of validity
might consist of the correlation between the inventory scores and the rat-
ings, that is, between two independent measures of the same attribute. One
might instead investigate the validity of the inventory by identifying other
behaviors or attributes to which interpersonal competence might theoreti-
cally be expected to relate. One might argue, for example, that interperson-
ally competent people are more likely to be chosen by their peers for posi-
tions of responsibility. Therefore, a sociometric measure based on peer
nominations may be a useful criterion. Or, one might intend to use the
inventory to select sales personnel, arguing that people who have a high
level of interpersonal competence are more likely to be successful in sales
occupations; a measure of sales success would be the appropriate criterion.
In these three example, we have moved from an alternative measure of the
same attribute to a measure of a distinctly different attribute in the role of
criterion measure. In all three cases, however, the criterion measure is cho-
sen on the basis of a considered hypothesis, not simply because it is con-
veniently available.
Whatever the criterion attribute might be, the validator needs to be
sure that it is effectively measured by the actual operations chosen. At a
practical level, this usually means that scores on the criterion measure are
not contaminated by irrelevant attributes. The teachers' ratings of interper-
sonal competence should not be based on how well the children have done
in classes. The peer nominations should not be based on some political quid
pro quo. The sales records should not be heavily influenced by the partic-
ular territory to which a given salesman has been assigned. Such contami-
nants-to whatever degree they influence variances-are validity-destroy-
ing characteristics of the criterion measures. Attempts might be made to
partial out the effects of such unwanted sources of variance or, better, to
find less contaminated operational variables to measure the same attributes.
At a more nearly fundamental level, the task of validating a criterion
measure requires a logical showing that it is indeed relevant to the intended
attribute. If the criterion concept is complex, including several components
or attributes, one must also have grounds for arguing that the measure is
complete in representing the complex set. Freedom from contamination,
relevance, and completeness are all matters of judgment. The judgments by
which criterion variables are evaluated, and their bases in logic on data,
should be so explicit and so well stated that they can be easily communi-
cated to and understood by others.
5. In a criterion-related validity study, the time interval, if any, between the
collection of predictor data and the collection of criterion data should be consistent
with the intended predictive interpretations. Predictions over short time inter-
vals are ordinarily more accurate than predictions over longer periods of
time. The interval between the two periods of data collection is ordinarily
uncontrolled; different things happen to different people, with differing
intensities; over time, there will be many influences on criterion perfor-
mance. Recidivism among hospital patients, for example, is influenced in
part by the patients' attributes at the time of release, but it is also partly
determined by home environments, opportunities for employment, com-
munity pressures, and a host of other variables of which the researcher may
never have an inkling. The longer the period of time, the greater the oppor-
tunity for the influence of these extraneous and uncontrolled variables. Ide-
ally, of course, the most influential variables in any given time interval
would be identified, measured, and made a part of the predictive equation.
Nevertheless, there always remains a residual of uncontrolled and unmea-
sured variability.
The difficulty is that the professional psychologist typically wants to
make long-range predictions. Vocational counselors want to predict occu-
pational adjustment after long years of educational preparation, specific
training, and occupational experience. Industrial psychologists want to pre-
dict performance of journeymen tradesmen on the basis of characteristics
that can be measured before they begin their apprenticeship programs. In
neither case is the predictive validity likely to be very high. Nevertheless,
substantial abbreviation of time periods-or, indeed, the absence of any
time period at all in concurrent validation studies-represents a fairly
severe departure from the realistic situation of the intended use. Test devel-
opers should be aware of such a departure from reality, and it should be
evaluated with great care. (See in particular Standards E7.4.2 and E7.4.3 All
of the standards under the general Standard E7, requiring that validation
procedures be consistent with the purposes of the study, are relevant to this
discussion.)
6. Results of empirical validation studies should be expressed, insofar as feasible,
as population estimates rather than as merely sample statistics; moreover, statistics
should be verified by either replication or cross-validation. The results of a study
of the validity of a measuring instrument are expressed in terms of statistics
derived from the specific sample studied. A full statement of the research
results would include descriptions of the distributions of both the predictor
and the criterion variables and straightforward statements of both the kind
(for example, linear or nonlinear) and degree of relationship. These descrip-
tive statistics are extremely important and account for an entire series of
statements of standards under the general Standard E8 (requiring that sta-
tistical analyses be reported so readers or users can determine the confi-
dence they will have in the results).
Nevertheless, sample statistics can be misleading. Factors that have
biased the sample, inadvertently or inevitably, tend also to bias statements
of validity. Implicitly, the Standards suggest statistical corrections of
obtained validity coefficients to provide estimates of population parameters.
If, for example, there has been a severe restriction of range in the sample,
either from prior selectivity or through selective factors operating during
128 ROBERT M. GUION
the time interval enclosed by the study, a correction might be made for the
reduced variance. If particular difficulties have been encountered with cri-
terion measures, corrections for the unreliability of the criterion might be
desired. In either case, the purpose of the correction is to obtain an estimate
of the population value that the investigator considers to be a better state-
ment of validity than that derived from the sample itself.
The Standards have indicated (in the comment under Standard E8.2.1)
that "it is ordinarily unwise" to set up chains of corrections. That is, the
comment is made that, in the opinion of the committee, it is a poor practice
to correct a sample statistic for restriction of range and then to use that esti-
mate of the parameter as if it were a sample statistic and make a further
"correction" for unreliability of the criterion, and so on. The committee
considered these corrections highly fallible, often requiring questionable
assumptions. This point of view has been challenged, as "simply in error"
by Schmidt et al. (1976, p. 475), who proceeded to make these two correc-
tions consecutively for each of several validity coefficients.
The point is not one on which members of the committee felt so
strongly that they would establish a standard that would in effect prohibit
the practice. What is of extreme importance, however, is that corrected coef-
ficients not be used for making significance checks, particularly if correc-
tions have been piled on top of each other.
Perhaps the main point of this discussion is that one should not con-
fuse validity with an obtained validity coefficient. Corrections, whether
based on obtained coefficients or previously corrected ones, are made in the
realization that the obtained coefficient is to some degree subject to error.
Some of that error is sampling error, and nothing is going to be as effective
in reducing reliance on results from nonrepresentative samples as doing the
study over. Verification through replication is a time-honored method in
scientific inquiry for evaluating the dependability of results and it should
be applied to studies of the validity of measurement.
Such verification is especially important in multivariate studies; in
these, the replication is ordinarily called cross validation. Where the vali-
dation research is intended mainly to assess the practical usefulness of a
test, it may be appropriate to include other variables in a multiple regres-
sion analysis. A population estimate might be based, for example, on an
equation that partials out the effect of certain uncontrolled variables. Or one
might want to assess the usefulness of the predictor being validated in rela-
tion to other available predictors in a linear composite predictor (Darling-
ton, 1968). Such research requires cross validation. (See particularly Stan-
dards EI0 through EI0.2.)
Cross validation is particularly important if the number of cases is
small, or the number of variables is large, or complex or nonlinear relation-
ships are observed, or negative regression weights are found. Cross vali-
dation is needed in all of these cases because the relative contribution of
the measure being evaluated is unreliable to some degree and therefore
requires verification. Cross validation is also essential when an empirical
scoring key for a test or inventory has been developed against some exter-
nal criterion. For example, a questionnaire providing an index number

intended for use in predicting marital adjustment might consist of personal
history items that have been selected and weighted according to their pre-
dictive validities as independent items. The resulting score is best under-
stood, therefore, as a composite much like the composite in a multiple
regression equation. In such cases, the validity of the resulting scores needs
to be determined with an independent cross-validation sample.
STANDARDS FOR MANUALS OR REPORTS
1. A manual or report should be prepared describing the instrument, its proper

use, and accumulated research data. When a test or other measuring instrument
has been developed, and when the development has included detailed
information on the validity of the instrument, that information is, strictly
speaking, relevant only when the instrument is used just as it was used in
the validity studies. That is, each measuring instrument should be pre-
sented and scored in a standardized or controlled way.
If the developer is to follow these same procedures at a later time, or if
another user wishes to use the same instrument with the same basis for
interpretation, there should be a record of the kind of standardization that
characterized the collection of data in the validity studies. The standardized
instrument, in its final form and in its development, is ordinarily the result
of some reasonably careful thought; that thought should be a matter of
record.
Standard AI, in conjunction with Standard A1.2.3, calls for the devel-
opment of a manual, and explicitly goes beyond the development of a man-
ual for a published test. If a measuring instrument has been developed for
use within a single practitioner's office, or a single employing organization,
then a manual of some sort is an essential part of the completion of that
work. It need not be as formal or broad in its coverage as the manual that
would accompany a published test, but it should be clear and complete
enough to permit those who must evaluate use of the test to have the infor-
mation they need. A manual, technical report, or official memorandum
should exist that will describe the requirements for administration and scor-
ing, the rationale behind the test, the thinking that went into test devel-
opment (such as setting item specifications), and the results or relevant
research. The manual or report should be a factual statement, not a political
instrument of self-enhancement on the part of the test developer. A manual
or report should not attempt to "sell" the use of the measuring instrument
as much as to identify its limitations, its likely forms of misuse, and related
caveats.
2. The manual or report should be an aid to the proper interpretation of scores.
At the very beginning, the test should not be described with a clever but
potentially misleading name (Standard B1.I). A simple vocabulary test, for
example, should not be called an academic aptitude test.
If certain data should be considered in interpreting a particular test
130 ROBERT M. GUION
score, such as moderating characteristics of the home life of the person

tested, or if scores appear to be influenced by socioeconomic status, race,
sex, or other variables irrelevant to the attribute measured, or if certain com-
mon errors or misinterpretations are likely, the manual should warn the test
user of these problems.
Specific interpretative aids should be developed. Expectancy tables or
norm tables should be presented in an easy, clearly readable form, without
exotic statistics that contribute little if anything to the accuracy of interpre-
tations. The conversion of raw scores to certain derived scales, such as IQ
scores or grade equivalent scores, is particularly likely to lead to misinter-
pretation because of the socially derived surplus meaning that such terms
have come to carry with them. (See Standards J5.1 and J5.2.) In contrast, a
simple expectancy, or a percentile rank, is easy to understand and clearly
requires norm-group identification. ("Better than 83% of whom?") Exotic
misinterpretations are less likely with such simple aids.
If the test score is not to have a norm-referenced interpretation (that is,
if it is to have a content-referenced one), the manual should offer interpre-
tative aids to identify the concomitants of various levels of mastery. Infor-
mation provided in manuals or reports should be consistent with the
intended use of the test. (Relevant standards are found in Sections Band
D.)
3. Tests and manuals should be revised periodically. Manuals need revision
more frequently than the tests themselves; at least they should, because
new data are accumulated over time. Each new study offers at least a particle
of new information leading to improved interpretations of test scores as
measures of the intended attributes. That is, it increases one's understand-
ing of the construct validity of the measure. As such data are accumulated,
their value for the interpretation of scores should be recognized by revising
the manual.
There is no set rule on how frequently a manual or a test should be
revised. Standard A3 indicates that revisions are appropriate at least as often
as changing conditions of use or changing data renders something in the
manual incorrect or misleading. The standard is silent on the signals of the
need for revision of the test itself; it may be presumed that tests require
revision when early validities no longer are obtained.
STANDARDS FOR THE USE OF PSYCHOLOGICAL

MEASUREMENT PROCEDURES
Professional psychologists do not necessarily develop the measurement

procedures they use. They often purchase tests or other assessment aids
from publishers. The standards for users are intended to apply to all users
of measuring instruments, whether they are self-developed, purchased, or
borrowed from others. "Users" are those people who make decisions about
tests and other measuring procedures, who are in charge of testing pro-
grams, who interpret test scores, or who make decisions or prescriptions

affecting the lives of other people on the basis of measures obtained.
1. The user should accept responsibility for understanding the validities of his
intended interpretatIOns. A test developer has, as a part of the responsibility
of test development, an obligation to accumulate evidence concerning the
validity of the intended interpretations. A test user is responsible for eval-
uating the evidence of validity accumulated by the developer. Moreover,
the user is responsible for mustering additional information. This may con-
sist of the development of a library of research reprints, a simple literature
survey, or empirical research in the user's own setting.
Test users often tend to develop their own special claims for the use of
a test. They may intuitively establish certain decision rules, such as cutting
scores for admission of candidates into certain opportunities, or they may
consider the test useful as a measure of an attribute quite different from that
originally claimed by the test developer. In such cases, the test user has the
obligation to seek, acquire, and evaluate available evidence, whether it sup-
ports or fails to support the interpretations he or she intends to make. (See
Standards E2, E2.1, E2.2, and E2.3.)
2. A test user should recognize his or her qualifications, and the limits to those
qualifications, for particular kinds of measurement activities. Not every profes-
sional psychologist is qualified to administer a Rorschach test, and, perhaps
surprisingly, not all are qualified observers or interviewers. Quite apart
from any questions of the validity or reliability of projective tests, observer
checklists, or interview protocols, it is important to see the user as an inte-
gral part of many measurement procedures. In these, the user may not func-
tion well as part of the measurement procedure unless he or she has been
well trained for that procedure, has had supervised practice, and can eval-
uate his or her performance against professionally accepted criteria. Even
users of presumably more objective tests should recognize whether they
have the training and experience necessary to administer and to interpret
scores on a particular type of test.
Section G of the Standards goes into detail on user qualifications. Test
users-under the broad interpretation of a test as defined in the 'Standards,
this means nearly all professional psychologists-should have a reasonably
substantial knowledge of psychometric principles and of the literature rel-
evant to the testing problems at hand. Such knowledge is important for the
research worker who will draw broad inferences about groups or total pop-
ulations, but it is particularly important for test users who must make deci-
sions affecting individuals' lives. Another generally applicable qualification
is the ability to make diligent efforts to avoid bias in choosing and using
tests, avoiding "even the appearance of discriminatory practice" (Standard
G4). That is, a most important qualification of a test user is a substantial
degree of professional and scientific objectivity in confronting tests, test
scores, and the inferences drawn from those scores about individuals.
3. Procedures followed by test users should be consistent with the standard
procedures used in the reported evaluation research. This principle has been
132 ROBERT M. GUION
implicit in many of the statements made in this chapter. Again, its intent is
clarified by expressing it in a negative form: Don't make substantial changes
in the way a test is used without revalidation to determine whether those
changes have enhanced, maintained, or destroyed validity (Standard E2.3).
On occasion, circumstances require modification of a test. Where this
happens, the user should apply the modifications consistently across all
examinees and serious attempts should be made to evaluate the effects of
the modifications.
The standardization problem should, incidentally, include standardi-
zation of materials and equipment. If paper is likely to become yellow with
age, or if holes in pegboards are likely to become larger through wear, the
test has changed in visual demands or in physical tolerances. Such changes
in a test as a stimulus can effect, often quite negatively, the validities of the
interpretations of the scores.
Where judgments are required in scoring, standard scoring guides are
typically available. Standardization of scoring procedures in such cases is
just as important as the standardization of administration procedures. (See
Standards 11, 11.1, 11.2, and 11.3.)
4. Test security should be maintained. This is a responsibility, according to
Standard IS, that the test user shares with the developer or distributor of
the test. It is a responsibility that should not be taken lightly.
A case study in the problems of test security is the controversy between
the Detroit Edison Company and the National Labor Relations Board (Ros-
kind, 1979). The case began when a promotion grievance was filed by the
union against Detroit Edison. As part of the grievance negotiations, the
union requested copies of the test, the scoring key, and the scores of indi-
viduals who, according to allegation, had either been promoted or passed
over for promotion on the basis of the test scores. Detroit Edison refused to
divulge test scores without written authorizations from the individuals
involved or to turn over to the union, without security safeguards, the test
and scoring keys. The union subsequently filed a charge of an unfair labor
practice with the National Labor Relations Board. Both the NLRB and the
Sixth Circuit Court of Appeals upheld the union position. The Detroit Edi-
son Company appealed the case to the Supreme Court, where the compa-
ny's professional responsibility to maintain test security was accepted and
the union request was denied.
Relatively few test users are likely to find themselves before the
Supreme Court. It is very common, however, for test users to be in situa-
tions where files may be left laying around, available for casual perusal, or
where the testing situation permits people to memorize and sell test ques-
tions or otherwise compromise the integrity of the test. Users should be as
diligent in avoiding these kinds of security problems as Detroit Edison was
in its litigation.
5. Tests should be accurately scored. Standard 13 calls for checking the
accuracy of all scoring, coding, or recording of scores. The responsibility for
avoiding what amounts to routine clerical error extends even to situations
where mechanical scoring aids are used. Samples of machine scored tests
should be checked by hand to be sure that no error has crept into the scor-
ing process.
6. Test users should be careful and thoughtful in the interpretation of individual
test scores. A test score is obtained under a specific set of circumstances, and
it is subject to unknown and often idiosyncratic sources of error. It is not,
according to Standard Jl, an "absolute characteristic" of the person tested.
Neither is it permanent or generalizable to all other kinds of circumstances
in which the person might find himself. Therefore, the total measurement
situation needs to be considered in interpreting obtained scores before deci-
sions are made about people. In particular, interpretations should be com-
plete enough that the shorthand of descriptive, general labels (e.g., organic,
retarded, incompetent) will not be applied to individuals. (See Standard
J2.3.) Just as the process of construct validation calls for the systematic
investigation of alternative interpretations for sets of test scores, a test user
should consider alternative interpretations for any specific individual score.
Possible alternative interpretations would include anxiety, language hand-
icaps in understanding instructions, faking, and others. (See Standard J7.)
Special care is needed where interpretations are reduced to a pass-fail
or accept-reject dichotomy, that is, where some form of cutting score is
applied. A test user who establishes a cutting score has, in effect, reduced
the distribution of possible scores to two. Any score is either above or below
the cutting score. A validity coefficient obtained on a two-level distribution
will almost certainly be different from one obtained on a full range of pos-
sible scores. Moreover, the validity coefficient changes as the point at which
a distribution is dichotomized changes. Therefore, users who wish to inter-
pret scores on a pass-fail basis should determine the validity of the scores
using the particular dichotomy intended. (See Standard 14.)
Finally, the interpretation of an individual's score should take into
account its currency. In many organizations, test scores are routinely kept
as a matter of file long after they are obtained. People change. The scores
they obtain become obsolete. It is better to purge the files of obsolete data
than to try to interpret them. (See Standard J9.)
7. Interpretations, not merely numbers, should be reported when the results of
measurement are reported to examinees or other interested persons. A number by
itself, such as a raw score, means very little. Translating a raw score to the
percentage of the items answered correctly will provide a content-refer-
enced interpretation, but it is also purely numerical. The addition of verbal
interpretive aids (for example, describing the percentage score in terms of
levels of mastery or achievement) is much more informative.
Raw scores can be transformed into centiles or standard scores. Again,
these norm-referenced interpretations are purely numerical. To be infor-
mative, they need to be accompanied by deSCriptions of the normative pop-
ulations used and their appropriateness for the individual or for the pur-
poses of the testing. Of the two, centiles fit the intent of this principle better
than standard scores because they are more readily understood. Expectancy
134 ROBERT M. GUION
charts provide numerical criterion-referenced interpretations, and these are

made more informative when accompanied by clear descriptions of the
research population, the various levels of criterion performance, and the
meaning of the expectancies. (See Standards J2.2, J2.2.l, JS, JS.l, and J.6.)
If norm-referenced interpretations are given, the user should be aware
of any differences between the characteristics of the examinee and those
typical in the normative population. If these differences are deemed sub-
stantial, and if better fitting norms are not available, the user may decline
to provide an interpretation on the basis that the test should not have been
used for that particular person (Standard J5.3). Normative interpretations
should, incidentally, not be given for scores in a chance range. Consider a
100-item-multiple-choice test with five options per item. A purely random
set of responses would get about 20 items correct. Normative data should
not be prepared for scores of 20 or below; scores in the 0-20 range should
not be given normative interpretations (Standard J5.S).
The amount of interpretive information to be given depends on the
purposes of testing. Subjects participating in test development research are
rarely given much feedback at all; there is little to offer them in validated
interpretation. In counseling circumstances, testing may be intended to
help the individual achieve self-insight. In these circumstances, interpre-
tations should be as extensive as existing validity information will allow,
including comparisons with several different norm groups and recognition
of confidence intervals.
In contrast, testing for institutional decisions, such as selection or licen-
sure decisions, rarely results in more than a pass-fail interpretation. Even
in these cases, one can (and ethically should) be more informative. One
might establish categories corresponding to percentage or percentile inter-
vals and offer narrative descriptions of test performance within the interval
in which the raw score appears. Or one might follow the lead of the Federal
Aviation Administration (U.S. Department of Transportation, 1977) and
provide diagnostic reports. The FAA reports of the results of pilot exami-
nations give numerical scores, which is not consistent with this principle,
but they also identify subject matter areas in which wrong answers were
given. These interpretative codes will not only help those who failed pre-
pare for retesting, but they help those who passed strengthen their knowl-
edge in areas of relative weakness.
The information to be given may depend on who is to receive the
report. In counseling or certification testing, the person tested generally
receives the report. Often, however, the results are reported to interested
persons other than the examinee: parents, potential employers, courts,
teachers, and others. The rule to be followed remains essentially the same:
test performance should be interpreted, and the report should be as difficult
to misinterpret as possible. Numerical raw scores should be reported only
to those who are qualified to interpret them; all others should receive
detailed verbal interpretations. (See Standard J2.)
CONCLUDING COMMENT
Statements of professional practice are elusive. They can never be as

precise as members of the profession, those affected by its practice, or those
who regulate its practice would like. At a very general, even ambiguous
level, statements describing good practice can be written and widely
accepted. Disagreements among reasonable interpreters of those general
statements arise, however, as soon as specific practices are evaluated against
them.
Consider, for example, the very first principle listed in this chapter:
that there should be a clear statement of the definition of the attribute to
be measured. If one decides to measure an attribute to be called verbal com-
prehension, the application of the principle is easy; verbal comprehension
is a finding in nearly all factor analytic studies of cognitive abilities. It is
operationally defined by types of test items that have been widely used for
several decades and it can be cleanly distinguished from related verbal abil-
ities such as semantic classification ability or general reasoning. Little dis-
agreement can be expected when a test author decides that the test is to
measure an attribute of verbal comprehension and defines the attribute as
(a) the ability to recognize the meanings of verbal units such as words or
short phrases, without (b) classifying the concepts involved, or (c) investi-
gating their possible implications.
Or is even such a well-established attribute of cognitive skill so much
beyond argument? The definition above fits nicely the Guilford theory of
the structure of intellect, with its distinctions among units, classes, rela-
tions, and other products of cognition (Guilford, 1967). Yet Guilford's the-
oretical basis for defining intellectual abilities is not without its critics (e.g.,
Brody & Brody, 1976), and those who do not accept the distinctions of the
theory may not consider a definition based on those distinctions as being
"stated clearly."
The problem becomes even more exacerbated when one wants to mea-
sure attributes commonly labeled by words that may mean many different
things. The word intelligence is a ready example. The kind of intelligence
measured by conventional mental testers, the concepts of intelligence
described by Brody and Brody (1976) or Bindra (1976), or the intelligence
studied as analogical reasoning by Sternberg (1977) are quite different.
Intelligence is not a single, unambiguous concept. One who approaches the
measurement of intelligence by defining the attribute from anyone of these
perspectives may expect to encounter wonder, if not hostility, from pro-
ponents of others. If it is difficult to provide a clear definition of intelli-
gence, which has been a part of the psychological lexicon for most of the
20th century, it is much more difficult still to define such attributes as per-
sonality, task performance, or various personal styles of behavior or prob-
lem solving. Yet the first in this list of principles is probably one of the least
likely to prove troublesome.
136 ROBERT M. GUION
The principles outlined in this chapter are technical principles. Their

history begins in a simpler psychometric era when they may have seemed
less ambiguous. Aptitude testing had a long history and certain procedures
had been established as right. A body of psychometric theory had devel-
oped that had prescribed useful methods of item analysis and of determi-
nation of reliability and validity coefficients. The measurement of interest
was widely accepted and personality inventories had been developed by
highly respected psychologists on the basis of careful research. Into this
complacent milieu, however, came the projective testing movement. How-
ever else one might describe projective tests, the one sure statement was
that they were something different. In the first place, some users of projec-
tive techniques (often a preferred term) did not even insist on a numerical
score as a result of testing. Even the nearly sacred principle of standardi-
zation of procedure was not universally demanded by the projective testers.
Conventional notions of reliability and validity seemed inapplicable. In
fact, studies attempting to show validity of such devices often failed, per-
haps because conventional ways of thinking about validity were not
entirely appropriate (Cronbach, 1949). Although the use of projective meth-
ods was met with much scepticism, it was also seen as a promising approach
to personality assessment by some rather prominent psychometricians (e.g.,
Cronbach, 1949; Thurstone, 1948, 1955) who found the problems of projec-
tive testing intellectually challenging. The efforts to meet the challenge
were partially responsible for the development of the Technical Recom-
mendations (APA et al., 1954) with that document's special concern for the
"diagnostic techniques" that didn't quite fit the conventional mold of a test.
Of course, the principal focus of the Technical Recommendations was on
the information that would be detailed in a well-prepared manual accom-
panying a published test.
A companion document directed toward educational measurement
contained many of the same recommendations. There were inevitably crit-
icisms of these two documents and, after long deliberation, a document was
issued that combined the two earlier sets of Technical Recommendations
into a single set of Standards (APA et al., 1966). Again, the principal empha-
sis was on informational standards. The document was intended to specify
the information that a test user needed in choosing among the many tests
available from test publishers and, not COincidentally, on the information
that test developers had an obligation to provide. The 1966 revision was
published after careful consideration of, among other things, the problems
test publishers had in complying with the earlier recommendations; it was
a balance of idealism and practicality.
The 1974 revision (APA et al., 1974) was necessary because the earlier
documents had stressed the test publisher without a similar stress on the
obligations of the test purchaser, test user, and developer and user of alter-
native methods of measurement. The growing social problems related to
test use in selecting employees and making educational admissions deci-
sions made necessary comparable statements of the standards of compe-

tence in test use.
To move from the information a commerical publisher should put in a
test manual to the standards of professional practice in using both conven-
tional tests and other measurement procedures tests is to make a very large
leap. It is a change from standards of professional practice directed explic-
itly to a relatively small group to standards of practice directed to virtually
all professional psychologists. It is a change from a relatively narrow focus
on the development and description of a measuring instrument intended
for very widespread use to a much broader focus on the use of any measur-
ing instrument in a very narrow setting. Even the statements concerning
test development changed from being directed to the responsibilities of the
commercial developer to the developer of the ad hoc or the one-time assess-
ment device as the target. Clearly, the scope-and inevitably the ambigu-
ity-of these standards grew substantially.
In addition, the scope of test use, the varieties of measurement meth-
ods, and the basic theoretical foundations of psychometric practice ha~e all
grown as well. Modern measurement theories that were only vaguely
known by the committee producing the 1974 revision have come to domi-
nate the psychometric literature and they may be expected to have major
impacts on the nature of psychometric practice. Program evaluation and
content-referenced measurement were explicitly acknowledged as missing.
A further revision of the standards may certainly be anticipated.
Each of these three generations represented a change. The 1954 version
changed the way testers talked about validity and changed in substantial
ways the nature of the evidence of validity presented in test manuals. the
1966 version brought concepts of educational measurement, such as content
validity, more strongly into the concerns of psychological testers by show-
ing that mental measurement, whether called psychological or educational,
was subject to a common set of principles. The 1974 version brought the
activities of the test user under scrutiny. The next version will assuredly
bring more change.
Yet within the change, the basic principles seem to have remained firm.
Throughout, the command has been to improve the validity of the inter-
pretation of scores, partly by research and partly by better understanding
of the nature of validity. Throughout, the command has been to be clear
about the nature of the attributes those interpretations imply. Throughout,
the command has been to recognize, in a very systematic way, the sources
of anticipated error in measuring those attributes. And so it goes. The fun-
damental principles of effective measurement have been clarified, and in
some respects expanded, but not basically altered. These principles may be
expected to apply even when the document they explicate is further
revised.
Paradoxically, however, the stability is tempered by the fact that the
principles also have become more ambiguous. By extending them from
138 ROBERT M. GUION
their narrow focus to a more global applicability, the possibilities for mis-
interpretation (or disagreements over interpretation in specific applica-
tions) also have become greater. Precisely how a principle mayor should
be applied is not, either in this chapter or in the Standards themselves,
made clear. That is proper. These statements are intended for the guidance
of the profession, not for enforceable law.
It would be hard to be legalistic about measurement in specific exam-
ples of psychological practice, even if it were desirable. The problems in
which testing is used are diverse. So are the attributes to be measured. So
are the methods of measurement-and they are growing ever more diverse.
So are the skills and the levels of psychometric sophistication among the
professional psychologists who try to apply these principles. With such
diversity, the first task of the individual psychologist is to come to the best
possible general understanding of the principles. Then the task is to find
specific ways in which the principles might be applied in a specific mea-
surement situation or to articulate reasons why certain principles are not
applicable. If the measurement problem often has been faced before, and
over a long period of time, by psychology in general, these tasks are not
likely to be difficult. If the measurement problem represents new ground
to plow, however, it can be a challenging task indeed. In the former case,
the professional psychologist is admonished to follow the best practice that
has evolved. In the latter, the professional psychologist is admonished to
do the very best he or she can.
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Brody, E. 8., & Brody, N. Intelligence: Nature, determinants, and consequences. New York: Aca-
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Brown, F. G. Principles of educational and psychological testing (2nd ed.). New York: Holt, Rine-
hart & Winston, 1976.
Cook, T. D., & Campbell, D. T. Quasi-experimentation: Design and analysis issues for field settings.
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Coombs, C. H., Dawes, R. M., & Tversky, A. Mathematical psychology. Englewood Cliffs, N.J.:
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5
Specialty Standards for Industrial-
Organizational Psychologists
C. PAUL SPARKS
Until quite recently there was no recognized source document that delin-
eated a set of standards or principles for the practice of what is commonly
known as industrial-organizational (1-0) psychology. During 1980 the
American Psychological Association (APA) finally adopted a set of Specialty
Guidelines for the Delivery of Services by Industrial/Organizational Psychologists
(1981). The reader will note that the title refers to "Guidelines" rather than
"Standards." APA characterizes these guidelines as "supplements to the
generic Standards for Providers of Psychological Services." The birth of these
guidelines was preceded by a long period of gestation during which abor-
tion frequently was proposed as the best solution. However, APA con-
cluded that, "The knowledge base in each of these specialty areas has
increased, refining the state of the art to the point that a set of uniform
Specialty Guidelines is now possible and desirable." Four professional spe-
cialties were recognized in this fashion: clinical, counseling, school, and
industrial/ organizational.
This is not to say that there were no standards or principles before
adoption of the Specialty Guidelines. However, it was necessary to derive
such standards or principles from a variety of sources. The diversity of fields
for which 1-0 psychologists are trained and the variety of applications to
which 1-0 psychology may be put have been the greatest deterrents to
development of a coherent and definitive set of standards or principles.
Industrial and organizational psychology is a taxonomic classification
given to a group of psychological specialties; it is not an entity. The Amer-
ican Psychological Association (1978) outlined 1-0 psychology as:
C. PAUL SPARKS. Employee Relations Department, Exxon Company, Houston, Texas

77001.
141
142 C. PAUL SPARKS
Personnel
Selection and Placement
Career Development and Training
Development and Training
Performance Evaluation
Job Satisfaction, Morale, and Attitudes
Retirement
Management and Organization
Organizational Behavior
Labor-Management Relations
Position and Task Analysis
Compensation
Human Relations
Organizational Development
Employee /Vocational Counseling
Environment & Quality of Life
Meltzer and Stagner (1980) were guest editors of a special issue of

Professional Psychology entitled Industrial/Organizational Psychology: 1980
Overview. Although the articles that appeared under their editorship were
intended to survey the more important components of contemporary indus-
trial/organizational psychology, the organization of this special issue high-
lighted the problems involved in developing standards that can apply to
someone who is labeled an industrial-organizational psychologist. Their
major subdivisions are:
Contemporary Personnel Psychology
The Individual in the Work Environment
Understanding Organizational Behavior
Organizational Development and Change
Clearly, this diversity can and does make for strange bedfellows. It is
possible for an 1-0 psychologist to have a full-time practice in one of these
specialties, e.g., development and training, and have no association with
practitioners in another, e.g., compensation. Yet, as we shall see later, there
is a communality among the 1-0 psychologists who ply these specialities,
something that sets them apart from other major areas of psychology, e.g.,
clinical or physiological, and from other practitioners who do not identify
themselves as psychologists. Finally, in addition to the varied activities of
1-0 psychologists, one must consider the settings in which they work. A
sampling of Division 14 members shows:
College or university
Consulting firm
Private business or industrial organization
Governmental agency
Civil service jurisdiction
Test publication enterprise
STANDARDS FOR INDUSTRIAL-ORGANIZATIONAL PSYCHOLOGISTS 143
Alluisi and Alluisi (1978) made a detailed analysis of the APA mem-
bership as of November 1977. One of their tabulations was the major field
of training reported. Industrial-organizational was the declared field of
6.65% of the members who declared a major field, a figure that ranked fifth
among all the major fields. Of those who declared their major field to be 1-
a psychology, 55.12% belonged to Division 14 (industrial and organiza-
tional psychology) if they belonged to any division, although I-a majors
also belonged in substantial numbers to other divisions: personality and
social (9.18%), general (6.27%), evaluation and measurement (5.93%), con-
sumer (5.59%), SPSSI (5.00%), military (4.47%), consulting (4.42%), and coun-
seling (4.03%). On the other side of the coin, 79.93% of all Division 14 mem-
bers had I-a psychology as their major field of training with social (4.23%)
a very distant second. Based on these data, the majority of those who were
trained in I-a psychology maintained a deep interest in I-a as evidenced
by membership in Division 14, but a large minority developed and main-
tained other interests. On the other hand, the Division 14 membership is
characteristically made up of persons who had their roots in I-a
psychology.
It must be noted that (given the taxonomy presented earlier) a substan-
tial number of I-a theoreticians and practitioners are either not psycholo-
gists or operate with little attention to psychological principles per se. Yet,
those persons who would identify themselves as psychologists must sub-
scribe to different standards and principles than those who would operate
under a different aegis. As psychologists, they are clearly bound by the
generic standards and principles of the profession. Not only is this neces-
sary to conform to the existing APA mandates, it is also necessary to con-
form to the bylaws of Division 14. There are also the new specialty guide-
lines of which more will be said later.
Even without the new Specialty Guidelines, and possibly a reflection
of the lack thereof, professional attention has been given to large segments
of I-a practice. Mirvis and Seashore (1979) concerned themselves with the
ethical problems encountered when social and behavioral scientists conduct
organizational research in real organizations. Among other things, the
authors suggested preparation of a casebook on ethical standards for orga-
nizational researchers. In another area of concern to many I-a psycholo-
gists, London and Bray (1980) considered ethical issues in testing and eval-
uation for personnel decisions. They considered formally published
professional standards and governmental guidelines but also wrote at
length on such topics as the psychologists' obligations to the profeSSion, to
those who are evaluated, and to the employer, and the obligations of
employers. An even narrower area of concern was addressed by the Task
Force on Assessment Center Standards which developed Standards and Eth-
ical Considerations for Assessment Center Operations (1978).
State laws also regulate the practice of psychology and are a source of
guidance for I-a psychologists. These vary widely in content and coverage
and each I-a psychologist must study those of his or her state and any other
states where he or she may wish to practice. The new Specialty Guidelines
144 C. PAUL SPARKS
specifically state, "Admission to the practice of psychology is regulated by

state statute." An example of state regulation is given later in this chapter.
For additional information see Chapter 11 and Fretz and Mills (1980).
The federal government, as well as many states and municipalities,
issue guidelines and orders that define acceptable practice in selected areas
of 1-0 psychology. The most notable of these are guidelines on acceptable
employee selection procedures, but there are also others: research with
human subjects, disclosure vs. privacy, etc. These regulations have been
generally upheld by the courts as proper interpretations of the appropriate
law and of professional standards. Thus, the 1-0 psychologists must be
attuned to the regulations and to the judicial interpretation of them.
This chapter will attempt to place the various constraints on the prac-
tice of 1-0 psychology in perspective.
APA STANDARDS
The hallmark of the true professional psychologist is adherence to the

various APA standards to the fullest extent possible. Many of these are not
specific to 1-0 psychologists and it becomes necessary to determine their
intent and the way in which they relate to specific 1-0 practices. The most
important of these are the Standards for Providers of Psychological Services
(American Psychological Association, 1977bi Chapter 2). These standards
note, "The kinds of psychological services covered by the present Standards
are those ordinarily involved in the practice of specialists in clinical, coun-
seling, industrial-organizational, and school psychology. However, it is
important to note that these Standards cover psychological functions and not
classes of practitioners."
In January 1980 the council of representatives and the board of direc-
tors of APA approved four sets of specialty guidelines. As noted earlier, one
of these was Specialty Guidelines for the Delivery of Services by Industrial/Orga-
nizational P&ychologists. A footnote by the author describes their preparation:
These Specialty Guidelines were prepared through the cooperative efforts of
the APA Committee on Standards for Providers of Psychological Services (COS-
POPS), chaired by Durand F. Jacobs, and the APA Division of Industrial and
Organizational Psychology (Division 14). Virginia Ellen Schein and Frank
Friedlander served as the I/O representatives on COSPOPS, and Thomas E. Tice
and C. J. Bartlett served as the key liaison persons from the Division 14 Execu-
tive Committee. (p. 664)
Though approved in January 1980, formal publication did not occur until
June 1981.
What follows is a digest of the Specialty Guidelines. Quotations are
used liberally since communication of content is the principal purpose. Sig-
nificant interpretations or implications must await further professional dis-
cussion after the Specialty Guidelines have been placed in effect.
The initial portions of the Specialty Guidelines are concerned with pur-
pose and coverage. The key provisions include the fact that they:
are designed to define the roles of I I 0 psychologists and the particular needs
of users of 1/0 psychological services.
are intended to educate the public, the profession, and other interested parties
regarding specialty professional practices. They are also intended to facilitate
the continued systematic development of the profession.
are intended to apply only to those psychologists who wish to be designated as
industrial Iorganizational psychologists. They do not apply to other psychologists.
[Italics in original.)
represent the profession's best judgment of the conditions, credentials, and
experience that contribute to competent professional practice. (p. 664)
The second portion of the Specialty Guidelines is concerned with prin-

ciples and implications of specialty guidelines. Eight principles are put for-
ward, followed by four implications. In this instance the material is para-
phrased to highlight the thrust of the principle:
1. Subordinate to statutory regulation where such is applicable

2. Uniform, regardless of setting or form of remuneration
3. Clearly articulated levels of quality, regardless of sponsor
4. Practitioners meet specified and appropriate levels of training and
experience
5. Present APA's position on levels for training and professional
practice
6. Covers both the private and the public sectors. Protects all users of
I/O psychological services
7. Promotes the interests and welfare of the users
8. Do not proscribe new methods or innovations
The four implications, each quite broad in scope, are as follows:
1. Provide for mutual understanding between provider and user and

facilitate evaluation of services provided and outcomes achieved
2. Contribute toward greater uniformity in legislative and regulatory
actions involving I/O psychologists
3. May impact training models; not intended to stifle innovations
4. Require continual review and revision
The third section of the Specialty Guidelines is concerned with defi-

nitions. Only one definition is given but it is crucial to those who would be
called I/O psychologists or would practice I/O psychology. It has many
parts and comments will be made on each.
A fully qualified 110 psychologist has a doctoral degree earned in a program pri-
marily psychological in nature. This degree may be from a department of psy-
chology or from a school of business, management, or administrative science in
a regionally accredited university. (p. 665)
In some states the doctoral degree from other than a department of psy-
chology precludes licensing, regardless of the psychological nature of the
degree.
146 C. PAUL SPARKS
Consistent with the commitment of I/O psychology to the scientist-professional

model, I/O psychologists are thoroughly prepared in basic scientific methods
as well as in psychological science; therefore, programs that do not include
training in basic scientific methods and research are not considered appropriate
educational and training models for I/O psychologists. (p. 665)
This provision clearly approves the PhD model and rejects the PsyD model.
The I/O psychology doctoral program provides training in (a) scientific and
professional ethics, (b) general psychological science, (c) research design and
methodology, (d) quantitative and qualitative methodology, and (e) psycholog-
ical measurement, as well as (f) a supervised practicum or laboratory experience
in an area of I/O psychology, (g) a field experience in the application and deliv-
ery of I/O services, (h) practice in the conduct of applied research, (i) training
in other areas of psychology, in business, and in the social and behavioral sci-
ences, as appropriate, and (j) preparation of a doctoral research dissertation. (p.
665)
Provision for grandparenting is provided and conditions of eligibility are

thoroughly spelled out. The training requirements themselves may seem
quite extensive and rigorous. The I/O psychologist should also check his or
her state licensing or certification act. There are probably additional train-
ing subject-matter requirements, some of which will appear unrelated to
I/O psychology.
Also included in this definitions section is the proviso that persons
who do not meet all the qualifications defined above may still provide I/O
psychological services, but such services must be performed under the
supervision of a fully qualified I/O psychologist.
The Specialty Guidelines then turn to a definition of "Industrial-orga-
nizational psychological services." Content and purpose are intertwined. Such
services:
involve the development and application of psychological theory and meth-
odology to problems of organizations and problems of individuals and groups
in organizational settings. The purpose of such applications to the assessment,
development, or evaluation of individuals, groups, or organizations is to
enhance the effectiveness of these individuals, groups, or organizations. (p. 666)
Six examples are given, each with a major heading and listing several spe-
cifics. The reader may wish to compare these with the several classifications
provided earlier.
A. Selection and placement of employees
B. Organization development
C. Training and development of employees
D. Personnel research
E. Improving employee motivation
F. Design and optimization of work environments (p. 666)
The document concludes with specific guidelines that are intended to
be controlling. Each guideline is followed by interpretation and explana-
tion, frequently quite extensive. The guideline statements are given below
without the interpretive material.
Guideline 1. Providers-Staffing and Qualifications of Staff

1.1 Professional I/O psychologists maintain current knowledge of sci-
entific and professional developments that are related to the ser-
vices they render
1.2 Professional I/O psychologists limit their practice to their demon-
strated areas of professional competence
1.3 Professional psychologists who wish to change their specialty to 1/
o areas meet the same requirements with respect to subject matter
and professional skills that apply to doctoral training in the new
specialty
1.4 Professional I/O psychologists are encouraged to develop innova-
tive procedures and theory
Guideline 2. Professional Considerations-Protecting the User
2.1 I/O psychological practice supports the legal and civil rights of the
user
2.2 All providers of I/O psychological services abide by policies of the
American Psychological Association that are relevant to I/O
psychologists
2.3 All providers within an I/O psychological service unit are familiar
with relevant statutes, regulations, and legal precedents estab-
lished by federal, state, and local governmental groups
2.4 Providers of I/O psychological services state explicitly what can
and cannot reasonably be expected from the service
2.5 The I/O psychologist does not seek to gain competitive advantage
through the use of privileged information
2.6 The I/O psychologist who purchases the services of another psy-
chologist provides a clear statement of the role of the purchaser
2.7 Providers of I/O psychological services establish a system to pro-
tect confidentiality of their records
Guideline 3. Accountability-Evaluating I/O Psychological Services
3.1 I/O psychologists' professional activity is guided primarily by the
principle of promoting l"\uman welfare
3.2 There are periodic, systematic, and effective evaluations of psycho-
logical services
The effect of these specialty guidelines remains to be seen. Clearly, the
individual who wishes to carry the label of fully qualified industrial-organi-
zation psychologist and follows them to that end will have established
impressive credentials. There may be some question as to the rewards for
this. We have noted that many of the activities carried on by 1-0 psychol-
ogists are also carried on by individuals trained in other disciplines. Also,
numerous individuals trained as 1-0 psychologists practice under some
other label, e.g., applied behavioral scientist. An answer may depend, at least
in part, on whether state licensing and certification laws attempt to protect
use of the terms psychology or psychologist or the practice of activities that
148 C. PAUL SPARKS
are generally in the purview of the profession. It is entirely possible that

the practice of 1-0 psychology as it is known today might cease to exist.
Another set of APA standards that 1-0 psychologists must be familiar
with and observe is the Ethical Standards of Psychologists (APA, 1977a; Chap-
ter 3). These standards are generic and many will not apply in a particular
setting nor for a particular activity. The 1-0 psychologist should be able to
apply the principle, even where the example does not fit exactly. The same
should be true of other standards and guidelines, viz., Guidelines for Condi-
tions of Employment of Psychologists (American Psychological Association,
1972); Ethical Principles in the Conduct of Research with Human Participants
(American Psychological Association, 1973a); Guidelines for Psychologists Con-
ducting Growth Groups (American Psychological Association, 1973b); and
Standards for Educational and Psychological Tests (American Psychological
Association 1974; Chapter 4).
The Ethical Principles in the Conduct of Research with Human Participants
can be particularly troublesome for the 1-0 psychologist. Activities fre-
quently taken for granted may violate these Principles unless certain precau-
tions are taken. For example, consider an 1-0 psychologist who wishes to
conduct some research on stressors in the work place. Typically, this will
include a questionnaire that contains some activity and performance items
that could be damaging to an employee's career if the responses were seen
by management. In order to be ethical, the researcher,must obtain informed
consent to aggregate the data in certain ways and insure that the employees
are informed of any limits to confidentiality of their responses. In another
area, consider an 1-0 psychologist desirous of developing a test of physical
strength that could be used to screen out applicants who would be unable
to perform satisfactorily on physically demanding jobs. The psychologist
would be attentive to the Standards for Educational and Psychological Tests. In
the developmental stage it would be unprofessional to use the tests for
actual screening of applicants. Under the Ethical Principles it would be
unethical to let applicants think that the test could affect their hiring
chances when it would not. The motivation to do one's best would be quite
different under a "makes no difference" vs. "for keeps" set, particularly in
a demanding physical effort situation. The 1-0 psychologist must exercise
real ingenuity to obtain valid results without violating the Principles.
LICENSING
In 1945 Connecticut adopted a law regulating the practice of psychol-

ogy and in subsequent years all the other states and the District of Columbia
adopted certification of licensure laws. Since Stigall (see Chapter 11) dis-
cusses the various features of the certification or licensure laws of individ-
ual states, there is no need to do it here. The 1-0 practitioner, however,
should read that chapter and obtain appropriate information for the state
of residence and all other states in which he or she may wish to practice.
This last caution is quite important since there are various reciprocity pro-
visions, various kinds of exceptions, and limitations on the amount of time
that the 1-0 psychologist may be permitted to practice in a state where he
or she is not licensed. Though a detailing of differing requirements has
been eschewed, the major features of one state are described here for illus-
trative purposes. The state of Texas has been chosen since it is the one in
which the author has been both certified and licensed and is accordingly
the one with which he is most familiar.
The Texas law, "Psychologists' Certification and Licensing Act," was
approved June 12, 1969, became effective September 1, 1969, and provides
that violation of the Act is a misdemeanor, punishable upon conviction by
a fine of not less than $50 nor more than $500, and by imprisonment in
county jail for not more than 30 days, with each day of violation considered
a separate offense. The hearings that led to an almost unanimous passage
by both houses of the legislature were characterized by testimony on the
need to protect an uninformed and naive public against charlatans and
unqualified persons. The law initially covered any person who used the
terms psychology, psychological, or psychologist when making any offerings of
service to the public. It was later amended to include "psychological ser-
vices" and defined these as "acts or behaviors coming within the purview
of the practice of psychology, including, but not limited to, the application
of psychological principles to the evaluation and remediation of learning,
.emotional, interpersonal, and behavior disorders."
Administration of the law was vested in the Texas State Board of Exam-
iners of Psychologists. The six members of the board were to be certified
psychologists and were to represent independent practice, teaching, and
research. (Many states require one or more public members.) The board was
instructed to make rules and adopt and publish a code of ethics. (The APA
Ethical Standards of Psychologists was adopted and is published annually in
its roster of licensed and certified psychologists.) (Texas State Board of
Examiners of Psychologists, 1982) The board was empowered to certify spe-
cialties including clinical, counseling, industrial, and school. To date this
has not happened for these specialties but specialty licensing for health ser-
vice providers has been established. (p. 112) In addition, the board has enor-
mous rule-making powers. For example, to be licensed or certified an appli-
cant must have received the doctoral degree from "a program of studies
whose content is primarily psychologicaL" (p. 100) if the degree was not
from a department of psychology, e.g., business or education degrees. It
chose to define the quoted phrase by a listing of required content areas, if
the degree was not from a department of psychology, e.g., business or edu-
cation degrees. It might interest 1-0 practitioners to know that physiological
psychology and psychopharmacology are among the subjects required.
The Act specifically exempted certain classes of individuals from the
certification or licensure requirement. These are paraphrased here in the
interest of space. Clarifying detail should be obtained from the law itself.
Specifically exempted were: persons employed as psychologists by any gov-
150 C. PAUL SPARKS
ernmental agency, public school district, institution of higher learning, or

any licensed hospital; students preparing for the profession of psychology;
residents of the state for no more than 30 days in any year if they were
authorized to practice in their home state or country; a sociologist with a
doctoral degree in sociology or social psychology who elects to use the title
social psychologist and so notifies the board; licensed registered nurses; qual-
ified members of other professional groups such as physicians, attorneys,
school counselors, social workers, Christian Scientist practitioners, or duly
ordained religious leaders; and licensed optometrists dealing with learning
or behavioral disorders associated with vision. The reader will note that
1-0 psychologists employed by a private business or industrial firm are not
exempt nor are 1-0 oriented consultants. A perusal of the current roster
(1979) indicates that almost all recognized Texas consultants offering 1-0
type services are licensed, as are the university based 1-0 psychologists who
do some outside consulting. On the other hand, only a very few of the 1-0
psychologists employed full-time in business or industry have been
licensed. This is illegal but has not been challenged except in rare instances
where the individuals were active in professional association activities and
were widely recognized as industrial psychologists. An interesting episode
was related recently by the attorney for a company in a civil rights court
case. He insisted that the company 1-0 psychologist become licensed before
the case came to trial in order to assure that the psychologist could be qual-
ified as an "expert" witness. The company's attorney did not wish to risk a
challenge by the plaintiff's attorney.
GOVERNMENTAL REGULATION
The final area of regulation of 1-0 psychologists are those rules pro-
mulgated by the federal government. Since 1964 and 1965 those 1-0 psy-
chologists whose work includes employee selection have had specific per-
formance requirements prescribed by the federal government, and, in
many instances, by state and municipal governments as well. The current
key regulation in the area is Uniform Guidelines on Employee Selection Proce-
dures (1978) (Equal Employment Opportunity Commission, Civil Service
Commission, Department of Labor, & Department of Justice, 1978). These
were further amplified by Adoption of Questions and Answers to Clarify and
Provide a Common Interpretation of the Uniform Guidelines on Employee Selection
Procedures (Equal Employment Opportunity Commission, Office of Person-
nel Management, Department of Justice, Department of Labor, & Depart-
ment of the Treasury, 1979) and by still more questions and answers in
1980. These Uniform Guidelines are the latest in a series that has seen issuance
of a new or revised regulation in 1966, 1968, 1970, 1971, 1976, and 1977.
Each regulation has been longer, more detailed, and more restrictive than
the last. The basic thrust of each is a definition of when an employer must
show that his or her employment procedure is valid, i.e., job-related, and a
delineation of what is an acceptable showing of this validity. Paper-and-
pencil tests, particularly standardized commercial tests, were the initial tar-
get of such regulations but this was modified and expanded as early as 1968.
Currently, Selection Procedure is defined in the Uniform Guidelines as:
Any measure, combination of measures, or procedure used as a basis for any
employment decision. Selection procedures include the full range of assessment
techniques from traditional paper-and-pencil tests, performance tests, training
programs, or probationary periods and physical, educational, and work expe-
rience requirements through informal or casual interviews and unscored appli-
cation forms. (p. 38308)
Similarly, Employment Decisions are defined in the Uniform Guidelines as:

Employment decisions include but are not limited to hiring, promotion, demo-
tion, membership (for example, in a labor organization), referral, retention, and
licensing and certification, to the extent that licensing and certification may be
covered by Federal equal employment opportunity law. Other selection deci-
sions, such as selection for training or transfer, may also be considered employ-
ment decisions if they lead to any of the decisions listed above. (p. 38296)
Note the "not limited to" phrase. Compensation, disciplinary actio1).s, and
assignment of overtime have all been included in charges and investiga-
tions as employment decisions. The various selection guidelines have fre-
quently been interpreted to require that all selection procedures must be
validated for all employment decisions. This is not true. A selection proce-
dure must be validated only if it has an adverse impact on the employment
opportunities of persons by identifiable race, sex, or ethnic group. In other
words, if a selection procedure in use results in disproportionate hiring of
blacks vs. whites or men vs. women it must be discontinued or modified or
validated. The Uniform Guidelines state:
The provisions of these guidelines relating to validation of selection procedures
are intended to be consistent with generally accepted professional standards for
evaluating standardized tests and other selection procedures, such as those
described in the Standards for Educational and Psychological Tests prepared by a
joint committee of the American Psychological Association, the American Edu-
cational Research Association, and the National Council on Measurement in
Education (American Psychological Association, Washington, D.C., 1974) (here-
inafter 'A.P.A. Standards') and standard textbooks and journals in the field of
personnel selection. (p. 38298) [See Chapter 4, this volume.]
Despite that statement, many 1-0 psychologists believe that one could com-
ply with the Standards and still not be in compliance with the Uniform Guide-
lines. A good example of this conflict is the treatment of intergroup differ-
enc~s in selection ratios. The Uniform Guidelines treat a hiring ratio of less
than .8 to 1.0 (.16 to .20; .024 to .030) as presumptive evidence of adverse
impact against the less-preferred group. The Standards insist on an appro-
priate level of statistical significance before drawing any conclusions. Sim-
ilarly, the Uniform Guidelines require the researcher to conduct a search for
suitable alternatives with a lesser adverse impact, even if the selection pro-
cedure studied had been shown to be valid. On the other hand, although
the Standards do indicate that psychologists should be aware of the fact that
multiple procedures may be available for accomplishing a given selection
152 C. PAUL SPARKS
decision, this principle is stated in the context of making the most valid or
the most accurate selection decision; it is not given in the context of mini-
mizing group differences. Increasing the researcher's dilemma, test manuals
and journal articles almost never have data on adverse impact as defined in
the Uniform Guidelines, even where good validation studies are reported.
This is true in many instances because adverse impact is a function of the
use of the selection data, not simply a matter of test score differences.
Despite these concerns, guidelines issued by the EEO enforcement agencies
have been upheld by the federal courts, up to and including the U.S.
Supreme Court (Albemarle Paper Company v. Moody, 1975; Griggs v. Duke
Power Co., 1971). It remains to be seen how the Uniform Guidelines will fare
with their added technical requirements and the extensive documentation
requirements.
In order to clarify the Standards with respect to the specific problems of
employee selection, placement, and promotion, Division 14 published in
1975 Principles for the Validation and Use of Personnel Selection Procedures. These
were revised in 1980, prompted in large part by much recent research in
the area of selection device validation and use. A joint review committee of
APA, AERA, and NCME has recommended that the Standards also be
revised and steps to that end are being undertaken. It remains to be seen if
these revisions will have any effect on the Uniform Guidelines. One hopeful
sign, however, is the U.S. Supreme Court (Gilbert v. General Electric Co., 1976)
ruling that a federal agency's regulation need not be controlling where it
is in conflict with a recognized body of professional opinion. This case did
not involve selection procedures but it was cited in U.S. v. South Carolina, a
case involving the examination of teachers. A three-judge panel heard the
case and cited both the Standards and the Principles as professional authori-
ties in upholding a validity study proffered as evidence by the State. The
lower court finding was affirmed without a hearing by the U.S. Supreme
Court (U.S. v. South Carolina, 1977, 1978). Many other cases could be cited
but it should be obvious from the sampling presented that the 1-0 psy-
chologist involved with personnel selection in any of its many phases must
study the Uniform Guidelines intently and be very attentive to court decisions
interpreting them.
The 1-0 psychologist working for or consulting with a federal contrac-
tor should also become familiar with the Federal Contract Compliance Manual,
issued by the Office of Federal Contract Compliance Programs of the U.S.
Department of Labor (1979). With respect to selection procedures, the OFCC
cites compliance with the Uniform Guidelines as the contractor's responsibil-
ity. However, the Manual amplifies the Uniform Guidelines in several
respects, particularly with respect to recordkeeping. For example, (pages 3
through 37) provide the following instructions, among others:
Interviews
A chronological list of the applicants interviewed for the last three or
four years showing:
Name, race, and sex

Date of interview
Job and department for which interviewed
Interviewer (include all interviews-initial and in-depth)
Disposition (results of interview, e.g., hired, promoted, or reason for
rejection) date of hire, job hired units, etc.
The Equal Opportunity Specialist (EOS) will determine from these data
whether the contractor's interviews had an adverse impact and, if so, ask
for evidence of validity. The Manual covers additional contractor responsi-
bilities such as nondiscrimination and affirmative action with respect to
religion, handicapped, and veterans. It also covers such subjects as how to
do a workforce analysis to determine whether minorities and/ or women are
being utilized appropriately, how to do-an analysis of the availability of
qualified or qualifiable minorities and/or women for the contractor's jobs,
and how to determine the existence of an "affected class" (women or minor-
ities who are still suffering the effects of past discrimination). The EOS will
arrive at many conclusions as a result of tabulating data by race, sex, or
ethnic group. The statistical expertise of the 1-0 psychologist can help
insure that these are valid conclusions.
CONCLUSION
It is perhaps ironic that what started as a discussion of "Specialty Stan-

dards for Industrial-Organizational Psychologists" has concerned itself so
greatly with legal and regulatory matters. It may well get worse before it
gets better. The regulatory agencies are still working on interpretations of
the Uniform Guidelines. Hundreds of cases are wending their way through
the federal courts, each with the potential to provide a new or expanded
interpretation of the adequacy of the 1-0 psychologist's work. Bills to reg-
ulate tests and testing have been introduced into the U.S. House of Repre-
sentatives and into the legislatures of several states. Two states (California
and New York) have passed laws regulating educational testing at the post-
secondary level. One of the bills introduced into the U.S. House (Gibbons,
1979) involves occupational testing, surely an area where the 1-0 psychol-
ogist would be involved. Hopefully, however, the situation will change so
that future editions of this book will see more attention to professional stan-
dards and less to legal prescriptions and proscriptions.
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Albemarle Paper Co. v. Moody, 422 U.S. 407 (1975).

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154 C. PAUL SPARKS

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U.S. Equal Employment Opportunity Commission, Office of Personnel Management, Depart-
ment of Justice, Department of Labor, & Department of the Treasury. Adoption of ques-
tions and answers to clarify and provide a common interpretation of the uniform guide-
lines on employee selection procedures. Federal Register, 1979, 44, 11996-12009.
U.S. Equal Employment Opportunity Commission, Office of Personnel Management, Depart-
ment of Justice, Department of the Treasury, & Department of Labor. Adoption of addi-
tional questions and answers to clarify and provide a common interpretation of the uni-
form guidelines on employee selection procedures. Federal Register, 1980, 45, 29530-
29531.
III
PROFESSIONAL ORGANIZATIONS
6
A Professional's Guide to the American
Psychological Association
RICHARD R. KILBURG and MICHAEL S. PALLAK
On July 8, 1892, G. Stanley Hall convened a meeting of eighteen psychol-

ogists who met at Clark University in Worcester, Massachusetts, to share
knowledge and to form a national organization to promote and support the
science of psychology. The first annual meeting of the new organization
took place on December 17, 1892. Twenty-six charter members and five
newly elected ones provided the human foundation of the American Psy-
chological Association (APA).
Over the past 88 years, APA has grown and diversified in a remarkable
tribute to the progress of a new science and profession. As of 1980, the orga-
nization had approximately 51,000 fellows, members, and associates. Its
assets approached 14 million dollars and its annual expenditures exceeded
12 million. With a complex governing structure and a large full-time profes-
sional staff, APA often appears remote, disinterested, and sometimes intim-
idating to the average psychologist. The purpose of this chapter is to dispel
these impressions. It will briefly survey the history of the organization,
describe the major features of its current structure and operations, discuss
strategies for making the organization work for you, and describe several
critical issues that confront APA today and in the near future.
HISTORY
No brief review can ever do justice to the richness and complexity that
have marked the course of APA's development. Since excellent descriptions
of the earliest decades are readily available (Fernberger, 1932, 1943; Napoli,
RICHARD R. KILBURG. American Psychological Association, Washington, D.C.

20036. MICHAEL S. PALLAK • American Psychological Association, Washington, D.C.
20036.
157
158 RICHARD R. KILBURG AND MICHAEL S. PALLAK
1975), this account will focus on some central aspects of APA's and orga-
nized psychology's investment in professional and applied issues.
Beginning with a clinic established by Lightner Witmer in 1896,
applied psychology has conSistently matched strides with the pure science
that provides the common bond for all that psychology has come to mean-
ingfully encompass. Today, the by-laws of the organization emphasize that:
The objects of the American Psychological Association should be to advance
psychology as a science and a profession and as a means of promoting human
welfare by the encouragement of psychology in all its branches in the broadest
and most liberal manner; by the promotion of research in psychology and the
improvement of research in methods and conditions; by the improvement of
the qualifications and usefulness of psychologists through high standards of
education and achievement; by the establishment and maintenance of the high-
est standards of profeSSional ethics and conduct of the members of the Associ-
ation; by the increase and diffusion of psychological knowledge through meet-
ings, professional contacts, reports, papers, discussions, and publications;
thereby to advance scientific interests and inquiry, and the application of
research findings to the promotion of the public welfare. (American Psycholog-
ical Association, 1979b, p. 22)
In the complex tapestry that psychology has become, the remarkable inter-
weaving of scientific and professional developments can be traced to the
earliest beginnings of this discipline. For example, in 1895, the Committee
on Physical and Mental Tests was formed by APA to try to develop guide-
lines and norms for the generation of tests and measurements (Centor,
1975). This focus on measurement and testing has continued as a central
concern of APA even to today.
In 1915 the first major effort to address standards of practice was under-
taken by APA. APA Council passed a resolution stating "this Association
discourages the use of mental tests for practical psychological diagnosis by
individuals psychologically unqualified for this work" (Napoli, 1975). A
committee was established to develop a certification program for "consult-
ing psychologists." After 12 years of wrestling with the complexity of the
regulation of practice, this committee and the certification program were
discontinued in 1927.
In the meantime, psychology and the U.S. government discovered each
other during World War I. In a memorable if not celebrated role, Robert
Yerkes, one of psychology's foremost scientists, led psychology'S initial
fight to establish itself as independent from the field of medicine. The lines
of battle were drawn over who should determine who was fit to serve in
the U.S. Army. As detailed by Napoli (1975), the battle fought then closely
resembles many of the struggles' currently facing APA. Psychology won
that battle and the first large-scale psychological testing program in history
was undertaken by the Army.
In the years between the wars, psychology continued to grow. The
membership of APA increased eightfold. The Association and the field
struggled with organizational and economic issues in the 1930s. The pub-
lication program was well established during 1925 with the acquisition of
the Psychological Review Company and its five journals, the Psychological
A GUIDE TO THE AMERICAN PSYCHOLOGICAL ASSOCIATION 159
Review, the Psychological Bulletin, the Journal of Experimental Psychology, the

Psychological Monographs, and the Psychological Index. Somewhat later, the
Journal of Abnormal and Social Psychology was given to APA as a gift from
Morton Prince and the Psychological Abstracts were developed with a grant
from the Laura Spelman Rockefeller Foundation.
World War II saw psychology again called upon to playa central role
in the selection of people to serve in the armed forces. This continued the
function established for psychology in the earlier conflict. In a related
development, the U.S. government, in a radical departure from past prac-
tice, began to provide funding for applied research on university campuses
and established government research programs that continue in somewhat
modified form today. This effort laid the foundation for much of the expan-
sion of the science and profession that occurred in the period follOWing
World War II. These developments are detailed in Napoli (1975).
In the years that immediately followed the war, APA and American
psychology lived through an explosion in growth and organizational devel-
opments. In 1945, a merger between APA and the American Association of
Applied Psychology (AAAP) took place. AAAP had been founded in 1937
to address the long-standing professional problems of uniform training,
certification, public relations, and ethical conduct. Efforts to address all of
these problems were made in the eight years of the organization's life. Spe-
cial emphasis was placed on development of state-level affiliated organiza-
tions that could undertake many actions in support of practitioners. AAAP
was extremely successful in identifying and placing applied psychologists
in key positions.in the military during the war. The vigorous efforts of its
leadership made it an organization second in importance only to APA.
When APA became more invested in professional issues during the war, a
merger of these organizations became a historical necessity.
The new structure for APA included the first 20 chartered divisions, a
full-time, professional staff in the central office, and the definition of a num-
ber of major units in what has become the governance structure of the orga-
nization. After the war, and largely because of the demonstrable contribu-
tions that psychology made to the military effort, the government
continued to pour millions of dollars into training psychologists and into
psychological research. The membership of APA literally began to explode
in size and complexity. The professionals in the organization began a sys-
tematic drive for legal recognition in the form of state licensure laws for
the practice of psychology. Connecticut became the first state to pass such
a statute in 1946. The blossoming of the profession of psychology had
begun, with the new by-laws adopted by APA Council establishing the
basic organizational framework that continues today.
During the 1950s and 1960s, APA involved itself increasingly in profes-
sional issues. A Code of Ethics designed to provide guidance for state asso-
ciations seeking to establish licensure laws was adopted and implemented
(American Psychological Association, 1977). Guidelines for state legislation
were passed in 1955 and then modified in 1967 (American Psychological
Association, 1955, 1967). State associations grew and demanded an
increased role in APA governance. For instance, in the 1920s and 1930s a
handful of states had established local psychological associations that pro-
vided support and information to the small communities of psychologists
spread around the country. As the number of psychologists exploded in the
1950s and 60s, the size and vigor of these state organizations increased
remarkably.
This growth provided a foundation for much of the professional orga-
nization that continues today. It culminated in the adoption of the Report
from the Albee Commission in 1968 which modified the rules for election
of members to Council. The new rules dramatically increased the represen-
tation of state associations in Council. Because these associations were over-
whelmingly professional in their orientation, this development provided
the impetus for a dramatic shift in the decision consensus in Council toward
professional psychology. The strains of growth and differentiation were
met by the development of a complex governance structure and increasing
central office staff which have tried to meet the demands of increasingly
vocal and demanding constituencies. Separate Boards for Scientific, Profes-
sional, and Education and Training Affairs were instituted. Committees on
Ethics, Accreditation, and Tests and Measurement were established. The
professional and scientific goals of the organization were debated with
increasing regularity and vigor. Professional psychology had finally
achieved an equal footing with the science and a new era was begun.
In the 1970s APA guided, implemented, and witnessed achievements
that were mere fantasies in the minds of a few psychologists three decades
earlier. The U.S. government has recognized psychologists as service pro-
viders in 19 different federally funded programs (American Psychological
Association, 1979a). A permanent national organization, the Association for
the Advancement of Psychology (AAP), was established to represent psy-
chology in the Congress. APA developed and approved Standards for Pro-
viders of Psychological Services. Specialty guidelines for providers of clin-
ical, counseling, school, and industrial/organizational psychological
services also were developed and approved in January of 1980. In 1978, the
last of the 51 major political jurisdictions passed a law regulating psychol-
ogy, fulfilling the dream of the first committee on certification. The size of
its membership, its central office, and its complex problems and programs
have surpassed the wildest imaginings of its founding fathers.
As APA moves into its ninth decade, it faces new challenges, com-
pletely unforseen several years ago. The licensing and certification statutes
are under attack in many states due to the passage of "sunset legislation"
(see Stigall, Chapter 11). A Commission on the Organization of APA is con-
sidering modifications in the governing structure that would meet the
growing demands for influence and autonomy of major constituencies in
psychology. Another major task force is developing new approaches to
defining education and training in psychology. The struggle with orga-
nized medicine continues unabated. However, the battleground has wid-
ened and now encompasses state and federal legislative, executive, and
judicial branches of government. But, more of these developments at a later

point.
THE SHAPE OF APA, 1980
The structure of APA as it exists today is represented in Table 1. What

follows is a brief description of each of these units of the governance struc-
ture, based on the APA Rules of Council (American Psychological Associa-
tion, 1982). Additional comments on current issues facing some of these
units will be made where appropriate.
COUNCIL OF REPRESENTATIVES
At the top of APA's governance structure sits the Council of Represen-

tatives. Known by most members of governance as the "Council," this unit
is the final arbiter of what is to be policy for American psychologists. Coun-
cil is comprised of approximately 115 members who are elected by the gen-
eral membership by way of an annual apportionment ballot. Each member
of APA gets 10 votes to allocate to those divisions, state associations, and
coalitions of states that he or she feels will best represent the psychologist's
interests in the coming year. The votes are tallied and the appropriate num-
ber of Council seats is granted to each organization based on the percentage
distribution of the total number of votes. The divisions and states them-
selves select the individuals who will represent them once the seats on
Council are allocated. Council meets twice a year, once at the annual con-
vention and again in mid-January. All meetings of APA governance units
are open to the membership.
Since every major issue confronting American psychology eventually
makes its way into the deliberations, it is hard to say just what the primary
focus has been for Council recently. Among the developments of interest
to professionals are: (1) In 1978, Council established a Blue Ribbon com-
mission on the organization of APA. This broadly representative group of
psychologists is attempting to define modifications in the structure of APA
that will make the organization more responsive to the needs of its constit-
uent entities and permit them more autonomy. (2) In 1979, Council estab-
lished a Task Force on Education and Credentialing in Psychology. This
group is designing an experimental project to define criteria and develop
procedures to officially designate programs that are training providers of
psychological services. It is hoped that designation will facilitate the oper-
ation of state licensing boards by helping them identify which applicants
for licensure have graduated from a program that is approved for training
psychologists. (3) Finally, in 1980, after a period of three years devoted to
its development, Council passed Specialty Guidelines for the Delivery of
Services by Clinical, Counseling, Industrial and Organizational, and School
TABLE 1
Boards and Committees of APA (1980)
Governance Structure
Council of Representatives
Committee on Structure and Functions of Council
Board of Directors
Finance Committee
Investment Committee
Membership Committee
Committee on Scientific and Professional Ethics
Committee on Academic Freedom & Conditions of Employment
Committee on International Relations in Psychology
Committee on Employment and Human Resources
Committee on Ethnic Minority Affairs
Committee on Public Information
Representatives to Other Organizations (BOD)
Ad Hoc Committee and Task Force (BOD)
Policy and Planning Board

Committee on APA/State Association Relations
Ad Hoc Committee & Task Force (P&P)
Board of Convention Affairs

Committee on Films and Other Media
Committee on Research and Evaluation
Committee on Program Innovations
Operations Committee
Ad Hoc Committee and Task Forces (BCA)
Board of Scientific Affairs

Committee on Scientific Awards
Committee on Psychological Tests and Assessments
Committee on Animal Research and Experimentation
Committee on Research Support
Committee for the Protection of Human Subjects
Ad Hoc Committee and Task Forces (BSA)
Representatives to Other Organizations
Education and Training Board

Committee on Undergraduate Education
Committee on Accreditation
Committee on Continuing Education
Ad Hoc Committee & Task Forces (E&T)
Board of Professional Affairs

Committee on Professional Practice
Committee on Professional Standards
Representatives to Other Organizations (BPA)
Ad Hoc Committee & Task Forces (BPA)
Board of Social & Ethical Responsibility

Committee on Women in Psychology
Committee on Psychology in the Public Interest Awards
Committee on Gay Concerns
Ad Hoc Committee and Task Forces (BSER)
TABLE 1 (continued)
Governance Structure
Publications/Communications Board
Council of Editors
PsycInfo Advisory Committee
Ad Hoc Committee & Task Forces (P&C)
Psychologists. These policies are designed to give guidance for the practice
of psychologists who voluntarily designate themselves as operating in one
of these four specialty areas.
As will be the case for all of the descriptions of the governance units,
information on gaining access to their deliberations, etc. will be summa-
rized later.
Committee on Structure and Function of Council

This six-member committee is elected from the members of Council. It
reviews and initiates recommendations about council functions and opera-
tions, maintains the Rules of Council, and develops "procedures to inform
Council about the history and nature of problems and issues currently fac-
ing APA" (American Psychological Association, 1982, p. 11). The committee
is currently examining the possibilities of establishing procedures that
would require the periodic review and evaluation of the various units of
APA governance.
Board of Directors
The Board of Directors acts as the executive committee of Council. It
can operate in lieu of Council in certain situations and can make public
statements on any issues in accord with APA policy or by-laws provided
the statements reflect the sentiment of the majority of the six elected direc-
tors. The board also has the other elected APA officials as members: presi-
dent-elect, president, past-president, treasurer, and secretary: The executive
officer sits as an ex officio member of the board. Two directors are elected
annually, as is the president-elect. The treasurer and secretary are elected
for five-year terms.
The board meets five times a year. Two major meetings are held in June
and December which provide the focus for the policy work in the rest of
the governance structure. Abbreviated sessions are held before each meet-
ing of the Council, and the board conducts a retreat meeting for several
days, usually in the spring. Frequent updates and briefings allow the Board
to act responsibly in the face of challenging time constraints and ever-
changing political, economic, and organizational issues. The board has
broad discretionary powers in its role as the executive committee of the

Council.
As seen in Figure I, the board has a variety of committees and task
forces reporting to it.
Finance Committee. This committee is chaired by the treasurer and is
comprised of six members elected for three-year terms. The finance com-
mittee reviews budget proposals made by the executive officer and gener-
ally oversees the fiscal operations of APA. This committee has been work-
ing to define long-range financial objectives in the face of a very complex
economic environment.
Investment Committee. This committee is comprised of four persons, at
least two of whom are members of the Association, and the treasurer. "It is
the responsibility of the Committee to recommend overall investment !,trat-
egy, including, but not limited to, amounts to be invested in equities,
bonds, short term media, and real estate; monitor the performance of the
investment managers, if any; research and develop alternative investments;
and advise the Treasurer and appropriate staff personnel in the investment
of funds not entrusted to an investment manager" (American Psychological
Association, 1982, p. 122). The record of this committee in recent years has
been excellent, with dramatic increases in the equity value of APA invest-
ments accompanied by a socially responSible policy that has allowed the
organization to stand completely behind its policies and ethics. This policy
guides APA investments to companies, products, and other investments
that do not discriminate against various minorities, are careful of the envi-
ronment, and have other socially responsive policies.
Membership Committee. This Committee is comprised of six Fellows of
the Association and one member of the Central Office who acts as the sec-
retary. It evaluates the credentials of those individuals applying for mem-
bership according to the Rules of Council. There are several classes of mem-
bership. Student affiliates are those pursuing their studies in psychology.
They are elected for periods of three years. If they have not completed their
work during one three-year term, they may reapply for three more years.
Students receive the publications of the Association at member rates. Asso-
ciate Members have completed at least two years of graduate work in psy-
chology at a graduate school recognized by the U.S. Office of Education.
They have "a year of acceptable experience in professional work that is psy-
chological in nature [and are] engaged in work that is primarily psycholog-
ical in character" (American Psychological Association, 1982, p. 34). Asso-
ciates gain full voting privileges after five years in the organization.
Members possess a doctoral degree in psychology or a related field and meet
the other requirements described above. Fellows are nominated by members
of divisions as having made a significant and outstanding contribution to
the field represented by that particular division. The Committee recom-
mends those persons meeting the criteria to the Council for election on an
annual basis. Applicants must not have a history of ethical or legal viola-
tions and they must be endorsed by two fellows of the Association.
Committee on Scientific and Professional Ethics. This committee is com-

prised of seven members of APA elected for three-year terms and a secre-
tary designated by the executive officer. The secretary is usually a doctoral
level psychologist who has considerable field experience. The committee
reviews, maintains, interprets, and enforces the Ethical Standards for Psy-
chologists (American Psychological Association, 1977) which are approved
by the Council. Written complaints of ethical violations by members are
reviewed by a subcommittee of this committee which determines whether
a full investigation and review is appropriate. Reviews are conducted in
confidence according to rules and procedures established by the committee.
A variety of remedies are available for those individuals found to be in vio-
lation of the Standards. These range from verbal agreements to cease and
desist from the unethical behavior, to the expulsion of a member. Disguised
case summaries are presented periodically in the American Psychologist to
educate the membership.
Recently, the committee has undertaken a full review of the Ethical
Standards and of its rules and procedures. Revisions are due to be made
shortly.
Committee on Academic Freedom and Conditions of Employment. This com-
mittee is comprised of five members elected for five-year terms. Its major
function is to "investigate the complaint of any member that the commonly
accepted canons of academic freedom and of professional employment have
been violated" (American Psychological Association, 1982, p. 15). The com-
mit.ee works (1) to establish the facts in any incident brought to its atten-
tion; (2) to "negotiate, initiate or intercede, if a wise course of action appears
open, in behalf of an injured party" (American Psychological Association,
1982, p. 15), and (3) "in extreme instances, to bring the active support of the
Association to bear when the injustice done a member constitutes a threat
to the integrity of a wider sector of the profession" (American Psychological
Association, 1982, p. 15). The critical issue that this group most often faces
centers on the terms under which psychologist accept employment, for
example, contractual or organizational obligations that would force the
individual to violate the policies of the national organization.
The committee meets at least once a year to consider complaints but
can operate fairly quickly in conjunction with the central office staff liaison
when the situation warrants. APA policy in the form of the Guidelines for
Conditions of Employment of Psychologists (American Psychological Associa-
tion, 1972) guides the deliberations of the committee.
Committee on International Relations in Psychology. This committee is
comprised of 13 members, 9 elected for three-year terms, the executive offi-
cer, ex officio, 2 representatives to the United States International Union of
Psychological Science (IUPS), and a representative to the United States
National Commission for UNESCO. One charge of this unit is to assist "in
the continuing development of psychology as a science and profession
throughout the world, consonant with APA guidelines and mps ethical
resolutions" (American Psychological Association, 1982, p. 100). It accom-
plishes this goal by maintaining and initiating international communica-

tion and exchange, encouraging "cooperative and ethical cross-cultural!
transnational research," "promoting the use of psychology, and increasing
sensitivity to cultural variances in the formulation of policy decisions in
international affairs" (American Psychological Association, 1982, p. 100),
and assessing "the impact of the APA's plans, programs, and operations on
psychologists in other countries and on other national and international
associations of psychologists" (American Psychological Association, 1982, p.
100). This committee has recently completed a set of guidelines to assist
APA governance in deciding when and how to visit other countries to
investigate alleged abuses of psychologists and others.
Committee on Employment and Human Resources. This committee is com-
prised of six members of the Association. Reporting through the Board of
Directors, it recommends "policy affecting the supply and demand for psy-
chologists and the utilization and employment of psychologists" (American
Psychological Association, 1982, p. 14), and promotes "the dissemination of
relevant data, including those from the APA Central Office as well as those
from other institutions and organizations" (American Psychological Asso-
ciation, 1982, p. 14). The committee conducts several surveys of the mem-
bership on an annual or bi-annual basis to fulfill its charge. It relates to the
other major boards in the area of employment and gives special consider-
ation to minority and underrepresented groups in psychology.
Committee on Ethnic Minority Affairs. This committee is comprised of 11
members of the Association and is broadly concerned with those aspects of
psychology that focus on ethnic minorities. It works to increase "scientific
understanding of those aspects of psychology that pertain to culture and
ethnicity" (American Psychological Association, 1982, p. 123); to increase
"the quality and quantity of educational and training opportunities for eth-
nic minority persons in psychology" (American Psychological Association,
1982, p. 123); to promote "the development of culturally sensitive models
for the delivery of psychological services" (American Psychological Asso-
ciation, 1982, p. 123); to advocate "on behalf of ethnic minority psycholo-
gists with respect to the formulation of the policies of the Association"
(American Psychological Assocation, 1982, p. 123); to maintain "satisfactory
relations with other groups of ethnic minority psychologists" (American
Psychological Association, 1982, p. 123); to maintain "appropriate commu-
nication involving ethnic minority affairs with the Association's member-
ship as well as with ethnic minority psychologists and communities at
large" (American Psychological Association, 1982, p. 123); to maintain
"effective liaison with other boards and committees of the Association
(American Psychological Association, 1982, p. 123); and to serve "as a clear-
inghouse for collection and dissemination of information relevant to or per-
taining to ethnic minority psychologists and students" (American Psycho-
logical Association, 1982, p. 123).
The members of the committee are chosen to be broadly representative
of ethnic minorities in psychology as well as the complete sweep of interest
areas in psychology. In a recent referendum, the membership of the Asso-

ciation has voted to make this committee into a standing Board of Ethnic
Minority Affairs, which will increase the range and depth of the group's
activities over a period of time.
Committee on Public Information. This is the last major committee that
reports to the Board of Directors. It was developed in 1978 in response to
an increasing need and demand from the public for information regarding
psychology. Comprised of nine members, it reviews and makes "recom-
mendations about the policies and procedures of the public information
activities of APA (American Psychological Association, 1982, p. 123). It
overviews and evaluates all media resources and reports on these activities
and resources on an annual basis to Council. It has been considering a vari-
ety of ways to provide better information to the public about psychology.
The Board of Directors also has a variety of task forces and ad hoc com-
mittees that it develops from time to time to address major issues that come
before it. We shall discuss at least one of these in a later section of the chap-
ter which deals with such major issues.
POLICY AND PLANNING BOARD
This nine-member board was created in the late 1940s with the major
function of considering the current and long-range policies of APA. It
recommends
to the members, Board of Directors, and Council of Representatives such
changes in existing policy and such extensions or restrictions of the functions
of the Association, its Divisions, or State Associations as are consonant with the
purposes of the Association. (American Psychological Association, 1982, p. 60)
The committee reports to the members annually in the American Psycholo-

gist. Every fifth year, it reviews the structure and function of the Association
as a whole and makes a written report to Council and the membership.
Recently, the P&P Board has reviewed the services APA provides to its
divisions and state associations; issues regarding the promotion of health
and prevention of disease; election of APA representatives by state associ-
ations; documenting the contribution of the science of psychology to the
public welfare; and the trends affecting the definition of a psychologist by
degree, training, and setting. The board's members represent the broadest
possible range of constituencies in psychology.
Committee on APAIState Association Relations. Reporting through the
Policy and Planning Board, this five-member committee meets three times
per year. Its mission is
(1) to study on an ongoing basis the most effective model on APA/State Asso-
ciations; (2) to develop better ways to utilize information generated by boards
and committees and Central Office programs involved with activities of concern
to state associations; (3) to assess the needs and problem areas in the various
states and make recommendations about the development and utilization of

resources at both the national and state level; (4) to identify problem areas both
nationally and locally which would have a precedential effect; (5) to ensure that
appropriate dissemination of the information gathered in the above activities is
accomplished. (American Psychological Association, 1982, p. 66)
BoARD OF CONVENTION AFFAIRS
This six-member board is elected for six-year terms by the Council at a

rate of one member each year. Other representatives are appointed by the
president of APA from time to time. The executive officer designates a staff
member who acts as secretary for the board.
The board is
responsible for the overall program of the Convention and for the coordination
of programs arranged by divisions of the Association, by boards and commit-
tees, and by affiliated organizations. It establishes rules concerning such things
as allocation of space and time, Call for Programs, Convention Program and
Proceedings, registration, exhibits and timelines for events." (American Psy-
chological Association, 1982, p. 76)
This board has been struggling with several major issues recently. APA
Council has mandated that convention be held only in states that have
passed the Equal Rights Amendment to the U.S. Constitution. This has
restricted the number of cities that can host a meeting as large as APA's.
The board also has made efforts to improve the accessibility of the conven-
tion for handicapped psychologists.
Committee on Films and Other Media. This four-member committee
reports to the Board of Convention Affairs and is responsible for reviewing
films and productions involving other communication media of interest
and relevance to psychologists and for selecting from them and assembling
a film and other communication media program for presentation at each
annual convention. It also develops other displays of interest to
psychologists.
Committee on Research and Evaluation. This four-member committee
reports to the Board of Convention Affairs and collects and evaluates "data
concerning the characteristics and conduct of the different kinds of conven-
tion activities, with particular reference to the characteristics of convention
attendees and their frustrations and satisfactions with the variety of con-
vention program activities" (American Psychological Association, 1982, p.
76). It makes recommendations on its findings to the board in order to make
the convention "more useful and attractive to the greatest number of mem-
bers" (American Psychological Association, 1982, p. 76).
Committee on Program Innovations. This committee of the Board of Con-
vention Affairs has four members and is "charged with generating, eliciting
and collecting ideas for new program formats and contexts" (American Psy-
chological Association, 1982, p. 76). It works closely with divisions, groups,
and other units of APA governance to "assure adequate assessment of pro-
gram innovation whenever possible" (American Psychological Association,

1982, p. 76).
Operations Committee. This committee serves as the executive committee
of the Board of Convention Affairs. Comprised of the board chair and two
board members, it is involved in "the coordination of the work of the com-
mittees of the Board [and assists] the chair in his/her deliberations in the
instances in which it is necessary for the Board to act without the possibility
of convening a meeting of the complete Board" (American Psychological
Association, 1982, p. 76).
BOARD OF SCIENTIFIC AFFAIRS
The Board of Scientific Affairs has nine members elected by Council

and reports to Council through the board of directors. It is broadly respon-
sible for monitoring developments germaine to the science of psychology
and for formulating and making recommendations for APA policy on these
matters. The board grants a series of annual awards for distinguished con-
tributions to science by APA members; formulates standards for research
conducted with human and animal subjects; monitors developments and
establishes standards in the field of psychological tests and assessment;
tracks sources of financial support for research funding; recommends leg-
islative advocacy in these areas; and educates the members about this
activity.
The Board of Scientific Affairs has undertaken several major projects in
its area of responsibility. Together with several other organizations, it is
beginning a revision of the APA standards for Educational Tests and Mea-
surement (American Psychological Association, 1974). It also is scheduled
to begin periodic publication of a Psychologist's Guide to Research Support
and has initiated the development of a state-level legislative advocacy net-
work for support of psychological research.
Committee on Scientific Awards. This committee of the Board of Scientific
Affairs is comprised of six members and supervises APA's annual awards
for science. Up to three awards of $1,000 are made annually for "Distin-
guished Scientific Contributions." One $1,000 award is made annually for
the "Applications of Psychology." Up to three $500 awards also are made
annually for an "Early Career Contribution to Psychology." Nominations
for these awards are solicited from the broadest possible range of sources.
Recipients are invited to address the annual convention on a topic of their
choice in the year following their award.
Committee on Psychological Tests and Assessment. This scientific affairs
committee has six members. Its responsibilities are to
consider problems regarding sound psychological testing and assessment prac-
tice; revise the APA Standards for Educational and Psychological Tests when nec-
essary; review annually the current Standards for Educational and Psychological
Tests; serve as technical advisors to the Committee on Scientific and Professional
Ethics and Conduct when so requested; consider governmental actions relative
to the regulation and control of assessment and testing practices; maintain a

knowledge of and concern regarding the educational, industrial, and clinical
aspects of testing; and maintain liaison and cooperation with other groups con-
cerned with tests and assessment. (American Psychological Association, 1982, p.
76)
As stated, the committee and other interested organizations currently are

undertaking a review and revision of the Standards.
Committee on Animal Research and Experimentation. This six-member com-
mittee reports to Council through the Board of Scientific Affairs. It is
responsible for establishing and maintaining "cooperative relations with
other organizations vitally interested in safeguarding animal experimenta-
tion" (American Psychological Association, 1982, p. 96). It disseminates
information "in cooperation with other organizations vitally interested in
safeguarding animal experimentation"; monitors the implementation of
AP A policy in this area; and periodically reviews and recommends changes
in them (American Psychological Association, 1982, p. 96).
Committee on Research Support. This six-member committee is responsi-
ble for
collecting information on sources of research funding, public and private; mon-
itoring changes in support agency policies which have potential impact on
research funding; meeting with support agency personnel to discuss policies
and their implications for research funding; preparing and disseminating infor-
mation on areas of research which need increased support; nominating quali-
fied individuals to serve on advisory and review committees in public and pri-
vate funding agencies; and coordinating with the Association for the
Advancement of Psychology in evaluating and responding to relevant legisla-
tion which has import for research funding. (American Psychological Associa-
tion, 1982, p. 98)
The committee has undertaken two major projects: periodic publication

of a Guide to Research Support and development of a state-level network
of people interested in working with their congressional delegations on the
issues of research support.
Committee for the Protection of Human Subjects. This six-member commit-
tee reports to Council through the Board of Scientific Affairs. Its responsi-
bilities include
engaging in such activities as may promote freedom of scientific inquiry con-
sistent with the protection of human subjects in research; participating in public
discussions on public concerns regarding the use of human subjects in research;
collecting information on public concerns regarding the use of human subjects;
preparing written and oral statements for appropriate public settings on the use
and protection of human subjects in research; and reviewing annually the cur-
rent Ethical Principles for the Conduct of Research with Human Participants and mak-
ing formal recommendations to this document. (American Psychological Asso-
ciation, 1982, p. 99)
This committee has been working with various arms of the federal gov-
ernment to further refine existing policies regarding the use of human sub-
jects~ Of special concern has been the clarification of the risk factors asso-
ciated with various forms of research such as that conducted with data
retrieved from archives or simple behavioral observation as opposed to that
which requires some form of biological invasion of the human body.
EDUCATION AND TRAINING BOARD
This nine-member board reports to the board of directors and has broad
responsibility for overseeing and making policy recommendations in mat-
ters pertaining to the education and training of psychologists. It supervises
the efforts of a number of committees specifically focusing on various
aspects of education and training. The accreditation and continuing edu-
cation programs are operated under its auspices. In addition, the board
reviews activities for high school, undergraduate, and graduate studies in
psychology. We shall focus on these activities in a little more detail below.
Recently, the board has been working with a number of groups includ-
ing the Council of Graduate Departments of Psychology (COGDOP) and
the Association of Professional Schools of Psychology (APSP) on the prob-
lems related to graduate education and training. As a result of this work
and the evaluation of its own operations and functions, the E&T Board has
reorganized itself in several important ways. It will meet fewer times dur~
ing the coming years and place members of the board on its major commit-
tees. In addition, it has developed a new Committee on Graduate Education.
The board is responsible for publishing, in conjunction with the Publica-
tions and Communications Board, a list of training programs in psychology
as well as a list of training programs approved by its Committee on
Accreditation.
Committee on Undergraduate Education. This committee has six members
and is "concerned with undergraduate students and their teachers." It col-
lects, analyzes, and reports information concerning undergraduate stu-
dents, teachers, and programs and makes recommendations to the Educa-
tion and Training Board regarding these issues. The committee has recently
undertaken a new program at the annual APA convention. The G. Stanley
Hall lecture series was approved by the Council and will attempt to provide
annual overviews of developments in the major subfields of psychology as
a way of orienting and supporting undergraduate faculty.
Committee on Accreditation. This ten-member committee reports to
Council through the Education and Training Board. It evaluates "doctoral
programs and facilities for internships in professional psychology, such as,
clinical, counseling and school" (American Psychological Association, 1982,
p. 84). It performs these evaluations in light of the APA accreditation cri-
teria which were recently revised by Council. These criteria present the best
present thinking about what standards training programs in psychology
should meet. The Accreditation Procedures Manual lays out the steps that the
committee uses in its deliberations and insures that the training programs
seeking accreditation will be accorded due process in APA decision making.
Committee on Continuing Education. This five-person committee also

reports to Council through the Education and Training Board. It has the
"responsibility for overseeing the activities of the APA's Continuing Edu-
cation Program and for developing policy and program recommendations
related to continuing education" (American Psychological Associati~n,
1982e, p. 87). This includes but is not limited to
CE programs and materials assessing continuing education needs, developing
recommendations for new continuing programs/materials, administering
APA's continuing education activities such as the Advanced Workshops and the
Master Lecture Series, and facilitating the continuing education activities of
APA affiliates; the CE Sponsor Approval System (overseeing the operation of
the system as approved by Council for sponsor review and approval, overseeing
a continuing education activities calendar/clearinghouse, overseeing a comput-
erized registry of continuing education activities/credits, and reviewing the
guidelines and procedures for the sponsor-approval system and recommend
revisions); and the CE information and clearinghouse (monitoring develop-
ments related to continuing education, maintaining liaison with other groups
within the Association and continuing education counterparts in other orga-
nizations, and considering continuing education-related issues brought before
the Association. (American Psychological Association, 1982, p. 87)
This group is empowered to delegate responsibilities to subcommittees

or task forces within limits established by the E&T Board. The two major
subgroups that it has established include the Subcommittee on Sponsor
Approval which reviews the applications of organizations seeking to par-
ticipate in the APA Sponsor Approval system, the mechanism by which
APA sanctions continuing education programs, and the Task Force on Self-
Assessment which is attempting to develop mechanisms that would allow
professional psychologists to identify knowledge and skill deficits and to
remediate them.
BOARD OF PROFESSIONAL AFFAIRS
This nine-member board is the focal point for all major issues that affect
the profession of psychology. It is
charged with the formulation of recommendations for the Association's general
policy in professional matters, including establishing standards of professional
practice, maintaining satisfactory relations with other professional groups, and
fostering the application of psychologic<ll knowledge to the promotion of the
public welfare at both state and national levels. (American Psychological Asso-
ciation, 1982, p. 91)
The board reorganized its committee structure in 1980 and has two
major groups reporting to it, the Committee on Professional Practice and
the Committee on Professional Standards. Both will be described in more
detail below.
During the past year, the board has focused on a variety of activities
including the complex set of issues involved in the multilevel training and
service delivery system of psychology. They are developing criteria by

which to evaluate newly emerging specialties in psychology, educational
materials concerning psychology's role in Health Maintenance Organiza-
tions (HMOs), and recommendations regarding psychologist's use of phys-
ical interventions.
Committee on Professional Practice. The major functions of this seven-
member committee are to
monitor, evaluate and develop information regarding the scientific and profes-
sional aspects of the delivery of psychological services in public and private
settings which are funded through governmental, private, third-party insur-
ance on other mechanisms; monitor and evaluate developments in the formu-
lation of Federal and State laws and regulations pertinent to the delivery of
psychological services by psychologists in various settings; formulate and rec-
ommend to the Board of Professional Affairs, policies and appropriate action to
implement these policies regarding the delivery of psychological services and
Federal and State laws and regulations affecting the delivery of psychological
services in order to insure the use of psychology in the public interest; and
maintain informational and educational liaisons with other groups that share
an interest in these areas. (American Psychological Association, 1982, p. 93)
The committee has been active on a number of reimbursement issues

during the past year, including coverage for psychological services in work-
ers compensation and disability insurance. It has monitored developments
in sunset and freedom-of-choice legislation and has made recommenda-
tions to the Board of Professional Affairs on a number of other legislative
and profeSSional issues.
Committee on Professional Standards. This seven-member committee is
responsible for monitoring and evaluating "all matters pertaining to the
establishment and maintenance of standards for providers of psychological
services and assuring the quality of those services." It recommends "policies
and actions for development, maintenance and operation of peer review
and other quality assurance mechanisms [and maintains] informational and
educational liaisons with other groups that share an interest in these areas"
(American Psychological Association, 1982, p. 92).
The committee is working to finish the editorial work on the Guidelines
for Services Provided by Clinical, Counseling, Industrial/Organizational and School
Psychologists. It is drafting a revised edition of the Standards for Providers of
Psychological Services based on the changes in the specialty guidelines. It will
be developing a pamphlet designed for consumers of psychological services
informing them of their rights and responsibilities. It also will periodically
publish its interpretations of the Standards in various cases it considers in
the archival issue of the American Psychologist.
BOARD OF SOCIAL AND ETHICAL RESPONSIBILITY IN PSYCHOLOGY
This nine-member board is responsible to the Council for making pol-

icy recommendations on "those aspects of psychology that involve solu-
tions to the fundamental problems of human justice" (American Psycholog-

ical Association, 1982, p. 56). It studies and suggests direction on social and
ethical matters "in the following areas: internal operations of the Associa-
tion; the Associations institutional role; the roles of psychologists in society;
social responsibility in human research, assessment and intervention pro-
cedures; research on social problems, and the development of public policy
actions or statements for the Association" (American Psychological Associ-
ation, 1982, p. 56). The board has public member(s) who participate and vote
with full rights in its deliberations. The other members are broadly repre-
sentative of the complete range of psychological interests.
Recently, the board has refined its operating policies and procedures.
It established a continuing Committee on Gay Concerns while dissolving
the Committee on Equal Opportunity in Psychology. (The functions of the
latter committee are being fulfilled by the Committee on Ethnic Minority
Affairs.) The board also endorsed a proposal to establish a Board of Women's
Issues in Psychology; worked on the social aspects of APA's investment pol-
icy; examined the issues surrounding treatment of the victims of psycho-
logical torture and the delivery of psychological services to the poor and to
children; and made recommendations regarding the physical and social
accessibility of convention sites for disabled persons.
Committee on Women in Psychology. This nine-member committee is con-
cerned with advancing "psychology as a science and as a means of promot-
ing human welfare ... by ensuring that women achieve equality as mem-
bers of the psychological community, in order that all human resources be
fully actualized" (American Psychological Association, 1982, p. 57). It acts
as a catalyst by interacting with all of the organizational components of
psychology and other groups. Specifically, it collects information and doc-
umentation concerning the status of women; develops recommendations
and guidelines; develops mechanisms to increase the participation of
women in roles and functions of the profeSSion; and communicates with
other agencies and institutions regarding the status of women.
Aside from performing its regular functions, this committee spent a
substantial portion of its resources in developing a proposal to become a
full-fledged Board of Women's Issues in Psychology. This would have given
them increased flexibility and visibility within the governance structure.
The proposal went before the membership for a general vote but it was
turned down in 1981.
Committee on Psychology in the Public Interest Awards. This six-member
committee is comprised of the three past presidents of APA and the three
past chairs of the Board of Social and Ethical Responsibility. It selects as
recipients for awards for distinguished contributions to psychology in the
public interest
not more than three persons who either through a single extraordinary achieve-
ment or a lifetime of outstanding contributions have met one of a number of
the following criteria:
1. A courageous and distinctive achievement in the science and/or profes-

sion of a psychology which makes a material contribution to the solution
of one of the world's most intransigent social problems.
2. A distinctive and innovative contribution which makes the science and/
or profession of psychology more accessible in a positive manner to a
greater number of persons.
3. An integration of the science and/or profession of psychology with social
action in a manner beneficial to all. (American Psychological Association,
1982, p. 58)
The Committee solicits nominations in the broadest manner possible.

Winners are invited to address the annual convention in the year that fol-
lows the receipt of the award.
Committee on Gay Concerns. This six-member group is one of the most
recent continuing committees of the Association. Its mission is
to study and evaluate on an ongoing basis how the problems of lesbian and gay
male psychologists can best be dealt with; to encourage objective and unbiased
research; to examine the consequences of stereotypes about homosexuality in
clinical practice; and to make recommendations regarding the integration of
these issues into the Association's activities to further the cause of the civil and
legal rights of gay psychologists within the profession. (American Psychologi-
cal Association, 1982, p. 59)
The committee has written and disseminated a report on the status of homo-
sexual psychologists.
PUBLICATIONS AND COMMUNICATIONS BOARD
This is the last of the nine member operating boards that report to
Council through the board of directors. Its principal function is "to make
recommendations on current and innovative plans on the acquisition, man-
agement, initiation or discontinuance of journals, separates, bibliographic
and related publications, and information services" (American Psychologi-
cal Association, 1982, p. 60). It also appoints Editors of all AP A journals
except the American Psychologist.
During 1980, this board has been involved with a number of issues
including searching for editors for several journals; establishing editorial
policies; reviewing technical innovations in the publishing business; and
considering changes in journal names, prices, and page allocations.
Council of Editors. This is the only continuing committee of the Publi-
cations and Communications Board. It consists of the editors of all journals
published by APA. It meets regularly "to discuss common editorial prob-
lems and to make recommendations particularly with regard to range of
coverage, limits of editorial responsibility, common problems of style and
the like" (American Psychological Association, 1982, p. 62). It also reviews
issues involving office expenses and editorial page allotments and makes
recommendations to the board.
As can be seen from the foregoing presentation, the major units of the
APA governance cover an enormous range of issues and concerns in Amer-
ican psychology. We will not discuss the equally large number of ad hoc
committees, task forces, and subcommittees that are more narrowly focused,
time-limited groups, working in concert with these major units. This is a
complex, democratically operated organizational structure. It works in a
cooperative spirit even though disagreements on policy matters occur with
some regularity. These differences are identified, sharpened, debated, and
ultimately, almost always, negotiated to a mutually acceptable conclusion.
In a later section of the chapter, we will track briefly the origin and dispo-
sition of several typical kinds of professional issues that confront APA as
an organization.
DIVISIONS AND STATE ASSOCIATIONS
The roles and functions of APA's divisions and affiliated state associa-
tions have been alluded to at several points in this chapter. A brief review
of these organizations seems to be in order to clarify their status and rela-
tionship to APA.
There are presently 40 official divisions of APA. These are autonomous
organizations that can be developed if a validated petition with signatures
of 1% of the membership of APA is presented to Council. The divisions vary
widely in size and interests. Most provide a newsletter/communication ser-
vice to their membership. Divisional status guarantees 18 hours of conven-
tion program time for the particular interest area. The apportionment ballot
for election of representatives to Council allows divisional representation
within this important body. These divisions operate within the confines of
APA's overall policies and have varying degrees of relations with central
office.
The 51 state associations affiliated with APA are similar in operation to
the divisions. A petition from 10 members of APA filed from any state is
sufficient to gain that organization affiliated status. States also gain council
representation through the apportionment ballot, operate newsletters, pro-
vide state and local meetings, organize legislative efforts, and conduct eth-
ics and peer review operations in their jurisdictions. They relate to APA
through CAPASAR (see above) and the State Association Program of the
Office of Professional Affairs (see below).
CENTRAL OFFICE
Figure 1 presents the organizational chart for the central office of APA.
This is the core of the organization's operations on an administrative and
programmatic level. The staff numbers approximately 225 and is housed in
two separate buildings owned by the Association, one in Washington, D.C.,
and one in Arlington, Virginia.
EXECUTIVE OFfiCE
EXECU1'IVE ASSOCIATE
I 1 >
IExECUTIVE OFFICE I I AMERICAN CJ
LIAISON FOR
COMMUN ICATION~ PSYCHOLOGIST
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is
PUBLIC
APA MONITOR
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INfORMATION
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DEPUTY EXECUTiVE OFFICE FOR BUSINESS ANOCOMMUNICATIQN$ ;;::
DEPUTV ExECUTIVE OFFICE FOR GOVERNANCE AfFAIRS
I r EXECUTIVE ASSOCIATE
I I Pi
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;.-
OFFICE OF PROGR.totS OFFICE. OF NATIONAl. ADMINISTRATIVE
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ASSOCIATE DIRECTOR HUMAN RESOURCES I CONVENTIONIMEETlNGS+ l
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POLICV STuDIES Pi
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H ETMICS SCIENCE POLICY USER SERVICES PRINTING SERVICES
r (Jl
Ir 1 >
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H ETHNIC MINORITY AFfAIRS I PU8LICATIONS OIVISION 1r FINANCIAL SERVICES DIVISION 1 o

n
H :;
H PROF ES$IONAl AHAIRS J PRIMARY JOURNALS CASH DISBURSEMENTS 1 ::l
r o
z
SCIENTIFIC AFFAI~ t ,PECIAl PUBL.ICATIONS CASH RECEIPTS
H I r 1
OATA PROCESSING
SOCIAL RESPONSl81l1TY f:HAMPW PROJEC,T I r euOOETING,AEPOATING
H SERVICES DIV I SiON
II ~ 1 1
WOMEN S PHOGRA .... ] f MINORITY FEL.L.OWSHIP ~ COMPuTER SERVICES PUBLISHING SUPPORT
Y PROGRAM r 1
PEASONNEL SERVICES'
SYSTEM OEVELOPMENT
r DEPARTMENT 1
'-'ARKETING/ADVERTISING
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FIGURE 1. 1980 APA Central Office Organizational Chart. "Membership, Convention/Meetings, Personnel, and Gov- ......
'-.J
'-.J
ernance Services receive policy direction from the Executive Officer but are organizationally assigned to the Deputy
Executive Office for Business and Communications for administration.
As can be seen in the figure, there are two major units in central office,
Governance Affairs and Business and Communications. In Governance
Affairs there are two major offices, Programs and Planning and National
Policy Studies. Within Programs and Planning, there are a series of separate
program offices that provide the staff support and fulfill liaison responsi-
bilities to most of the major boards and committees. Detailed presentations
on each area will not be made. The Office of National Policy Studies coor~
dinates APA's contacts with most of the major federal executive agencies. It
also coordinates APA policy and legislative strategy with the Association
for the Advancement of Psychology in the U.S. Congress.
The Office of Business and Communications covers a large array of pro-
gram areas. Providing the traditional business and logistical support for the
Association's accounting, personnel, and administrative services are major
aspects of its activities. This office also operates a large behavioral publica-
tion business. Sixteen APA journals, Psychlnfo, and the APA Separates Pro-
gram form the core of these activities. The structure is differentiated so as
to provide clear lines of accountability for the various publishing
endeavors.
The remainder of the central office reports directly through the exec-
utive office, a small cadre of professionals who support the day-to-day func-
tioning of the executive officer. The editor of the Monitor, and the directors
of public information and membership services all report directly to the
executive officer.
The names of the incumbent staff also appear in the figure. Because of
staff turnover and promotions, however, the organizational chart is always
in a state of flux. Frequent turnover occurs because the psychologists who
work in the central office sign only two-year contracts which are renewable
for up to six years. This has been done in an effort to recruit individuals
who wish to be trained in public policy development and the issues and
operations of the national professional organization and who will then
return to other jobs and help cultivate a broader appreciation of the chal-
lenges confronting psychology in America.
HOW THE SYSTEM OPERATES
Perhaps you have been in the position where you have had an expe-
rience or confronted an issue large enough and serious enough that you felt
you should share it with your colleagues in the hope of developing a joint
strategy for addressing the problem. If you were fairly assertive, you would
discuss it with some friends and you might do something together. If you
were knowledgeable about the structure of American psychology, you
would increase your ability to have a dramatic impact. Let us examine a few
of the more common ways of getting a response to such a concern. For
didactic purposes, we will use several recent examples that APA has
confronted.
A GUIDE TO THE AMERICAN PSYCHOLOGICAL ASSOCIATiON 179
A master's-level school psychologist, certified for school-based func-

tioning and meeting APA's definition of a profeSSional psychologist, was
fired from the school district in which she worked. Mter she exhausted her
administrative appeals, she sought relief through the courts. The attorney
for the psychologist contacted the president of Division 16, the school psy-
chology division, who, in turn, had a discussion with an APA staff member
about the matter. The attorney was then encouraged to contact the Associ-
ation directly. This resulted in an exploration of the issues by several mem-
bers of the central office staff. Their study revealed that the school district
in question apparently had violated several provisions of federal and state
law regarding the education of handicapped children. When the profes-
sional in question continued to conduct an ethical and responSible practice,
the school administration modified her reports, refused to let her discuss
her evaluative findings with parents, threatened her with sanctions for
noncompliance, violated her constitutional right of free speech by refusing
her permission to speak at a professional meeting, and finally dismissed
her. The staff prepared a briefing of the issues for the executive officer who
recommended to the board of directors that APA enter an amicus brief in
the case and provide other supportive services. The board of directors
approved this course of action and following three court actions, the results
of the judicial appeal are expected shortly.
A second example focuses on a letter recently written to an elected rep-
resentative to Council. The member was concerned about the plight of "dis-
tressed psychologists," those suffering from nervous and mental disorders,
alcoholism, drug abuse, and other debilitating syndromes. The Council rep-
resentative, in turn, introduced a resolution in Council calling for the for-
mation of a task force to develop approaches and recommendations to cope
with this problem. The proposal has been referred to several major units of
the governance structure for review and comment. Answers are expected
shortly and the board of directors will forumulate recommendations to be
forwarded to Council.
A final example should suffice to illustrate the range of methods to
impact on or receive services from APA. Recently, a psychologist tele-
phoned the Office of Professional Affairs seeking advice about the legallia-
bility which she and her colleagues would face when they initiated a new
training program in conjunction with their professional practice. The con-
versation revealed that the profeSSionals had not moved in the typical and
conventional way for developing such a program. Although they had
designed an excellent training program, in some ways they apparently gave
very little thought to its administrative, legal, or business ramifications.
They had no idea of the size of their potential market, even though they
had printed flyers and were accepting candidates for training. Legal and
professional liabilities had not been addressed with the exception of profes-
sional supervision. Logistic support for people in the program had not been
worked out in detail. Finally, they had no idea of when the program would
break even, make a profit, or sink them financially. The telephone contact
illuminated these problems in a matter of 15 minutes and the professional

involved left the conversation more knowledgeable and grateful for the
assistance.
These examples should suffice to demonstrate that APA is responsive
and helpful to its members and to the public. In reality, very simple tech-
niques enable any member of the association to gain access to the decision-
making and service-delivery structures. Chief among these are: (1) Call the
central office and explain what you want or need; you should be connected
to the program office most knowledgeable about the issue. Some patience
may be required if you are not clear about what you need as there are many
programs at APA. (2) Write to the officers or staff of the organization. Let
them know what you are thinking or what should be done in a particular
area. Your problems and issues will receive attention even though a written
response may take some time. (3) Talk to your representatives on APA
Council. It is likely that one or more of the divisions or state associations
you belong to has an elected representative in Council. You can get these
names from APA central office. Use of these techniques should enable you
to take better advantage of the resources of American psychology.
A note of caution is needed however. These avenues to gain access do
not necessarily guarantee that the Association can or will meet your every
expectation. Resource limitations will playa major role in how your request
or issue is managed. You may be disappointed at times with what APA can
or is willing to provide to you. Hopefully, however, any disappointment
will be outweighed by the knowledge that the organization is responsive
and human, albeit not perfect.
PROFESSIONAL ISSUES IN THE EIGHTIES
In a sense, the major issues confronting professional psychology in the

1980s are identical to those faced by the earliest professionals. The questions
we are pondering include: (1) who are we as a profession?; (2) how do we
compete successfully in the marketplace?; and (3) how do we organize so as
to perform our functions effectively? Although these issues have been and
probably always will be with us, the challenges of this decade are unique
and must be mastered if we are to move on in our development.
All roads lead from an individual's or an organization's identity. The
identity of professional psychology represents the fusion of the collectivity
of applied psychologists and is best seen through the concerted action of
their major institution, APA. As we discussed earlier, individuals were
applying psychology from the earliest days of its existence. The profes-
sional certification and standard-setting issues confronted by those early
psychologists have been surmounted successfully. We now face somewhat
different problems of the same type.
Consensus about what constitutes an educational program in psychol-
ogy has not been reached. State licensing and certification boards are rou-
tinely confronted by candidates with degrees from human development,
counseling, business, etc., who claim that their training is in psychology.

Most states have been unable to determine what the training of these indi-
viduals is except by the painstaking method of reviewing and documenting
their educational transcripts. A related problem involves the lack of clarity
in the identity of psychology as seen by the courts. In Washington, D.C.,
in 1975, Judge MacKinnon (in Burger v. Board of Psychologist Examiners)
found psychology to be an arcane discipline with no clear standards as to
what constitutes education and training in the field. This decision and other
factors led the Council for the National Register of Health Service Providers
in Psychology and the American Association of State Psychology Boards to
propose the establishment of a steering committee to develop a National
Commission on Education and Credentialing in Psychology.
APA supported the efforts of the steering committee and two national
conferences were held on the issues. A formal proposal was considered by
the Council of Representatives in 1979. Rather than approve the official for-
mation of a commission at this time, the Council adopted a board of direc-
tor's proposal for a Task Force on Education and Credentialing. This group
has been working to develop a pilot system for designating programs train-
ing providers of psychological services. It is refining a set of criteria by
which to evaluate these programs and is designing a research protocol to
determine the effects of such an effort on various constituencies.
If this project is successful, for the first time in its history, American
psychology will have a method to clearly determine which training pro-
grams are truly psychological. Eventually, the graduates of these programs
will be licensed eligible and the public will have a uniform standard of
background and experience for psychologists providing services.
The second major issue confronting organized psychology focuses on
further elaborating its ability to function in a free and open marketplace.
Several developments are relevant here.
As outlined in the first section of this chapter, the primary consider-
ation for the first full generation of professional psychologists was the
establishment of the status of our diScipline before the law, via licenSing.
The task was completed in all states by 1978. However, the wholesale adop-
tion of "sunset" legislation, which mandates the automatic termination of
state agencies unless re-established by legislatures, has resulted in the loss
of licensure statutes in South Dakota and Florida. At least eight other states
have made it through sunset proceedings, but the absorption of resources
and expenditure of political capital to accomplish this task has been enor-
mous. The lost opportunities are also telling, for the lesson of the past 20
years has been that licensure only gets your professional foot in the door.
There are at least 50 to 60 other areas of state law that require modification
in order for psychologists to be able to practice their profession fully in a
given state. This presents a challenge of the first magnitude for the current
generation of psychologists.
A related set of issues concerns the structure of several major markets
for psychological services, especially health and education. Health care in
this country has long been dominated by the profession of medicine. Phy-
sicians have been working for hundreds of years to improve the health of
people and to advance their own profession. They have been extraordinar-
ily successful at both tasks. Not only has the health of the country
improved, but medicine enjoys a virtual monopoly at the apex of the health
care industry. Virtually no care can be administered without the approval
of a physician. This presents enormous difficulty for any group of practi-
tioners that wishes to provide services in this sector of the economy.
For example, even after the passage of a licensure act in a given state
which allows psychologists to "diagnose and treat mental and nervous dis-
orders," third-party payors are not required to reimburse psychologists
directly. Many do so only after the physician "orders" the care. This is the
so-called medical necessity clause of many health care plans. It is promul-
gated as a quality assurance mechanism. In operation, it guarantees that
physicians are the only gatekeepers to health care. A second type of law
called "direct recognition legislation" (or freedom-of-choice legislation) has
been developed to get around this problem. It modifies state insurance
codes to require insurance companies to reimburse psychologists directly if
they are licensed to provide the care. Even this does not go far enough,
however, as insurance policies written outside of the state where the direct
recognition laws are in effect are not, according to many companies,
required to comply with the law. An extraterritoriality clause must then be
written into the statute to force the companies to comply fully with the law
by stating that even policies written outside of the state are subject to these
statutes. These are just some of the problems psychology is confronting in
the health care industry.
A final major issue facing psychology concerns how we are to be orga-
nized to advocate, educate, and regulate the discipline in the future. In the
past, APA as an organization was criticized for tilting too far toward science
and ignoring the real needs of the professionals. In the mid-to-Iate 1970s,
the reverse became true as scientists have threatened to leave the organi-
zation in droves if APA resources and policy were not more responsive to
their needs. In 1978, a Blue Ribbon Commission on the Organization of
APA was formed to address these issues. Over the past two years, a series
of proposals has been formulated which the commission feels will address
the major problems facing APA.
Central to the concerns of all constituencies in these deliberations are:
(1) Who speaks on behalf of American psychology? (2) How shall resources
be allocated within the organization to meet the needs of the constituen-
cies? and (3) How can the most effective and efficient type of organization
be retained? The commission's proposals, which are still being revised,
would retain much of the central office and the major boards and commit-
tees and the goals of the organization would remain unchanged. Council
would be divided into several interest sections (professionally, scientific,
public welfare) that would consider the issues of major concern to those
constituencies. Problems affecting all groups would be considered by Coun-
cil as a whole in a manner similar to the present scheme. In addition, the
number of officers elected by the general membership would increase and

the board of directors would be modified so as to guarantee representation
of the various constituencies and to give it more decision making authority
vis-a-vis Council and its various sections. The debate over those proposals
has been most vigorous.
A final set of plans from the commission was presented in 1981. The
plans have been debated on the floor of Council. The trial implementation
of a section of the proposal is already underway. Regardless of the final vote
and direction, the face of American psychology will be changing in the
coming years as it faces new challenges and continuing problems.
This chapter has attempted to provide an overview of the current status
of the American Psychological Association mostly for the benefit of profes-
sionals who seek to understand its goals, structure, and functions. No over-
view can do justice to any organization as complex and richly textured as
APA. Many facets of the organization have been passed over quickly and
others neglected completely. Hopefully, however, an accurate, if somewhat
general, vision of the organization has been gained. Most importantly, you
should have learned that APA is rooted strongly in the traditions and his-
tory of the science and profession of psychology. It is an alive, growing,
and vibrant organization eager to present psychology to the world and to
serve its membership. It is responsive to the culture of our times and is
democratically operated. The organization has had a distinguished past and
with the continued support of the membership and leadership, and work
from staff and governance, it will have an equally distinguished future.
REFERENCES
American Psychological Association. Joint report of the APA and CSPA Committee on Leg-
islation. American Psychologist, 1955, 10,727-756.
American Psychological Association. A model for state legislation affecting the practice of
psychology 1967: Report of APA Committee on Legislation. American Psychologist, 1967,
22, 1095-1103.
American Psychological Association. Guidelines for conditions of employment of psychologists.
ticipants. Washington, D.C.: Author, 1973.
American Psychological Association. Psychology as a health care profession. Washington, D.C.:
Author, 1979.(a)
American Psychological Association. Bylaws of the American Psychological Association. Wash-
ington, D.C.: Author, 1979.(b)
American Psychological Association. Principles for the care and use of animals. Washington,
D.C.: Author, 1979.(c)
American Psychological Association. Ethical standards for psychologists (rev. ed.). Washington,
D.C.: Author, 1981.(a)
American Psychological Association. Specialty guidelines for the delivery of services by clin-
ical psychologists. American Psychologist, 1981, 36, 640-681.(b)
counseling psychologists. American Psychologist, 1981, 36, 640-681.(c)
industrial/organizational psychologists. American Psychologist, 1981, 36, 640-681.(d)
school psychologists. American Psychologist, 1981,36, 640-681.(e)
American Psychological Association. Rules of Council, Washington, D.C.: Author, 1982.
Berger v. Board of Psychologist Examiners, 521 F.2d 1056 (1975).
Centor, A. American Psychological Association. In Wolman, B. B. (Ed.), International encyclo-
pedia of psychiatry, psychology, psychoanalysis, and neurology. New York: Van Nostrand
Reinhold, 1975.
Fernberger, S. W. The American Psychological Association: A historical summary 1892-1930.
Psychological Bulletin, 1932, 29(1), 1-89.
Fernberger, S. W. The American Psychological Association 1892-1942. Psychological Review,
1943,50(1),33-60.
Napoli, D. S. The architects of adjustment: The practice and professionalization of American psy-
chology, 1920-1945. Ann Arbor, Michigan: University Microfilms International, 1975.
7
The National Register of Health Service
Providers in Psychology
ALFRED M. WELLNER and CARL N. ZIMET
This chapter will describe the development of the National Register of

Health Service Providers in Psychology and will provide a perspective for
its position in professional psychology. Since the Register was initiated in
1974 it has quickly become recognized as a significant and major profes-
sional resource. Its rapid growth reflects both its timeliness and its accep-
tance by the profession and other relevant groups.
The National Register is a publication that lists psychologists who are
licensed or certified (at the independent practice level) by a State Board of
Examiners of Psychology and who have met the Register's criteria as health
service providers in psychology. The 1981 National Register and Supple-
ment list over 13,000 psychologists.
In the 1981 edition of the National Register, new information was
included for each listing. In addition to the basic identifying information
(name, highest degree earned, address, state of license or certification), the
National Register now includes the following information on the charac-
teristics of services:
1. Theoretical Orientations-Registrants may identify up to three the-
oretical operations, in order of preference from amoug the
following:
Behavioral Psychoanalytic
Eclectic Rational Emotive
Existential-Humanistic Reality
Gestalt Rogerian, Client-centered
Interpersonal Relationship Social Learning
Systems Oriented
ALFRED M. WELLNER. National Register of Health Service Providers in Psychology,

Washington, D.C. 20036. CARL N. ZIMET • Division of Clinical Psychology, University
of Colorado Health Services Center, Denver, Colorado 80262.
185
186 ALFRED M. WELLNER AND CARL N. ZIMET
2. Health Services Offered-Registrants may list up to three service

approaches in order of preference from among the following:
Individual Therapy Group Therapy
Family Therapy Diagnosis
Couples Therapy Consultation
General Practice
3. Specialized Health Services Offered-Registrants may list up to five
specialized services in order of preference from among the
following:
Biofeedback Pain Management
Child & Spouse Abuse Therapy Physical Illness/Disability
Disability Determination Play Therapy
Forensic Services Psychodrama
Hypnosis Rehabilitation
Learning Disabilities Sexual Dysfunction Therapy
Marital Therapy Stress Management
Neuropsychology Substance Abuse
Women's Issues
4. Ages Served-Registrants may identify the ages of patients served
using the following categories:
Children (under 12)
Adolescents (13-17)
Adults (18-64)
Aged (65 and over)
5. Language Fluency-Registrants identified languages in which they
can communicate fluently with patients whose spoken language is
other than English. In addition to the varieties of languages noted,
the designation "sign language" is used to identify the several
methods of communication with deaf persons.
BACKGROUND
The evolution of professional psychology as we know it today is a post-

World War II phenomenon, with the beginning of "health service" psy-
chology as an organized educational undertaking dating to 1945 with the
initiation of clinical psychology programs. The growth of professional psy-
chology in the 1940s and 1950s led to the development of standards cov-
ering the practice of psychology (see Chapters 3, 2, and 4) and to state stat-
utes (licensing and certification) covering the title and practice of
psychology in the states (see Chapter 11).
The emergence of state laws provided the public and the profession
with minimal standards for the identification of psychologists and for the
practice of psychology. As a growing, developing field the focus was on the
NATIONAL REGISTER OF HEALTH SERVICE PROVIDERS 187
general or generic field of psychology rather than on any specialty prac-

tices. Thus, the American Psychological Association (APA) proposed model
legislation emphasizing generic licensing. It is the same generic licensing
that lawyers or physicians have held. No physician, for example, practices
his or her specialty under a specific license. Rather, a radiologist practices
under the same license as a neurosurgeon and a patent attorney under the
same license as a criminal lawyer. The delineation among the specialties in
psychology and between any two specialties has not yet crystalized. Licens-
ing and certification by the state boards of examiners therefore has been
generic in almost every state.
The lack of specialty designation through state statues has resulted in
a number of problems. For example, state and federal legislators always
found it difficult, if not impossible, to include psychologists in health leg-
islation since the generic term psychologist included psychologists of all spe-
cialties, (e.g., clinical, counseling, engineering, industrial, physiological),
many of whom obviously would not be appropriate for inclusion in any
specific piece of legislation. With the advent of planning for a national
health system, the need for an instrument to identify health service proVid-
ers in psychology became all the more important for two reasons. First, any
national health policy must consider the availability and distribution of
professional manpower to provide the needed services. In order for psy-
chologists to be considered for inclusion in national health policies and par-
ticularly under a national health insurance system, policy planners must
have knowledge of the number of health psychologists, their geographic
distribution, and the nature of services. Thus it became clear that a mecha-
nism was needed to permit the identification of health service providers in
psychology. Second, the absence of a clear definition of health service pro-
viders in psychology made it difficult to incorporate psychology as a pro-
vider group under national health insurance. The development of an
instrument to identify health service providers in psychology, then, also
would facilitate plans for the inclusion of psychology as one of the major
health professions.
Another reason for identification of health service providers in psy-
chology came from the fact that psychologists over the past two decades
were included as independent providers by many third-party health reim-
bursement programs. The enactment of Freedom of Choice (Direct Recog-
nition) legislation further provided opportunities for psychological services
to be reimbursed directly through insurance programs. This state legisla-
tion, initiated in the mid 1960s, requires health insurers to reimburse qual-
ified psychologists directly where the insurance policy covers mental health
services and where the patient chose the psychologist to provide the ser-
vices. That is, the consumer has the freedom to choose between psycholo-
gists or medical practitioners for health services. By 1982, 65% of all states
and the District of Columbia had enacted Freedom of Choice legislation that
provides for direct access to psychologists without the need for any medical
referral. The following states have enacted freedom of choice or direct rec-
ognition legislation:
Alabama Missouri
Arkansas Montana
California Nebraska
Colorado Nevada
Connecticut New Jersey
District of Columbia New Mexico
Georgia New York
Illinois North Carolina
Kansas Ohio
Louisiana Oklahoma
Maine Oregon
Maryland Pennsylvania
Massachusetts Tennessee
Michigan Texas
Minnesota Utah
Mississi ppi Virginia
Washington
New Jersey established the first law in 1968. Yet, in the absence of a well-
established system of identifying psychologists as health service providers,
third-party carriers had to review the credentials of psychologists. The pro-
cedures they used tended to be unreliable and of questionable validity. This
provided further justification for developing a system to identify health ser-
vices in psychology.
The issues of national health insurance and third-party reimbursement
obviously are important ones and were significant factors in the need for
and the development of the National Register. However, there was also a
more basic and in many ways a more important aspect of this undertaking.
Since the early to mid-1960s, more and more psychologists were moving
into areas of functioning that could best be described under the label health
care. There were those involved in psychotherapy and that number swelled
every year. Others were dealing with a variety of harmful-substance abuse
problems such as alcohol, drugs, and tobacco. An increasing number of psy-
chologists began taking active roles in physical rehabilitation and in a vari-
ety of medical problems that have major psychological concomitants (e.g.,
cancer, diabetes, and asthma). Yet there was no recognition of these devel-
opments within American psychology. It seemed that the time had come to
make it clear to psychology and to the public at large that among the many
and varied activities engaged in by psychologists, the area of health service
provision was an important and a growing one. Just how important and
how much of a growth area it was was emphasized even further by the
petition for and the acceptance by AP A in 1978 of a new division, Health
Psychology.
Finally, the public interest also required a system of identifying health

service providers in psychology. Although consumers are somewhat pro-
tected through the state licensing or certification system, this system typi-
cally did not specify in what specialty each psychologist was qualified.
Although ethical standards stating that a psychologist must practice within
the limits of his or her competence provided some protection for the con-
sumer, they could not replace an identification system.
ORIGINS OF THE NATIONAL REGISTER
In a previous report (Zimet & Wellner, 1977), the authors noted some
of the developments in psychology that led to the establishment of the
Council for the National Register of Health Service Providers in Psychol-
ogy. Briefly, the APA Committee on Health Insurance (COHI) had initially
discussed the possibility of establishing a system to identify health service
providers in 1973 and had asked the American Association of State Psy-
chology Boards (AASPB) to implement this project. Because the basic legal
mission of the State Boards is generic licensing and certification, AASPB did
not feel that the compilation of a list of selected state-licensed/certified psy-
chologists would be appropriate. Indeed, it was felt that it might not even
be permissible.
Coinciding with these developments, the American Board of Profes-
sional Psychology (ABPP) was considering an alternative plan involving
the development of a specialty designation certificate below the formal
diplomate status. Under that plan an individual would be eligible to take
an examination for this "junior diplomate" or "board eligible" status two
years after the doctorate in anyone of the four traditional areas of clinical,
counseling, school, and industrial/organizational.
One of the authors, Carl N. Zimet, then a member of the ABPP Board
of Trustees, was appointed to develop a plan for such a program and to
consider alternate approaches. Out of this came a recommendation for the
development of a National Register for Health Service Providers which was
discussed by several of the trustees of ABPP and a few other professional
psychologists who had a particular interest in this area.
The concept of the Register was agreed to and was adopted at an ABPP
Board of Trustees meeting. At this point ABPP discussed this formal pro-
posal with APA. In October 1973, the APA Board of Professional Affairs
formally voted to recommend that APA request ABPP to establish a
National Register of Health Service Providers in Psychology. The request
was endorsed by the APA board and at the annual meeting of the board of
trustees of ABPP in March 1974, action was taken to implement the project.
ABPP called a meeting for May 31 and June 1, 1974, of a group of 12 psy-
chologists who were familiar with the range of health services, standards
of practice, and the various specialties in psychology. This group evolved
into the board of directors of the Register. At the first meeting of the
National Register Board it was decided to add three nonpsychologist mem-
bers who would add a public point of view to the board.
It should be noted that there were concerns about the desirability of
forming the National Register. For example, at the 1974 annual convention
of APA some members of state licensing boards argued that the state pre-
rogatives were being usurped since the National Register could serve as a
national "licensing" body. In response, it was made clear that the National
Register was in effect oriented toward strengthening state boards by requir-
ing licensing as a basic criterion for inclusion in the National Register and
by working closely with the boards in the enforcement of the laws. It did
not wish to, nor could it legally, replace state licensing boards. Others were
concerned about how individuals would be listed if they resided in a state
in which they did not have a license. The format of the listing in the Reg-
ister makes clear to the reader that the individual is not licensed in that
state. In addition, no registrant is shown for more than two years under the
geographic listing in a state where he or she does not hold a license/certif-
icate to practice. In recognition of these and other concerns, the National
Register's position was that given the need for the establishment of a list of
health service providers in psychology for various purposes (see above) the
Register when developing such a roster would be fully mindful of the exist-
ing standards of the profession and the various jurisdictional issues present.
The Council for the National Register of Health Service Providers in
Psychology was incorporated as a separate, nonprofit organization in the
fall of 1974. ABPP advanced the Council for the National Register seed
money, in the form of a loan, to initiate the project.
Since the National Register was designed to be a self-supporting
professional activity, there were many financial uncertainties regarding it
as there are with any new venture. In order to encourage early applications
that would permit the board of directors to determine the feasibility and
financial viability of establishing the National Register, information and an
application form were sent to all licensed/certified psychologists in the
United States. This mailing included an announcement of an early registra-
tion fee schedule. The normal fee of $100 ($50 for the application and cre-
dential review and $50 upon approval for listing) was reduced to $60 for
the early registration (a three-month period).
Within the three-month period, over 5,000 applications were received.
Obviously, this was a very strong and positive response and clearly
expressed the confidence of professional psychologists in the goals estab-
lished and in the viability and the need for a National Register of Health
Service Providers.
DEFINITION OF A HEALTH SERVICE PROVIDER IN PSYCHOLOGY
A central question the board of directors had to address initially was

the definition of a Health Service Provider in Psychology. No national def-
inition was available. In addition, trying to define it solely by specifying

the traditional specialties of clinical or counseling was insufficient since
health services cut across some of the traditional specialty areas in psychol-
ogy. The focus needed to be on the nature of services rather than on a tra-
ditional specialty label.
After considerable discussion the following definition was developed:
A Health Service Provider in Psychology is defined as a doctoral level psychol-
ogist, certified/licensed at the independent practice level in his/her state, who
is duly trained and experienced [I.e., meets criteria of training and experience
listed below] in the delivery of direct, preventive, assessment and therapeutic
intervention services to individuals whose growth, adjustment, or functioning
is actually impaired or is demonstrably at high risk of impairment.
The definition has served the National Register well and has provided
a reasonable basis upon which to evaluate the credentials of applicants for
listing in the Register. It also has served as a definition that has been found
helpful by various governmental agencies and health organizations.
CRITERIA FOR LISTING IN THE REGISTER
INITIAL CRITERIA (The Grandparent Period) 1974-1977
One of the first tasks of the group was to establish appropriate criteria
for listing. On the basis of the standards of the profession, the policy state-
ments established by APA, AASPB, and the general standards for the state
statutes, the following criteria were established for listing:
1. Licensed or certified by the State Board of Examiners in Psychology
at the independent practice level.
2. A doctoral degree from a regionally accredited university.
3. Two years of supervised experience in health services in psychology
of which at least one year is in an organized health service training
program or internship and one year is postdoctoral.
For a period of three years, until January 1978, applications
were accepted from psychologists without a doctoral degree if the
applicant had (a) been licensed or certified as a psychologist for the
independent practice by the State Board of Examiners of Psychology
by January I, 1975 and (b) had his/her graduate degree granted a
minimum of six years prior to January 1975 and had at least six years
of experience in psychology with at least two years of supervised
experience in health services, one of which was in an organized
health service training program.
Although the doctoral degree was the basic degree requirement, the
criteria also established the requirement that there be one year of postdoc-
toral supervised experience in health services in psychology. In order to
conform to due process of law, however, a "grandparent" period of approx-
imately three years was established to end January I, 1978. During this
grandparent period persons with other than the doctoral degree were
accepted and predoctoral experience was accepted in lieu of postdoctoral.
The need for a grandparent period in such an effort is clear. Although there
are some who wish to see the establishment of the highest standards at the
earliest possible time, such an interest must be tempered by the reality of
colleagues who have been in practice for some time and who have, in fact,
been licensed or certified to practice. State boards of examiners in psychol-
ogy also have worked with a grandparent principle upon enactment of state
legislation. It is a very common and well accepted practice which seems fair
to all in the development of a new system.
CURRENT CRITERIA January 1, 1978 to present
At the end of the grandparent period, January 1, 1978, the following

criteria were established:
1. Currently licensed or certified by the State Board of Examiners of
Psychology at the independent practice level of psychology
2. A doctoral degree in psychology from a regionally accredited edu-
cational institution
3. Two years of supervised experience in health service, one of these
years in an organized health service training program, and at least
one year must be postdoctoral
The requirement for licensure or certification at the independent prac-
tice level has not changed since the initial criteria. It is appropriate and
essential in view of the statutory responsibilities of the state boards and for
the protection of the public.
Since January 1, 1978, however, only applicants with a doctoral degree
in psychology are accepted for listing. As had been indicated to the profes-
sion since the beginning of the Register, acceptance of persons with other
than doctoral degrees was a time-limited occurrence in order to recognize
colleagues who have been in practice for some time and who have been
licensed at the independent level by the state boards of examiners of
psychology.
The requirement that it be a doctoral degree in psychology represented
the National Register'S commitment to upholding the standards of the
profession. This criterion emerged as a national consensus after initial dis-
cussions were undertaken between the National Register and other groups,
notably AASPB. Since January 1, 1978, persons whose degrees are not
clearly in psychology have been evaluated in terms of the recommenda-
tions that came from the Education and Credentialing in Psychology meet-
ings (1976, 1977) as developed in the Steering Committee Report on Edu-
cation and Credentialing in Psychology (Wellner, 1978). In addition, the
National Register also alerts applicants to the AASPB policy statement on
minimal educational standards for the appropriate definition of a doctoral
degree in psychology.
The two years of supervised experience in health services in psychol-

ogy have become somewhat more sharply defined since pre-1978. The
application forms for listing in the Register now include an internship con-
firmation form and a supervisor confirmation form. All applications must
include signed confirmation forms reflecting the applicant's completion of
an internship and one year of postdoctoral supervised experience in health
services in psychology. This change in procedure arose because one of the
areas that caused considerable concern in the early stages of the develop-
ment of the Register was the variety of supervised experiences and what
some colleagues suggested was an unverified process. That is, no indepen-
dent information was requested from applicants except in those cases where
some problems were raised and applicants were asked for additional infor-
mation. The internship and supervisor confirmation forms provide for a
very clear independent verification of the applicant's experiences. Each
form is signed by the appropriate supervisor or director of internship con-
firming that the applicant has completed the respective experience and also
identifies the name of the immediate supervisor, relationship of the intern-
ship to the doctoral program, length of time, etc.
The Review Process

It was clear at the outset that the diversity of training experiences
would necessitate a very individualized credentials review. This process
consists of each application being reviewed by one or more reviewers after
the staff has had a chance to determine that the application is complete. The
staff also makes a preliminary check on some of the basic criteria (degree,
license/certification, etc.). The reviewers, professional psychologists in the
Washington area who review applications in the Register office, have avail-
able to them other resource documents (Council on Postsecondary Accre-
ditation Directory, Association of Psychology Internship Centers Directory,
National Register, lists of APA approved doctoral programs and intern-
ships, etc.). If, during the early stages of the review, the application is not
considered complete or if there are items that need clarification or which
perhaps are inconsistent with other information either on the application
form or the confirmation forms, the applicant is asked for clarification. This
is the first opportunity the applicant has to add information and/ or clarify
data that were presented.
Upon receipt of the additional information the application is again
reviewed for sufficiency and responsiveness to the questions by the staff
and reviewers. The board of directors is then asked to evaluate the appli-
cation if it has not been judged to be acceptable for listing in the Register.
The board can determine that the application is acceptable and approve it
or it can request further clarification from the applicant and/or any super-
visors listed.
Upon receipt of the second additional information, the application is
again reviewed by the staff and the reviewers. If at that point the applica-
tion data are satisfactory, the reviewer will approve it. If more information
is needed, a further request goes out to the applicant. If the reviewers do

not judge it to be acceptable for listing in the National Register, the Board
of Directors then evaluates the application. At this point, the applicant may
be approved or disapproved. It is important to note that for the first seven
years (until 1982), only the Board of Directors determined disapproval.
Since 1982, a three-person panel of senior reviewers can approve or disap-
prove an application.
Should the application not warrant approval, the applicant is informed
of the decision with a note on the availability of an appeal process should
the individual wish to appeal the decision. The appeal board is comprised
of nine individuals, five of whom are psychologists. If the applicant files an
appeal, the appeal panel consisting of at least three members has all past
material and documentation available to it. The decision of the appeal board
is final.
It should be noted that the National Register's policy has always been
to provide reasonable advice to colleagues who write or call asking if their
credentials meet the criteria. Colleagues are discouraged from applying for
listing in the National Register if their training and experience do not seem
to meet these criteria and are encouraged to participate in further training
activities such as internships where appropriate.
LISTING IN THE NATIONAL REGISTER
Table 1 presents the information on the number of applications for list-

ing in the National Register received since the Register's inception.
As can be seen from Table 1, the first year of the Register's operation
was by far that of the largest number of applications. The early applications
reflected colleagues' interest in being listed, in participating in an early reg-
istration period, and in generally supporting a new professional effort. The
substantial number of applications in 1977 is a reflection of the end of the
"grandparent" period. As noted above, as of January 1, 1978, the criteria for
listing were changed, and a number of licensed/certified psychologists
applied for listing in the Register just prior to the implementation of the
new criteria.
TABLE 1
Number of Applications to the National
Register
Applications Cumulative
1974 7,167 7,167

1975 880 8,047
1976 918 8,965
1977 2,873 11,838
1978 1,075 12,913
1979 883 13,796
1980 906 14,702
1981 769 15,471
TABLE 2
Number of Psychologists Listed in National
Register
Edition Total
1975 (1st ed.) 6,900

1976 8,000
1978 11,000
1980 12,300
1981 12,700
1982 (as of September 22) 13,300
Although the criteria are fairly specific, there are individuals who
apply who do not meet them and are, therefore, not acceptable for listing
in the National Register. As of June 1982 approximately 85% of the appli-
cants have been approved. Table 2 shows the number of psychologists listed
in each of the publications and a cumulative total of all psychologists listed
in the National Register, now approximately 13,500.
In order to compare some characteristics of those licensed/certified
psychologists who are, or are not, included in the National Register, the
Register compiled an accurate list of these individuals that eliminated dou-
ble references where a psychologist was licensed/certified in more than one
state. This was the first such unduplicated list of licensed psychologists ever
compiled. On the basis of the analysis it was determined that as of the fall
of 1976 there were approximately 25,000 to 26,000 licensed/certified psy-
chologists. Survey forms were sent to all with a follow-up form to those
who had not responded after several months. By early 1977,75% of those
surveyed responded. Data obtained from that survey was initially quickly
disseminated through Register Research Reports and more recently devel-
oped in a more comprehensive manuscript (Mills, Wellner, & VandenBos,
1979). The data that follow were obtained in the survey.
1. Number of health service providers. An item on the survey asked if the
respondent was a "health service provider." This was a self-definition not
necessarily consistent with the criteria for listing in the National Register.
It was determined that approximately 74% of the respondents identified
themselves as health service providers with another 14% trained but not
currently providing such services. Projecting to the population of all
licensed/certified psychologists it was found that there were approximately
19,000 health service providers in psychology at that time.
2. Providers in private practice. The data showed that approximately 25%
of the providers were in private practice on a full-time basis and another
57% on a part-time basis.
3. Highest academic degree. A comparison of the highest academic
degrees for those listed and not listed in the National Register:
Listed 88% Doctorates
Not Listed 78% Doctorates
Given the requirements for a doctoral degree for listing as of January

1,1978, it is expected that the percentage of doctorates for listed individuals
will increase over time.
4. ABPP Diplomate Status. A comparison of the ABPP diplomate status
for those listed and not listed in the National Register showed:
Listed 13% Diplomates
Not Listed 9% Diplomates
The higher percentage of diplomate status for those listed in the
National Register is consistent with the generally higher percentage of per-
sons with doctorates who are listed in the National Register and the general
standards for listing.
This survey confirmed the belief that the National Register listed psy-
chologists with strong academic and other credentials, in comparison with
all licensed / certified psychologists.
RECOGNITION AND UTILIZATION OF THE NATIONAL REGISTER
With the listing of over 13,000 highly qualified health service provid-
ers in psychology by the summer of 1982, it is clear that the National Reg-
ister is a major resource tool. In fact, recognition of the National Register
has been achieved through the utilization of Register data by several fed-
eral, state, and private agencies for manpower planning purposes. For
example, over the past several years a number of federal agencies including
the recent President's Commission on Mental Health requested data from
the National Register on the number of health service providers in psy-
chology, their distribution, etc. Similarly, the Federal Employee Health
Benefit Program of Blue Cross/Blue Shield had long sought a procedure
that would identify appropriate providers of psychological services. Upon
hearing of the development of a National Register and upon review of the
criteria for listing, the Blue Cross/Blue Shield FEHB evaluated the Register
and its procedures and determined that listing in the Register would meet
their requirements. If the psychologist is not listed, the local Blue Cross/
Blue Shield office would have to conduct the usual investigation to deter-
mine if the provider is qualified. That is, the National Register as a volun-
tary listing served to facilitate the identification of qualified health service
providers for the Blue Cross/Blue Shield offices. In 1976-1977, the Aetna
Life Insurance Company also conducted a study of the National Register
and concluded that it provides an acceptable system of identifying qualified
health service psychologists for their FEHB plans. The directors of the
Aetna program made a formal statement of their study and presented their
conclusions at the open meeting of the National Register held during the
APA Convention in San Francisco in 1977.
The Civilian Health and Medical program (CHAMPUS) administered
by the Department of Defense also formally recognized the Register. And
the Model Direct Recognition Bill jointly developed by APA and the Health
Insurance Association of America (HIAA) for states to use in enacting direct
recognition (Freedom of Choice) legislation, refers to the National Register
as a means of identifying qualified providers of service.
The California legislature incorporated the National Register in iden-
tifying the credentials of psychologists in workers compensation legisla-
tion. The Maryland legislature recently enacted a law to give psychologists
recognition as expert witnesses and for the evaluation of individuals for
commitment purposes and uses the National Register as a reference for
identifying the credentials of psychologists under the law.
On the basis of the subscriptions to the Register, it seems clear that the
National Register also has been of great value to any number of organiza-
tions in identifying qualified providers of health services. It also seems clear
from information obtained through surveys of the subscribers that the Reg-
ister has facilitated the identification of psychologists in the health service
field in a wide variety of areas.
EDUCATION AND CREDENTIALING
Data gathered by the National Register served as a major stimulus for

encouraging the profession to assess critically the education and creden-
tialing components of the field. The Register's information showed that
psychologists were being trained in all kinds of educational institutions
with a variety of programs of which only some were related to psychology.
For example, when applications began to come from licensed/certified psy-
chologists to the National Register Central Office, the members of the Board
were astounded by the varieties of degrees (e.g., CAGS, Ed.S., MCP, PD,
DS.Sc., etc.), departments granting degrees (e.g., law, religion, speech, gen-
eral studies, political science, etc.) and major fields (e.g., research, supervi-
sion, education, administration, English) that were represented in addition
to the usual psychology specialties. There seemed to be little coherence and
clarity to the basic educational training that state licenSing/certification
boards accepted as psychology. Thus, the term doctoral degree in psychology
was not a precise enough concept. In the Berger v. District of Columbia court
case (1975) the court of appeals judge noted the following:
But the very reason psychology has not been regulated before is that it has been
and remains an amorphous, inexact, and even mysterious discipline. Possession
of a graduate degree in psychology does not signify the absorption of a corpus
of knowledge as does a medical, engineering or law degree, rather it is simply
a convenient line for legislatures to draw on the brave assumption that what-
ever is taught in the varied graduate curricula of university psychology depart-
ments, will make one a competent psychologist. (p. 1061)
Judge George McKinnon's statement served as a very strong added stimulus

to the need for the profession to come to grips with a doctoral program in
psychology .
The National Register's data, court opinions such as Berger, and

AASPB's experience cumulatively created strong pressures for the profes-
sion to address the problems inherent in an uncertain definition of the aca-
demic preparation for professional practice in psychology. The National
Register together with APA and AASPB organized two national meetings
on "Education and Credentialing in Psychology" (Wellner 1976, 1977). The
first, in 1976, was an exploratory one in which some of the issues related to
education and credentialing were identified and some broad general rec-
ommendations made. The participants at the meeting represented some of
the key organizations in psychology involved in either education or the
credentialing and practice field.
The second meeting, in 1977, brought together approximately SO col-
leagues representing 3S different organizations including 17 divisions of
the APA. In a two-day meeting the participants discussed the need for iden-
tifying the components of a doctoral degree in psychology and through an
open, frank discussion specific recommendations were made on the criteria
for such a definition. The participants at this meeting recommended the
following as the criteria for the designation of doctoral programs in
psychology.
1. Programs that are accredited by the American Psychological Asso-
ciation are recognized as meeting the definition of a professional
psychology program. The criteria for accreditation serve as a model
for professional psychology training. Programs not accredited by
the APA must meet criteria 2-10.
2. Training in professional psychology is doctoral training offered in
a regionally accredited institution of higher education.
3. The program, wherever it may be administratively housed, must
be clearly identified and labeled as a psychology program. Such a
program must specify in pertinent institutional catalogs and bro-
chures its intent to educate and train professional psychologists.
4. The psychology program must stand as a recognizable, coherent
organizational entity within the institution.
S. There must be a clear authority and primary responsibility for the
core and specialty areas whether or not the program cuts across
administrative lines.
6. The program must be an integrated, organized sequence of study.
7. There must be an identifiable psychology faculty and a psycholo-
gist responsible for the program.
S. The program must have an identifiable body of students who are
matriculated in that program for a degree.
9. The program must include supervised practicum, internship, and
field or laboratory training appropriate to the practice of
psychology.
10. The curriculum shall encompass a minimum of three academic
years of full time graduate study. In addition to instruction in sci-
entific and professional ethics and standards, research design and
methodology, statistics and psychometrics, the core program shall

require each student to demonstrate competence in each of the fol-
lowing substantive content areas. This typically will be met by
including a minimum of 3 or more graduate semester hours (5 or
more graduate quarter hours) in each of 4 substantive content
areas: (a) biological bases of behavior: physiological psychology, com-
parative psychology, neuropsychology, sensation and perception,
psychopharmacology; (b) cognitive-affective bases of behavior: learn-
ing, thinking, motivation, emotion; (c) social bases of behavior: social
psychology, group processes, organizational and systems theory;
(d) individual differences: personality theory, human development,
abnormal psychology.
In addition to these criteria, all professional education programs in psy-
chology will include course requirements in specialty areas.
Subsequent to the meeting in 1977 a report was developed (Wellner,
1978) that provided an overview of the issues and recommendations. In
addition, the participants at the 1977 meeting recommended that a National
Commission on Education and Credentialing in Psychology be formed in
order to provide for a comprehensive and well coordinated designation sys-
tem of doctoral programs in psychology. The 1978 report also included a
review of the experience of other professions including medicine and law
in the education and credentialing fields. It appeared that psychology was
undergoing a process similar to some of the other professions prior to the
clear articulation of the educational system in those professions. For exam-
ple, some of the data provided in the sourcebooks for the 1976 and 1977
meetings were comparable to the data Abraham Flexner developed in the
influential Flexner report on medical education conducted in 1910.
At this writing, the criteria developed for defining a doctoral degree in
psychology have received widespread distribution and have been incor-
porated in the criteria for listing in the National Register as mentioned
above. They also have served as the basis for the standards established by
AASPB on minimal education for licensure eligibility. In addition, the cri-
teria have been incorporated in the newly revised accreditation criteria for
APA doctoral programs in psychology as mentioned elsewhere (see Chapter
8).
The American Psychological Association is currently in the process of
conducting reviews on the development of a Designation system. There is
currently an APA Task Force on Education and Credentialing in Psychol-
ogy which has begun work on a Designation system. It is the policy of the
APA through a vote of the Council of Representatives in 1977 that the
implementation of a Designation system would be through an interorgan-
izational process (such as the National Commission proposal) unless there
were overriding reasons to establish another system.
In the meantime, the National Register established the Designation
system and published the first List of Designated Doctoral Programs in Psy-
chology in August 1981. The second edition (1982) was published in March
of that year and includes approximately 785 programs which were deter-
mined to meet the guidelines developed at the 1977 National Conference
on Education and Credentialing in Psychology. The National Register's
project was developed through numerous sources of information including
a survey of all doctoral programs listed in the AP A publication, "Graduate
Study in Psychology", collaborative efforts with the American Association
of State Psychology Boards (AASPB), and the State Boards of Examiners in
Psychology, contacts with the Council of Graduate Departments of Psy-
chology, information from over 15,000 applications for listing in the
National Register, transcripts of academic work, and communications with
department chairs, program directors, and other faculty. The National Reg-
ister's List of Designated Doctoral Programs in Psychology has been found
to be useful to prospective graduate students in psychology, to educational
institutions interested in developing a program which meets the standards
of the profession, and has also clearly served the review process for listing
in the National Register.
REFERENCES
Berger v. Board of Psychologist Examiners, 521 F.2d 1056 (1975).

Mills, D., Wellner, A. M., & VandenBos, G. The National Register survey: The first compre-
hensive study of all licensed/certified psychologists. In C. Keisler, N. Cummings, & G.
VandenBos (Eds.), Psychology in national health insurance. Washington, D.C.: American
Psychological Association, 1979.
Wellner, A. M. (Ed.). Education and credentialing in psychology: Preliminary report of a meeting.
Washington, D.C.: Steering Committee on Education and Credentialing, 1976.
Wellner, A. M. (Ed.). Education and credentialing in psychology II: Report of a meeting. Washing-
ton, D.C.: Steering Committee on Education and Credentialing, 1977.
Wellner, A. M. (Ed.). Education and credentialing in psychology. Washington, D.C.: Steering
Committee on Education and Credentialing, 1978.
Zimet, C. N., & Wellner, A. M. The Council for the National Register of Health Service Pro-
viders in Psychology. In B. Wolman (Ed.), International encyclopedia of neurology, psychia-
try, psychoanalysis and psychology. New York: Van Nostrand Reinhold, 1977.
IV
OTHER PROFESSIONAL
DEVELOPMENTS
8
Accreditation of Professional Training
Programs in Psychology
RONALD B. KURZ and ALFRED M. WELLNER
Shortly after World War II, federal agencies such as the Veterans Admin-
istration, the United Stated Public Health Service, and the Surgeon General
of the United States Army needed to identify appropriately trained psy-
chologists, (initially clinical then counseling psychologists). They also
needed to determine which training programs were worthy of federal sup-
port. In response to these expressed needs, to fulfill its responsibility to the
public, and to regulate the development of rapidly growing applied train-
ing programs, the American Psychological Association (APA) launched its
accreditation programs (Sears, 1947). By accreditation, we mean a recog-
nized system of establishing standards for professional training and for
publicly identifying programs that meet those standards.
Since its beginnings, growth in psychology accreditation has been
steady with respect both to numbers of programs and to areas of psychology
accredited. Starting with a few dozen university programs in the early
1950s, the number and scope had increased by 1968 to encompass 95 clinical
and counseling doctoral programs in universities and approximately 100
internship programs in service settings (Boneau & Simmons, 1970). By 1975
there were 128 accredited doctoral training programs, including 6 in school
psychology (a specialty area first accredited in 1970), and 115 predoctoral
internships accredited by the APA (Kurz, 1977b). In January 1983, the APA
listed 187 doctoral training programs (127 clinical, 35 counseling, 20 school,
and 5 in the combined category) and 243 internships (American Psycholog-
ical Association, 1983). At that time, the APA also reported active applica-
tions in process for 6 doctoral programs and 13 internships.
RONALD B. KURZ • Department of Pediatdc Psychology, Childrens Hospital National

Medical Center, Washington, D.C. 20010. ALFRED M. WELLNER. National Register of
Health Service Providers in Psychology, Washington D.C. 20036.
203
204 RONALD B. KURZ AND ALFRED M. WELLNER
The APA today is an internationally recognized agency that accredits

doctoral training programs in the professional practice areas of clinical,
counseling, and school psychology and predoctoral internships in clinical
and counseling psychology. The APA accredits under the authority of the
Council on Postsecondary Accreditation (COPA), which controls university
accreditation by recognizing certain accrediting agencies as having respon-
sibility for specific educational fields (Council of Postsecondary Accredita-
tion, 1978). The APA is also recognized by the U.S. Office of Education as
the accrediting agency for doctoral training programs and predoctoral
internships in profeSSional psychology.
The accreditation process in APA reflects the changing and growing
nature of psychology and remains responsive to the public's and the profes-
sion's needs. Thus, the forces that impinge on it are many and complex. For
example, accreditation represents model training in professional psychol-
ogy. As such it has to be representative of an evolving consensus in terms
of services, training, techniques, theory development, research data, etc.
Thus, the accreditation criteria may be viewed, in terms of these influences,
as a restraining or as a conservative element in the system, with innovative
or experimental approaches having to pass a test of time as well as
professional acceptability prior to being incorporated in the accreditation
criteria.
This moderating effect is viewed periodically as the accreditation pro-
cess not "keeping up" with the field. Indeed, there is a built-in lag between
experiences in the field and incorporation in the accreditation criteria. Yet,
it can be argued that such a lag is a necessary component of a viable accre-
ditation system. One of the advantages of such a moderating influence is
that the accreditation system is not "permitted" to incorporate what may be
experimental or faddist procedures, thereby preventing them from being
certified through the APA accreditation process as standard, acceptable
approaches. Mindful of some of these concerns and criticisms, the category
of Provisional Accreditation was developed. Provisional Accreditation can
serve to accommodate and identify innovative programs, while carefully
monitoring them to assure the viability of the model.
ADVANTAGES AND FUNCTIONS OF ACCREDITATION
Accreditation has clearly been taken very seriously by professional psy-

chology. Despite criticism that it is too expensive, that it interferes with the
degree of academic freedom training programs should have to develop
their own goals and approaches, or that it may stifle innovation, accredita-
tion continues to grow and expand in scope. There are, of course, certain
practical reasons why a training program would want to be accredited.
Funding decisions are often based, in part, on accreditation. For example,
the Veterans Administration (VA) will usually fund only trainees who are
ACCREDITATION OF PROFESSIONAL TRAINING PROGRAMS 205
graduate students in accredited training programs; the National Institute of

Mental Health (NIMH) tends strongly to award training grants only to doc-
toral programs that are accredited; and to be eligible for armed services vet-
eran's educational benefits, the student must be enrolled in an accredited
training program recognized by the U.S. Office of Education. Thus, most
training programs have as an important part of their motivation for accre-
ditation the need to become eligible for the various kinds of outside fund-
ing that has become associated with accreditation.
In addition, accreditation is often seen as a "stamp of approval" or a
means for achieving national recognition for newly developing programs.
Such recognition lends legitimacy to the training program and can help
attract quality students. Because the accredited training programs have a
higher level of national visibility, with their graduates in somewhat greater
demand in the employment market, and because there is more likely to be
stipend money available, the better students gravitate to the accredited
programs.
Many programs want to be accredited because it brings them recogni-
tion within their own institutions. In spite of the expense, nuisance, and
"interference" of accreditors, universities and service agencies see the prac-
tical value of accreditation. The requirements for approval, therefore,
become points of negotiation with administrators, and the weight and
objectivity of the national professional association can help programs
achieve levels of development and support they might not be able to
achieve without accreditation. Most accredited training programs also see
the accreditation process as a means of stimulating self-review, testing, and
validation of their training models and practices.
Although these practicalities are self-serving for the profession in that
they speak to the basic needs training programs have for funding, good
students, and recognition, they are not the major reason for or value of
accreditation. Since the profession's practice areas (clinical, counseling, and
school psychology) have the greatest direct contact with the public (Le.,
through the school systems, clinics, hospitals, counseling centers, and pris-
ons) accreditation will protect the public/clients by insuring that these psy-
chologists will have received training that met national standards. In addi-
tion, the public is further protected by the requirement that individual
practitioners be licensed/certified once they graduate (see below and Chap-
ter 11).
Students who are interested in training in professional psychology are
another important segment of the public served by APA's accreditation pro-
gram. Since the demand for professional psychological training has been
increasing in recent years, clinical, counseling, and school psychology pro-
grams are under pressure to accept more students and new university and
internship programs continue to develop to meet this need. Through its
accreditation mechanism, the APA has accepted the responsibility to pro-
vide advice, consultation, and developmental assistance to training pro-
grams and to provide potential students with some reasonable assurance

that the accredited programs they select for training will offer them expe-
riences that are relevant and of high quality.
ACCREDITATION PROCESS
The accreditation process involves several levels of the APA gover-

nance structure. The Council of Representatives is the highest governing
body of the APA and has overall authority for accreditation. The accredi-
tation program is directly administered by the Committee on Accreditation
which has the responsibility for reviewing applications for accreditation
and the annual reports of accredited training programs, rendering decisions
on accreditation status, and proposing policy. The committee, which is
served by the APA Office of Accreditation, consists of 10 members, 8 rep-
resenting the main areas of professional and general psychology and 2 pub-
lic (nonpsychologist) representative. They are elected by the Association's
Education and Training Board (E & T Board) for three-year terms on the
basis of the breadth of knowledge and experience in graduate education
and professional psychology. The nine-member E & T Board has general
responsibility for all educational and training matters involving psychol-
ogy. In addition to electing members to the Committee on Accreditation, it
develops and reviews accreditation policy but has no decision-making func-
tions regarding the accreditation status of training programs. The E & T
board members are elected by the Council of Representatives. The primary
responsibility of the Board of Directors of APA in the accreditation process
is to appoint ad hoc appeal panels for a review of adverse accreditation deci-
sions that are appealed by the programs.
The standards for university training programs and predoctoral intern-
ships in professional psychology are contained in the recently revised Cri-
teria for Accreditation of Doctoral Training Programs and Internships in
Professional Psychology (American Psychological Association, 1979b). The
standards broadly cover the following areas: (1) specification and articula-
tion of the training program's philosophy and model of training, (2) qual-
ifications of the psychology faculty, (3) support from the institutional
administration, (4) areas of curriculum coverage, (5) facilities and equip-
ment, (6) overall educational atmosphere of the department, (7) accessabil-
ity of faculty to students for counseling and supervision, (8) an environ-
ment that challenges students to participate in and undertake research and
professional activity, and (9) opportunities for planning and growth within
the program. Training in other subfields of psychology and in other
departments in the institution are evaluated only to the degree that it is
relevant to the goals of the professional psychology program which is
under review.
Programs interested in applying for accreditation are encouraged to do
SO only after they have engaged in self-study and are satisfied that they
meet the standards set forth in the criteria (American Psychological Asso-
ciation, 1979b). Self-study is most easily accomplished by inviting a psy-
cholOgist who is knowledgeable in the general substantive area of the pro-
gram and in the accreditation criteria to make a consultative visit to the
program. Such an advisory visit is often helpful to the staff, students, and
administration by offering an objective view of the program. Such a visit
also can highlight the strengths and weaknesses of the program and offer
advice as to when to apply, how to maximize the resources, and how to raise
the probability of a successful application being submitted.
The application for accreditation provides information on the goals and
philosophy of the program, staff, students, curriculum, facilities, support
from the institution's administration, and the general climate of the insti-
tution. If after review of the application the Committee on Accreditation
feels further consideration is warranted (as opposed to immediate rejec-
tion), a site visit to the training program is arranged. These visits typically
require a day and a half to two days, with teams being composed of from
two to five visitors depending upon the number and size of the programs
involved. Site visitors are most often chosen from the ranks of department
chairs, chief psychologists, program directors, past and current members of
the Committee on Accreditation and the Education and Training Board, and
other psychologists who are knowledgeable in the training and evaluation
of professional psychologists. Each team member is expected to be thor-
oughly familiar with the accreditation procedures and criteria, the appli-
cation submitted by the training program, and the characteristics and his-
tories of psychology training settings. Well in advance of the visit, the
visitor receives relevant background material on the program, including
reports of previous visits and annual reports. The visitor is also supplied
with guidelines that provide suggestions on conducting various phases of
the visit and for writing the site visit report.
The Committee on Accreditation suggests the follOWing plan for visits,
although it expects visitors to adapt themselves to varying local
circumstances:
1. An early conference with the chair or chief psychologist and with

the program director to gain an overall orientation to the depart-
ment and the professional training program.
2. Observation of facilities, especially those devoted to laboratory and
practicum instruction in professional psychology.
3. Interviews with administrative officials, such as the president of the
institution and the dean of the graduate school or the responsible
academic dean.
4. Interviews with teaching staff members and practicum supervisors.
5. Interviews with graduate students at each level of work, including
some not in the professional areas.
6. Visits to those classes, clinics, counseling centers, and laboratories

that can be arranged without inconvenience to the department or
agency.
7. Interviews as needed with chairpersons of other departments or
agency sections to assess present and potential relations and contri-
butions between the professional psychology training program and
these departments and sections.
8. An interview with the department chairperson, agency chief psy-
chologist, and training program director at the conclusion of the
visit to discuss their evaluation and clarify questions that may have
arisen during the visit. This interview may provide the program
with a preview of the visitors' final report.
Following the site visit, a detailed report is written describing the pro-
gram in the areas set forth in the criteria. Prior to consideration by the Com-
mittee on Accreditation, the report is sent to the institution for review, com-
ment, and correction of factual errors. The Committee on Accreditation
then uses the report and the response from the institution as well as other
information from the program as the basis for making a decision about the
program's accreditability.
Given the array of information, the range of judgments, the diversity
of criteria, and the dynamic aspect of an active program, it is reasonable to
expect that the Committee on Accreditation's decision will be a group pro-
cess based on its best judgment of the available data. Some criteria lend
themselves more easily to verification, while others require professional
judgments on the adequacy or degree to which a specific criterion is met.
As a result, the committee is now developing a site visitor's handbook
that will provide a more uniform data collection effort, serve to better
inform programs on the areas of evaluation and the nature of the infor-
mation sought, permit the committee to assess the characteristics of
accredited programs and evaluate all programs upon comparable data, and
more effectively plan for the future.
New programs are considered for one of two classes of accreditation. If
the program meets all of the criteria, it is placed on full accreditation status.
If it meets most but not all of the criteria, it may be provisionally accredited
if it can be expected to meet all of the criteria in a reasonable period of time
(usually three years). Thus provisional accreditation can serve the purpose
of a candidacy category for emerging programs that are strikingly innova-
tive and, therefore, deviate somewhat from the criteria. If a program is
granted full or provisional accreditation, the name of the institution is pub-
lished in the listing of accredited institutions that appears annually in the
American Psychologist.
Training programs that are already accredited but show evidence of
failing to meet the criteria may be placed on probation for specified periods
of time. Probationary actions are also reported in the listing in the American
Psychologist. If a program that is on probation fails to improve within the
probationary period, its accreditation may be withdrawn and the name of

the institution is removed from the listing.
Any adverse decisions, such as probation or withdrawal of accredita-
tion, may be appealed to the APA board of directors. The board does not
hear the appeal but has the responsibility to appoint an ad hoc appeal panel
for this purpose. The appeal panel is composed of a group of reputable psy-
chologists from the specialty area being appealed, and who are knowledge-
able about accreditation. The appeal panel has the authority to uphold the
decision of the Committee on Accreditation, to nullify it, or to render any
other decision regarding the accreditation status of the program in ques-
tion. Decisions of the appeal panel are final.
RECENT DEVELOPMENTS AND CURRENT ISSUES
PROFESSIONAL SCHOOLS, DOCTOR OF PSYCHOLOGY DEGREES, AND SOCIAL ISSUES
As already noted, the accreditation process is constantly under scrutiny

and evolving in response to important professional and societal changes.
This section will address the recent impact that developments in these two
areas have had upon the accreditation process.
In the 1970s a major change occurred in professional psychology with
the development of professional schools. Although there may be some dif-
ferences of opinion as to which was the first professional school in psy-
chology, there is no question that the first freestanding (nonuniversity affil-
iated) professional school was the California School of Professional
Psychology. The growth of these schools is a response to the oft-quoted
manpower needs of the 1960s for mental health services and professional
psychologists since many viewed with concern the limited number of prac-
titioners being trained through the traditional doctoral programs.
The great interest in and rapid growth of professional schools has led
to some concern regarding the soundness of some of the programs, partic-
ularly those that are freestanding and do not have direct access to the
resources of established universities. Further, a number of schools are not
recognized as viable educational institutions through regional accreditation
and consequently the standing of the schools and of their students is
unclear.
The 1970s also saw a series of developments on proposals to establish
and accept a doctoral degree in psychology (Psy.D.) as a legitimate alter-
native to the Ph.D. degree. The Vail Conference in 1973 (Korman, 1976)
served as a national forum for reinforcing the Psy.D., the professional
schools, and practitioner model directions. Thus, it is not surprising that a
number of Psy.D. programs emerged, some through revisions and modifi-
cations of traditional programs and others as independent training systems
within newly formed professional schools. In terms of education and train-
ing, the Psy.D. differs from the Ph.D. in emphasis rather than in content.
Since Psy.D. programs are designed to educate practitioners, greater empha-

sis is placed on practice rather than research. For example, whereas the dis-
sertation in Ph.D. programs emphasizes scholarly research, Psy.D. programs
may emphasize a different kind of product.
To the proponents, the Psy.D. degree was identified as a very substan-
tial advantage for psychology over the Ph.D. degree. As a specific and
unique degree for the field of psychology, it would make more visible to
the public those practitioners who are trained at the doctorate level in psy-
chology. It would establish psychology's identity very clearly and also
establish it as an identity for a practice profession. In contrast, the Ph.D. is
basically a research degree and is shared by any numer of other disciplines
and fields.
Independent of these particular professional developments but also
occuring relatively recently has been society's and professional psycholo-
gy's heightened sensitivity to social issues. There has been much concern
with individual rights, rights of minorities, and how society's institutions
can appropriately and legitimately rectify prior problems and discrimina-
tion practices. The basic question that has been raised in relation to profes-
sional psychology is how can there be sound training without full recog-
nition of the rights of individuals and minorities?
In the light of both the above developments and the Vail Conference,
the APA Council of Representatives in 1976 requested that the extant cri-
teria for accreditation (developed in 1973) be reviewed. After a two-and-a-
half year process of drafting a new set of criteria that were reviewed and
modified by the various units in the profession, the new criteria were
accepted by the Council of Representatives in January 1979 and established
as APA policy.
The current criteria reflect the developments in professional schools
and in the Psy.D. degree as an alternative degree. Yet, the criteria do not
favor one of the alternatives over the other. They also incorporate a set of
standards relating to the institutional settings offering the degree that are
based upon the recommendations of the Education and Credentialing in
Psychology meetings (Wellner, 1978). One of the requirements is that the
program must be clearly and publicly identified and labeled as a profes-
sional psychology program. Such a public statement provides protection for
the consumers (students and prospective students) and ensures that
entrance to the program offers a high degree of probability if not guarantees
that graduates will be eligible for licensure through the state examination
system and consequently entrance to practice as a psychologiSt.
The new criteria also attempt to be responsive to social issues with the
following statement:
It follows that social responsibility and respect for cultural and individual dif-
ferences are attitudes which must be imparted to students and trainees and be
reflected in all phases of the program's operation: faculty recruitment and pro-
motion, student recruitment and evaluation, curriculum and field training.
Social and personal diversity of faculty and students is an essential goal if the
trainees are to function optimally within our pluralistic society. (American Psy-
chological Association, 1979b, p. 4)
This statement must now be operationalized through the accreditation

review process. The standard reflects a very carefully worded compromise
from the numerous recommendations received. For some it is not a strong
enough statement, while for others it imposes noneducation issues on the
APA accreditation system.
One social issue that has received considerable attention over the past
several years has been the question of religious institutions that have either
certain preferences (based on religion) for selecting students or faculty or
specific exclusions based on religion. Historically, the courts have granted
special privileges to religious institutions and have held that they are
exempt from the civil rights act that prohibits discrimination on the basis
of religion.
After long and emotional debate by the APA's Council of Representa-
tives over the past several years, the following policy statement was passed:
The procedures and criteria of the Committee on Accreditation of the
American Psychological Association require nondiscrimination with respect to
religious orientation in faculty hiring and admission of students as a condition
of program approval. In the application of this general principle, exceptions
with respect to religion may be made in the case of institutions controlled by
religious groups, provided that any preferences in student admissions or faculty
hiring on religious grounds are explicit and publicly stated. When an institu-
tion meets the requirements for such an exception, the accrediting body should
formally record its opinion on whether and in what specific ways training pro-
vided by the institution is deficient because of its religious proscriptions and
shall refuse accreditation if these deficiencies are judged to be substantial and
severe. The APA Council of Representatives voted the following resolution at
its January 1979 meeting: "It is the sense of APA Council that APA accreditation
reflect our concern that all psychology departments and schools should assure
that their students receive preparation to function in a multi-cultural, multi-
racial society. This implies having systematic exposure to and contact with a
diversity of students, teachers, and patients or clients, such as, for example, by
special arrangement for interchange or contact with other institutions on a reg-
ular and organized basis." (American Psychological Association, 1979b, p. 4)
The burden then is on the Committee on Accreditation to determine if a
religious preference interferes with quality education.
Another significant change in the new criteria is the expansion of the
internship training standards. With the assistance of the Association of Psy-
chology Internship Centers, new criteria for internship accreditation were
developed to account for the evolution of consortia where several indepen-
dent programs pool resources to establish an internship.
INTERNSHIP ACCREDITATION
Modern predoctoral internships were first developed immediately fol-

lowing World War II, during the formative years of the scientist-practi-
tioner model of training in clinical psychology. Prior to that time there

were some formal internships, primarily offering clinical experience to
master's and post-master's practitioners. Frequently, internship level train-
ing was informal in the sense that the "trainee" was hired primarily to per-
form psychological services and received on-the-job supervision from more
seasoned clinicians. Clinical psychology training was not highly organized
as it is today and novice practitioners often sought employment in settings
that could provide supervised clinical experience to fill in the gaps in their
academic preparation. In the late 1940s the U.S. Army and the Veteran's
Administration found it necessary to provide training in clinical and coun-
seling psychology to fill their needs for appropriately trained personnel.
Present-day predoctoral internships in applied professional areas of psy-
chology have developed directly out of these early military and VA
programs.
The internship training programs that evolved in the postwar period
emphasized clinical work with individual patients and bore a clear resem-
blance to the medical internship. Current-day psychology internships have
broadened considerably to include training in institutions and agencies not
usually considered part of the traditional clinical setting, such as the
schools, correctional institutions, police departments, courts, and local,
state, and federal governmental agencies. Although the traditional clinical
skills of assessment and psychotherapy still form the backbone of most
internships, programs now also provide training in administration, consul-
tation, community action, and organization and environmental design.
The Shakow Report (American Psychological Association, 1947), which
became the basis for the organization of training and the development of
training standards in clinical psychology, provides a rationale for the
internship that is still currep.t today. The underlying principle for intern-
ship training is that the knowledge essential to the practice of psychology
cannot be obtained exclusively from textbooks, lectures, or seminars. If the
student is to acquire perspective and skill to apply the scientific facts and
techniques learned in the academic setting, it is essential that he or she
should have extensive and intensive experience with people, with social
systems, and with the interaction among them. The predoctoral internship
assumes that the student has completed most of the academic requirements
for the doctoral degree, including course work in the basic, nonapplied
areas of psychology, theory, technique courses, and practicum level expe-
riences in assessment, intervention methodologies, and other skill associ-
ated with the application of clinical, counseling, or school psychology, and
has developed sufficient research skill to embark on a dissertation. Thus it
is expected that the doctoral program in the university has provided the
necessary training in tool subjects so that the student is able to take the
fullest advantage of what the internship has to offer. More than 30 years
after the Shakow Report the accreditation standards (American Psycholog-
ical Association, 1979b) still strongly reflect this rationale for internship
training.
Since internship settings are far more varied than academic depart-
ments of psychology in universities, it is more difficult to set out accredi-
tation criteria that can encompass the range of possible training experiences
and models with the kind of specificity found in the criteria for academic
doctoral programs. The current criteria state some general points that are
considered essential for accreditation and which probably also serve as
guidelines for internship training centers that are not accredited. An intern-
ship comprises at least one calendar year of full-time experience or two cal-
endar years of half-time experience. Internship programs are expected to
develop a set of goals and a philosophy of training that are realistic and
consonant with the goals of the broader agency. The program should not
be overspecialized, but rather should provide supervised experience in a
range of activities in the general areas of assessment, intervention, and
research applications. Adequate supervision of the intern's activities is the
cornerstone of the internship training enterprise. The training staff should
provide a variety of role models and be relatively stable, with most well-
developed programs offering the interns the opportunity to interact with a
wide range of other professionals and disciplines. Programs involving a
very small staff and only one or two interns probably do not have sufficient
mass and capacity for varied training interactions and intertrainee stimu-
lation to offer adequate training. The trainees should have completed prior
practicum level experience and be enrolled in a doctoral training program
in the relevant area of professional psychology. Agency support for the
internship program should be apparent in respect to adequacy of resources
and the willingness to budget specifically for training activities.
Accreditation of internships involves special problems not typically
encountered in doctoral program approval. Internships are invariably much
smaller than doctoral programs. An internship with a dozen trainees is con-
sidered a large program and somewhere between two and four interns is
about average. Having a critical mass of trainees is always a problem for
such small programs. Likewise, the staffs of many internship agencies are
quite small and often are comprised primarily of part-time psychologists.
Further, whereas the main function of universities is education and train-
ing, service agencies offering internship training often do so as a low prior-
ity activity. This low priority is reflected in minimally adequate training
budgets, pressure on staff to spend their time in service rather than training
activities, and exploitation of interns as low-paid staff members rather than
treatment of them as trainees. Since internships are usually one-year expe-
riences, shifts in administrative attitudes toward the program, turnover
among small staffs, reduction in funding, or interpersonal strife within an
agency can have major effects on the quality of training.
Programs in smaller hospitals and clinics sometimes solve the problems
associated with small staffs, lack of diversity, and low levels of funding by
entering into consortium arrangements with several local agencies. Taken
individually, each member of the consortium may not have sufficient vari-
ety of clinical material or diversity of staff and role models to achieve accre-
ditation, but if interns are rotated among all or most of them an adequately
varied program can be arranged. Most consortia involve only three or four
agencies, as for example, the psychology department of a medical school, a
Veteran's Administration General Medical and Surgical Hospital, and a
community mental health center. As with other rotational programs, the
intern may spend three or four months working at each agency. A few have
recently developed that are very complex, involving 10 or 12 community
agencies. Although consortia allow for great variety in training experiences,
they present problems for the accreditation system because they also tend
to suffer from lack of central control, non uniformity of policies and stan-
dards for admission and evaluation of interns, and poorly articulated train-
ing goals and models. Nevertheless, consortium arrangements seem to be
appealing to an increasing number of programs, and with financial prob-
lems of training agencies becoming more serious, the number of consortia
seeking accreditation in the future will probably increase.
Professional autonomy is another matter of serious concern in the
accreditation of internships. Doctoral training programs in universities and
professional schools of psychology are under the direct control of psychol-
ogists. Except for some programs in university counseling centers, intern-
ships, on the other hand, are typically in settings run by other professions.
This is nowhere more evident and perhaps more serious than programs in
medical schools and teaching hospitals. There has been a sharp increase in
the number of psychologists employed in these settings in the past 25 years
(Lubin, 1979), with medical schools being a favorite place for psychology
internship training (Cohen, Lubin, & Nathan, 1979). Whereas such settings
give training high priority, are usually stable, and have large faculty and
intern groups, they are often lacking in autonomy for psychologists. Most
psychologists in medical schools are in departments of psychiatry where
their roles tend to be limited or fixed by other professions (Nathan, Mill-
ham, & Lubin, 1979), and where there has been large-scale exclusion of psy-
chologists from full voting privileges (Matarazzo, Lubin, & Nathan, 1978).
Although to this date APA's Accreditation Committee has not questioned
the approval of programs in medical settings where full voting medical staff
membership has not been afforded psychologists, certainly any programs
in which psychology has been placed in a narrow or subservient role, or in
which psychologists do not have essential control over their own training
activities would not be accreditable.
Finally, another set of concerns with internship training is being
addressed by the Association of Psychology Internship Centers (APIC).
Since 1968 APIC has been the primary source of information concerning
internship training for various professional groups, training programs, and
governmental agencies. The APA relies on APIC for advice and guidance
regarding accreditation of internship training activities. In addition to pub-
lishing a directory of internship training opportunities and settings, and
monitoring the timing of internship offers to students, APIC is presently
working on several issues that will have an impact on the accreditation cri-
teria. For example, aside from the general dictum that students accepted for
internship training should have adequate practicum level preparation, the
Criteria for Accreditation provide little guidance to training programs
regarding the quality and quantity of the pre-internship training. APIC is,
therefore, attempting to develop a set of standards for students at the begin-
ning of internship training. This will not only aid the internships in orga-
nizing their selection processes and help the Committee on Accreditation
to specify its own criteria, but also will eventually have an impact on the
doctoral programs by providing some clear goals for their training to pre-
pare students for internships. Similarly, APIC is in the process of defining
the skills and competencies interns ought to have on completion of intern-
ship training and the techniques for evaluating intern performance.
APIC also has under discussion whether unpaid internships should be
accredited. There are strong arguments on both sides of this issue. Some
believe that the internship, as the first foray of graduate students into the
real professional job situation, should provide financial remuneration as a
way of signifying the appropriate professional status and the role of the
intern. The stipend thus becomes another factor in establishing the auton-
omy and worth of psychology and its training programs. Others believe
that were we to eliminate unpaid training positions, we would deny many
good students the opportunity for internship training and would frustrate
the desires of many psychology staff members who ascribe high value and
status to their roles as psychology trainers.
RELATIONSHIP OF ACCREDITATION OF PROGRAMS AND LICENSING OF

PRACTITIONERS
As noted earlier and as noted in detail in Chapter 11, licensure / certi-

fication of professional psychologists is an additional means of protecting
the public. But who is qualified to seek such licensure/certification? The
obvious answer, namely, one who receives his or her doctoral degree from
a psychology program, has raised serious questions about what constitutes
such a program. In the absence of a clear definition, programs in fields that
were related to psychology (sometimes remotely) were being identified by
both educational institutions and students as being equivalent to psychol-
ogy degrees and their students were seeking psychology licensure/certifi-
cation upon graduation.
This complex issue was the focal point of two national meetings on
education and credentialing in psychology (Wellner, 1976, 1977). As a result
of these conferences, a national consensus emerged on the definition of a
doctoral program in psychology with the American Association of State
Psychology Boards (the licensing/certification boards) (AASPB) basing its
minimal educational standards on this definition (see Chapter 11).
The first criterion in the definition notes: "Programs that are accredited
by the American Psychological Association are recognized as meeting the
definition of a professional psychology program. The criteria for accredita-

tion serve as a model for professional psychology training" (Wellner, 1978,
p. 29). The APA accreditation criteria then are clearly viewed as the model
of training for quality education in psychology.
The other criteria that emerged included the requirement that such a
program be at the doctoral level and offered in a regionally accredited insti-
tution; be clearly identified and labeled as a psychology program; stand as
a recognizable, coherent organizational entity; involve an integrated, orga-
nized sequence of study; have an identifiable psychology faculty and body
of students who are matriculated in that program; involve supervised prac-
ticum, internship, field, or laboratory training; encompass a minimum of
three academic years of full-time graduate study; and include study in the
four substantive areas in psychology (Le., biological bases of behavior, cog-
nitive affective bases of behavior, social bases of behavior, and individual
differences) in addition to education in professional ethics and standards,
research deSign, statistics, psychometrics, etc. In addition to those curricu-
lum criteria, the programs must also include course requirements in these
specialty areas (see Wellner, 1978).
With the criteria for identifying a doctoral program in psychology
being available, the next step is to establish a designation system of psy-
chology programs. This designation would be the entrance requirement for
consideration for accreditation. That is, before programs would be reviewed
for APA accreditation they would have to meet the designation standards
for psychology programs. Such a two-tier system would be a major advance
in education and credentialing since the first tier insures that the doctoral
programs are psychology programs while the second insures that the pro-
grams are providing quality training.
Building on the work accomplished through the Education and Cre-
dentialing in Psychology meetings and the support received by various
components and organizations in the field, the APA Council of Represen-
tatives voted in September 1979 to begin a process in which APA will take
a major role in developing a designation system. The Council of Represen-
tatives also voted to support the concept of an interorganizational process
or a national commission to implement the designation system once it is in
place.
ACCREDITATION OF SPECIALTY AREAS: SOME DEVELOPMENTS AND PROBLEMS
Changes in the accreditation system are made periodically not only to

reflect major shifts in the education and practice of professional fields of
psychology already subject to accreditation, but also to accomodate addi-
tional areas of professional practice as they mature and receive public rec-
ognition. It is usually expected that the professional fields themselves, rep-
resented most often by the relevant divisions of APA, will press for
accreditation. Accreditation is not imposed by the APA on any specialty
field. Thus in the late 1960s school psychology, recognizing its responsibil-
ity to the public and its needs for standards and self-regulation, began to
urge APA to include it in the scope of the APA accreditation system. As
APA began to develop suitable criteria and other details necessary to
accredit this area, it became involved in a jurisdictional dispute with the
National Council for Accreditation of Teacher Education (NCATE) which
also accredits school psychology programs through its accreditational pro-
grams for the preparation of school service personnel, and with the
National Association of School Psychologists (NASP). The early history and
temporary resolution of this conflict which permitted APA to begin its
school psychology accreditation has been described elsewhere (Kurz, 1974).
Active discussions among the three organizations regarding the accredita-
tion of school psychology programs are continuing. A special task force has
also been convened to find common ground for resolution of matters per-
taining to the roles and responsibilities of each organization in accredita-
tion and other issues concerning titling and credentialing and the entry
level for the practice of school psychology (American Psychological Asso-
ciation, 1979c).
The entry of APA into the accreditation of school psychology programs
in 1970 was, and still is, confined to doctoral training programs. This is con-
sistent with the principle of the Council of Postsecondary Accreditation to
encourage accreditation activities at only one entry level of each profes-
sional field, with APA's accreditation of clinical and counseling psychology
programs at the doctoral level, and with current membership in APA set at
the doctoral level. It is not consistent with the large number of applied prac-
ticing psychological specialists who are practicing their specialties with
master's as the highest degree. For this reason, several conferences in the
early 1970s (Southern Regional Education Board, 1971; Western Interstate
Commission for Higher Education, 1971; Korman, 1976) have called on APA
for the development of accreditation at the master's level. The complica-
tions of taking such a step include the conflict with NCATE and NASP, the
requirements of COPA and the U.S. Office of Education, the enormous
increase in cost and administrative difficulties, the doctoral requirement for
the practice of psychology as established by the standards for providers of
psychological services, the very significant issue of admitting master's level
psychologists to full membership in the APA, and the state legislative
requirements for licensure and/or certification. It also is complicated by the
attempts to establish a consistent set of education and credentialing stan-
dards for psychologists in all specialty fields and the desire of psychologists
to be included in any national health insurance that might develop since
both of these goals are predicated on the Ph.D. as the minimum level.
Although a proposal for a cost-saving master's accreditation system (Kurz,
1971) had been approved by two training conferences (Western Interstate
Commission for Higher Education, 1971; Korman, 1976) the concept was too
controversial and unpopular with the general membership of APA to be
adopted.
When the APA began accrediting school psychology doctoral pro-

grams, it did so as part of a broadened approach to accreditation after dis-
cussions about APA's general role in accreditation (see below). This
approach permitted accreditation of new specialty areas and those that may
cut across several specialty areas of training in professional practice rather
than limiting accreditation to each of the established specialties (clinical
and counseling). This concept grew out of negotiations with the National
Commission on Accreditation (NCA, the predecessor organizatien to
COPA) over the jurisdiction for school psychology accreditation. Although
NCA initially denied APA's request to accredit school psychology programs
because of NCATE's claims in that area, NCA was also aware that changes
in the definition of clinical and counseling psychology were unclear and
that school psychology training frequently overlapped training in other
accredited specialties. By limiting accreditation to clinical and counseling
psychology, NCA was in danger of hampering innovation in psychology
training. As a result, the concept of broad professional accreditation was
devised and APA implemented a plan to accredit doctoral programs in clin-
ical, counseling, and school psychology separately and in combinations of
two or more of these areas under the label "combined professional scientific
program" (Buktenica, 1976; Kurz, 1977a). Reflecting the APA's caution over
the viability of this new area of accreditation, the category was set up ini-
tially as a provisional classification of accreditation to be monitored closely
by the Committee on Accreditation. The Committee was to assess the
demand from the training programs themselves for such a classification and
the need from the point of view of protection of the public. To date only
five training programs have successfully developed to the point of
accreditation.
The profession is continuing to confront the need to develop standards
for specialty practices in psychology. The field is in the midst of a careful
assessment of the varying specialties in psychology and the degree to which
specific criteria or standards can be identified that relate to the training in
those specialties and the practice. Starting with the development of the
Standards for Providers of Psychological Services (American Psychological
Association, 1974), there are new proposals for specialty standards in clini-
cal, counseling, and school and industrial/organizational (see Chapter 2).
As noted earlier, these four specialties have been the traditional applied
practitioner specialties in psychology and have been granting diplomates
in psychology from the American Board of Professional Psychology. Fur-
ther, the APA Council of Representatives has requested that the accredita-
tion system explore such specialty accreditation criteria for each of the three
specialties currently accredited (clinical, counseling, and school). Since
there may be a significant number of areas of overlap among the specialties,
further refinement and definition may be appropriate and necessary.
In the light of the varied groups in psychology currently dealing with
specialties, it seemed appropriate to establish a coordinated effort to evalu-
ate such a process. In addition to the APA concerns, the AASPB and the
individual state boards of examiners also are exploring the nature of spe-
cialty designation for licensure or certification of practitioners. Efforts are
currently under way to identify the nature of specialties, criteria which
relate to the training and practice of anyone specialty which will then have
impact on how these are developed for standards for providers as well as
standards or criteria for accreditation.
CONCLUSIONS
Accreditation has proven to be a very valuable force in American psy-

chology. Although it developed in response to public interests and con-
cerns with the delivery of psychological services in the post-World War II
period, it also has enhanced psychology's recognition as an independent
profession, provided students and prospective students with public guide-
lines and statements on programs that meet the standards, and provided the
profession with reasonable standards for quality education and training in
psychology. Yet, the accreditation system in APA, as a result of its central
position in key elements of the profession, has not been free from contro-
versies. It is fair to suggest that as accreditation grows, as the knowledge
base of the field expands, and as society's expectations of service expand,
controversies will continue to be present. Indeed, it is through the discus-
sion and resolution of differences of approaches, models, techniques, and
values that the standards for accreditation evolve and are tested in the field.
There are a number of areas and issues in which the accreditation system
will continue to be involved and which warrant continued attention:
Federal Government Regulation of Professions. Over the past several years
there have been increasing examples of federal interest in the regulation of
professions. Concerns are not only with the state statutory licenSing of prac-
titioners, but also with establishing appropriate human resource capabilities
in areas that may be underserved or in services that are needed for the cit-
izenry. It is likely that where the profession does not meet its obligation to
society through its own regulation or the development of practitioners to
meet the public's needs, the federal government will establish such proce-
dures or develop grants, stipends, or other financial programs to direct, con-
trol, or otherwise influence profeSSional education.
Specialties in Psychology. The accreditation standards thus far have
focused on accreditation of profeSSional programs in three specialty areas
and have been generic in their coverage. As is mentioned above, there are
increasing demands for the development of specialties in psychology, the
identification of those specialties, the development of standards for the edu-
cation and training of practitioners in the specialties, and for their licensing
or certification. Thus, we can expect to see continuing and increased atten-
tion to specialties within the accreditation process in the future.
Emerging Areas of Applied Psychology. In connection with the preceding

point, it seems clear that there are a number of specialty areasJn psychology
that heretofore have not been identified as applied areas for professional
practice but which seem to be emerging as applied or which are developing
separate identities. They includ developmental psychology, industrial/
organizational psychology, community psychology, law-psychology, health
psychology, and neuropsychology. Over the next several years it may be
expected that these fields may look to the accreditation process to assist in
their growth and identification.
Social Policies. Accreditation will continue to serve as a lightning rod
for the recognition and implementation of social policy issues. The 1980s
will certainly reflect additional concerns with how society handles individ-
ual rights, the disadvantaged, minorities, and the underserved citizenry.
The accreditation system will be asked to address these issues in various
ways.
Interprofessional Issues. As other groups strive for accreditation of edu-
cation programs, there is likely to be continued confrontation in areas that
may be viewed as psychology's turf by psychologists but as another group's
arena by other professions. Thus, jurisdictional disputes can be anticipated.
For example, areas such as family therapy, counseling, and psychoanalysis
are functions that may be shared by different groups and for which there
may be jurisdictional problems in terms of identifying the appropriate
professional body to accredit training.
Education and Credentialing in Psychology. The past few years have seen
dramatic developments in integrating the education and credentialing com-
ponents in the field. For example, the development of a system to deSignate
psychology programs may serve to enhance the accreditation process that
in turn will increase the quality of professional programs in psychology.
Thus, the accreditation system will continue to need to interact carefully
with these developments in education and credentialing.
Levels of Practice and Accreditation. Although the APA has focused on
the accreditation of doctoral programs and internships, there are continued
concerns about the possible accreditation of psychological service associates
or about the identification of functions that can be provided by persons at
other than a doctoral level. Over the next decade it can be expected that the
accreditation process will need to explore carefully the implications of rec-
ognition and/or accreditation of levels of psychological services at other
levels.
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Steering Committee, Washington, D.C., 1976.
Wellner, A. M. (Ed.). Education and credentialing in psychology II, report of a meeting. Steering
Committee on Education and Credentialing, Washington, D.C., 1977.
Wellner, A. M. (Ed.), Education and credentialing in Psychology. Steering Committee on Educa-
tion and Credentialing, Washington, D.C., 1978.
Western Interstate Commission for Higher Education. Master's degree psychologists. Boulder
Colo.: Western Interstate Commission on Education, 1971.
9
Peer Review Systems in Psychology
GEORGE STRICKER
Quality assessment is a process that is concerned with the measurement of

the quality of care. It is a preliminary step to quality assurance, which is
designed to improve the quality of care. Peer review is one method of qual-
ity assurance and occurs when the review and determination is made by a
co-professional. It is concerned only with the quality of care that has been
offered, not with the quality of care in the overall health delivery system,
a concern that would require attention to untreated as well as treated cases.
This chapter will be restricted to the nationwide peer review of health
care services offered by psychologists. The limitation to psychological ser-
vices eliminates concerns with quality assurance in medicine, an area with
a modern history that dates to the concerns of Florence Nightingale (Brook
& Davies-Avery, 1977). The restriction to health care services rules out
attention to peer review processes in other areas of psychology, such as the
monitoring of journal submissions and the procedures by which research
grants are awarded. I will also gloss over institutional approaches to peer
review and quality assurance such as professional ethics and statutory
licensing or certification, which are dealt with elsewhere in this volume.
The first portion of this chapter will describe three peer review pro-
grams of national scope. More restricted peer review programs will not be
covered, although a number of innovative and successful ones have been
developed at the local (Kazanjian, 1982) and statewide (Willens, 1977) lev-
els. The second section will compare the intricacies of these national
approaches, covering a number of critical dimensions of peer review.
PROFESSIONAL STANDARDS REVIEW ORGANIZATIONS (PSRO)
PSROs are primarily a medical system of review, but they do make

some provision for services offered by health care practitioners other than
GEORGE STRICKER. Institute of Advanced Psychological Studies, Adelphi University,

Garden City, New York 11530.
223
224 GEORGE STRICKER
physicians (HCPOP). They also are responsible for the review of some men-
tal health services. This approach to quality assurance for medical services
had its origins with area-wide organizations of physicians that were inter-
ested in matters concerning costs and quality of medical care. These orga-
nizations, called Foundations for Medical Care, gave rise to the Experimen-
tal Medical Care Review Organization (EMCRO) program, which in turn
provided the model for the development of PSROs (Brook & Williams,
1976). PSRO is only concerned with patients who are covered by Medicare,
Medicaid, or the Maternal and Child Health and Crippled Children's Ser-
vices programs (Titles XVIII, XIX, and V of the Social Security Act). Whether
or not services offered to these patients will be reimbursable will depend
on the PSRO review decision. Currently, it is being phased in primarily in
short-stay hospitals. Eventually, by statute, it must be extended to other
institutions, including long-term care facilities and specialty hospitals, and
ultimately, it will be applied to ambulatory care patients. The Department
of Health, Education and WelIare (HEW) has funded a series of demonstra-
tion projects in long-term care facilities and ambulatory settings with such
expansion clearly in mind. Further, if federal support should be extended,
such as through a National Health Insurance plan, a preponderance of
patients may fall under the protection of this legislation, assuming that they
are covered by the plan. States and insurance carriers who are experiencing
difficulty with mental health review also might turn to PSROs for review
services, if the PSRO system can demonstrate its effectiveness. Over half the
conditionally designated PSROs are currently performing some private
review in addition to their mandated functions, so that reimbursement deci-
sions are being made for patients who do not come under the federal aegis.
This type of review has been actively encouraged by the Department of
Health, Education and Welfare. Thus, although PSRO is a system that is
currently in a developmental phase, it may provide the basis of insuring
accountability in health care delivery on a widespread basis in the future.
PSRO is a federally mandated system to assure accountability in the
delivery of health services (Goran, Roberts, Kellogg, Fielding, & Jessee,
1975). It was authorized in 1972 as part of the amendments to the Social
Security Act under Public Law 92-603. The task of a PSRO is to determine
whether services are necessary, of proper quality, and appropriately deliv-
ered in the most economical setting. As of October 1978, 195 PSRO areas
had been deSignated and a PSRO was in some stage of operation in all but
two of these (Seidenberg, 1979).
Accountability in the provision of health services is concerned with the
dual components of quality assurance and cost containment. Quality assur-
ance focuses on the provision of at least adequate health services, while cost
containment assures that this is achieved through the provision of neces-
sary services at a reasonable cost and through the elimination of unneces-
sary or ineffective services.
There are three separate tasks assigned to a PSRO: concurrent review,
medical care evaluation studies, and profile analysis. The overall intention
PEER REVIEW SYSTEMS IN PSYCHOLOGY 225
of concurrent review is to certify the necessity, appropriateness, and quality

of service and the effectiveness of discharge planning. Concurrent review
consists of two separate components: admission certification and continued-
stay review. Admission certification establishes the requirement of hospi-
talization for treatment and sets, through local norms, a projected length of
stay. Continued-stay review occurs at the end of this projected length of
stay and determines whether continued hospital care is required, in which
case recertification occurs.
The general procedure of concurrent review is for a clerk to review the
records, matching them to professionally constructed criteria sets, and then
pulling all records that do not conform. These records are then reviewed
by a physician, who can determine whether the case has been treated
appropriately, even if it falls outside the criteria sets, and who can deny
admission certification where the case has been treated inappropriately. If
this occurs, admission still can take place, but it will not be reimbursable.
Thus, we have a rough screening procedure by a nonprofessional using
professionally constructed criteria, followed by a professional judgment
wherever necessary.
While concurrent review is concerned primarily with ongoing utiliza-
tion practice, medical care evaluation (MCE) studies are the primary basis
of assuring quality. They are broad research studies of a medical audit vari-
ety in that they use existing hospital records rather than collecting new
data. They focus on local systems and determine whether patients are
receiving adequate care, with the desired outcome ensuing. They represent
an attempt to relate procedures of care to the outcome of care, and to correct
deficiencies through educational programs and administrative changes.
They do not attempt to discover what procedures are effective, but presup-
pose what optimal procedures should be, and see whether or not practice
conforms to them.
Profile analysis is a retrospective review that identifies patterns of care
in a hospital. Profiles may be constructed for institutions, practitioners, or
patients and are used to provide indicators that can be employed by admin-
istrators in identifying problem areas and setting priorities for the revision
of procedures. They can affect concurrent review criteria and also give
direction to MCE studies by pointing to areas where practice does not con-
form to existing criteria.
It can be seen that the PSRO concerns itself with prospective, concur-
rent, and retrospective review procedures. Prospective reviews occur pread-
mission, when necessary for admission certification. Concurrent reviews
occur in the course of the patient's hospitalization. Retrospective reviews
take place after discharge, in the form of both MCE studies and profile anal-
ysis. The PSRO has the responsibility of attempting to correct identified
deficiencies in practice through the institution of educational programs.
Membership in the PSRO is restricted by law to physicians and osteo-
paths. However, the services of all health care providers, including psy-
chologists and groups as diverse as dentists, nurses, social workers, podia-
226 GEORGE STRICKER
trists, occupational therapists, and dieticians, among others, will be subject

to PSRO review. The role of these HCPOPs will be examined in some detail,
but it should first be noted that PSROs establish review committees in each
specialty area and these committees are charged with the construction of
criteria, norms, and standards. According to the PSRO Program Manual
(Department of HEW, 1974), criteria are professionally determined ele-
ments of quality service, against which ongoing services may be compared.
Norms represent the customary, statistically determined performance of a
professional, while a standard indicates the professionally determined vari-
ation from the norm or criterion that would be viewed as acceptable. Psy-
chologists certainly will be involved in constructing criteria, norms, and
standards for psychological services, and may be involved in the joint con-
struction of criteria, norms, and standards for mental health services. How-
ever, all these activities will be under the ultimate jurisdiction of a com-
mittee of physicians.
Section 730 of the PSRO Program Manual is explicit about the role of
HCPOPs in the PSRO:
Health care is provided by practitioners of a wide variety of health care disci-
plines. Review of care provided by non physician health care practitioners
should be performed by their peers. Thus, while the PSRO retains ultimate
responsibility for the decisions made under its aegis, it should seek the partic-
ipation of all health care practitioners in the development of criteria and stan-
dards and the selection of norms for their professions, in the establishment of
mechanisms to review the care provided by each type of practitioner, and in the
actual review of that care. The PSRO's formal plan shall contain a plan for the
involvement of nonphysician health care practitioners in the PSRO's review
system. (Ch. vn, p. 31)
It goes on to indicate, in Section 730.31:

The PSRO is responsibile for assuring, over time, that nonphysician health care
practitioners are involved in the establishment and ongoing modification of
norms, criteria and standards for their discipline. This is true both for PSRO
direct development and when development is delegated to hospitals. (Ch. VII,
p.31)
Finally, in the frequently ignored section 730.53, it states:

Where care is provided jointly by phYSicians and nonphysician health care
practitioners, the assessment of such care will be performed jointly by peer phy-
sician and nonphysician practitioners. (Ch. vn, p. 32)
These policies are reinforced by the Health Care Financing Adminis-

tration's Technical Assistance Document Number 9 (1977a) and its Trans-
mittal Number 44 (1977b), both of which detail policies concerning
HCPOPs. Unfortunately, these documents rely on Section 730.31 and give
little more than lip service to Section 730.53.
In performing concurrent review, a distinction is made between those
HCPOPs who may be accorded active hospital staff privileges and be
responsible for hospital admission, continued stay, and discharge and those
HCPOPs without such privileges. Psychologists are grouped in the former

category, along with dentists, oral surgeons, and podiatrists, and these
professions are involved in a wider range of review activities, commensur-
ate with their responsibilities in the hospital. This distinction is one further
argument for the current effort to gain hospital privileges for psychologists
on a wider basis (Copeland, 1980).
In MCE studies, HCPOPs participate to the extent that the care they
provide is being reviewed. In the review of psychological services, psy-
chologists will be involved in (1) developing and modifying norms, criteria,
and standards for psychological services, (2) working with sponsors of con-
tinuing education programs to assure that deficiencies in care identified
during the review process become topics for consideration in appropriate
educational programs, and (3) identifying, through MCE studies, needed
hospital administrative modifications related to their activities. In the
review of jointly offered services, such as psychotherapy, it is possible for
psychologists to participate along with other professions offering this ser-
vice, but the practice has been for review to be conducted along disciplinary
lines.
In the governance structure of the PSRO there are only limited roles
available for psychologists and other HCPOPs. The required statutory
mechanism for input of HCPOPs into the actual governance of the PSRO is
through the advisory group. Every PSRO or, in states with three or more
PSROs, so that they are combined in a statewide council, every council,
must be advised and assisted by an advisory group. Although HCPOPs may
not be members of the PSRO, they may be included on the governing board
of the PSRO, but this is not a statutory requirement. At least half of the
advisory group, however, must be representatives of HCPOPs. In chOOSing
those professions to represent on the advisory groups, emphasis is placed
on the selection of those disciplines that provide the greatest amount of
service or whose services have presented review problems. In addition,
PSROs may, if they wish, establish nonstatutory advisory committees com-
posed entirely of members of one diScipline or several disciplines with
common concerns. The advisory group is required to advise and assist the
PSRO in assuring that HCPOPs have an active part in the review system.
They may do this by assisting the PSRO in assuring that HCPOPs partici-
pate in the development and revision of norms, criteria, and standards for
their discipline; assisting the PSRO in the development of policies and pro-
cedures for the review of HCPOP care; encouraging active involvement of
HCPOPs in all phases of the development and implementation of review
mechanisms; and assisting the PSRO in identifying peer reviewers. It
should also be noted that in April of 1979, Senator Matsunaga of Hawaii
introduced a bill (S.913) that would amend the Social Security Act in order
to broaden membership in the PSRO and on the various committees in its
governance structure. Developments such as this may go a long way toward
insuring the active contribution of psychologists to the committee that is
empowered to review their services. Although psychologists do not have a
228 GEORGE STRICKER
great many services that are currently subject to PSRO review, it is critical
that they know about PSROs and be involved in PSRO developments, both
for pragmatic reasons and out of principle. The pragmatic reasons concern
the probable future expansion of PSROs into widespread review activities.
The principle is one that holds that only psychologists should review the
work of psychologists. It is pursuant to this principle that the American
Psychological Association (APA) has been active in the encouragement of
the development of Professional Standards Review Committees (PSRC).
PROFESSIONAL STANDARDS REVIEW COMMITTEES
Psychology as an organized profession has a long history of concern

about the demonstration of accountability. Before 1968, this responsibility
was discharged through the surveillance of training programs and the
development and enforcement of a code of ethics. Judgments about the
appropriateness and efficacy of any single patient-therapist transaction,
however, were left to the professional integrity of the therapist and the sub-
jective appraisal of the patient. Except in instances of unethical or illegal
conduct, the only recourse open to the patient was to transfer to a new
therapist.
This two-party contract between the patient and the therapist was dras-
tically altered when therapy became a three-party contract with the
entrance of a Fiscal Intermediary (FI), usually an insurance company. Psy-
chologists became recognized as independent providers by a number of FIs
in the mid-1960s. Over half the psychologists now in practice are in states
with direct recognition or freedom of choice statutes that mandate coverage
for the services of a psychologist under any policy that contains benefits for
mental health services. Along with recognition as independent providers
comes the responsibility of cooperation with the FI in a number of insur-
ance decisions. The National Register of Health Care Providers was psycholo-
gy's answer to the insurance industry's question about who psychologists
are. Having established this, the next questions concern what psychologists
do and when they should be paid for doing it. PSRCs were established by
the state psychological associations in order to help FIs reach decisions
about professional questions. They are psychology's way of assuring that
professional judgments will be made by professionals.
Part of the initiative for the establishment of PSRCs came from the
insurance industry and part from APA's Committee on Health Insurance
(COHI). FIs had the experience of referring review decisions to professional
review committees in the various medical specialties and turned to psy-
chology for similar services. COHI was pleased to respond to this request
and initial discussions were held between APA and the Health Insurance
Association of America (HIAA). After studying the operation of medical
peer review committees, AP A agreed to establish its own network of PSRCs
and to construct the principles and procedures by which they would oper-
ate. HIAA, in turn, agreed to act as a liaison between the FIs and the PSRCs,
and publicize the review mechanism to its member carriers (Rosenberg &
Theaman, 1982).
The first guidelines for the PSRCs were promulgated in 1968 and com-
mittees were established in a few states that had immediate needs for
review activity. By 1971, when the Aetna Insurance Company agreed to
include psychologists as providers under the Federal Employees Health
Benefits Plan, a policy covering federal employees that was administered
by Aetna, 10 regional review committees were established, covering the
entire United States.
At this time COHI, which had taken the initial leadership role in the
establishment of PSRCs, felt that it would be more appropriate if they with-
drew from the review picture. Since COHI was quite openly an advocacy
group, and review activities were clearly intended to be impartial and non-
adversarial, the danger of at least the suggestion of a conflict of interest
loomed. This led to a recommendation to the Board of Professional Affairs
of APA that they establish a Task Force on Peer Review Committees. This
task force, which consisted of five psychologists and two public members,
was established and charged with formulating plans for a network of inde-
pendent PSRCs and drafting new guidelines that would reflect the experi-
ence accumulated by the existing review groups. In 1973 these guidelines
were issued and in 1974 APA established a standing Committee on Profes-
sional Standards Review (COPSR). The function of COPSR was
(1) to monitor and evaluate all matters pertaining to professional standards
review, specifically including government systems of professional standards
review, (2) recommend policies and actions for the maintenance and operation
of state Professional Standards Review Committees, (3) maintain informational
and educational liaison with other groups within the Association that share an
interest in matters relevant to its mission. (Conger, 1976)
Each state and the District of Columbia now maintain PSRCs under the
auspices of the State Psychological Association, although the degree of
activity varies widely among them. The PSRC is composed of a varying
number of psychologists, depending on the size of the state, and it is rec-
ommended (American Psychological Association, 1975) that they also
include public members, which many of them do. While some PSRCs have
been involved in insurance review and have, by arrangement with a PSRO,
even extended their activities to the conduct of PSRO review, others have
never reviewed a case. These discrepancies are a result of factors such as the
number of active service providers in the state, the existence of direct rec-
ognition statutes, the willingness of the FI to make referrals, and the extent
of active effort by the PSRC in seeking referrals.
A case may be submitted for review by the therapist, the patient, or the
FI and may concern the activities of any of the other parties. When a case
is brought to review by the therapist it usually concerns an action taken by
the FI, with the PSRC asked to render a contrary judgment. A patient may
bring a similar case to review or may question some activities by the ther-
230 GEORGE STRICKER
apist, such as a charge for a missed session. The great majority of cases, how-
ever, are brought by the FIs and concern the practice of the provider. In any
of these situations, the decision of the PSRC is purely advisory and is not
binding on any of the parties, although it is usually accepted.
When the practice of a provider is under review, the decision of the
PSRC will concern whether that aspect of the practice was usual, customary,
or reasonable. These are terms that compare the practice to norms estab-
lished by the provider himself, the community of providers, and the situ-
ation. Thus, usual refers to the typical activity of the provider in question,
customary to the typical activity of all providers in the geographic area, and
reasonable to situations in which the practice may be neither usual nor cus-
tomary, but is justified by the particular needs of the case.
While many referrals to PSRCs from FIs involve decisions about fees,
this does not seem to be a good use of the review mechanism, since FIs
maintain excellent normative records and are in the best position to know
whether a fee is usual or customary. Perhaps they are asking whether an
unusual fee is reasonable for a particular case, but the question frequently
only asks whether a fee is customary.
When referral questions do not concern fees, they very often concern
the amount of service, either in terms of time per session, sessions per week,
or length of the therapeutic episode. Except in the case of innovative ther-
apeutic procedures, the quality of the service is rarely questioned. In any
case, the PSRC will try to determine whether the service was necessary,
efficient, economic, and rendered in a manner in keeping with profession-
ally recognized standards.
There are a clear set of procedural steps that the PSRC follows after
receipt of a case to review (American Psychological Association, 1975). The
provider will be informed that a case is under review and will be told of
the procedures. These vary, depending upon the complexity of the case. If
it is relatively straightforward, the chair of the PSRC may reach a prelimi-
nary subjective judgment, inform the other PSRC members by telephone
and, if they concur, forward that opinion to the FI. In more complex cases,
additional information may be sought from the provider, consultation may
occur among the PSRC members, either by telephone or in person and, in
some instances, the psychologist may be asked to appear before the PSRC.
If a physical meeting is required it usually involves the provider alone
although, on some occasions, the patient also may be asked to appear. The
purpose of the meeting is to elicit additional information and to exchange
opinions so that the nature and circumstances of the service might be clar-
ified. The meeting is considered to be one of fact-finding rather than an
adversary procedure with disciplinary consequences.
Whether the decision-making procedure is document-based or supple-
mented by interview, the notification of opinion is by mail, to the party
initiating the action. Any objection to the opinion by any of the parties
involved may be registered in the form of an appeal to the board of direc-
tors of the state psychological association. Much as with an appellate court,
the appeal only can be on procedural grounds, such as failure to follow the
committee's guidelines. The board does not wish to be placed in a position
of second-guessing one of its committees or repeating procedures that have
been properly conducted.
Protection of confidentiality is built into the procedures of the PSRC.
All names of providers and patients are deleted from materials that are cir-
culated and these materials are destroyed after the appeals period has
elapsed. The providers are asked in the original notification letter to obtain
the signed consent of the patient before supplying any information. The
patient is only asked to appear in person if absolutely necessary and, in the
event that occurs, the PSRC is particularly cognizant of the need to restrict
questions to the particular area of concern of the case.
There has been confusion in the minds of some about the scope of
responsibility of the PSRC, and how it differs from other review committees
of a more disciplinary nature. The PSRC is not an ethics committee or a
licensing board and it will not render judgments in these areas. If a case
brought to the PSRC has clear implications concerning ethics or licensing,
however, it is the responsibility of the PSRC to forward the case to the
appropriate committee for further action.
Aside from the rendering of review judgments, education is seen as an
integral part of the activities of the PSRC. The educational process begins
with the activity of the PSRC in the community as it makes providers, con-
sumers, and FIs aware of its existence so that its services may be utilized.
This is one area where PSRCs have been differentially proactive. Education
is also seen as part and parcel of the review process. For the provider, the
review decision offers a guideline concerning the view of peers as to what
constitutes usual, customary, and reasonable service and this knowledge
may help to shape future practice. For the patient, the decision is informa-
tive as to the boundaries of appropriate psychological services. For the FI,
the parameters of practice are drawn with increasing clarity and this should
serve to guide the selection of subsequent cases for review. Apart from the
review process, the PSRC also seeks to inform FIs as to the nature of sound
psychological practice and to inform providers about the procedures of FIs.
The PSRC is an outgrowth of organized psychology, yet it owes its alle-
giance to the principles of sound practice, rather than to the Psychological
Association that sponsored it. It provides an opportunity to see whether
psychologists will allow a sense of professionalism and public responsibil-
ity to govern their judgment. To the extent that this occurs, the PSRC will
be successful and psychology will be in a position to be proud of its place
in the community of professionals.
THE CHAMPUS PROJECT
The Civilian Health and Medical Program of the Uniformed Services

(CHAMPUS) is a health plan with over seven million beneficiaries. It was
232 GEORGE STRICKER
created by Congress in 1956 in order to provide medical benefits for the

dependents of active duty military personnel, retired military personnel
and, in some instances, for active duty servicemen. A mental health benefit
was added to the CHAMPUS program in 1966, at which time psychologists
who were not in the military were accepted as independent providers, a
status they have retained ever since. The mental health budget of CHAM-
PUS has grown to over 100 million dollars, representing almost 20% of the
entire budget of the program (Dorken, 1977). Of this mental health budget,
over 20% is concerned with outpatient care. The mental health benefit has
a small copayment feature, but no benefit ceiling, so that the only criterion
for continued covered care is the medical or psychological necessity of the
service. This relatively liberal benefit policy, combined with the reduced
capacity of the military direct service system to reduce CHAMPUS costs by
itself providing the mental health care, has led to a relatively dispropor-
tionate share of the benefit dollar going for mental health service outside
of the military.
After a number of years of experience with the mental health benefit,
a public scandal erupted concerning care in residential treatment centers,
predominantly for children. Dramatic allegations suggested that inadequate
and substandard facilities were drawing CHAMPUS funds for the care of
military dependents. Following congressional hearings, an agreement was
reached between the National Institute of Mental Health and CHAMPUS
in order to develop a review mechanism for residential treatment centers.
CHAMPUS established its first Select Committee on Psychiatric Care and
Evaluation (SCOPCE I) in order to evaluate these treatment services and to
develop standards for quality care based on these evaluations. This was an
interdisciplinary committee that produced a document that resulted in a
substantial reduction in payment to facilities that did not satisfy the stan-
dards that were developed. While this experience with quality assurance
resulted in great cost savings, it also raised the quality of service offered to
beneficiaries by the elimination of substandard programs (Claiborn, Biskin,
& Friedman, 1982).
With the SCOPCE experience in mind, CHAMPUS was quite receptive
to the mechanism of establishing professional criteria for peer review of
services. When a question concerning the continued funding of mental
health services was raised in Congress, largely because of the cost factors
involved, CHAMPUS agreed to establish national advisory panels in order
to construct criteria for the review of mental health services. In July 1977,
a contract was signed with the American Psychological Association for the
review of outpatient services and with the American Psychiatric Associa-
tion for the review of both outpatient and inpatient services. l This was con-
sistent with the SCOPCE model in that CHAMPUS was looking toward the
professional community for the establishment of standards to guide review
1 The
discrepancy between the two contracts reflects the preponderance of physician involve-
ment in inpatient care.
decisions. It departed significantly from the SCOPCE model in that a single

interdisciplinary committee was not established, but separate contracts
were signed with each of the disciplines authorized to provide independent
services under the terms of CHAMPUS regulations.
In approaching the task of developing a national review system, psy-
chology'S National Advisory Panel2 was working within a framework estab-
lished by CHAMPUS regulations. These provided that review would have
to be retrospective and would be document-based. Screening of the docu-
ments occurred after the 8th, 24th, 40th, and 60th sessions. This screening,
by insurance utilization reviewers/ would determine the disposition of the
claim and select certain claims for peer review by psychologists. Following
the 60th visit, or when more than two sessions a week were claimed, the
case would have to be referred for peer review. In this event, three psy-
chologists would be chosen to perform the review and they would render
independent recommendations as to the disposition of the claim. The tasks
of the National Advisory Panel included the selection of reviewers, the con-
struction of a review document, and the development of criteria to be
applied when evaluating the information contained in that document.
The CHAMPUS review system was implemented in 1980. The National
Advisory Panel has, as one of its additional responsibilities, the monitoring
of this implementation and the revision of the procedures as dictated by
experience. The system that will be described is seen as developmental and
evolutionary and can be modified to reflect changes in the nature of practice
and knowledge about appropriate services.
The initial activity of the panel was concerned with the selection of a
group of peer reviewers. Each state psychological association president and
each PSRC chair was invited to submit a list of nominees. These psycholo-
gists were invited to apply by completing a questionnaire, and the panel
then selected 475 reviewers from a pool of 758 applicants. Reviewers were
chosen on a state by state basis in relative proportion to the number of
CHAMPUS claims within the state.
Having selected reviewers, the next task involved the construction of
a document that would elicit information about the case. It was important
to collect enough information to allow utilization reviewers initially, and
then possibly peers, to reach an informed decision about the case and, at
2The original members of the National Advisory Panel were George Stricker (Chair, 1977-
1981); Russell Bent (Vice-Chair, 1977-1981; Chair, 1982-current), Melvin Gravitz, Anna
Rosenberg, Lee Sechrest, Joan Willens, and Harl Young. Gravitz resigned after one year and
was replaced by Roderick Pugh in 1980. In 1981, Rosenberg and Sechrest were replaced by
Diane Follingstad and Milton Theaman (Vice-Chair, 1982-current). In 1982, Willens and
Young were replaced by J. Benedict and Maurice Zemlick. William Claiborn was Project
Director from October 1977 to September 1981, and Sharon Shueman has served in that role
since then.
3People who work in the office of a fiscal intermediary, review claims on substantive rather
than administrative grounds and determine whether they should be paid, denied, or for-
warded for peer review.
234 GEORGE STRICKER
the same time, to gather no more information than was necessary, in order
to protect the privacy of the patient. The document that was constructed
asks the provider to submit a description of the past and current conditions,
therapeutic interventions, progress, and goals of treatment. A copy of this
document is included in the Appendix. It does not request detailed histor-
ical material, elaborate psychodynamic formulations, or detailed progress
notes. It must, however, supply sufficient information, stated in explicit
behavioral terms, to allow for a professionally informed review decision.
The burden for providing information is on the psychologist, and a failure
to provide necessary data might result in the denial of a claim.
This treatment report form is filed at each of the mandated review
points. The information is examined by utilization reviewers in the office
of the FI, usually Blue Cross/Blue Shield or Mutual of Omaha. These
reviewers, frequently nurses, then decide whether or not the case should
be referred to psychologist peer reviewers. The criteria that were con-
structed by the panel (Stricker, 1978, 1979) were to be applied by these uti-
lization reviewers, who determine on the basis of professionally con-
structed criteria whether or not a case requires peer review. In the event
that it does, all identifying information is removed before it is sent to the
three reviewers. The peer reviewers are not given any specific criteria but
are asked to use their best professional judgment in arriving at decisions
about the quality and appropriateness of service. Thus, the system is one in
which preliminary screening is done by non psychologists on the basis of
explicit, professionally constructed criteria, and further recommendations
are arrived at by psychologists on the basis of implicit clinical criteria.
It must be noted that the treatment report form, although it does
require a diagnosis for insurance purposes, does not rely on the diagnosis
for review purposes, representing a sharp break from a medical model of
review. In order for a diagnostic system to be of value, it must be applied
in a reliable way by practitioners and be discriminating in terms of treat-
ment expectations. The current psychiatric nomenclature, despite the fact
that it has the potential for reliable application (Matarazzo, 1978), is not
used in a reliable way by practitioners submitting insurance claims. The
usual experience with outpatient mental health services is that four diag-
nostic categories (anxiety, depression, situational reaction, behavioral dis-
order) account for almost 90% of the claims received. In part, this is due to
a conscious decision on the part of the therapist to circumvent the system
and protect the patient from possible future embarrassment or discrimina-
tion by submitting the most benign diagnosis conceivable. Whether the
motivation is in the interests of the provider or the patient, the effect of this
action is to render the diagnosis a meaningless point of entry into a review
system. Even if diagnosis was used in a reliable fashion, however, there is
considerable doubt as to whether different diagnoses indicate different
courses of treatment, especially when psychotherapeutic, rather than psy-
chopharmacological, treatments are involved. For example, the PSRO cri-
teria, which are diagnosis based, are virtually identical for each of the diag-
noses, indicating that diagnosis does not provide a differential basis for
treatment planning (American Medical Association, 1975).
The explicit review criteria that were constructed represented an
attempt to define adequate practice in order to select cases that exceed these
limits for peer review. The peer reviewer would then have the option of
allowing a particular practice to be reimbursed because it was reasonable
under the special circumstances of the case. It is important to recognize that
the criteria do not intend to be a straitjacket restricting practice to a spe-
cific set of procedures. Justification for practice outside the criteria may be
provided and will be reimbursable if approved by peer reviewers.
In order to clarify the nature of the review criteria, a representative
selection will be summarized. A portion of the treatment review form asks
for a statement of progress since the last review point. This progress must
relate to specific treatment goals and it must explain the reasons that under-
lie a lack of progress, if such is the case. The therapist is asked to make a
judgment of the progl'ess since the last review point.
The statement of the problem must be in sufficient detail to allow
determinations about the necessity of care. It should include information
about the circumstances, frequency, degree of disruption, and point of onset
of the problem. It must include evidence of either significant functional
impairment or significant personal distress. It must make clear that the
patient is unable to function effectively in at least one of the following
areas; home or family, job or school, interpersonal relationships, bodily
function, protection of self and/ or others, and personal comfort. This
emphasis on impairment stems from CHAMPUS regulations, which require
that mental health services be restorative, rather than for growth and devel-
opment, in order to qualify for reimbursement. This restriction should
make clear that services may fall outside of the criteria and still be profes-
sionally appropriate.
Since the statement of the problem is of more value than diagnosis and
defines the necessity for service, it is important that it be stated clearly and
behaviorally. A presenting problem such as "depression" would not be suf-
ficient, whereas a statement such as "the patient feels continuing sadness
associated with the loss of role clarity due to the growing independence of
children" would make the need for services far more clear.
Along this same line, a goal such as "the patient will feel better" would
not allow for informed review, while a statement such as "the patient will
have reported substantial relief from personal distress, including feeling
calmer, less tense, better able to handle stress, and eating and sleeping reg-
ularly" easily could,be used as a criterion for progress. This last example
illustrates the need for goals to be stated in specific and concrete terms. The
goals also must be related to the problems and must be stated in terms of
change expected by the next review point. The changes also must be ones
that are reasonably obtainable through psychotherapeutic processes.
There are a number of limitations upon service that are based on
CHAMPUS regulations, rather than on panel judgments as to clinical effi-
236 GEORGE STRICKER
cacy. Thus, interventions such as sex therapy or training analysis fall out-
side of the regulations and would not be reimbursable. Whatever interven-
tions are indicated must be related to the goals and problems that are stated
elsewhere in the treatment report form.
There are a number of time limitations, some of which are contained
in regulations and others that were devised by the panel. Individuai ther-
apy sessions must have a duration of 60 minutes or less, must total two
hours a week or less, and must occur at least once every two months. Marital
and family sessions must be between 45 and 90 minutes. Group therapy
must occur in a group of enrolled membership between 4 and 10, with
patients 8 years of age or older, and must have a duration of 60 to 120 min-
utes. In order to treat a child, the patient must be 4 years of age or older
and the treatment plan must show collateral involvement with a Significant
person in the patient's life.
Some of the limitations that have been mentioned can be waived in
either of two circumstances. The first is a therapeutic emergency. An emer-
gency is an abrupt and substantial change in behavior, usually associated
with a clear precipitating situation, and is in the direction of severe impair-
ment of functioning or marked increase in personal distress. During such a
clinical emergency the frequency and duration of treatment may be
increased, but there is a limit of eight emergency sessions within each epi-
sode of care.
The criteria might also be waived in circumstances where there are
clear and appropriate clinical reasons for doing so. The determination of
the appropriateness will be made by the peer reviewers, and thus the bur-
den will be on the psychologist to present reasons for deviation in a clear
and explicit manner. The general approach of the review system is to estab-
lish a framework for customary treatment and allow deviations to be
approved by peers wherever it is appropriate to do so.
Because of the request that is made for explicit information about
patients, it also was necessary to devise procedures that would insure the
confidentiality of the material and protect the privacy of the patients. An
initial step in this direction was the involvement of the patient in the con-
struction of the treatment report form. It is important to note that no doc-
ument will leave the office of the FI with any information identifying either
the therapist or the patient. The treatment report forms will be separated
from the claims documents and will not be microfilmed or copied in any
way except for review purposes. All documents will be destroyed as soon
as the episode of care is concluded and the period allowable for appeal of
review decisions has elapsed. These precautions should serve to protect the
privacy of the patient and minimize the potential for any abuse of confi-
dential information.
The system that has been described is one that was specifically con-
structed for one health plan, and which was tailored to the regulations of
that plan. The panel was aware of the limitations this created, and thus
developed two sets of criteria, a CHAMPUS-specific set and an ideal set of
model criteria that were independent of the constraints of CHAMPUS reg-

ulations. The panel recognized the implications of the project from the
beginning and did not assume the work would be restricted to a single plan.
In fact, a variation of this approach, utilizing the CHAMPUS reviewers, was
implemented by Aetna in July 1979, replacing that company's previous reli-
ance on PSRCs for review services. Since that time it has been extended to
a number of other third-party payers. If the future holds a National Health
Insurance program with a mental health benefit, it also seems as though
any workable system of ambulatory mental health review would be incor-
porated within that program. Thus the CHAMPUS program represents the
only example of a nationally implemented set of peer review criteria con-
structed by psychologists for implementation within the profession of psy-
chology.
COMPARISON OF THE SYSTEMS
Three major review programs of national scope have been described.

These programs are in varying stages of operation and only PSRO has had
sufficient time to allow for empirical evaluation (HCFA, 1979). However,
PSRO efforts largely have concerned acute hospitals, so that their effective-
ness in dealing with mental health problems is barely known and their use-
fulness in ambulatory care is virtually unknown. In this section, we will
look at some of the similarities and differences among these models of
review, highlighting some of the issues for peer review while making the
comparisons.
Origin and Funding

The PSRO program was mandated by an act of Congress and has been
funded by the federal government. The PSRC program was a voluntary
response on the part of psychology to the needs of third-party payers and,
eventually, to the needs of consumers. It has been funded exclusively by
state psychological associations, although third-party payers often make
some contribution toward meeting administrative costs. The CHAMPUS
program was based on a contract between the Department of Defense and
the American Psychological Association and has been funded by that con-
tract. PSRO and CHAMPUS both have flourished under the availability of
generous support, while the PSRC has had its activities limited by its bud-
get. On the other hand, the PSRC system, because it is self-funded, is
immune to external constraints and threats of withdrawal of funds.
Locus of Review
PSRO has been concerned with care provided in short-stay hospitals.
There is an unspecified provision for future movement into the ambulatory
238 GEORGE STRICKER
sector, but this has not yet been initiated on other than a demonstration
basis. The PSRC has been concerned almost exclusively with ambulatory
care, although it is possible for it to address itself to a hospital case if one
should be referred. The CHAMPUS program is exclusively concerned with
ambulatory care, although the parallel contract with the American Psychi-
atric Association does cover inpatient care. Along this line, it should be
noted that the CHAMPUS panel has developed a set of recommendations
and an approach to the review of care provided in alternative settings such
as day hospitals and crisis centers.
Staffing
PSROs are composed exclusively of physicians. There is a possibility
for the input of psychologists and the involvement of psychologists in the
review process. This involvement, however, is subject to the ultimate
responsibility of physicians and psychologists clearly serve at their request.
The PSRC is composed of psychologists and public members. It has the
clearest and most active involvement of the potential consumer of mental
health services. The CHAMPUS program consists exclUSively of
psychologists.
Scope of Effort
Aside from its review functions, the PSRO is also mandated to perform
medical care evaluation studies and profile analyses. The PSRC is concerned
entirely with the review of individual cases upon referral by a party to the
therapeutic transaction. CHAMPUS is concerned with the screening of all
cases that are submitted and the review of selected cases.
Perspective
PSRO review is prospective and concurrent in nature.' Both admission
certification and continued-stay review involve the monitoring of ongoing
cases, with decisions involving the immediate disposition of the health care
process. PSRC is concerned with retrospective review. It makes judgments
about services that already have been rendered and recommends reim-
bursement policies for these services. Its decisions also can have prospective
implications since one recommendation that is possible is the termination
of services. CHAMPUS operates in a similar manner. By regulation, the
review system must be retrospective and judgments must be made about
care already offered, although these judgments often have concurrent and
prospective implications. However, in the ideal review system that has been
constructed by the panel, review is prospective. Treatment plans are sub-
'PSROs also engage in retrospective reviews when doing MCEs and profile analyses, but
active case review is prospective and concurrent.
mitted and approved in advance. This assures both the provider and the
patient that ongoing services will be reimbursable.
Case Selection
Both PSRO and CHAMPUS are engaged in exceptiorts review. Rather
than making judgments about every case, which would be virtually impos-
sible because of the magnitude of work involved, certain cases are selected
for the careful attention of peer reviewers. The PSRC operates after this
selection and performs a total review on all cases that are submitted. PSRO
has the capacity, through profile analysis, to identify outliers. This is a
group of providers whose care is remarkably deviant from the customary.
The identification of outliers, if they represent a significant group, can lead
to a major cost savings and a sharp increase of quality of care by eliminating
or modifying the behavior of a group of practitioners whose care is beyortd
acceptable limits (Brook & Williams, 1976). In CHAMPUS's ideal system,
profile analysis also is indicated as a very valuable procedure for the pur-
pose of identifying outliers.
Criteria
Both PSRO and CHAMPUS have explicit screening criteria and
implicit peer review cirteria. Since PSRC does not do any screening, its cri-
teria are entirely implicit. In fact, peer review decisions in all three systems
are currently based on implicit criteria. One of the goals of the CHAMPUS
panel is to develop explicit criteria to aid peer reviewers in the judgment
process.
Decision Making
In the PSRO system the initial reviewer selects cases, but decisions are
made by peers. In the PSRC system all decisions are made by peers. In
CHAMPUS the explicit criteria that have been constructed include a num-
ber of decision alternatives that are placed in the hands of the initial utili-
zation reviewer. In some instances these decisions can be made without fur-
ther review, while other cases are designated for submission to peer
reviewers for a judgment. Although the actual decisions are not always
made directly by a peer in the CHAMPUS program, the panel considers the
utilization reviewer as implementing a set of professional standards and
thus acting as peer surrogates.
Definition of Quality
The classic foci for quality are the structure, the process, and the out-
come of treatment (Donabedian, 1966). Structural definitions are oriented
toward characteristics of the institution providing the care. Process defini-
240 GEORGE STRICKER
tions are oriented toward the provider and represent a judgment about the
nature of the services that are being provided. Outcome criteria are oriented
toward the patient and look at the effects of the service. Unfortunately, the
relationships among structure, process, and outcome are not clear and the
satisfaction of quality standards in one arena does not guarantee quality in
the others (Brook & Appel, 1973).
The only use of structural criteria is by the PSRO system. It will dele-
gate the review function to hospitals assuming, among other things, that
the hospital has met JCAH standards and these standards are largely struc-
tural in nature. The only aspect of PSRC or CHAMPUS review that approx-
imates the structural is the designation of who might be a qualified
provider.
All of the three systems are primarily process-based review systems.
They attend to the nature of the care that is offered and compare this with
explicit or implicit standards of professionally acceptable care. It must be
noted that each of these systems is more concerned with technical aspects
of care than with the art of care, a dimension usually overlooked in quality
assurance efforts (Brook, Williams, & Davies-Avery, 1976).
Outcome criteria are not used by PSRO in concurrent review activities,
but may be used retrospectively in medical care evaluation studies. The
PSRC has little opportunity to employ outcome criteria unless the case that
has been submitted has completed an episode of care. The CHAMPUS sys-
tem has attempted to recognize the value of outcome criteria by developing
a progress oriented treatment report form. This calls for an intermediate
statement of outcome and, if progress is not in keeping with goals, the case
may be reviewed unfavorably.
UNIQUE CONTRIBUTIONS OF PSYCHOLOGISTS
Peer review and quality assurance have developed largely within a

medical context. As psychologists have entered the health care field, they
also have found it important to engage in review activities. A question may
be raised as to whether psychologists will merely replicate the example of
physicians or if they have a unique perspective to bring to review activities.
Two possibilities for uniqueness that have been suggested (Hays, 1977) rest
with psychologists' particular knowledge about diagnostic testing and their
knowledge of research methodology. Psychologists appear to be the only
professional group capable of designing standards for psychological assess-
ment, and this has been explicitly done by the CHAMPUS program
(Stricker, 1979). Psychologists' thorough grounding in research may allow
for an easier acceptance of review procedures and some methodological
sophistication. It is not likely, however, that the volume of assessment per-
formed is by itself great enough to justify the inclusion of psychologists in
quality assurance programs and claims of research superiority may be invid-
ious and nonproductive.
Perhaps the area in which psychologists have the most important

unique contribution to make stems from the fact that they are not physi-
cians. This produces a freedom from the medical model with all of its built-
in constraints. For instance, psychologists were in a much better position
than phYSicians to go beyond diagnosis as a point of entry to review because
their training was not on a model wedded to the importance of a system of
classification. Along this line, it is interesting that the guidelines for psy-
choanalytic treatment were constructed separately from traditional medical
review criteria after recognition by a physician group that diagnosis was
not a sufficient indicator or contraindicator for treatment (American Psy-
chiatric Association, 1976). Nevertheless, for both sociological and political
reasons, the majority of psychiatrists continue to insist upon a diagnosis-
based review system.
The introduction of political considerations is also other than trivial.
Medicine, as an entrenched profession, has a great interest in maintaining
the status quo and, as such, may be resistant to review activities that will be
seen as threatening. Psychology, as a profession that is younger and has a
lesser vested interest, is in a better position to introduce innovations, hav-
ing less need to protect guild interests and advantages.
CONCLUSION
Psychology is currently under a great deal of pressure, both internal

and external, to provide a system of accountability. The external pressures
arise from statutory requirements, consumer interests, and third-party pay-
ers. The internal pressures arise from the responsibility of a profession to
regulate itself and to insure the delivery of necessary and high quality ser-
vices. Two points should be made clear. First, the external pressures have
made the establishment of quality assurance systems unavoidable. Second,
an internal sense of professional responsibility, desire for self-regulatipn,
and ethical pressure for accountability should have dictated movement in
this direction even without the external mandate. The extent to which psy-
chology is able to transcend its guild interests and respond by producing a
system of accountability in the public interest will be a measure of its stat-
ure as a profession.
REFERENCES
American Medical Association. Model screening criteria to assist professional standards review
organizations. Chicago: Author, 1975.
American Psychiatric Association, Peer Review Committee. Manual of psychiatric peer review.
American Psychological Association, Committee on Professional Standards Review. Proce-
dures manual for professional standards review committees of state psychological associations.
242 GEORGE STRICKER
Brook, R. H., & Appel, F. A. Quality of care assessment: Choosing a method for peer review.
New England Journal of Medicine, 1973, 288, 1323-1329.
Brook, R. H., & Davies-Avery, A. Mechanisms for assuring quality of u.s. medical care services:
Past, present, and future (R-1939-HEW). Santa Monica, Calif.: Rand Co., 1977.
Brook, R. H., & Williams, K. N. Evaluation of the New Mexico peer review system. Medical
Care, 1976, 14. (Supplement)
Brook, R. H., Williams, K. N.. , & Davies-Avery, A. Quality assurance today and tomorrow:
Forecast for the future. Annals of Internal Medicine, 1976, 85, 809-817.
Claiborn, W. L., Biskin, B. H. L., & Friedman, L. S. CHJ\¥PUS and quality assurance. Profes-
sional Psychology, 1982, 13,40-49.
Conger, J. J. Proceedings of the American Psychological Association, Incorporated, for the
year 1975: Minutes of the annual meeting of the Council of Representatives. American
Psychologist, 1976, 31, 406-434.
Copeland, B. A. Hospital privileges and staff membership for psychologists. Professional Psy-
chology, 1980, 11,676-683.
Department of Health, Education and Welfare, Office of Professional Standards Review.
PSRO program manual. Washington, D.C.: U.S. Government Printing Office, 1974.
Donabedian, A. Evaluating the quality of medical care. Milbank Memorial Fund Quarterly, 1966,
44 (2), 166-206.
Darken, H. CHAMPUS ten-state claim experience for mental disorder: Fiscal year 1975. Amer-
ican Psychologist, 1977, 32, 697-710.
Goran, M. J., Roberts, J. S.; Kellogg, M. A., Fielding, J., & Jessee, W. The PSRO hospital review
system. Medical Care, 1975, 13. (Supplement)
Hays, J. R. Three methods of peer review in a state mental hospital system. Psychological
Reports, 1977,41,519-525.
Health Care Financing Administration. Technical assistance document No.9: Suggestions for peer
review by health care practitioners other than physicians in PSRO short-stay hospital review.
Rockville, Md.: Author, 1977. (a)
Health Care Financing Administration. PSRO transmittal No. 44: Policies applicable to PSROs
involving health care practitioners other than physicians in peer review in short-stay hospitals.
Rockville, Md.: Author, 1977. (b)
Health Care Financing Administration. Professional standards review organization 1978 program
evaluation. Washington, D.C.: Author, 1979.
Kazanjian, V. Peer review: A private practice model. Professional Psychology, 1982, 13,74-78.
Matarazzo, J. D. The interview: Its reliability and validity in psychiatric diagnosis. In B. B.
Wolman (Ed.), Clinical diagnosis of mental disorders: A handbook. New York: Plenum Press,
1978.
Rosenberg, A. M., & Theaman, M. The Professional Standards Review Committee: Form and
function. Professional Psychology, 1982, 13, 119-124.
Seidenberg, G. R. Federal efforts toward quality assurance. Unpublished paper, 1979.
Stricker, G. Personality assessment and insurance reimbursement. Journal of Personality Assess-
ment, 1978,42,317-318.
Stricker, G. Criteria for insurance review of psychological services. Professional Psychology,
1979, 10, 118-122.
Willens, J. Colorado Medicare study: A history. American Psychologist, 1977, 32, 746-749.
Appendix
OUTPATIENT MENTAL HEALTH TREATMENT REPORT
ADMINISTRATIVE INFORMATION TO BE COMPLETED BY LEVEL II REVIEWER

Peer Review Case No. Report No. Date of Report:
Type of Physician _ _ Psychologist _ _ Marriage and Family

Provider: Therapist _ _ Social Worker _ _ Clinical Nurse _ _ Other __
(specify)
ADMINISTRATIVE INFORMATION TO BE COMPLETED BY THE PROVIDER

Patient's Date of Birth: Sex (circle one) Patient's Marital Status (circle
one)
M F Single Widowed Divorced
Married Separated
Date Treatment Began: Total No. of Sessions since Treatment Began: _ _
Is Treatment Continuing? Yes No (circle ·one)
If No, give termination date:
CLINICAL INFORMATION TO BE COMPLETED BY PROVIDER

(Please respond to al/ items using additional pages as necessary)
Note: As an alternative to completion of this report, a narrative summary may be

substituted, provided it contains the specific information requested in this
report. However, all administrative data above must be included.
DIAGNOSIS:
Use DSM-III Codes and Nomenclature:
Axis 1_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ___
Axis 11 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Axis 111 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Axis IV (optional) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
243
244 GEORGE STRICKER
Axis V (optional) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Other diagnostic formulation _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
I. State patient's initial reason for seeking treatment. Describe how and when the
condition or impairment of function was first manifested. Summarize prior treat-
ment by you or other therapist, if any.
II. Describe the patient's current condition. Describe the nature, duration, and
severity of functional impairments. Include current mental status or results of
psychological assessment.
Rate the severity of impairment (circle one):

Very severe Severe Marked Moderate Minimal
III. If applicable, give the date and describe the significant results of physical exam-
inations. Include pertinent laboratory tests, abnormal findings, and dates of
tests. (If diagnosis is alcoholism, provide results of neurological, liver function
and chemical screen.)
IV. Describe environmental, genetic; medical or personality factors contributing to

the patient's current impairments (biopsychosocial formulation) .
COMPONENTS OF PAST TREATMENT

V. Specify components of past treatment. (Respond to applicable items)
A. Describe progress to date:
Progress to date (circle one): None Some Moderate Substantial

Nearly complete
B. Components of treatment:
1. Psychotherapy: Specify types, frequency, and length of sessions. (If
group, give number of patients in the group. When applicable, explain
relationship and nature of treatment provided to members of the same
family.)
2. Medication: Name each drug, dosage, and duration:
3. Collateral contacts: (i.e., visits or sessions with a significant person in

the patient's life). Specify type, frequency, duration and purpose:
4. Adjunctive therapies: (e.g., physical or occupational therapies, etc.)

Specify type, frequency, and duration:
5. If psychotherapy sessions are more than two (2) per week, provide
rationale:
COMPONENTS OF PLANNED TREATMENT
VI. Specify components of planned treatment: (Respond to applicable items.)

A. Describe specific goals and estimated time to achieve these goals.
B. Components of treatment:
1. Psychotherapy: Specify types, frequency, and length of sessions. (If
group, give number of patients in the group. When applicable, explain
relationship and nature of treatment provided to members of the same
family.)
2. Medication: Name each drug, dosage, and duration.
3. Collateral contacts: (i.e., visits or sessions with a significant person in

the patient's life.) Specify type, frequency, duration, and purpose.
4. Adjunctive therapies: (e.g., physical or occupational therapies, etc.).

Specify type, frequency, and duration.
5. If psychotherapy sessions are more than two (2) per week, provide
rationale.
VII. Other remarks or additional detail (such as consultations) that would assist
professional reviewers in understanding this case.
NOTE: ALL INFORMATION BELOW IS NOT TO BE GIVEN TO PEER REVIEWERS
DATE NAME OF PROVIDER (please type or print) DEGREE

SIGNATURE
ADDRESS TELEPHONE
v
LAWS AFFECTING PROFESSIONAL
PRACTICE
10
Health Insurance and Third-Party
Reimbursement
HERBERT OORKEN
To illustrate from the start that this is a complex, highly varied, and often
confusing field, let me assert that there is no such thing as health "insur-
ance!" Your health is not being insured against the unlikely event that you
will ever be sick or disabled. Rather, based on the premise that health care
will be needed and is costly, we are simply prepaying expected costs in a
uniform, generally monthly, premium amount. In group health plans/pol-
icies, the prepayment is leveled across a broader group. Expenditures
become more predictable and administration and related costs become less
per each subscriber. For some subscribers the leveled cost actually will be
greater than what they might expend, while for others it will be less. Also,
apart from accidents and "catastrophic" sickness or disorder, the decision to
seek health care, where, from whom, and how often, has a high degree of
electivity.
Subscribers, after obtaining health care from recognized providers/
professionals (e.g., some plans will not cover optometric services) for ser-
vices included in the policy benefits (e.g., routine check-ups are not covered
by many plans), are entitled to be reimbursed for the cost of those services,
minus any deductible or co-payment requirement. Usually, the subscriber
is obliged to pay the first $100 of expenses in a year (the deductible), or say
20% of the first $1,000 or $2,000 of expenses (the co-payment/co-insurance).
The subscriber is of course responsible for paying the provider for services
rendered. To shortcut this process, some providers have a participating
agreement with the carrier whereby they are paid directly (except for the
deductible or co-payment). Essentially, then, they are not paid directly by
the client but by a "third party."
HERBERT DORKEN • Health Services Consultant, California State Psychological Associa-

tion, 508 Scripps Drive, Davis, California 95616.
249
250 HERBERT DORKEN
Coverage varies between plans. The federal laws bearing on health

insurance and health plans, as we shall see, recognize psychologists as pro-
viders in specific fashion but to varying degrees. Similarly, there is variance
among the states in the degree to which state laws call for third-party reim-
bursement of psychological services, as described later under state laws. It
is, therefore, necessary to know the statutory base underlying the plan/pro-
gram on the one hand and the coverage details of the policy on the other.
Hospitalization insurance was the initial form of health insurance and
is still the most widely held. Some 90% of the population are said to have
such coverage (Kristen, 1977). Yet, such coverage, because it is limited as to
location, is often inadequate and may lead to abuses and problems. For
example, when there is no outpatient or ambulatory coverage the insured
will often manage to be admitted to a hospital so that the policy covers the
cost. In addition, the disease orientation of our "health" insurance inher-
ently lacks effective market controls since supplier competition and effec-
tive consumer choice become very limited (Kristen, 1977). Stated otherwise,
it is not health that is insured but major disease or illness requiring hospi-
talization, where typically only a physician can admit and treat. Indeed, one
can view the prepayment mechanism cynically and hold that it serves more
to stabilize the income of facilities and providers than to meet the needs of
the consumer (Bodenheimer, 1972). Hospitals in the private sector typically
place severe limits and monopolistic controls on psychological practice. The
inherent problem becomes relatively more serious the less the coverage for
outpatient care (Dorken & Webb, 1979a).
Similar problems also are prevalent when we focus on the patient with
a mental disorder. Some insurors are skeptical that what is often advanced
as mental disorder is not sickness but an expression of problems in every-
day living. Others are concerned about the costs associated with long or
repeated hospitalization for mental disorder or with extended outpatient
psychotherapy. Visit limits, dollar and lifetime limits for mental disorder,
and high co-insurance (actually co-payment by the subscriber), such as
50%, are all too common. Since it is broadly recognized that providers are
major determiners of the type and extent of care rendered there is concern
by some as to which classes of provider to recognize. All physicians or only
psychiatrists? Psychologists or only clinical psychologists? And, if only doc-
tors are to be recognized, what about some psychologists? Clinical social
workers? Psychiatric nurses? Others?
Although many of the commercial carriers began to recognize psy-
chologists voluntarily in the sixties and reported no untoward utilization
or cost or claim problems, it seems clear now that further gains in recog-
nition for practitioners such as psychologists mainly will derive from stat-
utes that mandate it (Dorken, 1976; Dorken & Webb, 1981) or court deci-
sions that require it (Moore v. Metropolitan, 1974). This is so because without
such a law some Blue Shield plans refuse to recognize psychologist practi-
tioners. Forensic and workers' compensation practice, to cite two other
major markets, depend upon statute to accord recognition.
HEALTH INSURANCE AND THIRD-PARTY REIMBURSEMENT 251
The coverage purchased via a prepaid health plan is hardly uniform.

Unless you are familiar with the health plan or policy of your client you
will not know which and how much of your services are covered and to
what extent-at least until your claim for services is processed by the fiscal
intermediary. Just asking the client may not be too helpful either. Probably
fewer clients actually have read their policy than vote. Thus, after finding
out the name of the group through which your client is enrolled, you will
probably have to contact the regional or local claims office or professional
relations representative of the insuror in order to determine the nature and
extent of the coverage. If necessary, you then also can determine whether
dependents have the same level of coverage/benefits.
Even calling the insuror's office assumes a level of understanding about
this highly complex field that is necessary if you, the practitioner, are to
deal effectively with third parties and serve your clients' best interests. For
example, familiarity with pertinent federal and state laws, how to establish
"provider" status and complete claim forms, and how to market your ser-
vices or whether to be in solo, group, or corporate practice can improve
greatly your reimbursement experience. This chapter will provide the
needed background information.
MAJOR FEDERAL HEALTH PLANS
CHAMPUS
The Civilian Health and Medical Plan of the Uniformed Services

(CHAMPUS) has recognized the services of "clinical psychologists" since
1970 by administrative directive and since 1976 by law, PL 94-212. With
some 8.6 million lives covered, this is the single largest health plan in the
country. It enables nonmilitary health care to be provided for the depen-
dents of active-duty personnel, to retired military personnel and their
dependents, and to the dependents of deceased personnel. It was intended
by Congress to be not less generous than the most comprehensive plan
available to federal employees. Even so, it has been necessary to control
utilization, limit the professions recognized, and exclude peripheral ser-
vices in order to contain plan costs. The manner in which this was done
clearly recognizes the "clinical psychologist" as an independent practi-
tioner. PL 95-111, Sec. 844(g) from the Department of Defense Appropria-
tion Act for 1978 excludes
any service or supply which is not medically or psychologically necessary to
diagnose and treat a mental or physical illness, injury or bodily malfunction as
diagnosed by a physician, dentist, or a clinical psychologist, as appropriate.
Clinical psychologist is actually not defined in the CHAMP US, nor in

other federal statutes though there is frequent reference to this speciality.
The sense or parameters of a clinical psychologist are laid out in the Con-
252 HERBERT DORKEN
ference Committee Report that reconciled differences between the House

and Senate versions in enacting PL 93-363 in mid-1974, which amended the
Federal Employee Health Benefits Act.
"Licensed clinical psychologist" [means] a person licensed or certified under
state psychology statutes, wherein the basic standard for full entry into the
profession requires a doctoral degree from a recognized graduate psychology
program. In addition, one or more years of supervised experience and comple-
tion of a state board psychology examination is required.
Those grandparented into licensure are also recognized. A more focused

definition, along the health service provider model, was approved by the
Health Insurance Association of America in May 1976 and by the APA
Council of Representatives in September of that year, to wit:
duly licensed or certified in the state where the service is rendered and has a
doctoral degree in psychology and has had at least two year's clinical experience
in a recognized health setting, or has met the standards of the National Register
of Health Service Providers in Psychology.
CHAMPUS reports mental health utilization data for 10 states, which

include 46% of the u.s. resident beneficiaries. In fiscal 1975, psychologists
provided 28.5% of all outpatient and 1.2% of all inpatient mental health pro-
cedures under the CHAMPUS in these states. The average earnings by pro-
vider psychologists in 1975 from this program alone was $2,809 (Dorken,
1977b). The level of psychologists' activity varied among the states in accord
with the number of CHAMPUS beneficiaries resident there and, relatively,
was more important for psychologists in states that were without specific
state law beyond licensure that recognized the practice of psychology sim-
ply because they had fewer alternatives (Dorken & Webb, 1980). Stated oth-
erwise, federal laws apply across all states, even those where the insurance
and related codes do not recognize psychologists under health plans/poli-
cies underwritten or issued for delivery in that state. Psychologists practic-
ing in states without state law mandating their recognition are dependent
upon federal plans then for third-party reimbursement and the voluntary
recognition of some carriers.
For a more detailed analysiS of mental health services provided under
the CHAMPUS in 1975 and compared to the two prior years, see Dorken
(1977b). Suffice to say here that 81% of all outpatient visits were for hourly
psychotherapy, that psychologists supplied about 30% of these visits, that
their fees were slightly less than those of psychiatrists ($1.55 per visit for
this procedure), that under 2% of all CHAMPUS eligibles actually obtained
mental health services in the year but that they absorbed almost 18% of the
total benefit funds. In fact, such utilization is likely to increase. For instance,
after repeated inquiry by the U.S. Senate Committee on Appropriations, the
CHAMPUS administration studied the effectiveness of biofeedback proce-
dures and decided in June 1979 to recognize their use by qualified licensed
practitioners. Psychologists have pioneered in the application of these tech-
niques to certain major and common health problems (Biofeedback in
Action, 1973). Thus, the decision to recognize biofeedback could expand the
involvement of clinical psychologists in services to CHAMPUS
beneficiaries.
In order to qualify for reimbursement under the CHAMPUS, a service
provider must meet certain qualifications and conditions. First, as noted
above, reimbursement is limited to qualified providers and to services that,
in the language of the law, are "medically or psychologically necessary."
Second, CHAMPUS automatically will recognize those listed in the National
Register of Health Service Providers in Psychology (1978) as "clinical psycholo-
gists." Others must gain provider status by application and credential
review with the fiscal intermediary, an insurance carrier such as Aetna or
Blue Shield, or computer corporation that processes claims and issues pay-
ment for services under federal contract.
Third, in order to improve overall quality assurance of health care and
to effect review and control on the utilization of psychological services, the
American Psychological Association, under contract to the Department of
Defense, developed a peer review system for psychological services that was
implemented in 1980 (see Chapter 9). This system will insure that all claims
will become subject to review. Thus, the peer review system will exert pro-
gressively more scrutiny, the more frequent and extended a beneficiary's
visits. Certain procedures are excluded outright, that is, are not reimbursa-
ble at all. Others are allowed only on authorization. For more than a few
visits, treatment plans, including a statement of the problem to be
addressed and the outcome expected, will have to be filed for peer review
and continued care will have to be rejustified. The system is designed to
promote efficiency, effectiveness, and accountability and to limit utilization
to services that are necessary, are considered beneficial, and are delivered
by qualified providers. It is in the shape of things to come, not just for the
CHAMPUS program.
In effect, then, over a period of time there will have to be a demon-
strable benefit from services to retain them in a plan. Providers also will
have to establish that they meet accepted standards of the profession. The
days of repeated visits without a plan, except for a return visit, are coming
to an end, while greater precision in provider qefinition will limit those
who can be recognized as health practitioners. There will be hard questions
for psychologists to answer. Grinker (1972) put the dilemma well: "Can
anyone answer even one 'what' in the question: What kind of therapist,
using what kind of treatment, in what kind of setting, for which kind of
patient, achieves what kind of result? The answer is 'No.'" But such an
answer is obviously a very insufficient basis on which to provide a health
"benefit package."
In a plan the size of CHAMPUS, any change in benefit, provider rec-
ognition, or the extent of coverage obviously can have major cost implica-
tions. The service volume, however, also makes it feasible to generate
patient and provider profiles by computer for assistance in detecting pat-
terns of fraud and excessive use of diagnostic and/or treatment services.
254 HERBERT DORKEN
Another qualification for reimbursement is that the providers' fees

must be UCR (usual, customary, and reasonable). The charge must be usual
for the provider, customary for practice in the area, typically the PSRO area
within the state (see Chapter 9), and reasonable for the services rendered.
Percentile limits generally have been set so that the ceiling includes 75% of
the charges for the procedure, though the Senate Appropriations Commit-
tee recently recommended adopting the 80th percentile. The provider's
allowable charge, then, usually is the lessor of: (a) the amount billed; (b)
his/her usual charge for that procedure, that is, up to the 75th percentile.
Rates ordinarily are adjusted annually and have an inherent time lag. To
the extent that a provider's charges exceed his usual fee, they will be
reduced at the time. But when a consistently higher fee is billed from a
certain time, a new "usual" charge is established when the rates are later
adjusted in the next fiscal year.
In order to be reimbursed for professional services by a third party (nei-
ther the provider, nor the patient), it is necessary to bill for the services
rendered. Standard insurance claim forms are widely used and the CHAM-
PUS, because of its own reporting requirements and program size, has its
own claim form (see Appendix A). In order to process the volume of claims
submitted, CHAMPUS contracs with various fiscal intermediaries around
the country. For an administrative fee, the intermediary will review and
pay claims in accord with plan benefits. For example, Blue Shield is the
intermediary in several western states. It must be emphasized that the fiscal
intermediary handles the claims in accord with the benefits of the program
and other limits established by CHAMPUS and not in keeping with the way
it might conduct its own business.
Forms insufficiently or vaguely completed invite claim denial and/or
return. While some providers become very distressed about potential
breach of confidentiality, the government holds that it releases no infor-
mation and has a reasonable right to know relevant facts about the client
and the service provided in order to determine what properly can be reim-
bursed. Providers can gain a favorable cash flow and keep claim rejections
and returns for further information to a minimum by completing forms
adequately and legibly in the first place. Professional practice is a business
and these forms are in essence invoices for services delivered. For new pro-
viders and others experiencing a particular problem in completing the
form, the fiscal intermediary ordinarily will have a professional relations
representative to assist in resolving such difficulties.
Finally, a person who is eligible for CHAMPUS benefits may also be
eligible for other coverage. A standard condition when there is overlapping
coverage requires benefit coordination so that there will be no duplication of
benefits or double payment. In this process, the contribution each insurance
plan is to pay is based upon rank order or pro rata share. For example, per-
sons eligible for Medicare must use the Medicare benefits first; CHAMPUS
benefits then cover the remaining costs that are due. There is, of course,
only very limited recognition of psychological services under Medicare (see
below), but CHAMPUS will reimburse for psychological services not cov-
ered by Medicare that are recognized CHAMPUS benefits. On the other
hand, if a person is eligible for Medicaid benefits, CHAMPUS always pays
its benefits first. This avoids having to pick up from where the widely vary-
ing state Medicaid plans leave off or having to transfer CHAMPUS funds
to come under state administration, thereby expediting service access and
reimbursement.
FEHBA
The Federal Employee Health Benefit Act is the law that establishes
conditions and funding of group health plans for federal employees. With
the passage of PL 93-363, which became effective January 1, 1975, this law
was amended so that clinical psychologists (not other psychologists) and
optometrists became recognized as independent providers of health care for
covered benefits in these federal employee health benefit plans that collec-
tively, cover some 10 million lives.
There are about 20 plans, though by far the largest is the Blue Shield
government-wide health service plan. The second largest is the Aetna gov-
ernment-wide indemnity benefit plan. Without any statutory requirement,
Aetna took the "initiative" to recognize psychologists directly for covered
benefits in 1971. This was the initial break in the physician's referral
requirement, later consolidated into law through PL 93-363.
Each of the federal employee health plans differs in its benefits. Some
may not provide coverage for services or conditions that fall within the
practice of psychology. For the others, the provider must look to the plan
benefits for visit limits (e.g., 20 in a year), dollar limits (e.g., $500), location
limits (e.g., only hospital services), disability exclusions (e.g., alcoholism
and drug abuse), and the like.
The Senate did not agree to all provisions of the House bill (H.R. 9440-
Waldie) and the conference report to resolve the differences between the
houses narrowed the House proposal of psychologist to "clinical psychol-
ogist" with the intent language of the report setting limits of expectancy of
a basic standard under state statute of a doctoral degree from a recognized
graduate psychology program and one or more years of supervised experi-
ence. Those grandparented under such laws would also be included.
For its government-wide service benefit plan, Blue Cross/Blue Shield
defines clinical psychologist as a "psychologist who is duly licensed or cer-
tified in the state where the service was rendered and has a doctoral degree
in psychology and has at least two years of clinical experience in a recog-
nized health setting." It also adopted listing in the National Register as
equivalent to its definition and warranting direct recognition.
While no language in PL 93-363 makes any distinction between basic
and supplemental benefits, the Civil Service Commission currently inter-
prets these FEHBA amendments to mean that outpatient psychological ser-
256 HERBERT DORKEN
vices covered by the Blues are supplemental services and thus reimbursed
at 80%. Inpatient services are considered to fall under the basic benefits that
are to be "ordered and billed for by a physician." The recognition of inpa-
tient services are in flux at this time. Referred consultations will be consid-
ered basic services. Moreover, PL 93-363, as passed, not as introduced, con-
tains a loophole, "The provisions of this subsection shall not apply to group
practice prepayment plans," that is, these plans do not have to recognize
psychologists. Thus, this exemption clause eliminates any requirement that
psychologists be available to members of health maintenance organizations,
such as Kaiser, either as staff, on contract, or otherwise directly accessible
to plan members. Consequently, no psychological services need be pro-
vided in such group practice plans. The federal law delineating HMOs, PL
93-222, included Individual Practice Associations (IPAs) within the con-
cept. Rather than being composed of salaried personnel, these are federa-
tions of fee-for-service practitioners. Any IPA that serves federal employees
is not required to have psychologists as participating providers; nor is it
required to recognize psychological services.
For billing purposes there are standard forms, the most common of
which have been developed by the insurance industry, Blue Shield, the
American Medical Association, and certain government programs. Except
for special groups, one of these standard forms usually can be used to bill
a claim. The AMA form is included in Appendix B as an illustration. The
form used by Blue Cross/Blue Shield in California is highly similar. Forms
must be fully and accurately completed. The information supplied must be
sufficient to indicate to whom services were rendered, the charge billed,
and whether the services are a covered benefit of the plan. Failure to supply
sufficient and accurate information will only lead to reimbursement delays
and/or claim denials.
REHABILITATION
Even though the Rehabilitation Act of 1973, PL 93-112, placed priority

on the severely disabled, the mentally disordered are the single largest dis-
ability category. For example, in 1974 they comprised 31 % of those rehabil-
itated in that year (U.S. Department of Health, Education, & Welfare Final
Report). Additionally, 13% of those rehabilitated were mentally retarded.
Beyond those two broad categories i~ which psychologists might play an
obvious role, many of those who are physically disabled may well have psy-
chological complications that impede their rehabilitation. With the passage
of this law recognizing "physician or licensed psychologist" from January
1,1975, for assessment or restorative services to the disabled, psychologists
are recognized in all federally subvended state rehabilitation plans.
To qualify for rehabilitation services requires a prediction that the dis-
abled person can become employable or that the level of employability can
be improved. The rehabilitation funds that states receive annually are in a
fixed dollar / formula amount. Some states allocate smaller proportions of it
for restorative services than others. Most employ some psychologists or

rehabilitation counselors for assessment or restorative services. Some, often
by district, have a panel of providers on contract or to whom cases are
referred. Generally, the state agency will have a set or maximum rate that
may be less than prevailing or UCR fees in the area. In any event, psycho-
logical services, as authorized, can be reimbursed since this is a federally
subvended program recognizing licensed psychologists. As we discussed
under CHAMPUS, benefits typically are coordinated with any available
health insurance that the client may have.
MEDICARE
As Title XVIII under the Social Security Act, Medicare is the first fed-
eral involvement in a nationwide health insurance plan. With few excep-
tions, all residents 65 years of age and older have mandatory hospital insur-
ance coverage derived from Social Security revenues. In addition to this
Part A coverage, an optional voluntary Part B coverage for supplementary
medical insurance (Markus & O'Sullivan, 1977), which is nationally avail-
able, can be purchased by all Medicare beneficiaries. Within Medicare cov-
erage, certain costs are not covered (Le., deductibles plus certain services).
The state, however, can meet part or all of the cost of deductibles, cost shar-
ing, or similar charges under Part B of Medicare for Medicaid beneficiaries.
Similarly, persons may privately purchase "Medigap" insurance to supple-
ment or cover what Medicare does not.
An estimated 28.1 million persons held Medicare hospital insurance
protection in 1980, about 11% of an increasing segment of the population.
(In 1978 there were another 2.7 million chronically disabled, including
those with end-stage renal disease.) Total program cost was $35.7 billion, or
an average of $1,270 per person that year.
In sharp contrast to the three previous federal programs, psychologists
are very restricted in the services they can provide Medicare beneficiaries.
As of this time, psychological services are recognized in but two ways under
the Medicare Law. Licensed/certified psychologists as independent practi-
tioners may only bill for evaluative services upon medical referral. Other-
wise, psychological services are recognized only when "incident to" a phy-
sician's services; that is, when provided in the physician's facilities, under
phYSician supervision, and billed by the physician on a paramedical or
"physician extender" role. With the direction and supervision of the phy-
sician, the "extenders" enable a phYSician to increase the volume of services
for which he/she can be responsible. There is no dollar or visit limit on
such services. Further, even under any supplementary Medigap insurance,
psychological services would be recognized only in those states that have
direct recognition laws for psychologists.
By contrast, inpatient psychiatric hospitalization carries a lifetime limit
of 190 days. Physician services are fully recognized during that time and
psychological services are covered to the extent their cost is included within
258 HERBERT DORKEN
the per diem charge; that is, they are hospital employees and no fee is billed
for their services. In further contrast, outpatient psychiatric services require
50% co-payment by the patient and reimbursement is limited to $250 a year
(at $50 a visit, 10 visits; at $60 a visit, 8 visits). The combined effect is alleged
by critics to increase hospitalization unnecessarily. And, of course, without
access to the services of practitioner psychologists and given the more
highly urbanized distribution of psychiatrists, many of the elderly and dis-
abled Medicare beneficiaries are for practical purposes denied appropriate
care that might otherwise be available.
In the Medicare amendments of 1972, psychology sought independent
provider status but was "accepted" in committee for services only under
medical supervision. The amendment was opposed by psychology and
defeated, leaving the situation described above. Meanwhile, various bills
have been advanced seeking direct recognition but none has prevailed.
MEDICAID
This is a medical assistance program for certain needy and low-income

persons under Title XIX of the Social Security Act. States must provide the
basic five services, or any seven (or more) of the first sixteen services. The five
basic services are: (1) inpatient hospital services other than institutional ser-
vices for tuberculosis or mental disorder; (2) outpatient hospital services; (3)
other laboratory and X-ray services; 4(a) skilled nursing facility services
(other than for tuberculosis of mental disorder) for individuals 21 years of
age and older; (b) early periodic screening and diagnosis of those under 21;
and (c) family planning services and supplies; and (5) physician's services
furnished by a physician (MD/OD only). Additional services are at state
option. Psychological services could be included at state option under item
6, "other types of remedial care recognized under state law, furnished by a
licensed practitioner," and item 13, "other diagnostic ... and rehabilitative
services." The federal match ranges from 50% to 78% in lower per capita
income states.
When a state elects to include psychological services in its plan, it is
optional as to extent and degree of utilization controls imposed. Regardless
of the latitude provided on an outpatient basis, however, patients may be
hospitalized only when a physician certifies at the time of admission that
the services were required to be given on an inpatient basis. In skilled nurs-
ing facilities the health care must be under physician supervision. The fed-
erallaw does not give the state any other option if it is to qualify for federal
financial participation (FFP).
The American Psychological Association has found it very difficult to
obtain a current record of the extent to which Medicaid beneficiaries have
direct access to psychologists across the states. Indeed, a study by the BLK
group (1975) highlighted the inadequacy and noncomparability of state sta-
tistics. They did note that for four states (Maine, New Jersey, Nevada, and
Montana), the expenditures for psychological services in 1974 amounted to

an average of .17% of total Medicaid program costs.
An APA survey of 25 states in February 1978, which included all states
having some level of psychological service in their state plan, showed that
the Medicaid beneficiary had direct access to qualified psychologists for
both testing and therapy in 12 states (California, Kansas, Maine, Massachu-
setts, Minnesota, Montana, New Hampshire, New Jersey, New Mexico,
New York (except New York City), Ohio, and West Virginia). Collectively,
these states comprise about 35% of the national population. There was direct
access for testing in Utah, since expanded to include therapy. In six states
testing and therapy by psychologists were dependent upon physician refer-
ral (Connecticut, Georgia, Hawaii, Indiana, Oregon, and Vermont). Two
states only recognized testing on referral (Illinois and Michigan), while two
required medical supervision of psychological services (Arkansas and
Nebraska) and Tennessee required medical referral and accepted billing for
these services from physicians only. In Wisconsin, psychologist providers
are under state contract. Overall, there is somewhat greater recognition of
testing than therapy and limitations on visits, maximum fees, or dollar ben-
efit are common. Although five states apparently pay on a UCR basis, it is
more common to find maximum rates that are substantially below the cus-
tomary rate for psychological services in the state.
The exact recognition for psychological services changes frequently
due to negotiated or state statutory recognition, on the one hand, or its dis-
solution in whole or in part, on the other. Also, despite recognition, bud-
getary limitations may lead to fee reductions and cut off of optional services
toward the end of the fiscal year. Specific coverage details should be sought
from the state Medicaid administrator or third-party intermediary. Before
any claims can be processed or paid, it is first necessary to acquire a number
for billing purposes. Numbers are issued only to qualified practitioners in
the professions recognized under the state plan. Incidentally, as processed
claims are logged in, a provider profile develops showing the services pro-
vided and bills submitted and paid.
Each state makes its own intermediary arrangements, often contracting
with a major health service plan or insurance carrier, e.g., Blue Shield,
Aetna, or a computer data processing firm, to receive, screen, adjust, and
pay claims. In larger states, there may be regional claims offices. In states
where psychological services are recognized, all practitioners must establish
their eligibility and obtain a provider number from the fiscal intermediary
in order for their claims to be processed. Holding clear statutory authori-
zation for practice is ordinarily the basis upon which prOVider status is
accorded.
New Jersey, which has one of the more functional plans, has an hourly
rate for psychology generalists and a somewhat higher rate for psychology
specialists. Prior authorization by the state is required for services exceed-
ing $300 in anyone year. In California, testing is limited to a maximum of
five hours a year with each patient, and therapy cannot exceed two visits
260 HERBERT DORKEN
per month (less when shared by certain other limited recognition provid-
ers). The state's current (as of August 1980) maximum allowance or fee for
psychologists is $27.05 per hour. Conditions such as these limit the number
of psychologists willing to accept Medi-Cal (California Medicaid) clients. In
1976, only 55% of California's licensed psychologists who were active
health service providers saw any Medicaid beneficiaries. On the average,
they were paid $3,000 over the year. (By contrast, 88% of psychiatrists par-
ticipated and were paid an average>-()f $10,600.)
By survey of licensed psychologists, Darken and Webb (1980) found
that for full-time fee-service practitioners, Medicaid (Medicare also)
accounted for only a small proportion of their claims submitted to third
parties. They also brought the least satisfactory reimbursement experience
and the highest rate of submission to review. Such conditions and the lim-
ited number of states recognizing psychological services severely limit their
involvement in services to the poor.
Total Medicaid expenditures in 1979 were estimated at $20 billion.
Thus, Medicaid and Medicare combined accounted for almost $49.7 billion
of the total national expenditures on health care in 1979, up from $32.4 bil-
lion in 1976 when they were 23.3% of the $139.3 billion total. To place the
extent of the growing government involvement in health care in perspec-
tive, it should be noted that by 1975, the government paid over 42% of the
nation's total medical care bill, including 53% of the hospital costs (Kristein,
1977).
DISABILITY DETERMINATION
Under Title II, Old Age, Survivors and Disability Insurance (OASDI),
the Social Security benefits may be paid before age entitlement if the mem-
ber is disabled. Disability is defined as the
inability ... to engage in any substantial gainful activity by reason of any med-
ically determinable physical or mental impairment which can be expected to
result in death or which has lasted or can be expected to last for a continuous
period of not less than 12 months.
Psychological determination is now accepted as medical determination.

Under the same disability criteria, supplementary Social Security Income
may be awarded under Title XVI of the Social Security Act to augment
Social Security benefits paid to persons 65 or older, to the blind, and to the
disabled.
Until March 27, 1979, psychological evaluation of disability was
received as part of the medical evidence of disability, but the actual deter-
mination of disability was a medical judgment. On this date, however, the
Social Security Administration issued final rules that recognize the primary
evidentiary value of psychologists' reports. Such disability determination
has direct application to both Titles II and XVI of the Social Security Act.
For some years, psychologists have been actively and increasingly

involved as vocational experts in disability determination (Hanning, 1972).
Under Title II, the determination of the availability of employment for
which the claimant has a capacity or transferable skills requires an appre-
ciation of the psychosocial factors both in disability and the job market. The
emphasis is on the actual situation rather than on the possible. Therefore,
rehabilitation potential is not a component of disability determination. Sim-
ilarly, regulations issued September 18, 1975, by the Department of Labor,
recognize psychologists for determination of incapacity due to physical or
mental impairment under the Work Incentive Program of Title IV. Title V
also recognizes psychological evaluation in the Maternal and Child Health
Program in an effort to reduce the incidence of mental retardation and
other organically based handicapping conditions.
WORKERS' COMPENSATION
With the passage of PL 93-416, amending the Federal Employee Com-

pensation Act (FECA), the definitions of "physician" and "hospital services
and supplies" were broadened to include "clinical psychologist," this spe-
cialty designation having been derived from the Conference Committee's
report on PL 93-363, amending FEHBA. Thus, the clinical psychologist may
provide treatment, care, and evaluation for job-injured federal employees,
whether on an outpatient, office, or in-hospital basis. This is one of the few
statutory references to in-hospital care by psychologists. In most, the locus
of care is not specified. The government is a "self-insured" for this program.
VETERANS
As discussed above, psychologists under the CHAMPUS program pro-

vide services to dependents of active-duty military personnel and retired
personnel and their dependents. With the passage of PL 93-82, the services
of psychologists could be extended to the dependents of totally disabled
veterans. In 1979, Congress passed the Veterans Health Care Amendments
of 1979, PL 96-22, which established a readjustment counseling and related
mental health service program for Vietnam-era Veterans, again recognizing
the clinical psychologist as an independent health practitioner.
TAXES
While the services of psychologists are recognized in these federal laws

as described, their services have been recognized as deductible medical and
health expenses for those itemizing deductions in their annual federal
income tax return. Not only may insurance premiums be deducted, but also
262 HERBERT DORKEN
the cost of any deductible or co-payment associated with psychological ser-

vices. And, of course, fees paid to psychologists for health care and not
reimbursed by a third party also are deductible.
STATE LAWS
We have seen that federal law is a very major factor in whether and to
what extent psychological services will be reimbursed in various health
"insurance" plans. These laws, however, pertain only to federal programs
and agencies. Traditionally, certain areas of law that bear on practice are
matters of state jurisdiction. With several exceptions, the insurance industry
is regulated by state law. The licensing of health facilities and health prac-
titioners is also a state responsibility. The specifics of such laws will have a
definite effect from preventing, to limiting, to facilitating, to augmenting
the practice of psychology.
LICENSING / CERTIFICATION
Although the terms are sometimes used interchangeably, in the strict

sense, they are very distinct. Both, to be sure, are a form of statutory author-
ization. Licensure laws are practice acts and the manner and extent to which
the practice of psychology is defined is the statutory foundation upon
which psychological services and their scope can be provided. Certification
laws are essentially registration and title protection laws. Both set a mini-
mum standard for the state, but with some variation among the states. Some
states have more than one level of licensing/certification, some allow equi-
valencies for a doctorate degree in psychology and thus may not meet the
standards of federal programs already described. (For a complete discussion
of licensing/certification, see Chapter 11.)
More subtle, and given insufficient attention by the profession, from a
health perspective, are the typically weak practice definitions. All the many
psychological terms notwithstanding, only 12 state laws specifiy "diagno-
sis" and "treatment" as within the practice of psychology. For what other
services would one ordinarily expect reimbursement under health insur-
ance? Not counseling for adjustment problems. And what kind of treat-
ment? There are few that cite the array in the California licensing Law:
psychotherapy, psychoanalysis, hypnosis, behavior modification, and bio-
feedback (California Business and Professions Code, 1979).
The first licensing law was passed in Connecticut in 1945; the last in
Missouri in 1977. It took 32 years for psychology to gain statutory authori-
zation to practice in all states. Then, in 1979, the spectre of sunsetting var-
ious boards and commissions of state government gained political momen-
tum. First, South Dakota, then Florida, saw their law repealed, while Kansas
gained a one-year reprieve. Where a federal statute or state code requires
state licensure of practitioners, psychologists in sunset states can expect pro-

gressively severe difficulty in securing third-party reimbursement. Indeed,
practically all laws recognizing the practitioners of a profession for the
independent delivery of services, outside of government agencies and uni-
versities, require that the practitioners have state statutory authority to prac-
tice in the state where the services are rendered.
To the extent that the practice of psychology may face court challenge
or that practitioners seek recognition of their services through the courts,
they are on uncertain ground if the services they render are not founded
in law. No practitioner can afford to be a disinterested party regarding his
licensure/certification law. And if the law is "sunsetted," it would be naive
to expect that accreditation of the practitioner by a professional association
could have more than a short-term recognition effect unless the law is
reinstated.
DIRECT RECOGNITION / FREEDOM OF CHOICE
By June 1982,36 states and the District of Columbia had passed Direct
Recognition/Freedom of Choice (FOe) legislation, embracing 87% of the
population of the United States. This legislation amends state insurance and
related codes to require that where health plan/insurance policy benefits
fall within the practice of psychology the consumer / patient can have direct
access to qualified psychologists if that is his or her choice. This direct rec-
ognition does not alter the policy benefits, it only broadens the range of
providers who can render the covered service.
When considering whether the covered benefits/services fall within
the practice of psychology, it is prudent to think back on the Licensing/
Certification Act and for states to take action to assure that their law reflects
current psychological practice. Of course, without a law that mandates
access to psychologists, any recognition is voluntary on the part of the car-
rier. Actually, some of the major insurance carriers, such as Occidental and
Massachusetts Mutual, began to recognize psychological services in some of
their group health plans in the early sixties. What is voluntary, however,
rather than statutory, has no certainty. But their experience was favorable
and they so testified for psychology during hearings on PL 93-363 (see
FEHBA above).
Any insurance that is underwritten in or issued for delivery in a state
must meet the laws of that state. Some FOC laws, such as that in New Jersey,
have an extraterritoriality clause. Its constitutionality has not been tested in
court. In effect, that law seeks to require that a beneficiary of a New Jersey
policy wherever located and whether the beneficiary'S state of residence has
an FOC law or not, must recognize psychological practice. Otherwise,
despite a master policy issued in an FOC state, the claim department may
not accept claims from psychologists in non-FOC states. This occurs in large
companies with employees in various parts of the country. If the master
264 HERBERT DORKEN
policy is issued in an FOC state and the service is rendered in another FOC
state by a qualified practitioner, then reimbursement should follow. A pos-
sible exception is due to laws such as Ohio, Illinois, Georgia, or Virginia,
which recognize only psychologists licensed in that state. Conversely, if the
master policy is issued in a non-FOC state but the beneficiary is resident in
an FOC state, the carrier well can contend that there is no obligation to
recognize psychological services.
Thus, quite apart from the importance of an FOC law to psychologists
in the state, passage of such laws in other states reduces the gap in psy-
chologists' access for clients having health insurance plans issued out of
state. Table I shows the states having this direct recognition legislation. The
36 states and the District of Columbia contain 87% of the national popula-
tion plus, of course, federal employees and CHAMPUS beneficiaries in the
other twenty-one states. This table shows the order and data in which states
passed their FOC Laws, the 1976 population census estimate in thousands,
APA members by state, the unduplicated number of psychologists by state
recognized for independent practice, the ratio of these psychologists per
10,000 of population, and other details.
In order to assure greater consistency in the recognition of psycholo-
gists in state health insurance laws, a committee of the American Psycho-
logical Association undertook to negotiate a model law proposal with the
Health Insurance Association of American (HlAA) which represents several
hundred and more than 80% of the insurance carriers licensed to under-
write health insurance. The Model Psychologist Direct Recognition Bill was
approved by HlAA in May 1976 and by the APA Council of Representatives
as APA policy in September 1976. It is comparable to the National Register'S
minimum standard for listing. The Model Bill's definition of psychologist
is at once broader than graduation from an APA-approved doctoral pro-
gram in clinical psychology and narrower than state licensure / certification.
How much narrower? First the psychologist provider must be licensed/cer-
tified in the state where the service is rendered, not in some other state.
Second, the doctoral degree could be a Ph.D. or Psy.D., or possibly, an Ed.
D. or D.Sc. Third, the degree must be in psychology, not necessarily
awarded through a department of psychology, but in psychology, not in
education, counseling, theology, human engineering, sociology, or some
other related field. An earned, as opposed to an honorary degree is
assumed, and nothing is inferred as equivalent to a doctoral degree. Fourth,
two years of experience would be defined on a full-time equivalent basis
(FTE) in accord with state or federal practice. Depending upon the jurisdic-
tion, a year is usually considered to be 1,500 or 1,800 hours. Fifth, clinical
experience means direct patient care experience for health or disability, not
teaching, applied research, program evaluation, or administration. Sixth,
recognized health setting means that the place is in the business of health, not
social welfare or other endeavor. It might be the distinction between a stu-
dent health service and a student counseling center. Recognized infers a for-
mal basis, such as a state licensed health facility (hospital, skilled nursing
home, rehabilitation clinic} or a setting established upon statutory base,

such as a county mental health center or a foundation for medical care. It
would not include private office practice.
Since this definition is becoming an increasingly widely adopted
national standard, those seeking third-party reimbursement as psycholo-
gists under health insurance should expect increasingly to be held to the
definition as the minimum standard of the profession. We can expect that
it will be cited with increasing regularity in new laws dealing with health
services and recognizing psychologists. It does not, however, actually take
away from other psychologists the option to provide and be reimbursed for
these services, since they were not formally recognized as able to do so in
the first instance. In the interests of quality assurance, then, it narrows the
provider pool to those considered to have had sufficient training and expe-
rience to be able to meet expected standards of competency in health care
delivery.
MANDATORY MINIMAL MENTAL HEALTH INSURANCE
To assure that all group health insurance policies available within a

state will include at least a certain minimum level of coverage for nervous
and mental disorder, some states have enacted legislation that mandates
such coverage. By December 1978, nine states had enacted such mandatory
minimal mental health coverage (MMMHI) legislation, which recognized
psychologists for reimbursement (Colorado, Connecticut, Maryland, Maine,
Ohio, New Hampshire, Virginia, and Wisconsin, GLS Associates, 1979). The
Ohio law also includes coverage for alcoholism. Georgia, by contrast,
requires that if mental health benefits are not included, such a disclaimer
must be written across the face of the policy. An approach which appears
to be preferred by the insurance industry is "mandated availability" now
enacted in ten states (California, Florida, Illinois, Kansas, Louisiana, New
York, Oregon, Tennessee, Vermont, and West Virginia). In effect, when the
employee group/employer/purchaser requests it, mental benefits must be
included in a group disability (health) insurance plan. Among both the
"coverage" and "availability" states, while not less than $500 for outpatient
coverage is required in seven states, no state with such legislation appears
to have a lower ceiling. Eight states require that the co-payment for these
services not exceed 50%. Other state ceilings, such as in Minnesota, are more
liberal, and not less than 90% of the first $600 of outpatient mental health
services must be covered by the insurance.
The MMHC approach, when psychologists are recognized as providers,
has the same effect of direct recognition as FOC legislation, and when
broader, as in the case of Ohio, assures better coverage. Given its nature, it
is perhaps more feasible for a coalition of mental health association and
various mental health professions to support such legislation than an FOC
bill geared to a single profession. In any event, to know the minimum cov-
N
~
~
TABLE 1
Freedom of Choice Legislation Recognizing Psychology
Lic./
cert.
7/76 1978 No. Lic./ psycho.
Census APA cert.Q 10,000
No. State Passed (1,000) members psycho. popn. Explanatory note b
1 New Jersey 68 + 12/73 7,336 1,831 880 1.120 BOS

2 Michigan 6/68 9,104 1,683 529 .581 (B) in 81
3 Utah 3/69 + 75 1,228 228 136 1.107 BOS
4 New York 6/69 18,084 6,667 3,463 1.915 (M)BOS
5 California 69 + 8/74 + 9/80 21,520 5,804 3,213 1.493 (M)B,WC,9 /77;05,9 /81
6 Montana 3/71 753 109 74 .983 WC
7 Oklahoma 6/71 2,766 302 159 .575 B
8 Colorado 7/71 2,583 396 318 1.231 M
9 Washington 71 3,612 687 276 .764 (B) on 12/74
10 Maryland 7/72 4,144 1,350 553 1.334 MBOS
11 Virginia 9/73 5,032 1,101 491 .976 MB
12 Massachusetts 12/73 5,809 1,948 1,520 2.617 MBOS
13 Ohio 1/74 10,690 1,723 1,803 1.687 M + (WC)+(B)5/74+0S'80
14 Tennessee 2/74 4,214 612 427 1.013 (M)B
15 Kansas 3/74 2,310 528 247 1.069 (M)B ::I:
16 Nebraska 4/74 1,553 266 157 1.011 B :;0
'"
17 Mississippi 7/74 2,354 205 103 .438 B :;0
FEHBA 7/74 (8,500) F B WC on 9/74 OS ...'"'"
18 Hawaii 74 884 185 82 .928 B' 0
0'
:;0
19 Louisiana 74 + 7/75 3,841 282 172 .448 (M)B :>'(
20 Arkansas 3/75 2,109 173 162 .768 B Z

'"
21 Minnesota 5/75 3,965 803 697 1.758 MB ::c
22 Oregon 5/75 2,329 437 209 .897 (M)B ,...~
23 Connecticut 3,117 893 402 1.290 MB ...;
6/75 ::r:
24 Maine 6/75 1,070 181 156 1.458 B
25 New Hampshire 1/76 827 163 91 1.100 MB
Z
<J>
c::
26 District of Columbia 1/82 + 1/76 702 853 403 5.741 ::<l
;.-
27 Illinois 12/76 11,229 2,312 1,122 .999 (M)B Z
n
28 Texas 5/77 12,487 1,965 1,039 .832 B ;.-
'"
29 North Carolina 6/77 5,469 828 297 .543 B Z
0
30 New Mexico 9/77 1,092 187 89 .815 B -l
31 West Virginia 77 477 190 109 2.285 MB ::r:
iii
32 Pennsylvania 4/78 11,862 2,702 2,132 1.797 B 0
33 Nevada 7/79 610 107 51 .836 .;,
;.-
34 Georgia 3/80 4,984 713 314 .630 B ::<l
...;
35 Missouri 12/80 4,787 718 222 .464 B -<
:;>;:I
36 Alabama 4/82 3,665 402 157 .428 B ~
Florida 8,421 1,342 614 ~
37 6/82 .729 B OJ
c::
TOTALFOC: ::<l
<J>
37 187,019 41,175 22,872 1.223
87.1% of 87.8% of 90.5% of
'"~
National 214,659 46,891 25,267 1.177
'"...;Z
Total Non-FOC 27,640 5,716 2,395 .866
'Unduplicated, state resident, licensed/certified for independent practice as of 12/76 per National Register Report #2, 3/4/77.
·Unless otherwise specified, statute applies only to disability (health) insurance policies under the Insurance Code.
'Hawaii Health Care Act; universal coverage, negotiated inclusion.
M = Mental health coverage mandatory; (M): must be provided if requested by the insured group; psychologists recognized for reimbursement. B = Specific language
providing for coverage of Blue Shield contracts; (B): included by negotiation. OS = Specific language requiring recognition of psychological services for state residents under
policies issued out of state. WC = Specific language providing for coverage under Worker's Compensation Plans; (WC): negotiated inclusion in state fund. F = PL 93-363
applies to all Federal Employee Health Plans. F = PL 93-416 applies to federal work injuries compensation.
tv
'I
'"
268 HERBERT DORKEN
erage that is mandatory and whether psychologists are included it is nec-

essary to know the state law.
Still another avenue is possible. While National Health Insurance con-
tinues to be widely debated, five states (Connecticut, Hawaii, Maine, Rhode
Island, and Minnesota) had enacted comprehensive health insurance laws
by the end of 1976. In two of these states (Maine and Rhode Island) the
plans essentially are designed to assure coverage only when personal health
expenditures reach "catastrophic" levels. To date, only Hawaii through the
Hawaii Health Care Act, mandates health insurance coverage for all
employees and their dependents. Psychologists are recognized. Again,
when such bills are being advanced in state legislatures, psychologists must
take steps to be included, otherwise they will likely find that their services
are not a necessary part of the services to be available under these laws.
STATE PLANS
Sovereignty in certain jurisdictions is accorded to the states. This

includes the licensing of health profeSSionals; the regulation of health, life,
disability, liability, and casualty insurance; and the licensing of health facil-
ities. Thus, health insurance, health service plans, and workers' compensa-
tion insurance must comply with state law in order to be purchasable in the
state.
COMMERCIAL CARRIERS
The health insurance market is complex. It is complex not only because

there are literally hundreds of insurance companies underwriting health
insurance, but also because each group plan is tailored to the needs/wants
and ability to pay of the group. While the commercial carriers can offer a
package such as health-life-disability insurance, health service plans, such
as Blue Shield, can offer only health insurance. Blue Shield policies, how-
ever, are not subject to state tax or generally to a lesser tax when written as
health service plans that provide at least a compensating competitive
advantage. In some jurisdictions, generally under somewhat different titles,
however, Blue Shield also may underwrite as a commercial insurance car-
rier. A small number of companies, collectively, underwrite the majority of
the health insurance sold by the industry, with Aetna, Travelers, Metro-
politan, and Prudential having the largest premium volume (U.S. Depart-
ment of Health, Education & Welfare, 1976b).
To complicate matters further, the disability /health insurance plans of
the insurance industry, as well as the health service plans of Blue Shield
and the hospital service plans of Blue Cross, depending upon the state, well
may fall under different sections of the state code or different codes; for
example, the Insurance, Health and Safety, Labor, Business and Professions
codes, to use California as an example. HMOs and Individual Practice Asso-

ciations (IPAs) may fall under the same statutory provisions as Blue Shield,
but not necessarily. Finally, there are the self-insured employee welfare
benefit plans, also generally regulated by state law, as found in some union
groups, some government systems, and some industries (see "Self-
Insureds" below). Fraternal benefit organizations also can be self-insured
groups or they may purchase a group health plan.
The health insurance policies of the industry essentially indemnify
against loss, that is medical and other health care expenditures. These pol-
icies typically carry dollar limits, day limits and deductibles, and co-insur-
ance. While in the past most policies were exclusively or predominantly
hospital oriented, the newer comprehensive plans tend to make no distinc-
tion in locus of care. So long as it is a covered benefit and the subscriber
has accumulated expenses exceeding the deductible, the plan reimburses
but typically with a co-payment requirement of say 20% for the first several
thousand dollars of expenses. After that, coverage is 100% to the plan limit.
While there often are special limits placed on mental or dental care and
routine check-ups may be excluded, these plans generally make no distinc-
tion regarding the type of expense, whether office visit, drugs, lab tests, etc.
On patient authorization, providers can be reimbursed directly (minus the
deductible and co-insurance that the subscriber must pay to the provider).
Although there may be some limitations on coverage of provider ser-
vices, depending upon the location of the care, that is, whether provided
in the hospital, office, or home, coverage typically is worldwide, in contrast
to HMOs. Moreover, for those in low risk occupations or groups or in
employee groups that generally have better than average health status, such
as university faculty, the plan premium can be underwritten on the basis of
such favorable experience and expectancy (experience related), yielding a
premium cost that can be highly competitive. Plans that are community
rated have a uniform premium for all persons who enroll in the community
with the risk/cost averaged out.
THE BLUES
While Blue Cross traditionally covered the hospital component and

Blue Shield the providers, in most jurisdictions each is authorized to pro-
vide the entire coverage.
Each of the Blue Shield plans, while separate entities, can collaborate
on a national account plan, such as that for federal employees or the United
Auto Workers. Since the federal employee's direct access to psychologists is
based on law, this is honored across the country. The UAW master plan
only recognizes psychological services following medical referral and
under medical prescription. Some Blue Shield plans, however, having
accepted psychologists as independent providers in their regular book of
business, continue to do so in national accounts despite medical oversight
270 HERBERT DORKEN
conditions such as that for UAW. In 1978, 50 of the 69 Blue Shield plans
provided reimbursement for psychologists; it was mandated by law in 32
states (37 by 1982). As for physician involvement, 28 plans have no such
requirement, 11 require M.D. referral, 8 require M.D. supervision, and 3
require both referral and supervision. Fourteen of the plans have partici-
pating provider agreements with psychologists. The details are available
only by direct inquiry to each plan. It becomes essential to know the broad
plan policies regarding psychologists and then the specifics of subscriber /
member group or individual policy coverage.
Some of the Blue Shield policies provide a different rate of reimburse-
ment depending upon the profession of the provider; others make no dis-
tinction between psychiatrist or psychologist and simply aggregate the fee
screen data by procedure rather than by profession. In large states, it is com-
mon to find that usual fees vary among the PSRO areas of the state and
among procedures. Plans that offer participating provider agreements can
insist upon standards that are higher than simply licensure. Blue Shield of
California, for example, requires in addition to licensure that the
psychologist
hold an earned doctoral degree in psychology from an accredited university or
professional school and have had at least two years of clinical experience in a
recognized health setting, or [is] listed in the National Register of Health Service
Providers in Psychology.
As of this time, the Blues underwrite health insurance coverage for 84

million people, or 47% of all insured Americans. With demand set largely
by the supplier, these plans appear to have some immunity from competi-
tion (Boroson, 1974). Another perspective on the goliath status of the Blues
in prepaid health care is the extent of their coverage. In 1978,69 Blue Cross
plans covered 83 million subscribers for hospital care. Blue Shield, with 70
plans, insured about 70 million people for medical/health services.
Together, the Blues accounted for $17.3 billion of the $39.4 billion of sub-
scriptions or premium revenues collected by private health insurers in that
year. In January 1978, the two Blues began a process of consolidation that
is not yet complete. The Federal Trade Commission is beginning to express
some reservations that with Blue Shield largely a spin-off of the state med-
ical association the plans well may be anticompetitive if they favor reim-
bursement of M.D.s over other professionals.
HEALTH MAINTENANCE ORGANIZATIONS
As defined in federal law (PL 93-222) an HMO provides basic and sup-
plemental health services to its members for which they prepay a fixed,
community rated, payment. The services, within defined benefits, are pro-
vided through members of the staff as needed and unrelated to the prepay-
ment. The organization assumes full financial risk on a prospective basis.
An individual practice association (IPA) is a partnership, corporation, or

association that has a service arrangement with various licensed health
practitioners, the majority of whom are licensed to practice medicine or
osteopathy. Cast in less legal terminology, an HMO is an organized system
that provides comprehensive hospial, medical, and other health care ser-
vices to individuals and groups who voluntarily agree to obtain their health
care for a fixed sum of money paid in advance each month. There are two
types of HMOs. A closed panel HMO is composed of salaried physicians
and other health professionals jOined together under the same roof to pro-
vide health care. An open panel HMO, or IPA, combines prepayment with
solo practice and the individual fee for the service system. It is a federation
of practitioners utilizing existing facilities within a community. The IPAs
often are the county medical society's answer to the closed panel HMOs
that are spreading rapidly in the west (Dorken, 1978; Egdahl, 1979).
Although the Kaiser Permanente Medical Care program often is con-
sidered the prototype HMO and now serves three million enrollees in six
states, it began as a plan for Kaiser construction workers in 1938, but was
preceded by Ross-Loos in the late twenties, also in the Los Angeles region.
Nationally, HMO enrollment reached eight to nine million by the begin-
ning of 1980 and appears to be growing rapidly. There are now five west
cost urban areas where the HMO member penetration exceeds 18% of all
potential enrollees (Los Angeles, 19.5%; San Francisco, 32%; Sacramento,
27%; Seattle, 18%; and Portland, 24.5%). The Kaiser plan opened in Sacra-
mento about 15 years ago and now over 25% of all potential users are sub-
scribers. Area fee service practitioners have joined together to form a com-
peting IPA. Since these HMOs go to companies and major employers, offer
attractive plans, and have the resources to provide comprehensive health
care, they quite rapidly can "dry up" the source of private patients. Across
the country there were 217 HMOs in early 1979, with 235 expected by the
end of the year. Extensive federal and private capital is flowing into the
development of HMOs and IP As.
Since the law requires that all employers of 25 or more persons must,
if they provide health insurance for employees, offer a federally qualified
HMO/IPA health plan as an option if one is available in the community,
there is clear statutory pressure for the development of these plans. To be
a party to the action may require becoming a member or associate member
of the IPA or a participating provider. While being a participating provider
should increase subscriber flow from the plan, participation also involves
accepting plan fees as payment in full, short of any deductibles or co-insur-
ance. It also involves being "at risk." Depending upon the IPA, some 10 to
20% is withheld from the reimbursement for each service with this
"escrow" balance distributed at year-end in accord with the plan experi-
ence. All claims generally are subject to peer review and a serious effort is
made to control overutilization and unnecessary utilization. Since services
are paid on a prepaid basis, it follows that this is the sole revenue to support
services provided, hence the "at risk" situation. There tends, however, to
272 HERBERT DORKEN
be less required in the way of claim form information. In closed panel

HMOs, operating on a capitation basis, claim forms simply are not required.
The providers are salaried, the HMO owns its own facilities, the health plan
is prepaid by the subscriber, the subscriber is entitled to specified benefits,
these services are rendered by HMO practitioners in HMO facilities. There
is then no claim and no third-party reimbursement in the process. Funding
is by capitation, that is, each subscriber's premium. While HMOs, though
popularly known to care for subscribers, often will serve walk-ins and
. referrals on a fee-service basis, including inpatient services.
If there are any trends, it is first toward a clear increase in HMO and
IPA penetration. Second, persons of higher incomes and fewer children,
with less need perhaps for ambulatory walk-in care and a dislike of assem-
bly-line medicine, tend to switch to the comprehensive indemnity benefit
plans that are not restricted to a community area (as an HMO) though car-
rying deductibles and co-insurance. It becomes an economic decision
according to one's situation and preferences. Any major consumer shift in
any year will affect the extent to which psychological services will be reim-
bursed. For example, at the University of California, San Francisco Campus,
there are three options: the comprehensive Blue Cross policy for a family
at $150.90 monthly; the Kaiser of Northern California (an HMO) at $92.96;
and the Equitable Comprehensive Plan-an indemnity plan of the Equita-
ble Life Assurance Society (a commercial insurance carrier) at $92.04. The
University allows/covers up to $102 per month which pays the entire pre-
mium except for the Blue Cross policy which requires an employee contri-
bution of $48.90. Such a premium range could well be a factor in consumer
choice.
SELF-INSUREDS
Large companies not in high risk work may well find it attractive to be
self-insured. They can purchase administrative services only (ASO) from
insurance companies and/or "stop-loss" or high-deductible policies, for
example, where the insurance plan pays only when an individual's health
care expenses have exceeded or cost the company more than $5,000 in the
year. The Employee Retirement Income Security Act (ERISA, PL 93-406),
passed in 1974, preempts state law regarding employee welfare benefit
plans. Thus, state regulation no longer prevails and since there is little in
the way of federal regulation to· date regarding health insurance, group
health plans that are employer "established or maintained" or by an
employee organization are for practical purposes deregulated.
This federal law is focused largely on pension plans and possible
abuses, but both management and labor generally appear to support the
deregulation of group health insurance. Recent court decisions in New
Hampshire and Massachusetts suggest that mandatory mental health insur-
ance laws may have some immunity to ERISA's state preemption. On the
other hand, court decisions in California won by Standard Oil and Hewlett-
Packard make it clear that self-insureds, which these companies are, no

longer are subject to the jurisdiction of the state insurance commissioner. It
is small comfort to note that the employer-provided group health plan has
not yet been challenged in court. A closer reading of the ERISA law indi-
cates that it has the potential to overturn or set aside all state "freedom of
choice" or direct recognition laws, unless amended. At this point, however,
while state law cannot regulate an ERISA registered health plan directly, if
the employer purchases a plan, the insurer can be regulated.
WORKER'S COMPENSATION
Worker's Compensation plans, although generally not viewed as

health insurance, are casualty /liability insurance. In fact, they insure com-
prehensively in most states, not just for X visits, but typically for all nec-
essary medical care. Benefit coordination, that is, nonduplication with
health insurance, is standard practice, with health plans excluding coverage
for benefits payable from Worker's Compensation. The American Insurance
Association in New York City represents 150 stock companies in this field,
while the American Mutual Insurance Alliance in Chicago (The Alliance)
represents some 104 mutual companies. This is a very major market with
over $1 billion paid in medical and rehabilitation expenses in 1970. Indeed,
it appears to be growing more rapidly than the health insurance market.
Premiums written in California alone exceeded $1.5 billion in 1976. In addi-
tion to liability carriers authorized to underwrite in a state, some states have
a state compensation fund and others recognize self-insureds. Details by
state are reviewed in Darken (1979). In states recognizing private carriers,
a small number typically underwrite the majority of the coverage. For
example, of the 233 companies licensed to underwrite Worker's Compen-
sation coverage in California, 15 earned 62.5% of all the premiums under-
written by these companies. In this respect, it is like accident and health
insurance where the 10 largest commercial carriers in California issued
56.6% of coverage by 531 carriers in 1976.
Given the size of this market and the extent of services that are needed
to evaluate disability, provide restorative or rehabilitation services, and deal
effectively with the psychological aspects of job injury, dismemberment,
sensory loss, and cumulative stress, it is remarkable that psychology has
shown so little interest in this field. Only two states have recognized psy-
chological services under law regulating Worker's Compensation, Montana
in 1971 and California in 1978. In Ohio, psychologists negotiated recogni-
tion in the state compensation fund in 1974. Federally, PL 93-416 took effect
in 1975, amending the Federal Employee Compensation Act relating to
work injuries compensation for federal employees and recognizing "clinical
psychologists." The federal government is a self-insured for these services.
While statutory recognition is obviously preferable, select psycholo-
gists across the country have been active in the fields of industrial rehabil-
274 HERBERT OORKEN
itation, disability evaluation, and other services to job-injured employees

under Worker's Compensation by referral from carriers, employers, and
physicians. The practice of psychology is a professional business. If you
want business, you probably will have to exercise some initiative. There is
really no reason why it should just come to you. The first claim is the most
difficult. Before reimbursement is accorded, you first must be recognized as
a provider. Once this qualification is achieved, and not until then, claims
are processed on their merit. Perhaps the best way to "break the ice" is to
acquire a referral for some necessary service for which you have special
expertise that is not widely available; for example, skill in the use of operant
techniques for pain control. In the Department of Physical Rehabilitation
at Kaiser, Northern California, they learned that with prior psychological
consultation the frequency of back surgery could be sharply reduced. Word
of success like that has a way of traveling in local industry.
HOSPITAL PRACTICE
Direct recognition legislation is service rather than setting oriented.

With the exception of PL 93-416 and a few others, these laws are silent on
locus of care. In general, the preponderance of psychological practice is
office based. It is probably true, however, that the limited extent of hospital
practice by psychologists is not simply a matter of preference but reflects
the restrictions (Dorken & Webb, 1979a) on membership in the medical staff
and clinical privileges in the by-laws of many hospitals.
Even for those who seldom practice in a hospital, their importance is
that they are the hub or nucleus of health care delivery. Without hospital
access, continuity of care cannot be provided in some cases. Moreover, it is
a setting where collegiality among health professionals is established, infor-
malliasons develop, and referrals emanate. This is especially true for psy-
chologist practitioners engaged in health as distinct from mental health
care. Desirable or not, it is worth noting that health insurance benefits typ-
ically are weighted to greater coverage for in-hospital services, often with
lower co-insurance requirements and fewer restrictions on visits. As prac-
titioners begin to branch out from ambulatory care for minor mental dis-
orders, the reality is that they will have to develop effective working rela-
tionships with practitioners of other health disciplines, referring to them
and receiving referrals from them.
PRACTICE TRENDS
It is becoming increasingly clear that the market for psychological prac-

tice is by far broader in health care than simply in mental health care. While
this presents new opportunities, it obliges alliances with the medical com-
munity. Some of the newer treatment models developed by psychology,
such as biofeedback and the behavior therapies, have clearly proven effec-
tive with specific health problems.
It is also becoming clear not only from the HMO law but from the man-
dated adoption of the Professional Standards Review Organization amend-
ments to the Social Security Act and the oversight provided in the National
Health Planning and Resources Development Act of 1974 (PL 93-641) that
we are moving increasingly toward organized models of health services. In
effect, health care is becoming industrialized in the full sense of the
analogy.
IMPACT, OFFSET, AND ACE
From the pioneering studies of Follette and Cummings (1967) at Kaiser

Permanente in San Francisco (where psychologists are the backbone of the
mental health services), more than 25 studies claim to show that mental
health services reduce overall health care utilization. Most of the studies
have been reviewed in a summary report by Jones and Vischi (1979). Since
many were completed in organized systems, such as HMOs or industrial
corporations, general skepticism remains in the insurance industry as to
whether such findings really could be obtained in open fee-for-service prac-
tice. Blue Shield of Western Pennsylvania has, however, studied the recip-
ients of outpatient mental health services in its plan and found, comparable
to the organized model reports, a 30% reduction in medical utilization.
Graves and Hastrup (unpublished) also report a comparable impact of psy-
chological intervention upon medical utilization in children and adoles-
cents of low income, largely minority, families in a fully subsidized service.
While there are several reports that provide aggregate data on services
delivered by psychologists and psychiatrists, such as the CHAMPVS (Dar-
ken, 1980) and Federal Employee Blue Cross-Blue Shield program (Von
Korff & Kramer, 1979) no data showing the offset of one profession's activ-
ities upon the other appears to be available in the literature. Thus, the
report of the Hawaii Medical Service Association (Blue Shield) for 1977 is
of special interest. Against a fixed $500 outpatient psychiatric benefit limit,
with HMSA paying 75% of VCR charges, they found that 56% of cases were
seen by psychiatrists, 40% by psychologists, but only 4% by both. For 1978,
41 % of visits were to psychologists solely; only 3.3% to both. In effect, then,
such visits to a psychiatrist largely preclude visits to a psychologist and vice
versa. Access to both probably increases utilization slightly if only because
more practitioners are available (overall utilization was only 1.2% (1.36%,
1978) of eligible beneficiaries), but the use of one profeSSion largely offsets
the potential for use of the other. This illustrates rather dramatically the
economic competition that will occur when the consumer has equal access. l
1 Personal communication of Bernard A. K. S. Ho, Vice-President of Professional Relations to

Mr. Jay B. Constantine, U.S. Senate Committee on Finance, January 11, 1979.
276 HERBERT DORKEN
Incidentally, since the psychologist's fee was approximately $5 less, the con-
sumer could have about two more visits before the fiscal maximum was
reached. Those seeing only a psychiatrist or psychologist, however, aver-
aged only 7.3 visits. Again, though the data are rare, the economic compe-
tition is everyday reality and can dramatically affect a practitioner's reim-
bursement experiece. The development of working collegial relations with
general medicine and certain non psychiatric specialties seems the most
effective way in which to increase referrals.
With advancing age, use of health care resources increases. In 1975,
while those aged 65 and over were 10% of the population (now almost
11%), they consumed 29.4% of health expenditures. Stated otherwise, while
the national per capita health expenditure was $476, for those 65 and over
it was $1,360 per person (Mueller & Gibson, 1976). While Medicare alone
paid 72% of their hospital bill, there are mounting indications of over-hos-
pitalization and remarkably little use of community mental health and
other ambulatory mental health services. This is a practice area in clear need
of greater attention from the profession to assure inclusion under Medicare
(see above).
CHANGING PRACTICE
While private practice psychologists were reported to account for but

.8% of the direct care expenditures for the "mentally ill" in 1974 (Levine &
Willner, 1976) there are indications of their increasing representation and
involvement in private practice (Dorken & Webb, 1979b, 1981). Indeed,
where Gottfredson and Dyer (1978) found that 20.7% of licensed APA mem-
bers were in full-time private practice, Dorken and Webb found that a com-
parable proportion of licensed psychologists in 10 states were full-time
practitioners. This represents a dramatic practice increase in a short span of
years. Indeed, psychologists were recently described by Dorken (1977a) as
being unique among the health professions in the number of part-time
practitioners, licensed and capable of redirecting substantial amounts of
time to practice, given favorable conditions. This increased practice
involvement, while it may help to establish psychologists more firmly as
providers with third parties, results in some measure of added competition
to providers already in the field.
This increasing growth of practice will oblige psychologists gradually
to become more businesslike in their practice and to improve and maximize
cash flow, optimize collections, and minimize taxes. The day of solo practice
may well be coming to an end (DeLeon, 1977) inasmuch as solo practition-
ers cannot contract to provide comprehensive services (see HMOs and S"elf-
Insureds, above). Professional incorporation is likely to increase (Harsham,
1973) for the inherent tax advantages. As assignment and participating con-
tracts increase, direct collection from patients will decline as will their
expectations to have to pay directly. Perhaps it is the economics of scale that
has prompted the progressive increase of fee-service psychologist practi-

tioners (Dorken & Webb, 1979b, 1981).
Reimbursement difficulties as they occur are difficult to handle in iso-
lation. Some state psychological associations have set up information clear-
inghouses. In addition to assembling information on plans and programs,
the Division of Clinical and Professional Psychology of the California State
Psychological Association, maintains a Reimbursement Office to assemble
information on claim problems and to address them collectively. This expe-
rience has been assembled in a handbook (Hochberg & Stunden, 1979).
What resources does psychology now bring to this arena? Projecting
from the growth in licensed psychologists in 10 target survey states from
1976 to 1979 and national growth from 1974 to 1976, Dorken and Webb
(1981) conclude that there were about 35,225 licensed psychologists in the
United States in 1980. Within their 10 survey states, 76% were active as
health service providers while 91% had a doctoral degree. Thus, projecting
again one can estimate that as of 1980 there were 24,400 doctoral level,
licensed psychologists actively engaged in health care, some 22,200 of
whom are involved to some extent in fee for service practice.
REFERENCES
Biofeedback in action. World Medical News 1973 47-60, March 9.

BLK Group, The. Survey of clinical psychologists receiving payments under Title XIX of the
Social Security Act: Draft Final Report to National Institute of Mental Health. Contract
No. ADM-42-74-74.
Bodenheimer, T. The hoax of national health insurance. American Journal of Public Health,
1972, 62, 1324-1327.
Boronson, W. Diagnosing your health insurance. Money, 1974, 3, 39-51.
California Business and Professions Code, Chapter 6.6 (commencing with Section 2900, as
amended through 1979).
DeLeon, P. H. Implications of national health policies for professional psychology. Profes-
Dorken, H. Laws, regulations and psychological practice. In H. Dorken and Associates, The
professional psychologist today. San Francisco: Jossey-Bass, 1976.
Dorken, H. The practicing psychologist: A growing force in private sector health care deliv-
ery. Professional Psychology, 1977, 8, 269-274. (a)
Dorken, H. CHAMPUS ten state claim experience for mental disorder: Fiscal year 1975. In C.
Kiesler, M. Cummings, &. G. VandenBos (Eds.), Psychology in national health insurance: A
sourcebook. American Psychological Association, Washington, D.C.:1977.(b)
Dorken, H. Foundations for medical care. Professional Psychology, 1978, 8, 175-7.
Dorken, H. Worker's Compensation: Opening up a major market for psychological practice.
Professional Psychology, 1979, 10,834-840.
Dorken, H. Perspectives in national health insurance and rehabilitation. In E. Pan, T. Backer,
&. C. Vash (Eds.), Annual review of rehabilitation (VoU). New York: Springer, 1980.
Dorken, H., &. Webb, J. The hospital practice of psychology: An interstate comparison. Profes-
sional Psychology, 1979, 10, 619-630.(a)
Dorken, H., &. Webb, J. Licensed psychologists in health care: A survey of their practices. In
C. Kiesler, N. Cummings, &. G. VandenBos, (Eds.), Psychology and national health insurance:
A sourcebook. Washington, D.C.: American Psychological Association, 1979.(b)
278 HERBERT DORKEN
Dorken, H., &: Webb, J. 1976 Third-party reimbursement experience: An interstate compari-
son by carrier. American Psychologist, 1980, 35, 355- 363.
Dorken, H., &: Webb, J. Licensed psychologists on the increase: 1974-79. American Psychologist,
1981,36,1419-1426.
Egdahl, R, et al. Fee for service health maintenance organizations. Journal of the American
Medical Association, 1979, 241, 588-591.
Follette, W., &: Cummings, N. Psychiatric services and medical utilization in a prepaid health
plan setting. Medical Care, 1967,5,25-35.
GLS Associates. Analysis of state programs which mandate mental health benefits under pri-
vate health insurance. Final Report, June 29, 1979. NIMH #278-78-0040 (MH).
Gottfredson, G., &: Dyer, S. Health service providers in psychology. American Psychologist,
1978,33,314-338.
Grinker, R. Foreword. In B. Garger, Follow-up study of hospitalized adolescents. New York: Brun-
ner/Mazel,1972.
Hannings, R, et al. Forensic psychology in disability adjudication: A decade of experience.
HEW Publication No. 72-10284, Washington, D.C.
Harsham, P. What, me incorporate? Money, 1973, 2, 55-58.
Hochberg, R, &: Stunden, A. Psychology and compensation: A reimbursement handbook for
California licensed psychologists. Los Angeles: Division of Clinical and Professional
Psychology, California State Psychological Association, 1979.
Jones, K., &: Vischi, T. Impact of alcohol, drug abuse, and mental health treatment on medical
utilization: A review of the research literature. Medical Care, December 1979, 17, Supple-
ment, pp. 1-82.
Kristein, M., et al. Health economics and preventative care. Science, 1977, 195,457-461.
Levine, D., &: Willner, S. The cost of mental illness, 1974 Mental Health Statistical Note No.
125, February 1976. DHEW Publication No. (ADM) 76-158.
Markus, G., &: O'Sullivan, J. Medicare-Medicaid. Congressional Research Service, Library of
Congress, September 28,1977.
Moore v. Metropolitan. New York State Psychologist, 1974, 26,4. Also published as Insurance
Law upheld, New York State Psychologist, 1973, 25, 1 and 11.
Mueller, M., &: Gibson, R Age differences in health care spending. Fiscal year 1975. Social
Security Administration, DHEW Publication No. (SSA) 76-11700.
National Register of Health Service Providers in Psychology. Washington, D.C.: Council for the
National Register of Health Service Providers in Psychology, 1978.
U.S. Department of Health, Education &: Welfare, Rehabilitation Services Administration,
Final report on characteristics of clients rehabilitated during fiscal year 1974. Informa-
tion memo No. RSA-IM-76-87. Washington, D.C., 1976.(a)
u.s. Department of Health, Education &: Welfare, Social Security Administration Staff Paper
No. 21, Health Insurance Administrative Costs, DHEW Publication No. (SSA) 76-11856,
1976.(b)
Virginia Academy of Clinical Psychologists v. Blue Shield of Virginia, U.s. Court of Appeals, 4th
Circuit, No. 79-1345, Brief of American Psychological Association as Amicus Curiae,
1979.
Von Korff, M., &: Kramer, M. Mental and nervous disorders utilization and cost survey.
National Institute of Mental Health, 1979, Mimeograph.
Wiggins, J. Disability and rehabilitation services. In H. Dorken and Associates, The profes-
sional psychologist today. San Francisco: Jossey-Bass, 1976.
Appendix A
CHAMPUSICHAMPVA CLAIM FORM

For services or supplies proVided by civilian sources except Institutions
_ _ _ _._IIIe_kolt.... tonn_.. ............... _ ........ '
_ _ _ 1 _ 1 8 I O b e . . . . . . . - b I I l h o _ c l o o y l........ or_.1
1 PATI£NiSNAMEllMIn_ FlfSlname Mddlt"'~III) 2 PATENTSDATEOFBlRlM T SPONSOR"SNAME(Lulname.Fntname.Mdc* .....'
MONTH I DAY YEAR
3 PATIENTSAOOAESSfS1reet c:ttv SIaI8 ZlPcode) .. PA'1'ENTSSEX 8 SPONSOR'SSOClA.lSECURITYNO QRVAFlLENO p~ VA STATION NO

o MALE 0 FEMALE I
6 PATIENT'S RELATIONSHIP TO 10 SPONSOA'SDUTYSTATtONORNlORESSFORRETlRE£S
SI'ONSOR
f.:-"'""'."rr"''!=:S:'''::''=·~==~':''"'1lON;c.I''CARIl=~---------I BAOOF'TrOCHILD
~rURALOf 8 =~1lD
CARD NO OTHER (Specify)
~g~~~~~~~--rE~~~~-,~~;-lfx=~~~~~--t:~,,""5YE-::6"'S~=D=Di::::\",=,:----I~o:;:~~~=:a~ •1" 5I'ONSOIfS~

14 DOVOU HAVEOTHEfHtEALTH INSURANCE? a YES 0 NO M1LITARV SERVCE RELATED? 0 USA 0 USAF 0 USMC 0 USN
IFYES.ENTEANAMEOFOTHERPt.ANOR~OGRAM 0 YES OND OUS::60USPHS OHaM OVA
~~~~Il~ACCIDENT RELATIO? 1-:,:-,-="""""'==.S",,:::.=1\JS=c-----"----------I

o ACn\'E DUTY 0 RETIRED o DECEASED
16 INPATIENT,()UTPATlENTCARE
~~ ____________________ ~.!.~l!. _________ ~! _____

o OUTPAT£NT 0 INPATIENT-EMERGENCY 0 INPATlENTH09PrTAl-OUTSllE40MUFWlUS
0 INPATENT-SKfUEONURSlNGFACILITY 0 INPATENT-oTHER
'''' TYPE OF COVERAGE 0 INPATIENT HOSPITAL_WITHIN 4OMIt..E flADUS !ATTACH 00 FORM 1251)
o EMPLOYMENT (GRoup) 0 MEDICAID 0 STUDENT f'I..AN 17 OESCR&: CONDITION FOR WHCH YOU RECEIVED TREATMENT 1FC::""'OOW=RY=.7.NO:::"=-"""=C:""'''''''''''=NEO=---i
RELATIONSHIP
SIGNED DATE TOPATIENJ
_ 1 _ _ ( _ 18 1I>rougIISS ... 10 be comploled blithe phyIIclOn ., _ _ _.)
1. NAME.~&PHONENO OFFEFEMINOPHYSCIAN 20 NAME .. ADDRESS Of FACILITY Wl-£RE SEftVICES ~ lOIher tt.I home Of ofIIce)
o PI'I.....ATE PRACTICE or
0 UNIFOAMEO SERVICES
g~:ING
21 .~O~~S 122 HOSPfTAUZATIONINRlAMATION 123 L.A8WOAKOOTSIDEYOUROFFCE?
PHYSICIAN 1AOMITfED Me I DAY I YEAR DISCHARGED MO I DAY IYEAR I 0 YES D NO CHARGES
24 ~IAGNOSIS, SYMPTOM OR NATURE OF ILLNESS OR INJURY, Fl:LATE OIAGNOSlS TO IIROCEOURE IN COLUMN ·'0"" BY FEFERENCE TO NUMBERS 1.2. 3 or Ox CODE
a-
Z
25 A OATfSOFSERVICE C
PROCeDURE COOE F
MOOAYfY!AR ODENTIFY 'CHAIIGES
21 PATIENTS N:COUNT NO 29 PHYSICIANS OR OTHER PRQ\IIOER·S NAME ADDRESS. ZIP G TOTAL CHARGES
r;cOE .. PHONE NO (INCLUDING AREA CODE)
PHD 3~ P DC o~r~:6:20 32 AGREEMEPfT TO PARTICIPATE (READ BACK OF THIS FOAM)

"'"7·PROVIle=",","';;;SOC=~r.L·sec"'\IR=I1Y"'NO"'-~ Dvfn;£~i ~1F.f~hERr (j PH)) DVES DNO
33 SIGNA TI.JRE OF PH'I"$4CIAN OR OTHEFI PROVIDER (READ BACK OF
=OYER=,"O"NQ;;--1
"..;;-;;""'=Y1OEJI=.;;;."'...... ~~~: F~!~~I~~;~J~~ 941'2
THIS FORM B£FORf SIGNING I
mOYlDERNO SKlNEll DATE

"PLACE OF SERVICE COOES
1_(!H) _INPATIENTHOSPITAl 4 _ (H) - PATIENT·S HOME 7 - (NH) _ NURSING HOME A. -- Ill)- INDEPENDENT ~TORY
2 -101-1)- OUWATENT HOSPITAL 5 _ (OCFJ - O,f,.Y CARE FACILITY (f'SYl 11- (SNF) - S!<.IUEO NURSING FACILITV B - (OF) - OTHER MEDCAUSUAGCAL FACILITY
3 _ (0) - DOCTOR·S OFFICE 6 - (NCFI - NIGHT CARE FACILITY (P$Y) g -(AMB)-AMBULAM::E C - (RTC)- RESIDENTIAl. TREATMENT CENTER
O-COL) -OTHEflLOCATIONS 0 - (STf) - SPECIALIZED TREATMENT FAClllT'!"
CHAMPUS FORM SOO JUNE 1978
279
280 HERBERT DORKEN
PRIVACY ACT BENEFICIARY/PATIENT CERTIFlCATlON-

DATA REOUIRED BY THE PRIVACY ACT OF 1974: Legal author- ITEM 18
Ity for the personal Information, Including the Social Security By signing Item 18 of this CHAMPUS/CHAMPVA Claim Form 500,
Number, required on this Formis44 USC3101, 41 CFR 101 et I cerMy that to the best of my knowledge and belief the Informa-
seq., and 10 USC 1079 and 1086 The principal purpose ollhls tion prOVIded In Items 1 through 17 IS complete and correct I
information IS to evaluate eligibility for civilian health benefits au- further authorize the release of any medical information neces-
thor,zed by 10 USC Cnapter 55 and to Issue payment upon sary to adjudicate and process thiS claim to the Federal Govern-
establishment of eligibility and determination that the medical ment Incrudlng the CHAMPUS Contractor I also authorize the
care received IS authOrized by law. The information is subject to release of, or obtaining of, medical and/or other coverage infor-
venflcatlon With the appropriate Uniformed Service. mation to and from another organization with which I have the
The Office of the CIVilian Health and Medical Program of the other medical benefits plan or health insurance coverage.
Uniformed Services and CHAMPUS Contractors use the Informa- II I am submitting thiS claim for dIrect reimbursement to me, my
tion to control and process medical claims fOf payment, for con- signature further certifies that the speCific medical services/
trol and approval of medical treatments and Interface with pro- supplies for which I am claiming benefits were actually rendered
viders of medical care; to control and accomplish reviews of to me on the dates Indicated and that the attached Itemized
utilizallon; for review of claims related to possible third party liabil- statement represents a legal obligation to pay
Ity cases and initiation of recovery actIOns; for referral to Peer (Note· The above IS also certified if Item 181s Signed by the
Review Committees or Similar professional review organizatIOns sponsor, other parent or guardian.)
to control and review providers medical care; for disclosure to
third party contacts. without the consent of the individual to whom
the information pertains, In situations where the party to be con- PROVIDER PARTICIPATION -ITEM 32
tacted has, or IS expected to have, Information necessary to es- By checking "Yes" In Item 32 (and signing In Item 33) of the
tablish the validity of evidence or to verify the accuracy of Infor- CHAMPUS/CHAMPVA claim form, I agree to submit thiS claim to
mation presented by the IndiVidual concerning the indiVidual's the appropriate CHAMPUS contractor as a participating pro-
eligiblhty for benefits under CHAMPUStCHAMPVA, the amount of Vider I understand that I agree to accept the CHAMPUS-
beneftt payments, any review of suspected abuse or fraud, or determined reasonable charge as the total charge for medical
any concern for program integrity or quality appraisal; for the services/supplies listed on the claim form I will accept the
Issuance of deductible certificates, to respond to Inqulfles from CHAMPUS·determlned reasonable charge even If it IS less than
Congressional offices made at the request of the IndiVidual the billed amount, and also agree to accept the amount paid by
covered by the system, tor referral to the Secretary of the De- CHAMPUS, combined with the cost-shared amount and deduc-
partment of Health, Education and Welfare and/or to the AdmlnlS- tIble, If any, paid by or on behalf of the beneficiary/patient, as full
tralor of the Veteran's Administrallon consistent With their statu- payment for the medical services/supplies I will make no attempt
tory administrative responsibilities under CHAMPUS/CHAMPVA; to collect from the beneftclary/patlent (or sponsor) amounts over
for referral 10 the Department of Justice and/or foreign law en- the CHAMPUS-determined reasonable c~large CHAMPUS
forcement agencies for Investigation and pOSSible cnmlnal pros- agrees to make any benefits payable directly to me, If I submit a
ecution, and, for referral to the Department of Justice for repre- claim as a participating prOVider
sentallon of the Secretary of Defense In CIVil actIOns
(Any alteration of this statement by the prOVider may result in the
The information must be prOVided if the benefiCiary/patient (or claim being returned or processed as a non-partiCIpating claim
sponsor) deslfes to have a portion of the charges paid by the With payment made to the beneficiary )
government. Failure to prOVide informatIon Will result in denial of
or delay In payment of the claim. PROVIDER CERTIFICATION - ITEM 33
PATIENT/SPONSOR INFORMATION By Signing Item 33 of thiS CHAMPUS/CHAMPVA Claim Form 500,
I certify that the specific medical services/supplies listed on this
(ITEMS 1-18) form were, In fact. rendered to the speCific beneficiary/patient for
Items 1 through 18 must be completed and the certificate signed which beneftts are being claimed; were rendered or prOVided on
by the benefiCIary/patient If he/she is 18 years of age or older. If the speCifiC date(s) indicated; and that except for any amounts
the beneficiary/patient IS unable to Sign on his/her own behalf, shown in ttems 30 and 31, no payment has been received
reter to the special booklet, "How to Complete CHAMPUSf
I further certify that I am not an intern, resident, or otherwise In a
CHAMPVA Claim Form 500." The sponsor may sign for any
training status for which I am receiving compensation for serv-
beneficiary/patient under 18 years of age, or, In the absence of ices listed on thiS claim.
the sponsor, the other parent, the beneficlary/patient or bene-
ficiary/patient's guardian may sign. (NOTE: for pnvacy reasons, a I further certify that I am not (1) an active duty member of the
beneficiary/patient under 18 years of age may sign his/her own Uniformed Services; (2) a civilian employee of the United States
claim form.) Government; or (3) a contract employee of the United States
Government, either clv!lian or military (refer to 5 U_S C 5536)
IMPORTANT - READ CAREFULLY

Federal Laws (1 8 U.S,C, 287 and 1001) provide for Criminal penalties for knowingly submitting or makIng any false, flChtlous or
fraudulent statement or claim in any matter within the jurisdiction of any department or agency of the United States Examples of
fraud include situations in which ineligible persons knowingly use an unauthorized Identification Card in filing of a CHAMPUS/
CHAMPVA claim; or where prOViders submit claims for treatment, supplies or equipment not rendered to, or used for
CHAMPUs/CHAMPVA beneficiaries; or where a participating provider bills the beneficiary/patient (or sponsor) for amounts
over the CHAMPUS-determined reasonable charge; or where a beneficiary/patient (or sponsor) fails to disclose other medIcal
benefits or health insurance coverage.
INCOMPLETE CLAIM FORMS WILL BE RETURNED.

INSTRUCTIONS FOR COMPLEnNG CHAMPUs/CHAMPYA CLAIM FORM 500

These are bnef instructions for completing CHAMPUSfCHAMPVA Claim Form 500 -
(Tear off this instruction sheet before submitting claim)
ThiS claim form IS to be used when submmlng a claim WHERE TO FILE CLAIM
requesting payment for Inpallent or outpatient medical
Send the claim 10 the approprtate CHAMPUS contractor
services or supplies provided to eligible beneficiaries processmg claims for the state or country where the
under the CHAMPUS and CHAMPVA programs, when
services/supplies were prOVided Contact your CHAMPUS
provided by CIVIlian sources of medical care Those In-
AdVisor or OCHAMPUS for the name and address of the
clude physIcians. pharmaCies. medical suppliers, medical appropflate contractor (Exception - When entitled tq.....
equipment suppliers, ambulance companies, laboratOries,
other medical benefits coverage See Item 14 below)
or other authonzed non-Inslltutlonal providers
Important: All mformatlon m Items 1 through 18 IS reqUIred
WHO FILLS OUT CLAIM FORM to process the claim Double check Ihe form. especially
The beneflclary/pallent, sponsor (or other parent) at a Item 8 on SOCial Secuflly number or VA file number, Item 5
child under 18, or the guardian for the individual patient. IS on Idenhflcatlon card number, and Item 18. your signature
reqUIred to complete the Patient/Sponsor InformatIOn Sec- Be~eflclary/patJent's name, sponsor's name, and spon-
lIOn, Items 1 through 18 at the top of the form The sor S SOCial Securtty number or VA ftle number must also
beneficiary/patient (or sponsor) fills out that section re- be on all auachmenls Incomplete forms Will be returned
gardless of who submits the claim - the beneflclaryl for mlssmg InformatIon Retam a copy of the claim form
patient (or sponsor) or the prOVider of medical serVlceSI and alf attachments for your records
supplies Speclollnotructlon.:
When the claim IS submItted by a phySICian or other pro- • Submit a separate claim form for each beneflclaryl
vlder, the lower part of the form (Physlclan/Other PrOVIder pallen!
InformatIOn, Items 19 through 33) must be completed by • FIle no later than December 31 of the year follOWing
the prOVider Item 32, Agreement to PartiCipate. must be the year In which the services were prOVided If a
checked "Yes or No " If a prOVider does not choose to claim IS returned for addlltOnallnformatJon, It must be
partiCipate but completes the form. an authonzed resubmitted by the regular flhng deadhne, or WithIn 90
sIgnature must stili appear In Item 33 days of the notIce of the retumed form - whichever
date IS tater
When the claIm IS submItted by the beneflclarylpatlent or
sponsor for direct reimbursement. an Itemized statement PAnENT/SPONSOR INFORMATION
listing the servIces/supplies must be attached The lower REQUIRED
sectIon of the form for PhYSICian/Other ProVider Informa-
tIOn may be left blank FollOWing are explanations of some of the Items reqUired
on the claim form For a more detailed explanation of all
ITEMIZED STATEMENTS the Items, refer to the special booklet, "How to Complete
CHAMPUSICHAMPVA Claim Form 500," available from
If Items 19 through 33 of the claim form have not been
your nearest Untformed Services medIcal facility, your
completed by the phYSICian or other prOVider, an Itemized
CHAMPUS contractor, or from OCHAMPUS, Denver, Col·
statement must be attached An Itemized statement must
orado 80240
contam
a the benefiCiary/patient's name Item 5: Identification CercI Inform.don. Enter card
b date the services/supplies were prOVided number from space 1 of the IdentIfIcation card (DD
c descnplton of each service/supply Form 1173) If an actIve duty member uses his/her card for
d charge for each seNtce/supply dependents under age 10, use Card Number of DO Form
2A, WIth letters "AD" Indicating Active Duty, after the card
The Itemized statement must be on the prOVider's billing
number
letterhead, contaIning the provlder's name and address
For prescription drugs, the Itemized statement must con-
"om 8: SponIor'. Social Slcurrty Number. Enter spon·
sor's SoCial Securt!y number. Enter sponsor's former Serv-
tain Ice number only If the sponsor does not have a Social
a name of the benefiCiary/patient Secuflly number
b name, strength and quantity of each drug If CHAMPVA benefICiary, enter veteran's VA file number
c prescnptlon number of the drug
If a NATO benefiCiary, enter "NATO" In this space.
d name and address of the pharmacy
If a sponsor IS an active duty secUrtty agent, enter "Se-
e name and address of the prescnblng phYSICian
curtly "
Not acceptable as Itemized statements are billing state-
ments shOWIng only total charges, cancelled checks, cash
register receipts (or Similar type receipts).
282 HERBERT DORKEN
n.m.: VA Statton Number (CHAMPVA only). Enter the • Beyond 4O-mlle rildlul. A Nonavailabihty Statement
three digit number of the VA Station which issued the iden- IS not requlfed for admission to a Civilian hospital
tificatIOn card. when the beneficiary/panent lives more than 40 miles
_14: Do You Hove Other Hoot'" Inauranee? It you from a Military or Public Health Services hospital.
are covered under another medical benefits plan or health • Coll.lnflrmllry. A Nonavallabdlty Statement IS not
Insurance coverage, check "yes" and supply the name reqUIred for inpatient care In a cottege infirmary,
and address of the other health insurer, and what plan or
• Other exception•• A Nonavallablhty Statement IS not
program you have from that insurer required for admission to an approved Skilled Nurs-
CHAMPUS will not duphcate benefits of any olher health Ing FaCIlity, ReSidential Treatment Center, Speclahzed
Insurance plan or program. Treatment FaCIlity, or a ChnslJan SCience Sanatonum.
• Act{ve Duty Dependent. entitled to other medical
benefits or health Insurance coverage must fill out Item 18: Signuure. Every CHAMPUS/CHAMPVA claim
Ilems 1 through 18 on this form and file In the usual mljst be signed by the beneficiary'patient whE"n that bene-
manner. The CHAMPUS contractor Will coordinate I,(",ar,· ,S 18 or oller It It",e tenel'Clary'patrent,s una ole 10
benefits with the other medical care Insurer Sign on his/her own behalf, refer to the special booklet,
• R.t'...... Dependents of Retirees, Dependents of "How to complete CHAMPUS/CHAMPVA Claim Form
Deceaoed Spon ...... and CHAMPVA aeneflclarl•• 500 ,. The sponsor may sign for any benefiClary/palient
must first submit a claim for reimbursement to the under 18: or in the absence of the sponsor, the bene-
other medical care Insurer, except II the other cover- fiCiary/patient's parent or guardian may Sign For reasons
age IS Medicaid II Medicaid, first submit to CHAM- of privacy, a beneflciary/patJent under 18 may choose to
PUS After receiving an Explanation of Benefits (EOB) Sign and personally submit the claim.
or a work sheet from the other health Insurer, fill out
and file the CHAMPUSfCHAMPVA claim form, attach- PHYSICIAN/OTHER PROVIDER INFORMATION
mg a copy of the EOB or work sheet, being sure to FollOWing are explanaliOns of some 01 the Items reqUired
complete Items 1 through 18 of the CHAMPUSI when the phYSICian/other provider completes the claim
CHAMPVA claim form form For a more detailed explanation of all Items, refer to
Item 16: Inpatient/Outpatient care. Check appropriate the special booklet. "How to Complete CHAMPUS,
space according to the followmg explanallOns CHAMPVA Claim Form 500," available from your nearest
• OUlpatlont. All eligible CHAMPUSICHAMPVA Uniformed Services medical facility, your CHAMPUS
benefiCiaries may choose Outpatient care from contractor, or from OCHAMPUS, Denver, Colorado
either cIvIlian, Military or Public Health Services 80240
facllllles. A Nonavallablhty Statement (DO Form 1251)
IS not required for outpatient care
Item 28: Provider Number. Enter the provider number
assigned by the appropriate CHAMPUS contractor
• Inpatient For admiSSion to a cIvIlian hospital, a
Nonavadablhty Statement (DO Form 1251) IS reqUired hem 32: CHAMPUS Participation. If a provider chooses
by all beneficiaries (except CHAMPVA) who live to participate, check "Yes" In this box, Each provider
Within a 40-mlle radiUS of a Military or PubliC Health should carefully read the back of the claim form regarding
Services hospital A copy of the Nonavailability participation, and understand the agreement With the
Statement must be attached to each claim relating to Government, and the consequences for falSifYing any part
the Inpatient stay; i.e , attach a copy to the surgeon's of the claim form.
claim, to the anesthesiologist's claim, etc A
Item 33: Signature. Enter the signature of the phYSician
Nonavallabihty Statement IS Issued by the MIlitary or
or other provider, or his/her authOrized representative If
Public Health Services Hospital Commander before
the phYSICian or other provider completes the claim form,
medical care IS provided
the form must be signed regardless of whether or not
• Emergency Adml.llon. In the case of a bona fide
he/she agrees to partiCipate as a CHAMPUS provider
medical emergency, a Nonavallablhty Statement IS
See ftem 32 on CHAMPUS partiCipatIOn.
not reqUIred for an mpa!lent admiSSion
IMPORTANT REMINDER
All information In Items 1 through 18 IS reqUired to process the CHAMPUS/CHAMPVA claim form. Carefully check
\tem 8, Social Secunty number or VA file number: Item 5, Identification card, and 1Iem 18, signature identification
Information must also be on all attachments Incomplete forms will be returned for completion. Keep a copy of the
claim form and all attachments for your records
Appendix B
THIS FORM TO BE USED TO BI...L aWE CHOU O' SOUTHERN CAUFORNIA OR aWE SHIElD Of CAUFORNIA ONLY.
Pl.£ASE VEIIIFY VJlTH YOUR PATIENT THE CORRECT ORGANIZATION TO BILL
o o o
R£AO INSTRUCTJONS BEFORE COMPLfTING OR SGNING THIS FORM
TYPE OR PRINT MEOICAltE MEDI-CAL STANDARD
PATIENT & INSURED 'SUBSCRIBER) INFORMATION

I PATIENT·SNAME/'k$t~~_IM.Iut~ 2 PAlIENT'S DATE Of BIRTH
4 PATIENT'S ADDRESS lSu",. CIIr• .,.,.. ZIP codtIJ 5 PATIENt'S SEX 15 INSURED'S 10 NO. MEDICARE NO ANDIOR MEDICAID NO
(1tICIuW MY 1MI",.6j
~~~
9 OTHER HEALTH INSURANCE COVERAGE· Enlel' Nam. of 11 INSUREO'S ADDRESS (Str.". city. $1"1#,. ZIP CQt/eJ
Pohcyholderand Plan Name.ndAddfHIIand PohcyrwMechcaI
A PATIENrs EMPLOYMENT
YE'I I INO
B AN AUTO ACCIDENT
Si,gn'ngJ
,o"""__ A..... A.lOifnmOt!'.__""U,.,"-'"
17 PATIENT'S OR AUTHORIZED PERSON'S SIGNATURE IRetKIlMd b«tue 13IAUTHOiIJZEPA'1MfN101'MlDICALBENE"'S10UNDCRSIGNED
IAlAllorw""'R~..~ot ... ~M~ _ _ _ NftaU'1U>"'f1<:"plht. C,."" PHYSKI14NORSUl'l'LIERfORSEIIVlCEDESCRlBEOBlWW
MEDlCAREB."ot".'_"~I/ ..
PHYSICIAN OR SUPPLIER INFORMATION

~IftJURY IACeIDENT) OR
ILLNESS ,FIRST SYMPTOMJ OR 15 DATE FIRST CONSULTED 16 HAS PATIENT EVER HAD SAME OR SlMRAR SYMPTQMSl
18
YOU FOR THIS CONDITION
PREGNANCY (lMPI YES~NO
17 DATE PATIENT ABU; TO DATES OF TOTAl DISABIt.ITV OATES OF PARTIAL DISABILITY
RETURN TO WORK FROM ITHROUGH
FROM I
THROUGH
18 NAME AND ADDRESS OF REFERRING PHYSICIAN OR OTHER SOURCE 20 FOR SERVICES RELATED TO HOSPITALIZATION
A~~:OSPlTALIlATION DATErDISCHAAGED
21 NAME .. ADDRESS OF FACILITY WHERE SERVICES RENDERED {II OIhcr /hllll ~ til' Q/f"'~1 22 WAS LABORATORY WORK PERFORMED OUTSIDE VOUII OFFICEl
VES~ NO CHARGES
D~NOSIS OR NATURE OF ILLNESS OR INJURV RELATE DIAGNOSIS TO PROCEDURE IN COlUMN 0 BY REFERENCE TO NUMBERS I, 2 3, ETC OR OX CODE
, DFAMILVPlANNINGSERVICE
l 24 PROCEDURE C F LEAVE BLANK
~~ ~::!~ ~ _,:u...:~~_ '::-~:iu=~~':: :C~!:=S DIAG~~SIS 12 3 5 6
------=:":~~f~~==l=- :=:=1 , II
--- ---------,.------- ------------------------------------------- ------ --------------i--- --- -- ------- -- ------- -- ----------i----
i ! !
~==~==t=== ===r~~=-=r
-----l-- -- - ------ - - - - - - - --------
1
"1""----- -------------------------------- - ---
i I
r---
25 SIGNATURf OF PHYSICIAN OR SUPPLIER
l ..rtllyunde,penal,yol""IIIIY_'IMIfI;wwgo_
,ngos ...... ndcorrectlr_boo ...... ,Dt....
III"'''I.I
28 ACCEPT ASSIGNMENT
~lfllA~fNJIrI
27 TOTAL CHARGE I 28 AMOUNT PAID 129 BAlANCE DUE
PHD 38 P DO OOPL26520 11
32 YOUR PATIENT S ACCOUNT NO 33 YOUR EMPLOYER I 0 NO
DORKEN HERBERT 0 PHD
2q12 21ST AVENUE
• PLACE OF SERVICE CODES
1 _(.HI _ INPATIENT HOSPITAL 7 _ {ICFJ - INTERMEDIATE CAR£ FACILITY SAN FRANCISCO CA 941'2
2 - (CHI - OUTPAnENT HOSPITAl • - iSNFi - SKILLEDNURSING FACIUTY
3 _ (0) - DOCTOR'S OFFICE
• - - AMBULANCE
4 - (HI - PATIENTS HOME 0- (0lJ - OTHER LOCAnONS
• - - DAY CAllE FACILITY lPSY) A -(Ill - IM)EPENDENT lABORATORY
• - ,NIGHT CARE FACIUTY (PSVI • - - OTHER MfDICAVSURGICAL FACIUTY
C 4359 '11-78)
283
284 HERBERT DORKEN
REQUIRED FOR MEDICARE OR MEDI-CAL PROGRAMS ONLY
MEDICARE PAYMENTS: If the patient cannot write, have him sign by mark (X) and
have a witness sign in item 12. If the patient cannot sign by mark, another person may
sign, showing his relationship and indicating on the reverse of the form why the patient
could not sign. A patient's signature requests that payment be made and authorizes
release of medical information necessary to pay the claim. If item 9 is completed, the
patient's signature authorizes releasing of the information to the insurer or agency
shown. In assigned cases, the physician agrees to accept the charge determination of
the Medicare carrier as the full charge, and the patient is responsible only for the deduct-
ible, COinsurance, and noncovered services. Coinsurance and the deductible are based
upon the charge determination of the carrier, if this is less than the charge submitted.
MEDI-CAL PAYMENTS:
I hereby agree to keep such records as are necessary to disclose fully the extent of
services provided to individuals under the state's Title XIX plan and to furnish information
regarding any payments claimed for providing such services as the state agency may
request. I further agree to accept, as payment in full, the amount paid by the Medi-cal
program for those claims submitted for payment under that program, with the exception
of authorized deductibles and coinsurance.
SIGNATURE OF PHYSICIAN (OR SUPPLIER):

I certify that the services listed on this form were medically indicated and necessary to
the health of this patient and were personally rendered by me or under my personal
direction.
This is to certify that all information entered on this form is true, accurate and complete.
I understand that payment and satisfaction of this claim will be from Federal and State
funds, and that any false claims, statements, or documents, or concealment of a material
fact, may be prosecuted under applicable Federal or State laws.
11
Licensing and Certification
TOMMY T. STIGALL
The maturing of psychology as a profession is reflected in the widespread

and rapid enactment of psychology laws by state legislatures, particularly
during the decade of the 1960s when fully half of the states and six Cana-
dian provinces adopted regulatory statutes. The first state to enact such leg-
islation was Connecticut in 1945, followed in 1946 by Virginia, and by Ken-
tucky in 1948. The last dozen states to pass psychology licensing or
certification laws have done so since 1970, with Missouri completing the
roster in 1977.
Since 1977, the profession of psychology has been regulated by statute
in all 50 states and the District of Columbia.! All Canadian provinces, with
the exception of Newfoundland and Prince Edward Island, have enacted
legislation recognizing psychologists, and regulation for the Northwest
Territories has been introduced (Wand, 1982). The basis for such laws is the
legislative intent to protect the general health, safety, and well-being of the
public. Thus, it is held that, in matters requiring specialized knowledge,
skill, and professional training, the public is best served when qualified
members of the profession are appropriately credentialed and held legally
accountable for their actions.
The authority for credentialing and regulation of practice usually is
vested by law in a state board of examiners for psychology or other equiv-
alent public body. Boards receive and process applications for licensure or
certification, review qualifications of candidates, and conduct examinations
as prescribed by law. They also are given authority to suspend, revoke, or
deny credentials for reasons specified in regulations or statute, and they
IEffective July 1, 1979, the Florida and South Dakota laws were repealed as a result of legis-
lative sunset review. New regulatory statutes were enacted in both states during 1981.
TOMMY T. STIGALL. State Office of Mental Health and Substance Abuse, Louisiana
Department of Health and Human Resources, Baton Rouge, Louisiana 70821.
285
286 TOMMY T. STIGALL
may initiate proceedings to enjoin persons from engaging in activities in

violation of the law.
Most psychology boards in the United States and Canada are affiliated
with the American Association of State Psychology Boards (AASPB), an
organization founded in 1961 for the purposes of promoting sound admin-
istrative practices and facilitating communication among member boards
(Carlson, 1978; Smith, 1976). Perhaps the single most important undertak-
ing of AASPB has been the development and continued refinement, in col-
laboration with the Professional Examination Service of New York City, of
the Examination for Professional Practice in Psychology (Terris, 1973; Wiens,
1980). Between 1965, when Form 1 of the examination was first introduced,
and the October 1981 administration of Form 15, a total of 32,101 candidates
for licensure or certification had taken this examination as a part of the cre-
dentialing process in 56 jurisdictions of the United States and Canada
(Professional Examination Service, 1982).
Recent estimates of the number of licensed or certified psychologists in
the United States put the figure at about 25,500 as of 1976 with approxi-
mately 74% engaged in the provision of health services (Wellner & Mills,
1977). Some 3,433 candidates took the national examination in 1977,4,108
in 1978,4,350 in 1979,4,364 in 1980, and 4,690 in 1981 (Professional Exam-
ination Service, 1982). Allowing for attrition and normal administrative
delay, and assuming an annual growth rate of only 5%, it is conservatively
estimated that by 1986 there will be in excess of 40,000 statutOrily creden-
tialed psychologists in the United States. Based on information supplied by
the executive officer of the Canadian Psychological Association, the number
of psychologists registered under Canadian laws by this date is expected to
be not less than 5,000 (Myers, 1978).
A MODEL FOR LEGISLATION
The enactment and form of licensure and certification laws has been
influenced heavily by various policy statements and recommendations con-
cerning state legislation issued by the American Psychological Association
(APA). In particular, the report of the American Psychological Association
Committee on Legislation (1967) has served as a model for states to enact
new laws or to amend existing statutes. Recommendations for legislation
contained in the 1967 model were based, in part, upon an earlier joint report
of the APA and Conference of State. Psychological Associations Committee
on Legislation (Joint, 1955).
While acknowledging that "it has never been possible to prepare a
'model bill'" (p. 1097), the 1967 guidelines nevertheless contained specific
legislative recommendations covering 13 major areas of concern. This
model for state legislation was adopted as official policy at the September
1967 meeting of the APA Council of Representatives.
At the time these recommendations were published, there was already
serious concern about accommodating differing roles and legitimate aspi-
LICENSING AND CERTIFICATION 287
rations of psychologists engaged in professional practice and those primar-

ily committed to research and teaching. The committee expressed its con-
viction that "legislative problems can and should be worked out to permit
both scientific and professional psychologists to perform their respective
functions, yet remain unified within a single association, nationally and at
the state level" (p. 1096). Thus, the committee directed its efforts toward the
framing of legislative provisions that would be applicable to the practice of
psychology in general, while providing exemptions for psychologists
engaged in research and teaching. Whether this strategy will suffice to
maintain unity within the body politic of psychology remains uncertain
(Danish & Smyer, 1981; Walsh, 1979).
The 1967 guidelines departed from previous recommendations in sev-
eral respects, the most notable of which was a change in the kind of legis-
lation sought. Whereas the earlier document (Joint Report of the APA and
CSPA Committee on Legislation, 1955) had recommended certification as the
preferred type of legislation, the new model favored licensure for the added
measure of protection which it affords the public.
By regulating both title and function, licensing laws make it illegal for
any person, not licensed or exempted, to engage in the practice of psychol-
ogy as defined by law. By contrast, certification laws merely restrict the use
of the title psychologist and variations thereof, to qualified members of the
profession. Strictly speaking, certification laws are enforceable only in cases
where there is evidence of misrepresentation of credentials. Individuals
ineligible for certification as psychologists, and who may possess no profes-
sional qualifications, are able to escape prosecution simply by avoiding any
public representation of themselves as psychologists or their services as
psychological in nature (Thompson, 1978).
By 1967 the Committee on Legislation had formulated a comprehen-
sive definition of practice and recommended that it be incorporated in state
law. The definition was intended to accomplish two purposes. In broad lan-
guage, it would codify those activities and services traditionally encom-
passed by the field of psychology in its application to human affairs. It also
would serve to restrict unlicensed practitioners from undertaking any of
the enumerated functions unless exempted specifically by law. This defi-
nition of practice, with some variation, continues to be the language most
frequently found in licenSing laws at the present time.
The practice of psychology within the meaning of this act is defined as render-
ing to individuals, groups, organizations, or the public any psychological ser-
vice involving the application of principles, methods, and procedures of under-
standing, predicting, and influencing behavior, such as the principles
pertaining to learning, perception, motivation, thinking, emotions, and inter-
personal relationships; the methods and procedures of interviewing, counsel-
ing, and psychotherapy; of constructing, administering, and interpreting tests
of mental abilities, aptitudes, interests, attitudes, personality characteristics,
emotion and motivation; and of assessing public opinion.
The application of said principles and methods includes, but is not
restricted to: diagnosis, prevention, and amelioration of adjustment problems
and emotional and mental disorders of individuals and groups; hypnosis; edu-
cational and vocational counseling; personnel selection and management; the

evaluation and planning for effective work and learning situations; advertising
and market research; and the resolution of interpersonal and social conflicts.
Psychotherapy within the meaning of this act means the use of learning,
conditioning methods, and emotional reactions, in a professional relationship,
to assist a person or persons to modify feelings, attitudes, and behavior which
are intellectually, SOcially, or emotionally maladjustive or ineffectual. (pp. 1098-
1099)
Because of the broad scope and generic character of the recommended

definition of practice, it was necessary for the committee to recognize cer-
tain exemptions that also should be written into law. Exemptions for psy-
chology students and trainees under supervision, bona fide members of
other professions, and unlicensed psychologists lecturing for a fee could be
handled in a fairly straightforward manner. Exemptions for academic and
research psychologists, as well as for persons employed in government,
business, and industrial settings, were more difficult.
If psychologists employed by academic and research institutions, gov-
ernment agencies, and business corporations were to be exempted from
statutory regulation, should that exemption extend to activities undertaken
outside the scope of such employment, as in the case of paid consultation
or other services offered to the public for a fee? The committee decided yes
in some instances, no in others. Psychologists exempted by virtue of their
work setting could consult or provide scientific and research services to like
organizations for a fee over and above their salaried compensation, but they
were not to be permitted otherwise "to offer or provide psychological ser-
vices for a fee" (pp. 1100-1101). It was further recommended that "persons
employed as psychologists by organizations that sell psychological services
to the public should not be exempted" (p. 1101).
A broad exemption was recommended for "salaried employees of
accredited academic institutions, governmental agencies, research labora-
tories, and business corporations" (p. 1101), with the proviso that such
exemption should apply only to the salaried work setting, and with the fur-
ther understanding that such employees should not represent themselves
to the public as psychologists or describe their activities as psychological in
nature. The exemption was intended to apply in the case of clerical or tech-
nical employees who might engage in activities of a psychological nature.
In effect, however, this exemption has encouraged the employment of large
numbers of individuals to work in schools, hospitals, mental health facili-
ties, penal institutions, and a variety of human service agencies where they
are expected to render comprehenSive psychological services even though
they do not qualify for licensure or certification as a psychologist. Fre-
quently, such employees assume a formal or informal institutional title of
psychologist and they so represent themselves to other employees, clients, or
residents of the institution.
The 1967 guidelines recommended a single level of licensure, reserv-
ing the title of psychologist for persons possessing a "doctoral degree from
an accredited university or college in a program that is primarily psycho-
logical and no less than 2 years of supervised experience" (p. 1099). The
unfortunate choice of language referring to a doctorate "primarily psycho-
logical" in nature has continued to plague regulatory boards who must
interpret the educational credentials of candidates in light of such statutory
provisions. Frequently statutes allow for candidates to possess doctoral
training in a closely related field or that which is deemed to be "substan-
tially equivalent" to a doctoral degree in psychology. A review of board
actions in this area has led one observer to conclude that "primarily psy-
chological in nature" has become in practice a euphemism for "not psy-
chology" (Berger, 1976).
Reaffirming the 1955 policy, statutory definition and regulation of spe-
cialties within psychology was not recommended by the committee in 1967.
It chose instead to rely upon a code of ethics (American Psychological Asso-
ciation, 1981) and professional self-regulation to achieve conformance of
practice with specialty competence. Subsequent experience and public
opinion have not supported this approach, and there has been increasing
awareness of the need for standards of practice and credentialing within
recognized specialties in addition to generic licensure or certification
(American Psychological Association Committee on Professional Standards,
1981; American Psychological Association Committee on State Legislation,
1978).
Other recommendations of the 1967 model were intended to facilitate
geographic mobility for psychologists by encouraging reciprocal endorse-
ment of credentials among states and by allowing for time-limited practice
by out-of-state consultants. An explicit provision for privileged communi-
cation between psychologist and client was recommended. The composi-
tion of boards was to be representative of the different areas in psychology
so as to include especially psychologists concerned with education and
training as well as those engaged in practice. There was no mention of pub-
lic-member appointments to boards, a practice that now has become more
commonplace. Nor was there any recognition of continuing education as a
requirement for renewal of licensure or certification.
It is common for laws regulating the various professions to empower
boards to approve schools or professional training programs, as well as to
credential individuals (U.S. Department of Health, Education, and Welfare,
1977b). In some instances, boards make use of approved listings of programs
or schools meeting national standards of accreditation. The 1967 legislative
model for psychology specified only that candidates for licensure or certi-
fication should be graduates of accredited institutions and noted in addition
that "nothing in the law should require the registration of departments of
psychology or doctoral programs in psychology" (p. 1102). In discharging
their statutory responsibility to evaluate the educational qualifications of
individual applicants, boards nevertheless are required to make judgments
as to the adequacy of education and professional preparation offered in spe-
cific training programs. In this sense at least, on a case-by-case basis, boards
do undertake an implicit evaluation and approval of training programs as
well as individuals.
SURVEY OF REGULATORY STATUTES
All of the statutes enacted through 1981 pertaining to the credentialing

of psychologists in the United States and Canada were reviewed. Where
available, administrative rules and regulations also were analyzed. In some
instances, telephone contacts were initiated with state officials in order to
clarify board practices and interpretations of law.
Table 1 shows the pattern of organization of regulatory boards, citing
the relevant state or provincial law, the official title of each regulatory
authority, and the parent department or agency of government where
applicable. Also shown are the number of professional and public members,
the basis for nomination and appointment of board members, and the terms
of office served.
As governmental bodies representing the public, all boards within the
United States maintain an identity separate from professional organiza-
tions. Although laws in over one-third of the states specify that nomina-
tions for individuals to serve on state boards shall be made by the state
psychological association, it is no longer considered constitutionally defen-
sible to require membership in the state association as a condition of eligi-
bility for appointment. In other states, nomination is not required by stat-
ute, and appointment mayor may not be from a list provided by the
professional association. Underscoring this more liberal and consumer-ori-
ented philosophy is the fact that a total of 38 United States and Canadian
boards now include public members. Appointment of board members
almost always is made by the governor in United States jurisdictions but, in
a few instances, by another state official. In New York State, for example, it
is the Board of Regents that appoints members of the State Board for Psy-
chology, on recommendation of the Commissioner of Education and the
State Education Department.
Board members typically serve staggered terms of three to five years in
office, although in Canada two-year terms appear to be the rule. Laws fre-
quently specify qualifications for professional, as opposed to public, mem-
ber appointments on the basis of criteria similar to those establishing eli-
gibility for licensure or certification.
In marked contrast to the legal status of psychology in the United
States, credentialing of psychologists in Canada typically has been accom-
plished by enactment of laws that grant to provincial psychological associ-
ations the authority to establish standards and register individuals who
qualify. Thus, in British Columbia, Saskatchewan, Quebec, New Brunswick,
and Manitoba, membership in the provincial psychological association is
tantamount to statutory recognition as a psychologist. In Alberta the right
to practice psychology is not dependent upon membership in the associa-
tion, but is subject to the control and rule making authority of the Psychol-
ogists Association of Alberta. In Nova Scotia and Ontario the organization
of regulatory boards more closely resembles the United States model.
Requirements for credentialing in each state and Canadian province
are listed in Table 2. Virtually all laws are generic in character. That is to
say, the law is concerned with credentialing and regulation of psychologists

as a professional class, rather than specialties within the profession. How-
ever, some jurisdictions have specialty credentialing as well. Florida, Ohio,
Virginia, and Wisconsin issue limited licenses for the practice of school psy-
chology, and Virginia additionally has provision for licensure of clinical
psychologists by the State Board of Medicine on recommendation of the
Virginia Board of Psychology. Recent amendments to the Indiana and
Nebraska statutes provide for specialty certification of clinical psycholo-
gists. Texas law authorizes specialty certification in the areas of clinical,
counseling, school, and industrial psychology and for psychologists meet-
ing requirements for designation as health service providers. Licensure as
an educational psychologist by the Board of Behavioral Science Examiners
also is possible in California, with practice limited to educational evalua-
tion, counseling, and related functions.
The majority of states and half of the Canadian provinces credential
psychologists only at the doctoral level. Twenty-two United States jurisdic-
tions and four Canadian provinces also recognize subdoctoral providers of
psychological services, usually by such titles as psychological associate, psy-
chological assistant or psychological examiner. But, of this number, only seven
states, Iowa, Minnesota, Missouri, Pennsylvania, Vermont, West Virginia,
and Wisconsin, and the provinces of Alberta, New Brunswick, Nova Scotia,
and Quebec issue an unlimited credential as a psychologist to persons with
less than doctoral training in psychology. In all other jurisdictions, the right
to practice independently and use of the title psychologist is reserved for
individuals with doctoral training.
The requirement for a doctoral education in psychology as the neces-
sary level of training for licensure and independent professional practice is
consistent, not only with the APA model for state legislation, but also is
reaffirmed in the APA Standards for Providers of Psychological Services:
All persons providing psychological services shall meet minimally acceptable

levels of training and experience, which are consistent and appropriate with
the functions they perform. However, final responsibility and accountability
for services provided must rest with psychologists who have earned a doctoral
degree in a program that is primarily psychological at a regionally accredited
university or professional school. Those providing psychological services who
have lesser (or other) levels of training shall be supervised by a psychologist
with the above training. This level of qualification is necessary to assure that
the public receives services of high quality. (American Psychological Associa-
tion, 1977, p. 3)
Given the virtually universal circumstance of generic credentialing,

coupled with the widely accepted requirement of doctoral training for
licensure or certification as a psychologist, it follows that other statutorily
recognized classifications should be subject to special limitations of title and
function. The principle of supervision by a fully qualified psychologist is
characteristic of those jurisdictions where there is also statutory credential-
ing of psychological examiner, technician, assistant, or associate. Other lim-
itations as to work setting and functions that may be performed are usually
TABLE 1
Organization of Regulatory Boards
Number of members Nomination Term of
by state office
Jurisdiction Statutory citation' Authority Professional Public association b Appointment by (years)
Alabama Code §§ 34-26-1 to - Board of Examiners in 5 0 X Governor 5

48 (1975 & Supp. Psychology
1982)
Alaska Stat. §§ 08.86.01 0- Board of Psychologist and 4 Governor 4
.230 (1977 & Supp. Psychological Associate
1981) Examiners, Department
of Commerce and
Economic Development
Arizona Rev. Stat. Ann. §§ Board of Psychologist 5 2 Governor 5
32-2061 to - Examiners
2088(Supp. 1981-
1982)
Arkansas Stat. Ann. §§ 72- Board of Examiners in 6 X Governor 5
1501 to -1518 Psychology
(1979 & Supp.
1981)
California Bus. & Prof. Code §§ Psychology Examining 5 3 Governor 4
2900-2999 (West Committee, Board of
1974 & Supp. 1982) Medical Quality
Assurance
Colorado Rev. Stat. §§ 12-43- State Board of Psychologist 7 2 Governor 3
101 to -120 (1977 Examiners, Department
& Supp. 1981) of Regulatory Agencies
Connecticut Gen. Stat. §§ 20-186 Board of Examiners of 3 2 Governor 5
to -195 (1981 & Psychologists,
West Gen. Stat. Department of Health
Ann. Supp. 1982) Services
Delaware Code Ann. tit. 24 §§ State Board of Examiners of 5 0 X Governor 3
3501-3519 (1981) Psychologists
District of Columbia Code Ann. §§ 2- Board of Psychologist 5 0 Mayor 3
1704.1-.18 (1981) Examiners; Department
of Licenses,
Investigations, and
Inspections
Florida Stat. Ann. §§ Board of Psychological 5 2 Governor 4
490.001-.015 (West Examiners, Department
Supp. 1982 & Sess. of Professional
Law Servo 1982 ch. Regulation
82-179)
Georgia Code Ann. §§ 43-39 State Board of Examiners of 5 Governor 5
-1 to -20 (1982) Psychologists
Hawaii Rev. Stat. §§ 465-1 to Board of Certification for 5 2 Governor 3
-15 (1976 & Supp. Practicing Psychologists,
1981) Department of Commerce
and Consumer Affairs
Idaho Code §§ 54-2301 to - State Board of Psychologist 3 0 X Governor 3
2315 (1979 & Supp. Examiners, Department
1982) of Self-Governing
Agencies
Illinois Ann. Stat. ch. 111, §§ Psychologists Examining 5 0 Director of Department 5
5301-5329 (Smith- Committee, Department
Hurd 1978 & of Registration and
Supp.1982-1983) Education
Indiana Code Ann. §§ 25-33- State Board of Examiners in 5 Governor 3
1-1 to -17 (Burns Psychology
1982)
Iowa Code Ann. §§ 147.1- Board of Psychology 5 2 X Governor 3
.102 (West 1972 & Examiners, Department
Supp.1982-1983), of Health
154B.l-.7 (Supp.
1982-1983) Continued
TABLE 1 (continued)

by state office
Kansas Stat. Ann. §§ 74- Behavioral Sciences 4' 3 Governor 4

5301 to -5347,74- Regulatory Board
7501 to -7509
(1980 & Supp.
1981)
Kentucky Rev. Stat. Ann. §§ State Board of Examiners of 4 X Governor 4
319.005-.990 Psychologists
(Baldwin 1981)
Louisiana Rev. Stat. Ann. §§ State Board of Examiners of 5 0 X Governor 3
37:2351-:2369 Psychologists,
(West 1974 & Department of Health
Supp.1982) and Human Resources
Maine Rev. Stat. Ann. tit. 32 State Board of Examiners of 5 Governor 5
§§ 3811-3838 (1978 Psychologists
& Supp. 1981-
1982)
Maryland Health Occ. Code State Board of Examiners of 5 X Governor 3
Ann. §§ 16-101 to Psychologists,
-502 (1981) Department of Health
and Hygiene
Massachusetts Ann. Laws ch. 13, §§ Board of Registration of 5 0 Governor 5
76-79 (Michie/ Psychologists, Division of
Law. Co-op. 1980); Registration
ch. 112, §§ 118-129
(Michie/Law. Co-
Op.1975)
Michigan Compo Laws Ann. §§ Board of Psychology, 5 3 Governor 4
333.18201-.18237 Department of Public
(1980 & Supp. Health
1982-1983)
Minnesota Stat. Ann. §§ 148.88- Board of Psychology 7 4 Governor 4
.98 (West Supp.
1982)
Mississippi Code Ann. §§ 73-31- State Board of Psychological 5 X Governor 3
1 to -31 (1972 & Examiners
Supp.1981)
Missouri Ann. Stat. §§ State Committee of 5 Director of Department 5
337.010-.085 Psychologists;
(Vernon Supp. Department of Consumer
1982) Affairs, Regulation and
Licensing
Montana Code Ann. §§ 2-15- Board of Psychologists, 3 2 Governor 3
1851,37-17-301 to Department of Commerce
-313 (1981)
Nebraska Rev. Stat. §§ 71-3801 State Board of Examiners of 5 0 X Governor 5
to -3836 (1981) Psychologists
Nevada Rev. Stat. §§ 641.010- Board of Psychological 4 Governor 3
.440 (1981) Examiners
New Hampshire Rev. Stat. Ann. §§ State Board of Examiners of 5d Governor 5
330-A:l-:21 (1966 Psychologists
& Supp. 1981)
New Jersey Stat. Ann. §§ 45:1-2.2 State Board of Psychological 7 3' Governor 3
to -27, 45:14B-l to Examiners, Department
-30 (West 1978 & of Law and Public Safety
Supp. 1982-1983)
New Mexico Stat. Ann. §§ 61-9-1 State Board of Psychologist 5 X Governor 3
to -19 (Supp. 1980) Examiners
New York Educ. Law §§ 7600- State Board for Psychology, 11 Board of Regents 5
7605 (McKinney Education Department
1972)
North Carolina Gen. Stat. §§ 90- State Board of Examiners of 5 0 X Governor 3
270.1-.18 (1981 & Practicing Psychologists
Supp.1981)
North Dakota Cent. Code §§ 43- State Board of Psychologist 5 0 Governor 3
32-01 to -32 (1978 Examiners
& Supp. 1981) Continued
TABLE 1 (continued)
by state office
Jurisdiction Statutory citation" Authority Professional Public association" Appointment by (years)
Ohio Rev. Code Ann. §§ State Board of Psychology 6 X Governor 5

4732.01-.99 (Page
1977 &: Supp. 1981)
Oklahoma Stat. Ann. tit. 59 §§ State Board of Examiners of 5 0 X Governor 3
1351-1375 (West Psychologists
1971 &: Supp.
1981-1982)
Oregon Rev. Stat §§ 675.010- State Board of Psychologist 5 2 Governor 3
.ISO (1981) Examiners
Pennsylvania Stat. Ann. tit. 63 §§ State Board of Psychologist 4 sf Governor 3
1201-1215 (Purdon Examiners, Department
Supp. 1982-1983), of State
tit. 71 § 180-6.1
(Purdon Supp.
1963-1981)
Rhode Island Gen. Laws §§ 5-44-1 Board of Psychology, 4 Director of Health 3
to -25 (1976 &: Department of Health
Supp.1981)
South Carolina Code Ann. §§ 40-55- State Board of Examiners in 7 X Governor 5
20 to -180 (Law. Psychology
Co-op. 1976 &:
Supp.1981)
South Dakota Codified Laws Ann. Board of Examiners of 4 Governor 3
§§ 36-27A-I to -39 Psychologists,
(Supp. 1982) Department of Commerce
Tennessee Code Ann. §§ 63-11- State Board of Examiners in 5 0 X Governor 5
101 to -209(1982) Psychology, State
Licensing Board for the
Healing Arts
Texas Rev. Civ. Stat. Ann. State Board of Examiners of 7 2 Governor 6
art. 4512c (Vernon Psychologists
1976'" Supp. 1982)
Utah Code Ann. §§ 58-1-1 Representative Committee 4 Director of Registration 5
to -43, 58-25-1 to for Psychologists,
-12 (1974 '" Supp. Division of Registration
1981)
Vermont Stat. Ann. tit. 26 §§ Board of PsychOlogical 3 2 Governor 5
3001-3017 (Supp. Examiners
1982)
Virginia Code §§ 54-923 to - Board of Psychology, 5 0 Governor 5
931, 54-936 to - Department of Commerce
940 (1978 '" Supp.
1979)
Washington Rev. Code Ann. §§ Board of Psychologist 5 0 Governor 3
18.83.010-.900 Examiners, Department
(1978'" Supp. of Licensing
1982)
West Virginia Code §§ 30-21-1 to - State Board of Examiners of 5 Governor 3
15 (1980 '" Supp. Psychologists
1982)
Wisconsin Stat. Ann. §§ 455.01- Psychology Examining 4 X Governor 3
.11 (West 1974'" Board, Department of
Supp. 1981-1982) Regulation and Licensing
Wyoming Stat. §§ 33-27-101 to State Board of Psychologist 5 0 X Governor 3
-112 (1977 '" Examiners
Supp.1982)
Alberta Rev. Stat. ch. P-25 Council, PsychOlOgists 10 0 Elected by Psychologists
(1980) Association of Alberta Association
British Columbia Rev. Stat. ch. 342 Board of directors, British 5 2 Elected by Psychological 2
(1979) Columbia Psychological Association'
Association
Manitoba Rev. Stat. ch. P-190 Council of Psychologists, 7 0 Elected by Psychological 2
(1970) Psychological Association Association
of Manitoba
New Brunswick Stat. ch. 61 (1980) Registration Committee, 6k 0 Council, College of 2
College of Psychologists Psychologists
of New Brunswick Continued
TABLE 1 (continued)
by state office
Nova Scotia Stat. ch. 14 (1980) Board of Examiners in 5 0 x Governor in Council 3

Psychology
Ontario Rev. Stat. ch. 404 Board of Examiners in 5 0 Lt. Governor in Council 5
(1980) Psychology
Quebec Rev. Stat. ch. C-26 Bureau, Professional 21 4 Elected by Professional 2
(1977) Corporation of Corporation of
Psychologists of Quebec Psychologists'
Saskatchewan Rev. Stat. ch. R-14 Council, Saskatchewan 5 0 Elected by Psychological 2
(1978) Psychological Association Association
QLaw, as amended, establishing the regulatory authority for psychology; there may be other laws which affect the practice of psychologists or the function of the board.
bLaw specifies that nominations to the board shall be made by the psychological association; in other jurisdictions, nomination is unrestricted.
cComposed of two psychologists and two social workers.
dComposed of two certified psychologists, one associate psychologist, one teacher of psychology, and one certified pastoral counselor.
eInciudes two public members and one government member.
fInciudes one member nominated by the Office of Mental Health and Mental Retardation, one member nominated by mental health and mental retardation advocacy groups. Commissioner of Professional and
Occupational Affairs ex officio.
8Public members appointed by Lt. Governor in Council.
h Includes Registrar as nonvoting member.
ipublic members appOinted by Quebec Office of Professions.
TABLE 2
Requirements for Credential
Experience Examination
Jurisdiction Title Education Total Post Written Oral EPPP pass point'
Alabama Psychologist Doctoral 0 X X Mean

Alaska Psychologist Doctoral 1 X 70% correct
Psychological Associate" Master's 3 3 X 60% correct
Arizona Psychologist Doctoral 0 X Mean
Arkansas Psychologist Doctoral 1 X X 65% correct
Psychological Examiner" Master's 0 X X 60% correct
California Licensed Psychologist Doctoral 2 X X Mean
Educational Psychologist' Master's 3 X X N/A
Psychological Assistant"" Master's N/A
Colorado Psychologist Doctoral 2 2 X X 70% correct
Connecticut Psychologist Doctoral 1 1 X Mean
Delaware Psychologist Doctoral 5 or 2 X X 65% correct
District of Columbia Psychologist Doctoral 2 2 X X Mean
Florida Psychologist Doctoral 2 X -ISD.
School Psychologist Specialist' 3 X N/A
Georgia Licensed Applied Psychologist Doctoral X X Mean
Hawaii Psychologist Doctoral X X Mean
Idaho Psychologist Doctoral 2 2 X 70% correct
Illinois Psychologist Doctoral 2 X 75% correct
Indiana Clinical Psychologist Doctoral 2f N/A
Psychologist (Private Practice Certificate) Doctoral 2 X X Mean
Psychologistg (Basic Certificate) Doctoral 0 X X Mean
Iowa Psychologist Doctoral 1 X X 70% correct
Psychologist Master's 5 X X 70% correct
Kansas Psychologist Doctoral 2 2 X 75% correct
Kentucky Psychologist Doctoral X X -% S,D.
Certificando Master's X -15,0.
Continued
TABLE 2 (continued)
Louisiana Psychologist Doctoral 2 X X 25th percentile

Maine Psychologist Doctoral 2 X X 65% correct
Psychological Examiner Master's X X 60% correct
Maryland Psychologist Doctoral 2 X -%5.0.
Massachusetts Psychologist Doctoral 2 1 X X -1 S.D.
Michigan Psychologist" Doctoral 2 2 X N/A
Psychologisti' (Limited License) Master's' N/A
Minnesota Licensed Consulting Psychologist Doctoral 2 2 X X -1 S.D.
Licensed Psychologisti Master's 2 2 X X -1~ S.D.
Mississippi Psychologist Doctoral X X 75% correct
Missouri Psychologist Doctoral 1 1 X X Mean
Psychologist Master's 3 3 X X Mean
Montana Psychologist Doctoral 2 X X 65% correct
Nebraska Certified Clinical Psychologist Doctoral k X, X, N/A
Licensed Psychologist Doctoral 0 X -% S.D.
Nevada Psychologist Doctoral 1 X X 75% correct
New Hampshire Certified Psychologist Doctoral 2 X X Mean
Certified Associate Psychologistm Master's 5 4 X Mean
Psychological Assistantb,d Master's 0 N/A
New Jersey Practicing Psychologist Doctoral 2 X X -1 S.D.
New Mexico Psychologist Doctoral 2 2 X X 75% correct
New York Psychologist Doctoral 2 X n
North Carolina Practicing Psychologist Doctoral 2 2 X XO -1 S.D.
Psychological Associate b Master's 0 X XO -1~ S.D.
North Dakota Psychologist Doctoral 0 X X -~S.D.
Ohio Licensed Psychologist Doctoral 2 1 X X -~ S.D.
Licensed School Psychologist Master's 4 3 X N/A
Oklahoma Psychologist Doctoral 2 X X 70% correct
Oregon Psychologist Doctoral 2 X X Mean
Psychologist Associate b Master's 4 X X -1 S.D.
Pennsylvania Psychologist Doctoral 2 2 X 65% correct
Psychologist Master's 4 4 X 65% correct
Rhode Island Psychologist Doctoral 2 X X 70% correct
South Carolina Psychologist Doctoral 2 X X -l!; S.D. or 70% correct
South Dakota Psychologist Doctoral 2P X X -1 S.D.
Tennessee Psychologist Doctoral q X X -% S.D.
Psychological Examinerb Master's q X X -1l!; S.D.
Texas Licensed Psychologist Doctoral 2 X X 70% correct
Certified Psychologistt Doctoral 0 X X 70% correct
Psychological Associateb Master's r X 50% correct
Utah Psychologist Doctoral 2 X X 70% correct
Vermont Psychologist-Doctorate Doctoral 2' X -l!;S.D.
Psychologist-Master Master's 2' X X -l!; S.D.
Virginia Clinical Psychologist Doctoral 2P 1 X X -l!; S.D. or 65% correct
Psychologist Doctoral 2 2 X X -l!; S.D. or 65% correct
School Psychologist Master's 4P 4 X X -l!; S.D. or 65% correct
Washington Psychologist Doctoral 1 X X 75% correct
Psychological Affiliate b Master's 3 X X 75% correct
Psychological Assistantb Master's 3 X X 75% correct
West Virginia Psychologist Doctoral 1 1 X X -l!;S.D.
Psychologist Master's 5 5 X X -l!;S.D.
Wisconsin Psychologist Doctoral X Mean°
Psychologist Master's 4 4 X X Mean
School Psychologist Master's' N/A
Wyoming Psychologist Doctoral 0 X Mean
Alberta Certified Psychologist Master's 0 X N/A
British Columbia Psychologist Doctoral X X -l!;S.D.
Manitoba Psychologist Doctoral 2 X X -1 S.D. or 67% correct
New Brunswick Psychologist Doctoral X N/A
Psychologist Master's 4 X N/A
Nova Scotia Psychologist" Doctoral 2 1 X X N/A
Psychologist" Master's 6 6 X X N/A
Continued
TABLE 2 (continued)
Ontario Psychologist Doctoral 1 x X n
Quebec PsychologistW Postgraduate r o X· X· 50% correct
Saskatchewan Psychologist Doctoral o X N/A
Note: All jurisdictions have general requirements such as age, citizenship or residency, and character. Some jurisdictions may require continuing education for renewal of the
credential, including Arkansas, California, Colorado, Florida, Georgia, Iowa, Louisiana, Maryland, Michigan, Minnesota, Nevada, New Mexico, Nova Scotia, Oregon, South Dakota,
Utah, Vermont, Washington, West Virginia.
• All values relative to national norms on the Examination for Professional Practice in Psychology (EPPP).
b Must function under supervision in accordance with statutory limitations and board regulations.
C Licensed by Board of Behavioral Science Examiners under provisions of Calif. Bus. & Prof. Code §§ 17860-17870 (Supp. 1982).
d Statutorily recognized title; registration required.

e Law recognizes specialist or doctoral.
f Requires private practice certificate with two years experience in supervised health service setting, including one year in an organized health service training program.
S May not engage in independent private practice.
h Limited license available for postdoctoral training and other special status.
j Degree must have been earned on or before September 29,1984; application must have been filed with the board not later than September 29,1985.
i Must collaborate with licensed consulting psychologist for private practice.

k Requires licensure with either predoctoral clinical internship plus one year postdoctoral clinical experience, or approved clinical internship plus two additional years of clinical
experience.
I Examination not required for licensed psychologist with clinical internship and appropriate experience.
mExcept for renewal, expires July I, 1989. Must register intent to qualify by July I, 1983.
• Board uses Angoff procedure to set passing score for each administration.
• Special application only.
P Including required internship.
q Varies with declared competency areas.
, Requires 450 clock hours of experience under supervision of a qualified psychologist.
S Supervised practice of clinical psychology.
t In accordance with requirements for highest level of certification as a school psychologist established by Department of Public Instruction
• Until December 17, 1984, will register without examination applicant with doctorate and two years experience acceptable to board.
• Until December 17, 1984, will register without examination applicant with master's degree and four years of experience acceptable to the board. Thereafter, registration may be
available at discretion of board.
wWorking knowledge of French language required.
x Doctorate, licentiate, or master's.
specified in law or regulations. The following example is taken from the

rules of practice of the Texas State Board of Examiners of Psychologists.
A psychological associate may not practice independently. A psychological
associate may offer psychological services only as the employee of an exempt
agency or a licensed psychologist, or in an employment situation where a psy-
chological associate and a licensed psychologist who is the supervisor are both
employed full time by an agency or institution approved by the Board. A legally
binding supervisory contract among the psychologist, the psychological asso-
ciate, and the employer (if other than the psychologist) must be on file with the
Board at all times. 2
A period of satisfactory supervised work experience, usually one or two

years, is required for licensure or certification as a psychologist in all juris-
dictions except Alabama, Alberta, Arizona, Indiana (basic certificate only),
Michigan (limited license only), Nebraska, North Dakota, Quebec, Sas-
katchewan, South Carolina, Texas (certified psychologist only), and Wyo-
ming. The law usually requires that supervision in this instance be carried
out by a qualified psychologist, but in a few states supervision by another
mental health professional may be accepted. An approved internship is
required for licensure as a psychologist in South Dakota and for specialty
credentialing in Indiana, Nebraska, and Virginia. In calculating the total
work experience, several states allow the predoctoral internship year to be
substituted for one year of post doctoral work experience. For all applicants,
however, at least one year of postdoctoral supervised experience is required
in 23 jurisdictions, whereas 10 states require two years of postdoctoral
experience.
It is customary for state laws to authorize boards to administer both
written and oral examinations to candidates for licensure or certification.
Boards usually are granted considerable discretionary authority to waive
examinations, but they tend to be conservative in the exercise of such
authority. Specific circumstances recognized in statutes for the waiver of
examination include diplomate status with the American Board of Profes-
sional Psychology (ABPP), satisfactory performance on an examination pre-
viously administered in another jurisdiction, or recognized eminence in the
field of psychology. Waiver of examination under the grandfather clause of
regulatory statutes now is quite rare since almost all laws have been on the
books long enough for this provision to have expired.
In the more populous states, administration of oral examinations may
become particularly burdensome for boards due to the large number of
applicants. In these jurisdictions, the oral examination may not be used at
all, or it may be used only in special cases with handicapped individuals or
candidates whose educational qualifications or written test performance
may be considered questionable.
The AASPB Examination for Professional Practice in Psychology is now in
use by all states except Michigan and also is used by the Canadian provinces
2Texas State Board of Examiners of Psychologists, Rule of Practice 465.7.

of British Columbia, Manitoba, and Ontario. Wisconsin law limits the

authority of the board to examine candidates only on ethical issues; in this
state, therefore, the AASPB examination is reserved for master's level can-
didates or for special purposes, as in the case of foreign-trained candidates
or those desiring to demonstrate equivalence of educational background.
Limited use is made of the examination in Quebec at the discretion of the
Equivalency Committee of the Bureau.
The examination is intended to sample the knowledge relevant to
entry-level practice as a psychologist. It is generic in character and not
designed to yield sub-area scores. The classification scheme defines the
domains in which psychologists perform, the roles assumed by psycholo-
gists, and the knowledge required to perform these roles. The content of
the examination is based on knowledge represented by five domains and
six roles (American Association of State Psychology Boards, 1982):
Domain I: Techniques for Appraising and Assessing
Role 1: Select, modify and use psychological assessment techniques/
instruments, e.g., tests, observation and interview proce-
dures, survey instruments.
Role 2: Interpret and report results of assessment, e.g., feedback as
appropriate to client and/or referral source.
Domain II: Design, Implementation and Assessment of Intervention
Role 3: Design, implement and evaluate an intervention plan, based
on interpretation of assessment results and including ongo-
ing monitoring and final evaluation.
Domain III: Uses of Psychological Literature
Role 4: Interpret general psychological literature and apply it to
practice.
Domain IV: Techniques of Research
Role 5: Design and implement research, e.g., experimental and qua-
siexperimental designs, evaluation and validation research,
including design of instrumentation, data collection, data
analysis and interpretation of results.
Domain V: Professional and Ethical Issues
Role 6: Evaluate activities within the limitations of professional eth-
ical and legal statutes, e.g., confidentiality, adherence to
professional standards, informed consent, honest represen-
tation of professional services. (Adapted from American
Association of State Psychology Boards, 1982, pp. 4-6)
An objectively scored, multiple choice examination, now 200 items in
length, the Examination for Professional Practice in Psychology is administered
nationally each year in April and October. Common testing dates have been
established by AASPB through 1989 according to the following schedule:
April 8, October 14, 1983; April 13, October 26, 1984; April 19, October 11,
1985; April 11, October 10, 1986; April 10, October 23,1987; April 15, Octo-
ber 14, 1988; April 14, October 6, 1989 (American Association of State Psy-
chology Boards, 1982 p. 10). A new form of the examination is constructed
prior to each administration, with items drawn from a common pool that is
LiCENSING AND CERTIFICATION 305
continually renewed by solicitation of new items through AASPB member

boards. Individual candidate scores are reported to regulatory authorities,
along with statistical information concerning the relevant national norms.
It is the responsibility of each regulatory board to make use of the
national examination consistent with its own statutory authority. Thus,
boards are free to establish passing scores on the examination that are
appropriate for use within their respective jurisdictions. Table 2 incorpo-
rates passing scores reported by regulatory agencies during 1982. For licen-
sure or certification at the doctoral level the most frequently reported pass-
ing point is the national mean score. Where the examination may be used
as a part of the credentialing procedure for subdoctoral classifications, a
lower passing score usually is set. This practice is in keeping with data
showing that candidates holding the Ph.D. in psychology score signifi-
cantly higher on the Examination for Professional Practice in Psychology than
do candidates holding the Ed.D. or master's degree (Hays & Mullins, 1978;
Hays & Schreiner, 1977; Shrader, 1980; Terris, 1973).
Forty-two United States jurisdictions and the Canadian provinces of
British Columbia and Quebec have statutory language defining the practice
of psychology. These definitions go beyond the simple assertion that the
practice of psychology includes representation of oneself to the public as a
psychologist or one's services as psychological in nature. Thus, the laws in
these jurisdictions enumerate specific services or functions that legally may
be performed by a qualified psychologist. Manitoba and New York have
adopted by regulation a definition of practice. In five other states there is
statutory language equivalent to a definition of practice or other provisions
that bear on this question. A 1977 amendment to the Arizona law includes
explicit provision for diagnosis and treatment by a certified psychologist.
Statutes in North Dakota, Rhode Island, and Wyoming define "psychology"
or "psychologist" in such a way as to include functions normally encom-
passed in a definition of practice. In the Florida statute, only a definition
limiting the practice of school psychology is found.
Table 3 summarizes a number of important elements within the scope
of practice recognized in state and provincial law. Almost half of the states,
as well as British Columbia and Manitoba, include research as an aspect of
the definition of practice of psychology. This is sometimes specified as
"advertising and market research," or the provision may be as broad as
"research on problems relating to human behavior." Teaching of psychol-
ogy also is regulated outside of exempt settings in 10 states.
British Columbia, Manitoba, and 31 states recognize psychotherapy as
falling within the domain of psychological practice. Nineteen states and the
provinces of Manitoba and British Columbia specifically acknowledge diag-
nosis and treatment as being within the scope of practice of a psychologist.
In Alabama, such recognition is based on an interpretation of law by the
state attorney general. The critical distinction made in rendering this opin-
ion appears to have been that "the assignment of a case diagnosis or psy-
chological evaluation by a licensed psychologist in Alabama does not con-
stitute the practice of medicine" ("Diagnosis by psychologists," 1977).
TABLE 3
Provisions Related to Scope of Practice
Definition Diagnosis
of and Psycho- Biofeed- School! Counseling! Behavior Physician
Jurisdiction practice Research Teaching treatment therapy back education guidance modification Hypnosis collaboration
Alabama X X X X psychotherapy
Alaska X X X X X X X X
Arizona X
Arkansas X X X X X psychotherapy
California X X X X X X X
Colorado X X X X X X X X psychotherapy
Connecticut X X X X X X
Delaware
District of Columbia X X X X X X medical
problem
Florida X
Georgia X X X X
Hawaii X X
Idaho X X X X X
Illinois X X X X X mental illness
Indiana X X X X X X mental or
physical
illness
Iowa X X X X X X
Kansas X X X X X X
Kentucky X X X
Louisiana X X X X X X X X
Maine X X X X
Maryland X X X X X X X
Massachusetts X X X X X X X X
Michigan X X X X X X X
Minnesota X X X X X
Mississippi X X X X X
Missouri X X X X X X X X
Montana X X X X X
Nebraska X X X X organic or
psychiatric
disease
Nevada X X X X psychotherapy
New Hampshire
New Jersey X X X
New Mexico X X X X X X
New York X X X X X
North Carolina X X X X X X
North Dakota X X X X
Ohio X X X X X X X psychotherapy
Oklahoma X X X X
Oregon X X X X X X X
Pennsylvania X X X X
Rhode Island X X
South Carolina X X extended
psychotherapy
South Dakota X X X X X X X
Tennessee X X X X psychotherapy
Texas
Utah X X X X X X X X
Vermont X X X
Virginia X X X X X X
Washington X X X X
West Virginia X X X
Wisconsin X X X X X X X
Wyoming X X X X X
Alberta
British Columbia X X X X X X X
Manitoba X X X X X X treatment of
mental
disorder
Continued
TABLE 3
Provisions Related to Scope of Practice (continued)
Definition Diagnosis
of and Psycho- Biofeed- School! Counseling! Behavior Physician
Jurisdiction practice Research Teaching treatment therapy back education guidance modification Hypnosis collaboration
New Brunswick
Nova Scotia
Ontario treatment of
mental
disorder
Quebec x x
Saskatchewan
Note: All definitions recognize psychological testing, evaluation, or assessment as being within the scope of practice of a psychologist.
aNo definition of practice in statute; law authorizes certified psychologist to diagnose, treat, and correct human conditions ordinarily within the scope of practice of a psychologist.
~Limited definition of practice for school psychologist only.
'Nonstatutory definition of practice has been adopted by regulatory body.
dNo definition of practice in statute; provisions specified are found in definition of psychology or psychologist.
'Psychological diagnosis only.
The question of overlapping areas of competence with other disci-

plines, particularly the medical specialty of psychiatry, has been a delicate
matter to negotiate as psychologists have sought enactment of regulatory
laws. On the assumption that medical collaboration or consultation may be
desirable in order to make provision for diagnosis and treatment of condi-
tions outside the scope of practice of a psychologist, the laws of Alabama,
Arkansas, Colorado, Nevada, Ohio, and Tennessee require physician collab-
oration as a condition of undertaking psychotherapy. Ohio regulations,
however, make clear that physician involvement shall be at the initiative
of the attending psychologist when, in the opinion of the psychologist,
such consultation may be in the best interest of the client. The South Car-
olina statute has a similar provision with respe~t to "extended psychother-
apy." The Nebraska statute refers to "organic or major psychiatric disease,"
while Illinois and Indiana laws speak of "mental illness" and "mental or
physical illness," respectively, as circumstances necessitating medical col-
laboration. The Canadian jurisdictions of Manitoba and Ontario both
require association with a medical doctor as a condition of treatment for
"mental disorder." In the District of Columbia, collaboration with a physi-
cian is more broadly anticipated in order to make provision for the diag-
nosis and treatment of "relevant medical problems."
Most laws also contain a specific disclaimer to the effect that licensure
or certification as a psychologist does not constitute authorization to engage
in the practice of medicine. Aside from the questionable logic involved in
disclaiming a right that has not been sought or granted, this more general
language would appear to be quite adequate to protect the public interest
since the vast majority of laws (41 states and 6 provinces) contain no further
specification of physician referral, collaboration or consultation. In most
jurisdictions, there is also the additional safeguard provided in law or board
rules and regulations that requires that psychologists limit their practice to
demonstrated areas of competence in accordance with the code of ethics of
the profession (American Psychological Association, 1981). Failure to do so
may be cause for suspension or revocation of license.
Application of psychological principles, methods, and procedures in
school or educational settings is specified within the definition of practice
for a majority of laws. This is true also for the provision of counseling or
guidance services to individuals or groups of persons. These activities
appear to be well established aspects of generic definitions of practice
throughout the United States and Canada.
More recently incorporated in state law, but already established in 24
jurisdictions, is the application of behavior modification techniques or
behavior therapy within the scope of practice of psychology. This is in
keeping with the recommendation of Agras (1973) to the effect that these
procedures do not constitute the basis for a separate profession but that they
should be carried out by individuals appropriately qualified and creden-
tialed in one of the established mental health disciplines. Other practices
authorized by law include hypnosis in 19 jurisdictions and the use of bio-
feedback techniques in Alaska, California, Colorado, Louisiana, Maryland,

Michigan, South Dakota, and Utah.
Laws contain numerous exemptions accorded to persons with special
status who may be permitted to represent themselves as a psychologist or
to undertake psychological functions under specified conditions without
being licensed or certified as a psychologist. Table 4 summarizes the most
common exemptions by title. The laws of all states contain an exemption
for psychology students, interns, or trainees who, in the course of their
supervised training, may engage in psychological practice and render ser-
vices to the public. The laws are quite specific in restricting such individuals
to practice only under supervision and only under conditions where the
student's training status is made clear to the recipient of services. Among
the Canadian statutes, only Nova Scotia includes an exemption for persons
in training. Apparently, Canadian students elsewhere would not find them-
selves in violation of the law unless they were to misrepresent themselves
by use of a protected title.
Exemptions for members of other professions are found in statutes
almost as frequently as those for students and trainees. The language of the
exemption mayor may not specifically enumerate the professions
exempted. In some instances, the exemption is limited to other statutorily
recognized professions. In all cases, the exemption requires that the mem-
ber of another profession not be represented as a psychologist.
Assistants working under supervision also are exempted in a signifi-
cant number of jurisdictions. In California, Hawaii, Oklahoma, Pennsylva-
nia, and Vermont, supervision may be provided by a professional person
other than a psychologist (e.g., physician, social worker, nurse). Boards also
may impose other specific limitations or conditions of employment that
apply to supervised assistants.
A time limitation, typically restricting practice to not more than 60 days
in any calendar year, is imposed for psychologists working outside the juris-
diction of their credential. Other limitations sometimes are placed on the
out-of-state psychologist, such as the requirement that he practice in asso-
ciation with a licensed or certified local psychologist or that prior nofitica-
tion of intent be given to the board. In states where there is no specific
exemption provided by law, the board may issue a temporary license to a
qualified nonresident psychologist. Where an extended period of practice
is anticipated, the psychologist usually will seek permanent licensure or
certification by endorsement. Fifteen states allow visiting lecturers to rep-
resent themselves as psychologists on the strength of their academic or
research credentials without requiring licensure or certification, provided
they do not otherwise engage in the practice of psychology.
Less than half of the states continue to offer exemptions for persons
practicing as a "social psychologist." Such individuals usually are required
to have a doctoral degree in sociology or social psychology recognized by
the board and to meet certain other qualifications specified by law. This
exemption is a vestige of a 1959 agreement between the APA and the Amer-
TABLE 4
Exemptions by Title
Certified Out of
Social school state Visiting Supervised Student Other
Jurisdiction psychologist psychologist psychologist' lecturers assistants intern / trainee professionsb
Alabama X X X
Alaska X X
Arizona Xd X X
Arkansas X X X
California X"d X X' X Xf
Colorado Xd X X X X
Connecticut X' X X
Delaware X X X X
District of Columbia X X X X
Florida Xd,h X X X
Georgia X X
Hawaii X X xj
Idaho X X X
Illinois X Xd X X X Xk
Indiana X X'" X X X,
Iowa X X X X'"
Kansas X Xd X X X Xk
Kentucky d,n X X
Louisiana X X X X
Maine X X X XO
Maryland XP X X
Massachusetts X X X X
Michigan Xd X X X X X
Minnesota X X X X X
Mississippi X X X X
Missouri X X X X
Montana X X X X X
Continued
TABLE 4
Exemptions by Title (continued)
Certified Out of
Social school state Visiting Supervised Student Other
Jurisdiction psychologist psychologist psychologist' lecturers assistants intern I trainee professionsb
Nebraska X X X X X
Nevada X X' X Xf
New Hampshire X
New Jersey Xd X X X
New Mexico X X X
New York X X Xk,/
North Carolina X X X xm
North Dakota Xd X X X
Ohio X Xd,h X X X X
Oklahoma X X X X X
Oregon X Xd X Xf
Pennsylvania X Xd X X X X
Rhode Island Xd X X
South Carolina X Xd X X X X
South Dakota X· xd,g X X X
Tennessee xd,t X X X
Texas X X
Utah X X
Vermont X X X X
Virginia X' X X·
Washington X Xd X XW
West Virginia Xd X X X X
Wisconsin X Xd,h X X X X Xk
Wyoming d,x X X X
Alberta
British Columbia Xl
Manitoba
New Brunswick X
Nova Scotia X
Ontario Xi
Quebec X'
y,d
Saskatchewan
Q Exemption applies for limited time period to psychologist credentialed in another jurisdiction.
b Except as noted, may not be represented as a psychologist.
, Or psychometrist.
d Exemption limited to school employment only.
e Registration required.
I Exemption limited to other professions recognized by law.
g Or school psychological examiner.
h Statutory licensure for independent practice of school psychology available.
i Temporary permit available.
j Only medical practitioner specified.
k Any person exempted, not using title of psychologist.
I May not describe services as psychological.
m Any person may use title without engaging in practice.
R Exemption for certified psychometrician.
o Only teachers and school counselors specified.

P Requires masters degree in psychology or substantial equivalent .
• Exemption for school psychological examiner; may not be represented as a psychologist.
, If invited as a consultant by psychologist certified in Nevada,
S Exemption includes persons consulting in experimental, industrial/organizational, developmental, social psychOlogy, or research design; must notify board of activities unless
otherwise exempted.
I Or school psychological services worker.
U Exemption for any person employed as a psychologist by a public school district.
v Any person exempted, not charging a fee and not represented as licensed,
W Only counseling and gUidance specified.
x Exemption for persons with educational certification in guidance or psychological services,

Y Exemption for school psychologist or teacher psychologist,
ican Sociological Association pertaining to the "sociologically trained social

psychologist." The agreement was established prior to the widespread
availability of doctoral training in social psychology in graduate depart-
ments of psychology.
Also exempt from licensure or certification as a psychologist in 23 states
are individuals holding nonstatutory certification as a school psychologist
issued by the state education authority. A similar provision obtains in the
province of Saskatchewan for a person employed as a school psychologist
or "teacher psychologist." California, Indiana, and Kentucky provide an
exemption for psychometricians, whereas school psychological examiners
are exempt in Connecticut and Missouri. An exemption in Texas law applies
to an individual employed as a psychologist by any public school distriCt.
Holders of a current pupil personnel certificate endorsed for guidance or
psychological services are exempt from licensure in Wyoming. All exemp-
tions in this category apply only to school employment except in Connect-
icut, Iowa, and Massachusetts. The states of Florida, Ohio, Virginia, and
Wisconsin have statutory licensure for school psychologists.
Table 5 shows exemptions from licensure or certification for persons
working in various governmental and nongovernmental agencies or insti-
tutions. The almost universal exemption which has been accorded public
agencies, especially government facilities and programs, has come increas-
ingly to be challenged on the grounds that the public is entitled to the same
level of care or treatment in public institutions as may be available in the
private sector. In the landmark Wyatt v. Stickney decision, court-ordered
standards for Bryce and Searcy hospitals specified that
each Qualified Mental Health Professional and each physician shall meet all
licensing and certification requirements promulgated by the State of Alabama
for persons engaged in private practice of the same profession elsewhere in
Alabama. Other staff members shall meet the same licensing and certification
requirements as persons who engage in private practice of their specialty else-
where in Alabama. 3
The practice of allowing a lesser standard of qualifications for providers of

psychological services in the public sector also has come to be looked on
with disfavor by the profession. According to the APA Standards for Pro-
viders of Psychological Services,
there should be a uniform set of standards governing the quality of services to
all users of psychological services in both the private and public sectors. There
is no justification for maintaining the double standard presently embedded in
most state legislation whereby providers of private fee-based psychological ser-
vices are subject to statutory regulation, while those providing similar psycho-
logical services under governmental auspices are usually exempt from such reg-
ulations. (American Psychological Association, 1977, p. 3)
Individuals affiliated with educational and research institutions also

are quite regularly provided with exempt status in licensing and certifica-
3Wyatt v. Stickney, 344 F.Supp. 373 at 383 (M.D. Ala. 1972).

1:""'
i'i
TABLE 5 z<f>'"
Exemptions by Setting Z
Cl
Government Educational Business/ Research Nonprofit/ Clinic/ z:>-

Cl
Jurisdiction Federal State / province Other' institution industry institution charitable /religious hospital
(')
Alabama X X X X X· X '"'....."
X' X' X' X'
:;;
Alaska i'i
Arizona Xd Xd Xd X',f :>-
.....
Arkansas X X X X' X X (5
xg xg xg Z
California X
Colorado X',f X·"
Connecticut X X X X X
Delaware X X X
District of Columbia Xi Xi Xi Xi x· X'
Florida X X X X X· X X, Xi
Georgia X X X X X· X·
Hawaii X X X X'
Idaho X X X X
Illinois X X X X X
Indiana X·" X·
Iowa X X X X X X
Kansas X X X X X
Kentucky X X' X
Louisiana X, X, X,
Maine X X X' X
Maryland X X X X X
Massach usetts X X X X X X
Michigan X, X' xm X"
Minnesota X X X X' X X
Mississippi X X X X
Missouri X X X X X X w
Montana X X X X X X X ( JI
Continued
-
V>
.....
'"
TABLE 5
Exemptions by Setting (continued)
Government Educational Business/ Research Nonprofit/ Clinic/

Jurisdiction Federal State / province Other' institution industry institution charitable /religious hospital
Nebraska X X X X
Nevada XC X
New Hampshire X X X X
New Jersey X X X X X X X,
New Mexico X X X X X
New York X X X X
North Carolina X X
North Dakota X, X, X, X, X,
Ohio X
Oklahoma X X X X X
Oregon X X X X' X
Pennsylvania X X X X X X X
Rhode Island X X X X X X
South Carolina X X X X X
South Dakota X·,o X X,
Tennessee >-l
X X X X' X X 0
Texas X X X X' XP ;;::
;;::
Utah X X -<
Vermont X X X X X X ;l
X' (J'J
Virginia X X X X X
Washington X X X X' Xi ~
>
c-<
West Virginia X X, X, X' c-<
Wisconsin X X X X' r'
Wyoming X Pi
Alberta '"Z
British Columbia X X X X' 2
Cl
Manitoba X X X X X' »
New Brunswick X' Z
0
Nova Scotia (')
Ontario X X X' '"'".....
Quebec :;;
Saskatchewan X X X Pi
»
::l
0
z
Note: Exemptions are limited to place of salaried employment, and services may not be offered to the public independently for a fee.
, Usually applies to county or municipal government setting.
b Use of title, psychologist, specifically prohibited.
, Must be under supervision of employer.
d Doctorate must obtain certification within one year of employment; subdoctorate must be supervised by qualified psychologist.
, Higher education specified.
f May not engage in clinical practice of psychology.
g May not be primarily involved in direct health or mental health services.
h For clergy within religious organization.
; Services may not include psychotherapy.
j Developmental services program, mental health, alcohol or drug abuse facility specified.
• Must be supervised by licensed psychologist.
1 Specifies U.S. military service, U.S. Public Health Service, U.S. Department of Agriculture, U.S. Veterans Administration.
mLimited to self-help, peer counseling, or support services provided by non-profit organization.
n Licensed substance abuse service specified.
o Public agency specified.
P Must be licensed by State Department of Health.
q Community mental health agency specified; services must be supervised by qualified psychologist.
, Limited to accredited hospitals.
w
"'-l
-
tion laws. Twenty states offer exemptions to business and industry; 14

exempt nonprofit, charitable, or religious institutions; hospital or clinic
exemptions are found in only 7 states. In general, all persons exempted
from licensure or certification on the basis of their responsibilities in a par-
ticular work setting are prohibited from engaging in the practice of psy-
chology elsewhere or offering psychological services to the public for a fee.
In a few instances, this exemption is conditional on continuing supervision
by a licensed psychologist.
ISSUES AND PROSPECTS
A number of issues related to licensing and certification can be iden-

tified as having special significance for the future growth and development
of the profession. Many of these issues also have captured the attention of
various public interest groups and government officials (Shimberg & Roe-
derer, 1978). They are not necessarily the issues that were of primary con-
cern to psychologists and lawmakers even a decade ago. But just as the pres-
ent laws reflect and interpret concerns of the past, so must these emerging
issues be addressed in future legislation.
ACCREDITATION OF TRAINING PROGRAMS AND LICENSURE
Should state regulatory boards have the authority to approve or

accredit professional training programs in psychology? Some have argued
against such a practice on the grounds that education, accreditation, and
credentialing should remain separate and distinct functions carried out
independently by authorities representing different constituencies (Matar-
azzo, 1977). It is feared that interlocking control could stifle innovation in
training and lead to restriction of the supply of practitioners, contrary to
the public interest. Others have raised even more basic objections to accre-
ditation, challenging any requirement of formal education for professional
practice unless a direct relationship to competency can be shown (Hogan,
1979). Yet there is recognized value in an articulated system of professional
training and competency assurance that may include elements of specialty
credentialing, continuing education, and peer review, as well as basic edu-
cational requirements, accreditation of training programs, supervised prac-
tice, and generic licensure or certification (Albee & Kessler, 1977). Viewed
from the perspective of the individual seeking to become a professional
psychologist, a predictable sequence of known requirements is preferable
to the uncertainty of a series of career challenges and confrontations (Hess,
1977). The student should know from the beginning whether completion
of a particular training program will make one eligible for licensure or cer-
tification. Faculty and administrative officials should know what is required
in order for a program to receive accreditation.
The degree to which boards have or exercise authority to approve train-

ing programs, as well as to credential and regulate practice, varies widely.
In Nebraska, the law states that "nothing ... shall require the registration
of departments of psychology or of doctoral programs in psychology of col-
leges or universities."4 But consider the following language that appears in
the Nevada statute:
The board shall determine which schools in and out of this state do or do not
have courses of study for the preparation of psychologists which are sufficient
and thorough for certification purposes. Published lists of educational institu-
tions accredited by recognized accrediting organizations may be used in the
evaluation of such courses of study.s
In New York State, it is the responsibility of the State Department of Edu-

cation to register doctoral programs in psychology that meet educational
requirements for admission of graduates to the licensing examination. The
Department must determine that candidates for examination have com-
pleted a doctorate in psychology from a registered program or from a pro-
gram .deemed equivalent. 6
Although the majority of state laws remain silent on this question, it
has become a recent focus of concern among elements within organized
psychology. In 1975 the APA Committee on State Legislation was charged
with the responsibility to monitor and evaluate legislation that may affect
the scientific and professional activities of psychologists and to recommend
policies and action relative to state legislation (American Psychological
Association Council of Representatives, 1975). Working over a period of
several years, the Committee proposed various changes in the APA guide-
lines for state legislation, including the recommendation that "applicants
for licensure shall possess a doctoral degree from a regionally accredited
institution, provided that the degree is obtained from an integrated pro-
gram of graduate study in psychology as defined by the rules and regula-
tions of the licensing board" (American Psychological Association Commit-
tee on State Legislation, 1978, p. 19). The committee further anticipated that
boards would be guided by national standards in formulating rules and reg-
ulations defining professional education in psychology. Such standards
have been developed by the American Association of State Psychology
Boards (AASPB), based on the deliberations and recommendations of two
national conferences on education and credentialing in psychology (Well-
ner, 1976, 1977). The AASPB standards were adopted as policy to be rec-
ommended for implementation by member boards at the 1977 annual meet-
ing of official delegates in San Francisco. Subsequently, boards have begun
to make use of these standards in promulgating rules and regulations gov-
erning the educational qualifications of candidates for licensure and certi-
fication (Stigall, 1979).
4Neb. Rev. Stat. § 71-3827 (1981).

sNev. Rev. Stat. § 641.120 (1981).
6N.Y. Educ. Law § 7603 (McKinney 1972).
The AASPB standards recognize programs that are accredited by APA

as meeting the definition of a professional psychology program. Also in
keeping with AP A accreditation practices (American Psychological Associ-
ation, 1979a), the AASPB standards specify that professional training in psy-
chology must be offered at the doctoral level in a regionally accredited insti-
tution of higher education. The training program must constitute an
organized, coherent sequence of study that publicly declares its intent to
educate and train professional psychologists. The program is required to
include practicum, internship, field, or laboratory experience, and must
encompass a minimum of three academic years consisting of at least 40
semester hours of full-time graduate study. The standards also recommend
essential areas of core curriculum that must be present: scientific and profes-
sional ethics and standards, history and systems, research design and meth-
odology, statistics and psychometrics, biological bases of behavior, cogni-
tive-affective bases of behavior, and individual differences. Supervised
training in psychological assessment and intervention is required in order
to develop the necessary skills for competent professional practice.
In addition to APA accreditation and the standards recommended by
AASPB, there is the prospect of program endorsement by the proposed
National Commission on Education and Credentialing in Psychology (Well-
ner, 1978). Conceived as an interorganizational body jointly representing
the constituencies of psychology training programs, credentialing authori-
ties, consumers of psychological services, and the profession of psychology,
the commission would identify and designate doctoral programs in psy-
chology that meet minimum criteria subscribed to by the commission. State
regulatory boards could make use of the National Commission listing of
programs to establish candidate eligibility for admission to examination.
Meanwhile, the Council for the National Register of Health Service
Providers in Psychology (1982) has produced a list of programs meeting
established criteria for deSignation as training programs in psychology.
And the APA Task Force on Education and Credentialing has begun des-
ignation trials to evaluate the feasibility of a formal designation system for
training programs in professional psychology (Buklad, 1981).
One impetus for movement in the direction of national standards for
accreditation of training programs has been a series of court challenges to
licensing boards by applicants denied licensure or certification on the
grounds that their training in psychology was not acceptable to the board
(Smith, 1978; Stigall, 1977). In Traweek v. Alabama Board of Examiners in Psy-
chology/ the issue was whether Traweek's doctoral degree with a major in
educational psychology and counseling and guidance qualified him to be
admitted to the examination for licensure as a psychologist in Alabama. The
board held that Traweek's course work was insufficient in the basic science
subject matter of psychology and, therefore, his doctoral preparation was
7Traweek v. Alabama Board of Examiners in Psychology cir. c/o Jefferson Co., AI., Equity No.
198-073 (1976).
not sufficiently "psychological in nature" to qualify him for licensure. In

this case, the court upheld the board and ruled against the plaintiff. In the
words of Smith (1978) who served as an expert witness in this case,
the court observed that the applicant, while having certain specialized knowl-
edge, did not possess the necessary training in the core areas of psychology to
qualify for the generic license issued by the state. In other words, the Alabama
Court accepted the notion that there is a definable core of knowledge that is
encompassed by psychology and that the applicant, by the nature of his very
specialized training in only one area of psychology (educational psychology)
did not possess the appropriate educational experience to be licensed as a psy-
chologist. (p. 494)
The Mississippi State Board of Psychological Examiners did not fare so

well in a lawsuit where the plaintiff offered testimony that his doctorate
from a department of counseling and guidance, retroactively changed to the
Department of Counseling and Guidance and Counseling Psychology, was
sufficient to meet the test of "primarily psychological in nature." Since the
Mississippi board had failed to establish in rules and regulations an explicit
interpretation of the educational requirements for licensure, the State
Supreme Court on appeal ruled that plaintiff Coxe was not only education-
ally qualified for licensure but that the Board must issue a license without
examination.s It is important to understand the dangerous precedent
involved in this case where the court, in the absence of clear and specific
educational criteria, assumes the prerogative of deciding that an individual
is qualified to practice psychology and to represent himself as a psycholo-
gist on the strength of his own assertion that his training is sufficiently psy-
chological in nature.
This fundamental problem of educational credibility, at least insofar as
it relates to credentialing for practice, already had been addressed by Dis-
trict of Columbia Circuit Court of Appeals Judge MacKinnon in Berger v.
Board of Psychologist Examiners.
The very reason psychology has not been regulated before is that it has been
and remains an amorphous, inexact, and even mysterious discipline. Possession
of a graduate degree in psychology does not signify the absorption of a corpus
of knowledge as does a medical, engineering, or law degree, rather it is simply
a convenient line for legislatures to draw on the brave assumption that what-
ever is taught in the varied graduate curricula of university psychology depart-
ments, will make one a competent psychologist. 9
This is an extremely serious challenge to the relevance of graduate training

in psychology for professional practice and it cannot be dismissed lightly.
Enhancement of educational credibility could be expected to follow from
the administration of more uniform standards. State regulatory boards are,
therefore, likely to remain quite receptive to the responsible development
of national standards for accreditation of training programs in psychology.
8State Board of Psychological Examiners v. Coxe, Miss., 355 So.2d 669 (1978).
9Berger v. Board of Psychologist Examiners, 521 F.2d 1056 (D.C. Cir. 1975).
FEDERAL REGULATION OF PSYCHOLOGY AS A HEALTH CARE PROFESSION
The status of psychology as a health profession is well-documented

(American Psychological Association, 1979b; Council for the National Reg-
ister of Health Service Providers in Psychology, 1981; Dorken & Webb,
1979; Dorken & Whiting, 1976; Gottfredson & Dyer, 1978; Wellner & Mills,
1977; Wright, 1976). Gottfredson and Dyer surveyed a stratified random
sample of APA members in late 1976 and concluded that 22,980 were health
service providers, with about 81% of the doctoral-level practitioners
licensed or certified. The remainder presumably were employed in exempt
settings. The survey by Wellner and Mills of all known licensed or certified
psychologists, also conducted in 1976, resulted in a population projection
of 22,588 health service providers meeting the following criteria:
A Health Service Provider in Psychology is defined as a psychologist, certified/

licensed at the independent practice level in his/her state, who is duly trained
and experienced in the delivery of direct, preventive, assessment, and thera-
peutic intervention services to individuals whose growth, adjustment, or func-
tioning is actually impaired or is demonstrably at high risk of impairment.
(p.2)
The National Register of Health Service Providers in Psychology is widely rec-

ognized as an authoritative listing of licensed or certified psychologists
qualified to render health services. The 1981 edition of the Register contains
the names of some 13,000 psychologists who meet the established criteria
for voluntary listing.
It is one thing to speak of a national consensus on educational stan-
dards for professional training. It is quite a different matter to advocate fed-
eral government credentialing of a profession. A series of reports issued
between 1971 and 1977 by the U.S. Department of Health, Education, and
Welfare sought to address the problems of variable credentialing standards
in different jurisdictions, geographic maldistribution of health care practi-
tioners, and the fact that numerous health occupations have been unregu-
lated or have relied on a system of self-certification. Federal government
interest in this area has been predicated on the investment of federal funds
in programs of third party payment for services and training of health man-
power, as well as concern for the impact of licensure and certification on
the quality of public health care.
Abandoning an earlier proposal to impose national standards for cre-
dentialing health occupations and to limit reimbursement under federal
health care financing to those providers licensed or certified in accordance
with such standards, the 1977 report called for creation of a nonfederal
national commission that would develop criteria and procedures for the
evaluation of nonstatutory certifying agencies for the allied health profes-
sions. Under this alternative, states would not be subject to federal reim-
bursement controls. The final report also called for the development of
national standards for the credentialing of selected health occupations with
participation by the relevant professional organizations and other elements

in the private sector, state, and federal government.
The standards thus developed should be utilized for the various purposes for
which standards are required, including professional certification, licensure,
private sector and civil service employment, and third party reimbursement ....
It is important to emphasize that the development and adoption of national
standards should not be confused with Federal licensure. Licensure is presently,
and will continue to be, a function of State government. What is recommended
here is the development of a set of uniform standards for health personnel
which will assist States in formulating compatible licensure programs, where
licensure is the appropriate mode of credentialing. (United States Department
of Health, Education, and Welfare, 1977a, pp. 10-11)
The much softer version of federal initiative contained in the 1977

report appears to be, at least in part, the result of strong objections raised
by established professional groups already regulated under state law. The
Federation of Associations of Health Regulatory Boards (FAHRB), repre-
senting national organizations of examining boards for dentistry, veteri-
nary medicine, psychology, nursing, podiatry, chiropractic, medicine,
optometry, and pharmacy, in December 1976, submitted an extensive opin-
ion and legal brief to the Department of Health, Education, and Welfare
challenging on constitutional and other grounds the prospect of federal
preemption of state police power in the area of professional regulation.
Subsequent developments have led to the organization of a National
Commission for Health Certifying Agencies, apparently with the continued
encouragement and support of the federal government. Initial membership
in the commission included such diverse organizations as the American
Dental Association, the National Association of Retail Druggists, and the
Psychological Corporation. In June 1978, the APA Board of Directors
approved the budgeting of funds to support APA membership for 1979 in
the National Commission for Health Certifying Agencies. Subsequent
action by the APA Council of Representatives, however, did not support
this recommendation. While it is not yet clear what will be the long-term
impact of the commission on health manpower credentialing, the estab-
lished role of state psychology boards in this context appears to be relatively
secure.
SPECIALTY CREDENTIALING
The tradition of generic licensure or certification for psychologists par-

allels that of other professions, such as medicine and law, on the principle
that there is an essential knowledge base common to the practice of psy-
chology regardless of specialty application. This principle has been empha-
sized as the basis for the recommendations contained in the report of the
Steering Committee on Education and Credentialing in Psychology: ''The
foundation of professional practice in psychology is the evolving body of
knowledge in the discipline of psychology" (Wellner, 1978, p. 33). An

important corollary of this principle is that specialty credentialing should
remain complementary to generic licensure or certification and should not
be considered an alternative to generic credentialing (Stigall, 1981). Indi-
viduals seeking to prepare themselves for a career in the practice of psy-
chology should first complete an accredited doctoral program of profes-
sional training in psychology and thereafter meet the statutory
requirements for credentialing as a psychologist. Concurrent or subsequent
specialized training and experience may indeed qualify an individual for
specialty practice, in which case specialty credentialing also may be desir-
able. Just as licensure or certification as a psychologist is intended to pro-
vide some assurance to the public that the individual so credentialed has
met minimum standards of education and experience, including the mas-
tery of basic science knowledge in psychology, so should the specialty cre-
dential signify that the individual possesses the requisite knowledge, abil-
ity, and skill to be represented by a specialty title and engage in specialty
practice. In both instances, the objective clearly is the same: protection of
the public health and welfare.
Specialty credentialing could take the form of self-certification by the
profession or it could be accomplished under the rule-making authority of
psychology examining boards. The American Psychological Association
Committee on State Legislation (1978) has proposed the following language
for incorporation in state laws.
The board shall define by regulation areas and techniques of practice in psy-
chology for which specialized training is required and shall set standards for
such training. No psychologist licensed under this act may engage in practice
in such specialty areas, or may apply such techniques in independent, unsu-
pervised practice, until he or she has met the standards set by the board. (p. 25)
In most jurisdictions boards already are given authority to promulgate

rules governing and' regulating practice. Using this authority, they may
require registration of specialty competence to achieve the effect of spe-
cialty credentialing whether or not a formal certificate is issued. Sometimes
the law is quite specific on this point.
The Board may certify specialties within the field of psychological services and
may employ consultants when necessary for the implementation of this Act.
The Board shall adopt rules applicable to the certification of specialties and to
the employment of consultants. Specialty certifications by the Board may
include certifications for clinical psychologists, counseling psychologists,
industrial psychologists, school psychologists, and psychologists designated as
health service providers. lo
A special provision in Mississippi law authorizes the Board of Psycho-

logical Examiners to certify those licensed psychologists who are qualified
to perform civil commitments." Written and oral examinations may be
administered to establish qualifications for this recognition.
IOTex. Rev. Civ. Stat. Ann. art. 4512c, § 8(b) (Vernon 1976 & Supp. 1982).
llMiss. Code Ann. § 41-21-61(f) (Supp. 1980).
The first state to enact legislation requiring specialty certification in

addition to generic licensure was Nebraska. A 1978 amendment to the psy-
chology licensing law provides that no licensed psychologist in Nebraska
shall represent himself or herself as qualified to practice clinical psychology
without meeting the specialized training and experience, or examination,
requirements established by law. 12 A similar provision has been enacted in
Indiana law, effective July 1, 1982, which states
If a psychologist certified for private practice under this chapter has a doctoral
degree in psychology and has fulfilled the two [2) years experience requirement
in a supervised health service setting, with one [1) year being obtained in an
organized health service training program, the board shall also certify such
individual as a clinical psychologist. 13
It is the responsibility of the profession itself to develop both general

and specific standards governing the practice of psychologists. Generic
standards have been established by AP A with provision for continued
review and elaboration as necessary (American Psychological Association,
1977). The standards are intended to apply to all persons rendering psycho-
logical services in any setting, whether public or private, profit or non-
profit. Standards for specialty practice also are being developed (American
Psychological Association Committee on Professional Standards, 1981).
But what are the specialties within the field of psychology and how are
they to be identified? Those areas of specialty training and practice that usu-
ally are recognized by virtue of tradition and maturity of development are
clinical, counseling, school, and industrial-organizational psychology.
These are the same four specialties that are recognized for the awarding of
ABPP diplomas to qualified applicants who fulfill the requirements for
diploma status (American Board of Professional Psychology, 1978). But
other areas of specialization can be expected to emerge, and some procedure
for official designation of specialties will become crucial, both in regard to
specialty training and specialty credentialing.
If psychology is to remain an integrated discipline, it is necessary not
only to define the specialties within psychology but also to decide what is
not psychology. Sometimes the boundaries between psychology and other
closely related fields can become quite obscure. Is counseling, for example,
a specialty area of practice within psychology, or is it a technique practiced
by a variety of disciplines such as law, medicine, psychology, and the
clergy? Or is it an independent profession with its own specialized body of
knowledge, theory, and practice? Can it be all three? The American Person-
nel and Guidance Association, through its affiliated state organizations, has
been pressing for state licensure of counselors. Several states have enacted
such legislation, sometimes with a definition of practice essentially equiv-
alent to that for psychology (American Personnel and Guidance Associa-
tion, 1978). The American Association of Marriage and Family Counselors
12Neb. Rev. Stat. §§ 71-3835, 71-3836 (1981).

13Ind. Code Ann. § 25-33-1-6(c) (Burns 1982).
has sought support from APA for its efforts to secure recognition from the
U.S. Office of Education as the accrediting body for graduate training of
marriage and family counselors. Yet, in some states where marriage and
family counseling laws have been enacted, psychologists and other mental
health professionals have been prosecuted for practicing without a license
issued by the board of marriage and family counseling (Williams, 1978).
Fragmentation of psychology as a profession can also occur on the basis
of multiple levels of training and credentialing, as well as across specialty
areas. An alternative to the model of generic licensure followed by specialty
certification is embodied in master's degree training programs for individ-
uals to function as school psychologists with credentials issued by state
departments of education or public instruction. Such persons usually are
exempt from the requirement for statutory licensure or certification, either
because of a general institutional exemption or a specific exemption for cer-
tified school psychologists. While APA accreditation of school psychology
training is limited to doctoral programs, the National Commission on
Accreditation of Teacher Education (NCATE) accredits master's programs in
school psychology. In most jurisdictions, individuals practicing school psy-
chology on the basis of an educational certificate are limited to employment
within the school setting and are prohibited from engaging in the practice
of psychology in any other context. Thus, there are doctoral level school
psychologists who meet all requirements for licensure or certification by
statute. There also are individuals with master's training in school psychol-
ogy who are ineligible for statutory licensure or certification but who con-
tinue to represent themselves as psychologists and function within the pub-
lic or private schools on the strength of a specialty credential that has been
issued in lieu of generic licensure or certification. In an address to the
National Association of School Psychologists (NASP), Bardon (1979) raises
the question whether school psychology is an independent profession or a
specialty of psychology.
I have been unable to find any basis for believing that school psychology is, in
and of itself, a profession. School psychology has no special body of knowledge.
It relies on the science and practice of psychology in all its aspects for its prac-
tice. Its ethics are adaptations of psychology's ethical code to a specific social
institution. It relies for its power and prestige and its public image on how
professional psychology is perceived, these perceptions determined in very
large part by what is said and written about other professional specialties, espe-
cially clinical psychology. It is not viewed by the public or even by the schools
as a profession. One can call it a profession, but, in fact, it simply is not one.
(pp. 164-165)
In order to resolve the present double standard for school psychology,

Bardon proposes that nondoctoral training programs in school psychology
be redesignated to indicate that their graduates are preparing for careers as
pupil personnel service specialists and that such programs continue to be
accredited through NCATE. He further suggests that NASP change its title
to something like the "National Association of School Psychological Per-
sonnel" and work with APA to implement the Standards for Providers of Psy-
chological Services, including supervision of unlicensed school psychological
service workers. Bardon concludes by asserting that
there cannot be professional psychology at the doctoral level and school psy-
chology at the non-doctoral level without some recognition of the meaning of
the difference. APA will not back down. It seems to me that at the very least
American psychology would have to do what has been done with cigarettes.
When professional psychology is mentioned, a disclaimer will have to be made
to the effect that "School Psychology is not psychology. Please take heed." If
this happens, who will win what? (pp. 166-167)
Subdoctoral training with specialty emphasis also occurs in areas other

than school psychology. Sometimes these programs are identified by titles
such as "rehabilitation psychology" or "community psychology." It is espe-
cially unfortunate when students in such programs are led to believe that
they will be eligible to practice autonomously as a psychologist without
further training, since this is contrary to law in most jurisdictions. It is dif-
ficult to see how training at the master's level can accomodate a sufficient
background in basic science knowledge and, at the same time, provide the
necessary supervised experience and training for applied specialty practice.
In a one- or two-year master's degree curriculum, either the basic science
emphasis or the applied skills must suffer. In the'more exceptional master's
training program, that may require as many as three years to complete and
include a supervised internship, the investment of resources and time
approaches that of doctoral training. In either case, Bardon's comments con-
cerning school psychology may well be apropos. Training programs at the
master's level should be identified clearly to indicate the kind of training
provided and the limitations on the use of the title and practice of psy-
chology which can be anticipated.
Of the two models for specialty training and credentialing that have
been advanced, the generic model that incorporates a second level of spe-
cialty training and credentialing is to be preferred. An example of this
model is provided by the Nebraska and Indiana statutes requiring specialty
certification of clinical psychologists beyond the first level of generic cre-
dentialing. The alternative, as exemplified by master's level training in
school psychology or for other limited practice, can be expected to result in
the fragmentation of psychology as a coherent discipline and the erosion
of basic science curricula in profeSSional education.
CONTINUING EDUCATION AND COMPETENCY ASSURANCE
It is widely acknowledged that continuing education for the profes-

sions offers no guarantee of competency, but increasingly there is recogni-
tion that entry-level credentialing for practice is only the first step toward
competency assurance and that continuing education is at least another step
in the right direction (Fish, 1977; Jones, 1975). By the end of 1981, at least
19 states have enacted legislation authorizing boards to require documen-
tation of continuing education credits as a condition of the psychologist's
licensure or certification renewal (see Table 2, Note).
The American Psychological Association Committee on State Legisla-
tion (1978) has recommended that psychology regulatory boards be empow-
ered by law to issue regulations specifying the continuing education
requirements that must be met by each licensee. This recommendation is
based upon appreciation of the complexities involved in defining and
administering continuing education requirements and the inappropriate-
ness of attempting to incorporate these details in the law itself. The legal
responsibility of boards of examiners has been distinguished from the
profession's responsibility for continuing education in the AASPB Guide-
lines for Accrediting Continuing Education in Psychology (Fish, 1977). Regulatory
boards would assume the responsibility for approval of continuing educa-
tion offerings, set the number of credits that may be earned in various cat-
egories of participation, and verify compliance on the part of individual
psychologists. Professional organizations and educational institutions
would be responsible for developing and promoting continuing education
offerings. Formal training experiences in the form of workshops, seminars,
or postgraduate course work would be expected to constitute the bulk of
creditable activities. However, a significant proportion of credits might also
be earned through informal activities approved by the board. These could
include self-study programs or individual, creative professional activities.
The AASPB Guidelines make it clear that "credit for continuing education
should not be applicable to advanced standing in specialty educational pro-
grams. Career changes should be preceded by formal, accredited academic
or professional educational programs" (p. 257).
Continuing education offerings endorsed by the APA (American Psy-
chological Association, 1982) or other recognized accrediting bodies could
be accepted by psychology examining boards without further evaluation.
Other continuing education programs and offerings would need to be eval-
uated on the basis of criteria adopted by the state or provincial regulatory
authority. The AASPB Guidelines recommend that boards establish criteria
for evaluation of programs on the basis of the following general consider-
ations: sponsorship, administration, faculty, program content, evaluation
and documentation of participation, and facilities. Approved offerings
would be expected to include a procedure for evaluating the benefit of par-
ticipation in terms of the announced goals and objectives of the training
program.
Beyond continuing education there are other mechanisms that have
been advanced for promoting continued professional competence. The 1977
Public Health Service report on Credentialing Health Manpower recom-
mended further study of alternative means for competency assurance on a
priority basis.
Instead of endorsing a single method such as continuing education, which itself

is often unvalidated or of questionable relevance to continued competence, PHS
urges that additional support be given to the development of more sophisti-
cated approaches to continued competence which ultimately can be tied into a
mandatory recertification or relicensure requirement. These approaches may
include peer review through Professional Standards Review Organizations,
reexamination, self-assessment techniques, and supervisory assessments, as
well as continuing education. (U.s. Department of Health, Education, and Wel-
fare, 1977a, p. 17)
The report also recommended that
certification organizations, licensure boards, and professional associations

should take steps to recognize and promote the widespread adoption of effec-
tive competency measures to determine the qualifications of health personnel.
Special attention should be given to the further development of proficiency and
equivalency measures for appropriate categories of health manpower. (p. 16)
Although definitions of competence usually refer to some combination

of knowledge, skill and ability, the measurement of competence remains an
elusive goal (Menne, 1981; Schoon & Gullion, 1978). The problem of defin-
ing the domain of practice, either in terms of essential skills or content
areas, is an especially formidable task facing those who advocate "compe-
tency-based" examination for credentialing in the human service profes-
sions (Schoon, 1981). Nevertheless, efforts in this direction are underway
for psychology and some progress can be anticipated. The ABPP examina-
tion process, intended to evaluate advanced specialty competence, now
includes direct observation of the candidate's performance in the daily
work setting as well as submission of work samples and oral examination
(American Board of Professional Psychology, 1978).
For assessment of knowledge at the entry level of practice, the national
licensing examination is being subjected to intensive analysis and refine-
ment. The AASPB Examination Committee has recommended a series of
validation studies on the Examination for Professional Practice in Psychology
and proposals for this research have been invited for possible funding by
the AASPB (Hall & Wertheimer, 1981). The first of these studies is intended
to delineate the major areas of professional practice in psychology in order
to establish the basis for an empirical assessment of the practice-relatedness
of examination content (Richman, 1980).
Efforts to improve and refine various aspects of the overall process of
credentialing and competency assurance should be continued. In the
absence of more unitary and direct measures of professional competence,
society will continue to rely upon a series of imperfect evaluation and
review procedures that are believed to have some relationship to compe-
tence. In this connection, psychologists can expect to see more of continu-
ing education and peer review following entry-level credentialing for prac-
tice (Brown, Leichtman, Blass, & Fleisher, 1982; Claiborn, Stricker, & Bent,
1982; Vitulano & Copeland, 1980; Wilson, 1982).
PROFESSIONAL REGULATION AND DISCIPLINE
If it is difficult to guarantee competence through credentialing, the

public at least should be assured of some protection against incompetence
and unethical behavior on the part of licensed psychologists. State psy-
chology boards are authorized by statute to regulate practice and discipline
psychologists who practice in violation of the law or ethical standards of
the profession. It is unfortunately all too often the case that boards have
been absorbed in responsibilities related to credentialing while neglecting
the unwelcome but essential task of enforcement.
Resources of boards to carry out the enforcement provisions of law may
be meager. The process of investigation of complaints, taking of testimony,
and conduct of hearings, as well as the matter of litigation itself, can be
time-consuming and expensive. Board members typically serve without
compensation, except for expenses, and the initiation of extended disciplin-
ary proceedings can be costly for all parties concerned. Nevertheless, this
important public service must be performed and board members should be
supported and encouraged by other members of the profession when dis-
charging their responsibilities in this area. State legislatures and govern-
ment officials should be educated to understand the need for providing suf-
ficient resources, including legal counsel and investigative staff, to support
the regulatory and disciplinary functions of the board. While boards tradi-
tionally have been funded on the basis of fees paid by candidates for licen-
sure or certification, there is also justification for funding on the basis of
general tax revenues since the function of the board is to protect the general
welfare of the public.
Most boards subscribe to an ethical code of professional conduct, with
penalties for violation specified in law or regulation. Sometimes there is a
detailed codification of those activities that constitute unprofessional con-
duct. Examples of such activities include direct solicitation of clients; fee-
splitting; misrepresentation of credentials or professional qualifications;
failure to exercise appropriate supervision over assistants; false, fraudulent,
or misleading claims regarding services; and intimidation or exploitation of
clients. The psychologist is frequently in a position of advantage relative to
the patient or client, both in terms of status and influence. The highest stan-
dards of moral and ethical conduct must be applied if this advantage is to
be used in the best interests of the client. Frequently this means that
restraint must be exercised on the part of the psychologist within the con-
text of a professional relationship.
Ethical violations can be errors of commission or omission. This some-
times poses a dilemma for the psychologist, as in the case where a client
presents a danger to himself or others.14 Not all violations are intentional
14See, for example, Tarasoff v. Regents of the University of California, 33 Cal. 3d 275,108 Cal.
Rep. 878 (1973); aff'd 529 P.2d 553, 118 Cal. Rep. 129 (1974); vacated after rehearing, 551
P.2d 334, 131 Cal. Rep. 14 (1976).
or malicious; many result from simple ignorance or poor judgment con-

cerning matters of professional conduct (Keith-Spiegel, 1977). All practicing
psychologists should be thoroughly familiar with the professional, legal,
and ethical standards for psychology. In addition to the Ethical Principles of
Psychologists (American Psychological Association, 1981) and Standards for
Providers of Psychological Services (American Psychological Association, 1977),
psychologists undertaking research with human subjects should be guided
by the APA Ethical Principles in the Conduct of Research with Human Participants
(American Psychological Association, 1973).
RESEARCH AND TEACHING
From the beginning of efforts to establish statutory credentialing for

psychologists, the question of whether to include research and teaching as
statutOrily regulated functions has been debated. The position that gradu-
ally has evolved is that research and teaching per se do not constitute the
practice of psychology and these activities should not require one to be
licensed as a psychologist. Acknowledgment of this position, however,
should not be construed to mean that unlicensed persons who are engaged
in psychological research or teaching may otherwise engage in the practice
of psychology without licensure. The statutory language recommended by
the APA Committee on State Legislation (1978) is intended to apply in all
settings:
Psychologists who are primarily employed in teaching and/ or research but who
also engage in the writing or editing of scholarly manuscripts, the presentation
of invited lectures and testimony, and research consultation shall be exempt
from the provisions of this act for those activities. Nothing in this section shall
be interpreted to exempt such an individual if that person renders other profes-
sional services as a psychologist. (p. 17)
LEGISLATIVE SUNSET REVIEW
By 1979, sunset legislation had been enacted in at least 34 states, but

was not reported for any of the Canadian provinces (Sippola, 1979). The
rationale for such legislation is to ensure increased accountability on the
part of state government agencies through periodic review and automatic
elimination of agencies and programs that no longer can justify their exis-
tence. Sunset laws can take different forms, but the most common approach
is to provide for the automatic termination of an existing statute unless spe-
cific action is taken by the legislature to reenact the law or to replace it with
a new statute. The scope of sunset laws may be quite broad in their appli-
cation to most elements of state government or they may be much more
narrowly focused in their intent to deal only with certain regulatory
agencies.
Only Florida and South Dakota have had psychology licensing laws
terminated as a result of legislative sunset review, and both subsequently
have enacted new legislation. In other states where this process has taken
place, laws have been continued, reenacted, or have been modified based
on recommendations arising from the legislative study committee.
Experience in states undergoing the sunset review process indicates
that this can become an occasion for great divisiveness within the profes-
sion, since all the statutory provisions regulating practice are open to chal-
lenge (Cohen & Goldman, 1980). The most hotly contested issue is likely to
be that of minimum educational requirements for credentialing as a psy-
chologist, with groups ineligible for licensure under the existing statute
lobbying for more liberal standards or alternative "equivalency" provi-
sions. For example, it may be argued that an applicant need not have been
trained in an accredited graduate department or school of professional psy-
chology so long as the content of training can be shown to be "substan-
tially" or "primarily" psychological in nature. Others may seek to substitute
years of supervised work experience or "competency-based" examinations
for formal graduate education and training. Still other special interest
groups may seize upon sunset review as an opportunity to institute new
grandfathering provisions for a time-limited period. With an increasingly
firm national consensus on the definition of professional psychology and
the necessary qualifications of service providers, these pressures can be
resisted more successfully.
Although the goal of sunset legislation has been to promote efficiency
and accountability in state government and to minimize unnecessary gov-
ernment regulation in the private sector, the practical consequence has
been negligible in terms of significant bureaucratic reform or government
cost savings. For the profession of psychology, however, legislative sunset
review poses a clear and present challenge as licensing boards are faced
with the prospect of public hearings and legislative audits concerning their
credentialing, disciplinary, and fiscal activities. The essential question that
boards of examiners of psychologists and, indeed, the community of psy-
chologists as a whole must answer is: "How does statutory regulation of the
practice of psychology benefit and protect the public at large?"
The profeSSion has long held that statutory credentialing and regula-
tion of practice is to be preferred over nonstatutory credentiaiing, such as
self-certification by the state psychological association, which existed prior
to the enactment of laws in most jurisdictions. One effect of legislative sun-
set review is to bring about a confrontation of this issue and to force a care-
ful reconsideration of the merits of both approaches. Although it is difficult
to document fully the effect that loss of statutory credentialing may have
on either the profession or the public, a number of consequences have been
anticipated and described by various groups concerned with credentialing
issues and the regulation of practice. The American Psychological Associa-
tion Committee on State Legislation (1979) has enumerated the following
hazards for the consumer that may follow from the absence of professional
recognition in state law:
1. Loss of assurance of minimal standards of education and training

before professional services are offered to the public as safeguards
against public harm to the public by unqualified providers
2. Loss of ultimate control of credentialing and regulation of practice
by the elected public representatives (legislative) and return of
these functions to special interest groups
3. Loss of uniformity in standards for psychologists licensed under
state authority as contrasted with potential variation in standards
when self-certification is provided by a professionally controlled
group or by competing professional groups who are answerable
only to their own membership
4. Loss of statutory requirement for continuing education to promote
continuing competency
5. Loss of opportunity for public redress of grievance related to
alleged malpractice or incompetence without the expense of
litigation
6. Loss of assurance of due process in handling complaints, investi-
gations and hearing procedures as well as effective use of legal
sanctions of denial, nonrenewal, suspensions or revocation of a
license
7. Loss of privileged communication for the individual citizen when
consulting a psychologist practitioner
8. Loss of incentive for reduction of health care costs through statu-
torily credentialed alternatives to the medical practitioner
9. Loss of third-party reimbursement to consumers of psychological
services under various private and government health care reim-
bursement and pre-paid group enrollment plans
10. Loss of freedom by the public to select the services of a psycholo-
gist because of health insurance industry requirements that reim-
bursement be limited to services provided by licensed practitioners
11. Loss of services that are mandated by laws to be performed by
licensed psychologists (e.g., civil commitment, special education,
Title lXX, health codes)
12. Loss of legal enforceability of a professional code of conduct that
has been incorporated into existing licensing laws
The American Psychological Association Board of Professional Affairs

(1979) has recommended a proactive stance on the part of psychologists in
states facing legislative sunset review. This recommendation takes account
of the political realities involved in the legislative review process and the
inevitable public forum that is afforded to both proponents and opponents
of statutory credentialing. State boards of examiners of psychologists also
have been advised by AASPB to prepare early for the sunset review process
and to consider this an opportunity to document the board's activities in
protecting the public welfare (Reaves, 1982). On the basis of the additional
safeguards and protections afforded to the public, the American Association
of State Psychology Boards Executive Committee (1979) has taken a position
reaffirming the necessity for statutory credentialing and emphasizing that

it does not view nonstatutory credentialing as an acceptable alternative.
RECIPROCITY
Finally, the matter of regulation across jurisdictional boundaries

remains an issue. To the extent that laws differ in their requirements' for
licensure or certification, geographic mobility of psychologists may be
impeded. This can be a particular problem for psychologists employed by
large organizations and subject to frequent transfer. As noted by Reaves
(1982), case law establishes that because "an individual is licensed in one
state does not require any other state to automatically grant such status
within its jurisdiction" (p. 2).
In addition to the provision for temporary registration often provided
by law, most boards are granted the power to issue a credential without
examination in the case of an individual previously licensed or certified in
another jurisdiction if the requirements for licensure or certification are
deemed comparable. This process is commonly referred to as licensure by
"reciprocity," but it is more accurate to speak of endorsement of a prior
credential since very few states have a preexisting, formal agreement for
automatic acceptance of the out-of-state credential. With the advent of more
uniform standards for licensure, reciprocal endorsement among boards
could be facilitated.
CONCLUSION
Statutory regulation of the professions is based upon legislative author-

ity and intent to safeguard the public welfare. Although licensing and cer-
tification provide no guarantee of professional competence or protection for
the consumer, there has come to be widespread public acceptance of this
method of professional regulation. Statutory credentialing provides assur-
ance that the individual practitioner has met minimum standards required
by law, including appropriate education and experience. Examination of
candidates for licensure or certification affords an opportunity to demon-
strate knowledge relevant to entry-level practice. Enforcement and disci-
plinary functions of regulatory authorities also are intended to protect the
public against the unqualified or incompetent practitioner.
Licensure and certification can only be justified if the benefits to society
outweigh the limitations on individual freedom imposed by exercise of the
regulatory authority of the state. The favorable experience of most psy-
chology boards undergoing legislative sunset review provides some evi-
dence in favor of this assumption.
Professional responsibility and accountability also can be demonstrated

through related mechanisms of continuing education, peer review, and
quality assurance. Uniform professional standards for education, creden-
tialing, and practice contribute to an informed public policy and legislative
recognition of psychologists.
The maturing of psychology as a profession roughly parallels the prog-
ress achieved over the past 40 years in securing credentialing for practice.
Even though licensure or certification of psychologists is now well estab-
lished throughout the United States and Canada, legislative activity per-
taining to credentialing and regulation of practice is certain to continue.
The dynamics of professional growth and change will influence the char-
acter of future legislation which, in turn, inevitably will shape the profes-
sion of psychology tomorrow.
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12
Mental Health Law
GOVERNMENTAL REGULATION OF DISORDERED PERSONS
AND THE ROLE OF THE PROFESSIONAL PSYCHOLOGIST
STEPHEN J. MORSE
For hundreds of years the Anglo-American legal system has been devel-
oping special rules for dealing with problems caused by the inherently per-
plexing phenomenon of mentally disordered behavior. In almost every area
of civil and criminal law, from rules concerning preventive detention to
rules concerning criminal responsibility, mentally disordered persons are
treated differently from nonmentally disordered persons.
This chapter will first discuss the nature and assumptions of mental
health law, analyzing why special legal treatment of disordered persons is
authorized. It then describes the following substantive mental health laws:
civil commitment, guardianship and conservatorship, competence to stand
trial, the insanity defense, mentally disordered sex offender provisions, the
rights of patients (including the right to treatment and the right to refuse
treatment), and civil competence in general. The aim is to provide the
professional psychologist with an understanding of the major legal doc-
trines that treat mentally disordered persons specially.! Finally, it will ana-
Sections of this chapter are taken or adapted from prior articles (Morse, 1978a, 1978b).
IThis chapter does not aim to make its readers experts in mental health law; rather, as noted,
it aims to provide a general familiarity with doctrines and the important issues. The prac-
ticing professional psychologist who is faced with a forensic issue or who participates in
forensic mental health cases should of course consult the statutes, regulations, and judicial
decisions of his or her state to determine what the specifically applicable law is. (Indeed,
some states treat issues quite differently from the dominant approach outlined in the chap-
ter.) Another extended general treatment of many of the issues covered in this chapter is
R. L. Schwitzgebel and Schwitzgebel (1980).
STEPHEN J. MORSE. Law Center, University of Southern California, Los Angeles, Cali-
fornia 90007.
339
340 STEPHEN J. MORSE
lyze two of the primary services offered by the professional psychologist-

evaluation and expert testimony-when the law intervenes in the life of a
mentally disordered person and offer a proposal for reforming the scope of
expert mental health testimony.
THE NATURE AND ASSUMPTIONS OF MENTAL HEALTH LAW
The legal system and mental health science are both concerned with
understanding and controlling human behavior. In polar terms, the legal
system approaches human behavior from the standpoint of moral evalua-
tion and the imposition of values, whereas mental health science
approaches it in terms of scientific, value-neutral, empirical investigation.
Further, the legal model of behavior holds that persons have free will: they
choose their behavior and thus are morally and legally responsible for it.
By contrast, the scientific model is deterministic: behavior, like all phenom-
ena, is caused by its antecedents and questions of moral and legal respon-
sibility are supposedly irrelevant. 2
In most instances, the different approaches of the legal system and
mental health science cause few difficulties. It is generally believed that the
fundamental assumptions of the legal system adequately interpret and deal
with the problems of normal behavior. The problems associated with men-
tal disorder, however, cause a very different reaction. Society and the legal
system have always been confused and often frightened by mental disorder
(Rabkin, 1972; Sarbin & Mancuso, 1970).
Special legal rules seem compelled in response to problems created by
disordered behavior because it intuitively appears that disordered persons
are significantly different from most persons in fundamental ways.
Although society assumes that most persons have free choice concerning
their behavior, disordered persons are viewed as having little or no choice
(Chodoff, 1976). Observers believe that persons who are normal would not
freely choose to behave in a mentally disordered-inexplicably irrational
or crazy-fashion. Consequently, when disordered persons engage in
legally relevant behavior, the legal system must decide if it can properly
apply to them generally applicable legal rules. They, after all, appear to be
fundamentally different and to lack normal ability to control their behavior
within reasonable limits. The explanations for disordered behavior have
changed over the centuries, but special legal treatment of disordered indi-
viduals always has been bottomed upon the assumption that such persons
are fundamentally different from normal persons.
Applying special rules to adjudicate the problems created by mental
disorder raises fundamental moral, social, and political issues. For example,
2Readers with philosophical training will recognize that many philosophers deny that there
is an antinomy between free will and determinism (Ayer, 1954; Griinbaum, 1972; Schlick,
1939/1962). Nevertheless, the description in the text is an accurate depiction of the general
view, in polar terms, of most participants in both systems.
MENTAL HEALTH LAW 341
mental health laws authorize preventive detention by civil commitment

even though the person is not suspected of criminal behavior (e.g., Califor-
nia Welfare & Institutions Code §§ 5150, 1980; 5250, 1972). Mental health
laws also authorize a defense, in some instances, to the enforcement of a
contract (Ortelere v. Teachers' Retirement Board., 1969).
The law recognizes these implications and generally presumes first,
that persons are not mentally disordered and have control over their behav-
ior, and, second, that they should not be treated specially unless disorder
and lack of control can be affirmatively shown (People v. Silver, 1974; Sta-
chulak v. Coughlin, 1975). On the one hand, to treat disordered persons like
everyone else seems counterintuitive and morally improper. On the other,
to treat them differently, usually to their disadvantage in terms of freedom
and autonomy, is equally morally improper unless there is a powerful jus-
tification for doing so.
Proponents of mental health laws claim that such laws are humane and
that they enhance both the dignity of disordered persons and the moral
climate of our society. They argue that it is unjust to treat persons who are
incapable of behaving like everyone else as if they were so capable (Cho-
doff, 1976; A. Goldstein, 1967; Stone, 1975). Critics of these laws, however,
believe that they diminish the dignity of disordered persons (Dershowitz,
1969; K. S. Miller, 1976; Morse 1982a; Szasz, 1963). Although disordered per-
sons indeed may behave differently from most others, critics claim that in
many and perhaps most cases there is good reason to believe that mentally
disordered persons are sufficiently like most people and are able to control
their behavior; thus they should be treated like other persons and held
responsible for their behavior. It erodes the moral climate of society and
infringes on the rights of mentally disordered persons to subject them to
special laws that deny their responsibility and consequently reduce their
dignity. The choice between these two alternative views of the relevance
of mental disorder to legal rules clearly presents a difficult moral, social,
political, and legal dilemma. The difficulty in part explains the readiness of
the legal system to turn to mental health experts, especially psychologists
and psychiatrists, for assistance when decisions must be made (see Mezer &
Rheingold, 1962). Confronted with problems caused by mystifying behav-
ior, the legal system naturally turns to scientific experts for explanations
and understanding. Much of the moral difficulty engendered by special
treatment seems to be rendered moot if the question of how to treat disor-
dered persons can be redefined as essentially a medical, psychological, or
scientific question, rather than as a legal one.
The legal system, then, has come to rely primarily on the medical
model of mental disorder that teaches, in part, that disordered behavior is
a symptom of an underlying illness, a condition that is not under the per-
son's control (see Kety, 1974). Consequently, the actor is not considered
causally responsible for his or her disordered behavior. The situation is
analogized to that of a person with an infection who is not held responsible
for a consequent fever. If legally relevant behavior is the product of disor-
der, illness, or disease rather than of free choice, a special legal response
seems warranted. Then, rather than having to rely on a discomforting, intu-

itive basis for the nonresponsibility assumption that justifies the different
legal treatment of disordered persons, the legal system (and society at large)
is comforted by the allegedly scientific justification offered by mental health
science.
It is not surprising that mental health science has had an enormous
influence on mental health law. Much of the legal doctrine and operation
of mental health legal system depends on the assumptions and learning of
mental health science. Most lawyers regard mental disorders as arcane and
disturbing phenomena that are beyond their comprehension and are
understood by only a few highly trained experts (see Cohen, 1966). They
view the response to problems created by mental disorder as primarily the
concern of mental health professionals. Lawyers therefore tend to defer to
mental health experts and mental health law decisions at all levels, espe-
cially if the proceedings are not truly adversary, often are based more on
psychological reasoning and conclusions than on legal reasoning (Hall,
1964; Washington v. U.S., 1967).
In addition to claiming that there is scientific justification for treating
the mentally ill differently, some advocates of the strong influence of men-
tal health science believe that decisions about the competence, freedom,
and responsibility of the allegedly disordered person should be made pri-
marily by experts (Brakel & Rock, 1971; Davison, 1965; Szasz, 1963). Men-
tally disordered persons are allegedly so abnormal that legal decision mak-
ing about them is largely irrelevant. The legal fact finders and law-appliers
must, of course, "make" the final decision but, it is argued, the major influ-
ence of these decisions should be the experts who understand the behavior.
The essential moral and legal nature of questions of freedom, competence,
and responsibility then come to be seen as proper questions for largely
expert determination.
As I shall argue (see p. 406), I believe that this view is mistaken. Ques-
tions concerning liberty, responsibility, and competence are irreducibly
moral, social, and political questions. When mentally disordered citizens
are involved, mental health data may be relevant to decision making, but
scientific data about what "is" cannot answer questions about what "ought
to be" (G. E. Moore, 1922/1971). Who should be hospitalized involuntarily
or who should be considered incompetent are questions that society can
resolve only by reference to its moral, political, and social values.
SUBSTANTIVE AND PROCEDURAL MENTAL HEALTH LAW
INTRODUCTION: THE STRUCTURE OF MENTAL HEALTH LAWS
The structure of all mental health laws is fundamentally the same:

They require findings of (I) a mental disorder; (2) a behavioral component
("legally relevant behavior"); and (3) a causal connection between the men-
tal disorder and the behavioral component (at least in principle) (e.g., Cal-
ifornia Welfare & Institutions Code, § 5250, 1972; Weihofen, 1960). For
instance, civil commitment usually is based on findings that the person is
(1) mentally ill; (2) dangerous to self or to others, or gravely disabled; and
(3) that the dangerousness or grave disablement is a product or result of the
mental disorder or defect (Note, 1974). A criminal defendant is incompetent
to stand trial if he or she is mentally ill and therefore unable to understand
the charges, assist counsel, or understand the consequences of the proceed-
ings (Stilten & Tullis, 1977). Guardianship or conservatorship may be
imposed upon an individual who is mentally ill and therefore unable to
care for his or her property or self (e.g., California Probate Code § 1460,
1977; Horst"man, 1975).
As discussed (pp. 340-42), mentally disordered persons have been sin-
gled out for special legal treatment because it is believed that it is morally
and socially inappropriate to treat them as everyone else. The moral and
legal basis for this special treatment depends on three factual assumptions
concerning mentally disordered persons: (1) they are significantly different
from most persons because they are ill; (2) their legally relevant behavior
is the product of their illness and not of their free, rational choice; and (3)
their future behavior is particularly predictable. The validity of these
assumptions, especially the first two, is the foundation of mental health law.
Only if a person is abnormal, nonresponsible, and in some cases predictable
should he or she be accorded special legal treatment.
Mental illness alone does not warrant special legal intervention. A per-
son who is simply mentally ill is left alone unless the actor behaves in one
of the legally relevant ways described by the behavioral components. But
when mentally disordered persons behave in legally relevant ways, such as
dangerously or incompetently, special rules apply to them that do not apply
to "normal" dangerous or incompetent persons. For example, extremely
dangerous but nonmentally disordered persons, even those who might be
"reformed," are not preventively confinable by civil commitment upon the
basis of dangerousness alone.
Two points concerning the behavioral component of mental health
laws must be noted. First, in all cases the behavioral component is the pri-
mary impetus for legal regulation. What disturbs society, for example, is an
individual's dangerousness, grave disablement, inability to assist counsel,
or inability to manage financial affairs. In other words, society believes that
it must protect itself from dangerous persons, that it must protect disabled
persons from themselves, that a criminal trial is unfair unless certain con-
ditions are met, and that it is inhumane to let an incompetent person mis-
manage his or her property. Second, behaviors described by the behavioral
standards, such as dangerousness or various incompetencies, also appear in
the conduct of normal persons. The behavior is neither necessarily related
to mental health problems nor is it exclusively or especially within the
province of mental health science and professionals.
It is noteworthy that the special legal treatment of disordered persons
is authorized even though the vast majority of mentally disordered persons

do not meet the behavioral components of the various mental health laws
and many normal persons do meet these behavioral standards. In other
words, the mentally ill are not especially dangerous or incompetent (Brakel
& Rock, 1971; Guze, 1976; Monahan, 1981; Monahan & Cummings, 1975;
Monahan & Steadman, 1982; Rabkin, 1979; Rappeport, 1967; Vecchione v.
Wohlgemuth, 1974; Zitrin, Hardesty, Burdock, & Drossman, 1976). But,
despite the over- and under-inclusive nature of mental disorder as a basis
for furthering the social goals that are explicitly or implicitly identified by
the behavioral component of mental health laws, the law is clearly instilled
with the idea that mental disorder should authorize special treatment.
CIVIL COMMITMENT
The Commitment of Adults

Civil commitment is the process whereby a person is admitted to a
mental hospital under standards and procedures mandated by state law. All
states provide for commitment, which may be either voluntary or invol-
untary. Rather than giving a comprehensive overview of all state laws,
which differ from state to state, this chapter will instead provide a summary
statement of the law and an analysis of it. Any psychologist interested in
the law of a particular state should therefore consult the statutes, cases, and
regulations of the jurisdiction in question for specific information.
Voluntary commitment, like most hospitalization for any reason, is
accomplished when the hospital agrees to admit a patient who is voluntar-
ily seeking admission. Although the patient may be freely admitted, in
many states he or she must give the hospital advance notice that release is
desired (California Welfare & Institutions Code, 1980) and the hospital is
given the authority to hold the patient involuntarily for a short time, typ-
ically, three to five days (Georgia Code Annotated § 88-503.3, 1979). The
purpose of the involuntary hold period is to enable the hospital to institute
involuntary civil commitment proceedings against the patient if the hos-
pital believes that releaSing the person would be inadvisable. Thus, unlike
the patient who enters a hospital for physical illness, in many states the
voluntary mental patient cannot leave the hospital at will. Furthermore, in
some states the voluntary patient must agree to remain in the hospital for
an initial statutorily decreed period (Texas Code Annotated Art. 5547-23;
1958).
In the recent past there has been a marked increase in the proportion
of patients who are voluntarily committed. In the early 1960s, about 90% of
all public hospital patients were involuntarily committed whereas at pres-
ent between 40 and 60% of patients are voluntarily committed (Stone, 1975).
It is difficult to obtain an exact percentage because some proportion of those
persons voluntarily committed agree to commit themselves voluntarily
only under the explicit or implicit threat that otherwise they will be
involuntarily committed or sent to jail (Gilboy & Schmidt, 1971). Thus an
unknown percentage of voluntarily committed patients are not truly vol-
untary. Nonetheless, it is undoubtedly true that the percentage of truly vol-
untary patients has increased for many reasons. First and most important,
on both ideological and scientific grounds, most mental health profession-
als now favor voluntary commitment because it restricts liberty less and,
allegedly, consensual hospitalization and treatment is believed to be far
more conducive to improvement in a patient's condition (Wexler, 1974). In
addition, hospitals tend to be more humane and better equipped than they
previously were and most try to limit the length of stay as much as possible.
Thus, current patients have less reason to fear that they are committing
themselves to a ghastly institution that might keep them hospitalized for
inordinately long periods, and even for life (but see Los Angeles Times, 1979).
Involuntary civil commitment laws permit the state to incarcerate a
person against his or her will in order to protect the person or to protect
society (Note, 1974). Although the person is not accused or convicted of a
crime, he or she thus may be deprived of physical freedom, the right to free
association, the right to travel, and often the right to free speech, and may
be subject to involuntary treatment of various sorts. Each day there are
between 100,000 and 200,000 citizens in hospitals who have been involun-
tarily hospitalized, and the average patient in a state or county hospital is
incarcerated for 42 days (Stone, 1975). This massive intrusion on liberty is
an extraordinary exercise of the state's power, and the constitutionality and
propriety of involuntary commitment has therefore engendered enormous
debate in the last two decades (Dershowitz, 1969; K. S. Miller, 1976; Morse,
1982a; Peszke, 1975; Szasz, 1963; Stone, 1975; Zusman, 1982).
The standards for involuntary commitment vary from state to state, but
all require that the person is mentally disordered and has behaved or is
predicted to behave in a legally relevant fashion (i.e., meets the behavioral
component of the law). The most usual behaviors included in the various
statutes, expressed in varying language, are that the person is dangerous to
self, dangerous to others, or in need of care and treatment (Livermore,
Malmquist, & Meehl, 1968). It should be noted, as will be discussed further
below, that "in need of care and treatment" type criteria are now becoming
quite rare; indeed, courts faced with the question of the constitutionality of
such criteria have held them unconstitutional (e.g., Lessard v. Schmidt, 1973).
Of course, many persons without serious mental disorder are dangerous to
themselves or others or are in need of care and treatment, yet the state does
not authorize intervention in the lives of such nonmentally disordered per-
sons in order to protect, care for, or treat them. The reason that state inter-
vention is authorized for mentally disordered persons is that it is believed
that such individuals cannot exercise ordinary and rational self-control over
the behavior that is dangerous or creates the need for treatment. The justi-
fication for involuntary hospitalization and treatment is thus supposedly
benign. It aims to prevent a group of people who are allegedly incapable of
behaving in their own interests or reasonably within society's expectations

from behaving in ways deleterious to society or themselves. Furthermore,
it is hoped that hospitalization will provide treatment that will alleviate
suffering, diminish dangerousness, and enable the person to achieve the
capability to behave in accord with his or her own self-interest (Livermore,
Malmquist, & Meehl, 1968).
Clearly defining the standards for commitment is difficult. For exam-
ple, although most statutes refer simply to mental disorder, disease, or ill-
ness without any qualification, it is nearly invariably agreed, at least in
practice, that in order to be committable the patient should be suffering
from a severe mental disorder. Even the standard of "severe mental illness"
leaves much room for disagreement, but it is a substantial qualification on
the breadth of the statutory criterion.
Most dispute about the appropriate standards for commitment has
focused on the behavioral components. There is disagreement concerning
which standards are appropriate and how they ought to be defined. The
modern trend is overwhelmingly to prefer "dangerousness" standards
because the perceived harm seems more tangible and immediate than stan-
dards such as "in need of care," "treatment," or "hospitalization" (Commit-
ment, 1974; Note, 1974; Schwitzgebel, 1981). The latter are much broader
and seem to reflect the view that commitment decisions are almost purely
mental health decisions rather than social and legal decisions of great
moment. Extraordinary deprivations of liberty arguably should be reserved
for cases of clear social harm. It is believed, further, that "dangerousness"
is a more behavioral and easily operationalized standard, thus rendering it
capable of more reliable adjudication. Although the foregoing reasons for
preferring dangerousness standards have been persuasive to many, the dan-
gerousness approach has been criticized on the grounds that dangerous
behavior is untreatable by mental health methods and that it is better dealt
with by the criminal justice system (Stone, 1975). Proponents of this view
believe that hospitalization should provide care and treatment for severely
suffering persons and should not be used as a mechanism for controlling
dangerous deviants (Stone, 1975).
A definition of dangerousness ideally should specify both the degree
of danger and the degree of likelihood of that danger ocurring that together
will suffice to justify involuntary commitment. But criteria are rarely
defined with much specificity and wide discretion is usually left to the com-
mitment decisionmaker (judge, administrative panel, or jury). In addition,
there is dispute over whether dangerousness commitments, which often
can be based on threats alone, are ever justified in the absence of an overt
act. Some argue, with nearly universal empirical support, that in the
absence of a recent overt act, the successful prediction of future dangerous-
ness is beyond present professional competence. Despite the empirical sup-
port for this position, courts have upheld the constitutionality of danger-
ousness commitments based on clinical predictions where there was no
requirement of a showing that an overt act had occurred (Mathew v. Nelson,
1978).
The definition of "need for care" or "treatment" standards is especially

problematic because no particular behavior that clearly meets the standard
usually can be discerned. There is little agreement about the degree of need
necessary to justify commitment and, in the absence of an operationalized
standard, enormous reliance on subjective expertise and extensive decision-
making discretion are the rule. Indeed, it is arguable that such a standard
is indistinguishable from the mental disorder standard itself (Dershowitz,
1969; Note, 1974). Inherent in this type of standard is the belief that hos-
pitalization and treatment will yield a beneficial result. Indeed, such stan-
dards are highly paternalistic; to libertarians, they appear to be an unwar-
ranted intrusion on the liberty of citizens except in extreme cases.
Nevertheless, the statutes are typically silent about what predicted results
will justify incarceration. This is a disturbing definitional problem because
these standards consequently focus attention only on the person's imme-
diate need for treatment rather than on a preferable, complete cost-benefit
analysis of hospitalization. Some courts will be concerned with what results
can be expected, but statutes do not require this inquiry and, in my expe-
rience, it is rarely made.
A primary route to commitment is via emergency or temporary proce-
dures, the purpose of which is to prevent imminent harm or to allow obser-
vation of the patient (e.g., California Welfare & Institutions Code § 5250,
1972; see Suzuki v. Alba, 1977). Such procedures allow a physician or police
officer or sometimes a family member or anyone else to accomplish the com-
mit~ent by taking the person to a hospital or by filling out necessary forms
and having the person taken to the hospital. Without any hearing or other
protection for the patient (except for the decision of the admitting physi-
cian), the allegedly disordered person then may be admitted for temporary
care, observation, and perhaps treatment. The range of allowable periods
for such commitments is from as little as 48 hours in some states to as much
as 15 days in others. Because they have so few safeguards for the patient,
emergency procedures should be restricted to situations where serious
harm is imminent and the use of cumbersome full procedures would create
unacceptable risks to the person or society. Moreover, the prediction prob-
lem may be alleviated somewhat in the emergency context if commitment
is temporally contiguous to overt dangerous behavior (Monahan, 1977; see
also Rofman, Askinazi, & Fant, 1980). Unfortunately, many states allow tem-
porary or emergency commitment without requiring imminent harm, thus
making unjustified commitment far too simple (Suzuki v. Alba, 1977). If it is
necessary to require a period of temporary observation in order to deter-
mine if a person is truly committable, there is no reason not to seek prior
court review of the temporary detention unless the person is imminently
dangerous. Moreover, even brief commitment is a serious deprivation of
liberty and should probably require at least some type of probable cause
hearing within a reasonably brief period after the person is detained (Doe
v. Galiinot, 1979, 1981; Marx, 1978). Temporary or emergency commitment
can be especially abusive because a detained and hospitalized person has
greater difficulty contesting full involuntary commitment than a person at
liberty (Dix, 1968). In short, emergency or temporary commitment has legit-

imate uses, but it should be used sparingly and only when necessary.
Full civil commitment procedures require some type of hearing before
a court or an administrative board. Many states require an automatic hear-
ing (Lessard v. Schmidt, 1973), whereas others simply grant a patient-initi-
ated request for a hearing (usually by a petition for habeas corpus) as a mat-
ter of right (California Welfare & Institutions Code § 5275, 1973; Morse,
1980). Requiring patients to initiate hearings may be unconstitutional, how-
ever, as at least one court has held (Doe v. Gallinot, 1981).
It is now reasonably well settled that potential committees are entitled
to notice (State ex rei. Hawks v. Lazaro, 1974) and the assistance of counsel
during involuntary commitment proceedings (Elkins, 1979; Lessard v.
Schmidt, 1973), but the applicability of other procedural safeguards, e.g., the
privilege against self-incrimination, is in dispute. Simply put, the contro-
versy centers on whether commitment should be viewed as essentially a
mental health question with a presumption in favor of commitment and
treatment or as a legal question with a presumption in favor of liberty. If
one takes the former view, there is a presumption that commitment should
be facilitated by reducing the number of procedural barriers to it. This is
the view of most supporters of commitment who favor some, but not too
many, safeguards (People ex rei. Rogers v. Stanley, 1966, Justice Bergan dis-
senting). Opponents of this view believe that civil commitment is an
extraordinary deprivation of liberty and that potential patients should be
given as many safeguards as possible in order to prevent commitment
except in those cases where it is clearly justified. Those in favor of greater
safeguards liken the involuntary commitment process to the criminal justice
process and seek to impose on the former the procedural safeguards of the
latter (e.g., the privilege against self-incrimination, the right to confront
and cross-examine witnesses, application of the reasonable doubt standard
of proof) (see Lessard v. Schmidt, 1973). The balance between a paternalistic
desire to intervene for the person's own good or preventively to detain a
pOSSibly dangerous person on the one hand and the right to liberty on the
other is not easy to strike. There are weighty interests in favor of facilitating
and hindering easy commitment.
At present, the law favors the right to liberty, but most courts are still
unwilling competely to analogize the involuntary commitment process to
the criminal justice process. For instance, in a recent case, Addington v. Texas
(1979), the United States Supreme Court reasoned that although the usual
civil standard of proof, a preponderance of the evidence, was insufficient to
protect the liberty of a potential involuntary commitment patient, the rea-
sonable doubt standard in use in the criminal process did not need to be
applied to commitment. The Court held that the intermediate standard of
"clear and convincing evidence" was sufficient to satisfy due process.
Addington clearly struck a compromise between libertarian and paternalistic
interests.
Commitment procedures tend to be far more weighty in the statute
books and judicial decisions than they are in practice. Although in theory
involuntary commitment now requires a reasonably full hearing with many

due process safeguards, actual hearings still tend to be rather informal, not
fully adversary, and perfunctory (Hiday, 1977; Morse, 1982a; Warren, 1977).
Strict attention is not paid to the statutory or judicially imposed safeguards;
rather, judges seem to exercise rough, paternalistic, and intuitive justice,
guided by the advice (i.e., expert testimony) of the state's expert, the mental
health professional. There are many causes of this failure to adhere to
requirements; e.g., the lack of resources necessary for counsel to exercise
warm adversary zeal in behalf of their commitment clients and paternalism
by counsel (Poythress, 1978). In many commitment hearings, counsel
appear in a pro forma capacity and do not put the state to the full test of
proving its case according to strict standards and procedures (see State ex rei
Memel v. Mundy, 1977). Moreover, unlike the situation that prevails in the
criminal justice system, there are very few appeals from commitment deci-
sions that would provide appellate courts the opportunity to insure trial
court conformity to the statutory requirements.
Present practice represents an uneasy compromise. Reforms of the com-
mitment process have occurred and appear quite substantial on the books,
but involuntary commitment is still too easily accomplished; full due pro-
cess is not accorded to the majority of allegedly disordered persons. The
failure to adjudicate commitment cases strictly in accord with required stan-
dards and procedures is unfortunate. Circumvention of necessary safe-
guards permits unwarranted commitment, a gross abuse of liberty. Further-
more, careful observation of strict standards and procedures (including the
reasonable doubt standard of proof) does not prevent commitment from
occuring in those cases where the commitment criteria are truly met; adher-
ence to legal norms does not prevent proper commitment in appropriate
cases (Zander, 1976).
Civil commitment statutes provide for either definite or indefinite
terms of confinement. Under definite terms, the patient is released when
he or she no longer meets the statutory criteria for confinement or when
the prescribed period of confinement is completed, whichever occurs first.
Indefinite confinement is said to be for a period "from one day to life," and
release occurs if the patient no longer satisfies the statutory criteria for con-
finement. In states with indefinite commitment terms, patients generally
are entitled to formal periodic reexamination and the Supreme Court
appeared to require such reexamination in Addington. But, one would hope,
reexamination of involuntarily committed persons should be constantly
ongoing.
The Commitment of Minors

Minors are hospitalized by procedures different from those used for
adults. As a general rule, parents and guardians have the statutory right to
"voluntarily" admit their children to mental hospitals, subject only to
acceptance of the minor by the hospital (California Welfare & Institutions
Code § 6000, 1980; Ellis, 1974). Such plenary power is of course part of the
parents' near absolute control over the care, custody, and upbringing of
their children. Indeed, the United States Supreme Court has recently held
in a celebrated case, J. R. v. Parham (1979), that such power is traditional and
that the child's due process rights are adequately safeguarded by the par-
ents' concern and the admitting physician's independent, medical, expert
decision to admit the child to the hospital. Some jurisidictions, such as Cal-
ifornia (In re Roger 5.,1977), have held on state constitutional grounds that
due process requires counsel, some sort of hearing, and certain other rights
before a minor of 14 years of age or older may be "involuntarily" admitted
to a hospital. But no jurisdiction is compelled by the federal Constitution to
provide more due process than the Parham case requires. In the vast major-
ity of jurisdictions, then, almost no process is due before minors can be
involuntarily "voluntarily" admitted by their parents, and, in effect, the
substantive standard for the commitment of a minor is that the parent and
hospital agree that the minor is mentally disordered and needs or could
benefit from hospitalization (see also, In re Roger S., 1977). Because the
implicit substantive standard is undefined, enormous and extraordinary
discretion is left in the hands of the parents and the hospital.
"Voluntarily" admitted minors are released from hospitals upon the
request of their parents, at the discretion of the hospital, or at the age when
adult civil commitment standards first apply, that is, unless they are recom-
mitted according to the usual procedures applied to adults (Melville v. Sab-
batina, 1973). If the hospital or some other responsible person (e.g., social
service worker) believes that the child desperately needs to be hospitalized
or needs continued hospitalization, but the parents refuse to sign the child
in or insist on signing the child out, the only solution is to have the child
declared a ward of the court on the grounds of parental neglect (California
Welfare & Institutions Code § 300, 1980). Then a guardian may be appointed
who will be granted the power to admit the minor to the hospital or to
retain him or her therein. Appointment of a guardian in order to insure
mental hospitalization of a child is a rare event, however. Finally, when a
hospitalized minor reaches the age at which adult procedures apply the
state must initiate ordinary civil commitment in order to retain the individ-
ual in the hospital.
The commitment of minors to mental hospitals poses vexing problems
of law and social policy. When the commitment of an adult is in question
only the rights of the state and the adult need to be considered and bal-
anced, but in decisions concerning the commitment of minors, the right of
the parents also must be weighed. On the one hand, as noted, parents tra-
ditionally have near absolute authority over the care and upbringing of
their minor children, including decisions about medical care (see also, J.
Goldstein, Freud, & Solnit, 1979). Providing the minor with independent
due process rights clearly interferes with parental rights. On the other
hand, involuntary hospitalization is an extraordinary loss of liberty for the
minor and also may result in serious stigma. Being incarcerated in a strange
institution may be terrifying and disruptive (see Lindsey, 1977) and, in
addition, knowledge of effective treatments for minors, especially for those

who are the most disabled, is severely limited and benefits to the minor may
therefore be few (Morse, 1978c; but see also Tramontana, 1980). In sum, hos-
pitalization of a minor is a decision of great consequence. The question,
then, is whether parents and hospitals almost always can be trusted to make
a sound judgment in the minor's best interests.
Many parents and hospitals will exercise their discretion in good faith
and in the minor's best interests. But hospitalization also may represent a
perceived "way out" for parents troubled by a wayward and apparently
uncontrollable minor who is nevertheless not seriously disordered and not
in need of hospitalization (see Bartley v. Kremens, 1975). Difficult children
can cause extensive family disharmony and hospitalization may appear to
be a means to extrude the minor for his or her own benefit rather than, as
is truly the case, for the benefit of the families or parents. Indeed, in many
cases distraught parents may be acting conSciously in good faith, but their
anger, resentment, and confusion may cause them to make incorrect deci-
sions based more on disciplinary or family harmony needs than on those of
men~al health. Moreover, many hospitals are probably only too glad to fill
their beds, especially if they are "for profit" institutions. Given the wide
definition of what can constitute mental disorder, nearly any admission is
potentially justifiable.
There is good reason to provide reasonable, independent, due process
protections to minors. Seriously psychotic and disabled youngsters will be
admitted under any procedural scheme because such cases clearly will meet
any reasonable criteria for confinement. But the cases of difficult or delin-
quent adolescents, where hospitalization may appear to be the "answer" to
parents and to doctors with a broad view of the need for treatment, are the
types of cases where hospitalization often is not appropriate and where sub-
stantial due process protections will prevent injustice.
Least Restrictive Alternatives and Deinstitutionalization

One of the most important "rights" a potentially committable patient
may have is the right in appropriate cases not to be an inpatient, not to be
institutionalized. It is well recognized that many, indeed perhaps most,
committable persons can be treated as well in the community as in a hos-
pital (Rappaport, 1977) and, moreover, that inpatient hospitalization may
be substantially deleterious to a significant number of patients (Wing, 1962).
One result of this recognition, aided by improvements in treatment tech-
nology, most notably psychotropic medications, has been a shortening of
the average term of involuntary commitments. Another result was the com-
munity mental health movement which aimed, in part, to treat patients in
their local communities and, preferably, on an outpatient basis if possible
(Musto, 1975). A third result was the attempt to insure by law that hospi-
talization would be avoided or minimized in appropriate cases. The primary
route by which this has been accomplished is the "least restrictive alterna-
tives" (LRA) doctrine (also known as the "less drastic means" or "reasonable
alternatives" doctrine [see Chambers, 1972]). The rights of patients in gen-
eral, including the right to treatment, will be discussed later in this chapter
(see p. 372). LRA is discussed here because it is a right that prevents a person
from being hospitalized and in the mental health law context it is applied
to date primarily to civil commitment and not to other forms of
commitment.
The LRA doctrine has been announced by the United States Supreme
Court in a number of cases in varying contexts (e.g., Shelton v. Tucker, 1960).
Simplistically and briefly, LRA holds that when state regulations infringe
on constitutionally protected rights and interests (e.g., liberty) in order to
fulfill legitimate state purposes, they should do so using the means least
restrictive of those rights and interests. The LRA doctrine is eminently sen-
sible in a free society; it is desirable that the state should seek to promote
its purposes by those means that least restrict important rights. Assuming,
as many persons do, that the state has legitimate purposes in providing for
involuntary hospitalization (e.g., protecting society from dangerous men-
tally disordered people, protecting mentally disordered persons who are
dangerous to themselves, caring for and treating disordered persons who
are incapable of doing so for themselves), it is nonetheless true that invol-
untary hospitalization trenches on important rights including the right to
physical liberty, to travel, to free association, and others. If hospitalization
is not needed for protection or care, it should not be used because the state's
intrusion on individual rights is thereby minimized.
Although at one point the United States Supreme Court appeared to
have denied the applicability of the doctrine to the civil commitment con-
text (State v. Sanchez, 1969), in O'Connor v. Donaldson (1975, citing Shelton v.
Tucker) the Court later appeared implicitly to approve its applicability in
civil commitment cases. In any case, the question is not settled as a matter
of constitutuionallaw, but many lower courts (e.g., Lessard v. Schmidt, 1973;
Lynch v. Baxley, 1974) have applied the doctrine to civil commitment. For
instance, in the landmark case of Lessard v. Schmidt (1973), a federal district
court held, inter alia, that before a person could be hospitalized involuntar-
ily the party recommending confinement had to prove to the court: (1) what
alternatives were available, (2) "what alternatives were investigated," and
(3) "why the investigated alternatives were not deemed suitable." Hospi-
talization could be ordered only if other, less freedom-infringing, alterna-
tives would not do.
In addition to judicial decisions that have applied the LRA doctrine to
civil commitment on constitutional grounds, a large number of jurisdictions
have passed legislation adopting the doctrine. For instance, by an act of
Congress the District of Columbia has had such legislation for many years
(D.C. Code § 21-54S(b), 1967).
As is often the case, the law in the books or as expressed in judicial
opinions has not been carried out to the letter or in spirit (Hoffman & Foust,
1977). Effectuating LRA is time-consuming and expensive-rather than
simply putting all persons into a hospital, alternatives must be considered

and investigated-and the commitment process rarely does an adequate job.
Furthermore, it is easy to decide that almost all persons ''belong'' in the
hospital, especially if there is no adequate supervision of commitment deci-
sion making by appellate courts. As a result of such factors, the District of
Columbia, for example, never properly implemented its LRA legislation
and it was finally faced with a class action on behalf of all patients institu-
tionalized, Dixon v. Weinberger (1975), in which the court ordered the proper
implementation of the statutory rights in the District.
An important resolution of some of these issues was expected when the
United States Supreme Court agreed to hear Pennhurst v. Halderman.
Although the case involved retarded persons and not the mentally disor-
dered, the LRA principle is analogously applicable in both instances. As we
shall see presently, the Supreme Court ultimately decided the case on nar-
row, statutory grounds-thus inviting further litigation on the constitu-
tional issues-but the litigation was representative and bears extended
discussion.
Pennhurst began in 1974 when Terri Lee Halderman, a mentally
retarded inmate of Pennsylvania's Pennhurst State School and Hospital,
filed a complaint alleging that all the residents "live in inhumane and dan-
gerous conditions, are subjected to unnecessary physical restraints, are
given unnecessary and dangerous medication, are consigned to lives of
idleness because of lack of habilitative programs, and are subjected to
numerous physical injuries resulting from lack of adequate supervision"
(quoted in 4 Mental Disab. Law Reporter at 15, 1980). As a result of these
inadequate and abusive conditions, alleged Halderman, she and all those
like her (the entire class) deteriorated and regressed "emotionally, intellec-
tually and physically" (Halderman v. Pennhurst, 1980b). After extensive pre-
trial discovery, a long trial was held.
In December 1977, the federal district court issued an opinion finding
the plaintiff's allegations true; conditions at Pennhurst were dreadful and
habilitation for the inmates was virtually nonexistent. Consequently, the
court held (1) there was a right to minimally adequate habilitation based on
constitutional and federal statutory grounds and that the Constitution
required that habilitation be provided in the "least restrictive setting con-
sistent with ... [an] individual's habilitative needs"; (2) inmates had a con-
stitutional right to be free from harm; and (3) there was a federal statutory
and constitutional right to nondiscriminatory habilitation (Halderman v.
Pennhurst, 1977). (This chapter will discuss later and in detail the general
right to treatment, see p. 374.) Although Pennhurst bears on this issue, it is
discussed here because of its direct bearing on the deinstitutionalization of
civilly committed persons.)
After the Pennhurst decision, the parties could not agree on an appro-
priate plan to correct the manifold problems at the institution and the court
was forced to issue a further, corrective order in March 1978. For our pur-
poses, the most important points of the order were (1) Pennhurst would
eventually be closed and all its residents would be placed in the community
where they would receive services based on individualized plans; (2) every
retarded inmate or another person speaking for him or her would partici-
pate in the formulation of the plans; (3) the state had to submit plans for
placement of the residents in community programs that were individual-
ized and set up in the least restrictive manner; and (4) the state was enjoined
from recommending or placing further persons at Pennhurst (Halderman v.
Pennhurst, 1979).
The defendants appealed to the federal Third Circuit Court of Appeals
which affirmed much of the district court's opinion but did so on a different
basis (Halderman v. Pennhurst, 1979). By this point, it was universally agreed
that conditions at Pennhurst were abominable; the court therefore concen-
trated on the merits. It affirmed that the retarded have a right to habilitation
in the least restrictive environment, but these rights were founded on fed-
eral and state statutory grounds (the federal Developmentally Disabled
Assistance and Bill of Rights Act and Pennsylvania's Mental Health/Mental
Retardation Act of 1976) rather than on constitutional grounds. But, said the
court, a legal preference for deinstitutionalization did not mean that no one
should be hospitalized; for some patients, institutionalization might be jus-
tified as appropriate so long as the states did not rely solely on such insti-
tutions and provided alternative facilities for those patients who did not
require institutionalization to be habilitated. The right to habilitation in the
least restrictive setting, including a preference for deinstitutionalization,
was therefore upheld, but the appellate court did so on statutory grounds
and held that some institutionalization was allowable.
The Supreme Court reversed the Court of Appeals decision, Pennhurst
v. Halderman (1981), and held that the federal Developmentally Disabled
Assistance and Bill of Rights Act did not grant the mentally retarded the
right to habilitation in the least restrictive environment. Because the statute
does not expressly condition the right to receive federal funds on state com-
pliance with providing patients with treatment in the least restrictive set-
ting, the Court construed the statute as merely expressing a congressional
preference for deinstitutionalization (or LRA). The Court decided the case
on narrow grounds, strictly interpreting the federal statutory language,
without considering the federal constitutional or state statutory grounds
that were the basis for relief in the district court.
Most recently, in Youngberg v. Romeo (1982), another patients' rights
class action suit originating in the Pennhurst institution, the United States
Supreme Court held that institutionalized retarded patients have a consti-
tutionalliberty interest in safety and freedom from bodily restraint. To pro-
tect these rights, the Court held further that permanently institutionalized
retarded inmates have a right to the training that "an appropriate profes-
sional would consider reasonable to ensure his safety and to facilitate his
ability to function free from bodily restraints." Although Youngberg is pri-
marily a patients' rights case and does not grant the right to deinstitution-
alization, it does hold that retarded persons are entitled to treatment that
reasonably may secure physical liberty in an institution. (Youngberg will be

discussed in greater detail beginning on page 376 in the section that deals
with the rights of patients.)
The Pennhurst holding that the least restrictive alternative is not statu-
torily mandated by federal law and the constitutional beginnings in Young-
berg will ensure the continuation of litigation to determine if the federal
and state constitutions grant institutionalized inmates the substantive right
to treatment in the least restrictive setting. Although Pennhurst and Young-
berg apply to retarded persons, the issues for retarded and disordered per-
sons are similar and one can expect at least some decisions that will further
the trend toward deinstitutionalization.
The evidence supporting the viability of deinstitutionalization (Kies-
ler, 1982) coupled with an increasing legal preference for it have resulted
in far fewer long-term hospitalizations of mentally disordered persons.
Consequently, large numbers of such persons who formerly would have
been institutionalized are now living in the community (Arnhoff, 1975;
New York Times, 1979a, 1979b, 1979c). In one sense, then, deinstitutionali-
zation has been successful; but to date, it has been a mixed achievement. A
primary idea underlying deinstitutionalization was that community ser-
vices and treatment would be provided. Community care would be cheaper
than hospitalization, equally if not more efficacious, and far less intrusive
on liberty. Deinstitutionalization was an excellent, viable idea in principle,
but through outrageous neglect, it has been a failure in practice. Patients
are "dumped" into the community, often living in squalid conditions in
welfare hotels in the inner cities. There they lead marginal lives-poor,
lonely, and preyed on by criminals-and are not provided the services nec-
essary to make deinstitutionalization and community life a success (Arn-
hoff, 1975; New York Times, 1979a,b,c). Conditions of misery and degrada-
tion make a mockery of the claims for deinstitutionalization. Nonetheless,
the conclusion observers and critics often draw-that deinstitutionalization
should be abandoned-is a breathtaking non sequitur. The proper response
to the failure to provide community services is not to return patients invol-
untarily to hospitals with all the costs involved in involuntary institution-
alization. Rather, the states should provide the necessary community ser-
vices that would allow deinstitutionalization to succeed. As all would agree,
it is far preferable to provide adequate care and treatment without resorting
to hospitalization. To abandon deinstitutionalization, without allowing it a
proper trial, would be a moral and scientific failure of immense proportions.
GUARDIANSHIP AND CONSERVATORSHIP
Guardianship and conservatorship refer to those situations when one

person is legally given the authority and responsibility to act on behalf of
another person who is deemed incompetent to manage his or her person
and/or property (Taylor, 1935). As always, statutory language varies, rang-
ing from the vague (e.g., incompetent by reason of mental illness and
senility) (Annotated Missouri Statutes § 475.060(9), 1956) to the amusing
(e.g., likely to be prevailed upon by artful and designing persons) (Califor-
nia Probate Code § 1460, 1956/77), but the essential thrust of all such laws
is that the person is unable within reason to look after oneself or one's
financial resources.
Guardianship or conservatorship proceedings are usually initiated by
family members or sometimes by the state and they are accomplished in
most jurisdictions by a judicial proceeding (see Alexander & Lewin, 1972;
Horstman, 1975). The alleged incompetent will appear unable to manage
food, shelter, clothing or medical needs, or will seem to manage finances
foolishly. A guardian of the person is given the power to care for the phys-
ical needs of the person, to consent to medical care, and even to authorize
inpatient hospitalization for the person. In many states guardianship may
be strictly limited and tailored to the specific incompetency displayed by
the ward. In a sense, the guardian stands in relationship to the ward as a
parent does to a child. A guardian or conservator of the estate is given the
power completely to manage the finances of the ward to whom the guard-
ian or conservator has a fiduciary duty. In some cases, guardianship may be
ordered over both the person and the estate of an incompetent.
Although the need for the various forms of guardianship is readily
apparent in some cases, guardianship, like involuntary commitment, is a
fundamental intrusion on the liberty, autonomy, and dignity of a person.
There is less public and professional concern with the civil liberties aspects
of guardianship than with those of involuntary commitment, but courts and
psychologists should exercise caution in this area as well. It is most impor-
tant here to separate distaste for the behavior of an actor based on value
differences from a judgment that the actor is truly incapable of managing
his or her person or finances. For instance, is an elderly widower who
spends his money lavishly on a young woman, to the disadvantage of his
children who expected to inherit a sizeable estate, behaving incompetently
(see In re Oakes, 1845)? The answers to such questions are rarely clear, but
if the widower is competent, his right to behave in ways others perceive as
foolish should be preserved.
It is difficult to give the concept of competence a precise meaning and
courts and commentators have rarely explicated this vague concept (but ct.
Fingarette, 1972; Murphy, 1974). In my opinion, competence should refer
to a combination of the abilities, within reasonable limits, to attend to and
weigh the data relevant to a particular decision (Morse, 1978). It does not
mean that the person always attends to or weighs such data or that the per-
son always reaches sensible decisions. It means only that the individual has
the abilities necessary to be deemed competent. Focusing on ability rather
than on outcome is much more protective of the person's dignity and auton-
omy. A person may choose to disregard data that most other persons would
find dispositive of action in a particular context, but so long as the actor is
capable of considering and weighing the data, his or her right to choose
"wrong" should be respected.
Even if a reasonable definition that focuses on competence capacity can
be formulated and justified, how is a decisionmaker to determine if such
capacity exists? The best course of action, albeit an imperfect one, is to exam-
ine the person's behavior in as much detail as possible (Morse, 1978). If he
or she demonstrates a capacity for rational action in a wide variety of cir-
cumstances, or does so consistently in a particular context, it is reasonable
to conclude that the person is generally competent or competent in the par-
ticular context, and that a given "irrational" action is a matter of choice
based on differing values. Of course, if a person always appears to behave
unreasonably, even with a broad, tolerant definition of "reasonable," then
perhaps a judgment that the person is incapable of behaving reasonably is
warranted. But in most cases, it is probably wiser to have a presumption
against a finding of incompetence because of the deprivation of rights occa-
sioned by such a finding.
As one would expect, guardianship may be terminated, again most
often by a judicial proceeding, at any time that the ward's competence is
restored.
COMPETENCE TO STAND TRIAL
The Supreme Court of the United States has held that due process of
law is violated when an incompetent criminal defendant is tried. In other
words, a criminal trial can be fundamentally fair only if the accused is com-
petent to stand trial (Drope v. Missouri, 1975; Pate v. Robinson, 1966). Again,
the standards for competence to stand trial vary somewhat from state to
state, but a relatively standard formulation is this: the defendant must be
able (I) to understand the nature of the charges against him or her and the
proceedings; and (2) assist his or her counsel (Dusky v. U.S., 1960; Note,
1966). Unless the accused meets them, he or she will be unable to participate
effectively in the defense, thereby negating the defendant's ability to main-
tain his or her innocence and defeat the state's allegation of guilt. More-
over, trying an incompetent defendant compromises the dignity of the pro-
ceedings. Indeed, competence to stand trial is so important that the
Supreme Court has held that a judge must raise the issue sua sponte if he or
she has reason to believe a defendant is incompetent (Drope v. Missouri,
1975). Unlike the insanity defense (which will be discussed on p. 360), the
competence to stand trial issue is raised frequently (Steadman, 1979).
Although incompetence to stand trial theoretically may be produced
by any cause that affects mental functioning, almost all persons found
incompetent are so found because of mental disorder (Stilten & Tullis,
1977). Nevertheless, not all mentally disordered defendants are incompe-
tent; the mental disorder also must produce the legally relevant behavior:
inability to understand the charges and proceedings or the inability to assist
counsel. Moreover, if a disordered incompetent defendant is competent
when taking psychotropic medication (so-called synthetic sanity), most
courts have held that such a defendant should be deemed competent and
may be tried although the competence is produced by medication (e.g., State
v. Rand, 1969; see generally, Haddox, Gross, & Pollack, 1974).
The legal standards for competence to stand trial are readily compre-
hensible; yet, like most such standards, they present problems of vagueness
in their application. How much comprehension of the charges and pro-
ceedings is enough? How much assistance to one's counsel is sufficient?
Extreme cases are, of course, easy to decide, but, as always, the majority of
cases will fall in the "gray" area. Still, the competence to stand trial stan-
dards reflect an important social, ethical, and legal concern, and courts must
do their best to apply the standards on a case-by-case basis. There has been
at least one notable research attempt to ope rationalize carefully the com-
petence standards (Harvard Laboratory of Community Psychiatry, 1973),
but it was not completely satisfactory and competence adjudication still pro-
ceeds almost entirely without the benefit of such operationalized standards.
If the district attorney, defense counsel, or judge believes that a defen-
dant is incompetent at any stage in the criminal proceedings, an order for
a competence evaluation will be sought and typically will be granted. The
evaluation is done by a mental health professional and then the court deter-
mines after a hearing if the defendant is incompetent. In the majority of
states the decision is made by the judge, but a few states provide for a jury
determination of the competence issue. In nearly all cases, the judge will
agree with the mental health professional's finding (Steadman, 1979). If the
defendant is found incompetent, he or she generally is committed to a state
hospital (often for the criminally insane) for treatment designed to restore
him or her to competence. Some states, such as California, allow some
incompetent defendants to be treated on an outpatient basis (California
Penal Code § 1370, 1980), but hospitalization is the usual rule. When the
hospital believes that the accused is competent, he or she is returned to
court to determine if this is the case. Furthermore, some states provide for
formal, periodic reexamination of the defendant's competence and it is
highly likely that such periodic reexamination is constitutionally required
in light of Jackson v. Indiana (1972; [discussed infra]) and Addington v. Texas
(1979). If the defendant is found competent, and typically he or she is so
found if the hospital certifies it, the criminal process proceeds to its final
resolution.
In view of the immense deference given to mental health professionals
in this context, an interesting question to note here is whether mental
health professionals are really experts on the questions of the defendant's
ability to understand the charges or to assist counsel. Although mental
health professionals may be expert at providing data about mental disorder,
might not an experienced criminal attorney be better able to provide data
on the legally relevant behavior in this area? (See also p. 406 infra; Morse,
1978a).
Until 1972, when the U.S. Supreme Court decided the important case
of Jackson v. Indiana, defendants hospitalized as incompetent to stand trial
could be hospitalized as long as necessary in order to restore them to com-
petence. In effect, incompetence commitments were for a term of one day
to life, irrespective of the nature of the charge against the defendant.
Indeed, many defendants remained hospitalized for periods of time vastly
in excess of the maximum terms of imprisonment for the crimes charged
against them. Although never convicted of a crime, many incompetent
defendants, including a large number accused only of minor crimes, lan-
guished in hospitals for decades (Group for the Advancement of Psychiatry,
1974). In Jackson v. Indiana, the Supreme Court recognized the injustice of
indefinite incompetence to stand trial commitments and held that they
were unconstitutional. The Court held that incompetent defendants could
be committed only for a reasonable time necessary to restore them to com-
petence. If competence could not be restored within a reasonable time, the
accused had to be released. If the state believed the accused still required
hospitalization, civil commitment was the appropriate procedure.
The Court did not set a particular time limit on the length of permis-
sible commitment and states therefore have dealt with the question of "rea-
sonableness" in different ways. At a minimum, it seems clear that commit-
ment cannot be longer than the maximum prison term possible for the
charges against the defendant, and probably it should be shorter. Further-
more, the commitment period should cease at any time that the treating
professionals determine that restoring the defendant to competence is
beyond their present capacities. California's new commitment scheme (Cal-
ifornia Penal Code § 1370, 1980) is worthy of mention because California is
often a national leader in legislative and judicial reform. There the com-
mitment period runs only as long as treatment is provided and a "substan-
tiallikelikhood" exists that the defendant will regain his or her competence
in the foreseeable future. Moreover, the maximum term possible is three
years or the maximum term of imprisonment for the most serious charge
against the defendant, whichever is shorter. Thus California has set a rela-
tively brief maximum commitment period and requires evidence of treat-
ment and a substantial likelihood of improvement in order to justify con-
tinued incompetence to stand trial commitments. This is as it should be.
Incompetence commitments are based on the need to treat the defendant
so as to restore his or her competence. If treatment is not available or is
unlikely to be effective, the commitment should not be ordered or should
cease. Moreover, since most cases involve actively psychotic persons who
can be stabilized relatively qufckly on appropriate medication and since
incompetent defendants have not been convicted of a crime, incompetence
commitments, which deprive the defendant of liberty, should be relatively
brief. Indeed, even the relatively brief three-year maximum in California is
probably much longer than is necessary.
THE INSANITY DEFENSE, DIMINISHED CAPACITY, AND GUILTY BUT MENTALLY ILL
The Insanity Defense

For hundreds of years it has been recognized that an actor should not
be held criminally responsible if his or her criminal act was substantially
caused by mental disorder or, in older language, insanity, lunacy, or the like
(Walker, 1968). The law generally presumes that all persons are sane (Eule,
1978; People v. Silver, 1974) and in control of their behavior and therefore
are morally and legally responsible for their actions. In some cases, how-
ever, the defendant's disorder seems to affect his or her functioning to such
an extent that it appears that the criminal behavior is largely uncontrollable
or that the actor is fundamentally irrational; therefore the individual should
not be considered responsible and blameworthy (Fingarette & Hasse, 1979;
M. S. Moore, 1975, 1980; Morse, 1978). Moreover, arguably none of the tra-
ditional goals of penal law-retribution, deterrence, incapacitation, reha-
bilitation, education (H. M. Hart, 1958)-is best or well served by punishing
an insane offender. An insane offender does not deserve to be punished;
punishing him or her will not deter others because the offender is per-
ceived to be quite different from others. The specific offender cannot be
deterred because he or she cannot control either the mental disorder that is
causally related to his or her criminal behavior or the criminal behavior that
is produced by the mental disorder. Punishment is not the appropriate
method to cure a disordered person; punishment of a disordered person is
not necessary to educate society about moral and legal rules because, again,
disordered persons are not perceived as playing according to the usual
rules. Incapacitation can be served by criminal imprisonment, but it can be
equally and more appropriately accomplished for insane persons by thera-
peutic hospitalization.
Not all mentally disordered defendants seem so disordered that escape
from criminal liability is warranted. But in response to the powerful intui-
tion that at least some disordered defendants should not be held criminally
responsible, various tests have been devised in order to identify those
defendants who are not appropriate subjects for punishment. At least since
Aristotle, it has been recognized that cognitive and volitional disabilities
might negate responsibility (Aristotle, 1930). Thus, all insanity defense tests
seek to assess the extent to which disorder has affected the defendant's cog-
nitive and/or volitional capacities.
Before continuing with a description of the tests now in use a few fun-
damental points about all of them should be noted. First, for purposes of
the insanity defense, insanity is a legal, not a psychological, concept. A per-
son who is mentally disordered is also legally insane only if he or she meets
the tests for legal insanity, all of which include criteria other than mental
disorder alone. Second, the defendant must have been legally insane at the
time of the criminal act in order successfully to assert the insanity defense.
Earlier or later disorder may be relevant to determining whether the defen-
dant was legally insane at the time of the act, but the crucial question is the
accused's mental state when the violation of criminal law occurred.
The most famous and still most widely used test is that formulated by
the British House of Lords in 1843 in M'Naghten's case. In response to a
series of questions put to it for an advisory opinion, the Lords formulated
the following test for the insanity defense:
To establish a defense on the ground of insanity it must be clearly proved that,
at the time of the committing of the act, the party accused was labouring under
such a defect of reason, from disease of the mind, as not to know the nature and
quality of the act he was doing; or, if he did know it, that he did not know he
was doing what was wrong. (M'Naghten's Case, 1843, p. 931)
Note that the M'Naghten test, colloquially called the "right/wrong" test, in
principle focuses entirely on cognitive capacity; affective and volitional
incapacity is ignored. Some states, however, have revised M'Naghten, appar-
ently to include an affective component whereby the defendant must be
unable to know and "comprehend" the nature and quality of his or her act
(see People v. Wolff, 1964 [now supplanted by People v. Drew, 1978]).
The M'Naghten rule makes perfectly good sense: defendants who do
not know what they are doing or who do not know society's moral or legal
rules because of disorder are consequently incapable of conforming their
behavior to law and should be excused. Nevertheless, criticisms of M'Nagh-
ten are numerous (see People v. Drew, 1978). It is said to be a psychologically
unrealistic test because it ignores the full range of human psychological
functioning, treating persons as if they were simply cognitive beings.
M'Naghten also allegedly unduly restricts the scope of expert testimony
because experts are limited to testifying only about cognitive incapacity.
Moreover, it is asserted that the M'Naghten rule is unrealistic because it is
an "all-or-nothing" test, whereas the relationship of disorder to responsi-
bility is one of degree and subtle shadings. On the other hand, M'Naghten
has staunch defenders (Livermore & Meehl, 1967) who believe this hoary
test sensibly delineates the minimal legal preconditions for responsibility
(M'Naghten is not a test of psychological disorder) while avoiding meta-
physical questions about volition. Also, many of the criticisms that seem apt
in theory are not problematic in practice. In M'Naghten jurisdictions, for
example, experts are not prevented from offering broad testimony about a
defendant's mental state.
Another prominent test is what may be called the "control" test, pop-
ularly known as the "irresistible impulse" test. A classic formulation of this
test is,
If, by reason of the duress of such mental disease he [the accused] had so far
lost the power to choose between the right and the wrong, and to avoid doing
the act in question, as that his free agency was at the time destroyed. (Parsons
v. State, 1887, p. 597)
This test was an outgrowth of the so-called wild beast test, wherein an
insane criminal defendant was analogized to a wild beast, that is, a creature
incapable of controlling behavior by making moral choices (Platt & Dia-

mond, 1965). Those jurisdictions that have adopted the control test have
done so as an addendum to M'Naghten; no jurisdiction uses only this test.
The control test, too, has been criticized ([British] Department of Health
& Social Security, 1975; Fingarette & Hasse, 1979; R. Smith, 1979; Wootton,
1968). It supposedly speaks in all-or-none terms and does not attend to a
continuum of volitional control problems. Experts in control test jurisdic-
tions allegedly are limited to providing an incomplete psychiatric and psy-
chological portrait of the defendant. Moreover the test is considered philo-
sophically incoherent and unverifiable objectively: How is one to
distinguish between an impulse that is "irresistible" and one that simply
was not resisted?
Another test, the Durham rule, enjoyed .a great vogue among some com-
mentators and mental health professionals after its inception in 1954 (Dur-
ham v. U.S., 1954), but it was adopted in only one jurisdiction, the District
of Columbia, which abandoned it in 1972 (U.S. v. Brawner, 1972, adopting
the American Law Institute (ALI) test discussed infra). The Durham rule,
which was very similar to the test in force in New Hampshire since 1870
(State v. Pike, 1869-70), was short and seemingly straightforward:
An accused is not criminally responsible if his unlawful act was the product of
mental disease or defect. (pp. 874-875)
The United States Court of Appeals for the District of Columbia later char-
acterized the Durham rule as a "more fruitful, accurate and considered
reflection of the sensibilities of the community as revised and expanded in
the light of the continued study of abnormal human behavior" (Brawner, p.
976). The new test was broader than M'Naghten or the "control" test or a
combination of the two. No mediating incapacity between mental disorder
and criminal behavior was required. Moreover, the rule seemed to give
mental health professionals free reign to provide a complete picture of the
defendant's mental health and the relationship of the accused's disorder or
defect to the criminal behavior.
The Durham test did not succeed in practice as its proponents hoped it
would. Many of the terms, such as disease and product, needed to be defined,
a task the same court, the United States Court of Appeals for the District of
Columbia, undertook with great difficulty in a series of cases after 1954 (e.g.,
McDonald v. U.S., 1962 ). Furthermore and most importantly, the Durham
test led to expert domination of trial proceedings in insanity defense cases
(Washington v. U.S., 1967.) There was no generally accepted understanding
of the "product" requirement, a requirement that basically expressed an
ethical and legal conclusion. Experts would offer conclusions on the "prod-
uct" issue, thus offering opinions on the ultimate legal issue as if it were a
scientific question. Durham had been adopted to give the experts freer reign,
but, ironically, the rule allowed experts to usurp the function of the judge
or jury. In 1967, in Washington v. United States, the Court of Appeals dealt
with expert domination by prohibiting experts from using conclusory diag-
nostic labels and from offering conclusions about "productivity." The

court's remedy was insufficient, however. The Durham test simply was not
comprehensible to the jury, the laypersons who had to decide the ethical
and legal issue, the defendant's criminal responsibility. In 1972, in United
States v. Brawner, the United States Court of Appeals for the District of
Columbia rejected the Durham rule and replaced it with the ALI test.
The American Law Institute promulgated its now famous test in 1962,
after years of study:
1. A person is not responsible for criminal conduct if at the time of
such conduct as a result of mental disease or defect he lacks substan-
tial capacity either to appreciate the criminality [wrongfulness] of
his conduct or to conform his conduct to the requirements of law.
2. As used in this Article, the terms "mental disease or defect" do not
include an abnormality manifested only by repeated criminal or
otherwise anti-social conduct. (ALI, 1962, § 4.01)
Although the ALI test has been adopted by the vast majority of jurisdictions
that have reconsidered the insanity defense during the past two decades, it
is still not the majority test, except in the federal jurisdictions were it has
been adopted by 11 of the 12 courts of appeals.
The supposed advantages of the ALI test are that it considers both cog-
nitive and volitional problems in relative terms: A defendant only need
lack "substantial capacity" in order to be considered criminally insane. As
a broad test that recognizes a range of relationships between mental disor-
der and criminal behavior, in alleged contrast to other tests, the ALI test
allows experts wide latitude to provide adequate testimony concerning the
defendant's mental state and its relationship to criminal responsibility. On
the other hand, the ALI test is not substantially different from a combina-
tion of the M'Naghten and control tests, and in practice it probably operates
much the same as the other tests.
It is ironic that although there are a number of insanity defense tests,
some research evidence demonstrates that juries do not behave differently
depending on which test they are instructed to use (Simon, 1967). Evidently
juries faced with an allegedly insane defendant simply make the rough
moral judgment of deciding if the defendant was too crazy, too different
from normal people, to be a fit subject for the imposition of criminal respon-
sibility. Furthermore, it seems apparent that in insanity defense cases
almost all judges allow expert witnesses wide latitude to provide a broad
range of testimony concerning the defendant's psychiatric and psycholog-
ical state (A. Goldstein, 1967). Thus, for example, expert testimony in
M'Naghten jurisdictions tends not to be appreciably narrower than such tes-
timony in ALI jurisdictions. It is probable, then, that there is not a great
deal of difference in fact in the operation of the different tests.
Over the years, however, there have been repeated calls for the aboli-
tion of the insanity defense (e.g., J. Goldstein & Katz, 1963; N. Morris &
Hawkins, 1970; New York State Department of Mental Hygiene, 1978; see
also, N. Morris, 1968), a movement that may be further catalyzed by the

insanity acquittal of John W. Hinckley, Jr., who attempted to assassinate
President Reagan and also wounded three others. Critics have complained
that it provides an easy excuse for those who are truly responsible; that it
is an excuse that benefits mainly those wealthy enough to afford the exper-
tise sufficient to mount a successful defense; that it undercuts general deter-
rence because many persons believe that they can sham insanity and thus
avoid punishment; and that its administration is inefficient when the "real"
issue in insanity defense cases is disposition and not responsibility assess-
ment (see generally, N. Morris, 1968). Despite these criticisms and others,
efforts to abolish the insanity defense have been almost totally unsuccess-
ful. Prestigious law professors and even the New York State Department of
Mental Hygiene have led the abolitionist movement, but with few excep-
tions, e.g., Idaho, which abolished the defense by statute in 1982, the insan-
ity defense is still the law in all jurisdictions and appears likely to remain
so. Indeed, some state cases have held that it would be unconstitutional to
abolish the insanity defense (State v. Strasburg, 1910).
Although it is unlikely that the United States Supreme Court would
hold that the insanity defense is constitutionally required (cf. Powell v.
Texas, Harlan concurring, 1968), the intuition that some persons are too
crazy to be held criminally responsible is too strong to allow abandonment
of the tests that express this intuition. Our task as a society must be to decide
coolly if the insanity defense is morally necessary and, if it is, to ensure that
insanity defense trials are conducted rationally, that questionable verdicts
are minimized, and that the disposition leads to the protection of society
and the appropriate treatment of the person acquitted. Despite our ques-
tions about psychiatry or psychology as a science or our doubts about our
understanding of mental disorder, the true moral issue is whether it is just
to hold responsible and punish a defendant who was terribly crazy at the
time of the offense. Those who believe that it is fair to abolish the defense
must be willing to claim either that no defendant is wildly out of touch
with reality or that it is morally proper to convict such defendants. I believe
that few people are willing to make either eiaim, both of which would be
hard to justify. Some defendants are clearly and severely crazy at the time
of their offense and if it is not just to convict the very few defendants who
are that crazy, the defense ought to be retained. At the same time, however,
the defense must be reformed to correct the undoubted abuses that are the
real source of discontent.
The insanity defense is an issue that generates interest, debate, and
scholarship far out of proportion to its practical impact. Many defendants
are evaluated as incompetent to stand trial, but few raise the insanity
defense and of those who do, few are successful (Steadman, 1979). Indeed,
the insanity defense was formerly raised almost entirely in homicide cases
where the death penalty was a possible sanction. In other cases, a success-
fully asserted insanity defense could produce a negative outcome for the
accused: incarceration in a state hospital for the criminally insane for a term
longer than the maximum term of imprisonment allowed for the offense
charged. Thus, as the death penalty fell into disuse, the insanity defense
was raised more sparingly. In the future, however, one may safely predict
a revival of the use of the insanity plea. First, and perhaps foremost, the
United States Supreme Court has declared that under certain conditions the
death penalty may be imposed consonant with the Constitution (Gregg v.
Georgia, 1976). Second, as we shall discuss below, the procedures following
an insanity acquittal have changed. Defendants acquitted by reason of
insanity no longer face the near certainty of lifelong commitment to a hos-
pital for the criminally insane. Statutory and judicial developments have
now made it far easier for insanity acquittees to demonstrate that they are
no longer mentally ill and dangerous and therefore far easier for them to
secure their release from commitment (see Matter of Torsney, 1979). In Cal-
ifornia, for another example, an insanity acquittee can be committed ini-
tially for a term not longer than the maximum term of imprisonment
allowed for the crime with which he or she was charged (In re Moye, 1978).
Let us turn now to an examination of insanity defense procedures.
Almost always the defense is raised by the defendant, but in some jurisdic-
tions the judge may raise the issue sua sponte if the case seems clearly to call
for an adjudication of the defendant's sanity (U.S. v. Robertson, 1974). In
many jurisdictions the defense must notify the prosecution in advance of
the former's intention to raise the insanity defense at trial (e.g., Fed. R.
Crim. Pro., 12.2). The requirement of such advance notification of a defense
is unusual in our highly adversary criminal justice system, but it is believed
that the assistance of mental health experts is necessary for both sides prop-
erly to prepare insanity defense cases. The prosecution is therefore able to
have experts examine the defendant in advance of trial in order to make its
own trial preparations. There are many who believe that it is a violation of
the Fifth Amendment self-incrimination privilege to force the defendant to
speak to a mental health professional who is working for the prosecution
(Lefelt, 1972; Note, 1970; Rollerson v. U.S., 1964), but the majority rule
appears to be to the contrary (Rollerson v. U.S., 1964).
A plea of not guilty by reason of insanity may be combined with a plea
of not guilty. In other words, the defendant may claim that he or she had
another justification or excuse, such as self-defense or duress, and, if those
fail, that he or she was insane in any case. Some jurisdictions try all defenses
at once whereas others have adopted what are known as bifurcated pro-
ceedings. In the latter situation, the first phase of the trial ajudicates
whether the defendant is guilty of the charged offense without regard to
his or her possible legal insanity. (In some jurisdictions, evidence of mental
disorder short of legal insanity may be introduced at the first phase simply
to negate a mental state that is a necessary element of the offense charged.
This is known as diminished capacity, a topic to which this chapter will
turn on p. 368.) If the defendant is acquitted at the first phase of a bifurcated
trial, he or she is discharged from custody. If the accused is convicted at the
first phase, the question of the defendant's legal sanity is adjudicated at the
second phase of the bifurcated trial. If, on the other hand, the defendant
has pled only "not guilty by reason of insanity," there is no bifurcated trial,
but only a hearing on the sanity issue. If the judge or jury rejects the insan-
ity plea, the accused is treated like any other convicted criminal and is sen-
tenced according to the usual procedures. But if the defendant is acquitted
by reason of insanity, he or she is then subject to a special set of procedures.
Successful defenses to criminal charges lead to acquittal and freedom
for the defendant. The insanity defense is the major exception to this rule,
for it usually leads to onerous confinement in a state hospital for the crim-
inally insane which is typically akin to a maximum security prison (Cali-
fornia Penal Code § 1026, 1976). The reason for this atypical response to an
"acquittal" is readily comprehensible. Most acquitted defendants are not
considered dangerous to society because a reasonable doubt has been cast
on whether they committed the act charged or because a reasonable justi-
fication or excuse, such as self-defense, was demonstrated. By contrast, an
insane defendant has an excuse that negates criminal responsibility but not
his or her dangerousness. Although the defendant may not be blameworthy
for antisocial behavior caused by legal insanity, he or she will be considered
a threat to society until the insanity is ameliorated or cured and the conse-
quent dangerousness is reduced (see J. Goldstein & Katz, 1963; see also, Fin-
garette & Hasse, 1979). Confinement in a custodial mental health setting
therefore seems appropriate.
There are three main types of procedures whereby commitment of
insanity acquittees is accomplished: (1) automatic commitment; (2) commit-
ment according to procedures similar to, but different from, civil commit-
ment procedures; and (3) ordinary civil commitment (German & Singer,
1976). Of these, the first seems least desirable, unless it is for a short term
of evaluation, because it is assumed that a defendant who was insane at the
time of the criminal act is still insane and dangerous at the much later time
when he or she is tried. As any clinical psychologist would recognize, a
person who is clearly mentally disordered at one time may behave quite
normally at another. Thus, the justification for automatic commitment
seems relatively weak.
Some type of civil commitment procedure that freshly decides whether
hospitalization is imminently necessary is justifiable because, in the some-
what recent past, the defendant has committed an antisocial act caused, at
least in substantial part, by mental disorder. The only question, then, is
whether standards and procedures different from those applicable in ordi-
nary civil commitment cases are warranted. Proponents of different stan-
dards argue that there should be at least some presumption of continuing
disorder and insanity (see In re Franklin, 1972) leading to a commitment pro-
cess whereby it is more easily accomplished. On the other hand, it is argued
that an insanity acquittee is theoretically no different from any other citizen
who is potentially committable on dangerousness grounds and should
therefore be subject to ordinary civil commitment standards. The United
States Supreme Court has not decided this issue, thus leaving the state leg-
islatures and courts to fashion their own standards and procedures. Some
form of nonautomatic commitment is the trend among those states that
have recently faced this issue (State ex rei. Kovach v. Schubert, 1974; Wilson v.
State, 1972).
Once an insanity acquittee is committed to a hospital, the next impor-
tant issue concerns the standards and procedures by which he or she may
secure release from custody. Again, the states vary widely regarding their
approach to the release of insanity acquittees. Basically, all require that the
defendant is no longer disordered and/or dangerous. As a matter of logic,
the criteria for release ought to be disjunctive rather than conjunctive. If the
person becomes either mentally normal or nondangerous, involuntary
incarceration in a hospital on the ground of dangerousness caused by men-
tal disorder is unnecessary. Other procedural issues that are currently under
consideration by courts and legislatures are the necessity for periodic
review, which is now probably required constitutionally in light of Adding-
ton v. Texas, and whether the acquittee or the state bears the burden of per-
suasion at a release hearing. There is good evidence that insanity acquittees
are not a significant threat to society after release (Thornberry & Jacoby,
1979) and the trend is clear: Insanity acquittees are being provided with
reasonable opportunities to secure their release and courts are willing to
accept the propriety of release in a growing number of cases.
The increasing ease of release from postinsanity acquittal commitments
has caused a great deal of concern in some quarters and has strengthened
calls for the abolition of the insanity defense. It is believed that it is too easy
to feign insanity (Yochelson & Samenow, 1975). When insanity acquittals
resulted in lifelong commitments, this possibility was not troublesome
because "acquitted" defendants were ultimately "punished" anyway by
imprisonment in a state hospital for the criminally insane. Now, however,
with restrictions on release easing, there is fear that persons who deserve
punishment may be escaping their just deserts. Both positions are quite
illogical, but they do evince societal ambivalence about the insanity
defense. If a jury decides a defendant is truly not criminally responsible
because of mental disorder, a punitive response is not appropriate. The per-
son should be treated and allowed to return to society as soon as his or her
psychological condition permits. Still, society feels punitive toward crazy
offenders and cheated if they are not punished in one way or another. Thus
the dilemma: Society is discomforted by punishing those who seem irre-
sponsible because they are clearly crazy, but we are equally discomforted
by lenient treatment of persons who commit antisocial acts even if they are
crazy. This ambivalence, coupled with growing skepticism about the non-
responsibility of many defendants who plead not guilty by reason of insan-
ity, is one of the reasons for the continued disenchantment with the insan-
ity defense. Although some states have abolished the defense in response
to such disenchantment, it is safe to predict that few states will follow suit.
Substantial narrowing and reform of the defense may be expected,
however.
Diminished Capacity
In addition to the insanity defense, a slight majority of American juris-
dictions also allow a partial defense to criminal responsibility based on
mental disorder or defect that is termed "diminished responsibility,"
"diminished capacity," or "partial responsibility" (Note, 1977). One form of
this defense allows the defendant to demonstrate that because of mental
abnormality he or she did not form, or was incapable of forming, a specific
mental state required for the commission of a particular offense (Common-
wealth v. Walzack, 1976). For instance, a conviction for first degree murder
may be predicated upon an intentional killing that is committed, to use
common statutory language, "willfully, deliberately and premeditatedly."
A murder defendant who is mentally disordered but not legally insane may
try to demonstrate that his or her abnormality was sufficient to prevent him
or her from killing "willfully, deliberately and premeditatedly" even if the
killing was intentional. If the jury is convinced that the defendant did not
have the required mental element of the crime, premeditation, the defen-
dant cannot be convicted of first degree murder. The defendant still may be
convicted of second degree murder, an intentional killing without preme-
ditation. Thus, a defendant who successfully asserts a diminished respon-
sibility defense is convicted of a lower degree of crime than the one origi-
nally charged and consequently receives a lesser punishment. Although
this form of the diminished capacity defense should in principle apply to
all crimes, in some jurisdictions various illogical restrictions have limited
its use to prosecutions of only some (Morse, 1979).
Another approach to diminished capacity, primarily developed in
Great Britain (and applied there only to prosecutions for murder), is simply
to reduce the degree of crime for which a mentally abnormal defendant
may be convicted even if his or her conduct fully satisfied all the defini-
tional elements of the higher, originally charged crime (English Homicide
Act, 1957; J. c. Smith & Hogan, 1978). This approach does not ask a "for-
mal," definitional question: Were the statutory elements of the crime
negated by mental abnormality? Rather, it poses the moral question of
whether the defendant is less responsible because he or she was not fully
normal when the crime was committed.
A defendant who successfully asserts a diminished capacity defense is
not committed to a hospital. As noted, he or she is simply convicted of a
lower degree of crime and in most cases is sentenced like any other defen-
dant convicted of the same lower offense.
Much confusion and illogic has attended the development of the law
of diminished capacity (Morse, 1979). Some jurisdictions have taken the
position that, for legal purposes, insanity is an all or none issue; if the
defendant does not plead not guilty by reason of insanity, evidence of
insanity is rendered irrelevant. Such a position is illogical and probably
unconstitutional. One may decide to take this position as a matter of social
policy, but evidence of mental disorder hardly seems irrelevant to criminal
responsibility either (1) if it casts doubt on whether the defendant enter-

tained a mental state required by law for the commission of the crime or (2)
if it casts doubt on whether the defendant's ability morally to evaluate or
to control his conduct was substantially impaired. Again, however, there
appears to be a fear that defendants will "get off" too easily if the doctrine
of diminished capacity is adopted or expanded. Thus, many states have
refused to adopt it, and those that have done so have usually carefully
bounded the doctrine with numerous limitations. (California was a notable
exception see People v. Wetmore, 1978, but diminished capacity as a separate
defense has now been abolished there by statute.) Nevertheless, the
national trend is toward increasing adoption of the doctrine (see e.g., Com-
monwealth v. Gould, 1980) and there is evidence of its expansion where it has
already been adopted.
Guilty but Mentally III

In recent years, a small but growing number of jurisdictions (Michigan,
Illinois, Indiana, Georgia) have adopted by statute a new criminal law ver-
dict, "Guilty but mentally ill" (GBMI; see, e.g., Michigan, MCLA § 768.36,
1975). A plea of GBMI is usually entered in conjunction with an insanity
plea as an alternative to it. A person will be found GBMI if he or she com-
mitted the act in question and was legally sane but mentally ill at the time.
It does not appear that the defendant's mental illness need have been
related to the commission of the offense. Unlike a defendant acquitted by
reason of insanity, a person found GBMI is held fully responsible for his or
her criminal act and may receive any sentence that a person simply found
guilty might receive. The primary difference between a guilty verdict and
a verdict of GBMI is that a GMBI defendant who is still disordered at the
time of sentencing is theoretically entitled to appropriate psychiatric treat-
ment as a matter of statutory right.
The use of the GBMI verdict appears to create dangers. A jury presented
with the alternatives of an insanity acquittal or a GBMI verdict understand-
ably may be confused. Deciding whether a defendant meets the statutory
definition of legal insanity is difficult enough without having to distinguish
it from mental illness insufficient to negate responsibility. Or, a jury that
simply dislikes the insanity defense may resort to GBMI as a compromise-
one that allows it to acknowledge the evidence of mental disorder and
holds out the promise of treatment, while allowing it to express its indig-
nation at the defendant's act and assuring it that he or she will be back on
the streets no sooner than if it simply had found the defendant guilty. Some
defendants who should justly be acquitted by reason of insanity may there-
fore be deprived of a legitimate defense.
The treatment of mentally disordered but legally sane criminals is a
laudable goal and may prevent recidivism where criminal behavior seems
caused by the mental disorder. Nevertheless, it is difficult to perceive why
these goals cannot be achieved without resort to a potentially confusing and

unjust verdict. Moreover, it seems that a defendant found GBMI should not
enjoy special advantages. On humanitarian and possibly on federal consti-
tutional grounds as well, a convicted defendant ought to receive minimally
reasonable care for present mental disorder whether he or she was disor-
dered at the time of the offense or not. And, finally, from the point of view
of social safety, the GBMI defendant can not be incarcerated longer than a
defendant found simply guilty (although in Michigan the probation term
may be longer). Unless the GBMI defendant actually receives effective treat-
ment for his or her mental disorder (which is far from certain), neither the
criminal nor society will gain any real benefit from the verdict.
In sum, the GBMI verdict is a significant development in criminal law.
But whether it is needed, and especially whether it is wise, is open to
question.
QUASI-CRIMINAL COMMITMENT
In a small and decreasing fraction of the states there are special statu-
tory schemes to deal with a small class of legally sane but mentally abnor-
mal criminal offenders who are not necessarily able to assert the diminished
capacity defense but who are considered especially dangerous because of
their mental abnormality (see Wexler, 1976). Today these laws are limited
primarily to persons whose sexual behavior is considered dangerous and
the product of mental disorder. Such laws are called "mentally disordered
sex offender" laws, "sexually dangerous persons" laws, or the like (e.g.,
Massachusetts General Laws Annotated chap. 123A, §§ I-II, 1969; see gen-
erally Note, 1964). (Hereafter, we shall refer to all these laws and the people
they apply to by their Massachusetts shorthand, "SDP.") Another outstand-
ing example of quasi-criminal commitment was Maryland's infamous defec-
tive delinquent law which provided for indefinite confinement in an insti-
tution known as Patuxent (Maryland Annotated Code art. 31B, 1971, 1977).
Recently, a small number of states has adopted enhanced sentencing pro-
visions which apply to mentally abnormal offenders generally, but quasi-
criminal commitment to secure hospitals has historically been used for sex-
ual dangerousness.
The purpose of SDP commitments appears clear. The SDP is viewed as
a special type of offender because he is dangerous in a particularly unset-
tling way and that dangerousness is caused by mental abnormality.
Although most SDPs are not psychotic, it is believed that they suffer from
a refractory form of mental disorder and that they therefore need extensive
treatment and should be incarcerated in order to protect society. These com-
mitments usually are triggered by the person's accusation or conviction of
a criminal offense, which must be of a sexual nature in many states (Brakel
& Rock, 1971). SDPs are considered both "mad" and "bad." Their commit-
ments, which are triggered by the criminal process, but which are based in
large part on a finding of mental disorder and the need for treatment, are
therefore termed "quasi-criminal" (see generally, Stone, 1975, Chap. 11).
After the necessary triggering part of the criminal justice system, e.g.,
accusation, conviction, has occurred, if the prosecutor believes the defen-
dant is an SDP, he or she may petition the court of appropriate jurisdiction
for the commencement of SDP proceedings. The court will order that the
defendant be examined and then a hearing is held to determine if the
defendant is in fact an SDP. As always, the criteria for SDP commitment
vary from jurisdiction to jurisdiction, but the Massachusetts code is typical:
The words "sexually dangerous person" as used in this chapter have the follow-
ing meaning:-any person whose misconduct in sexual matters indicates a gen-
erallack of power to control his sexual impulses, as evidenced by repetitive or
compulsive behavior and either violence, or aggression by an adult against a
victim under the age of sixteen years, and who as a result is likely to attack or
otherwise inflict injury on the objects of his uncontrolled or uncontrollable
desires. (Massachusetts General Laws Annotated chap. 123 § 1, 1958)
The United States Supreme Court has held that in SDP type hearings,
the state must grant SDP defendants many, but not all, of the due process
protections accorded in criminal trials (Specht v. Patterson, 1967). Thus SDP
hearings tend to be rather formal, and the trend today is to provide by stat-
ute or judicial decision increasing due process protections at such hearings.
SDP defendants are accorded extensive due process protections because the
results of an SDP findings are similar to those of a criminal conviction: sig-
nificant loss of liberty and the imposition of stigma. These are such severe
costs to citizens (In re Winship, 1970), that the state must provide substantial
safeguards to the defendant before they may be imposed (In re Burnick, 1975;
People v. Feagley, 1975). If a defendant is ultimately found to be an SDP, the
court has the authority to commit the person to a hospital for custody and
treatment.
In recent years there has been much reform of the SDP commitment
process because its theoretical and practical bases are increasingly in ques-
tion (see generally, Wexler, 1976). First, most SDPs are not psychotic and,
as most clinical psychologists recognize, there is doubt about whether much
"deviant" sexual behavior should be conceptualized as mental disorder.
Second, it is difficult to determine whether or not a sex offender's behavior
is the product of mental disorder: There is little good evidence or concep-
tual reason for finding a causal relationship between an "independent"
mental disorder and sexual misconduct which is the "symptom" of the dis-
order (see Morse, 1978). It is therefore easy for nonmental health factors
(e.g., a desire to achieve an unlimited term of commitment on pure social
danger grounds) to influence the finding. Third, the ability of mental
health professionals to predict the future dangerousness of SDPs (or any-
body else) is very limited (see Note, 1976). Fourth, evidence does not bear
out the fear that most sexual offenders are recidivists who "graduate" to
increasingly serious and dangerous aberrational behavior unless they are
incarcerated and cured (Tappan, 1955). Fifth, clinical evidence and growing
social tolerance have together led to a decrease in the belief that minor
types of sexual offenses, such as indecent exposure, are terribly dangerous
either to the mental health of individuals or to the society as a whole (Cross
v. Harris, 1969). Sixth and last, there is little evidence that reasonably non-
intrusive and consensual treatments for sexual deviation are efficacious (see
Meyer, 1975).
In addition to the disenchantment with the theoretical and practical
bases for SOP commitments, a related motivation for reform in this area has
been the view that SOP commitments are often violative of the civil liber-
ties of the committees (Note, 1976). An SOP commitment is commonly used
to incarcerate a defendant for a far longer time period than the term of
imprisonment authorized for his criminal offense. In the past, the term of
an SOP commitment was unlimited because, allegedly, the defendant could
not be safely released until he was "cured" and therefore no longer "sex-
ually dangerous." Consequently, commitments often became life terms
even wh~n the offense that triggered the SOP proceeding may have been
relatively minor, say, indecent exposure. This outcome seems especially
unjust in light of four factors: (I) the questionable reliability and validity of
the SOP status; (2) the questionable dangerousness of many SOPs; (3) the
lack of effective treatment for the alleged disorder; and (4) the often inhu-
mane conditions in the "hospitals" in which SOPs are housed. In sum, an
SOP defendant might receive what was in fact a life term of imprisonment
in an institution not essentially different from a prison, where no adequate
treatment was, or could be, provided (People v. Feagley, 1975), and all of this
was done on the basis of a judgment that was conceptually doubtful and
scientifically unreliable.
In response to these critical concerns, many states have at least
reformed SOP laws, but sexual offenses and offenders produce highly emo-
tional reactions and a consequent perceived need to "do something" about
sex offenders. Thus, SOP laws remain on the books, albeit statutorily or judi-
cially reformed in most states that retain them. Defendants are given
increased due process protections, such as raising the state's burden of per-
suasion to "beyond a reasonable doubt" (Stachulak v. Coughlin, 1975), to help
the defendant guard against a wrongful finding of SOP status. Furthermore,
the term of commitment has been limited and the right to treatment where
appropriate has been granted in various jurisdictions. Unfortunately, how-
ever, SOP laws still pose a very substantial threat to scientific integrity and
civil liberties, while failing to provide humane benefits to SOPs or substan-
tial benefit to society at large.
THE RIGHTS OF HOSPITALIZED PATIENTS
This subsection of the chapter will discuss the rights of patients com-
mitted under various types of commitment, but especially civil commit-
ment, with special emphasis on the relationship of hospitalization to civil

competence, the right to treatment, and the right to refuse treatment.
Civil Competence and Other Civil Rights

Adult citizens in all states are presumed competent to manage their
persons and property unless there is a judicial finding or other legal process
determining that the person is incompetent. In the past, involuntary com-
mitted mental patients usually were deemed incompetent because they
were committed involuntarily (Brakel & Rock, 1971). Thus, a patient typi-
cally lost the right to manage property, to contract, to vote, to qualify for a
driver's license, to communicate freely with the outside (including one's
family, attorney, or agents of the government), and the like. Moreover,
those rights retained by the patient were revocable by the institutional staff
if it believed revocation was in the patient's interest (California Welfare &
Institutions Code § 5326, 1980). In sum, mental patients were treated like
children and their competence could be restored only by a separate judicial
proceeding or, in some states, simply upon release from the institution. The
rationale for this unusual and disrespectful treatment of patients was the
assumption that mental disorder robbed them of the rationality and under-
standing considered necessary for the reasonable conduct of the everyday
affairs of an adult.
Legislators, judges, mental health professionals, and laypersons in gen-
eral have become more sophisticated about the relationship between mental
disorders and competence, and, at the same time, more concerned about the
civil rights of mental patients. It is now recognized first, that incompetence
is neither a necessary nor even a usual concomitant of mental disorder and
hospitalization (Allen, Ferster, & Weihofen, 1968), and, second, that it is a
massive infringement of civil liberty and an insult to the dignity and auton-
omy of a person to deprive him or her of various civil competencies. Con-
sequently, the majority of jurisdictions today separate the issue of commit-
ment from that of competence; a separate finding is necessary to deem a
person incompetent. Legislation and judicial opinions increasingly provide
that mental patients do not automatically lose particular civil rights, such
as the right to manage their finances, to vote, contract, or drive (e.g., Vec-
chione v. Wohlgemuth, 1974). Finally, as provided for by statute in the various
states, the modern trend is for patients to retain most of their civil rights,
such as the rights to communicate freely, to wear one's own clothes, and to
receive visitors unless the institution denies these rights for good cause
(e.g., California Welfare & Institutions Code § 5325, 5326, 1980).
Although the modern trend is gratifyingly civil libertarian, problems
do remain. The question of competence is, as we have discussed earlier (see
p. 356) a vexed one; adequate criteria for resolving competence questions
have continued to elude lawmakers and commentators alike. If the end
result of a person's behavior appears irrational, it is all too easy to conclude
that the person must be irrational or incompetent. Yet this is a conclusion
that should be reached extremely carefully because it undermines respect

for dignity and autonomy. Psychologists should remember not to equate
another person's violation of the psychologist's preferences with the other's
incompetence.
A second problem in the area of patients' civil rights is created by the
"good cause" criterion by which hospitals can deprive patients of rights to
which the patients would otherwise be entitled. Although a "good cause"
provision makes sense in principle, it is a vague criterion that easily can be
abused in practice. Hospital personnel who are overly concerned with order
or feel threatened by patients who challenge their authority or expertise
may rely on "good cause" to deprive patients of their rights in an inappro-
priate situation. A remedy for this possible abuse of discretion is not simple
to fashion. At the very least, the hospital should have the obligation to
make a detailed record of the facts and reasoning that lead to the denial of
a patient's rights (compare California Welfare & Institutions Code § 5326,
1980). A provision requiring some type of hearing, at which the patient
would be represented, would be even more protective of the patient's
rights. Any remedial provision can be circumvented by a hospital acting in
bad faith, but if patients are entitled to particular protections, they legally
can challenge denials of these protections in an attempt to insure that the
hospital complies with its legal obligations.
The Right to Treatment

In an oft-cited article (1960), lawyer-physician Morton Birnbaum sug-
gested that mental patients have a "right to treatment" that should be oblig-
atory as a matter of law. (At the very least, it certainly seems required as a
matter of medical and psychological ethics.) On its face, the existence of
such a right hardly seems surprising. If the state locks a person up in a
hospital on the ground that the person is mentally disordered, it seems
utterly obligatory that the state should treat the person to the fullest extent
reasonably possible. After all, hospitals exist to care for and treat the sick.
If care is inadequate and no treatment is provided, then the hospital is little
more than a prison called by a different name. One would therefore have
expected that adequate care and treatment were widely provided and that
discussion of a so-called right to treatment should have been unnecessary.
The reality of care in state and county mental hospitals was of course shock-
ingly different from one's reasonable expectations for such institutions.
Adequate treatment was almost nonexistent in many institutions and the
level of custodial care was widely and appallingly substandard. Exposes
of conditions in the "snake pits" were a regularly occurring event across
the nation (see Los Angeles Times, 1976), but reforms were nearly al-
ways totally insufficient. Although there was some legislative provision
of a right to treatment and even some judicial decision making in the area
(Rouse v. Cameron, 1966), until the beginning of the 1970s the right to treat-
ment was not secured widely either by legislation or by judicial decisions
announcing the basis of the right in the federal Constitution. Patients had
no right to treatment and, in the absence of such an enforceable right, ade-
quate treatment and care was rarely provided. One associates the abuses in
mental hospitals with an age long past, but they existed without serious
challenge until the last decade and they continue to exist in too many insti-
tutions despite such challenges.
The first, epochal case to recognize a constitutional right to treatment
was Wyatt v. Stickney (1971). In Wyatt, Federal District Judge Frank M. John-
son held that involuntarily committed mental patients "unquestionably
have a constitutional right to receive such individual treatment as will give
each of them a realistic opportunity to be cured or to improve his or her
mental condition" (p. 784). Wyatt had begun as a suit by Alabama mental
hospital employees who were challenging layoffs. As the state hospital sys-
tem was explored, however, the suit was transformed into a right to treat-
ment suit. Conditions in the hospitals under consideration were shocking:
overcrowding, ghastly sanitation, lack of privacy, and inadequate medical
care were the norm, and mental health treatment was in effect nonexistent.
The decision announcing the right to treatment followed and included a
requirement that the state should report to the court its progress in imple-
menting a hospital reorganization plan. The court considered the report
and in a second opinion (Wyatt v. Stickney, 1971b) held that there were three
"fundamental conditions for adequate and effective treatment" (p. 1343): a
"humane psychological and physical environment"; qualified staff "in
numbers sufficient to administer adequate treatment" (p. 1343); and indi-
vidualized treatment plans. In a further opinion (1972), the court ordered
the state, inter alia, to implement an elaborate set of standards imposed by the
court that covered every aspect of the functioning of the hospitals, to estab-
lish human rights committees for the hospitals, and to prepare and file
progress reports on the implementation of the standards.
In addition to establishing an important precedent, the Wyatt cases also
instituted in the mental health area the massive intrusion of the federal
courts into the running of state mental institutions. Many persons object to
such intrusion on the grounds that it exceeds the proper powers of a federal
court and that courts lack the competence to oversee the details of the
administration of mental hospitals. Nonetheless, the federal district court
did not back down from its position and Wyatt was upheld on appeal (Wyatt
v. Aderholt, 1974). The Wyatt litigation continued, however, and the Ala-
bama hospitals were finally placed in receivership in 1979 by Judge
Johnson.
The next major right to treatment case, Donaldson v. O'Connor, also was
decided by the Court of Appeals for the Fifth Circuit (1974; see also Don-
aldson, 1976). Kenneth Donaldson had been involuntarily hospitalized in
Florida for over a decade although he was dangerous neither to himself nor
to others. After numerous unsuccessful attempts to obtain his release, he
brought suit once again, raising a consititutional claim based on the depri-
vation of the right to treatment and suing individual doctors under the fed-
eral Civil Rights Act (42 U.S.c. § 1983) on the ground that they had
deprived him of a constitutional right. The trial court found for Donaldson
and on appeal the United States Court of Appeal for the Fifth Circuit
affirmed, holding again that a constitutional right to treatment did exist
(Donaldson v. O'Connor, 1974).
The case was appealed to the United States Supreme Court, which was
expected finally to decide whether there was a constitutionally based right
to treatment. Those interested in a definitive decision on this issue were
disappointed, however, because the Court's decision, O'Connor v. Donaldson
(1975), did not address the right to treatment issue except peripherally and
by implication. Rather, the Court opined that the case should be decided on
the narrower issue of the right to liberty, and held that a nondangerous
person who was able to live in the community alone or with the help of
family and friends could not simply be custodially confined. Donaldson
was therefore freed at last. The Court explicitly noted that it was not decid-
ing the right to treatment issue and vacated the Fifth Circuit's opinion on
this issue; but, in dictum, it also noted that whether adequate treatment had
been provided in a particular case was clearly a justiciable issue. In a sepa-
rate concurrence, however, Mr. Chief Justice Burger wrote that he believed
that there was no constitutional right to treatment. Finally, on the issue of
whether the individual doctors were liable for depriving Donaldson of his
right to liberty, the Court remanded the case for reconsideration in light of
another case (Wood v. Strickland, 1975) which granted public servants qual-
ified immunity. (The individual cause of action was ultimately settled when
the defendant doctors agreed to pay Donaldson $20,000.)
In a recent case, Youngberg v. Romeo (1982), discussed briefly supra, the
Supreme Court made a hesitant beginning in setting forth the rights of
institutionalized mental patients to reasonable hospital conditions and
treatment. Romeo (respondent) was a profoundly retarded adult male who
could not talk and lacked the most basic self-care skills. In 1974 he was com-
mitted to the Pennhurst State School and Hospital after involuntary com-
mitment proceedings initiated by his mother. While at Pennhurst, he was
injured on numerous occasions, both by his own violence and by the reac-
tions of other residents to him. In 1976 his mother filed suit in district court
against the superintendent of Pennhurst and others on her son's behalf.
The complaint alleged that Pennhurst officials knew, or should have
known, (1) that Romeo was suffering injuries and that they had failed to
institute appropriate preventive procedures, thus violating his Eighth and
Fourteenth Amendment rights; (2) that Romeo was being restrained for
prolonged periods on a routine basis; and (3) that defendants had failed to
provide him with appropriate treatment or programs for his mental retar-
dation. The issue as ultimately presented to the Supreme Court was
whether Romeo had substantive rights under the Due Process Clause of the
Fourteenth Amendment to safe conditions of confinement, freedom from
bodily restraints, and training or "habilitation."
The majority stated initially that "the mere fact that Romeo has been
committed under proper procedures does not deprive him of all substantive
liberty interests under the Fourteenth Amendment." Referring to cases in
which the right to personal security and the right to freedom from bodily
restraint had been held to survive criminal conviction, it quickly found that
these were among the liberty interests retained by a person involuntarily
committed as well. The Court also noted, with evident approval, that the
petitioner, the superintendent of the institution, conceded that the state had
a duty to provide adequate food, shelter, clothing, and medical care.
The Court found respondent's claim to a "constitutional right to min-
imally adequate habilitation" more troubling. It avoided as not clearly
before it resolution of "the difficult question whether a mentally retarded
person, involuntarily committed to a state institution, has some general
constitutional right to training per se." It did hold, however, that such a
person's "liberty interests require the State to provide minimally adequate
or reasonable training to ensure safety and freedom from undue restraint."
Thus "the state is under a duty to provide respondent with such training as
an appropriate professional would consider reasonable to ensure his safety
and to facilitate his ability to function free from bodily restraints." (The
Court described an appropriate professional in a footnote as a "person com-
petent, whether by education, training, or experience, to make the partic-
ular decision at issue. Long-term treatment decisions normally should be
made by persons with degrees in medicine or nursing, or with appropriate
training in areas such as psychology, physical therapy, or the care and train-
ing of the retarded.") A failure by the state to provide such "minimally ade-
quate or reasonable training to ensure safety and freedom from undue
restraints" is an unconstitutional infringement of those rights.
The Court acknowledged that respondent's liberty interests in safety
and freedom of movement were not absolute and could be in conflict with
state interests. It thus confronted the question of how to determine whether
the extent or nature of the restraint or lack of absolute safety is such as to
violate due process. Such a determination, the Court held, requires a bal-
ancing of the liberty of the individual and the demands of an organized
society. Responsibility for balancing these interests lies primarily with the
treating professionals. The Court agreed with Chief Justice Seitz of the
court of appeals who had written that, "the Constitution only requires that
the courts make certain that professional judgment in fact was exercised. It
is not appropriate for the courts to specify which of several professionally
acceptable choices should have been made." The courts also must show def-
erence to the judgments of qualified professionals on the issue of treatment,
their decisions as to what is reasonable in light of a patient's liberty interests
being presumptively valid.
The Court concluded by noting that this presumption may be over-
come, and liability imposed, "only when the decision by the professional is
such a substantial departure from accepted professional judgment, practices
or standards as to demonstrate that the person responsible actually did not

base the decision on such a judgment." Moreover, if the professional is
unable to satisfy normal professional standards because of budgetary con-
straints, good faith immunity will bar liability.
In a concurrence, Justice Blackmun, writing also for Justices Brennan
and O'Connor, agreed with the majority that the issue of respondent's right
to "treatment" per se was not properly raised below, and that the record in
any case did not show a total failure to provide treatment. He indicated his
belief, however, that a state could not constitutionally accept a patient for
"care and treatment," as Pennhurst had (under the Pennsylvania Mental
Health and Mental Retardation Act of 1966), and then refuse to provide any
treatment. Citing Jackson v. Indiana (1972), Blackmun wrote that, "In such a
case, commitment without any 'treatment' whatsoever would not bear a rea-
sonable relation to the purposes of the person's confinement," a relation
required by the Due Process Clause. The extent of a state's obligation to
involuntarily committed retarded persons would seem, under this view, to
depend at least in part on what it chooses to state as the purposes of such
commitment.
Another question left open by the Court but addressed by Blackmun
was whether respondent had a constitutional claim "to the 'habilitation' or
training necessary to preserve those basic self-care skills he possessed when
he first entered Pennhurst." Blackmun felt he had, and that this was con-
sistent with the Court's reasoning and definition of "minimally adequate
training required by the Constitution." Blackmun agreed that deference to
the judgment of professionals as to whether training would in fact preserve
such skills was proper.
Echoing his concurrence in O'Connor, Chief Justice Burger concurred
again and wrote that the issue of respOndent's right to treatment per se was
clearly before the Court. He observed "1 agree with much of the Court's
opinion. However, I would hold flatly that respondent has no constitu-
tional right to training, or 'habilitation,' per se." He explained:
I agree with the Court that some amount of self-care instruction may be neces-
sary to avoid unreasonable infringment of a mentally-retarded person's inter-
ests in safety and freedom from restraint; but it seems clear to me that the Con-
stitution does not otherwise place an affirmative duty on the State to provide
any particular kind of training or habilitation-even such as might be encom-
passed under the essentially standardless rubric "minimally adequate training,"
to which the Court refers. (p. 2465)
Although the Chief Justice is clearly a staunch opponent of a constitutional

right to treatment, he apparently has little if any support from the other
justices for this view.
Despite the voluminous literature and many court decisions (e.g., Bur-
ris, 1969; Hoffman & Dunn, 1975; G. Morris, 1970; R. K. Schwitzgebel, 1974;
Stone, 1975), there is still no definitive answer to the question of whether
a constitutional right to treatment exists. Commentators have argued, more-
over, that most of the constitutional reasoning upon which the lower courts
have based their opinions is fallacious (Spece, 1978). Nonetheless, there is

a creditable argument that such a right does exist (Spece, 1978). Youngberg
seems to hold open the possibility that it may exist in some cases, many
legislatures have provided for it, and courts continue to behave as if the
constitutional right does exist. In recent years there have been fewer major
judicial decisions based on the right to treatment and it now appears that
the major class actions are being settled by consent decrees (Stone, 1977)
whereby the state agrees to provide more adequate treatment and the agree-
ment is accepted by the court in which the suit was brought. Thus, the
movement to provide a right to treatment proceeds apace, and even if the
constitutional credentials of the right are neither impeccable nor settled, it
is almost universally agreed that the right is sound social policy and, more-
over, morally obligatory.
It would be gratifying to report that the right to treatment suits and
legislation of the 1970s have adequately reformed those state hospitals that
were unacceptably inadequate, converting them from inhumane ware-
houses to treating and curing institutions that deserve the appellation hos-
pital. But, although there have been important and worthwhile reforms in
many places, legislatures have been loathe to provide the funds necessary
for truly adequate care and treatment and courts have been unwilling to
define the right to mean that the state must provide optimum treatment.
Thus, hospitals often do not provide high level treatment, scandalous con-
ditions are widely prevalent (Flakes v. Percy, 1981; Wyatt v. Ireland, 1979),
and when faced with right to treatment suits, the states appear to prefer to
dump patients back into the community (abetted by the rhetoric, but not
the true meaning, of the deinstitutionalization movement) rather than to
provide proper treatment.
Despite the essentially negative assessment of the results of the right
to treatment movement just given, on the whole, right to treatment litiga-
tion and legislation have been more beneficial than not to mental patients.
It has produced continuous exposure of the inadequate conditions in men-
tal hospitals and it has led to worthwhile reforms. While the Alabama hos-
pitals, for example, are by no means ideal even today, they are far better
than they would have been without the Wyatt cases and the continuing
supervision that followed them. Moreover, patients involuntarily commit-
ted to inadequate hospitals now have a legal theory and in many jurisdic-
tions an enforceable right with which to compel the state to attempt to meet
its clear moral commitment to provide adequate care and treatment.
It is easy to blame state legislatures for the failure to provide funds
adequate for the proper care and treatment of mental patients-such blame
often is clearly deserved-but, in my opinion, blame also must be placed
squarely on the mental health professions and especially on psychiatry. I
believe that psychiatrists and other professionals should have refused to
work in many state hospitals because the care provided in them did not
begin to comport with reasonable professional practice or humane stan-
dards. The contention that conditions would have been even worse without
their participation simply will not do, even if it is partially true. No mental
health professional should have condoned and indeed perpetuated the
standard of care at many of our public mental hospitals by his or her
employment at such poor institutions. An inadequate hospital system can-
not be justified and maintained if professionals refuse to work there unless
conditions are vastly improved. Moreover, professional organizations
should have devoted far more of their resources to efforts to improve the
state hospitals. The point of this accusation is simple: Psychologists should
recognize their ethical responsibilities when they are involved as care pro-
viders to involuntarily committed patients and they should not condone in
any way the operation of an inadequate institution. Furthermore, when
their advice is sought about the standard of care to be provided, they should
strenuously insist on the highest standard possible.
The Right to Refuse Treatment

As psychologists recognize, mental health treatments of all kinds oper-
ate primarily by changing behavior (broadly defined here to include
thoughts, feelings, and actions). All medical and psychological treatments
involve invasions of a person's privacy and autonomy (which is why
informed consent is necessary if the treatment provider wishes to avoid tort
liability) but, arguably, mental treatments are especially intrusive because
by altering behavior they alter a person's identity or sense of self. It is con-
sequently a grave matter to administer mental treatments involuntarily to
a person (Ford, 1980; Plotkin, 1977). Proponents of such involuntary treat-
ment argue, however, that concerns about dignity, autonomy and privacy
appear obviated by the assumption that involuntarily committed mental
patients are incompetent to make decisions about what is in their own best
interests. What is more, patients have been involuntarily hospitalized
because they are mentally disordered and thus they need treatment by def-
inition; to fail to provide it is therefore illogical. As the old wisdom con-
cluded, no serious problem was presented when a mental hospital treated
an involuntary patient without obtaining the patient's informed consent
(Special Section, 1980). Nonetheless, the involuntary mental patient's right
to refuse treatment is at last gaining a legal foothold.
Four factors have operated together, slowly to be sure, to create the
intellectual and legal climate in which a right to refuse treatment is increas-
ingly being recognized. First, the recognition that mental patients should
retain their civil rights as much as possible and that their autonomy and
dignity deserve respect has been influential. Second, there is everwidening
appreciation (discussed on p. 373 infra) that mentally disordered and com-
mittable persons are not necessarily incompetent to make all decisions
about their own welfare. For example, a person committed as mentally dis-
ordered and dangerous very well might be able to assess rationally the costs
and benefits of a profferred treatment. Third, the increased availability and
acceptance of broadly useful but powerful treatments such as the various
psychotropic medications have caused concern. And, fourth, it has been rec-
ognized that powerful treatments may be improperly used through lack of
knowledge (e.g., perhaps psychosurgery) or through calculated abuse such
as using a treatment primarily for ward control or for punishment of the
patient (Plotkin, 1977; R. K. Schwitzgebel, 1973; Symposium, 1969).
Most of the early important cases were of limited importance, however,
because they involved unusual circumstances and were therefore of argu-
ably restricted generalizability as precedents. For instance, Winters v. Miller
(1971) concerned a patient who refused medication on the ground that she
was a Christian Scientist. The court held that the state's interest in treating
the patient had to yield to the patient's reasonably raised First Amendment
right to the free exercise of her religion. In another case, Knecht v. Gillman
(1973), the United States Court of Appeals for the Eighth Circuit recognized
that an aversive conditioning program used with mentally disordered crim-
inals could be used for cruel and unusual punishment rather than treat-
ment. Therefore, held the court, before certain treatments could be used,
the institution needed the written informed consent of the inmate, which
consent was revocable at the will of the inmate. Other cases, too (e.g., Price
v. Sheppard, 1976), recognized a nascent right to refuse treatment and the
necessity of considering factors such as the intrusiveness of the treatment
before involuntary treatment could be authorized. Until 1978, however,
there was no judicial opinion of broad applicability that recognized a wide
right to refuse treatment.
Prior to the major judicial decisions, which we shall discuss presently,
some protection of the right to refuse treatment, usually of limited scope,
was provided statutorily. California, for instance, imposed a stringent set of
limitations on the use of the most intrusive therapies, psychosurgery and
electroconvulsive therapy, on involuntary and voluntary patients (Califor-
nia Welfare & Institutions Code § 5325, 1980). Although some of the pro-
visions were held unconstitutional because they violated a patient's right
to privacy or interfered unduly in the doctor-patient relationship (Aden v.
Younger, 1976), the vast bulk of the regulatory scheme is still in force. Fur-
thermore, California requires informed consent for all treatments if the
patient is competent to provide such consent. Thus, it is exceedingly diffi-
cult for a California state hospital involuntarily to administer ECT and it is
impossible in California to perform psychosurgery involuntarily. Wide
ranging statutory schemes such as California's are rare, however, and the
task of dealing with the right to refuse treatment was primarily taken up
by the courts.
In 1978, the Federal District Court for the District of New Jersey held
in Rennie v. Klein (Rennie 1) that an involuntarily committed mental patient
has the right to refuse psychotropic medication in a non emergency situa-
tion. Plaintiff Rennie appeared to suffer intermittently from severe mental
disorder that rendered him homicidal and suicidal, but he complained of
the side effects of Prolixin and related drugs and sought to avoid taking
them. A number of constitutional arguments to support the right to refuse
medication were offered to the court, but all were rejected except the con-
stitutional right to privacy, upon which the holding was finally based. The
right to refuse medication was not held to be absolute, however, and the
court suggested a numer of factors that should be considered when decid-
ing whether to override the right: (1) whether without medication the
patient endangered other patients or staff; (2) the patient's capacity to
decide on a particular treatment; (3) whether a less restrictive alternative
existed; and (4) the risk of permanent side effects from the proposed treat-
ment. The court also held that for patients committed on a parens patriae
basis, forced medication was allowable only after the patient was found
incompetent at a hearing. Although Rennie [ did not provide an absolute
right to refuse, it was the most generally extensive affirmation of the right
to that date.
In Rennie [ the court refused to issue an injunction because at the time
of the opinion Rennie was not receiving psychotropic medication. Later in
the year, however, the hospital resumed Rennie's drug treatment and he
obtained a preliminary injunction against involuntary treatment on behalf
of himself and the entire class of institutionalized patients in New Jersey.
In its opinion in Rennie II, the court reiterated the factors that Rennie [
ordered to be considered when deciding whether to override a right to
refuse treatment, and it specified in some detail the procedures to be used
before patients could be involuntarily medicated. Consent forms had to be
used unless the patient was legally incompetent (upon court determination)
or functionally incompetent (upon determination by a physician). In case
of either type of incompetence, a patient advocate had to be provided and
independent review by an outside psychiatrist was provided for when the
patient's wishes were overruled or the patient was deemed incompetent.
Attorneys or "adversary" psychiatric consultants did not have to be pro-
vided for the patient, however, and the patient had no right to call or exam-
ine witnesses. Further, decisions generally were not reviewable for 60 days.
Finally an emergency was defined as "a sudden, significant change in the
patient's condition which creates danger to the patient himself or to others
in the hospital" (p. 1313). In such a situation, medication could be admin-
istered for only 72 hours unless a physician certified that the emergency
was continuing. Thus Rennie II reaffirmed and expanded the holding in Ren-
nie [.(See also Rennie III, 1981, which modified Rennie II, but affirmed that
there was a constitutionally based, but qualified, right to refuse treatment.)
In Rogers v. Okin (1979), a federal district court in Massachusetts issued
the most far reaching right to refuse treatment decision to date, holding in
a class action suit that voluntary and involuntary mental patients have an
absolute constitutional right to refuse medication except in emergency sit-
uations (defined as a situation where there is a "substantial likelihood of
physical harm to the patient or others" [po 1365]). The case also held on
statutory grounds that patients had the right to refuse seclusion except in
emergency situations. The court flatly denied that mental patients are
incompetent to make treatment decisions and held that even incompetent
patients did not need to abide by the hospital treatment decisions, but
instead could be represented by a guardian who would make such decisions
for them. The court held further that the constitutional right to refuse treat-
ment, which could be overriden by compelling state interests only in cases
of emergency, was founded on the right to privacy and the First Amend-
ment right freely to produce thoughts.
The court also found that very few of the patients affected, only 12 of
1,000, refused medication for prolonged periods of time and most of these
patients changed their minds within a few days. Thus, the court found fan-
ciful the fears of wholesale treatment refusal by patients who had the right
to refuse treatment and all the hypothesized problems attendant thereto.
Moreover, even if allowing the patient to choose was more costly and
inconvenient, the court argued that such factors could not override consti-
tutional rights. Finally, the court rejected the claim that courts were acting
improperly when they overrode the decisions of hospital personnel. Profes-
sional judgments, countered the court, always are subject to judicial review
when there is an allegation that such judgments have created a deprivation
of constitutional rights.
As noted, the extensive right to refuse treatment created by Rogers
could be overridden only in emergency situations, and the court defined
these very restrictively. Substantial harm to self and others did not include
bizarre behavior, extreme anxiety, and other conditions that mental health
professionals generally would agree ought to be treated. The need for treat-
ment simpliciter was outweighed only by the constitutional rights to privacy
and free thought, which themselves could be outweighed by the compel-
ling state interest that arose only when there was a "substantial likelihood
of physical harm to that patient, other patients, or staff members of the insti-
tution" (p. 1365 [italics added]). As one would expect, the psychiatric profes-
sion was outraged by Rogers I (Special Section, 1980). They believed that it
unduly restricted the proper provision of care and treatment and the rea-
sonable exercise of their medical authority. Response from professional psy-
chology was comparatively scant, however, because, I hypothesize, psy-
chologists are not in principle directly involved in the prescription of
psychotropic medication.
Rogers I was appealed, and in Rogers v. Okin (1980) (Rogers lI), the Court
of Appeals for the First Circuit affirmed the lower court's ruling that psy-
chotropic drugs could be forcibly administered only in emergencies or after
a determination of incompetency had been made. Thus a competent
patient's right to refuse treatment except in emergencies had to be
respected. But Rogers II granted physicians the authority in potential emer-
gency situations to decide whether the state's interest in preventing vio-
lence outweighed the due process right of the patient to refuse treatment.
The court stressed that such a decision involves a process of balancing
numerous factors unique to particular situations. The lower court's "unitary
standard," which asked only if there was a substantial likelihood of vio-
lence, was found to be too rigid and difficult to apply and the appellate
court held that the decision forcibly to medicate a patient had to be made
on an individualized basis. Rogers II therefore remanded the case to the
lower court to design new procedures to insure that before drugs were forc-
ibly administered in an emergency that, first, the patient's interests in refus-
ing antipsychotic medication were taken into account, and second, that a
qualified physician weighed the competing interests and determined that
the state's interest was paramount and that less restrictive alternatives were
unavailable. Rogers II also broadened the lower court's definition of emer-
gency situations to allow forcible administration of drugs if reasonably
believed to be necessary to prevent further deterioration in the patient's
mental health (italics added). Although Rogers II both extends medical
authority and broadens the definition of an emergency beyond the limits
set in Rogers I, the due process right of a competent patient to refuse treat-
ment was upheld.
Rogers II was appealed to the Supreme Court, which agreed to hear the
case (now entitled Mills v. Rogers), but after the high court accepted the
Rogers II case, the Supreme Judicial Court of Massachusetts decided another
major right to refuse treatment case, In the Matter of Guardianship of Richard
Roe, III (Roe III, 1981). As we shall see, Roe III had a major effect on the
Supreme Court's decision in Mills v. Rogers (Mills, 1982).
Roe ("the ward") had twice been committed to a state hospital for
observation: the first time after becoming violent toward his sister and
another, the second time after being charged with attempted unarmed rob-
bery and assault and battery. He also attacked another patient during his
second stay. He was diagnosed as suffering from schizophrenia, paranoid
type, and antipsychotic medication was recommended. He refused. this and
all other treatment. Upon release he lived with his family. Roe's father was
appointed guardian by the probate court, which determined that Roe was
unable to care for himself by reason of mental illness (thus "incompetent").
The issue before the Supreme Judicial Court of Massachusetts was whether
the probate judge had erred in granting the father, as guardian, authority
to consent to the forcible administration of antipsychotic medication to his
noninstitutionalized ward in the absence of an emergency. Basing its deci-
sion on both federal and state law, the court held that he had.
The court said first that its guidelines were applicable where all of the
following exist:
1. An incompetent individual is not institutionalized.
2. A party with standing actually seeks to administer medication to the
incompetent person in the absence of an emergency (which the
court defined as an unforeseen combination of circumstances or
the resulting state that calls for immediate action) .
3. The proposed medication is an antipsychotic drug.
There appears to have been no dispute that a decision to consent to
such medication over the patient's objections should be made, if at all, pur-
suant to a substituted judgment determination, a determination of what the
patient himself would decide if not incompetent. The controversy con-

cerned who had the authority to make such a determination. The court held
that it must be made by a judge, not by the ward's guardian. "The deter-
mination of what the incompetent individual would do if competent will
probe the incompetent individual's values and preferences, and such an
inquiry, in a case involving antipsychotic drugs, is best made in courts of
competent jurisdiction" (p. 52). A guardian has authority to make some
treatment decisions over a ward's objections, but not this one. In so saying
the court stressed (1) the intrusiveness of the proposed treatment; (2) the
possibility of adverse side effects; (3) the absence of an emergency; (4) the
nature and extant of prior judicial involvement (here, the fact that an adju-
dication of incompetency had already been made meant that a judicial sub-
stituted judgment should not take long to obtain when sought); and (5) the
likelihood of conflicting interests ("Those characteristics laudable in a par-
ent might often be a substantial handicap to a guardian faced with such a
decision" [po 52]).
To decide whether a ward would accept medication if competent, the
court stressed that the determination should be subjective and "must 'give
the fullest possible expression to the character and circumstances of that
individual.'" The court then listed the nonexclusive factors to be consid-
ered: "(1) the ward's expressed preference regarding treatment; (2) his reli-
gious beliefs; (3) the impact upon the ward's family; (4) the probability of
adverse side effects; (5) the consequences if treatment is refused; and (6) the
prognosis with treatment" (p. 57).
If the judicial determination is that the ward would accept the medi-
cation if competent, it is administered. If the judicial determination is to the
contrary, it still may be administered if the judge finds that state interests
capable of overwhelming the right to refuse treatment exist. As examples
of such interests, the court listed: (1) the preservation of (the ward's own)
life, (2) the protection of the interests of innocent third parties (i.e., pre-
venting the infliction of violence upon members of the community)," (3)
the prevention of suicide; and (4) maintaining the ethical integrity of the
medical profession" (p. 59). Its discussion dealt mainly with the second of
these. When the state's interest is the prevention of violence, "the character
of the government intrusion changes" and antipsychotic drugs function as
chemical restraints forcibly imposed upon unwilling individuals who, if
competent, would refuse such treatment. Examined in terms of personal lib-
erty, such an infringement is at least the equal of involuntary commitment
to a state hospital. The court therefore held that, where the likelihood of
serious harm must be established, the same standard of proof-beyond a
reasonable doubt-is applicable in both involuntary commitment and
involuntary medication proceedings" (p. 60). Moreover, if such a likelihood
is suitably established, the ward is entitled to an extended substituted judg-
ment determination. "In order to satisfy the least intrusive means test, the
incompetent is entitled to choose, by way of substituted judgment, between
involuntary commitment and involuntary medication" (p. 61).
The court was careful to note the limits of its holdings. First, it deals
with a noninstitutionalized individual in a nonemergency situation. What
the proper course of conduct would be in an emergency the court does not
say. Second, it deals with noninstitutionalized individuals. "Specifically, we
decline to rule on the rights of patients confined against their will to state
hospitals to refuse antipsychotic medication" (p. 62). Third, "we wish to
emphasize as well that in this case we treat the ward's right to a determi-
nation only in so far as it concerns antipsychotic medication" (p. 62).
The significance of Roe III for future cases involving right to refuse
treatment is that it is a leading precedent that has strong sympathy for strin-
gently protecting the rights of mental patients, including requiring a high
degree of judicial participation in what many regard as primarily medic~l
decisions. Although the holding is limited to noninstitutionalized individ-
uals, it is reasonably clear the court's sympathies also will extend to insti-
tutionalized patients.
As we shall see next, the Supreme Court's decision in Mills was heavily
influenced by Roe III, and Roe III will probably be the basis for future deci-
sions by the court of appeals on remand in Mills. Therefore, it is useful to
conclude the discussion of Roe III by noting its observance that Rogers II
was mistaken when it held that the guardian should be given the disputed
authority to decide (although Roe III noted also that the decision in Rogers
II was in accord with the law controlling at the time).
It was expected that in Mills v. Rogers the United States Supreme Court
would finally resolve the question of whether institutionalized mental
patients have a federal constitutional right to refuse antipsychotic drug
treatment. Ultimately, however, the Court unanimously refused to decide
the case on the merits. Instead, it vacated the judgment of the court of
appeals and directed that court to det~rmine whether: (1) Roe III required
revision of its holdings, or (2) potentially dispositive state law questions
should be certified to the Supreme Judicial Court of Massachusetts, or (3)
abstention (declining to decide or delaying decision to await state court
action) was appropriate.
Although the failure to decide was disappointing, the Supreme Court's
reasons for doing so were reasonable. The Court noted that state constitu-
tions and state law generally might properly grant an individual greater
substantive and procedural protection than the federal constitution, which
sets only minimum limits. Thus, where state protections were broader, as is
commonly the case, state law would be dispositive of the rights and duties
of the parties. In this particular instance, the Roe III decision, discussed
immediately above, had been decided by the Supreme Judicial Court of
Massachusetts after the federal court of appeals decision in Mills and after
the Supreme Court had agreed to hear Mills. Furthermore, the patients (Ms.
Rogers et al.) clearly had relied on state law in their arguments to the court
of appeals. Because Roe III granted disordered persons very extensive rights,
the Supreme Court concluded that, "we cannot say with confidence that
adjudication based solely on identification of federal constitutional interests
would determine the actual rights and duties of the parties." In other
words, since it was probable that the Massachusetts law was broader than
federal law in this context and might control the case, the Supreme Court
refused to decide because it adheres to a settled policy of avoiding unnec-
essary decisions of federal constitutional issues.
In the course of reaching its conclusions, the Court did offer a number
of hints about what its views might be were it to decide the issue on the
merits. It observed that both parties in Mills "agree that the Constitution
recognizes a liberty interest in avoiding the unwanted administration of
antipsychotic drugs." The Court was studiously noncommittal, however,
about whether involuntary mental patients retain such liberty interests. For
example, it wrote, "Assuming that [the parties in Mills] are correct in this
respect," and in a later footnote again only assumed, for purposes of dis-
cussion, that involuntarily committed mental patients do retain liberty
interests protected directly by the Constitution and that these interests are
implicated by the involuntary administration of antipsychotic drugs. The
Court wrote finally that, assuming the existence of such interests, it inti-
mated "no view as to the weight of such interests in comparison with coun-
tervailing state interests." Despite this string of disclaimers, it appears clear
in light of Youngberg v. Romeo (discussed above at p. 376) that the Court does
recognize such rights and will so hold if it ever decides this exact issue.
The Court went on to compare the rights granted by Roe III with those
granted in related Supreme Court cases (Addington, discussed at p. 348;
Youngberg, discussed at p. 376, and Parham, discussed at p. 350), observing
thal "it is distinctly possible that Massachusetts recognizes liberty interests
of persons adjudged incompetent that are broader than those protected by
the Constitution of the United States." The Court referred to Roe III's grant
of continuing liberty interests to those judged incompetent and its require-
ment of judicial oversight of decisions in this area as examples. The most
obvious implication is that if the Supreme Court finally decides the ques-
tion of the right of involuntary patients to refuse antipsychotic drug treat-
ment, it will recognize some liberty interest for the committed person, but
neither the substantive rights granted nor the procedures required to pro-
tect those rights will be extensive.
In the absence of a definitive Supreme Court resolution of the right to
refuse treatment issue and in light of the Court's recognition that state law
may be more extensive than federal protections, there is still considerable
opportunity for legislative and judicial lawmaking, and psychologists will
be able to provide information to the legal system as it attempts to resolve
this difficult issue.
Whereas the right to treatment was approved nearly universally, at
least in principle, as a sound social policy, the right to refuse treatment has
generated enormous debate. Supporters of the right weigh heavily the
patient's right to dignity, autonomy, and privacy and they fear equally the
extraordinary intrusion on these rights represented by involuntary mental
treatments, especially the most intrusive such as psychotropic medication,
electroconvulsive treatment, and psychosurgery (Plotkin, 1977). The most

radical proponents of the right think of the issue politically, considering
involuntary treatments as a form of "mind control" or an attempt physically
to eradicate conduct that is perceived as socially deviant (see Chorover,
1979).
Opponents of the right argue that most involuntarily committed men-
tal patients are too disordered to make reasonably competent decisions
about whether and what treatments to undergo. It also is alleged that the
rights to dignity, autonomy, and privacy are only abstractions when one is
dealing with disabled and disorganized disordered persons because such
persons lack what is sometimes termed "effective liberty." Such persons are
sick and should be treated; to fail to treat them is to behave inhumanely in
the name of principles that cannot be applied realistically to them (see Cho-
doff, 1976). Many opponents of the right also are outraged by what they
perceive to be its legal interference with the autonomous and proper prac-
tice of psychiatry and psychology. They claim that treatment decisions are
not legal decisions at all and should be left entirely to the discretion of
clinical personnel. Finally, it is observed, to allow hospital inmates to refuse
treatment interferes substantially with the successful administration of a
hospital and the adequate treatment of all its patients (Torrey, 1980).
Untreated patients, especially those who are acutely or most seriously dis-
ordered, present problems of safety and order and threaten the therapeutic
milieu generally. Such patients can be disruptive and manipulative, creat-
ing conditions deleterious to the improvement of patients in general and
forcing the staff to use time in unproductive activities.
As is often the case, extremists on both sides of the right to refuse treat-
ment controversy probably are misguided. Many patients are competent
and forced treatment of such people is an extraordinary deprivation of
rights. Involuntary treatment decisions are not simply clinical; they have
serious legal, moral, and social implications. On the other hand, all treat-
ment is not political mind control; some patients are terribly disordered and
incompetent and probably should receive treatment involuntarily, if need
be. Furthermore, while it is doubtless the case that untreated patients may
be troublesome, one wonders in light of the findings in Rogers I whether a
substantial percentage of patients will refuse treatment if the costs and ben-
efits are explained to them clearly and respectfully by staff who convey the
impression that they truly care about the welfare of this person. The parade
of horribles predicted by opponents of the right is probably overdrawn. In
sum, an absolute right to refuse treatment for competent patients except in
emergency situations ought to be workable. The problem involved in mak-
ing competence decisions cannot be gainsaid (see p. 356 supra; Stone, 1975a),
but such a right should offer a sensible balance between mental health
interests and liberty interests.
In light of the foregOing, one can only wonder at the extreme disgrun-
tlement that has followed those decisions granting involuntarily institu-
tionalized patients a right to refuse treatment. True, patients now have a
right according to those decisions to prevent psychiatrists and psychologists
from doing what they are trained and paid to do-treat patients-but most
patients will not refuse treatment. Mental health professionals will have
more work than they can reasonably manage treating the vast majority of
hospitalized patients who will accept willingly the treatments offered to
them. Fears for the therapeutic milieu, the welfare of patients, and the like
simply seem overwrought.
The rights of patients have expanded enormously in the last decade
and one can only hope that they will continue to do so in the future. Never-
theless, some regression or counterraction in some jurisdictions would not
be surprising (A. E. & R. R. v. Mitchell, 1980). Still, I suspect that the right
to refuse treatment will spread to many if not most jurisdictions and will
become a permanent feature of the mental health law terrain. At the very
least, spurred by cases such as Rogers I and II, Roe III, and Rennie I and II,
patients' rights advocates will certainly press for litigation and legislation
to provide the right in those jurisdictions where it is now lacking. In the
next decade, consequently, mental health professionals across the nation
can expect constantly to confront the appropriate parameters of the right to
refuse treatment.
As behavior change technologies become increasingly powerful (and
perhaps also intrusive and irreversible), as they surely will, the right to
treatment will become an even more salient legal issue. For psychologists,
the major questions will concern the widening repertoire of behavior ther-
apies, especially those such as aversive conditioning, which can be forced
on a patient and which may be highly intrusive. Indeed, behavioral tech-
nologies may come to be seen as more problematic than some somatic treat-
ments such as psychotropic medication, which may in some cases be less
intrusive and no more irreversible. Psychologists cannot afford to lose sight
of the consequences of their technologies; nor, gratifyingly, have they done
so. They can expect, however, legal challenges to their treatments, much as
psychiatrists have faced the initial challenges to medication, psychosurgery,
and ECT. One can only hope that psychologists will react less defensively
and with recognition of the fact that consensual treatment is preferable
because it is more respectful.
OTHER CIVIL MENTAL HEALTH LAWS
This subsection will discuss a group of civil mental health laws that,
unlike the civil commitment and guardianship systems, do not fit under
any particular rubric. Such laws are numerous and diverse, and although
they are less "glamorous" than the laws already discussed, they are impor-
tant. Indeed, although there is no hard evidence to support this contention,
my estimate is that the majority of contacts psychologists have with the
legal system involve these laws.
In general civil law, mental disorder plays two different roles. First, it
is a disability that in some situations negates the usual legal significance of
a person's behavior. For example, disordered persons sometimes may avoid
enforcement of their contracts, have a defense to tort liability, or, post mor-
tem, fail to have their wills admitted to probate. In such cases, the person is
not necessarily deemed generally incompetent and subject to guardianship
or the like. Rather, a particular activity is affected by mental disorder, cre-
ating legal consequences. Second, mental disorder sometimes appears to be
the outcome of the various stresses and serves as a basis for recovery against
the stressors or for receiving transfer payments from the government. For
example, disordered persons may recover money to compensate them for
their disorder if they are disabled by it or if it is the result of work-related
injury or tortious harms. To discuss all possible civil mental health laws
would be a task as gargantuan as it would be tedious, so this section will
simply use illustrative examples to explore the two branches of civil mental
health law.
Specific Civil Competencies

In our society persons engage in various private and public civil activ-
ities that create legal rights and duties or that are regulated by law (see
generally H. L. A. Hart, 1968). Individuals order their private relations by
contract, dispose of their property at death by will, serve as witnesses or
jurors, and so on. There is a presumption in all these situations that the actor
is fully competent to engage in these activities. Permitting incompetent per-
sons to perform them, however, would undermine the results society seeks
to accomplish by allowing or requiring persons to engage in them.
Freedom of testation, for instance, is founded on the policy assump-
tions, inter alia, that: (1) testators can best provide for their own desires and
needs and allowing them to do so leads to a maximum utilization of prop-
erty and (2) if testators know their property will be disposed of as they wish,
their incentive to create and accumulate wealth is increased (Note, 1966).
As a matter of logic, these policies would be undermined if a testator had
little idea what he or she was doing when the will was made. To serve these
policies, the law has developed the following criteria for testamentary
capacity: The testators must know and understand three elements: first, the
identity of the heirs; second, the nature and extent of the property; and
third, the disposition of the property (Atkinson, 1953; In re Lingentelter's
Estate, 1952). In addition, the testator must be able to appreciate the fore-
going three elements in relation to one another and to form an orderly
desire as to the disposition of the property. If a testator meets these criteria,
the property will be disposed of as he or she wishes. If the criteria are not
met, the will is not admitted to probate and the testator's property is dis-
posed of by the laws of intestacy (i.e., state laws providing for the disposi-
tion of property in the absense of a valid will) or by private agreement of
the heirs.
The usual reasons for ascriptions of civil incompetence are "unsound
mind" or insanity (California Civil Code §§ 38,39, 4425(c), 1970; California
Probate Code § 20, 1980). Simply performing the activity badly or unwisely
is not sufficient, although a quite abnormal performance such as drawing

an "unnatural" will may be taken as evidence of unsound mind or craziness
(Green, 1944). For instance, in a classic case, the court refused to allow
recovery on a note made by decedent as payment to a person hired to cure
him of his ills by conjuring (Cooper v. Livingston, 1883). After quoting Hawk-
ins's Pleas of the Crown on conjuring, the court concluded:
"Conjuring" over a sick man "to make him well" is not a valid consideration
for a promissory note; and ... no man with a healthy mind would voluntarily
give a note for $250, with interest at two per cent a month, for the services of a
conjurer, who proposes to cure a lingering disease by conjuring or incantations.
(Cooper v. Livingston, 1883, p. 694)
It would be possible, of course, to nullify the legal significance of one's

actions simply because they were performed very unwisely or because an
unfair or unjust outcome resulted. Some policies might then be furthered
(e.g., protection of heirs from pauperization), but another fundamental
legal. policy would be violated: the presumption that persons should be
free, within limits, to manage their affairs and should abide by the conse-
quences of their decisions. This presumption protects the dignity and
autonomy of actors even if it sometimes results in unpleasant consequences
to others, such as heirs, or in unfortunate consequences to the actor, such
as tort liability or financial loss from a business decision.
When unfortunate consequences result from mental disorder, how-
ever, the law is able to avoid the quandary presented by the conflict
between allowing freedom to actors on the one hand and protecting them
or others from their unwise actions on the other. To choose another exam-
ple, it seems much less unfair to let a foolish businessman impoverish him-
self and his family by a bad deal than to let a crazy businessman impoverish
himself and his family by the same deal. The reason for the difference, of
course, is that it is assumed that a disordered actor's incompetence is beyond
his or her control and not simply a matter of carelessness, lack of wisdom,
poor judgment, or the like. When mental disorder seems related to incom-
petent conduct, the assumption of uncontrollable incompetence saves soci-
ety and the legal system from facing the hard moral and social problem of
deciding when nullification of an actor's conduct is justified.
It often seems to be the case, however, that an unjust or unwise result
leads tautologically to the conclusion that the actor was insane or of
unsound mind; that is, it is assumed that no one in his right mind would
have behaved that way (Cooper v. Livingston, 1883). If the assumption of lack
of free choice is the foundation for nullification, however, then to avoid
uncertainty there ought to be both independent evidence of mental disor-
der and evidence that links the disorder directly to the absence of one or
more of the criteria for competence. To the extent that the law serves impor-
tant policies by considering various incompetencies, it should continue to
do so, but on the basis of careful application of explicit behavioral stan-
dards. In general, the law should interfere and nullify the usual legal sig-
nificance of a person's actions only if it is satisfied that the individual was

incapable of meeting the functional criteria for competence and full legal
responsibility for the action under consideration. And, as was discussed
above (see p. 357), this can be best done by considering the actor's behavior
in as much detail as possible and by avoiding the conflation of scientific
and value judgments.
Mental Disorder as Ground for Recovery or Transfer Payments

Mental disorder may serve as a basis for compensating persons if it is
caused by tortious conduct or work-related conditions or if it disables the
person by preventing the actor from working or fulfilling his or her usual
roles. The direct analogy for such recovery is clearly to physical harm or
disease and their effects. The issue for analysis here is whether and to what
extent mental disorder and its alleged effects should be compensable. One
may point to cases where a person has undergone without fault on his or
her part a severe mental stress and now seems disabled in ways clearly
related to that stress. For instance, suppose a truck driver runs over and
fatally injures a good friend. Afterwards, the trucker claims that he or she
is unable to return to work (see Todd v. Goostree, 1973). Or, take the case of
a worker who watches a friend killed by a fall and who narrowly escapes
serious injury himself when the scaffolding on which they are working
gives way. Suppose he claims that he cannot return to the scaffold even
though he may know rationally that the particular accident was unusual.
(see Bailey v. American General Insurance Company, 1955). If it is clear to any
reasonable observer that these workers are not faking (e.g., the scaffold
worker faints when he climbs a scaffold), these situations present a sym-
pathetic and compelling case for compensation and perhaps the workers
should be considered disabled on the ground of mental disorder or
disability.
The law attempts to base such claims on "medical" knowledge, now
almost always defined to include psychological data, to ensure that they are
"real." This can best be demonstrated by examining the federal definition
of disability for social security benefits:
The term "disability" means-[an] inability to engage in any substantial gainful
activity by reason of any medically determinable . .. mental impairment. (42 U.S.c.
§ 423(d)(I)(A), 1970 [italics added])
"[M]ental impairment" is an impairment that results from anatomical, physio-

logical or psychological abnormalities which are demonstrable by medically
acceptable clinical and laboratory diagnostic techniques. (42 U.S.C. § 423(d)(3),
1970 [italics added])
At base, however, the finding of disability rests on the belief that the
worker is not shamming when claiming that he or she feels unable to work
and in fact is somehow prevented from working. This is often a difficult
determination to make and, as always, professional psychologists should
abstain from offering conclusions as scientific that are based in fact on sim-
ple observation and common sense. Nor should they offer unproven theo-
ries to support conclusions reached primarily by common sense (see p. 406
infra for further discussion of this issue).
The difficulties attending the conceptualization and confirmation of
mental disability claims reach their greatest heights in cases of "compen-
sation neurosis," wherein the worker's neurotic disability is in part influ-
enced by an "unconscious desire to obtain or prolong compensation" or by
"sheer anxiety over the outcome of compensation litigation" (Larson, 1970).
Compensation neurosis, of course, must be distinguised from conscious
malingering, but as honest professional psychologists recognize, it is often
difficult to distinguish malingering from real disorder.
Even if one accepts that mental disorder may be both a result of stress
and a cause of uncontrollable disability, the question of remediation pre-
sents additional difficulties. For example, persons seeking social security
disability benefits or worker's compensation can be compelled to undergo
reasonable treatment that may help remedy their disability (Henry v. Gard-
ner, 1967; see California Labor Code § 4056, 1971). An impairment that can
be remedied by reasonable treatment will not serve as a basis for a finding
of disability. As one court noted:
An individual will be deemed not under a disability if with reasonable effort

and safety to himself, the impairment can be diminished to the extent that the
individual will not be prevented by the impairment from engaging in substan-
tial gainful activity. (Henry v. Gardner, 1967, p. 195)
Or, as one statute puts it,

No compensation is payable in case of ... disability ... caused, continued, or
aggravated by an unreasonable refusal to submit to medical treatment ... if the
risk of the treatment is inconsiderable in view of the seriousness of the injury.
(California Labor Code, § 4056, 1971)
Once again, however, there is no independent standard other than behav-

ior itself with which to judge if a mental health treatment has been suc-
cessful. Nor, unlike much physical medicine, is there any underlying con-
dition whose remediation supports the inference that the person should be
less disabled. For example, if a worker has terrible back pain caused by a
herniated disc that is clearly evident by certain radiological techniques, an
operation that corrects the disc should lead to some amelioration of the pain
and disability. If the disc is corrected, the person should feel much better
once the side effects of the operation have dissipated. If relief does not
ensue, the continued disability might be attributed in part to psychological
factors. It is difficult, if not impossible, for a psychologist to state scientifi-
cally the degree to which a treated client is responsible for his or her lack
of improvement. Still, the courts will ask for opinions on such matters and
the psychologist must do his or her best, within ethical limits, to supply the
needed information.
THE PSYCHOLOGIST'S ROLE IN MENTAL HEALTH LAW
Psychologists primarily provide two types of service in mental health

law, forensic evaluation and expert testimony. Treatment of persons
affected by mental health laws, e.g., committed persons, is a third service
provided by psychologists. Although there may be ethical concerns peculiar
to the provision of services to clients who are involved with the law (see
Monahan, 1980; see also pp. 379-80, supra), treatment is not a service spe-
cific to mental health law and it will not be discussed here. This section will
first discuss the psychologist's task as an evaluator and expert witness. Then
it will offer an analysis of and a proposal for reforming the scope of mental
health expert testimony.
EVALUATION AND EXPERT TESTIMONY
In general, testifying witnesses are not allowed to draw conclusions

about the issues in question. Rather, they are expected to limit their testi-
mony to factual material gained through the use of their five senses. On the
other hand, experts are allowed to draw inferences from facts and to state
conclusions about subjects on which jurors and judges are not competent to
draw their own inferences or to form conclusions. Such subjects are those
that are "distinctly related to some science, profession ... as to be beyond
the ken of the average layman" (McCormick, 1972, p. 29). It is also the law,
however, that expert testimony will not be allowed if the state of the rele-
vant scientific discipline does not allow for truly "expert" opinion
(McCormick,1972).
It is widely believed, of course, that mental disorder and its conse-
quences fall within the criteria of the proper scope of expert testimony.
Indeed, in a recent opinion, Addington v. Texas (1979; discussed more fully
on p. 348, supra), the United States Supreme Court said:
There may be factual issues to resolve in a commitment proceeding, but the

factual aspects represent only the beginning of the inquiry. Whether the indi-
vidual is mentally ill and dangerous to either himself or others and is in need
of confined therapy turns on the meaning of the facts which must be interpreted
by expert psychiatrists and psychologists. (p. 429)
Although the case involved civil commitment and this part of the decision
is not binding on the states, such a statement by the nation's highest court
reflects a widely held view applicable to all mental health law decision
making and it surely will be influential when the proper role of expertise
is debated. Whether the statement is as broadly valid as the Court seems to
believe will be discussed on pages 405ff infra.
It is also noteworthy that the Court explicitly refers to psychologists as
experts because, for many years, only medically trained persons, whether
or not they had extensive mental health training or experience, were qual-
ified to testify as experts on mental health issues. Increasingly, the various

states are recognizing psychologists, too, as mental health experts for legal
purposes (Drude, 1978). Although psychologists have not yet achieved the
stature or authority of psychiatrists as mental health experts in the legal
system (or in the public mind), the time of relative equality seems to be
approaching. Of course, psychologists will not be qualified as experts on
some mental health issues that are explicitly "medical," but the range of
questions that do not require medical training is enormous and the role of
psychologists in the legal system may be expected to expand considerably.
Before turning to an examination of the type of expertise psychologists
are asked to provide to the law, we should pause a moment to inject a pre-
liminary note of caution. When cast in the role of experts, psychologists
should always ask themselves two questions: (1) to what degree are we
really experts on the questions being asked and (2) are those questions truly
"scientific," or are they moral and social in nature, thereby compelling us
to deliver social and moral judgments in the guise of scientific conclusions?
A later section (see p. 406) will examine these questions in detail, but the
reader should constantly bear them in mind.
It will be recalled that all mental health laws are of the form:
Mental Disorder Causation Behavioral Component
(legally relevant behavior)
Mental health laws therefore primarily pose two questions for psycholo-
gists to help answer: First, is the person normal, i.e., is he or she suffering
from mental disorder, disease, or defect? Second, is the mental disorder
causally related to the legally relevant behavior that is alleged to have
occurred? In addition, some mental health laws, such as civil commitment
laws, require psychologists to make predictions about the allegedly disor-
dered person's future behavior. (It should be clear that often the threshold
question of whether the legally relevant behavior occurred is a nonscien-
tific, factual one that requires no expertise.) Providing information to the
legal system on all these questions obviously requires the psychologist to
evaluate the allegedly disordered person and/or to consider external data
relevant to the question at hand, whether or not the psychologist ultimately
will testify in court.
Operating in the context of the legal system places the professional
psychologist in an unaccustomed role. Psychologists are trained as scientists
and clinicians. As scientists, they are taught to resolve "disputes" largely by
the use of nonadversary methods that rely, under optimal conditions, on
the rigorous canons of experimental logic and design. As clinicians, they
are trained to be the sole agent of the patient or client, concerned entirely
with his or her best interests. By contrast, the legal system is a dispute res-
olution system that is based on an adversary philosophy and methods. In
brief, the theory of the adversary system is that truth is best determined if
each disputant presents as strongly as possible the affirmative side of his or
her own case and attacks as strongly as possible the other side's case. Then,
a neutral and detached fact finder, the judge or jury, resolves the dispute.
Such noncooperative and unscientific methodology is alien to most psy-
chologists and entering the adversary system places them in an unfamiliar
and often uncomfortable milieu (but see Levine, 1974, who argues for the
use of the adversary method in some instances to resolve scientific dis-
putes). In order to perform most effectively and to avoid undue discomfort,
the psychologist should therefore understand both the types of pressures
and conflicts that will beset him or her as a participant in the adversary
system and the roles expected of him or her (see Brodsky, 1977).
When the psychologist enters a case, he or she almost always will do
so on one side of a dispute. As a consequence, the psychologist will overtly
and covertly be placed in the role of an advocate, even if he or she had
every intention of providing "neutral" scientific information regardless of
which side employed him or her. Because the psychologist is being
employed by that side and is a member of a team, it is hard to resist the
pressures. This is especially true because issues and questions can be
phrased in a fashion that will not ask the psychologist to compromise his
or her professional integrity.
Even without any direct pressure, the psychologist will feel himself or
herself slipping into an adversary role. To use a rather analogous example,
all lawyers quickly learn that they begin to "believe in" the side they are
representing. Indeed, law students experience this even when engaging in
simulated exercises such as "moot court" competitions. This phenomenon
occurs even though the lawyer recognizes that the case may be fairly evenly
balanced and that if chance had placed him or her on the other side, he or
she would have felt the same way about the opponent's case. The pressure
to become an advocate is heightened for the psychologist who is in an unfa-
miliar environment and therefore is especially subject to the role expecta-
tions of that environment. Of course, almost all psychological evaluations
are subject to wide interpretations, and as the psychologist discusses his or
her findings with counsel, the psychologist should not be surprised or
ashamed to discover (if he or she is honestly self-observant) a desire to
please and aid the attorney. Often, the longer one spends with a case, the
stronger it seems. These psychological reactions would be well understood
by psychologists if they were studying them from an outside vantage point.
The legal system expects an expert witness, within the bounds of
professional integrity, to act on behalf of his or her client. Most psycholog-
ical issues in forensic cases are capable of alternative resolutions. There is
therefore nothing inherently unethical or dishonest about allowing oneself
to become an advocate as long as the psychologist behaves in accordance
with scientific and clinical canons. Of course, the psychologist should never
reach a conclusion or offer an opinion unless he or she believes it is reason-
ably supported by clinical and research evidence. In sum, the psychologist
should not deny his or her growing bias, but should acknowledge it and
work with it. Otherwise, skillful opposing counsel will be sure on cross-
examination to make use of the psychologist's obvious defensiveness on

this point.
Other forms of bias are less subtle and should also be acknowledged
and dealt with. Some psychologists will enter a case already having an
opinion concerning the outcome of that case or of such cases in general. For
instance, a case may have received much attention by the media and the
psychologist may believe that a particular decision is just. For another
instance, a psychologist may believe that few persons from a particular
background are fully responsible for their criminal behavior or that impris-
onment is always unjust; thus the psychologist always will be willing to
testify in favor of a criminal defendant's lack of responsibility. Again, there
is nothing inherently unethical about such biases or about participating in
the legal system while possessing them unless the psychologist is willing
to compromise his or her professional integrity in order to promote a spe-
cific or general cause that he or she believes is just.
Psychologists are entitled to their moral, social, and political views. As
jurors they can vote for them in a given case, and as citizens they may vote
or lobby for them through their chosen representatives. But when psychol-
ogists are called as advocates, they should do so with strict respect for their
scientific and clinical integrity. If they have strong specific or general
biases, they should attend especially carefully to whether they are tailoring
their services too much toward their desired outcome. If they do not do so,
it often will be easy to attack their credibility, especially if they often par-
ticipate in the legal system and develop a reputation for always supporting
the same side, say, the defense in criminal prosecutions. Under such cir-
cumstances, even if the psychologist agrees to testify only in cases where
the outcome suggested by the bias is also justified by the facts, it is relatively
easy to believe that the psychologist's position may be dictated more by
social, political, or legal views than by scientific data.
A task that psychologists are asked to perform that is particularly alien
to them is to evaluate the allegedly disordered person for the side adversary
to the disordered person. For instance, a district attorney may ask the psy-
chologist to examine the person for the purpose of helping to defeat an
insanity defense, or the state may wish to involuntarily commit the alleg-
edly disordered person, or an insurance company may wish to defeat a dis-
ability claim based on mental disorder. Here there is no pretense whatso-
ever that the psychologist is a helping professional. He or she has been
hired for the sole purpose of defeating the allegedly disordered person's
claim of disorder (in the insanity defense or insurance case) or normality
(in the involuntary commitment case). In this role, the psychologist is
clearly the adversary of the person being evaluated. In all probability, few
tasks will be as unfamiliar and unsettling to a psychologist. Nevertheless,
if the professional psychologist accepts the premises of the adversary sys-
tem and is willing to participate in it, he or she should be willing to partic-
ipate as an adversary evaluator and witness. After all, our justice system is
not meant to be therapeutic; it is meant to resolve disputes by a particular

method. So long as our form of legal system is maintained, psychologists in
the system often will assume non therapeutic roles. Each professional psy-
chologist must therefore decide whether he or she is willing to exercise his
or her professional skills in aid of this endeavor.
On some occasions, psychologists will be appointed by a court to pro-
vide it, rather than a particular party, with neutral, detached expertise.
Although in principle the mental health expert is always supposed to be a
neutral scientist, it is recognized in practice that experts doing evaluation
and testifying for disputants are rarely neutral (Braginsky & Braginsky,
1974; Diamond, 1959, 1973). By contrast, the " independent" court-
appOinted expert seems to present a different and, for the professional
psychologist, more satisfying situation. But the psychologist should be cau-
tious here as well. He or she will have various social and political attitudes,
dispositions, and biases at differing levels of consciousness that will influ-
ence his or her evaluation work. Furthermore, after the psychologist has
reached his or her conclusion and is asked to state it in court and defend it
under vigorous cross-examination, there will be a natural tendency to
become an ever more stout adherent of that view-especially when it is
attacked. The expert psychologist whose role is nominally independent
should not feel unduly smug about his or her impartiality when presenting
his or her own view of clinical and scientific truth to the judge or jury for
he or she is not truly neutral.
An expert who is asked to evaluate a person for legal purposes may be
asked to testify in court, if necessary, about the results of that evaluation,
including the conclusions reached. I say "if necessary" because a vast major-
ity of lawsuits are "settled," that is, the parties reach an agreement without
the necessity of going to trial. In the criminal justice system, the equivalent
process is the negotiated plea, the so-called plea bargain.
The settlement process is usually aided by pretrial "discovery" proce-
dures that allow each side some degree of access to the other's case prior to
trial. Part of the pretrial process, 'especially in civil cases, may involve the
taking of depositions. A deposition is a written or oral declaration of a wit-
ness taken under oath prior to trial. The purpose of a deposition is for the
opposing party to discover much of the opponent's case, and to preserve
the opposing witnesses' statements in order to use them for cross-exami-
nation at trial. The psychologist therefore may be questioned under oath
prior to trial. The depOSition process, and discovery procedures in general,
often convinces the parties of the strength of the opponent's case and thus
these procedures encourage compromise settlements, where everybody gets
something, rather than trials, which tend to be zero-sum games. All the
same, many cases do go to trial or some kind of hearing and the professional
psychologist may be required to testify in court.
Professional psychologists who engage in forensic work may be con-
cerned about the application of the psychotherapist-patient privilege in
such cases. Let us therefore turn to a general discussion of this issue. (Of
course the specific rules about privilege vary from jurisdiction to jurisdic-
tion and the psychologist should become familiar with the rules of his or
her jurisdiction. Moreover, this brief discussion will not attempt completely
to cover all forensic circumstances in which privilege is an issue.) There are
classes of communication between persons who stand in particular relation-
ship to one another, e.g., attorney and client, doctor and patient, that on
grounds of public policy the law will not allow to be disclosed or inquired
into in a legal proceeding. Such communications are said to be privileged
(see generally, Saltzburg, 1980). Such communications are also confidential,
i.e., the "receiver" has a general duty not to disclose the contents of the
communication to third parties without the "sender's" consent. For
instance, communications between a doctor and patient are both confiden-
tial and privileged in order to encourage patients to consult physicians
freely and to disclose to them all information necessary to receive effective
medical care. Of course, the holder of a privilege, say, a patient, may waive
the privilege if he or she so wishes.
Until relatively recently, communications between nonmedical psy-
chotherapists and patients were not privileged in most jurisdictions. As a
clear matter of logiC, however, the policy that supports the physician-
patient privilege is equally applicable to psychotherapist-patient commu-
nications, even if the therapist does not hold the M.D. degree. This has been
recognized by legislatures and courts and a broad psychotherapist-patient
privilege is now commonly applicable when the patient consults the ther-
apist for the diagnosis or treatment of mental disorder or for the purposes
of scientific research (e.g., California Evidence Code § 1014, 1979). There
are, however, exceptions, when the privilege is not applicable.
If a patient puts his or her mental condition in issue in a legal proceed-
ing, he or she waives the privilege as to any psychotherapist-patient com-
munication concerning that condition. A very common and related situa-
tion occurs when a patient consults an attorney and it appears that the
patient's mental condition will be an issue in the forthcoming litigation.
What an experienced attorney does then is to hire an expert as a "consul-
tant" to examine the patient to help the attorney prepare the case. Because
the examination was primarily for legal purposes, the results of the evalu-
ation will be privileged under the attorney-client privilege (but see People
v. Edney, 1976). If the evaluator later testifies, then the privilege is of course
clearly waived.
Another common occurrence is when a court appoints a mental health
professional to examine a criminal defendant in order to help the defense
counsel decide whether to raise the insanity defense. As long as the profes-
sional never testifies, the results of the examination will be privileged. But
when a criminal defendant gives notice of an intent to raise the insanity
defense or some other defense based on mental condition, or when a party
to a civil action raises an issue of mental condition, then typically the pros-
ecution or opposing party is allowed to have the allegedly disordered per-

son examined. In such situations of "adversary examination" there is no
pretense of a therapeutic relationship and the privilege does not apply.
In many forensic situations, then, the psychotherapist-patient privi-
lege will not be applicable and the psychologist may be asked publicly to
divulge intimate and embarassing material that will cause the patient much
pain. If a psychologist is not comfortable doing this, he or she should make
it clear to counsel that he or she is unwilling ever to testify and is willing
to serve only as a consultant. On the other hand, if a past or present patient
chooses to put his or her mental state in issue in a legal proceeding, the
treating psychologist's records may be discovered and he or she may be
called, examined, and forced to divulge information about the patient. This
can occur even if the psychologist has not been hired specially as an expert
and whether or not the psychologist wishes to be involved. Finally, the
psychologist interested in forensic work should remember that confiden-
tiality is not consistent with the adversary method of dispute resolution, or
perhaps with any other method; confidentiality does prevent the full dis-
closure of material facts. Legally compelled waiver of privilege is an aspect
of the adversary legal system that a psychologist should recognize and
accept if he or she expects to participate comfortably in the dispute resolu-
tion phase of our legal system.
The public policy that protects the confidentiality of psychotherapist-
patient communications is not the only restriction on the testimony of men-
tal health professionals in criminal cases. Constitutional issues may be
involved as well. The recent Supreme Court case of Estelle v. Smith (1981),
for example, held that the testimony of a psychiatrist during a death penalty
proceeding had violated the Fifth and Sixth Amendment rights of a
defendant.
The defendant in Estelle had not placed his mental condition in issue,
but the trial judge nevertheless ordered a pretrial examination of his com-
petency to stand trial. The examining psychiatrist stated in his report to the
judge that the defendant was "a severe sociopath," but that he was compe-
tent to stand trial. The defendant was subsequently tried and convicted of
murder, a capital offense. The separate proceeding to determine whether
the defendant should receive the death penalty required the jury to assess
the defendant's future dangerousness as one of three essential issues. The
psychiatrist who conducted the competency examination was the prosecu-
tion's sole witness on this issue. Based on his conversation with the defen-
dant at the competency examination, the psychiatrist offered his profes-
sional opinion that the defendant was a very severe sociopath whose
sociopathic condition would only get worse, that he was without remorse
or regard for human life, and that he would commit similar criminal acts if
given the opportunity. The defendant was sentenced to death.
The Supreme Court held, first, that the psychiatrist's testimony had
violated the defendant's Fifth Amendment privilege against compelled self-
incrimination. The court noted that the issue would not have arisen if his
findings had been used for the "limited, neutral purpose" of establishing
the defendant's competency, since a competency examination by itself is
not part of the adversarial process that determines guilt and imposes sen-
tence. When the psychiatrist testified for the prosecution at the death pen-
alty hearing on the crucial issue of the defendant's future dangerousness,
however, the doctor ceased to act as a neutral agent of the court and became
instead an agent of the state. The court-ordered examination thus became
"a phase of the adversary system," and a critical one at that. Since ~he defen-
dant had not been advised prior to the examination of his right to remain
silent and warned that anything he said could be used against him at trial,
his right to be free of compelled self-incrimination was violated by the
admission of testimony based on that examination.
Second, since a defendant is entitled to have his attorney present at any
interrogation or interview that is or will be made a part of his trial, the
defendant's Sixth Amendment right to the assistance of counsel also was
violated. (This issue, too, would not have arisen if the psychiatrist's finding
had been used only to establish competency.) Only if his attorney had been
present to advise him of his rights-particularly his Fifth Amendment
rights-and when to exercise them, would the psychiatrist's testimony have
been admissible at trial.
The mental health professional, then, can expect that his or her testi-
mony may be subject in various contexts to constitutional and procedural
constraints. This does not mean, however, that he or she is expected to
become an expert in constitutional law and criminal procedure. Responsi-
bility for seeing that the proper restrictions are observed lies primarily with
the attorneys in a case and with the court.
At the trial itself, the psychologist will be subject to two kinds of exam-
ination (questioning by the attorneys): direct (and re-direct) by the attorney
representing his or her side, and cross-examination (and re-cross) by the
opposing attorney. The psychologist will be called to the witness stand
when it is the turn of his or her side to present its case. But the trial is
typically not the first time the psychologist witness will have "gone over"
his or her testimony and the possible objections to it. (An exception to this
rule occurs in certain types of routinized cases, such as civil commitment
hearings in some jurisdictions, where the adversary system is not function-
ing fully and effectively [Morse, 1978a, 1982a].) Each attorney will "prepare"
his or her witnesses for trial; that is, they will discuss and practice the direct
testimony the witness will give and the probable cross-examination that
will ensue. If the case is important enough, they may practice this process
many times, although most attorneys try to avoid having their witnesses
appear as if they were giving their testimony by rote. If all this sounds quite
calculating, it is supposed to be. Attorneys detest surprises in the courtroom.
They want to know well in advance the strengths and weaknesses of the
case and they want to prepare the witness psychologically for the rigors of
the witness stand. Thus, the psychologist usually will come to court quite
well-prepared.
The direct examination of an expert witness by his or her own attorney

begins with the "qualification" of the expert. It must be established that the
witness is indeed a member of the special class of persons entitled to draw
inferences and to offer conclusions about the particular issues in this case.
As discussed above, in the past psychologists as a class were disqualified
from testifying at all or on the ultimate issue in mental health law cases,
but now they usually are deemed qualified to give data and, increasingly,
to offer an opinion on the ultimate legal issue. At present, therefore, counsel
is unlikely to have to spend much time convincing the judge of the thresh-
old appropriateness of allowing a psychologist to testify. Assuming this is
the case, the attorney should try to demonstrate that this particular psychol-
ogist is truly an expert on the issues under consideration. But in mental
health law cases, even though different cases may raise different mental
health issues, such as prediction, treatment, or developmental ones, and
psychologists may differ from issue to issue in their degree of expertise, the
court rarely requires a finding of expertise particularly tailored to the par-
ticular issues in the case. Rather, if the expert is a general mental health
expert, that is enough.
What is required, then, to be qualified as a general mental health
expert? There is no set rule. Jurisdictions vary and great deference is given
to a trial court's determination of this issue. In general, a holder of the doc-
torate in psychology who is licensed to practice in his or her state may be
expected to qualify as an expert. The actual procedure by which an expert
is qualified is rather simple. The attorney simply will ask the witness a
series of questions designed to elicit information concerning the witness'
academic background, clinical training, scholarly reputation, and other rel-
evant experience or indicia of expertise. At the end of this portion of the
direct examination, the witness will be qualified unless opposing counsel
objects to qualification or, more rarely, if the judge sua sponte declares the
witness unqualified. If the objection is made, counsel will argue the merits
of the qualification issue to the judge, who then will rule whether the
expert should be qualified or not.
In some cases, the opposing side may stipulate to the qualifications of
the witness, thereby avoiding the necessity of undertaking the qualification
procedure. Nonetheless, counsel still may wish to qualify the witness in
order to bring strongly to the judge's or jury's attention the eminence of the
witness. In most warmly contested cases there is no stipulation because
there will be a "battle of the experts," with each side represented by its own
experts who will have reached opposing views, and deciding which expert
is more "expert" is a matter for the jury. Thus, each side will try to dem-
onstrate that the opinion of its expert, by dint of more prestigious creden-
tials, extensive experience, or the like, is entitled to greater weight.
One point worth mentioning before leaving the question of qualifica-
tions is this: On cross-examination, opposing counsel may try to bring out
that a psychologist, although nominally qualified as an expert, is not as well
qualified to offer opinions as a psychiatrist (see generally, Levine 1971).
This is a common ploy if the opposition's expert witness is a psychiatrist.

When faced with such a challenge, psychologists must try to be nondefen-
sive, to admit freely any expertise they in fact lack, and to try to stress the
positive aspects of their knowledge.
Once the witness is qualified, direct examination usually proceeds by
narrative testimony. Typically, a foundation must be laid for the expert's
conclusions. This means that the witness testifies about how he or she
obtained the information from which inferences are to be drawn or conclu-
sions offered. In the case of a psychologist, the testimony will consist of a
description of the evaluation procedures. The psychologist who uses psy-
chological tests or other technical means of evaluation often will be asked
to describe in some detail the nature and purposes of the techniques he or
she used. Once the foundation is laid, the expert will be asked whether on
the basis of the evaluation he or she has formed an opinion about the issue
in question, for example, whether, in an involuntary commitment case, the
person is mentally disordered. The expert is expected to give that opinion
and to explain it. Under ideal conditions, the psychologist should relate the
opinion to the underlying facts obtained during the assessment. For
instance, the psychologist may testify that the person is mentally disordered
and the diagnosis is schizophrenia. The psychologist might then explain
what the diagnosis of schizophrenia means and how it was arrived at in
this case.
The importance of giving the underlying facts upon which the opinion
is based cannot be emphasized too strongly. All too often, psychologists and
other expert witnesses succumb to the temptation to offer their conclusions,
often in jargon, without apprising the fact finder of the underlying facts
and the steps in reasoning that led from those facts to the ultimate conclu-
sions (Washington v. U.S., 1967). Unfortunately, courts often will allow this
to happen, especially in routinized cases. This is unfortunate because con-
clusory testimony undermines the function of the fact finder. Without
being aware of the underlying facts and reasoning that led to the expert's
conclusions, the fact finder will be unable to assess the logic and persua-
siveness of the expert's conclusion, that is, the weight it should be given.
Such assessment is the fact finder's role, however, and simply to accept an
expert's conclusion is to fail to fulfill that role faithfully. Thus, a truly
professional psychologist should not offer conclusions on the witness stand
without first offering the factual basis and inferential reasoning that led to
the opinion.
Some experts might claim that the fact finder does not need the under-
lying data but should simply accept the expert's opinion-after all, he or
she is an expert. It should be remembered, however, that the expert is not
the ultimate decision maker; rather, he or she is testifying to aid the judge
or jury to make its decision, a task they cannot perform properly without
sufficient information. Moreover, honesty should compel a psychologist,
especially in the mental health area, to admit that the scientific foundation
for his or her opinions is often not as firm as he or she ideally might prefer.
Indeed, if the psychologist forces himself or herself in advance to think

through in detail the facts and reasoning that were the basis of his or her
opinion, it will help the psychologist assess the scientific weight and cer-
tainty of the conclusion. Thus, to use the example of a diagnosis of schizo-
phrenia, the expert should describe in detail the patient's behavior or test
responses that, in light of the diagnostic categories employed, led to the
conclusion that the patient is indeed schizophrenic.
On occasion an expert witness will be asked to offer a conclusion on
the basis of facts that are in the court record but that were not gained first-
hand by the psychologist. The psychologist may gain access to these facts
in two ways: by being present when the testimony asserting them is offered
or by being asked a "hypothetical question" that includes and is based on
those facts and that assumes their truth. Although both techniques are
widely used, they also are widely criticized and many commentators argue
that the "hypothetical question" form of expert testimony should not be
retained (see Ladd, 1952). This chapter is obviously not the proper forum
in which to analyze further these points of the law of evidence, but the
psychologist should be aware that he or she may someday be asked to testify
in this fashion. The psychologist should be wary about offering opinions
based solely on data derived from others. There is great difficulty in obtain-
ing both reliable behavioral observations and reliable and valid conclusions
based on direct observation; such difficulties are surely multiplied exponen-
tially if the opinion is based solely on secondhand data.
After the direct examination is concluded, the witness may then be
cross-examined by opposing counsel. The purpose of cross-examination is
to probe and expose weaknesses in the expert's direct testimony. To do so,
opposing counsel may ask questions about the expert's qualifications, the
quality of the examination, and the persuasiveness of the opinion. Leading
questions may be asked on cross-examination and, by skillful questioning,
the expert may be induced to give answers that appear to diminish the
weight of the direct testimony. Attorneys vary in their approach to cross-
examination, from soft and insinuating to hostile and attacking. Every psy-
chologist who testifies must be aware, however, that opposing counsel of
all types generally aim to undermine the witness and that few witnesses
enjoy being skillfully cross-examined. Experts may be especially prone to
feelings of discomfort engendered by cross-examination; after all, experts
such as mental health professionals are rarely publicly attacked and
impugned in such a direct fashion. Nevertheless, cross-examination is a
fundamental part of the adversary process. If psychologists agree to testify,
they must learn to deal with this threatening aspect of the role and to per-
form as nondefensively as possible.
After cross-examination is complete, the expert's own attorney may
attempt to "rehabilitate" the expert and his or her opinions by a few more
questions on "re-direct examination." And, in some instances, there may be
one more round of cross-examination on "re-cross." Upon the completion
of all testimony, the psychologist will be excused.
AN ANALYSIS OF AND A PROPOSAL FOR REFORM OF PSYCHOLOGICAL EXPERT

TESTIMONY
As is well known, mental health professionals testifying in court for

opposing sides often will give diametrically opposed opinions on the same
issue. This has come to be known as the ''battle of the experts," a phenom-
enon that has caused a great deal of disrespect for the science and ethics
possessed by mental health professionals. The ill effects of the battle of the
experts are especially exacerbated by well-publicized and notorious cases
such as the Sirhan Sirhan and Patty Hearst prosecutions, when the media
chronicled for wide consumption the unseemly spectacle of disagreeing
experts. Of course, in all types of cases where expert testimony is used, the
experts will disagree and there will be a battle of the experts. Nevertheless,
cases involving mental health expertise are often particularly public and
vulnerable to criticism. This subsection will examine why mental health
testimony is so vulnerable and will suggest how psychologists can mitigate
the problem by offering their services as expert witnesses in the most sci-
entifically respectable and legally useful manner (for a more complete dis-
cussion of these issues, see Morse, 1978a, 1982b; see also the similar analyses
of these issues in Fersch, 1980; and Robinson, 1980; but see Bonnie & Slo-
bogin, 1980).
Perhaps the major reason the "battle of the experts" is more problem-
atic for mental health professionals is that for them it sometimes occurs in
criminal cases that are widely publicized "morality plays" that involve the
feelings of large segments of the population. The trials of Patty Hearst, Sir-
han Sirhan, John W. Hinckley, Jr., and other such cases receive infinitely
more public exposure than, say, malpractice cases. And public response
leads to public scrutiny, especially where the issue involved-guilt or inno-
cence in a highly charged case-is perceived as a matter of great moment
to the public. Moreover, when the insanity defense is raised, for example,
the outcome of the battle of the experts may be dispositive, thus further
focusing attention on the expert testimony. Finally, and very importantly,
compared to other types of expert testimony, mental health testimony often
relies on "softer" data and offers more subjective, empirically unverifiable
opinions and conclusions. Rather than sounding like carefully considered
scientific judgment, mental health testimony often sounds to observers like
personal value judgments couched in pseudoscientific jargon. Indeed, men-
tal health professionals themselves often are appalled by the injudicious
behavior of their colleagues on the witness stand.
To suggest a proposal for reform necessitates that we first analyze the
questions asked of mental health professionals by the law. It will be recalled
that all mental health laws are based upon the assumptions that mentally
disordered persons are abnormal and significantly different from most per-
sons and that their legally relevant behavior, such as dangerousness or
incompetence, is the product of their disorder and not of their free choice.
In addition, it is often assumed that the behavior of mentally disordered
persons is especially predictable when that behavior is related to mental

disorder. And, it will be recalled from page 342 that the structure of all
mental health laws is essentially the same, reflecting those common
assumptions: All mental health laws require findings that the person is
mentally disordered and that the person's legally relevant behavior is
caused by the disorder. Finally, some mental health laws require a finding
that the legally relevant behavior caused by mental disorder will continue
in the future.
The three questions to be decided by the courts in mental health cases
flow naturally from the structure and assumptions of mental health law.
They are:
1. Is the person normal? That is, is the actor suffering from a mental
disorder, illness, or disease?
2. Could the person have behaved otherwise? Is the legally relevant
behavior the product of free choice, or is it the product of a disor-
dered mind over which the person has no control? That is, is the
person causally responsible for the behavior?
3. How will the person behave in the future? For instance, will the
person be a danger to self or others?
The gist of the present reform proposal is that these questions are fun-
damentally social, moral, and legal, not scientific ones. Although they
appear to call for scientific answers, in fact they can be answered best on
the basis of commonsense observations and social, moral, and common-
sense evaluations of behavior. Experts can be most useful and receive least
criticism by limiting themselves to providing factual information that is not
readily accessible to untrained lay observers and by refusing to offer opin-
ions on the ultimate legal issues, such as whether a criminal defendant is
legally insane, which are not scientific issues in any case. To explore this
proposal, let us turn to an analysis of the three questions and how they can
properly be answered by experts.
The first question asks whether the actor is normal, that is, whether he
or she suffers from a mental disorder. When we examine what we mean by
mental disorder, we find that we are talking about more or less crazy
thoughts, feelings, and actions (American Psychiatric Association, 1980;
Morse, 1978a; Orford, 1976). Disordered behavior is a necessary (and usu-
ally sufficient) precondition for an ascription or diagnosis of mental disor-
der. Despite relatively dramatic advances in mental health science in the
past few years, especially in the biology of disordered behavior, very few
causative, underlying abnormalities (to use extremely condensed short-
hand) have been definitively established so far, and the necessary and suf-
ficient causes of disordered behavior are not generally known. At best,
mental health professionals have knowledge of some weakly predisposing
causes (Meehl, 1973). But the only matter experts from all schools agree
upon is that disordered behavior is the necessary condition of mental dis-
order or illness.
Whether it recognizes this fact or not, the law is not concerned mainly
with whether a person suffers from a mental disorder as categorized in the
Diagnostic and Statistical Manual of Mental Disorders III (American Psycholog-
ical Association, 1980; Fingarette & Hasse, 1979). Surely, as epidemiological
reviews demonstrate (Dohrenwend & Dohrenwend, 1969), the number of
persons who might be diagnosed mentally ill according to present stan-
dards is considerably larger than the number of persons who are so differ-
ent from most people that society believes, on moral grounds, that special
rules ought to be applied to them. What the law requires is the social and
moral determination that the person in question is so fundamentally differ-
ent from others by virtue of his or her craziness that he or she cannot be
considered a normal person to whom the usual rules apply (M. S. Moore,
1975; Roche, 1967; Weihofen, 1960). Thus, professionals are not very helpful
to a court if they simply identify the person as suffering from this or that
mental disorder. In addition, the professional generally is more likely than
the lay person to identify particular behaviors as indicative of mental dis-
order (D'Arcy & Brockman, 1976). Finally, present diagnostic reliability is
still somewhat problematic (Morse, 1982a; Townsend, 1980), albeit improv-
ing significantly (Helzer, Clayton, Pambakian, Reich, Woodruff, & Reiley,
1977; Morse, 1982a). At best, the professional can say that the behavior
exhibited is so crazy that for treatment and other nonlegal reasons the per-
son ought to be considered mentally disordered.
If special legal rules are authorized for crazy people, such rules surely
apply to those people who are clearly crazy. In such cases, laypersons and
experts will agree and the scientific and legal criteria will overlap perfectly,
or almost so. But in cases of less than obvious extreme disorder, even
though experts might agree that the person suffers from this or that mental
disorder, whether he or she is crazy enough for the application of special
legal rules must be decided by the judge or jury because a diagnOSiS of men-
tal disorder does not necessarily imply that the person is crazy for legal
purposes. DSM-III itself appropriately cautions that its validity for legal
purposes is not established. Moreover, again as DSM-IJI recognizes,
although the new diagnostic criteria are more precise than those of DSM-
II, they are still vague enough to permit persons who behave quite differ-
ently to fit properly into the same diagnostic category. Anyone can say who
is crazy (or behaviorally disordered). The determination is nearly always
socioculturally conditioned (Dohrenwend & Dohrenwend, 1974; Soddy,
1967). Experts cannot make a scientific determination for the law in less clear
cases (or in any case) because the legal determination is not scientific. The
question for the law is not whether the actor is psychotic, for example, but
whether the actor is sufficiently disordered to warrant special legal treat-
ment. Thus, the question of whether the person is crazy enough for special
treatment is a question of social, moral, and ultimately, legal choice (Baze-
lon, 1976, 1977; Morse, 1978a; Roche, 1967; Washington v. U.S., 1967).
The second question asked by courts is whether legally relevant behav-
ior, such as dangerousness, is caused by or is the product of mental illness.
If SO, the law reasons that the person is not causally responsible and thus
not morally and legally responsible for the behavior (Developments, 1974;
Hall, 1960, 1968). The situation is analagous to that of a person with an
infection, who is not held responsible for a consequent fever. If the person's
legally relevant behavior is beyond control rather than the product of free
choice, then legal intervention in the person's life seems justified because
such intervention seemingly will not infringe unduly on the actor's liberty,
dignity, and autonomy (Morse, 1978a).
I have argued that mental disorder is really crazy behavior of largely
unknown origin. Thus, when one asks if mental disorder is the cause of
legally relevant behavior, one is really asking when behavior causes behav-
ior. That is, when are crazy thoughts, feelings, or actions the cause of legally
relevant thoughts, feelings, or actions? Put this way, three types of relation-
ships between mental disorder and legally relevant behavior may be
distinguished:
1. No relationship: a paranoid who self-defensively strikes a person
who has attacked the paranoid without provocation. Even paranoids
have real enemies.
2. Clear relationship: a paranoid attacks someone who is not an enemy
but who is part of the paranoid's delusional system.
3. Unapparent but assumed relationship: the legally relevant behavior
itself seems crazy but there is no other independent and significant
evidence of craziness (e.g., cases of impulse disorder such as inex-
plicable violent outbursts).
These three types of relationships can be assessed and identified by
anyone who has the behavioral data, as I assume judges and juries would.
They are commonsense connections and require no special expertise to be
made. In the case of no relationship, special treatment is not warranted
because the mental disorder does not seem to be the cause of the legally
relevant behavior. In the cases of clear relationship or assumed relationship,
attributions of nonresponsibility and special legal treatment are warranted
only if the causal connection between the craziness and the legally relevant
behavior was unbreakable by the choice of the actor. The question for men-
tal health professionals, therefore, is whether behavioral science can deter-
mine scientifically if the relationship between craziness and other behavior
is uncontrollable. Let us examine this question.
The first issue to be analyzed is whether there is a strong positive rela-
tionship between craziness and legally relevant behavior. In other words,
do nearly all crazy persons or nearly all of a particular class of crazy persons
engage in particular legally relevant behavior, such as dangerousness? The
answer is clearly no. Craziness is neither necessary nor sufficient to produce
legally relevant behavior. For example, delusional persons do not invaria-
bly act on the basis of their delusions, nor do persons with powerful anti-
social impulses always act on them. Indeed, mental disorder does not even
seem terribly predisposing to the sorts of behavior, such as dangerousness
or grave incompetence, that lead to legal intervention (Brakel & Rock, 1971;
Guze, 1976; Monahan, 1981; Rabkin, 1979; Rappeport, 1967; Vecchione v.
Wohlgemuth, 1973). Moreover, for example, there is no significant relation-
ship between any particular mental disorder and criminal behavior. (Mon-
ahan & Steadman, 1983). Indeed, mental disorder is much less disposing
than, for comparison, poverty is to crime. Yet the law does not excuse even
the most disadvantaged offenders on the basis of their deprived back-
grounds (Morse, 1976).
Courts are not faced with aggregated data, however, but must decide
individual cases on a case-by-case basis. Even if, in general, craziness is not
predisposing to legally relevant behavior, how should one assess individual
responsibility in cases of a clear relationship between craziness and legally
relevant behavior (e.g., a paranoid who acts on the basis of a delusion about
hostile powers and harms another who is believed to be a hostile agent)?
Could the paranoid attend to and weigh information contra to the delu-
sional belief, or at least control overt action based on the belief? These ques-
tions may seem strange or even clinically absurd, but their answers are at
the theoretical base of why such persons are treated specially. Further, they
seem strange largely because mental health professionals (and most per-
sons) assume they know the answers despite the lack of what most of us
would accept as scientific proof. When we cannot make sense of a person's
behavior, we often ascribe lack of control to him or her. But there is little
hard evidence to prove lack of control.
Again, there is no underlying abnormality or pathology perceivable
only to the expert; the determination to be made involves a relationship
between behaviors that can be determined by anyone. Given that there is a
clear relationship between craziness and legally relevant behavior in a spe-
cific case, could the person have acted otherwise? I do not know and I sug-
gest that no one does. There is no scientific test for whether a person can
control himself or herself. Behavioral scientists and lay persons both have
intuitive feelings: Observers simply decide whether in their judgment it
was too hard for the crazy person in question to behave normally (Morse,
1976, 1978 a, 1978 b )- for example, to control legally relevant behavior
related to and seemingly caused by craziness.
But where is the line to be drawn in deciding which cases are too hard
to ascribe moral and legal responsibility to the actor? How hard is too hard?
I suggest again that this is a matter for social and moral judgment. It is not
a factual question such as: At what temperature will water boil? Behavioral
scientists cannot tell a court on the basis of special data or methods that a
given individual could or could not have behaved otherwise. If a mental
health professional's judgment is really a moral and intuitive feeling, this
judgment should be made only when, as a layperson, the professional
serves on a jury. It is a moral judgment and should be recognized and
treated as such.
The third and last question asked of mental health professionals is how
the person will behave in the future. Not all mental health and mental
health related laws pose this question, but in many important areas, such
as civil commitment or the best-interests-of-the-child standard in child cus-
tody disputes, predictions are placed firmly in the center of the legal
inquiry. Here the question is not whether mental health professionals have
general prognostic information, as indeed they often do, but whether they
can predict better than laypersons future, specific, legally relevant behavior.
Or, to put the question in more legally congenial form: Can professionals
predict sufficiently better than laypersons to qualify them as experts on the
question of prediction? Although the prediction question is more empirical
than those dealing with normality and responsibility, our expertise is lim-
ited all the same. As is well known, future specific behavior, especially
infrequent behavior over the long term, is very hard for anyone to predict
with accuracy, even with the use of actuarial methods (Livermore, Malm-
quist & Meehl, 1968; Meehl & Rosen, 1955/1973). In a court of law the risks
to the person who is a false positive-the loss of liberty, dignity, reputation,
and autonomy-are very serious. Mental health professionals should and
increasingly do recognize that they are not seers (American Psychological
Association, 1978/1980). For example, the limited ability to predict long-
term violent behavior using clinical methods is well recognized (Monahan,
1981). But even though we know this, too many of us forget it when we
appear in court.
Now let me return to the three questions and suggest what I think
mental health professionals can offer to the courts and how they ought to
offer it. First, let us consider the threshold quesion of normality. For various
reasons, mental health professionals have more experience with crazy per-
sons than do most laypersons. It is fair to argue that professionals know the
right questions to ask to determine if the person behaves crazily enough
perhaps to warrant special legal treatment. Thus, a layperson may not know
to ask if an allegedly mentally disordered person sometimes hears voices or
is hypersomniac or has lost a lot of weight recently. In other words, for legal
purposes, professionals can best act as trained, acute observers. They can tell
the judge or jury better or more efficiently than others that the person in
question hears voices or has thoughts of suicide. Of course, the allegedly
disordered person's family, friends, colleagues, and the like also can pro-
vide such data when they have them. Then using lay and expert testimony,
the judge or jury, as the social, moral, and legal decision maker, can decide
if the person is crazy enough to warrant special legal treatment.
Another major nurmality-related issue is whether the person is faking
crazy symptoms. Are professionals reliably better than others at determin-
ing faking? It is unfortunate, but there are rarely "underlying" signs, such
as the quasidiagnostic criterion of pathological tissue, to help answer the
question whether the observable symptoms are probably real. I am not sure
whether professionals are better but, at the least, David Rosenhan's (1973)
study (despite strong criticism of it [Spitzer, 1975]) and studies of impres-
sion management (e.g., Braginsky, Braginsky, & Ring, 1969; Martin, Hunter,
& Moore, 1977) make me uncomfortable about claiming that psychologists
can reliably distinguish rationally chosen faking from "real" disorder or

"pathological malingering."
Of course, some psychological tests may be useful in determining
whether a person is disordered, but I suggest that if the person seems suf-
ficiently normal to require a test to determine if he or she is truly disor-
dered, the person is probably not legally crazy. Moreover, the ability of tests
to distinguish malingerers is doubtful. In any case, the question for the law
is not the person's response on a test, but his or her behavior in the real
world. Thus, I believe psychological tests are not of great value for legal
purposes even though they may be in many other areas (Gass, 1979; see also,
Bersoff, 1979). If psychologists do testify on the basis of test data, however,
they should explain clearly to the fact finder, in commonsense language,
how reliable and valid the test is and then the fact finder can decide how
much weight to give the conclusion drawn from the test data.
In sum, mental health professionals generally should not testify about
diagnoses or report conclusions about mental illness or even abnormality.
They should simply provide the court with information about the allegedly
disturbed person's thoughts, feelings, and actions that the court is not likely
to hear about from family, friends, neighbors, and other lay observers. Then
the judge or jury can decide the legal issue of normality presented by the
behavior of the disordered person.
On the question of causal responsibility, let me suggest that profes-
sionals should offer only retrospective probability data and clinical impres-
sions to the courts. In other words, professionals should tell the courts what
percentage of nondisordered persons behave in the same legally relevant
way. Then the law will have some sense of how predisposing craziness was
to the legally relevant behavior in question. In the absence of hard actuarial
data, the psychologist should limit his or her testimony to descriptions in
commonsense and factual terms of the person's mental state in order to give
the decisionmaker a phenomenological sense of the actor's state of mind.
Then, once again, with these data juries and judges can decide the moral
question of whether the choice to behave otherwise was too hard for them
to ascribe moral and legal responsibility to the person.
Let me give an example. In a famous homicide case (State v. Sikora,
1965), there was expert testimony that the defendant killed the victim in
order to avoid psychic disintegration. If this is correct, then the defendant
was faced with a very hard choice indeed-kill or psychically disinte-
grate-and the individual would hardly seem as responsible as the cool
killer for hire. But some clarifying questions should be asked. Can assess-
ments of the fear of psychic diSintegration be made reliably? More funda-
mentally, is this type of theorizing sufficiently respectable to justify its
being offered in a court of law rather than as a research or therapeutic heu-
ristic? For example, I believe (and have argued at length elsewhere [Morse,
1982b]) that psychodynamic theory is too speculative to be offered as part
of or the basis for expert testimony. It would be more accurate scientifically
if the clinician simply reported to the court in commonsense terms that the
defendant felt a certain way, rather than reporting that the killing was the
inexorable or near inexorable product of threatened ego disintegration.
Such cases are not like the patellar reflex. What percentage of people with
disintegration fears kill? Was the fear of disintegration a necessary or suf-
ficient cause of killing? In cases of this type, the judgment that the person
could not have acted otherwise, that the defendant's choice was too hard,
is a moral judgment, and not a scientific one.
In conclusion, it is suggested that psychologists be very careful when
discussing causal questions. We should not present a causal variable as nec-
essary and sufficient when there are no hard data to support this contention.
Nor should we overly inject insuffiCiently tested theory as fact or propound
our commonsense factual judgments as scientific. Mental health profession-
als simply do not often have scientific data to say whether a person could
or could not have acted otherwise. And, finally, questions about legal and
moral responsibility are not scientific questions; consequently, the psychol-
ogist should not draw conclusions about responsibility.
On the question of prediction, the law generally asks professionals
about relatively specific behavior (e.g., the outcomes of various therapeutic
interventions or the prediction of dangerousness) about which we do have
data (Bergin & Lambert, 1978; May, 1976; Monahan, 1981; M. L. Smith &
Glass, 1977). But these questions often are asked in terms of relatively
vague, general criteria of probability. My suggestion here is that we profes-
sionals abandon the crystal ball and simply present to the courts the data
we have in precise form rather than drawing legal conclusions. For
instance, instead of telling the court, "This person is likely to improve if
placed in a token economy," professionals should give courts such infor-
mation in the folJowing type of form: "On the average, X% of persons of
this sort change in y, z specific ways over the time period t." Then the court
can decide if that probability of specific change meets the discretionary legal
standard of "likely to improve" (and thus, perhaps, if involuntary treatment
is warranted for the person). The expert has then offered what professional
expertise can contribute and cannot be accused of playing fortune-teller or
drawing legal conclusions in the guise of scientific data.
The courts should be informed if such data do not exist for a given
prediction and professionals should not offer a guess based on clinical wis-
dom. Sometimes the clinician is better than the computer but, as Paul Meehl
has taught (1973), we cannot yet identify those cases in which this will be
so. The guess of a professional, no matter how well intentioned, is unlikely
to be better than the guess of the average judge or juror and thus is not
really an expert opinion. If there are no data, the law should be forced to
make the hard moral choices by itself and should not be allowed to abdicate
its moral responsibility.
Some psychologists may find my conclusions and assessments of our
expertise unduly harsh or pessimistic. We must be honest with ourselves,
however, recognizing the limitations of our science and clinical acumen.
Psychologists have little to gain from extending themselves beyond their
limits when they testify in court: Professional conservatism is realistic and

will shield psychologists from public criticism. If psychologists offer data
rather than ultimate conclusions, it will be clear that they are intruding
their own value judgments as little as possible and that they are offering
the true expertise they possess. Indeed, to the extent that professionals
largely limit their testimony to observable data, they are less likely to dis-
agree, even if they "represent" opposing sides. Much of the disagreement
between experts concerns conclusions, for example, about responSibility or
diagnosis, rather than facts, for example, does the person hear voices
(Morse, 1982b)? If psychologists limit their testimony to facts, very probably
the battle of the experts can be almost entirely avoided. I understand that
this proposal runs counter to the United States Supreme Court's intimation
in Addington v. Texas (1979) that profeSSionals are needed to interpret the
facts (quoted above at p. 394), but psychologists must set their own stan-
dards for the proper performance of their role as experts in the legal system.
CONCLUSION: LAW, LAWYERS AND THE PROFESSIONAL

PSYCHOLOGIST
Mental health law cases, in all their diversity and interesting perplex-
i.ties, are a primary context in which professional psychologists interact
with the law and lawyers. There are literally millions of such cases each
year in the United States, and psychologists are increasingly asked to pro-
vide their expertise to their resolution. Although there are specialists in
forensic psychology, attested to by the incorporation of the American Board
of Forensic Psychology, probably there never will be sufficient numbers of
board certified forensic specialists to handle the cases that arise. Profes-
sional psychologists in general consequently may expect to play some role
in mental health law cases on at least some occasions. This chapter therefore
has sought to present a broad overview of mental health law that describes
the general state of the law and that considers analytically the most impor-
tant issues. It has also attempted to describe and analyze the role of profes-
sional psychologists in mental health law cases.
In conclusion, the primary message I wish to convey is that lawyers
and psychologists often approach problems with differing conceptual
frameworks and speak very different languages. Psychologists must learn
that mental health law cases involve social, moral, political, and legal issues
and values and they should not become condescending or exasperated
when their "scientific" view of a case is not entirely accepted and indeed is
VOciferously challenged. Moreover, psychologists should recognize their
own values and biases and should avoid conflating those values and biases
with scientific fact or opinion. Finally, psychologists should offer their
expertise and opinions to lawyers with the same degree of caution that is
always warranted when they present their work to psychological col-
leagues. After all, scientific knowledge about human behavior is limited in

natural settings and psychologists should not behave as if this were not the
case when they operate in the legal system. If professional psychologists
exercise due caution, they can provide useful information that will enhance
reasoned legal decision making.
ACKNOWLEDGMENTS
I should like to thank my research assistants, Lynn M. Skordal and Dick

Ferguson, for their invaluable assistance in the preparation of this chapter.
CASES
1. A. E. and R. R. v. Mitchell, 5 Mental Disability Law Reporter 154 (D.C. Utah 1980).
2. Addington v. Texas, 441 U.S. 418 (1979).
3. Aden v. Younger, 57 Cal.App.3d 662 (Ct. App. 1976).
4. Bailey v. American Gen. Ins. Co., 154 Tex. 430 (1955).
5. Bartley v. Kremens, 402 F.Supp. 1039 (E.D. Pa. 1975), prob. juris noted, 424 U.S. 964 (1976).
6. Commonwealth v. Gould, 405 N.E.2d 927 (Mass. 1980).
7. Cross v. Harris, 418 F.2d 1095 (D.C. Cir. 1969).
8. Dixon v. Weinberger, 405 F.Supp. 974 (D.D.C. 1975).
9. Doe v. Gallinot, 486 F.Supp. 983 (C.D. Cal. 1979),657 F.2d 1017 (9th Cir. 1981).
10. Drope v. Missouri, 420 U.S. 162 (1975).
11. Durham v. U.S., 214 F.2d 862 (D.C. Cil'. 1954).
12. Dusky v. U.S., 362 U.S. 402 (1960) (per curiam).
13. English Homicide Act of 1957,S&:6 Eliz. II, C.I1.
14. Estelle v. Smith, 451 U.S. 454 (1981).
15. Flakes v. Percy, 511 F.Supp. 1325 (W.O. Wis. 1981).
16. Gregg v. Georgia, 428 U.S. 153 (1976).
17. Halderman v. Pennhurs~ State School and Hospital, 446 F.Supp. 1295 (E.D. Pa. 1977),451
F.Supp. 233 (E.D. Pa. 1978), modified 612 F.2d 84 (3d Cir. 1979).
18. Halderman v. Pennhurst, 451 U.S. 1 (1981).
19. Henry v. Gardner, 381 F.2d 191 (6th Cir.), cert. denied, 389 U.S. 993 (1967).
20. In re Burnick, 14 Cal.3d 306 (1975).
21. In re Franklin, 7 Cal.3d 126 (1972).
22. In re lingenfelter's Estate, 38 Cal.2d 571 (1952).
23. In re Moye, 22 Cal.3d 457 (1978).
24. In re Oakes, 8 Law Reporter 122 (Sup. Jud. Ct. Mass. 1845).
25. In re Roger S., 19 Cal. 3d 921 (1977).
26. In re Winship, 397 U.S. 358 (1970).
27. J. R. v. Parham, 442 U.S. 584 (1979). (412 F.Supp. 112 (M.D. Ga. 1976).)
28. Jackson v. Indiana, 406 U.S. 715 (1972).
29. Knecht v. Gillman, 488 F.2d 1136 (8th Cir. 1973).
30. Lessard v. Schmidt, 349 F.Supp. 1078 (E.D. Wis. 1972), vacated and remanded on procedural
grounds, 414 U.S. 473, new j'mt entered, 379 F.Supp. 1376 (E.D. Wis. 1974), vacated and
remanded, 421 U.S. 957 (1975), prior j'mt reinstated, 413 F.Supp. 1318 (E.D. Wis. 1976).
31. Lynch v. Baxley, 368 F.Supp. 378 (M.D. Ala. 1974).
32. Mathew v. Nelson, 461 F.Supp. 707 (N.D. Ill. 1978).
33. Matter of Guardianship of Richard Roe, III, 421 N.E.2d 40 (Mass. 1981).
34. Matter of Torsney, 47 N.Y.2d 667 (Ct. App. 1979).
35. McDonald v. U.S., 321 F.2d 847,114 U.S.App. D.C. 120 (en bane, 1962).
36. Melville v. Sabbatino, 30 Conn. Supp. 320 (Sup. Ct. 1973).
37. Milis v. Rogers, 102 S. Ct. 2442 (1982).

38. M'Naghten's Case, 4 St. Tr. N.S. 847,8 Engl. Rep. 71 (H.L. 1843).
39. O'Connor v. Donaldson, 422 U.S. 563 (1975). Donaldson v. O'Connor, 493 F.2d 507 (5th
Cir. 1974).
40. Ortelere v. Teachers' Retirement Board, 25 N.Y.2d 196 (1969).
41. Parsons v. State, 81 Ala. 577 (1887).
42. Pate v. Robinson, 383 U.S. 375 (1966).
43. People v. Drew, 22 Cal.3d 333,149 Cal.Rptr. 275 (1978).
44. People v. Edney, 385 N.Y.S.2d 23 (Ct.App. 1976).
45. People v. Peagley, 14 Cal.3d 338 (1975).
46. People v. Silver, 33 N.Y.2d 475, 310 N.E.2d 520 (1974).
47. People v. Wetmore, 22 Cal.3d 318,149 Cal. Rptr. 265 (1978).
48. People v. Wolff, 61 Cal.2d 795, 40 Cal.Rptr. 271 (1964).
49. People ex rei. Rogers v. Stanley, 17 N.Y.2d 256, 217 N.E.2d 636 (1966) (Bergan, J.,
dissenting.).
50. Powell v. Texas, 392 U.S. 524 (1968).
51. Price v. Sheppard, 307 Minn. 250 (1976).
52. Rennie v. Klein I, 462 F.Supp. 1131 (D.C.N.J. 1978). Rennie v. Klein II, 476 F.Supp. 1294
(D.N.J. 1979). Rennie v. Klein III, 653 F.2d 836 (3d Cir. 1981).
53. Rogers v. Okin, 478 F.Supp. 1342 (D.C. Mass. 1979), affm'd in part, rev'd in part, vacated and
remanded, Rogers v. Okin, 634 F.2d 650 (1st Cir. 1980).
54. Rollerson v. U.S., 343 F.2d 269 (D.C. Cir. 1964).
55. Rouse v. Cameron, 373 F.2d 451 (D.C. Cir. 1966).
56. Shelton v. Tucker, 364 U.S. 479 (1960).
57. Specht v. Patterson, 386 U.S. 605 (1967).
58. Stachulak v. Coughlin, 520 F.2d 931 (7th Cir. 1975), cert. denied, 424 U.S. 947 (1976).
59. State v. Pike, 49 N.H. 399,402 (1869-70).
60. State v. Rand, 247 N.E.2d 342 (Ohio, 1969).
61. State v. Sikora, 44 N.J. 453 (1965).
62. State v. Strasburg, 60 Wash. 106 (1910).
63. State ex rei. Hawks v. Lazaro, 202 S.E.2d 109 (W. Va. 1974).
64. State ex reI. Kovach v. Schubert, 64 Wis. 2d 612 (1974), appeal dismissed, 419 U.S. 1117
(1975).
65. State ex rei. Memel v. Mundy, 75 Wis.2d 276, 249 N.W.2d 573 (1977).
66. State v. Sanchez, 80 N.M. 438 (1969), appeal dismissed, 396 U.S. 276 (1970).
67. Suzuki v. Alba, 438 F.Supp. 1106 (D. Hawaii 1977).
68. Todd v. Goostree, 493 S.W.2d 411 (mo. Ct. App. 1973).
69. U.S. v. Brawner, 471 F.2d 969 (D.C. Cir. 1972).
70. U.S. v. Robertson, 507 F.2d 1148 (D.C. Cir. 1974).
71. Vecchione v. Wohlgemuth, 377 F.Supp. 1361 (E.D. Pa. 1974).
72. Washington v. U.S., 390 F.2d 444,129 U.S. App.D.C. 29 (1967).
73. Wilson v. State, 259 Ind. 375 (1972).
74. Winters v. Miller, 446 F.2d 65 (2d Cir. 19971), cert. denied. 404 U.S. 984 (1971).
75. Wood v. Strickland, 420 U.S. 308 (1975).
76. Wyatt v. Ireland, 3 Mental Disab. Law Reporter 403 (M.D. Ala. 1979).
77. Wyatt v. Stickney, 325 F.Supp. 781 (M.D. Ala. 1971),334 F.Supp. 1341 (M.D. Ala. 1971),
enforced 344 F.Supp. 373, 344 F.Supp. 387 (M.D. Ala. 1972), aff'd in part, rev'd in part,
remanded in part, sub. nom Wyatt v. Aderholt, 503 F.2d 1305 (5th Cir. 1974).
78. Youngberg v. Romeo, 102 S. Ct. 2452 (1982).
STATUTES
1. Annotated Missouri Statutes § 475.060(9) (Vernon 1956).

2. California Civil Code §§ 38, 39, 4425(c) (West 1970).
3. California Evidence Code § 1014 (Deering 1979).

4. California Labor Code § 4056 (West 1971).
5. California Penal Code § 1026 (West Supp. 1976).
6. California Penal Code § 1370 (West 1980).
7. California Probate Code § 20 (West Supp. 1980).
8. California Probate Code § 1460 (West & Supp. 1956/1977); now amended, § 1460 (West
Supp. 1979).
9. California Welfare & Institutions Code § 300 (West Supp. 1980).
11. California Welfare & Institutions Code § 5250 (West 1972).
14. California Welfare & Institutions Code § 5275 (West 1972).
16. California Welfare & Institutions Code § 6316.1 (West 1980).
17. California Welfare & Institutions Code § 6550, et seq. (West 1972).
18. District of Columbia Code § 21-545(b) (West 1967).
19. Georgia Code Annotated § 88-503.3 (Harrison 1979).
20. Maryland Annotated Code Art. 31B (1971 & Cum. Supp. 1977).
21. Massachusetts General Laws Annotated ch. 123A, §§ I-II (1969).
22. Michigan Compiled Laws Annotated § 768.36 (1975).
23. Texas Code Annotated Art. 5547-23 (Vernon 1958).
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13
Developmental Disabilities Law and the
Roles of Psychologists
MICHAEL KINDRED
INTRODUCTION
Over the last decade Congress has passed a number of laws affecting devel-
opmentally disabled persons. I Federal and state courts also have articulated
important rights for developmentally disabled persons. 2 State legislatures
have enacted new laws, often in response to congressional or court action. 3
IThe first specific federal assistance to mentally retarded persons occurred in 1935, when the
Social Security Act created the Crippled Children's Bureau. The Vocational Rehabilitation
Act of 1945 also covered the mentally retarded. Funds to support mental retardation teacher
training programs were authorized in 1958. In 1961 President Kennedy established the Pres-
ident's Panel on Mental Retardation, which recommended an increased federal involve-
ment. A more substantial federal role has developed since that time. The details of this
involvement will appear in the discussion of specific topics infra.
20n the American tradition of using the courts to vindicate the rights of politically disfa-
vored groups and the relationship of progress for the handicapped to other aspects of the
civil rights movement (see T. Gilhool, The Right to Community Services, in M. Kindred et
ai., eds., for the President's Committee on Mental Retardation, The Mentally Retarded Citizen
and the Law 173, n. 5 at 174. New York: Free Press, 1976. [hereinafter cited as The Mentally
Retarded CitizenD.
3For example, while the first federal court decisions articulating a constitutional right to
treatment or habilitation were related to Alabama institutions, they induced the director of
the Ohio Department of Mental Health and Mental Retardation to establish a task force to
propose reforms of Ohio laws relating to institutional care. K. Gaver, Reaction Comment, The
Mentally Retarded Citizen, supra note 2 at 411, 413. As a result, the Ohio Legislature enacted
S.B. 336 (1973) establishing, among other things, a statutory right to habilitation for the
mentally retarded. This law is now codified at Ohio Rev. Code Ann. §§ 5123.68-5123.99
(Page Supp. 1978). A statutory right to education for handicapped children in Ohio was not
established until enactment of mandatory federal legislation and the threat of withdrawal
MICHAEL KINDRED. College of Law, Ohio State University Law School, Columbus,
Ohio 43210.
423
424 MICHAEL KINDRED
Finally, federal and state administrative agencies have promulgated regu-

lations affecting the developmentally disabled. These statutes, court deci-
sions, and regulations often establish advisory committees and require diag-
nostic evaluations, prescriptive program plans, and treatment for
developmentally disabled persons. Their significance for psychologists is,
therefore, considerable.
This chapter will provide an introduction to some areas where the law
has a significant impact upon the delivery of services for developmentally
disabled and other handicapped persons. It will suggest roles that psychol-
ogists can play. In order to function effectively in these roles, the psychol-
ogist must have a basic understanding of the legal concepts and processes
involved.
The term developmental disabilities law is deceptive. In fact, the relation-
ship between the law and the concept "developmental disabilities" is
unusual and complex. For centuries the law has had rules governing some
classes of persons who now come within the broad concept "develop-
mentally disabled," but early legal provisions spoke of "idiots," "imbe-
ciles," and "feeble-minded persons." Later the law sometimes spoke in
terms of "mental defect" or "mental retardation."4 The term developmental
disability first appeared as a legal concept in the Developmental Disabilities
Services and Facilities Construction Amendments of 1970.5 Congress coined
this new term rather than utilize diagnostic terms in current use in order
to ensure that individuals whose needs are similar are not denied services
just because of diagnostiC category.6 Some states have responded to Con-
gress's new terminology by enacting new laws or amending old laws to
of federal funds. For current provisions, see Ohio Rev. Code Ann., Chapter 3323 (Page Supp.
1978).
The best source of information on current legal developments in this area is The Mental
Disability Law Reporter, published bimonthly by the American Bar Association Mental Dis-
ability Legal Resource Center (1800 M Street N.W., Washington, D.C. 20036). See also Ami-
cus, published bimonthly by the National Center on Law and the Handicapped (211 W.
Washington Street, South Bend, Indiana 46601).
4Almost all pre-1960 laws affecting the mentally retarded emphasized the limitations of such
persons and provided for the restriction or denial of rights enjoyed by most members of
society. Discussion of these laws and analytical tables are to be found in American Bar Foun-
dation, The Mentally Disabled and the Law (1st ed., 1961 Lindman & McIntyre, eds., Chi-
cago: University of Chicago Press, 1961 [cited hereinafter as Lindman & McIntyre]). Special
restrictive laws also were enacted that dealt with epileptics. See R. Barrow & H. Fabing,
Epilepsy and the Law (2d ed., New York: Harper & Row, 1966) and Epilepsy Foundation of
America, The Legal Rights of Persons with Epilepsy (4th ed., Washington, D.C.: Epilepsy
Foundation of America, 1976). Only very recently has the law created entitlements, rather
than restrictions, for the handicapped. A few positive changes are reflected in American Bar
Foundation, The Mentally Disabled and the Law (2d ed., Brakel & Rock, eds., Chicago: Uni-
versity of Chicago Press, 1971 [cited hereinafter as Brakel & Rock]). Others will be discussed
throughout this chapter.
584 Stat. 1316, codified as amended at 42 U.S.c. 6001-6081 (1976).
6H.R. Rep. No. 1277, 91st Cong., 2d Sess. (1970) at 1970 U.S. Code Congressional and Admin-
istrative News 4714, 4717.
DEVELOPMENTAL DISABILITIES LAW 425
utilize "developmental disability" as an operative term.7 Thus, the term

"developmental disability" has gradually become a term with legal signif-
icance under both federal and state law. 8 Of course, older or different ter-
minology also continues to be utilized in some statutes.
Several factors increase the complexity of this law. First, Congress has
changed its definition of "developmental disabilities" several times. In the
original 1970 enactment developmental disability was defined as:
a disability attributable to mental retardation, cerebral palsy, epilepsy, or
another neurological condition ... found by the Secretary to be closely related
to mental retardation or to require treatment similar to that required for men-
tally' retarded individuals, which disability originates before the individual
attains eighteen, which has continued or can be expected to continue indefi-
nitely, and which constitutes a substantial handicap to such individual. 9
The secretary never exercised the power granted in this definition to extend
the benefits of the law to "closely related" groups. Because the legislation
was perceived by consumer groups to confer valuable benefits, however,
advocates for the autistic and for persons with dyslexia secured explicit
inclusion within the federal definition of "developmental disability"
between 1970 and 1976.
The definition was a source of continuing controversy. Some persons
felt its use of diagnostic categories excluded deserving and needy individ-
uals. Others felt the definition was insufficiently targeted-in other words,
too broad-and spread scarce funds too thinly with too little assistance for
those with the greatest need. In 1975 Congress ordered a study/o which was
completed and led to a substantial revision of the definition in 1978.11 The
new definition of developmental disability is a severe, chronic disability of a
person that:
1. Is attributable to a mental or physical impairment or combination of
mental and physical impairments
7With funding from the Developmental Disabilities Office of the Department of Health, Edu-
cation, and Welfare the Developmental Disabilities State Legislative Project of the American
Bar Association Commission on the Mentally Disabled (1800 M Street N.W., Washington,
D.C. 20036) (hereinafter the ABA Commission) has published a series of model state acts
dealing with the developmentally disabled.
80ne must beware of the effects of any effort at "modernization" of the law by substituting
"developmentally disabled" for "mentally retarded." Since the former is broader in some
ways than the latter, and perhaps narrower in others (see n. 9-12 infra), substitution of terms
may serve inadvisably to change the coverage of the substantive provision. For example, to
modernize a statute that prohibits mentally retarded persons from voting or permits their
institutionalization (both questionable in themselves) to cover the "developmentally dis-
abled" would be a significant restrictive act. New persons would be limited or subject to
incarceration. At the least, the merits of such a change should be thoroughly considered.
These would be far from "mere technical" changes.
9pub. L. 91-517, § 102(5),84 Stat. 1325.
IODevelopmentally Disabled Assistance and Bill of Rights Act of 1975, Pub. L. 94-103, §
301(b), 89 Stat. 506.
IIRehabilitation Comprehensive Services and Developmental Disabilities Amendments of
1978, Pub. L. 95-602, § 503(a), 92 Stat. 3004.
426 MICHAEL KINDRED
2. Is manifested before the person attains age twenty-two

3. Is likely to continue indefinitely
4. Results in substantial functional limitations in three or more of the fol-
lowing areas of major life activity: (i) self-care, (ii) receptive and
expressive language, (iii) learning, (iv) mobility, (v) self-direction,
(vi) capacity for independent living, (vii) and economic self-
sufficiency
5. Reflects the person's need for a combination and sequence of special,
interdisciplinary, or generic care, treatment, or other services which
are of lifelong or extended duration and are individually planned and
coordinated12
This definitional change has several significant components. First, a
client need not fit a specific diagnostic category to be included. Second, the
developmental period is extended through 21 years of age, by which time
the disability must be "manifest." Third, and most importantly, great
emphasis is put on the severity of the handicap by the use of the terms
severe, chronic disability, substantial functional limitations, and services of lifelong
or extended duration, as well as by the requirement that there be limitations
in three or more named functional areas. Of couse, such terms as severe,
substantial, and extended are relative adjectives waiting to be given content
by a skillful diagnostician or advocate who can demonstrate that a clit'nt
qualifies for services. They offer equal basis for the bureaucrat to deny ser-
vices because a disability is not severe enough.
This process of congressional definition and redefinition causes con-
fusion itself. The confusion is magnified in state legislation. A state law
referring to "developmental disabilities" that was enacted in 1971 would
probably have utilized the then current federal definition. Another law
enacted in the same state eight years later on another topic may utilize a
different definition, perhaps the current federal one. It is thus distinctly
possible for a particular state to utilize the term developmental disability in
several different ways, either intentionally or by accident.
Both federal and state law also continue to use operative categories in
other laws that are broader or more narrow than "developmental disabili-
ties." Two of the most important federal statutes in this area confer their
benefits on "the handicapped," a category substantially broader than
"developmentally disabled."13 Many state laws still limit their coverage to
mentally retarded persons or some other specific diagnostic category.14
The net result of centuries of legal activity is that developmentally dis-
abled persons have rights and may be subject to restrictions.
12Id. (emphasis supplied) now codified at 42 V.S.c. 6001 (1976).

13The Education for all Handicapped Children Act of 1975, Pub. L. 94-142, now codified at
20 V.S.c. §§ 1401-1420 (1976); Rehabilitation Act of 1973, Pub. 1. 93-112, relevant portions
now codified as amended at 29 V.S.c. §§ 793-796 (1976).
14See Brakel & Rock.
Psychologists have a number of roles to play in securing the rights of

developmentally disabled persons and ensuring that such persons are not
inappropriately restricted. Numerous statutes call for diagnostic assess-
ments. The law often mandates or permits psychologists to be part of the
assessment process. 15 Another frequent legal requirement is the preparation
of a prescriptive plan, with a role for psychologists either mandated or per-
mitted. Finally, in the delivery of counseling services to the develop-
mentally disabled person, psychologists can play important roles. Involve-
ment in these technical roles may lead to use of a psychologist as an expert
witness in a broad variety of contexts. Beyond the technical diagnostic, pre-
scriptive, and treatment roles of the psychologist, other professional
involvement is clearly needed. An extremely important role, which will be
developed below, is in advocacy. This may be for services in an individual
client's case, for general agency policy change within a service delivery
structure, or before legislative or administrative bodies to influence the
shape of the law. Finally, the service system is replete with advisory boards,
to which the psychologist often can make major contributions. Many of the
technical roles fit within the remunerated aspect of one's professional life.
Others must be characterized primarily as public service, in which any
financial benefits come indirectly as a result of increased expertise and pub-
lic exposure.
The psychologist's ability to communicate effectively with consumers,
legislators, and professionals of other disciplines is essential to the roles
described in this chapter. Because of differences in educational and profes-
sional background, jargon, assumptions, and prejudices, such communica-
tion is difficult. The psychologist who intends to advocate for a consumer
must be able to hear what the consumer wants. A psychologist who would
operate in the educational context must be prepared to understand the edu-
cational system and its teaching and administrative personnel. The psy-
chologist who would participate in hearings as either expert or advocate
must deal effectively with lawyers. Awareness of the relative limits of one's
own expertise may suggest to a psychologist that consultation with a neu-
rologist, social worker, or lawyer is important to a full evaluation or plan
for the client. The relatively new phenomenon of interdisciplinary evalu-
ations requires an even broader ability to work effectively with other
professionals. The law increasingly requires that evaluations be conducted
by an interdisciplinary team. It is essential in such team evaluations that a
psychologist (a) be prepared to acknowledge the professional expertise of
others, (b) speak and formulate recommendations in language that is under-
standable by other team members, and (c) remember that his or her final
duty is to the client and not the team, even if this requires the filing of
dissenting positions from those of the rest of the team.
15 Occasionally,laws still contain references to "physicians" that seem to relegate psycholo-

gists to a subordinate role.
428 MICHAEL KINDRED
The remainder of this chapter will examine a number of discrete legal

topics as well as roles for psychologists within each area. The topics dis-
cussed should indicate the myriad professional opportunities for psychol-
ogists in working with developmentally disabled individuals. They also
should indicate ways in which the law affects the professional work of the
psychologist.
ADVOCACY
Improving the life opportunities of developmentally disabled persons,

individually and collectively, requires continual advocacy at several levels.
Psychologists have vital roles to play in this process. This section will exam-
ine the importance of this advocacy, its historical development, types of
advocacy, and the special place of psychologists in the advocacy process.
Historically, society has restricted developmentally disabled persons
through institutionalization and excluded them from educational and voca-
tional opportunities. For this reason, improvement of the life opportunities
of developmentally disabled persons requires a very substantial change in
society's orientation. Unfortunately, resistance to change is a constant force.
Efforts to establish small residences for handicapped persons are resisted by
neighbors. Integration of a handicapped child into a regular school often is
resisted by the school administration. Integration into the regular classroom
often is resisted by the classroom teacher. Reconstruction of a college cam-
pus to make it accessible to the physically handicapped is resisted by college
administrators. Governmental officials are sometimes resistant simply to the
change in routine demanded by an orientation that calls for inclusion and
service delivery. In order to counter this resistance to change and the ste-
reotyped thinking behind such resistance, advocacy is essential.
Self-advocacy by developmentally disabled persons is an important
part of the advocacy effort and psychologists as counselors can help devel-
opmentally disabled clients to become self-advocates. Because such persons
often have been raised to see themselves as devalued people and to adopt
a passive role (or an ineffectively aggressive one) toward authority, the psy-
chologist can play an important role in helping his or her client to become
more effective as a self-advocate, as a person able and willing to identify
and assert his or her own interests.
Advocacy by others on behalf of developmentally disabled persons is
also essential. Many developmentally disabled individuals must have some-
one advocate their rights for them. Some lack the intellectual ability to com-
prehend the complexity of governmental bureaucracies and regulations.
Others have developed such a dependent posture or assumed such a def-
erential attitude toward authority that self-advocacy is impossible. Even
where the individual is able and inclined to assert his or her own interests,
social attitudes toward handicapped persons often lead to a devaluation of
their assertions. Because of the importance in our society of normalcy, intel-
ligence, and physical appearance, assertions by a handicapped person of his

or her own interests often are ignored by those with the power to make
required changes.
Historically, the advocacy movement for the developmentally disabled
is of recent origin. It was only after World War II that parent groups devel-
oped, first to build their own cooperative programs for their develop-
mentally disabled children and then to form advocacy structures to demand
that services be provided by government. It was only in the late-1960s that
advocates for the handicapped began to use litigation in federal court and
sophisticated lobbying processes to gain major structural change. It is only
in the 1970s that handicapped individuals themselves have become a major
self-advocacy force for change. Demonstrations by the handicapped in
Washington in the mid-1970s, demanding that the Secretary of Health, Edu-
cation, and Welfare promulgate anti-discrimination regulations, was a phe-
nomenon unthinkable 20 years earlier. As the importance of advocacy has
become apparent and the power of advocacy groups has increased, govern-
ment itself has reenforced the advocacy movement.
Various models of government-sponsored advocacy structures are to be
found. The development of these structures is still at an early stage. One of
the first efforts was the establishment of The New York Mental Health
Information Service, through which the New York legislature mandated
that there be an independent organization in each judicial district to inform
mental patients of their rights and provide assistance in vindicating those
rights. '6 Other early state efforts were the establishment of a cabinet-level
Office of the Public Advocate in New Jerseyl7 and the establishment of an
independent Legal Rights Service in Ohio. '8 The federal government
picked up on these initiatives and in 1975 mandated that every state estab-
lish a protection and advocacy system for the developmentally disabled as
a condition of receipt of federal funds under the Developmental Disabilities
Assistance and Bill of Rights Act. '9 While the organization and effectiveness
of these advocacy systems varies from state to state,20 a major step has been
taken. The Developmental Disabilities State Legislative Project of the Amer-
ican Bar Association Commission on the Mentally Disabled (hereinafter
ABA Commission) has published an analysis of state laws establishing
I"N.Y. Mental Hygiene Law § 29.09 (McKinney 1978). Although the New York Mental Health
Information Service originally was limited to mental health matters, it since has had its
jurisdiction extended to mental retardation issues as well. N.Y. Mental Hygiene Law § 9107
(McKinney 1978). See generally Note, The New York Mental Health Information Service: A New
Approach to Hospitalization of the Mentally III, 67 Colum. L. Rev. 672 (1967).
17N.J. Stat. Ann., Chapter 52:27E and especially §§ 52:27E-21 through 52:27E-27 (West Supp.
1979).
ISOhio Rev. Code Ann. § 5122.94 (Page Supp. 1978).
19pub. L. 94-103, 89 Stat. 496 (codified at 42 U.S.c. §§ 6001-6081 (1976). See especially 42
U.S.c. § 6012.
2OS. Herr, Advocacy Under the Developmental Disabilities Act (H.E.W. 1976); Herr, The New
Clients: Legal Services for Mentally Retarded Persons, 31 Stan. L. Rev. 553 (1979).
430 MICHAEL KINDRED
advocacy systems and a recommended model act. 21 While formal advocacy

structures are being established, thousands of private individuals and orga-
nizations continue to engage in advocacy on behalf of individual develop-
mentally disabled persons and on behalf of such persons collectively.
There are various types of advocacy. We have noted previously the dif-
ference between self-advocacy and advocacy for another. Another funda-
mental distinction is between case advocacy and systems advocacy. The first
is advocacy for a particular individual's needs or rights. The second relates
to the structure of the service system and the way in which that system
affects developmentally disabled individuals generally. A third distinction
is between lay and professional advocacy. As indicated above, original
advocacy movements were very much of a "lay" variety. With the growth
of formal advocacy structures, professional advocates have become more
common. Both lay and professional advocacy still have important roles to
play; cooperation between them is vital and increases the strength and
effectiveness of both. The professional advocate often has more information
and expertise on the governmental bureaucracy than the nonprofessional.
On the other hand, the personal involvement and expertise of the lay advo-
cate often can present a more compelling case.
In effective advocacy, coalition building, teamwork, and cooperation
are vital. Very often the interests of a single developmentally disabled per-
son are shared by many such persons. They also may be shared by other
handicapped persons and by substantial groups of nonhandicapped per-
sons. In fact, when viewed in any kind of long-term perspective, the inter-
ests of the developmentally disabled person may be perfectly consistent
with the interests of all members of society. Because system change is a
political process, it is critical to identify the broadest possible coalition of
allies in a given situation and press together for the kind of change that is
needed.
Psychologists have a central role to play in advocacy for develop-
mentally disabled persons. In individual case situations, the psychologist
can be vital. The psychologist is the expert and his or her word carries great
weight. If a psychological evaluation describes a developmentally disabled
person in stereotyped, static terms that emphasize the individual's disabil-
ities, the individual may be excluded from programs or benefits. If the eval-
uation emphasizes the developmental potential of the individual and
describes creatively the programs and approaches that are needed to maxi-
mize that potential, the positive prognosis, rather than the negative one,
may become self-fulfilling. It is vital for the psychologist to know the cri-
teria to which his or her evaluation is addressed and to be aware of his or
her power and concomitant responsibility.
21 ABACommission, Advocacy (1978) supra note 7; see a/so, recommendations of an Illinois

Governor's Commission for a statutory "Mental Health and Developmental Disabilities
Legal Advocacy Service," 1 M.D.L. Rep. 278 (1977).
In systems advocacy as well, the psychologist has a critical role. Here,

the expertise, educational background, and prestige of the professional psy-
chologist carries with it power. In addition, the relative sophistication of
psychologists regarding social structures and individual motivation provide
special tools to be used in the advocacy process. Finally, the relative wealth
and organization of psychologists as a profession offer an opportunity to
engage in effective systems advocacy in coalition with other interested
groups. Many state psychological associations have retained lobbyists (at
least part-time) to represent their professional interests (i.e., to seek inclu-
sion of psychological services in public and private insurance systems, to
obtain professionally beneficial licensing or certification legislation, and to
resist undesired legislative or administrative action). State associations need
to see their role more broadly and place their influence and resources
behind efforts at systems change for developmentally disabled and other
handicapped individuals.
Several cautionary notes are required on the pitfalls of advocacy.
Because advocacy often involves the representation or assertion of the inter-
ests of others, caution and circumspection are required. To make decisions
for another is an awesome responsibility. It is hard enough to decide what
is in one's own interest. It is often much more difficult to be confident of
what is in another's interest. Advocacy requires humility, a willingness to
pause and ask whether what one is asserting is truly in the other person's
interest or is simply based upon one's own assumptions. The dilemma
posed here is not one for which a formula response can be framed, but that
makes it no less important.
Second, because advocacy has become a term with positive connota-
tions, it is not uncommon for government officials to change the name of
existing government functionaries to include the term. Thus, case managers
and protective service workers may be redesignated "client advocate." In
short, advocacy is an activity, not a title, and the reality must be judged
despite nomenclature and not through it.
ENVIRONMENTAL BARRIERS
The limitations experienced by handicapped persons seldom inhere in

the handicapped person alone. Rather, they represent a conflict between
the individual and the surrounding social and physical environment. This
is true in a very broad sense and in the narrower sense of physical environ-
mental barriers to mobility. In the broader sense, for example, an educa-
tional system that requires its participants to progress in a lockstep acqui-
sition of competence to handle mathematical concepts will define a person
with limited conceptual ability as handicapped, unfit, or incompetent. The
individual begins with an inherently below average ability for conceptual
reasoning; the definition of this as an incompetence occurs, however, only
when the social context in which he or she must operate defines conceptual
432 MICHAEL KINDRED
reasoning as a sine qua non of competence or legitimacy.22 Various aspects of

this broad interaction between the individual and the social environment
will be seen throughout this chapter. In this section, we will deal with the
narrower issue of physical environmental barriers that inhibit mobility.23
They are of two primary types: (1) engineering barriers, such as public
transportation vehicles that require a high stepping egress; and (2) archi-
tectural barriers, such as inaccessible buildings and streets. 24
While part of our physical environment is in its natural state (e.g., for-
est preserves), a large part of it has been planned by engineers and archi-
tects and constructed. This constructed environment creates many impedi-
ments (often insuperable impediments) to participation by physically
handicapped persons. In many cases, it effectively excludes them from
access to, and thus participation in, whole spheres of activity that are taken
for granted by most members of society. Inaccessible schools can preclude
an education for handicapped children. Inaccessible industrial environ-
ments can exclude a person from productive employment. Inaccessible
courthouses can exclude participation in the governmental process. The
existence of widespread architectural barriers is testimony to society's long
neglect of its handicapped citizens. Increasingly, however, those citizens
are demanding redress. Because public funds are used to fund much con-
struction (schools, streets, hospitals) and government building permits are
required for most of the rest, an important issue has become whether this
governmental involvement should be used to set minimum standards of
accessibility. Some action in this direction has been taken.
The federal government enacted the Architectural Barriers Act in
1968.25 It required that most buildings thereafter constructed, altered,
leased, or financed by the United States government meet standards
designed to ensure ready access and use whenever possible by physically
handicapped persons.26 This act has since been amended several times in
order to provide minimum standards of acceSSibility, tighten up a "waiver"
process that had been criticized as too informal, and improve enforcement.27
Section 504 of the Rehabilitation Act of 1973,28 prohibiting discrimi-
nation against handicapped persons by federally funded programs,
22The importance of the social system's norms and expectations in the definition of mental
retardation is explored in Mercer, Labeling the Mentally Retarded (Berkeley, California:
University of California Press, 1973).
23The problems addressed by this section concern physically handicapped persons. Thus,
"physical handicap" is the operative statutory concept. 42 U.S.c. §§ 4151-4157 (1976). While
many developmentally disabled persons have no mobility impairment, such impairments
are not infrequently an aspect of the developmental disability.
24Much of this section is based upon ABA Commission, Eliminating Environmental Barriers
(1979), supra note 7, which analyzes relevant federal and state laws and proposes a model
act for adoption by state legislatures.
25Pub. L. 90-480, codified as amended at 42 U.S.c. 4151-4157 (1976).
26 42 U.S.C. §§ 4151-4156 (1976).
27 ABA Commission, Eliminating Environmental Barriers 6-7(1979), supra note 7.

28pub. L. 93-112, 87 Stat. 394. Section 504 is now codified at 29 U.S.c. 794 (1976).
increased the role of the federal government. Under regulations issued pur-
suant to that act, such programs now are required to ensure that all new
facilities are accessible and also to make adjustments in present programs to
ensure that they are generally accessible. 29
In the area of public transportation, the federal government also has
required that federally supported public transportation programs (which is
almost all of them) make "special efforts" to provide public transportation
availability to handicapped persons. 30 Debate rages on whether separate
transportation systems can compensate for the inaccessibility of the general
public transportation system, or whether vehicles used in general public
transportation also must be accessible to handicapped persons. 31
All states also have addressed the issue of environmental barriers to
some degree, although most state statutes leave much to be desired in terms
of both coverage and effective enforcement mechanisms. The ABA Com-
mission has provided a recent analysis of federal and state law in the area
and has proposed a model act for adoption by the states. 32
The primary role for psychologists in this area is an advocacy one. A
major priority must be placed upon securing comprehensive, effective state
statutes; psychologists can play a valuable role in the coalition that is
needed to secure such regulation over the opposition of powerful construc-
tion and other business 10bbies.33 State acts sometimes provide for public
advisory boards, which may provide a role for psychologists. Perhaps most
importantly, the psychologist can playa critical role within whatever insti-
tution or community he or she lives and works to encourage the removal
of its environmental barriers. The psychologist also can assist handicapped
persons with whom he or she works to recognize that the barriers are out-
side of the handicapped individual and to encourage the person to become
involved in self-advocacy efforts.
EDUCATION
Education is one of the major public services provided by local, state,

and federal governments. It provides a broad range of instruction, from
driver's training through vocational training to academic instruction. It
serves a population diverse in background, abilities, and interests. In spite
of this diversity in program and clientele, until recently many develop-
mentally disabled children were totally excluded from the educational sys-
tem. Others were assigned to segregated, second-rate, inappropriate
programs.
29 45 C.F.R. §§ 84.21-84.23 (1978).

3°49 U.S.c. § 1612 (1976).
31Compare, e.g., Vanho v. Finley, 440 F. Supp. 656 (N.D. Ohio, 1977) and United Handicapped
Federation v. Andre, 558 F.2nd 413 (8th Cir. 1978).
32ABA Commission, Eliminating Environmental Barriers (1979), supra note 7.
330rganizations representing veterans and the elderly are natural allies on this issue.
434 MICHAEL KINDRED
At the beginning of this decade advocates for handicapped children

went to federal court to challenge exclusion of handicapped children from
public education. The federal courts were generally responsive to the chal-
lenge, declared exclusion to be a denial of equal protection of the laws,
required integration to the greatest extent possible, and established proce-
dural due process protections to protect such children from arbitrary
administrative decisions. 34
The gains made and principles established in the early court decisions
were then consolidated in congressional action. The federal Education For
All Handicapped Children Act of 197535 is of great significance to handi-
capped children and to those who work with and for them. The act requires
all states to have policies and practices designed to assure that all handi-
capped children receive educational and "related" services.36 States that fail
to meet this requirement are subject to the termination of substantial federal
funding. 37 Because of the relevance of psychologists' skills to the identifi-
cation and evaluation of and planning for such children, potentially signif-
icant roles exist. In addition, the federal law mandates that "related ser-
vices" be provided, which includes therapy of a kind provided by
psychologists.
Prior to federal action and the Education for All Handicapped Children
Act of 1975, many state laws specifically excluded some handicapped chil-
dren from education. Others lacked provisions that would ensure such edu-
cation.38 The threat of a federal fund cutoff led the states to bring their laws
into compliance with federal law. Thus, substantial revision of state law has
taken place in the last several years. 39 Implementing the promise of the
right to education is an ongoing process and probably represents the most
promising arena for psychologists. Before discussing the various roles, sev-
eral preliminary comments are needed.
First, a psychologist practicing in this arena should gain a familiarity
with the provisions of both federal and state education law, including both
statutes and regulations on each level. While the scope of this chapter pre-
cludes a complete description of the federal statute and regulations, a num-
345ee, e.g., Pennsylvania Association for Retarded Children v. Pennsylvania, 334 F. Supp. 1257
(E.D. Pa. 1971); Mills v. Board of EducatiOn for the District of Columbia, 348 F. Supp. 866
(D.C.C. 1972); Fialkowski v. Shapp, 405 F. Supp. 946 (E.D. Pa. 1975).
35pub. L. 94-142, 89 Stat. 773, codified at 20 U.S.c. §§ 1401-61 (1976).
36 20 U.S.c. § 1412 (1976).
37 20 U.S.c. § 1416 (1976).
38F. Weintraub, A. Abeson, & D. Braddock, State Law and Education of Handicapped Chil-
dren 11 (1971); S. Herr, The Right to An Appropriate Free Public Education, The Mentally
Retarded Citizen 252.
39 A current listing of state special education statutes is contained in T. Overcast & B. Sales,
Psychologists in State Special Education. In Professional Psychology, author, in preparation.

The reform of state law was spurred by a requirement that each state's attorney general
certify that the state plan is consistent with state law. 20 C.F.R. § 121a.112(b)(2) (1978).
ber of articles discussing them are available. 4U State statutes, regulations, and
plans vary considerably, but they should be available from each state's edu-
cation agency.
Second, severe ethical strains can develop. Conversion of the educa-
tional system from one that excludes handicapped children to one that
serves them is administratively, fiscally, and psychologically (for school
personnel) burdensome. Thus, in individual cases handicapped children or
their parents demanding appropriate services can find themselves in an
adversary posture to the school administration. The psychologist employed
by or paid on contract with the school system sometimes will be expected
by school officials to maintain a protective posture for the school. It can be
difficult to recommend expensive services that the psychologist knows the
school lacks. Nevertheless, the criteria for evaluation and recommendation
are the child's needs and the appropriate services for the child.
Third, the operative term in this law is handicapped child. The term
developmentally disabled is not used. "Handicapped child" is defined as
mentally retarded, hard of hearing, deaf, speech impaired, visually handi-
capped, seriously emotionally disturbed, orthopedically impaired, or other
health impaired children, or children with specific learning disabilities, who by
reason thereof require special education and related services. 41
The regulations promulgated by the Secretary of Health, Education, and

Welfare pursuant to the act supplement this definition by defining the var-
ious named disabilities. 42 The statute and regulations exclude from the con-
cept "specific learning disability" -children "who have learning problems
which are primarily the result of ... environmental, cultural, or economic
disadvantage."43
The federal law and state laws enacted pursuant to it suggest the pos-
sible roles for psychologists.
1. Identification of handicapped children. The states are required to have a
system for the identification of all handicapped children in the state from
the age of 0 to 21.44 The purpose of this requirement is to ensure that appro-
priate educational planning can be begun from an early age. Psychologists
can assist in the identification process. Psychologists on the staffs of hospi-
tals and clinics can be instrumental in ensuring that these institutions have
policies to assist in passing along early indications of handicap to appro-
priate school officials. Also, because the birth of a handicapped child may
cause family stress, parents of such children may come to the attention of
.oE.g., S. Blakely, Judicial and Legislative Attitudes toward the Right to an Education for the Handi-
capped, 40 Ohio State 1. J. 603 (1979); Note, The Education of all Handicapped Children Act of
1975,1976 Mich. J. 1. Ref. 110.
41 20 U.S.c. § 1401(1) (1976).
4245 C.F.R. § 121a.5(b) (1978).

43 20 U.s.c. § 1401(15) (1976); 45 C.F.R. 121a.5(b)(9) (1978).
4420 U.S.C. § 1412(2)(C) (1976); 45 C.F.R. § 121a.128 (1978).

436 MICHAEL KINDRED
psychologists. They then have the opportunity to see that the educational
system is aware of the child and can serve his or her needs, thus often alle-
viating some of the cause for familial concern.
2. Evaluation of handicap. A critical step in planning appropriate educa-
tional services is the accurate diagnosis of the handicapping condition.
Often psychologists are uniquely capable of assisting in this evaluation pro-
cess. Several different sorts of evaluation are called for by the federal law.
They can be categorized as preplacement evaluation, periodic reevaluation,
and independent evaluation. The law requires that every handicapped
child be evaluated prior to placement in special education services. 45 This
evaluation must be conducted by a multidisciplinary team46 and will gen-
erally be conducted by school personnel or persons on contract to the
school system. The school psychologist will often be a part of that team.
Where it is thought that the child may have a "specific learning disability,"
the regulations require that testing be done by a person professionally qual-
ified to do so. Psychologists are specifically mentioned. 47
The law also requires periodic reevaluations. These must be conducted
at least once every three years and more often at the request of the parents. 48
Provision is also made for independent evaluations, that is, evaluations
by persons other than school personnel or contract personnel. 49 Where the
independent evaluation differs from the school's evaluation and is utilized
to alter the placement suggested, the independent evaluation is to be at
public expense. 50 State law can provide for these to be at public expense in
other cases as well. In any case, a parent is entitled to secure an independent
evaluation and to have these considered by the placement team and any
hearing officer upon appeal. This is a critical role for the psychologist not
employed by the school system. The law requires the school system to keep
a list of persons qualified to conduct independent evaluations.51 Psycholo-
gists interested in this role should be sure they are included on such lists.
When parents have appealed a placement decision, the hearing officer also
may request an independent evaluation, in which case it is at public
expense.52
3. Development of the individual educational program (IEP). After the eval-
uation is completed, the law requires that a team prepare an individual edu-
cational program, specifying the services required by the child. 53 These
45C.P.R. § 121a.531 (1978).

C6ld. § 121a.532(e) (1978).
47ld. § 121a.540(b) (1978).
"Id. § 121a.534(b) (1978).
49 20 U.S.C. § 1415(b)(1)(A) (1976); 45 C.P.R. § 121a.503 (1978).
50 45 C.P.R. § 121a.503(b) (1978).
51 Id. § 121a.503(a)(2) (1978).

'2Id. § 121a.503(d) (1978).
SlId. §§ 121a.531 and 121a.343-346 (1978).
team conferences are to include the parents.54 Where a psychologist has

been involved in the evaluation process, he or she should also see to being
involved in the IEP team.
4. Hearing officer. The law requires that parents have an opportunity for
a hearing before an independent hearing officer when they do not agree
with the placement decision of the school. 55 The federal law does not spec-
ify the professional qualifications of the hearing officer. While one may
expect that school systems often will look to attorneys to fulfill this role, an
argument can be made that it would be better filled by a person with tech-
nical expertise in the area involved. Certainly a person with training in
both psychology and law would be an attractive prospect as a hearing
officer.
5. Program evaluation. The law requires an annual evaluation of the
effectiveness of the state' program plan in meeting the needs of handi-
capped children.56 Psychologists logically could be included in such pro-
gram evaluation teams.
6. In-service training. The law requires that the states have in place an
in-service training program to meet staff training deficits indicated by a per-
sonnel survey.57 Because many teachers have not previously had to teach
handicapped children, this is a particularly important area during the tran-
sition period. Psychologists should be included in such in-service training
programs.
7. Advisory board participation. The federal statute establishes a National
Advisory Committee on Handicapped Children58 and requires that each
state establish an advisory committee of persons interested in education of
handicapped children. 59 Although federal law does not require, and no state
statutes seem to mandate, the creation of advisory bodies to local educa-
tional agencies, there is nothing to prevent a local school administrator or
school board from establishing such advisory bodies. Advisory bodies pro-
vide a forum through which psychologists experienced in the area of edu-
cation of handicapped children can have an impact upon program
planning.
8. Teaching. Psychologists who meet state certification requirements for
special education may even find a role in instruction of handicapped chil-
dren on a full or part-time basis.
9. Psychological services. The law requires that all states provide all hand-
icapped children with a free appropriate public education60 and then
MId. § 121a.345 (1978).

55Id. §§ 121a.506-507 (1978).
56 20 U.S.C § 1413(a)(1l) (1976); 20 CF.R. § 121a.601 (1978).
57 20 U.S.C § 1413(a)(3) (1976); 45 CF.R. §§ 121a.380-121a.386 (1978).
58 20 U.S.C. § 1403 (1976).
59 20 U.S.C § 1413(a)(12) (1976); 45 C.F.R. §§ 121a.650-121a.653.

60 20 U.S.C § 1412(1) (1976); 45 CF.R. §§ 121a.1(a) and 121a.121 (1978).
438 MICHAEL KINDRED
defines the latter to include "special education and related services to meet
their unique needs."61 "Related services" include "psychological services,"62
which are defined to include:
a. Administering psychological and educational tests and other assess-
ment procedures
b. Interpreting assessment results
c. Obtaining, integrating, and interpreting information about child
behavior and conditions relating to learning
d. Consulting with other staff members in planning school programs
to meet the special needs of children as indicated by psychological
tests, interviews, and behavioral evaluations
e. Planning and managing a program of psychological services, includ-
ing psychological counseling for children and parents63
10. Advocacy. Finally, it must be clear that within the educational con-
text the opportunities for the professional psychologist as advocate are
enormous. The transformation of the school system from an institution
excluding handicapped persons, or many of them, to one serving all hand-
icapped children requires creative advocacy.
Psychologists involved with children in the educational system will
have countless opportl,1nities to fashion prescriptive programs for handi-
capped children and to advocate their implementation. Effective interper-
sonal relations are essential to this process. Beyond that, the psychologist
can have a substantial impact by stressing the developmental potential of
the child that can be realized by, but only by, implementation of an effec-
tive educational plan for him or her. The psychologist also will have the
opportunity to identify recurrent problems within the educational system
that require systemic change to better serve all handicapped children.
Beyond the walls of the school, the psychologist who is armed with statis-
tics and illustrations from his or her experience can be an effective advocate
in the continuing efforts to secure appropriate laws to ensure effective edu-
cation for the handicapped and the appropriation of sufficient resources,
whether from the state legislature or through local tax levies.
ZONING
The inhumanity and economic wastefulness of segregating large num-

bers of developmentally disabled individuals in large institutions is now
61 20 u.s.c. § 1401(18) (1976); 45 C.P.R § 121a.4(1978).

62 20 U.S.C. § 1401(17) (1976); 45 C.P.R. § 121a.13 (1978).
63 45 C.P.R. § 121a.13{b){8) (1978) (emphasis supplied).
broadly condemned.64 The illegality of unnecessary institutionalization has

been declared by a number of courts. 65 Reintegration of developmentally
disabled individuals into the communities of America is now a goal of both
the federal and state governments. 66 A major obstacle to such reintegration
has been the hostility of neighborhoods to the development of small group
living facilities for the developmentally disabled. This hostility is often
expressed through "zoning" decisions in which it is asserted that the neigh-
borhood in question is zoned for single family use and that such facilities
are not legally permitted.67
The United States Supreme Court has refused to utilize federal consti-
tutional principles to strike down exclusionary "single family" zoning
restrictions. 68 While the case in which this decision was reached dealt with
a group of college students wanting to live together in a single family dis-
trict, the principles of local control enunciated by the court would seem to
be of broader application. 69 New York courts, however, seem to have
regarded the situation as distinguishable and have held the exclusion of
group homes from residential neighborhoods unlawful?O Given the present
"President's Committee on Mental Retardation, Mental Retardation: Century of Decision (A
Report to the President) 22 (1976); R. Conley, The Economics of Mental Retardation 372
(1973).
65See, e.g., Wyatt v. Stickney, 344 F. Supp. 387 (M.D. Ala. 1972), aff'd in part and remanded in
part sub nom Wyatt v. Aderholt, 503 F.2d 1305 (5th Cir. 1974); Welsch v. Likins, 373 F. Supp.
487 (D. Minn. 1974), vacated on other grounds and remanded 550 F.2d 1122 (8th Cir. 1977);
Davis v. Watkins, 384 F. Supp. 1196 (N.D. Ohio 1974). While the primary thrust of each of
these opinions is to condemn dehumanizing institutional conditions as unconstitutional,
each articulates as well a right to placement in the least restrictive setting compatible with
the plaintiff's needs.
"Congress has made the following finding with respect to the rights of developmentally
disabled persons:
The treatment, services, and habilitation for a person with developmental disabilities
should be designed to maximize the developmental potential of the person and should be
provided in the setting which is least restrictive Of the person's personal liberty. 42 U.S.c. § 6010(2)
(1976) (emphasis supplied)
For an illustration of a similar state policy statement see Ohio Rev. Code Ann. § 5123.67
(Page Supp. 1978), which reads in relevant part as follows:
[This Chapter) shalJ be liberally interpreted to accomplish the following purposes: ... (0)
To maximize the assimilation of mentally retarded persons into the ordinary life of the
communities in which they live.
67For a general discussion of this problem, see ABA Commission, Zoning for Community
Homes (1978), supra note 7, and materials cited therein.
68Village of Belle Terre v. Borass, 416 U.S. 1 (1974).
69For a detailed analysis of the impact of Belle Terre on group homes for the handicapped see
Comment, Exclusionary Zoning and Its Effects on Group Homes in Areas Zoned for Single-Family
Dwellings,24 Kans. L. Rev. 677 (1976).
70City of White Plains v. Ferraioli, 34 N.Y.2d 300, 313 N.E.2d 756 (1974); Moore v. Nowa-
kowski, 46 App. Div. 2d 996, 361 N.Y.S.2d 795 (1974); Group House of Port Washington,
Inc. v. Board of Zoning and Appeals, 82 Misc.2d 634. For an apparent limit on the New
York doctrine, see People v. Renaissance Project, 36 N.Y.2d 65, 324 N.E.2d 355 (1975). 370
N.Y.S.2d 433 (1975).
440 MICHAEL KINDRED
temper of the Supreme Court,71 it is unlikely that resolution of this problem

will be sought, or if sought found, from that source. Thus, the battle to
secure decent group living settings for developmentally disabled individ-
uals must be resolved at the state and local level. Several approaches are
possible. The first is that the state, utilizing its traditional power of eminent
domain, can purchase and operate group homes without regard for local
zoning restrictions. 72 The second approach is through general legislative
change. This can take the form either of a statewide preemptive statute of
a kind advocated by the American Bar Association Commission on the Men-
tally Disabled73 or through a municipal ordinance specifically providing for
the inclusion of small group residences in single family neighborhoods?'
The third possible approach is on a case-by-case basis through the process
known as a variance. In this approach a municipal body is asked to approve
the use of a particular property as a small group home as an exception to
generally exclusionary zoning laws.
Anyone of these approaches will be highly controversial. A decision
concerning which approach to take depends on an evaluation of the polit-
ical realities in the state or municipality. Because of the likelihood of con-
troversy, it is critical for psychologists to join with others in a coalition
effort to address the problem. 75 Where a local variance is sought, the num-
ber of supporters that appear physically before the decision-making body
and write letters to key officials can be important. Psychologists need to
participate in forming a network that can turn out supporters for such
action. Local or statewide legislative action requires a showing of grassroots
support through letter writing, personal contact, campaigns, and sophisti-
"O'Connor v. Donaldson, 422 U.S. 563 (1975) (refusal to reach right to treatment issue);
Southeastern Community College v. Davis, 442 U.S. 397 (1979) (restrictive interpretation of
prohibition against discrimination on the basis of handicap in 29 U.S.c. 794); Parham v. J.
R., 442 U.S. 584 (1979) (minimal due process protections approved in committing a child to
a state institution); Addington v. Texas, 441 U.S. 418 (1979) (proof beyond a reasonable
doubt not required for commitment on grounds that defendant is mentally ill and
dangerous).
72Comment, The Inapplicability of Municipal Zoning Ordinances to Governmental Land Uses, 19 Syr.
L. Rev. 698 (1968). The extent to which and manner in which the state can exercise this
power, however, has been challenged. Hillsborough Association for Retarded Citizens v.
Temple Terrace, 332 S.2d 610 (1976); Note, Governmental Immunity from Local Zoning Ordi-
nances, 84 Harv. L. Rev. 869 (1971).
13 Supra, n. 67.
14Por guidance in developing such ordinances, see R. Hopperton, Zoning for Community
Homes: A Handbook for Local Legislative Change (1975) and R. Hopperton, Zoning for
Community Homes: A Handbook for Municipal Officials (1975). These two publications are
available from the Ohio Developmental Disabilities Council, State Office Tower, Columbus,
Ohio.
75The coalition building process involved here is particularly delicate. On the one hand,
more substantial positive political support can be developed with a broad coalition. On the
other hand, political opposition can be considerably greater against a state or locallegisla-
tive approach embracing homes for offenders and addicts as well as persons who are devel-
opmentally disabled.
cated lobbying efforts. Again, coalition work must be the order of the day.
Psychologists can throw the personnel and fiscal resources of their local and
state associations behind these efforts. They also can become personally
involved through testimony, informal contacts, and letter writing. As on
many topics, the expertise and authority that psychologists can bring to
bear is important. Psychologists can testify to the needs of developmentally
disabled persons, their potential for productive lives in the community, and
the negative effect of segregation in institutions or urban ghettos.
MARRIAGE AND PERSONAL/FAMILIAL RIGHTS
Marriage is a voluntary act. Therefore, some threshold intellectual

capacity is required in all states. Where a person is incapable of understand-
ing the nature and consequences of marriage, state court assistance can be
sought to block or void a marriage. 76
Some states go beyond these general consent requirements to prohibit
specifically the marriage of some developmentally disabled persons. Many
of these laws use antiquated terminology in describing the restricted class,
such as "idiots," "imbeciles," feeble-minded."77 There is no federallegisla-
tion on this topic.
The constitutionality of categorical marriage prohibitions against men-
tally retarded persons is highly doubtfu1. 78 The United States Supreme
Court has held that marriage is a fundamental constitutional right.19 Because
of this status, states can restrict the right only for a compelling purpose80
and only to the extent necessary to accomplish that purpose. 81 In addition,
the categorization used in the restriction will be subject to strict judicial
scrutiny.82 A general procedure to ensure that any person entering marriage
is capable of understanding its nature and consequences is probably per-
missible, as long as the procedure is not applied discriminatorily and is not
more burdensome than is necessary to accomplish the stated goal.
The most common justification for broad prohibitions is eugenic, but
this rationale is not supported by current scientific opinion. 83 Another ratio-
76See generally Brakel & Rock 226-229.

77For a review of state statutes as of 1971, see Brakel & Rock, Table 7.1 at 240-243. A compar-
ison with the 1961 analysis in Lindman & McIntyre, Table VII-A at 207-210 shows that a
number of states repealed marriage prohibitions against persons with epilepsy in the inter-
vening decade. A current analysis of marriage statutes is being prepared for future publi-
cation by the ABA Commission.
78p. Wald, Basic Personal and Civil Rights, The Mentally Retarded Citizen 7, supra note 2 at.
79Loving v. Virginia, 388 U.s. 1,12 (1967).
8ORoe v. Wade, 410 U.S. 113, 155 (1973).
81Shelton v. Tucker, 364 U.S. 479, 488 (1960); Stanley v. Illinois, 405 U.S. 645,657 (1972).
82Skinner v. Oklahoma, 316 U.s. 535, 541 (1942).
83Brakel & Rock 212; President's Committee on Mental Retardation, Mental Retardation Past
and Present 227 (1977); but see P. Reilly, Genetics, Law, and Social Policy 131 (1977).
442 MICHAEL KINDRED
nale sometimes asserted is that mentally retarded persons are incapable of

caring for any children who might be born of the marriage. The real prob-
lem with both of these justifications is that the relation between the ratio-
nale and the prohibited class cannot withstand strict judicial scrutiny. Nei-
ther purification of the race nor assurance of fit parenting can rationally
lead to a ban on marriage by mentally retarded persons. The categorization
is both too broad and too narrow. It is too broad because much mental retar-
dation is not genetk and some mentally retarded persons are capable of
adequate parenting.M It is too narrow because rational policies of racial puri-
fication or parenting assurance would have to strike more broadly, for
example, at all persons with clearly inheritable "negative" characteristics or
at all child abusers. 85
Psychologists can play an important counseling role with mentally
retarded persons contemplating marriage. This is in large part the same
function as would be played with other clients contemplating a major life
decision. The psychologist may want to explore the client's knowledge and
experience with sexual matters and arrange for sex education in appropriate
cases. It may be important to explore attitudes toward family planning and
make appropriate referrals for contraceptive materials. Where the client has
decided against having children, the possibility of sterilization may be
explored. Where the client does plan to have a family, it may be important
to arrange for training in child care and to make a preliminary survey of
supportive services that would be available.
A second possible role for the psychologist is evaluative. Where some-
one has suggested that the marriage may be prohibited by state law, a psy-
chologist may be able to assist in the determination of whether the stated
prohibition is applicable. This will require an understanding of the state
law involved. Because state laws vary conSiderably, consultation with an
attorney may be required. Where the prohibition is based upon ability to
comprehend the nature of marriage or the ability to be a proper parent, the
psychologist may be competent to make the evaluation. Where it has a
eugenic base, consultation with a geneticist is indicated. Where it appears
that the prohibitory criteria may be met, the possibility of educative or
social service support measures to compensate for the individual's deficits
should be explored. Because the right to marry is regarded as so fundamen-
tal a right in our society, a psychologist should be hesitant to conclude that
the individual is prohibited from it. Given the relativity of the notions of
competence and parental fitness and the difficulty of predicting the latter,
84 [d. Of particular interest is a study on marital competence reported in J. Mattin50n, Marriage

and Mental Handicap in Human Sexuality and the Mentally Retarded 169 (1973 F. LaCruz &
G. LaVeck eds.).
"Even if valid classifications were utilized to reach goals that are clearly compelling, Stanley
v. Illinois, 405 U.S. 645 (1972) would seem to require individual hearings to determine
whether a particular person falls within the category.
it will be a rare case where the psychologist can be confident of a negative

conclusion.
A third possible role is in the advocacy arena. Where state law contains
broad prohibitions, a psychologist might work through a professional asso-
ciation or coalition to advocate a revision of state statutes before the legis-
lature. The literature and expertise upon which a psychologist can draw
could be valuable in such an effort. Alternatively, the psychologist may
decide to take on an advocacy role in an individual case where someone is
trying to prohibit a mentally retarded client from marrying. Effective advo-
cacy of this sort will require (1) maximizing the capabilities of the client by
the means suggested in the previous paragraph, (2) ensuring that a number
of credible witnesses are familiar with these capabilities, (3) marshaling
information, where relevant, that demonstrates the irrationality of the pro-
hibition in state law. It is likely that an advocacy effort of this kind will
need to be a team enterprise, involving various treating and training profes-
sionals as well as an attorney.
Several other issues are closely related to that of marriage. They are the
right to raise one's own children and the right to control procreativity
through sterilization. These, too, are sensitive issues in which psychologists
have potential roles in both counseling and advocacy.
All states have laws that permit the state to remove a child from its
natural home if the child is neglected or dependent.86 Unlike some of the
marriage prohibition statutes, these laws are phrased generally; they are not
directed specifically at handicapped parents. They are clearly designed to
satisfy a compelling state interest, the protection of children from neglect-
ful or abusive parents.
Problems with these laws arise in their application and specifically in
their application to developmentally disabled parents. The two major issues
are (1) the standard of care that society enforces through these laws and (2)
the possibility of discriminatory application against developmentally dis-
abled parents.
While virtually all members of modern American society would agree
that children should be removed from sadistic, physically brutal parents,
consensus beyond that point is less readily achieved. In tension with the
interest in protecting children is a strong sentiment that parents have a fun-
damental right to raise their own children. 87 It is only in extreme cases that
society intervenes to terminate that right. The literature has explored the
concept of "psychological abuse or neglect,"88 but few reported court deci-
86 5. Katz, R. Howe, & M. McGrath, Child Neglect Laws in America, 9 Family Law. Quarterly 1
(1975).
87 Stanley v. Illinois, 405 U.S. 645 (1972).
88e. Foote, R. Levy, & F. Sander, Cases and Materials on Family Law 64 (2d ed. 1976). M.
Wald, State Intervention on Behalf of "Neglected" Children: A Search for Realistic Standards, 27
Stan. 1. Rev. 985,1014 (1975).
444 MICHAEL KINDRED
sions rely explicitly upon that rationale for removing children from their
parents.
Two new concepts have appeared recently that may be signs of a more
interventionist approach. The first is "the best interest of the child."89 A
concept first developed for use in custody disputes between divorcing par-
ents, where the right of parenthood is equal/a it has since been utilized to
resolve conflicts between parents and the state or third parties.91 The diffi-
culty with its application in this context is that it permits the state to deter-
mine that any parent doing a passable job of parenting is not the best parent
that the child could have and that, therefore, "in the best interest of the
child" the child should be removed from the parents and placed in a pref-
erable home. While this may keep the concept from coming into general
use, there is a risk that it will be used in special cases where a judge feels
that a child should be removed from the home, but cannot find evidence of
the level of abuse or neglect that would generally be required for termi-
nation of parental rights. One well might fear that removal of a newborn
child from mentally retarded parents could be such a case, with stereotypes,
assumptions, and a novel legal doctrine replacing proof and analysis.
The second concept that has arisen is that of "intellectual stimulation"
as a requisite element of adequate parenting. In the case of In re McDonald,92
the Iowa Supreme Court said:
The juvenile court was "reluctantly convinced that because of this mother's
very low I.Q. she could never adequately take the proper care of their twins or
at least provide them with the stimulation in their home that they must have
to grow into normal healthy children." ... We conclude, as did the juvenile
court, that the best interests of the twins require termination [of the parental
tiesj.93
It is hard to imagine that the courts are prepared to examine whether par-
ents in general provide sufficient "stimulation" to their children and to
replace the parents if they do not. This seems to be a case of a rule having
been invented to intervene in the parent-child relationship where the par-
ent is mentally retarded. 94
89 See R. Drinan, The Rights of Children in Modern American Family Law, 2 J. Family L. 101 (1962);
Note, Alternatives to "Parental Right" in Child Custody Disputes Involving Third Parties, 73 Yale
L. J. 151 (1963); J. Goldstein, A. Freud, & A. Solnit, Beyond the Best Interests of the Child
(1973).
90Finlay v. Finlay, 240 N.Y. 429, 148 N.E. 624 (1925) (Cardoza, J.).
91 M. Paulsen, The Delinquency, Neglect, and Dependency Jurisdiction of the Juvenile Court in Justice
for the Child 68 (M. Rosenheim ed. 1962). McKay v. Ruffcorn, 247 Iowa 195,201,73 N.W.2d
78 (1955); Painter v. Bannister, 258 Iowa 1390, 140 N.w.2d 152 (1966); In re McDonald, 201
N.w.2d 447, 453 (1972).
92In re McDonald, 201 N.W.2d 447 (1972).
93Id. at 453.
94 [Pjarental "inadequacy" in and of itself should not be a basis for intervention, other than
the offer of services available on a truly voluntary basis. The term "inadequate home" or
"inadequate parent" is even harder to define than emotional neglect. There is certainly no
consensus about what types of "inadequate" behavior would justify intervention. Given
the vagueness of the standard, almost unlimited intervention would be pOSSible. Wald,
supra n. 88 at 1022.
Because the laws governing this topic speak in general and nondiscri-
minatory terms and are designed to serve a generally legitimate purpose, it
is unlikely that the solution is to be found in legislative reform. Neverthe-
less, critical roles exist for the psychologist. Counseling is primary. Where
a developmentally disabled individual is considering the possibility of hav-
ing a child, the psychologist may well want to explore the ramifications of
that decision. The ability of the potential parent to fill the contemplated
role may need to be explored. Where a developmentally disabled person
chooses not to have children because of difficulties contemplated in child
raising, or for any other reason, counseling about the ways to prevent par-
enthood needs to be explored. Where a developmentally disabled person is
about to assume a parenting role, the psychologist can be helpful in arrang-
ing for training in child care skills.
The psychologist also may have a role where state intervention is con-
templated. The first possible role is a general, educational one. Social work-
ers and judges who might be involved in the intervention process need to
learn that developmentally disabled persons often can be perfectly com-
petent parents and that the same standards of adequate parenting and pre-
sumptions of competence should be applied to them. Second, the psychol-
ogist can be important in the context of an active attempt to terminate the
parental rights of a developmentally disabled person. In some situations the
court may be authorized to order an evaluation of the home situation. The
psychologist must be prepared to examine how the home is functioning, to
describe the functional adequacy of the home objectively (without pre-
sumptions that the fact of disability may decrease the parenting ability), to
look for special strengths in the home environment that may relate to the
parent's handicap, and to prescribe support steps that might be taken by
social service agencies to assist the parent in functioning more adequately.
Of course, where the psychologist concludes that the child is neglected or
dependent in the usual legal sense of that term and that social service assis-
tance cannot remedy the situation, it is necessary to report that fact to the
court. The psychologist also may be called into the situation by the parent
or someone on the parent's behalf before the situation has reached the lit-
igation stage or in preparation for litigation. Here, as in the case where the
psychologist is appOinted by the court, it may be possible to affirm positive
aspects of the parenting situation and to prescribe social service assistance
or training in parental skills that may make the person a clearly adequate
parent and prevent the issue of separation from arising.
The issue of family planning has been mentioned at several points in
this section. This touches on a very emotional topic, and a difficult legal one:
sterilization. The nature of the legal issue will depend on state law, which
varies considerably from state to state.95 Some states have laws permitting
the sterilization of mentally retarded persons without their consent, upon
the authorization of a public official or private guardian, sometimes with
95For a discussion of the history of sterilization laws and a survey of state statutes, see Brakel
& Rock 207.
446 MICHAEL KINDRED
certain procedural protections. Other states have no laws on the subject at

all. Two courts have held that sterilizations can be performed in the absence
of any applicable statute.96 Either legal context presents problems.
The United States Supreme Court has characterized control of one's
ability to procreate as a fundamental personal right.97 The usual corollaries
of such a characterization are several. First, the state cannot restrict a fun-
damental personal right without a "compelling state interest." Second,
restrictions can be imposed only if the state's compelling interest cannot be
accomplished by a less drastic means. And third, classifications restricting
the fundamental rights of some, but. not all, persons will be subjected to
"strict judicial scrutiny."98 While it would seem that statutes singling out
mentally retarded individuals for sterilization would be subject to attack,
the Supreme Court upheld a statute providing for sterilization of mentally
retarded persons 50 years ago99 and has not addressed this question directly
since then. State courts have been reluctant to strike down such laws. 1°O
This reluctance may be explained by the other horn of the dilemma.
Where there is no statute authorizing sterilizations, a doctor may refuse to
perform a sterilization because of concern about ineffective informed con-
sent. The result of this can be that a mentally retarded person who wants
to be sterilized (in the same way as millions of other Americans desire ster-
ilization) and for whom sterilization is a sensible decision cannot be
sterilized.
Although the legal situation is unclear, the psychologist can play an
important role. Where involuntary sterilization is suggested, the psychol-
ogist may be able to provide general information to negate the presump-
tions underlying the proposed intervention or specific information on the
individual's skills and characteristics. Where a doctor refuses to perform a
voluntary sterilization, the psychologist may be able to provide evaluative
information on the individual's competence to give an informed consent.101
In addition, pscyhologists involved in the legislative reform process
may be able to help legislators find ways that have not yet been tried to
resolve the policy dilemma.
THE CRIMINAL JUSTICE PROCESS
Some developmentally disabled individuals, like some individuals in

society at large, commit antisocial acts that have been defined by society as
96Ruby v. Massey, 452 F. Supp. 361 (D. Conn. 1978); In re 1. G., 170 N.J. Super. 98, 405 A.2d
851 (1979).
97Skinner v. Oklahoma, 316 U.s. 535 (1942).
98 See notes 80-82 supra.
99Buck v. Bell, 274 U.S. 200 (1927).

IOOSee, e.g., In re Sterilization of Moore, 289 N.C. 95 221 S.E.2d 307 (1976); In re Cavitt, 182
Neb. 712, 157 N.W.2d 171 (1968).
IOIThe psychologist must, of course, use care in such an evaluation and submit a full written
evaluative report, since he or she might be liable for certifying the competence of a person
who is then sterilized and later found to have lacked competence to consent.
crimes. The regulation of criminal behavior poses major policy problems

generally; the problems are aggravated when a suspected offender is hand-
icapped, particularly when the handicapping condition is mental retarda-
tion. This is so in large part because the concepts of mental normalcy are
closely related to basic tenents of criminal responsibility and fair criminal
procedure.
Federal law defines some crimes, which are prosecuted by federal pros-
ecutors in federal courts with federal prison sentences as potential sanc-
tions. In addition, each state has its own criminal code, prosecutors, courts,
and prisons. The federal constitution also establishes some broad principles
that are binding on all states; several of these are of particular importance
in the subject discussed below. The vast majority of crimes in this country
fall within the jurisdiction of the states and their subdivisions and thus are
governed by state law within federal constitutional limits.
Since the beginning of the 20th century, children have been dealt with
by separate state laws and courts. In recent years, this system has been made
to conform closely, in parallel, to the adult criminal system. 102 Thus, in the
discussion that follows, the same problems generally can be foreseen for
juveniles as for adults.
The criminal justice system can be seen as a series of steps from anti-
social incident to prison incarceration.
Police officials are assigned initial responsibility for investigation,
arrest, and interrogation. There is a particular risk with a developmentally
disabled person that perfectly innocent behavior may be mistaken for crim-
inal behavior. The misapprehension that a person with a mobility impair-
ment is intoxicated is the most obvious example. Police officers need to
receive training in the characteristics of disabilities so that they make as few
of these errors as possible. Psychologists can have a role in advocating for
adequate police training programs and might even be involved in such
programs.
Probably the most serious problem at the police stage has to do with
control of interrogation of developmentally disabled suspects. Police offi-
cers use interrogation as a common source of evidence; confessions are
highly valued as proof of gUilt. 103 Some officers are highly skilled at inter-
rogation, and physical and psychological abuse have been alleged fre-
quently as they drive for proof of guilt and evidence that will secure a con-
viction. 104 The United States Supreme Court took cognizance of this
problem in the 1960s. 105 It was concerned that coercive behavior often effec-
tively denied an accused person the right to counsel and the privilege
against self-incrimination that are guaranteed by the United States Consti-
tution. The Court also was concerned that coercion could produce false
I02See generally S. Fox, The Law of Juvenile Courts in a Nutshell (2d ed. 1977); S. Fox, Cases
and Materials on Modern Juvenile Justice (1972).
I03Miranda v. Arizona. 384 U.S. 436, 448-454 (1966).
104ld.
losEscobedo v. Illinois, 378 U.S. 478 (1964); Miranda v. Arizona, 384 U.S. 436 (1966).
448 MICHAEL KINDRED
confessions and that lawless behavior by police officers would undermine

respect for the law generally. Thus, the Court reaffirmed that suspects who
have been taken into custody have the right not to respond to police ques-
tions and the right to consult with an attorney, paid for by the state in case
of indigence. In order to shield suspects from overzealous police interro-
gators, the Court further held that no interrogation may be initiated unless
the suspect has been informed of his or her constitutional rights and has
waived those rights in a voluntary, knowing, and intelligent manner.l06
There is often reason to doubt that a developmentally disabled suspect
can make the knowing and intelligent waiver required by the Supreme
Court. Moreover, the general concern that interrogation under pressure can
produce false confessions is accentuated in the case of developmentally dis-
abled suspects since they may be especially deferential toward authority
figures and thus prepared to say whatever a police interrogator wants them
to say.l07 Once again, this problem must first be addressed by adequate train-
ing of police officers. In addition, it may be desirable to establish special
procedures that prohibit interrogation of an obviously handicapped person
in the absence of counsel. Where such questioning has taken place, the
validity of the waiver of rights may be raised in a request (or motion) to the
trial court prior to trial that the confession be "suppressed" or excluded
from evidence at trial. At this stage a psychologist may be asked by the
prosecutor, the court, or defense counsel to evaluate the defendant and to
offer an expert opinion as to whether in the circumstances of the confession
the defendant was capable of giving a voluntary, knOWing, and intelligent
waiver of his constitutional rights.
Informal handling or diversion of defendants is sometimes done by the
police. It is also a primary function of the prosecutor and increasingly is
being viewed as exclusively the prosecutor's function. At this stage a psy-
chologist may have a role to play in suggesting alternative community pro-
grams into which the defendant might be placed. Indeed, more farsighted
psychologists might be instrumental in establishing community treatment
programs for developmentally disabled persons accused of crime. Without
alternatives, the prosecutor may feel he or she must proceed to trial. One
might note that there seems to be an overly great tendency to divert devel-
opmentally disabled persons from the criminal process just because of their
handicap. As with other persons, repeated diversion of chronic offenders
can create the impression that there is no reason not to engage in criminal
behavior. In many cases, however, diversion is highly desirable, if appro-
priate treatment programs exist.
Once one approaches the trial stage, it may be asked whether a devel-
opmentally disabled defendant is "competent to stand triaL" The law has
I06Miranda v. Arizona, 384 U.S. 436 (1966).

lO7Fikes v. Alabama, 352 U.S. 191, 196-198 (1957); for a preliminary perspective on "the acqui-
escent personality," see M. Rosen, G. Clark, &: M. Kivitz, Habilitation of the Handicapped
205 (1977).
long required that, in order for a person to be tried for a criminal offense,
the person must be capable of understanding the nature of the proceedings
and cooperating with defense counse1. 108 The Supreme Court has said that
this concept is constitutionally mandated. 109 The issue can be raised by
either the prosecutor or the defense counsel; a judge with reason to doubt
the competence of a defendant before him has a constitutional obligation
to inquire into the matter llO and order an evaluation. Psychologists often
are asked to perform such evaluations. If the person is found competent
after evaluation, the trial proceeds. If he or she is found incompetent but
treatable to regain competence within a reasonable time, a period of treat-
ment may be ordered. Psychologists may be involved in such treatment. If
the person is found permanently incompetent, confinement is permissible
only pursuant to civil commitment procedures. lll (For greater detail on
incompetency in general, see Chapter 12.)
Another issue that can arise, and can involve psychological evaluation,
is the defendant's criminal responsibility. In most jurisdictions this issue
only can be raised by the defendant. The tests for criminal responsibility
vary from state to state, but a common one is whether flat the time of such
conduct as a result of mental disease or defect he lacks substantial capacity
either to appreciate the wrongfulness of his conduct or to conform his con-
duct to the requirements of the law."ll2 Some jurisdictions also have
adopted the concept of partial or diminished capacity that calls for explo-
ration of whether, for example, a defendant accused of first degree homi-
cide was capable of premeditation. ll3 Expert testimony from psychologists
may be admissible on either of these issues. (For greater detail, see Chapter
12.)
Once a conviction has been obtained, or an individual has been found
to lack either capacity to stand trial or criminal responsibility, questions of
disposition arise. Where the person is found incompetent or not responsi-
ble, a further evaluation and hearing may be required to determine
whether he or she fits requirements for confinement outside of the penal
system. Where he or she is convicted, the court will have to make decisions
108 4 Blackstone, Commentaries 24 (1665).
I09Drope v. Missouri, 420 U.S. 162 (1975); Pate v. Robinson, 383 U.S. 375 (1966); Bishop v.
United States, 350 U.S. 961 (1956).
lloDrope v. Missouri, 420 U.S. 162 (1975); Pate v. Robinson, 383 U.S. 375 (1966). There is a
risk of prosecutors raising the issue to avoid a trial on a weak case, since a finding of incom-
petence to stand trial can result in at least some period of incarceration without trial or
conviction.
lllJackson v. Indiana, 406 U.S. 715 (1972).
U2American Law Institute, Model Penal Code § 4.01(1) (Proposed Official Draft, 1962). See
generally J. Goldstein, The Insanity Defense (1967); H. Weihofen, Mental Disorder as a
Criminal Defense (1954).
113See generally W. LaFave & A. Scott, Jr., Handbook on Criminal Law 325 (1972); P. Arenella,
"The Diminished Capacity and Diminished Responsibility Defenses: Two Children of a
Doomed Marriage," 77 Colum. L. Rev. 827 (1977).
450 MICHAEL KINDRED
on whether to order incarceration or probation, and if incarceration, where

to order the offender confined. In this process, some kind of a broad psy-
chological evaluation and social study often is called for. Psychologists can
playa critical role in prescribing imaginative treatment programs that con-
sider the unique characteristics of the developmentally disabled accused or
offender. They also can play important roles within institutions and in the
community by calling attention to the need for treatment programs.
PROHIBITION OF DISCRIMINATION
As American society has rejected discrimination against various of its

component groups it has passed federal and state legislation prohibiting
such discrimination and established administrative agencies with the
responsibility to enforce these prohibitions. The Civil Rights Act of 1964
broadly prohibited discrimination on the basis of "race, color, or national
origin" in any activity or program receiving federal financial assistanceY4
It also prohibited discrimination in private employment on these grounds
or on the grounds of religion or sex liS and established the Equal Employ-
ment Opportunity Commission to enforce these prohibitions. 1l6 In 1973
Congress acted to require the federal government and most contractors
with the federal government to take affirmative action to hire "the handi-
capped." lI7 1t also prohibited discrimination on the basis of handicap of "an
otherwise qualified person" by any program or activity that receives federal
financial assistance. liS It left enforcement of these provisions, however, to
the Secretary of Health, Education, and Welfare, rather than providing for
enforcement by the Equal Employment Opportunity Commission. lI9 This
1973 act is of great importance in the battle for the rights of develop-
mentally disabled and otherwise handicapped persons, although the
enforcement mechanisms and the exclusion from its coverage of discrimi-
nation in private employment leave something to be desired.
A number of states also have enacted prohibitions against discrimina-
tion on the basis of handicap. While the coverage of these acts and the ade-
quacy of their enforcement mechanisms vary from state to state, they pro-
vide another useful tool. The ABA Commission has published an analysis
of these state laws and a recommended model act. l20 Psychologists can play
an important role in cooperation with, or leadership of, a coalition of con-
sumers and professionals to ensure that their state has an antidiscrimination
statute of broad coverage and effective enforcement mechanisms.
11442 U.S.C. § 2000(d) (1976).

115 42 U.s.c. § 2000(e) (1976).
116 42 U.S.c. § 2000(e)(5) (1976).
117 29 U.S.c. §§ 791 and 793 (1976).
118 29 U.S.C. § 794 (1976).
119 A.B.A Commission, Prohibiting Discrimination 3 (1978) supra note 7.
120A.B.A Commission, Prohibiting Discrimination (1978) supra note 7.

When the law provides benefits or services or imposes restrictions, it

classifies in drawing lines between those who are eligible and those who
are not. Virtually all classification of persons according to their race or reli-
gion is viewed as discriminatory because of the judgment that these criteria
are never, or almost never, a legitimate basis for granting or denying ser-
vices. In the area of sex discrimination, a debate continues about whether
there are situations in which sex is a legitimate basis for classification. It is
now broadly accepted that, at the most, very few such classifications are
legitimate. The concept of discrimination against the handicapped may be
somewhat more complex. This, too, is a matter of debate, but it seems likely
that there are at least some matters upon which a severely handicapping
condition is a legitimate basis for classification.
On the other hand, the denial of services or opportunities to handi-
capped persons very often is irrational or discriminatory. It is sometimes
said that the present claims of the handicapped are for special privileges
and treatment and not for a freedom from discrimination. One of the lead-
ing legal advocates on behalf of handicapped individuals, Thomas Gilhool,
has emphasized the importance of factual analysis to a demonstration that
the claims are in fact often for freedom from discrimination rather than
special claims for special treatment.l21 Historically, mentally and physically
handicapped persons have been locked away in institutions outside the
communities in which the rest of society lives; they have been excluded
from school systems that otherwise serve a diverse set of needs and interests
and provide a multiplicity of developmental programs; they often have
been unable to attend public meetings or go to public universities because
of architectural barriers. Yet, when permission is sought to establish a group
home in a residential neighborhood, when access is sought to an appropri-
ate educational program in the public schools, or when a proposal is made
to build curb cuts or ramps to facilitate access to public buildings and uni-
versities, it is said that special privilege is being sought. These measures can
as well, or better, be characterized as steps to remove past discrimination.
Essential to this analysis is a recognition that the institutions of our society
serve a broad cross section of needs and that a failure to extend their cov-
erage to a segment of society, such as the handicapped, is itself discrimi-
natory. Thus, the ability to characterize a set of facts as illustrative of dis-
crimination is vital to the way in which resolution of the problem can be
cast.
The examples of education, housing, and employment are specific top-
ics, two of which are addressed in other sections of this chapter. Broad pro-
hibitions against discrimination are important even where there is specific
legislation addressing a particular need. It can supplement these special
provisions and provide a second, and sometimes more flexible, source of
remedy. It also is conceptually important to see specific topical statutes as
I21T. Gilhool, The Right to Community Services, The Mentally Retarded Citizen 173, supra
note 2.
452 MICHAEL KINDRED
specific remedies for a more general problem of discrimination against the

handicapped. The statutory prohibition against discrimination also is
important in areas where the courts have decreed the existence of specific
constitutional rights. Here it is important to reenforce the values articulated
in the constitutional determination. Because constitutional doctrines can be
unmade by the courts as fast as they are made, the statutory provision pro-
vides an important backstop.l22 It is no accident that there is a coincidence
of constitutional rights and statutory rights in antidiscrimination statutes,
since one of the major constitutional principles involved in litigation for
the handicapped is that government cannot claSSify persons in such a way
as to deny rights to some that are granted to others without some rational
basis for doing so. Another is that if government acts in such a way as to
restrict a person's fundamental rights, it cannot be done in a manner that
is broader than would be necessary to accomplish the goal sought by the
restriction.
Psychologists have a number of critical roles to play in combatting dis-
crimination against developmentally disabled persons. Some of these are
addressed in other sections of this chapter. It was noted above that one. role
for psychologists is as advocates in the legislative process to ensure that
their state has adequate antidiscrimination legislation. A second is on for-
mal advisory committees that focus on discriminatory practices. State laws
may mandate such committees. Beyond legally mandated committees, how-
ever, psychologists can playa role in securing the establishment of and
serving on such committees at the local and institutional level as nonman-
dated committees of local government or of institutions in whiCh they work
or with which they are associated in one way or another. Finally, the psy-
chologist as evaluator and counselor of handicapped individuals can play
a critical role. Handicapped individuals may hesitate to identify discrimi-
natory obstacles to their full participation in society and internalize their
difficulties as personal shortcomings or failures. As counselor, the psychol-
ogist can assist the handicapped individual to see that the obstacles are not
of his or her creation. This realization may strengthen the individual and
lead him or her to seek the removal of discriminatory practices.
The psychologist also can play an important role as diagnostician or
evaluator. A recent United States Supreme Court role is illustrative of this
122 Anexcellent illustration of this phenomenon is provided by the case of Halderman v.

Pennhurst State School & Hospital, 446 F. Supp. 1295 (E.D. Pa. 1977), affd. 612 F.2d 84 (3rd
Cir. (en bane) 1979). In this case the district court did hold that institutionalized mentally
retarded persons have a constitutional right to habilitation. It bolstered its position by also
finding parallel rights under the equal protection clause of the 14th Amendment, state
statutes, and Section 504 of the Rehabilitation Act of 1973 (29 U.S.c. 794 (1976».
The Third Circuit noted the judicial preference for statutory, as opposed to constitu-
tional, grounds and interpreted the Developmentally Disabled Assistance and Bill of
Rights Act, Pub. L. 94-103, codified at 42 U.S.c. §§ 6001-6081 (1976) to provide a federal
statutory basis for a right to habilitation. This interpretation was reversed by the United
States Supreme Court in Pennhurst State School and Hospital v. Halderman, 451 U.S.
1(1981).
kind of a role. In Southeastern Community College v. Davis,123 the Supreme

Court was asked for the first time to interpret the effect of the federal anti-
discrimination legislation on recipients of federal funds, in this case a uni-
versity with a nursing program. Ms. Davis had a significant hearing impair-
ment and applied for admission to the nursing program. She was rejected
on the grounds that her hearing impairment would prevent her from fully
participating in the prescribed nursing program, which included instruc-
tion in the operating room context where surgical masks would prevent lip
reading and could endanger patients with whom student nurses work. The
Supreme Court sustained the exclusion, holding that the broad design of
the curriculum, which was inspired in large part by nurse licensing require-
ments through which a licensed nurse is certified as competent to perform
a broad range of tasks, was reasonable and that the college was justified in
its decision that Ms. Davis' hearing impairment disqualified her from the
program. 124 Ms. Davis' position was that she was fully capable of performing
many nursing functions and would be excluded from these areas by exclu-
sion from nurses' training. She wanted a program designed to train her for
those functions she was capable of performing.
The Court ignored the fact that it was the breadth of nursing licensing
and nursing education that created the barrier for Ms. Davis and that this
breadth had the effect of excluding a broad range of handicapped individ-
uals from jobs that they were fully able of performing in spite of their hand-
icap. The Court took the curricular structure and admissions requirements
as givens and held that Ms. Davis was not qualified for nursing training. It
held that the college did not have an obligation to take the kind of "affirm-
ative action" that it saw as needed to accommodate Ms. Davis. l25 It said,
however,
We do not suggest that the line between a lawful refusal to extend affirmative
action and illegal discrimination against handicapped persons always will be
clear. It is possible to envision situations where an insistence on continuing past
requirements and practices might arbitrarily deprive genuinely qualified hand-
icapped persons of the opportunity to participate in a covered program. Tech-
nological advances can be expected to enhance opportunities to rehabilitate the
handicapped or otherwise qualify them for some useful employment. Such
advances also may enable attainment of these goals without imposing undue
financial and administrative burdens upon the State. Thus situations may arise
where a refusal to modify an existing program might become unreasonable and
discriminatory.l26
The Court makes it clear, if it were not before, that there is an "unrea-
sonableness" dimension to discrimination. A psychologist can aid greatly
in the demonstration that exclusions and barriers to inclusion are unreason-
able by evaluations that emphasize graphically the positive competencies
123 442 U.S. 397 (1979) [cite to be filled in, case #78-711, decided 6-11-79]
124!d. at 414.
125ld. at 410.
126ld. at 412-413.
454 MICHAEL KINDRED
of the handicapped individual, the unreasonableness of long-established

practices that result in exclusion of the handicapped, and the relatively
minor nature of the accommodations that would be required in order to
permit inclusion rather than exclusion of handicapped individuals.
OTHER AREAS
There are a considerable number of other areas in which the law deals
with developmentally disabled individuals in such a way that the evalua-
tive and treatment skills as well as the advocacy skills and advisory wisdom
of psychologists can be of great importance. Guardianship and conservator-
ship proceedings require judgments about competence. Welfare entitle-
ments and vocational rehabilitation eligibility may require expert evalua-
tion of disability. Within residential programs and community sheltered
workshop programs psychological evaluation and program prescription
may be of vital importance. And, of course, to the extent that civil commit-
ment still exists, psychologists may be asked to evaluate the suitability of a
developmentally disabled person for institutional confinement.
CONCLUSION
The law has come to be a factor of great importance to psychologists.

A statute that requires that all assessments be done by a physician has a
direct impact on the livelihood and professional standing of psychologists.
A law that requires that evaluations include information that is profession-
ally unattainable places the evaluator-psychologist in an awkward pOSition.
A law that uses terminology that is foreign to a psychologist makes his or
her job in operating within that law perilous. As a result it is critical that
psychologists become involved in the broad professional role of influenc-
ing the law as well as acting within its present structures.
A closing word about advertising is in order. While customary ethical
precepts have taught that advertising is "unprofessional" and could indeed
lead to loss of profeSSional certification, that view is under increasing chal-
lenge. The United States Supreme Court has said that "[W]e find the pos-
tulated connection between advertising and the erosion of true profession-
alism to be severely strained."l27 The Court added: "Since the belief that
lawyers are somehow 'above' trade has become an anachronism, the histor-
ical foundation for the advertising restraint has crumbled."l28 The Supreme
Court has held that total bans on advertising by both lawyers129 and
127Bates v. State Bar of Arizona, 433 U.S. 350, 368 (1977).

128 Id.at 371.
129Id. at 384.
pharmacists130 violate the Constitution's free speech guarantee. It is hard to

see why a similar rationale will not be applicable to psychologists. In the
meantime, parents and friends of developmentally disabled persons often
are ignorant of where they can find professional assistance to help secure
the rights of their developmentally disabled children and friends. Within
the bounds permitted by law, psychologists need to consider making
known their individual willingness to provide such services, either pub-
licly through traditional advertising or more discreetly through the con-
sumer organizations.
130Virginia Pharmacy Board v. Virginia Consumer Council, 425 U.S. 748 (1976).
14
Malpractice Liability of Psychologistsl
R. KIRKLAND GABLE
Psychologists appear to be exposed to increasing risk of malpractice liabil-

ity. This is reflected not only in the frequency of claims but also in their
size. 2 This may be caused in part by the general trend toward using mal-
practice suits against medical and other practitioners when there has been
injury, loss, or dissatisfaction regardless of the practitioner's capability.
Although many persons use the term malpractice to refer to any type of legal
suit against practitioners resulting from their practice, in law it refers spe-
cifically to legal actions based upon the practitioner's negligence. Other
types of liability may arise from the practitioner's assault and battery
(unconsented touching), false imprisonment, or other forms of misconduct.
In fact, practitioners often are sued on several theories of liability of which
malpractice may be only one. Because of the potential importance of this
law to the professional psychologist, the rest of this chapter will review it.
Since cases of malpractice involving only psychologists are rather few,
however, the law applicable to psychologists often must be inferred from
cases involving psychiatrists or other mental health or medical practition-
ers. Following a discussion of malpractice based upon negligence, other
types of potential liability will be considered.
1Because of the rapidly changing law in the area of malpractice and the diversity of decisions
in various jurisdictions, this chapter can present legal principles only in broad outline. If
legal advice or other expert assistance is required, the services of a competent professional
person should be sought.
2Insurance losses through malpractice suits against psychologists show great variability from
year to year but gradually and significantly have increased, e.g., approximately $13,000 loss
in 1964 to about $134,000 loss in 1973. (The loss in 1970 was approximately $260,000. This
resulted from the payment in one case of $210,000 paid in 1974, but aSSigned to 1970, the
year the claim was initiated.) Recent claims have run as high as $2,000,000.
R. KIRKLAND GABLE. Department of Psychology, California Lutheran College, Thousand

Oaks, California 91360.
457
458 R. KIRKLAND GABLE
MALPRACTICE-NEGLIGENCE SUITS
GENERAL INTRODUCTION
The basic concept underlying malpractice is that of negligence. The

law imposes upon psychologists and other mental health personnel special
duties when they work with patients (or clients). Psychological malpractice
may be briefly defined as a negligent act or an omission by a psychologist
during the treatment of a patient that is inconsistent with the reasonable
care and skill usually exercised by similar practitioners of good standing.3
Although the concept of negligence may seem rather straightforward, a
cautionary note may be useful. Readers expecting to find consistency
among legal decisions in this area and clear legal guidelines are likely to be
disappointed. This is because the area of malpractice is undergoing rapid
change and the judicial handling of mental health issues has not always
been a matter of consistency or enlightenment.
For example, in discussing malpractice, Feldman has referred (humor-
ously?) to the "Lallapaluza Rule,"4 which is a rule made arbitrarily by a per-
son to achieve his own immediate advantage. Its fairness is not important.
In Feldman's words:
Courts are also free to utilize the Lallapaluza Rule. In the name of public policy
they may ignore scientific data, the status of medical knowledge, community
standards of practice, and apparently, even logic to impose decisions they
believe desirable. When it became obvious to one early court that a child was
born out of wedlock because the husband had been to sea for 7 years, they
merely rendered the opinion, that in this case, the pregnancy had a duration
equal to that time. Later, other courts, not to be outdone, were free to extend
other pregnancies for even longer periods.
In medical liability for example, the basic issue is negligence. Essentially,
negligence is the means of attaching liability. It is the magic word used for
recovering money damages. Negligence is supposed to mean that the physician
has departed from the standards of his peers, but when the courts ignore com-
munity practices and impose liability based upon their own ex post facto stan-
dards, they impose a difficult burden indeed. In no field of medicine have the
changing rules, the blurred roles, the social pressures, and the confused semlln-
tics been more evident than in psychiatry.s
Feldman's conclusion may not be overly exaggerated. For example, one

legal commentator has called the lawyer in psychiatric malpractice cases the
"healing hammer," since in the writer's opinion a legal wrong "needs to be
nailed to the wrongdoer and the victim made whole.,,6 Use of a legal ham-
mer has unfortunately characterized too much of malpractice litigation.
3See, Dawidoff, D. J. The Malpractice of Psychiatrists. Springfield, Ill.: Thomas, 1973, pp. 15-18;
Tarshis, C. B. Liability for psychotherapy. Faculty of Law Review, 1972,30,75-96.
'Feldman, W. S. The courts and the lallapaluza rule. Journal of Psychiatry and Law, 1976,4,
535-550.
5 ld. at 535-537.
6Sauer, J. G. Psychiatric malpractice-A survey. Washburn Law Journal, 1972,2, 461-470, p.
461.
MALPRACTICE LIABILITY OF PSYCHOLOGISTS 459
Although on the whole, the developments in malpractice law have proba-

bly helped to balance patient and practitioner rights, there has been con-
siderable confusion and misunderstanding. The following general com-
ments are offered to help practitioners avoid treatment by the legal
hammer.
In order for a patient (plaintiff) to succeed in a malpractice action
against a practitioner (defendant), the patient must prove to the court four
facts or "elements" of liability. These are:
1. that the practitioner owed a duty to the patient to conform to a
professional standard of care and skill;
2. that there was a dereliction or breach of this duty by the
practitioner;
3. that because of the dereliction of this duty by the practitioner the
patient suffered some injury or harm; and
4. that the practitioner's dereliction of duty was the direct or proximate
cause of injury or harm suffered by the patient.7
These four elements of malpractice liability will be discussed below.
LEGAL DuTY TO PATIENT
As previously noted, psychological malpractice involves a negligent

(unintentional) act or omission on the part of the psychologist. Negligence,
in turn, presupposes a duty on the part of the psychologist toward the
patient that involves the failure of the psychologist to conform to a profes-
sional standard of care and skill. Care refers to the manner in which the
patient (client) was treated and given attention, while skill refers to the
technical proficiency with which the treatment (service) was conducted.
The legally required standard of care and skill often has been a matter of
litigation and is currently undergoing considerable redefinition and
change; thus there are several different formulations of it.
It often has been said that the practitioner must meet the "generally
accepted" or the "customary" standards of the profession. s It also has been
said that practitioners should possess skill and exercise "reasonable" care.9
Sometimes the term average has been used to describe the skill required of
the practitioner. lo But this could be somewhat misleading. The term average
7See, Heller, M. S. Some comments to lawyers on the practice of psychiatry. Temple Law Quar-
terly, 1957, 30, 401-407, p. 402; Rothblatt, H. B., & Leroy, D. H. Avoiding psychiatric liability.
California Western Law Review, 1973,9,260-272, p. 263.
8See, e.g., Fernandez v. Baruch, 244 A.2d 113 (N.H. 1968).
9Tarshis, supra note 3, at 82.
lOSee, e.g., Shier v. Freedman, 206 N.W.2d 166, 174 (Wise. 1973); Pederson v. Dumouchel, 431
P.2d 973 (Wash. 1967) (en bane); Duckworth, G. F. Torts: Medical malpractice: Expert testi-
mony as affected by the "locality rule." Oklahoma Law Review, 1973, 26, 296-300, p. 300;
Tarshis, supra note 3, at pp. 82-83.
does not refer to an arithmetic mean. That would automatically make one-
half of the practitioners below average and thus legally negligent. It would
be more reasonable to interpret average to mean usual or customary.l1
In the past, practitioners were required to meet the usual and custom-
ary standards of practice within their own or similar localities. This was
known as the "locality rule." Among the reasons for it was the belief that
it would be unfair to hold the small-town practitioner to the same standard
as the practitioner in the more sophisticated urban area. This rule, however,
now has been substantially eroded!2 since most courts now look to the
nationally accepted or customary standards of the practitioner's particular
school of practice.!3 The locality may, however, still be considered as a factor
that might allow some modification or interpretation of the national stan-
dards. For example, some localities may not have resources available that
are necessary to meet those national standards usually considered desirable
and thus it may be unfair to penalize the practitioner.
Although the legally required standard may vary from jurisdiction to
jurisdiction, it is quite clear that the psychologist does not have to be the
best or the most skilled practitioner in his or her particular school of prac-
tice.!4 There is room for professional judgment, even error, before malprac-
tice liability may be imposed upon the practitioner. Yet, practitioners who
claim to be specialists are held to higher standards than the usual practi-
tioner. IS This is because it is reasonable to expect that a specialist has more
than customary skill in dealing with a disorder or problem. Typically, spe-
cialists have been required to use the care and skill customarily used by
other similar specialists throughout the country. As noted in Robbins v.
Footer/ 6 "Specialists are required to exercise that degree of care and skill
expected of a reasonably competent practitioner in his specialty acting in
the same or similar circumstances."
A person is held to the standard of care and skill of a specialist if that
person claims to be a specialist. Thus, for example, a psychologist who
claims to be a specialist in treating enuresis will be expected to be generally
as competent as other psychological specialists in the country who treat this
disorder. The psychologist will be held to this higher-than-usual national
standard regardless of whether he or she has had specialized training in the
treatment of the disorder.
IlDeleon, P. H., & Borreliz, M. Malpractice: Professional liability and the law. Professional
Psychology, 1978,9,467-477, p. 468.
12Chayet, N. L. Malpraetice-a break with the past. New England Journal of Medicine, 1968,278,
1275-1276.
13See, e.g., Pederson v. Dumouchel, 431 P.2d 973 (Wash. 1967) (en bane); Brune v. Belinkoff,
235 N.E.2d 793 (Mass. 1968); Robbins v. Footer, 553 F.2d 123 (D.C. Cir. 1977).
1fTarshis, supra note 3, at 82-83; Johnson v. United States, 409 F. Supp. 1283, 1292 (M.D. Fla.
1976).
15See, e.g., Kronke v. Danielson, 499 P.2d 156 (Ariz. 1972).
16 553 F.2d 123, 129 (D.C. Cir. 1977).
Similarly, psychiatrists, as medical specialists, are held to a higher stan-

dard of care and skill than general medical practitioners when they are
dealing with mental or behavioral problems. For example, in Christy v. Sal-
itermann,t7 a psychiatrist dismissed a patient from a hospital by telephone
without seeing him. Heavy sedation was prescribed for the patient at home
although neither the patient nor his family was warned about the powerful
effects of the medication. During the first night of his release, the heavily
sedated patient set himself on fire with a cigarette and was seriously
burned. The court found the psychiatrist negligent for failing to evaluate
the patient more carefully prior to discharge and for neglecting to warn the
patient about the effects of the medication. The court held the psychiatrist
responsible for meeting the national standards of the psychiatric specialty.
Similarly, psychologists practicing as specialists would be expected to be
familiar with the major treatment concepts of their speciality and to keep
informed about current developments through professional journals and
national conferences. They would be required to have up-to-date skills
developed through workshops and other forms of in-service or postdegree
training.
The standard of care required of a psychologist or other practitioner
may be established, at least in part, by statute and by the psychologist's
membership in professional organizations. For example, the violation of a
state or federal statute or regulation may be used to establish a standard of
required care if the intent of the statute or regulation was primarily to pro-
tect the class of individuals harmed by the psychologist's dereliction. IS
Thus, drug prescriptions by physicians in violation of a statute have been
used to support claims of malpractice. 19 An example of a dereliction of duty
by a psychologist would be the failure to obtain the written consent of a
research subject prior to the conduct of the research if such consent was
required by state statute or by state or local regulations. (The need for
informed consent is discussed in more detail later.)
An example of duty created by membership in a professional organi-
zation was presented in Stone v. Proctor. 20 In that case, a psychiatrist who
was a fellow of the American Psychiatric Association administered a series
of electroshock treatments to a patient who complained of severe pains in
his lower back following the first treatment. Although some treatment was
17 179 N.w. 2d 288 (Minn. 1970).

18See generally, Dornette, W. H. The legal impact on voluntary standards in civil actions
against the health care provider. New York Law School Law Review, 1977,22,925-942. If the
statute or regulation does not contain a provision for civil liability, the decision to use the
statute or regulation to establish a standard of care is a matter of judicial choice if it furthers
the general purpose of the statute or regulation. Id. at 932 citing Restatement (Second) of Torts,
§§ 286, 288B(l),(2) and comments.
19E.g., Rosenfeld v. Coleman, Pa. D &< C 2d 635, 645 (1959) (psychiatrist's violation of Anti-
Narcotics Act); Blinder v. California, 101 Cal. Rptr. 635 (1972).
20 131 S.E.2d 297 (N. Carolina 1963).
given for the pain, no X-rays were taken to determine its cause and electro-
shock treatments were continued and increased in intensity and duration.
After discharge from the hospital, the patient was found to have a com-
pressed fracture of the ninth vertebra. The Committee on Therapy of the
APA had 10 years prior to the suit prepared a document entitled "Standards
for Electroshock Treatment" which had been approved by the Council of
the APA. This document read in part, "If the patient should complain of
pain or impairment of function, he should receive a physical examination,
including X-rays, to ascertain whether he has suffered accidental damage."2!
The Supreme Court of North Carolina concluded that the psychiatrist's fail-
ure to follow the "Standards for Electroshock Treatment" could be used as
evidence of malpractice.
The code of ethics of the profesional organizations to which practition-
ers belong also may be used by the courts to help determine the standard
of care required. Ethical standards are not, however, directly usable as legal
standards in determining negligence. As Tarshis observes,
The real problem is to what extent the ethics can be relied to be a guide to the
court in defining a standard of care. Their generality is self-defeating. There is
nothing that is directly and uniquely applicable to psychotherapy. The precepts
are directed at unethical behavior, not negligent behavior, and the two tests
may give different results. Ethical standards may be more or less rigorous than
negligent standards depending on the circumstances. However, they may still
be useful as corroborative of a reasonable standard of practice. 22
Thus a practitioner who violates an ethical standard should be alert to the

increased risk of malpractice liability.
Practitioners, however, do not have to conform perfectly to all pub-
lished statutes, regulations, professional standards, and ethical codes to
avoid liability for malpractice. Reasonable modifications or deviations are
permitted based upon the particular circumstances of the case. Experts often
disagree as to the best course of treatment, especially in the practice of psy-
chotherapy. Practitioners are not even required to conform their practices
to the dominant or majority view in the profession, but their practice
should generally be acceptable to a "respectable minority" or school within
the profession. If not, then their practices may be characterized as experi-
mental and the patients and clients should be so informed.
In addition, practitioners are permitted to modify in a reasonable man-
ner traditional methods of practice. Otherwise, there would be little prog-
ress toward the improvement of treatment. Thus, psychiatrists have been
permitted to use the relativeiy new "open door" approach to the release of
mental patients from hospitals as this approach gradually obtained profes-
sional recognition. In evaluating this new "open door" policy, a federal dis-
trict court determined that under the applicable law, "a physician is not an
insurer of a successful cure; he may decide which of two or more approved
21Id. at 298.
methods to use in treating a patient, and will not be liable for honest mis-
takes or errors of judgment so long as he was exercising a reasonable degree
of care and skill."23
Yet, although a practitioner may follow the generally accepted and cus-
tomary standards of practice, there may nevertheless be some small risk of
liability. This may result from the application of the so-called Lallapaluza
Rule previously mentioned. The court determines the standard to apply
even if that standard is beyond that of customary pracitce. For example, in
a well-known case imposing liability upon a hospital, Darling v. Charleston
Community Memorial Hospital,24 the Illinois Supreme Court agreed with the
hospital that it had followed the usual standard of practice. The court con-
cluded, however, that there are occasions when "a whole calling may have
unduly lagged" and a higher standard must be judicially imposed. 25 The
hospital was found liable. In an earlier case,26 a court decided that even
though it was customary for surgeons to accept the count of sponges made
by nurses this was not an acceptable procedure. A sponge left in the abdo-
men of the patient was negligent practice and the surgeon could be found
liable for malpractice.
More recently, the Supreme Court of Washington determined that two
ophthalmologists in joint practice were negligent for failing to give a
patient under 40 years of age a pressure test to determine glaucoma. 21 The
defendant argued that the generally accepted standard of professional prac-
tice did not require the giving of routine pressure tests to persons under 40
because the risk of glaucoma is rare in this lower age group. (Approximately
one person out of 25,000 under 40 may have glaucoma.) The court noted
that the test for glaucoma is simple, relatively inexpensive, and involves no
judgment. It then concluded, "Under the facts of this case reasonable pru-
dence required the timely giving of the pressure test to this plaintiff. The
precaution of giving this test to detect the incidence of glaucoma to patients
under 40 years of age is so imperative that irrespective of its disregard by
the standards of the opthalmology profession, it is the duty of the courts to
say what is required to protect patients under 40 from the damaging results
of glaucoma.,,28
23Johnson v. United States, 409 F. Supp. 1283, 1292 (M.D. Fla. 1976). See also Johnston v. Rodis,
151 F. Supp. 345 (D. D.C. 1957). rev'd on other grounds, 251 F.2d 917 (D.C. Cir. 1958); Slov-
enko, R. Psychiatry and law. Boston: Little, Brown, 1973, pp. 407-408.
24211 N.E.2d 253 (Ill. 1965).
2SId. at 257 citing the T. J. Hooper case, 60 F.2d 737, 740 (2nd Cir. 1932). In that famous case,
Judge Learned Hand wrote the decision in which it was decided that custom alone could
not establish the required standard. Tug boats such as the "Hooper" usually did not have
radio receiving sets to obtain weather reports but they were legally required to have them
in order to avoid loss and accidents. The T. J. Hooper, 60 F.2d 737, 740 (2nd Cir. 1932).
26 Ales v. Ryan, 64 P.2d 409 (Cal. 1936). See also Morgan v. Sheppard, 188 N.E.2d 808 (Ohio
Ct. App. 1963).
27Helling v. Carey, 519 P.2d 981 (Wash. 1974).
28 ld. at 983.
Finally, Roston and Sherrer9 have noted that an accountant was found
liable even though he followed "generally acceptable accounting princi-
ples." In commenting on this case, they suggest that the accountant's legal
defense that he followed acceptable practice "would be roughly comparable
to a psychologist defending his actions by alleging that he complied with
the professional and ethical standards of the American Psychological Asso-
ciation and had used his skills and abilities as most other psychologists
would."30
DERELICTION OF DuTY
Before malpractice liability can be imposed, there must be proof of the

dereliction or breach of a duty owed by the practitioner to the patient. In
psychiatric and psychological practice, there are special areas of dereliction
of duty that have tended to give rise to malpractice suits. Several are dis-
cussed below:
Failure to Obtain Informed Consent

Prior to diagnosis or treatment in most cases, a psychologist must
obtain the informed consent of the patient, the patient's parents or guard-
ian, or in the case of a mentally incompetent patient, from the court. There
are times, however, when the patient's consent may be inferred from the
behavior of the patient when he voluntarily goes to the psychologist and
cooperates with procedures such as testing, psychotherapy, group encoun-
ter sessions, parent training, and behavior modification. This is usually a
reasonable inference and is accepted in medical practice. 31 But it assumes
that the patient has the necessary information to make a reasonable decision
about participation. There not only must be consent, there must be informed
consent. A few clients may not have sufficient information or the mental
capacity to give informed consent. For this reason, as well as for evidential
purposes, most legal commentators urge the use of written consent forms
(or tape recordings) to provide some evidence that the client or patient has
been fully informed about the treatment. 32
If the practitioner obtains the patient's consent, but the information
given to the person prior to the consent is inadequate, the practitioner may
29Roston, R. A., & Sherrer, C. W. Malpractice: What's new. Professional Psychology, 1973,4,
270-276.
3lJld. at 271.
31Slovenko, supra note 23, at 405.
32 E.g., Rothblatt and Leroy, supra note 7, at 268.
be liable for either malpractice or battery (discussed later). The claim for
malpractice in this situation is the more common and current view.33 The
practitioner is considered negligent because practitioners have a duty (and
it is a generally accepted and customary practice) to provide adequate infor-
mation to the prospective patient.
Granting that some information must be given to a prospective patient
prior to obtaining consent, the issue becomes one of determining what that
information is. Although the legal requirements here are blurred and vary
from jurisdiction to jurisdiction, some guidelines might be suggested. The
relationship between the practitioner and the patient should be one of can-
dor and trust. It is sometimes said to be a "fiduciary" relationship in which
the practitioner must take particular care to be honest, fair, and concerned
with the welfare of the patient or client.34 In Cobbs v. Grant, 35 the Supreme
Court of California summarized the duty of disclosure in the following
manner:
[T]he patient's right of self-decision is the measure of the physician's duty to
reveal. That right can be effectively exercised only if the patient possesses ade-
quate information to enable an intelligent choice. The scope of the physician's
communications to the patient, then must be measured by the patient's need,
and that need is whatever information is material to the decision. Thus the test
for determining whether a potential peril must be divulged is its materiality to
the patient's decision.
There would probably be general agreement that the practitioner must

provide information about the basic nature of the proposed treatment, and
the "material risks" involved. 36 The materiality of the risks may be deter-
mined by the incidence and severity of possible injury considered in light
of the patient's particular concerns. One court has used the following defi-
nition of material risk: "A risk is thus material when a reasonable person,
in what the physician knows or should know to be the patient's position,
alE.g., Shetter v. Rochelle, 409 P.2d 74, 86 (Ariz. 1965); Aiken v. Clary, 396 S.W.2d 668 (Mo.
1965); Miller v. Kennedy, 522 P.2d 852 (Wash. Ct. App. 1974); Wilson v. Scott, 396 S.W.2d
532 (Tex. Cir. App. 1965), aff'd. 412 S.W.2d 299, 301, 302 (1967); Aden v. Younger, 120 Cal.
Rptr. 535 (Calif. Ct. App. 1976) (dicta). Edwards, S. L. Failure to inform as medical malprac-
tice. Vanderbilt Law Review, 1970, 23, 754-774.
34See, e.g., Miller v. Kennedy, 522 P.2d 852, 860 (Wash. Ct. App. 1974); Dawidoff, supra note
4, Chapter IV, at 43-60.
35Cobbs v. Grant, 502 P.2d 1, 11 (1972) (en banc). To impose liability, there must be a causal
relationship between the failure to inform and the plaintiff's injury, i.e., proof that had the
plaintiff been fully informed he (or a prudent person) would not have consented to the
treatment. Id. at 11-12.
36See, e.g., Getchell v. Mansfield, 489 P.2d 953, 956 (Or. 1971); Mitchell v. Robinson, 334
S.W.2d 11 (Mo. 1960); Meisel, A. The expansion of liability for medical accidents: From
negligence to strict liability by way of informed consent. Nebraska Law Review, 1977, 56, 51-
152 (argues that the doctrine of informed consent is moving toward imposing liability upon
physicians that is similar to strict liability); Edwards, supra note 33, at 770.
would be likely to attach significance to the risk or cluster of risks in decid-

ing whether or not to undergo the proposed therapy.'t37
But what probability of harm constitutes a material risk? Here, again,
there is no clear legal answer. Not only do the courts disagree, but pro-
spective patients may weigh probable risks differently. Clearly, "it is not
necessary that a physician tell the patient any and all of the possible risks
and dangers of a proposed procedure."38 But "a very small thance of death
or serious, disablement may well be significant; a potential disability which
dramatically outweighs the potential benefit of therapy or the detriments
of the existing malady may require appropriate discussions with the
patient."39 In one malpractice suit, the court suggested that it was standard
medical practice to inform prospective patients of a one percent likelihood
of a loss in hearing following stapedectomy.40 A 3% risk of death or paralysis
in an arteriogram procedure has been sufficient risk to require disclosure.41
Some courts, however, have decided that very improbable or very
minor risks need not be disclosed. One court concluded that there was no
need to inform the parents of a child of the unlikely possibility that as their
child recovered from anesthesia his struggle might cause a catheter to punc-
ture his heart (which unfortunately resulted in death)Y The court in Cobbs
observed that the patient need not be given "a lengthy polysyllabic dis-
course on all possible complications" or a "mini-course in medical sci-
ence."43 Thus, relatively minor risks inherent in common procedures need
not be discussed "when it is common knowledge that such risks inherent
in the procedure are of very low incidence."" On the other hand, compli-
cated procedures that involve a risk of death or serious harm require an
explanation in lay terms. 45 Let us consider now what this law would mean
in specific psychological practice situations.
The risk of serious injury or untoward results from electroshock treat-
ment requires disclosure to the prospective patient. 46 Other forms of mental
treatment, whether organic or not, probably would require the disclosure
of risks of similar probability and seriousness. Ideally, the prospective
37Holland v. Sisters of Saint Joseph of Peace, 522 P.2d 208, 211-212 (Or. 1974) (en banc),
quoting Waltz, J. R., and Scheuneman, T. W. Informed consent to therapy. Northwestern
University Law Review, 1969,64,638,640.
38Wilkinson v. Vesey, 295 A.2d 676, 689 (R.1. 1972).
39Id.
"'Wilson v. Scott, 412 S.W.2d 299 (Tex. 1967).

41Bowers v. Talmadge, 159 So.2d 888 (Fla. Ct. App. 1963).
42Williams v. Menehan, 379 P.2d 292 (Kan. 1963); see also Natason v. Kline, 350 P.2d 1093,
rehearing denied 354 P.2d 670 (Kan. 1960).
43 502 P.2d 1, 11, (Calif. 1972) (en banc).
44Id.
45Id. The court also noted that the physician must reveal to the patient "such additional infor-
mation as a skilled practitioner of good standing would provide under similar
circumstances."
"See, e.g., Mitchell v. Robinson, 334 S.W.2d 11 (Mo. 1960); Woods v. Brumlop, 377 P.2d 520
(N. Mex. 1962).
patient should be informed about (1) the diagnosis or purpose of the treat-
ment, (2) the nature and duration of the treatment, (3) the risks involved,
(4) the prospects of success or benefit, (5) possible disadvantages if the treat-
ment is not undertaken, and (6) alternative methods of treatment. 47
Focusing specifically upon treatment using behavior modification pro-
cedures, Tryon48 has discussed the disclosure necessary for informed con-
sent after treatment goals and options have been considered. He suggests
the following:
The therapist should describe the procedures that constitute the various treat-
ments, the length of time that treatment will require, the cost of such treatment,
and any possible side effects that could reasonably be expected to occur as a
result of the treatment. For example, if parents were being counseled to extin-
guish a child's temper tantrums by ignoring this behavior, then the parents
should also be told that extinction initially produces increased variability and
intensity of response; hence, the parents should expect the temper tantrums to
increase before they decrease. The parents should also be told that the child
may attempt to modify the parents' behavior with some new form of undesir-
able behavior. If aromatic ammonia (smelling salts) were to be used as the
unconditioned stimulus in an olfactory aversion treatment, then the client
would have to be told that repeated inhalation of aromatic ammonia can cause
vasodilatation and thereby produce headaches and nasal irritation.49
In a few situations, the duty to disclose may be reduced because a

detailed disclosure would unduly disturb an unstable patient thus making
successful treatment less likely.50 Such nondisclosure may, however,
involve considerable legal risk. (In such situations, it might be therapeuti-
cally and legally useful to discuss the treatment with a spouse, close rela-
tive, or best friend of the patient.) However, somewhat inadequate or less
than desirable disclosure of information is not sufficient to impose liability.
There is room for moderate error or mistaken judgment; liability requires
"unreasonably inadequate" communication. 51 Finally, there are two com-
mon legal defenses to allegedly inadequate disclosure. One is that the
patient knew or should have known of the risks without the disclosure. 52
The other is that the patient did not wish to be informed about the treat-
ment or its risks. 53
Special issues of consent are presented by mentally incompetent per-
sons. For example, persons committed by a court to a hospital or clinic for
47 Adapted from Louisell, D. W., & Williams, H. Medical malpractice. New York: Matthew
Bender, 1960, § 22.01.
48Tryon, W. W. Behavior modification and the law, Professional Psychology, 1976,7,468-474.
49 Id. at 471.
SIlsee generally, Woods, v. Brumlock, 377 P.2d 520 (N. Mex. 1962); Wilkinson v. Vesey, 295
A.2d 676 (R.I. 1972); Louisell & Williams, supra note 47, at § 22.02; Pappas, G. Informed
consent: A malpractice headache. Chicago-Kent Law Review, 1970,47,242-252, p. 250.
51 See, Wilkinson v. Vesey, 295 A.2d 676, 689 (R.l. 1972).
52Edwards, supra note 33, at 770.
53see Cobbs v. Grant, 502 P.2d 1 (Calif. 1972) (en bane); Aden v. Younger, 129 Cal Rptr. 535
(Calif. Ct. App. 1976) (dicta).
observation prior to a formal determination of their mental competency

should not be treated without their express consent. Commitment for obser-
vation (as well as involuntary civil commitment in many states) is not a
determination of the patient's competency to make treatment decisions or
to refuse treatment. In many jurisdictions, a specific judicial finding of
incompetency on the part of the patient is required prior to unconsented
treatment. 54 Such a finding may be conveniently made at the initial com-
mitment hearing without necessitating an additional hearing after commit-
ment. In some jurisdictions, however, consent by the court on behalf of the
patient may be inferred from the court's commitment of the patient for care
and treatment as found in many commitment statutes.55
Improper Diagnosis or Evaluation

Historically, the courts have recognized the difficulty that mental
health practitioners may have in assessing mental status and future conduct.
For example, patients assessed as being nonviolent who have been released
from hospitals have subsequently injured others or committed suicide. If
the assessment prior to release followed generally accepted and customary
practice, the practitioner usually has not been found liable. There have,
however, been exceptions.56 Slovenko57 has summarized the general trend
of the cases involving faulty psychiatric diagnosis:
A physician who makes a diagnostic mistake or error in judgment does not
incur liability, whatever the harm, provided the error is one which other sim-
ilarly trained physicians would have made under comparable circumstances,
and provided that all necessary diagnostic means were utilized. A mistaken or
missed diagnosis does not in itself constitute fault or malpractice. A physician
is not a warrantor of cures. The patient must establish that a wrong diagnosis
or treatment was caused by the physician's failure to exercise ordinary diligence
and skill and that it led to untoward consequences.
Moreover, the practitioner must exercise reasonable care and diligence

in the application of knowledge and skill. Good faith or intention alone is
54A specific finding of this type may be particulary necessary in those states that do not
include as a commitment criterion the patient's lack of insight or capacity to make treatment
decisions. In those states that do include this criterion for commitment, e.g., Hawaii, South
Carolina, and Utah, or provisions for treatment, e.g., Kansas, Michigan, and North Dakota,
a reasonable inference may be made that standard forms of nonintrusive treatment may be
conducted with nonprotecting committed patients. A table of state commitment criteria in
the 50 states and the District of Columbia may be found in Schwitzgebel, R. K., Survey of
state civil commitment statutes, in McGarry, A. L., Schwitzgebel, R. K., Lipsitt, P. D., &
Lelos, D. Civil commitment and social policy. Washington, D.C.: National Institute of Health
(Center for Studies of Crime and Delinquency), GPO, 1981.
55In situations where the consent is inferred and the patient expressly or indirectly refuses
to cooperate in treatment, express consent should be obtained from the court or a court-
appointed guardian or committee.
56See text infra at notes 89 to 100.
57Slovenko, supra note 23, at 399.
not sufficient to avoid liability if an inaccurate assessment harms the patient

or others. There is, however, some room for honest error. The reason for
allowing some error was expressed in Taig v. States in which the court
found that the practitioner was not liable for the assault and battery com-
mitted by a released patient. In the words of the court
If a liability were imposed on the physician or the State each time the prediction
of future course of mental disease was wrong, few releases would ever be made
and the hope of recovery and rehabilitation of a vast number of patients would
be impeded and frustrated. This is one of the medical and public risks which
must be taken on balance, even though it may sometimes be in injury to the
patient or others. 59
Liability for misdiagnosis most often involves the incorrect assessment

of a physical disorder rather than the assessment of mental status or future
conduct. For example, in Brown v. Moore6/) physicians were found negligent
when they diagnosed a physical disorder as an hysterical paralysiS without
conducting the proper tests. As a result the patient suffered progressive
paralysis and died. However, liability has been imposed for the negligent
diagnOSis of a mental condition, particularly when that diagnosis has
resulted in commitment.61
As a general rule, there must be at least an examination of a patient
before arriving at a diagnosis of the patient's mental status. 62 The casual
observation of a prospective patient in a store or on the street may not be
sufficient examination for the certification of a patient for commitment.63 In
addition, particular care should be taken to avoid relying upon hearsay in
reaching conclusions about the client. Statements by others about the client
may be based upon misunderstanding or hostility.64 Moreover, the courts
generally have been concerned that the examinations be carefully con-
ducted. 6S Negligent or careless examinations may result in liability.66
For example, in O'Neil v. State,67 a physican at a state mental hospital
failed to discover a newly admitted patient's addiction to barbiturates
58 241 N.Y.S.2d 495 (App. Div. 1963).
"'[d. at 496-497. See also, Johnson v. United States, 409 F. Supp. 1283,1293 (M.D. Fla. 1976)
(prolonged commitment to be avoided).
60 247 F.2d 711 (3rd Cir. 1957); see also Stone v. Proctor, 131 S.E.2d 297 (N.C. 1963) text at supra
note 20.
61 See, e.g., Kleber v. Stevens, 241 N.Y.S.2d 497 (Sup. Ct. 1963). But many states provide priv-
ilege or immunity for practitioners involved in the judicial commitment process. For a
detailed discussion of malpractice and involuntary commitment, see Dawidoff, supra note
3, Chapter VIII, pp. 98-128.
62See, e.g., O'Rourke v. O'Rourke, 50 So.2d 832 (La Ct. App. 1951); Daniels v. Finney, 262
S.W.2d 431 (Tex. Civ. App. 1953).
63Bacon v. Bacon, 24 So. 968 (Miss. 1899).
MSee, e.g., Kleber v. Stevens, 241 N.Y.S.2d 497 (Sup. Ct. 1963) (vindictive husband).
65See, e.g., Beckham v. Cline, 10 So.2d 419 (Fla. 1942).
66S ee, e.g., DiGiovanni v. Pessel, 250 A.2d 756 (N.J. 1968); Kleber v. Stevens, 241 N.Y.S.2d 497
(Sup. Ct. 1963).
67 323 N.Y.S.2d 56 (Ct. Cl. 1971).
although the patient mentioned taking a barbiturate and exhibited signs of

barbiturate poisoning. Also, the physican did not attempt to obtain medical
records of her prior admission at the same hospital that would have shown
that the symptoms were a result of drug abuse. The patient died within four
days. The court noted that honest errors of professional judgment are allow-
able, but in this situation, the physician was liable for the incorrect diag-
nosis because he failed to follow proper and acceptable medical procedure.
Physical Contact and Sexual Relations

Physical contact with patients or clients when consented to is not nec-
essarily malpractice. In fact, the typical practice of medicine would be
impossible without physical contact. (Even an X-ray is legally a "touching"
of the patient.) Liability depends upon the nature of the consent and the
contact. For example, consider the case that is probably most frequently
cited in this area involving malpractice liability, Hammer v. Rosen. 68 Dr. John
Rosen was a psychiatrist well known for his innovative and controversial
treatment method of "direct analysis" used with schizophrenics. This
involved becoming a parental figure for his patients and directly interpret-
ing unconscious material that often was shocking to his patients (and audi-
ences). The plaintiff was treated by him for seven years for schizophrenia
at a total cost of $55,000. Prior to treatment by Dr. Rosen, she had received
between 150 and 200 electroshock treatments from other practitioners. Dur-
ing "direct analysis," Dr. Rosen allegedly struck or beat her on several occa-
sions which might have caused her some unnecessary pain and suffering.
The Court of Appeals of New York modified a decision of a lower court and
noted that "the very nature of the acts complained of bespeaks improper
treatment and malpractice and that, if the defendant chooses to justify those
acts as proper treatment, he is under the necessity of offering evidence to
that effect."69 Damages also have been awarded when mental hospital atten-
dants have struck or choked patients. 70 In fact, physical abuse can lead not
only to civil liability but to criminal liability as well. If the patient or client
is not a legal adult in the jurisdiction, child abuse statutes might also be
applicable.
Liability for malpractice also has been found for "rage reduction" ther-
apy by a psychologist which resulted in injury to the client.71 The client
claimed that for 12 hours in a group session, she was "choked and tortured
68 181 N.Y.S.2d 805 (Sup. Ct. 1959), modified, 198 N.Y.S.2d 65, 165 N.E.2d 756 (Ct. App. 1960)
(no liability imposed on claims of fraud and breach of contract). Note that plaintiffs alleging
physical contact have relied upon a wide variety of legal theories in addition to malpractice.
69 Id. 165 N.E.2d at 757.
7°E.G., Traver v. Feinstein, 331 N.Y.S.2d 150 (App. Div. 1972); Davis v. N.Y., 332 N.Y.S.2d 569
(N.Y. 1972).
71Abraham v. Zaslow, 1 Civil 33219, Sup. Ct. No. 245862 (Cal. Ct. App. Feb. 2,1975). See also
Psychologist faces malpractice charges. APA Monitor, September 1972, 3, 1.
and beaten and couldn't get out of the situation."n After the session, she
allegedly suffered from acute anxiety, bruises, vomiting, and temporary
renal failure of both kidneys. The appellate court affirmed a judgment
against the psychologist because, in part, the treatment did not conform to
an acceptable standard of care.
Sexual relationships with patients or clients, although sometimes advo-
cated as therapeutically acceptable,73 have not been approved by the psy-
chiatric or psychological professions. The 1977 revision of the Ethical Stan-
dards of Psychologists expressly states that "Sexual intimacies with clients are
unethical.,,74 In the case of Zipkin v. Freeman/ 5 the psychiatrist took advan-
tage of a patient who "fell in love" with him. Not only was sexual intimacy
involved, but he also induced the patient to live with him and work on his
farm. She was encouraged to sue her husband and steal from him. On one
occasion, the psychiatrist gave her a pistol and directed her to go to her
husband's home where she was to "shoot anyone who got in the way and
to take anything she might want."76 This, of course, goes far beyond accept-
able practice.
In Roy v. Hartogs,77 a psychiatrist allegedly administered sexual inter-
course to a woman for over one year to cure her lesbianism. He was found
liable for malpractice. Sexual intercourse under the guise of treatment has
consistently resulted in civil liability and sometimes has led to criminal
charges of rape, seduction, assault, and battery, or criminal conversation
(wrongful appropriation of another person's property). The plaintiff in Roy
claimed she was misled. However, a dissenting judge noted that the plain-
tiff's mental competency was not at issue. "Is it not fair to infer, therefore,
that she was capable of giving a knowing and meaningful consent? For
almost one and a half years while this 'meaningful' relationship continued,
the plaintiff was not heard to complain. Upon the defendant terminating
the relationship, this lawsuit evolves."78 While consent does not eliminate
liability for malpractice, it may reduce the likelihood of legal actions based
upon other legal theories such as deception or unconsented touching, such
as assault and battery.
72 Id. at 3.
73E.g., Shepard, M. The love treatment: Sexual Intimacy Between Patients and Psychotherapist. New
York: Wyden, 1971.
74 American Psychological Association, Ethical Standards of Psychologists. Washington, D.C.:
Author, 1977, Principle 6(a), p. 4.

75 436 S.w.2d 753 (Mo. 1968).
76Id. at 759.
77366 N.Y.S.2d 297 (N.Y.C. Civ. Ct. 1975); 381 N.Y.S.2d 587 (Sup. Ct. App. Term 1976). The
defendant psychiatrist presented evidence of a physical disability that would not have per-
mitted him to have sexual intercourse with the patient. Nevertheless, the patient was
awarded $153,679.50 in damages. A later court asserted that the defendant "prescribed and
personally administered multiple, repetitive doses of 'fornicatus Hartogus' to the patient."
Hartogs v. Employers Ins., 89 Misc. 2d 468 (N.Y. Sup. Ct. 1977).
78Id. at 591.
In Nicholson v. Han/ 9 a psychiatrist treated a husband and wife to

improve the couple's marriage. The marriage situation, however, deterio-
rated over a period of years and there was finally a divorce. Two years later
the husband accidentally happened to see a hospital record pertaining to
his former wife that indicated that she had been sexually intimate with the
psychiatrist during and following the course of therapy. Following a com-
plex legal battle, the court determined that the husband's claim was not for
malpractice, but for alienation of affection and criminal conversation. For-
tunately for the psychiatrist, these two causes of action were eliminated by
the state legislature shortly before the suit was filed. The psychiatrist was
not found liable.
Sexual intimacy with the spouse of a client also may result in malprac-
tice liability, particularly if that client is being seen for marriage counseling.
In Whitesell v. Green so a psychologist was intimate with a client's wife. The
court concluded that practitioners in good standing generally are not inti-
mate with client's wives as a method of treating marital discord.
Although sexual intimacy with patients and clients is uniformly con-
demned in official publications, actual behavior often seems to be in vari-
ance. A survey of 460 physicians by Kardener et al. found that five to fifteen
percent of the physicians engaged in erotic behaviors including intercourse
with patients.S! Nineteen percent of the sample of physicians indicated a
belief that erotic contact with a patient might be beneficial to a patient. In
a different study, 25% of a sample of freshmen medical students believed
that sexual intimacies with patients might be acceptable if there was a gen-
uineness of feeling between the two parties,B2 although psychiatrists are less
likely to engage in erotic acts than obstetrician-gynecologists and general
practitioners.83 Kardiner concludes, "To those who would forsake their
patients' needs in the pursuit of the gratification of their own (even openly
acknowledged) needs, Berne's injunction applies, 'If you want the patient
to be your therapist, be sure first that you can afford to pay him your usual
fee."'" This admonition applies to psychologists as well. Holroyd and
Brodsky s5 found that 27% of the 703 psychologists sampled occasionally
79 162 N.w.2d 313 (Mich. Ct. App. 1968).
8°Hawaii District Court, Honolulu, Docket No. 38745 (Nov. 19, 1973).
81Kardener, S. H., Fuller, M., & Mensh, I. N. A Survey of physicians' attitudes and practices
regarding erotic and nonerotic contact with patients. American Journal of Psychiatry, 1973,
130, 1077-1081; Kardener, S. H. Sex and the physician-patient relationship. American Jour-
nal of Psychiatry, 1974, 131, 1134-1136. A sample of 114 psychiatrists indicated that 5% of
those responding had engaged in sexual intercourse with patients.
82Wagner, N. Ethical concerns of medical students. Paper read at the 1972 Western Workshop
of the Center for Sex Education in Medicine, Santa Barbara, Calif., 1972. Cited in Kardener,
supra note 81.
83Kardener, supra note 81.
84Kardener, supra note 81, at 1136. (Berne, E. Principles of Group Treatment. New York: Oxford,
1966, p. 358 as cited in Kardener).
8SHolroyd, J. c., & Brodsky, A. M. Psychologist's attitudes and practices regarding erotic and
nonerotic physical contact with patients. American Psychologist, 1977, 843-849.
engaged in nonerotic hugging, kissing, or affectionate touching with oppo-

site-sex clients. Of those sampled, 5.5% of the males and .6% of the females
had sexual intercourse with clients during treatment.
Finally, clinics that use sexual surrogate partners in treatment pro-
grams run the risk of charges of pandering, prostitution, adultery, and other
offenses. However, it has been argued that legitimate, medical practitioners
should be permitted to offer sexual therapy to appropriate patients86 and
Perr suggests that psychotherapy, sex therapy, and personal relationships
be sharply distinguished. B7 Outside of the therapeutic context, "occurrences
in which therapists and patients do become involved in a meaningful and
mature relationship are frequent enough to reflect that such may not be
pathological and harmful. Therapists and patients have married or other-
wise have become reasonably involved in a nontherapeutic relationship.
This is not to be confused in any manner, however, with sexual activity
entered into in the guise of therapy. If a personalized relationship develops,
then alternate modes of therapy and referral elsewhere should be
considered."88
Suicide and Homocide by Patients

Practitioners and hospitals have been held liable for self-inflicted inju-
ries and suicide by patientsB9 and typically liability has most often been
found where the patient was hospitalized. 90 The reason for this is simply
that the private practitioner lacks the same ability to observe and control
the patient that the practitioner has in a hospital setting. The required stan-
dard of care is difficult to determine because legal decisions are sometimes
both conflicting and inconsistent with professional practice. 91 The court in
Fernandez v. Baruch 92 has summarized the general view
The controlling factor in determining whether there may be a recovery for fail-
ure to prevent a suicide is whether the defendants reasonably should have
anticipated the danger that the deceased would attempt to harm himself ....
Since there was no proof that generally accepted medical standards required
the defendant doctors to conclude that Fernandez was likely to attempt suicide,
they cannot be said to be guilty of malpractice in not predicting to the police
that the decedent might attempt to do away with himself.
86Leroy, D. H. The potential criminal liability of human, sex clinics and their patients. Saint
Louis University Law Journal, 1972, 16,586-603.
B7Perr, I. N. Legal aspects of sexual therapies. The Journal of Legal Medicine, 1975,3,33-38.
88 Id. at 98.
B9See, e.g., Hunt v. King County, 481 P.2d 593 (Wash. Ct. App. 1971). A useful listing of cases
appears in Slovenko, supra note 23, at 425-426.
90See Schwartz, V. E. Civil liability for causing suicide: A synthesis of law and psychiatry.
Vanderbilt Law Review, 1971, 24, 217-256, p. 246.
91See discussion in Perr, I. N. Suicide and civil litigation. The Journal of Forensic Sciences, 1974,
19,261-266.
92 244 A.2d 109, 112 (N.J. 1968) (psychiatrists not liable for release of a patient to the police
who four days later committed suicide).
Moreover, at least three factors appear to be important in determining lia-

bility: (1) the foreseeability of the patient's suicidal attempt, (2) the reason-
ableness of professional judgment in directing a course of treatment, and
(3) the dependability with which the patient carried out the directions for
treatment.
The foreseeability of a suicide attempt is a matter of professional spec-
ulation and debate. Liability is rarely imposed in the absence of some prior
observable acts or verbal threats by the patient. For example, in Bogust v.
Iverson,93 a college student at a state college saw a college guidance coun-
selor for personal problems. After five months of sessions, the counselor
suggested that the interviews be terminated. Six weeks later, the student
committed suicide. There were no clear indications of suicide and no behav-
iors that would have prompted the counselor to initiate procedures for the
civil commitment of the student. The court properly found the counselor
not liable and also noted that a guidance counselor might not be held to
the same degree of care as a person trained in medicine or psychiatry. It is
tempting to think that the imposition of liability for client suicide in situ-
ations like this would increase the quality of care for this age group which
has a high rate of suicide. However, the difficulty in predicting suicide and
the limited effectiveness of available treatment interventions suggest that
liability should not be presently expanded.
Practitioners may be held liable for certain reasonably foreseeable,
harmful acts of those patients under their care. As in the situation with sui-
cide, the nature of that duty is only vaguely defined. In Merchants National
Bank & Trust Co. v. United States94 psychiatrists and psychologists were found
liable when they released a patient from a Veterans Administration Hos-
pital and placed him on a ranch without informing the owner about his
mental illness. They also failed to give the owner specific instructions for
the patient's care or supervision. The patient left the ranch and attempted
to run down his wife with a car. Failing that, he left the vehicle and shot
and killed her. She had earlier repeatedly warned the hospital that he
would attempt to kill her. The court concluded that "[T]he Government's
agents and employees not only did not exercise due care; in the view of this
Court they exercised no care at a11."95
In another case imposing liability,% the difficulty began when a
recently released mental patient attended a conference with his wife's attor-
ney. Suddenly, without warning, the patient leaped across the desk and bit
off a portion of the attorney's nose .. The patient was charged with assault
and battery for which he was sentenced to three years in prison. The attor-
ney also sued and won a judgment for $200,000 against a psychiatrist and
93 102 N.W.2d 228 (Wise., 1960).

94 272 F. Supp. 409 (D.N.D. 1967).
95 [d. at 417.
96Vassalo v. County of Westchester Halcyon Rest Hosp., cited in Medical World News; $200,000
award points toward widening malpractice liability, October 14, 1966, 170-171.
the hospital on the theory that they failed to confine and supervise a dan-
gerous mental patient.
Cases such as these, however, reflect the exception rather than the gen-
eral rule in judicial decisions. The usual standard is whether a hospital or
practitioner followed that degree of care that a reasonably prudent person
would have exercised under the same or similar circumstances. This stan-
dard may take into account the uncertainties of psychiatric analysis and
"negligence may not ordinarily be found short of serious error or mistake,
and not necessarily when the error or mistake is serious."97 An illustrative
case is Johnson v. United States. 98 In this case, a released mental patient killed
his brother-in-law, wounded his wife, and committed suicide. The patient
received extensive evaluation and treatment prior to his release, but there
was an error in assessment with regard to his future dangerousness. In view
of the difficulty of predicting dangerousness and the current "open door"
policy of hospitals, the court found no liability. In the words of the Johnson
court:
Modern psychiatry has recognized the importance of making every reasonable
effort to return a patient to an active and productive life. Thus, the patient is
encouraged to develop his self-confidence by adjusting to the demands of
everyday existence. In this view, mental hospitals are not seen as dumping
grounds for all persons whose behavior society might find inconvenient or
offensive; institutionalization is the exception, not the rule, and is called for
only when a paramount therapeutic interest or the protection of society leaves
no choice. Furthermore, all the expert witnesses for both parties agreed that
accurate predictions of dangerous behavior, and particularly of suicide and
homicide, are almost never possible. Especially in view of this fact, the Court is
persuaded that modern psychiatric practice does not require a patient to be iso-
lated from normal human activities until every possible danger has passed.
Because of the virtual impossibility of predicting dangerousness, such an
approach would necessarily lead to prolonged incarceration for many patients
who could become useful members of society. It has also been made clear to the
Court that constant supervision and restriction will often tend to promote the
very disorders which they are designed to controL This is especially true when
the patient is suffering from paranoia and might view his custodians as mem-
bers of a "paranoid pseudo community" which is forming against him. On the
other hand, despite the therapeutic benefits of this "open door" approach, the
practice admittedly entails a higher potential of danger both for the patient and
for those with whom he comes in contact ....
The Court is aware that some psychiatrists adhere to the older, more cus-
todial approach. However, it has been proved to the Court's satisfaction that the
"open door" policy and the judgmental balancing test are an accepted method
of treatment. Therefore, no liability can arise merely because a psychiatrist
favors the newer over the older approach. 99
97Hicks v. United States, 511 F.2d 407, 417 (D.C. Cir. 1975).
98 409 F. Supp. 1283 (M. D. Fla. 1976) (the court noted the difference in facts between this case
and those in Merchants Nat'l Bank & Trust Co. v. United States, 272 F. Supp. 409 [D.N.D.
1967] wherein liability was found).
99 ld. at 1293.
The rationale expressed here seems sound and probably reflects the
current trend in this area of malpractice. However, as noted below, the
courts may at the same time impose an increasing duty to protect potential
victims. loo
INJURY OR HARM TO THE PATIENT
Several areas of liability in which there may be a breach of professional

duty to the patient have been discussed above. This breach or dereliction of
duty does not, or itself, make the practitioner liable for malpractice. As a
result of such dereliction, the patient must have suffered some injury or
harm. In the absence of such injury or harm, the practitioner is not liable
for malpractice.
In the vast majority of medical and psychological malpractice cases, the
harm is fairly obvious physical harm ranging from death to moderate phys-
ical disabilities. In addition, if pain or suffering is alleged by the plaintiff,
there is usually a physical injury also involved. If, however, as a result of
malpractice, the only harm alleged is of a mental nature, the plaintiff may
face serious legal difficulties in proving sufficient harm. This is because the
law has traditionally been reluctant to allow claims for mental injury or
distress in the absence of an accompanying physical injury. This is partic-
ularly true when the alleged mental injury is the result of negligence rather
than the result of an intentioned act to frighten or disturb a person, as with
practical jokes. lol
The reluctance of the courts to allow claims of mental injury or distress
alone seems to be based largely upon problems of proof. I02 The courts may
fear fraudulent claims by persons faking mental disturbances or, even in
the absence of fraud, the nature of the mental injury or distress may be too
difficult to discern reliably. If, however, the alleged mental injury, such as
fear or shock, gives rise to a physical injury such as fainting or elevated
blood pressure, the mental injury may be considered in determining the
financial compensation (damages) due to the plaintiff. The physical injury
provides some proof to the court that the plaintiff has not merely simulated
the mental injury or distress. The courts, however, gradually are requiring
less evidence of physical injury before allowing claims of mental injury or
harm only.
lOO5ee text infra at notes 130 to 136.

101 See, e.g., Nickerson v. Hodges, 84 So. 37 (La. 1920) (early American case of liability for a
practical joke without touching); Mahnke v. Moore, 77 A.2d 932 (Md. App. Ct. 1951).
102Por a classic and still relevant discussion of proof in the context of litigation, see Smith, H.
W. Problems of proof in psychic injury cases. Syracuse Law Review, 1963, 14,586-633.
As Tarshis notes:
The problem then is in the legal definition of emotional harm. The least rigor-
ous definition would extend liability for emotional upset, humiliation, grief,
anger-in other words any unpleasant emotion. It is clear that this degree of
mental suffering is not enough. The most rigorous definition requires a palpa-
ble bodily injury, such as a miscarriage. In this case recovery is really for the
physical injury, not for the emotional injury. A moderate definition is emotional
harm serious enough to require medical attention, for example, shock, neuroses,
psychosomatic disabilities, continued nervousness, or sleeplessness. This is the
type of emotional harm that would be found in psychotherapeutic cases. Of
course, the amount of recovery would vary with the gravity of the harm. The
difficulty is that there is no consensus on what emotional disturbances require
medical attention-normality is an open question.'03
Another possibility, also suggested by Tarshis, is to consider evidence of the

plaintiff's social functioning. "[I]f the plaintiff can continue to function ade-
quately in the areas which society considers fundamental, i.e. employment,
and perhaps marriage and parenthood, his emotional harm is not serious
enough to be compensated."104
Deleon and Borreliz 105 observe that "Thus far, malpractice claims prem-
ised on strictly psychotherapeutic harm have largely been unsuccessful.
The two main exceptions in appellate case law both involved rather extreme
circumstances of palpably tortious conduct."I06 They suggest that because
psychotherapy is a complex process and one that is in many ways more
subjective than medical practice, introduction of the fault standard of mal-
practice law into this context would generate inequitities, dysfunctions, liti-
gious waste, and professional tension. Thus, they recommend a no-fault sys-
tem of compensation in which physical harm would not need to be alleged
and established. Yet, such an approach could also be taken in our current
"fault" system.
For example, in the case of Roy v. Hartogs, previously discussed,l07 the
defendant's alleged intercourse with the plaintiff did not apparently cause
physical harm to her. She claimed an aggravation of her preexisting mental

1041d. at 94.
\05 Supra note 11, at 473.
I06This statement is probably correct. In support, the authors cite Zipkin v. Freeman, 436
S.W.2d 753 (Mo. 1968) and Hammer v. Rosen, 181 N.Y.S.2d 805, modified, 198 N.Y.5.2d 65,
165 N.E.2d 756 (Ct. App. 1960). Zipkin, a garnishment proceeding, involved an earlier
action in which the psychiatrist was found liable for mismanagement of transference that
included personal and social contacts and directions to commit illegal acts. The plaintiff
(patient) claimed inability to sleep and headaches as well as mental anguish, humiliation,
loss of respect of friends and family, and other complaints. 436 S.W.2d at 755-56, 759. In
Hammer, the plaintiff (patient) alleged bruises from the defendant's treatment as well as
pain and suffering. 151 N.Y.S.2d at 807,198 N.Y.S.2d at 67-68,165 N.E.2d at 757-58.
107 Supra notes 77-78.
disorders. This the majority of the court allowed. lOB No physical injury of
the conventional type was necessary for the plaintiff to succeed in the
recovery of $25,000 from the defendant. Yet, it is not clear as to what extent
this represents a possible emerging trend in case law as the cases are infre-
quent. In this particular case, the fact of mental injury was fairly clear
because of its preexisting nature. Thus, the court did not need to deal with
some of the problems of proof more commonly found in cases of alleged
mental injury or distress produced in the first instance by the practitioner.
INJURY OR HARM CAUSED BY THE PRACTITIONER'S DERELICTION OF DuTY
To recover damages in a malpractice action, the plaintiff must prove

that the practitioner's dereliction of duty was the direct or proximate cause
of the injury or harm suffered by the plaintiff. Establishing the dereliction
of duty and the existence of an injury is not sufficient. There must also be
proof that the dereliction of duty caused the injury. Probably the simplest
situation logically is that in which the dereliction of duty produces an
observable physical injury. In addition to this injury, the patient then may
claim certain emotional injuries or distress that are typically associated with
the physical injury. Thus, in Hammer v. Rosen/09 the patient suffered bruises
from the beatings as well as pain and suffering. When there is no physical
injury, the relationship between the dereliction of duty and the mental
injury or distress will be much more difficult to prove. This is in part
because of the relatively unknown nature of mental illness and mental
functioning.
In discussing proof of injury and proximate cause, Dawidoff suggests
that:
Sometimes, ... patients who have begun psychotherapy, after having estab-
lished a pattern of neurotic symptoms, experience psychotic episodes while in
treatment. It must be understood that such incidents may be unavoidable in the
course of therapeutic probing. However, what is peculiar in this situation is that
a suit instituted after such an incident may fix liability upon the downside of a
curve before its future path upward has had a chance to emerge. The difficulty
of proving injury in such a case is, in part, due to insufficient knowledge of the
course of the illness. Thus the tendency in some instances to attribute failure of
improvement to a breach of duty on the part of the psychiatrist may be a dan-
gerous oneYo
Although a failure to show improvement from treatment might be dif-

ficult to prove after sufficient time for treatment had passed, the aggravation
108 A dissenting opinion appropriately suggested, "The relief sought by this plaintiff consti-
tutes the closest approach to a conventional action for seduction, and hence must be treated
as such." 381 N.Y.S.2d 587, 592 (Sup. Ct. App. Term 1976).
I09See discussion supra at notes 68, 69, 105.
1I0Supra note 3, at 72-73.
of a preexisting disorder would be easier to prove. This matter usually

would involve expert testimony. In these situations there are usually some
general guidelines. For example, the careful withdrawal of the reinforcers
of a child's temper tantrums often will produce a temporary increase in tan-
trums. That situation, sometimes known as the "post-extinction burst," may
precede a rapid decline in the tantrums.1l1 Rough guidelines of practice
would indicate that in most cases this increase should not last more than
several days to a maximum of a few weeks. An increase lasting for several
months would be unusual and might suggest a practitioner's dereliction of
duty. There would, however, need to be proof of a relationship between
the practitioner's conduct and the duration of increased tantrums since the
unexpected duration of the tantrums might have been caused completely
(or in large part) by changes in the child's school environment, health or
family context, for example, death of a grandmother-events over which
the practitioner had little or no control or could not reasonably foresee.
Now that we have some understanding of the importance of proving
a relationship between the practitioner's dereliction of duty and the resul-
tant injury, let us consider that relationship in greater detail. The notion
that the negligent person (the practitioner) is liable for the direct or proxi-
mate consequences of his negligent conduct is commonly accepted in tort
law. But much effort has been spent in attempting to develop a workable
concept of proximate cause. For example, it is fairly clear that the negligent
person is liable for directly caused harm (e.g., a burn produced by his neg-
ligent use of an X-ray machine) and that the practitioner is not liable for
extremely distant or remote harms produced by the person's negligent con-
duct. For example, a practitioner who negligently gave a man an excessive
dosage of X-rays producing sterility would not be liable for the loss of a job
by the man's mother because she became depressed over the fact that she
could never become a grandmother. Such a harm would be too remote. The
practitioner might be liable, however, for the loss of the child-producing
capacity with regard to the man and his wife. Between direct and remote
cause lies the grey area of proximate cause.
"Proximate cause" is not so much a rule as it is a legal concept that
allows a court to examine the facts of a case and arrive at a conclusion based
upon notions of causation, social policy, and precedent. In this context it
may be useful to consider negligence as the "creation of unreasonable
risks."112 Thus, liability is usually limited to those harms that a reasonable
man would expect to flow from his conduct.ll3 In short, liability for harms
lllSalzer-Ozaroff, B., & Mayer, G. R. Applying Behavior-Analysis Procedures with Children and
Youth. New York: Holt, Rinehart and Winston, 1977, p. 151; Schwitzgebel. R. K., & Kolb,
D. A., Changing human behavior: Principles of planned intervention. New York: McGraw-Hill,
1974, p. 63.
112Keeton, R. E. Legal Cause in the Law of Torts. Columbus, Ohio: Ohio State University Press,
1963, p. 8.
' l3 Id. at 10-11.
caused by the negligent conduct are limited by the foreseeability of that

harm. Evaluation of the likelihood of that harm occurring is to be from the
view of the actor at the time of conduct, not after the harm has occurred
when hindsight could provide a clearer or more scientific view of conse-
quences and causes. Proximate cause therefore often refers to the harms or
injuries falling within the scope of reasonably foreseeable risks.
In malpractice, reasonably foreseeable risks often must be a matter of
divergent opinion because of the uncertain nature of mental and behavioral
problems and the effects of treatment interventions. Some guidance might
be provided by asking questions such as whether the person injured was
among the group to be protected by the duty imposed upon the practi-
tioner."4 Was the injury to the patient the type of injury that the practition-
er's conformance to duty was intended to prevent?
ASSAULT AND BATTERY SUITS
Battery is essentially the intentional, unconsented touching of another

person. Thus, carelessness or negligence cannot be the basis for this type of
suit, nor does the touching have to be harmful, offensive, or done out of
malice. Of course, in typical battery cases (as in the local barroom), the
defendant usually acts out of malice. This element, however, is irrelevant
to the legal action. In addition, intentional touching alone does not consti-
tute battery. The central issue is whether there was consent for the touch-
ing. A practitioner may have very positive intentions and feelings and still
be liable for battery if there has not been consent. 1IS The touching may even
produce very positive results, but without consent it nevertheless still may
be a battery.1l6 However, some courts apparently are reluctant to find bat-
tery when customarily accepted forms of treatment have been involved and
there is no injury to the patient. 117
Assault, in contrast to battery, does not require a touching. Apprehen-
sion or a fear of the touching is sufficient. As with battery, there should be
intent on the part of the defendant, not mere negligence. It is possible to
have battery without assault or assault without battery. Often, however,
legal actions involve both assault and battery. Frequently, in both everyday
discussions and in legal opinions the distinctions between assault and bat-
tery are blurred or overlooked.
mSee Dawidoff, supra note 3, at 72.

1I5See, e.g., Mohr v. Williams, 104 N.W. 12 (1905). This is a classic case of an operation on
patient's left ear without her consent. She had consented to an operation on her right ear.
I16See Pappas, G. Informed consent: A malpractice headache. Chicago-Kent Law Review, 1970,
47, 242-252.
117 See Dawidoff, supra note 3, at 88.
For consent to be valid, the patient should understand substantially the

nature of the treatment and the probable results. Without this understand-
ing prior to treatment, there may be no valid consent and the treatment may
be a battery. liB Similarly, giving a prospective patient misleading facts
would invalidate the patient's consent, thus making the treatment a battery.
It may not be possible to give prospective patients all available infor-
mation about a proposed treatment and some risks may not be known ahead
of time. Nevertheless, information material to the patient's decision-making
process should be given. The failure to disclose facts collateral rather than
central to the nature and risks of treatment and the patient's known con-
cerns about the treatment may not invalidate the consent. But this failure
may expose the practitioner to liability for negligence (malpractice) if other
practitioners customarily give this information to prospective patients. The
practitioner is considered negligent because practitioners have a duty to
provide adequate information. Courts vary as to whether inadequate infor-
mation to a patient gives rise to a legal action in battery or in malpractice.
Generally, unless the information is so inadequate as to invalidate consent,
the current view seems to be toward malpractice actions.lI9
Particular care needs to be taken with regard to consent when treating
mental patients. Without a judicial determination of a person's capacity to
consent to treatment, the person usually is presumed to be competent to
make treatment decisions. Thus, the person's consent to, or refusal of, treat-
ment is valid, and in some states, judicial commitment of a patient to an
institution does not automatically permit treatment of a patient without the
additional consent of the patient (or a special judicial hearing on the matter
of treatment).
A psychiatrist's assumption that judicial commitment permitted treat-
ment without the patient's consent resulted in liability in Stowers v. Wol-
odzko. 120 The psychiatrist was found guilty of assault and battery for treating
a patient who had been committed by a court to a private hospital for obser-
vation prior to a formal determination of the patient's mental condition.
The Michigan Supreme Court determined that the wording of state's com-
mitment statute permitted treatment during observation in a state hospital
but not in a private hospital. The court further concluded that the treatment
permitted at a state hospital prior to the formal adjudication of the patient's
118Pappas, supra note 116 (citing cases involving medical treatment). See a/so, Darrah v. Kite,
301 N.Y.S.2d 286, 290 (N.Y. App. Div. 1969); Bang v. Charles T. Miller Hospital 88 N.W.2d
186 (Minn. 1958); Cox v. Stretton, 352 N.Y.S.2d 834 (Sup. Ct. 1974).
119E.g., Shetter v. Rochelle, 409 P.2d 74, 86 (Ariz. 1965); Aiken v. Clary, 396 S.W.2d 668 (Mo.
1965); Miller v. Kennedy, 522 P.2d 852 (Wash. Ct. App. 1974); Wilson v. Scott, 396 S.W.2d
532 (Tex. Civ. App. 1965), aff'd. 412 S.W.2d 299,301,302 (1967); Aden v. Younger, 120 Cal.
Rptr. 535 (Calif. Ct. App. 1976) (dicta); Edwards, S. L. Failure to inform as medical mal-
practice. Vanderbilt Law Review, 1970,23,754-774.
120 191 N.W.2d 355 (Mich. 1971).
mental status would be only that necessary to keep patients on the premises
or to prevent them from harming themselves or others. Assault and battery
in this case consisted of the involuntary administration of medication to the
patient.
FALSE IMPRISONMENT SUITS
False imprisonment (deprivation of liberty without legal process)

rather than malpractice is a common cause of action when there has been
an inadequate evaluation leading to commitment. In 1899, the Supreme
Court of Mississippi considered a case in which two physicians casually
observed a woman and then subsequently without a formal examination
signed commitment certificates. 121 One occasion of observation occurred
while she was waiting for a few moments for the services of a salesperson
in a shoe store. She seemed to stare vacantly out into the street. As a result
of observations such as these, she was confined in a mental hospital for
three months against her will and was later awarded $1,500 by a jury. In
this precedent-setting case, Bacon v. Bacon, the court concluded:
[W]e cannot say the jury was clearly wrong. The amount of the verdict, even as
compensatory damages, cannot be said to shock reason or conscience. A sad,
silent, and fragile little lady now beyond middle life, wrongfully declared a
lunatic, and that of the most repulsive style, shut up in a mad house, under the
circumstances disclosed, and with a stigma branded upon her name and char-
acter which verdicts of juries and judgments of courts may never wholly efface,
and with endurance of such shame, humiliation and crucifixion of soul as hap-
pily does not often fall to woman's lot, has appealed to the courts for redress of
her wrongs, and we do not feel authorized to take from her the poor fruits of
her victory. 122
Only rarely do cases of false imprisonment involve the element of mal-

ice. For example, under many state statutes, no malice on the part of the
practitioner is necessary for liability for false imprisonment. More often,
carelessness and/or the pressures of the situation lead to decisions resulting
in liability. In Sammons v. Neymandi/ 23 the director of a county mental
health center was found liable for false imprisonment for initiating com-
mitment procedures against a woman who picketed and threatened to blow
up the center. Therefore, extreme caution should be used if any deception
of the patient (even well-intentioned misleading) is involved in the com-
mitment process. The avoidance of unnecessary public scenes and stress is
l2lBacon v. Bacon, 24 50. 968 (Miss. 1899).

122 [d.at 971.
123 177 5.E.2d 209 (N. C. 1970). The defendant failed to have an emergency commitment form
properly authorized or witnessed and thus did not follow the required legal process. The
court permitted the plaintiff to have a new trial on c~mpensatory damages. Punitive dam-
ages were not permitted suggesting that malice might not have been involved.
desirable, but courts and patients are likely to become quite upset with
deception. The professional relationship has sometimes been considered a
fiduciary one demanding a high degree of honesty because of the patient's
trust. One may not as once was attempted, trick a woman into signing her-
self into a mental hospital when she thinks she is signing a form for the
treatment of a physical complaint. In this particular case, Geddes v. Daughters
of Charity/24 the patient was also uncharitably held in the hospital for over
one year against her protests until she managed to contact an attorney.
In Meier v. Combs,!25 a university student demanded to see a university
president to discuss an alleged narcotics ring involving faculty members,
hypnosis of students in class, and bizarre sexual activities. He was referred
to the dean of men who arranged a conference with him in the company
of the medical director of the student health service and a clinical psychol-
ogist. They decided that he was hallucinating and to facilitate matters told
him that he would be taken by the campus police to nearby law enforce-
ment authorities to report his allegations. Instead, the campus police took
him to a mental hospital where he was held against his will. The required
commitment procedures were not followed. The court concluded that there
could be liability for false imprisonment.
In some states, there is broad statutory immunity for persons present-
ing information to the court relevant to the need for the commitment of
another person. 126 The person presenting the information should believe
that it is true and should not be acting out of malice. Under these conditions
of statutory immunity, there may be no liability for false imprisonment (or
negligence) even when the observation of the prospective patient is very
informal and brief.'27 The extent of the immunity varies greatly from state
to state.
CONFIDENTIALITY AND PRIVACY SUITS
As previously discussed,!28 practitioners owe a duty to others to protect

them from foreseeable harm by their patients. At times, this duty has come
into conflict with another duty, namely, the obligation to maintain the con-
fidentiality of information communicated to them in confidence by their
patients. In most jurisdictions, there are many exceptions to the confiden-
tiality of therapist-patient communications. Typical exceptions involve, for
124 348 F.2d 144 (5th Cir. 1965). See Marcus v. Liebman, No. 76-286 (Ill. Cir. Ct., Cook County,
1978) cited in Mental Disability Law Reporter, March 1978,2,557-558.
125 263 N.E.2d 194 (Ind. Ct. App. 1970).
126See, e.g., Rhiver v. Rietman, 265 N.E.2d 245 (Ind. Ct. App. 1970) (but dicta suggesting qual-
ified immunity if negligent); Williams v. Westbrook Psychiatric Hospital, 420 F. Supp. 322
(E.D. Va. 1976).
127Schwartz v. Thiele, 51 Cal. Rptr. 767 (Ct. App. 1966). See discussion infra at note 142.
128See discussion supra at notes 94-99.
example, gunshot wounds and child abuse. Some courts are reluctant to
enforce confidential communications or privileged communications when
confidentiality may result in clear, substantial harm to others as a matter of
public policy.129
A widely discussed case concerning this matter is Tarasoff v. Regents of
the University of California. 130 The legal action in this case was not for mal-
practice but for the recovery of damages for the murder of the plaintiff's
daughter. Briefly summarized, Prosenjit Poddar was seen as a voluntary out-
patient at a student mental health clinic by a psychologist for treatment.
The psychologist, recognizing the seriousness of Poddar's problems, and
because of Poddar's threats against his former girlfriend and his intention
a
to purchase gun, requested the campus police by letter to assist in the
commitment of Poddar. The police took Poddar into custody but, being sat-
isfied that he was rational, released him. No further attempts at commit-
ment were made because apparently the supervising psychiatrist decided
that commitment was not needed. The psychiatrist also directed that the
psychologist's letter and notes related to Poddar be destroyed. Shortly
thereafter, Poddar killed his former girlfriend as he had threatened.
The Supreme Court of California decided that "[O]nce a therapist does
in fact determine, or under applicable profeSSional standards reasonably
should have determined, that a patient poses a serious danger of violence
to others, he bears a duty to exercise reasonable care to protect the foresee-
able victim of that danger.,,13l The court was aware of the difficulty in pre-
dicting violence, but concluded that "The risk that unnecessary warnings
may be given is a reasonable price to pay for the lives of possible victims
that may be saved.11l32 Warning foreseeable victims was not specifically
required by the court. The duty is to "protect" the potential victim. That
might be accomplished by reasonable methods other than warning the per-
son such as by notifying the police, committing the patient, removing
instrumentalities of harm, modifying the intensity or method of treatment,
providing continuous community supervision (with the consent of the
patient), etc., depending upon the particular circumstances. It may be noted
that the duty to protect foreseeable victims was imposed in Tarasoff at, or
shortly following, the termination of treatment. (Dicta in the case would
also suggest that the same duty is required during treatment.)133
129Privileged communication refers to a legal right existing by statute that protects clients
from having their confidences revealed publicly without their permission during legal
proceedings. Generally, this right belongs to the client, not to the practitioner. The prac-
titioner is obligated not to reveal sensitive information unless there is some compelling
duty to supply information that outweighs the obligation to remain silent.
130 529 P.2d 553 (Cal. 1974), vac., reheard in bank, and alf'd. 551 P.2d 334 (1976).
131 [d. at 345.
132 Id. at 346.
133For a contrary interpretation, see Leonard, J. B. A therapist'S duty to potential victims: A
nonthreatening view of Tarasoff. Law and Human Behavior, 1977, 1, 309-317, p. 316.
The duty to protect or at least inform others of potential danger is not

unique to the Tarasolf case. In the area of malpractice such an obligation may
be imposed upon practitioners or institutions. l34 For example, in the case of
Hicks v. United States/ 35 a mental hospital was found negligent for failing to
report to a court information about a patient's mental condition so that the
court could make a reasonable decision about the patient. Following release,
the patient killed his wife. Both of these cases may not take sufficiently into
account the difficulty in predicting dangerousness and the current policy of
returning patients to society to minimize the effects of institution-
alization. 136
The Tarasolf decision has prompted extensive and heated debate. 137
There will certainly be tensions caused by Tarasolf and related decisions
until the duty to protect (or warn) has been more clearly defined and
professionally interpreted. l38 For example, the Ethical Standards of Psycholo-
gists states that information received in confidence may be revealed "only"
to professional workers or public authorities. 139 No provision is made for
the warning of nonprofessional persons, for example, potential victims, as
suggested in Tarasolf. This ethical principle will have to be considered in
view of current legal developments.
The Tarasolf decision, however, does not require the warning of third
parties in situations involving potential suicide by a patient. In Bellah v.
134See discussion supra at notes 94-99.

135 511 F.2d 407 (D. C. Cir. 1975).
136See, Comment, Torts-Psychiatry and the law-Duty to warn potential victim of a homo-
cidal patient (Tarasoff v. Regents of the Univ. of Cal., New York Law School Review, 1977,
22, 1011-1023); Johnson v. United States, 409 F. Supp. 1283 (M.D. Fla. 1976); and text at
supra note 109.
137 See, e.g., Siegel, M. Confidentiality, The Clinical Psychologist, 1976, 30, 1 and 23 (strongly
opposed); Brooks, A. D. Mental health law, Administration in Mental Health, 1976,4,94-97.
(generally positive). Brooks suggests that attorneys also may have a duty to protect poten-
tial victims. Schindler, R. J. Malpractice-Another new dimension of liability-a critical
analysis. Trial Lawyer's Guide, 1976,20, 129-149 (sharply critical). Schindler notes that the
court requires the therapist to warn the threatened victim "discreetly." He then asks
whether the following letter should be sent by mail to the threatened person:
Dear Miss Jones,
One of my patients, John Smith, residing at 10201 S. Winthrop Boulevard, Los Angeles,
California, has confided to me that he intends to kill you with an axe. I and my colleagues
have made a judgment based upon our experience that it is more likely than unlikely that
John Smith will attempt to kill you with an axe. I, therefore, hereby discreetly advise you
that John Smith, my patient, is more likely than not likely to attempt to kill you with an
axe.
Very truly yours,
T. C. Higginbottom, M.D.
cc: John Smith Id.146
138 A useful discussion of privilege and confidentiality in group therapy according to federal
and state law including the Tarasoff decision can be found in Meyer, R. G., & Smith, S. R.
A crisis in group therapy. American Psychologist, 1977,32,638-643.
139 American Psychological Association, Ethical Standards of Psychologists. Washington, D. c.:
Author, 1977, Principle 5(a), p. 4.
Greenson/40 the California Supreme Court declined to extend the Tarasoff

duty to include warning the parents of a patient that she might commit
suicide. The court expressly observed that Tarasoff applies to injury to oth-
ers, not self-inflicted harm or suicide.
For public policy reasons, including the protection of others or the
patients themselves, there has been until recently little legal delineation of
the right of privacy for patients. There is, however, an increasing recogni-
tion of this right, particularly for committed patients, in statutes and case
law. 141 Outside of the institutional setting, the right to privacy is less certain.
For example, in Schwartz v. Thiele/ 42 the defendant phYSician observed the
plaintiff while she and her sister were walking by her automobile in a park-
ing lot. Apparently, the defendant then engaged the plaintiff briefly in con-
versation. He was a complete stranger to her. The conversation did not last
longer than three minutes for within that span of time the plaintiff was able
to call her attorney by telephone to report the incident. On the basis of this
"examination" the defendant acting in his profeSSional capacity, wrote a
letter to the court stating that in his opinion, she was mentally ill and
because of such illness, she was likely to injure herself or others. The court
subsequently appointed a physician to examine the patient. She did not see
this phYSician, but instead engaged her own physican to examine her. He
sent a report to the court stating that she was not mentally ill and there
were no more commitment proceedings. As a result of alleged mental pain,
physical suffering, humiliation, annoyance, mortification, public ridicule,
and disgrace, the defendant asked for $100,000 damages. The plaintiff
claimed an invasion of her privacy. The court noted, however, that on the
public street or in other public places there is no invasion of privacy by
following and observing a person. Furthermore, the content of the letter to
the court was not published or made public. No liability was found. The
plaintiff received nothing and parking-lot diagnosis is still presumably pos-
sible in California.
BREACH OF CONTRACT SUITS
It has long been recognized that a physician may be liable for breach
of contract in the performance of the duties of care and skill. l43 The contract
1401 Civ. No. 39770 (Cal. Oct. 5, 1977). Now on appeal.

141 See, e.g., Wyatt v. Stickney, 325 F. Supp. 781 (M.D. Ala. 1971), enforced in 334 F. Supp. 1341
(M.D.Ala. 1971),344 F. Supp. 373 (M.D. Ala. 1972), aff'd sub nom Wyatt v. Aderholt, 503 F.2d
1305 (5th Cir. 1974).
142 51 Cal Rptr. 767 (Ct. App. 1966).
143Dawidoff, supra note 3, at 49, suggests that they remedy was long ago recognized in Black-
stone's Commentaries. Although malpractice actions may sound in either tort or contract, it
appears that there has traditionally been somewhat more preference for tort actions than
contract actions in the United States. Miller, T. W. Medical malpractice-Constitutionality
of limits on liability. West Virginia Law Review, 1978, 78, 381-390, pp. 381-82.
may be either express or implied, and does not have to be in written form.l44
(A written contract does, however, tend to define the contractual obliga-
tions and provide usable evidence for litigation.) That contracts usually
exist in physician-patient relationships even though they are not express
can be demonstrated readily when patients fail to pay their bills. Physicians
may recover the value of their services by suing under a theory of breach
of contract even though there was no express discussion of fees with the
patients.
It is a reasonable assumption on the part of the physicians that patients
will pay for services, will follow instructions, will not conceal symptoms,
and will in other ways conform their conduct to the customary role of
patient unless there is an express agreement to the contrary.145 Similarly,
patients reasonably may assume that physicians will provide treatment
using at least ordinary care and skill. As noted in Noel v. Proud/ 46 "The
improper performance by a physician or surgeon of the duties imposed
upon him by reason of the professional services undertaken, whether under
a contractual relationship with the patient arising out of either an express
or implied contract of employment or the obligation imposed by law under
a consensual relationship, whereby the patient is injured in body and
health for which he seeks damages, is malpractice.// When the terms of the
contract for treatment are not express, they may be inferred from customary
practice or from the conduct of the parties in the particular case.
The obligations under a contract with a psychiatrist may not be entirely
mutual. 147 A patient, for example, may terminate therapy without incurring
liability for the cost of unattended sessions for which the therapist cannot
find patients. On the other hand, the therapist may not be permitted to ter-
minate therapy if the patient would be harmed thereby or if provisions for
alternative treatment are not made. However, these obligations are not
absolute or fixed. As Dawidoff suggests: "The physician may, perhaps, have
the right to discontinue the therapy if his fee is not paid, or absent reason-
able deferrals, there does not appear to be reasonable likelihood of its being
paid. Similarly, he may have a right to discontinue therapy if the patient
destroys some of his furniture, is uncontrollably destructive to a group
undergoing therapy together, or simply does not follow the doctor's orders.
This latter condition may be the most telling, for it means that the mutual
undertaking to pursue a therapeutic path is no longer being followed, and
as such, continuance under a mutual jOinder of the spirit in an effort to work
behavior change is no longer possible.//I48
144Dawidoff, supra note 3, at 11.

145Schwitzgebel, R. K. A contractual model for the protection of the rights of institutionalized
mental patients. American Psychologist, 1975, 30, 815-820.
146 367 P.2d 61, 66 (Kan. 1962).
141Dawidoff, supra note 3, at 13.

148 Id. at 13.
It may be helpful to both the patient and the therapist to make certain
conditions of the treatment explicit at the outset. 149 It might be possible, for
example, to specify treatment goals or objectives prior to the initiation of
treatment. lso With institutionalized patients, certain goals might be contrac~
tually established as indicators of suitability for release. Sample treatment
contracts have been prepared by Adams and Orgel/51 Ayllon and Skuban,152
and Stuart. l53 Together, these contracts outline matters such as the treatment
objectives, treatment techniques, professional publications desCribing the
treatment techniques, possible undesirable side effects, fee arrangements,
assessment procedures, renegotiation of the contract, confidentiality of the
information provided by the patient, etc. Model contracts such as these
might be used and modified with legal consultation to meet the needs of
particular treatment situations.
Although contractually required treatment methods might be inferred
from the particular circumstances of a therapeutic situation/54 explicit
agreement ahead of time might prevent misunderstanding by clarifying the
therapist's responsibilities and patient expectations. For example, in the
treatment of patients with suicidal tendencies the use of restraint or force
may become an important issue. The patient and his or her family should
understand and agree to the possible need for reasonable restraint by the
therapist or institution. Alternatively, if the parties agree that no restraint
is to be used, then in the event of suicide (which might have been pre-
vented by restraint) the therapist or institution should not be contractually
liable. 155
The usual express or implied contracts between patients and therapists
do not guarantee cures or the remission of symptoms. The failure of a ther-
apist to achieve a cure or a specific result does not automatically indicate a
lack of proper care or skill on the part of the therapist. l56 However, if a
therapist wishes to promise a specific result or to use a particular treatment
technique, he or she may do so. In Nicholson v. Han/ 57 the court noted that
149Schwitzgebel, R. K. The right to effective mental treatment. California Law Review, 1974,62,
936-956, 951-52.
1soLombillo, J. R, Kiresuk, T. J., & Sherman, R E. Evaluating a community mental health
program: Contract fulfillment analysis. Hospital and Community Psychiatry, 1973, 24, 760-
763.
lSI Adams, S., & Orgel. Through the mental health maze: a consumer's guide to finding a psychother-
apist, including a sample consumer/therapist contract. Washington, D. c.: Public Citizen's
Health Research Group, 1975.
152Ayllon, T., & Skuban, W. Accountability in psychotherapy: A test case. Journal of Behavior
Therapy and Experimental Therapy, 1973,4,19-30.
153Stuart, R B. Client-therapist treatment contract, Champaign, Ill.: Research Press, 1975.
154Stewart, v. Rudner, 84 N.W.2d 816 (Mich. 1957). Failure to perform Caesarean section in
light of circumstances resulted in breach of contractual obligations.
IssSchwitzgebel, supra note 145.
156See, e.g., Johnston v. Rodis, 151 F. Supp. 345 (D. D.C. 1957), rev'd on other grounds, 251 F.2d
917 (D.C. Cir. 1958) (electroshock therapy).
157 162 N.W.2d 313 (Mich. App. 1968). See also Hawkins v. McGee, 146 A.641 (N.H. 1929).
a psychiatrist may enter into an express contract for psychiatric services that
contains a warranty of cure. In this case, the psychiatrist allegedly stated
that he would improve the plaintiff's marital relations, but in fact he had a
sexual relationship with the plaintiff's wife. Eventually the marriage was
terminated by a divorce decree obtained by the plaintiff's wife. The defen-
dant, however, was not found liable on contract grounds because the verbal
agreement made between him and the plaintiff was not sufficiently clear.
The most typical type of special agreement made by a therapist with a
patient involves some form of reassurance. It is tempting for a therapist to
tell a patient that everything will be fine. Such a statement may be thera-
peutically beneficial. The therapist, however, also must deal with the
patient in candor and must honor the patient's trust even when the prog-
nosis is poor. The balancing of these therapeutic and legal obligations by
the therapist may be difficult in some situations and the law regarding this
matter is unsettled. Yet it is fairly clear that the therapist must not mislead
the patient if the patient specifically asks about possible risks or results. Spe-
cial care must be taken to avoid concealing risks. Thus, a physician who
orally agrees and warrants that no harm will occur as a r.esult of an opera-
tion may be liable if harm subsequently occurs,us In Johnston v. Rodis/59 the
psychiatrist's promise that "everything would be all right" and his state-
ment that shock treatments are "perfectly safe" constituted a legally bind-
ing warranty. Some reassurance of the patient is permitted. But this reas-
surance should generally not be at the expense of withholding information
about material risks that may affect the patient's decision to participate in
treatment. l60
SUGGESTIONS AND CONCLUSIONS
There is little doubt that the legal liability of psychologists has been
expanded in the past decade. Nevertheless, some or even much risk of lia-
bility may be reduced by improving the patient's understanding of the
professional relationship. Prior to its initiation, there should be a mutual
discussion of expectations, risks, and matters that might raise professional
or legal issues. For example, it might be useful to discuss with the patient
the limits of confidential communication. 161 In fact, this is required by Prin-
ciple 5(d) of the Ethical Standards of Psychologists: liThe psychologist is
responsible for informing the client of the limits of confidentiality."162
158 Noel v. Proud, 367 P.2d 61 (Kan. 1962). Operations produced a severe loss of hearing.
159 151 F.Supp. 345 (D. D.C. 1957), rev'd on other grounds, 251 F.2d 917 (D.C. Cir. 1958). With-
holding information from a patient about possible risks may also subject the therapist to
liability for misrepresentation. See, e.g., Woods v. Brumlop, 377 P.2d 520 (N.M. 1962).
160See text supra at notes 34-53.
161 See Bersoff, D. M. Therapists as protectors and policemen: New roles as a result of Tarasoff?
Professional Psychology, 1976,7,267-273.

162American Psychological Association, supra note 139, at 4.
(Although ethical standards are not the same as the standards of acceptable
practice that are used to impose legal duties upon practitioners, they may
reflect a general professional agreement about the desirability of a practice.)
The patient should be informed that substantial threats to injure identifia-
ble others may not be kept confidential, although a client who has been
given notice of this may choose to limit the type of information or details
provided to the practitioner. If information is to be collected that might be
made available to schools, other public agencies, or insurance companies, it
may be desirable to inform the prospective client of this fact.
If the proposed treatment involves nonerotic physical contact, this also
might be discussed ahead of time with the client to avoid misinterpretations
and misunderstandings. Written consent should be obtained from the pro-
spective patient in marriage counseling or for the treatment of sexual dys-
function or variation. Consent of the patient's spouse (if any) also should
be obtained because that person may be substantially affected by the treat-
ment through changes in the patient's behavior.
Some practitioners tape record or video tape the patient's consent and
the discussions related to it. Although this has the advantage of conve-
niently recording much detail, it is not absolutely necessary. Written con-
sent, properly witnessed, is satisfactory. The consent form may contain a
statement of the major items discussed such as the possible benefits and
risks of the proposed treatment. In this way it is fairly certain that the
patient's consent is an informed one.
If misunderstandings or difficulties arise during treatment, consulta-
tion with other qualified colleagues may be desirable. When consultation is
sought before taking a particular course of action, it might be used in court
to indicate non negligence in matters such as the duty to protect third par-
ties from danger. 163 It also may be useful to keep extensive notes of encoun-
ters or sessions with patients where palpable negative transference, para-
noia, or other symptoms are present. 1M
In any event, accurate and nonspeculative records should be kept.
Thoughts about possible diagnoses, speculations, tentative hypotheses, and
observations, on the other hand, may be recorded separately as personal
notes. These notes should not be made a part of the treatment record
because the treatment record, in contrast to personal notes, may in certain
legal situations be viewed by the patient, his attorney, the courts, public
agencies, and other agencies with legitimate interests.
If difficulties with the patient arise, the patient might be referred to
another practitioner for treatment. Alternately, another practitioner might
be involved jointly in the treatment program. If the patient has been
referred to another, however, a good faith effort should be made to con-
163Brooks, supra note 118, at 97.

164Dawidoff, D. J. Some suggestions to psychiatrists for avoiding legal jeopardy. Archives of
General Psychiatry, 1973,29,699-701.
tinue treatment, to be supportive, and to be available in emergency situa-

tions until the patient has had a reasonable opportunity to see the other
practitioner or make alternative arrangements. Care should be taken to
avoid "abandoning" the patient before other treatment is available for the
patient to utilize.
Good intentions alone in treatment, research, and other professional
activities are not sufficient to avoid malpractice liability. It is becoming
increasingly necessary to become aware of nationally recognized standards
of practice within one's own field of professional activity. To the extent that
the psychologist follows customary and usual practice, the risk of liability
is small. Fortunately, perfection is not required-not even of psychologists.
ACKNOWLEDGMENTS
The assistance of David C. Helgeson in the preparation of this chapter

is gratefully acknowledged.
VI
MANAGERIAL AND BUSINESS SKILLS
15
The Psychologist as a Manager
RICHARD R. KILBURG
Graduate education in psychology exposes a professional to a broad range

of conceptual models concerning human behavior, strategies and technol-
ogies for the conduct of psychological research, and various techniques for
assessment and therapeutic intervention. The knowledge of ethics, stan-
dards, professional practices, and operating in the human service environ-
ment are among the topics to which students are least exposed during their
training, yet internships and course content typically provide some expe-
rience. It is, however, a rare student who finishes training with anything
but the vaguest possible notion about management.
Yet, whether psychologists realize it or not, they are all managers, and
all perform managerial functions and tasks. Often it is their managerial
behaviors that determine the success or failure they achieve as profession-
als. Even if psychologists never assume responsibility for the efforts of oth-
ers, they always have responsibility for managing themselves. The concepts
and skills that form the foundation of effective management are therefore
equally important to psychologists in whatever role or setting they find
themselves.
That is obvious, you might say, for the department chair who may be
responsible for dozens of faculty members and scores of students organized
into a number of programs, or for the psychologist who heads a human
service agency or works for a local, state, or federal government depart-
ment. It is certainly true for those psychologists who work in industry. It
might even be stretched for private practitioners who worry about bills,
referrals, etc. But, does this assertion hold for a junior faculty member fresh
out of school, or a psychologist in the direct service trenches of a state hos-
pital? To all of those people, the answer is yes. They are all managers. To
some extent they live or die on their managerial skills.
RICHARD R. KILBURG • Office of Professional Affairs, American Psychological Associa-

tion, Washington, D.C. 20036.
495
496 RICHARD R. KILBURG
Most psychologists are not directly aware of this aspect of their profes-
sionallives and someone with training and conceptual skills in this area is
a rarity indeed. The purposes of this chapter are to present some basic prin-
ciples and skills of management in a format that the average psychologist
can readily grasp and use. Because of the extensive range of management
knowledge, however, the presentation will not be comprehensive. Rather,
it will contain the most relevant issues and principles with sufficient exam-
ples so that their application by psychologists should be readily understood.
ISSUES AND PRINCIPLES IN MANAGEMENT
Average psychologists approach their first full-time professional job

with the variety of skills, experiences, and sources of knowledge discussed
above. To some extent, they may have voluntarily narrowed their interests
during the training years to work in a certain problem area or with a par-
ticular population or technology. Nevertheless, the beginning psychologist
is remarkably adaptable, capable of working in widely diversified environ-
ments. Thus, the first choices or opportunities often are critical in establish-
ing the basic pathway that a career will follow. What are the major issues
faced in these choices? Briefly stated they are: survival, organization, opti-
mization, resource management, and the management of interdependency.
Let us explore each of them.
SURVIVAL
Although this may seem like a somewhat melodramatic use of the term,
the single most important issue anyone faces is survival. This can assume a
variety of meanings depending on one's perspective. For me, survival
means being able to obtain sufficient resources to live an adequate personal
and professional life which is not forshortened by forseeable and hence
preventable misfortunes. To some extent it may take on the dictionary
meaning of outliving or o~tstruggling one's peers, colleagues, etc. This,
however, is a subset of the major theme. Getting your share and contribut-
ing your share are the essence of this issue.
All psychologists live and work in environments with other people.
All of those others also are struggling with the issue of survival. The effec-
tive professional recognizes this as a basic parameter of nature and uses it
as a theme around which to mobilize energy, talents, and skills for the work
at hand. The extent to which the professional succeeds at this most basic
task depends of course on a host of other things.
ORGANIZATION
Von Bertalanffy (1960), states that "the problem of life is that of orga-
nization" (p. 12). Since we have defined living and hence life in terms of
THE PSYCHOLOGIST AS A MANAGER 497
survival, it is safe to extend Von Bertalanffy's statement by saying a central

task of survival involves organization. Braham (1973) describes organiza-
tion as involving "two terms: organizing and organization. By the term 'orga-
nizing' we refer to the process through which discrete units or individuals
develop their internal structures and functions and at the same time asso-
ciate, or form relationships, with other units or individuals for some out-
come or function. By the term organization, we refer to the product that is
the result of the organizing process" (p. 14).
Entering that first job, or any job for that matter, entails a host of orga-
nizing activities. For example, the psychologist must learn the nature of the
enterprise, its strengths, weaknesses, composition, history and directions
for the future. Simultaneoulsy, the psychologist must learn what is expected
of him or her; what is possible to do immediately; what skills or knowledge
are needed; who can be trusted and learned from; how much room there is
to grow and develop, etc. Once this information is gathered, the profes-
sional creates an organization with a structure (roles, tasks, schedules, work-
ing relationships, etc.) and processes (communication, transaction, etc.). To
the extent that the psychologist organizes well and the organization works
efficiently and effectively, he or she will survive in that job.
You may be asking if that is all there is to it or saying that sounds
depressing and confining. You are correct within limits. The basic problems
are deeper and more complex than survival and organization.
OPTIMIZATION AND ACTUALIZATION
As the psychologist organizes and creates him or herself as an organi-

zation, the tendency will be to do the best possible job with the resources
available. This assumes a minimal level of pathology or ineffectiveness in
the individual and an environment that is not so hostile as to preclude
growth. These are sometimes dangerous assumptions with human beings
and human organizations. Nevertheless, Braham (1973) states "that every
organization, as a rule, tends toward the maximum development that is pos-
sible to it within its particular environment" (p. 20). This hardly ever is
realized, so it is safer to say that an organization tends toward optimization,
a state "in which the organization is able to manifest its form and fulfill its
functions with the least possible expenditure of energy" (Braham, 1973 p.
20). For the psychologist on the job this basically means developing to the
point where the structure and processes involved in that job can be done
well in no more time than is absolutely necessary.
But optimization will hardly be satisfying to many profeSSionals since
these are the people who try to perform to the limits of their potential and
who consistently operate at the furthest reaches of those limits. Few if any
professionals ever reach this point although many strive toward it. The pro-
cesses of optimization and even more of actualization hopefully remove
some of the harshness from the issue of survival. Survival is basic and a
professional can and must optimize in order to survive. But the human
spirit strives beyond both survival and optimization seeking a progressively

more meaningful and fulfilling way of life-actualization.
RESOURCE ALLOCATION
Moving away from these more global issues, the professional is imme-
diately confronted by the "how to" questions. What skills, abilities and
experiences can facilitate the process of actualization? Perhaps the most
basic issues involve the development and allocation of resources that are to
be devoted to these tasks. For example, the foundation of all professional
resou!ces is time. It is the one dimension that remains absolutely rigid. Each
day contains only 24 hours. Each portion of these hours is allocated to dif-
ferent roles, tasks, and functions. When a day is consumed, it cannot be
recovered; when time is wasted, it cannot be recycled. To be sure, other
resources such as energy level, intelligence, character structure, and support
systems come into play. But they all rotate around what you do with your
time. A key challenge then focuses on how to use the time and the other
resources time represents most effectively in the pursuit of actualization,
organization, and survival. If you've ever had the feeling that others are
passing you by and that your activities are not as well organized as they
might be, then you have confronted resource allocation issues.
Resource allocation may sound like another buzzword or phrase, but it
is not. Embedded in it are a complex of issues that include: planning, eval-
uation, program development, stress management, setting and effecting
prioritizing strategies, budgeting, accounting, supervision, and so forth.
Unless professionals develop and implement resource allocation techniques
they will continue to experience a feeling of marking time and become
obsolete while watching the growth of their career decline. Since inade-
quate or limited resources is a fundamental fact of most of life, managing
limited resources effectively makes all the difference in the struggle to
actualize, organize, and survive.
INTERDEPENDENCE
The final principle in our quest to actualize, organize, and survive is

premised on the fact that each of us remains, to some extent, dependent on
a variety of environmental resources. Whether one draws from classical the-
ories of learning, psychoanalysis, or gestalt psychology, or from modern
theories of behavioral analysis and ecological systems theory, behavior does
not last long in a vacuum. Thus, the psychologist is shaped by the ideas,
thoughts, feelings, and experiences he or she has when interacting with his
or her environment, including colleagues, family, and friends. The process
is reciprocal.
Once a professional is aware of this interdependence, he or she can
analyze the major sources of professional dependence and develop and
implement strategies to modify those dependencies in directions that will

facilitate actualization, organization, and survival. Without such careful
management, constant, debilitating struggles to maintain sufficient
resources to continue one's growth will be encountered. Interdependence
and struggle are permanently bonded but the results for any individual are
always in doubt. For example, the psychologist in a human service organi-
zation is dependent on the hierarchy for role definition, salary, and orga-
nizational support; on colleagues for recognition, assistance with difficult
cases, and emotional and intellectual support; and on clients and funding
organizations for a sufficient salary to allow the person to continue working
at that job. Inattention to relations with any of these areas of dependency
can lead to a lack of promotional or other career advancement opportunities
and subsequently to unemployment. The task of dependency management
is complex and difficult but extremely important. In fact, along with
resource allocation, dependence relations creates the two basic tools for
management.
In order to survive, the psychologist must create an organization that
operates at an optimum level. To do this, he or she must manage both lim-
ited resources and interdependencies effi'ciently and effectively. If the orga-
nization performs well, the psychologist will move far along the path of
actualization. Assuming certain levels of talent and intelligence hold for
professional psychologists and that training to the doctoral level produces
a relatively common background, then the central issue becomes how the
talent, intelligence, and training can be organized and managed for sur-
vival, actualization, and success.
CONCEPTUAL FOUNDATIONS OF MANAGERIAL BEHAVIORS
The above analysis is strongly rooted in the concepts of ecological-sys-

tems theory. An understanding of the theory's tenets therefore should aid
the reader in understanding the more specific issues that will be addressed
later in the chapter. I will not attempt to overview these concepts thor-
oughly, however, since I am assuming that the reader will have some famil-
iarity with them. In addition, for those who do not have this background,
excellent overviews are available in Von Bertalanffy (1968), Kuhn (1974),
Miller (1972), Kilburg (1977), Buckley (1967, 1968), Berrien (1968), Church-
man (1968), Emery (1969), Murrell (1973), R. C. Barker (1968), and R. G. Bar-
ker and Schoggen (1973). What follows, then, is a general summary of those
concepts that will be most useful as we discuss more specific issues later on.
From a structural viewpoint, our basic unit of analysis is the individual
psychologist. An individual can be divided into a set of components follow-
ing a variety of principles. For example, we can look at the psychological,
physical and social components of the individual or at his/her cognitive,
emotional, and social attributes. The list of potential sets is nearly endless.
The second unit of analysis is the environment. This is a broad term
that will be interpreted to include formal and informal groups, organiza-
tions, communities, and societies. Each of these is itself a social system with
various elements, components, and subsystems. Any complex social system
or overlapping systems involve behavioral ecology which produces a stun-
ning array of psycho-social-economic niches for individuals, groups, and
organizations to fill and offers the psychologist basic opportunities for sur-
vival. It is not merely that there are jobs to be done, roles to be played, or
services to be delivered. The concept of niche goes well beyond this to
include an all-encompassing symbiosis between the capacities of the indi-
vidual and his or her behavioral subsystems or components and the needs
of the niche. Thus, an individual can have a set of skills needed by or for a
niche but not the right attitudes, values, or cultural experiences to make a
good "fit" or vice versa.
The fit between the individual and niche(s} is a dynamically interact-
ing process determining survival for the individual as well as for the envi-
ronment. Broadly defined it involves the process of adaptation. Piaget
(1977) states that adaptation is comprised of cognitive and behavioral assim-
ilation and accommodation. Assimilation involves the integration of new
"action schemata" by interaction with the environment(s}. These action
schemata are behavioral patterns that can react to and act on a situational
reality so as to "transform" it in some way. Accommodation is the process
by which the individual uses these action schemata to adjust to changes in
old environments or to completely new situations. These are the basic
behavioral building blocks on which the whole adaptive process rests.
Action schemata are gradually organized into new types of behavioral
and conceptual skills called "concrete operations." These add many dimen-
sions to the adaptive capacity of the organism. If all goes well, they evolve
into "formal operations," a logico-mathematical, auto-regulatory, cognitive
structure. When fully developed, formal operations represent the most
important tool humans possess for adaptation. For example, approaches to
new environments or new niches can be much more successful if these cog-
nitive and behavioral skills are systematically applied to the problem of the
fit.
Any environment will have a set of requirements for the various niches
(e.g., as a clinician, administrator, or consultant) it contains. These require-
ments can be skills, knowledge, experience, attitudes, etc., with the individ-
ual having to go through a sequence of stages as he or she attempts to adapt
to those requirements. The requirements of each niche can vary widely,
with the success of the adaptation determining the probability of the indi-
vidual's survival in that environment.
Assuming that the psychologist possesses formal operations, has cho-
sen or has been placed in a given environment, and faces adapting to a
given niche, he or she will begin a behavioral transformation that, when
successfully completed, will result in an excellent fit between that psychol-
ogist and the niche. Figure 1 presents a flow chart of this process roughly
following the discussion of Braham (1973).
At the point of origination, when individuals enter into the environ-
ment, they are toti-potential. This suggests that their intelligence, skill,
THE PSYCHOLOGIST A.S A MANAGER 501
-
POINT OF ORIGINATION
STAGE I ORGANISM IS TOn-POTENTIAL
EVALUATION
I
STAGE II DIVERGENCE/DI FFERENTIATION

-
EVALUATION
I
STAGE III NEW STRUCTURE
EVALUATION
I
STAGE IV INTEGRATION
EVALUATION
I
STAGE V TRANSFORMATION/EMERGENCE -
FIGURE 1. The process of behavioral transformation.
knowledge, motivation, and adaptive capacity are vigorously flexible and

can be pushed, pulled, or otherwise molded in a wide variety of directions.
To be sure, there are huge differences in the degree to which any individual
is toti-potential. Graduate training and early career choices certainly alter
the individual's capacity. Yet, it is reasonable to assume that most psychol-
ogists have a great degree of behavioral flexibility when entering an envi-
ronment and a niche.
Almost immediately upon entry, the niche begins to place demands on
the individual. The clinician will face a new group of colleagues, a set of
challenging patients, new procedures to learn, and an entire organization
to adapt to. The requirements of each set of activities force the initiation of
Stage II, Divergence or Differentiation. During this stage, new behaviors
and systems of behaviors are added to what the psychologist brought to the
niche. For example, supervisory skills are acquired in the heat of helping
others to make decisions about their lives and develop skills that will carry
them into their own new environments. New therapeutic approaches are
required as different client populations are experienced. Changes in life-

style and conceptual understanding are frequently the result of new learn-
ing. This process is often accompanied by a feeling of tremendous growth,
with the commitments to those differing roles or functions giving each of
them a life of its own. This perception is accurate. The psychologist is get-
ting organized and building an organization.
As the organizing process continues, the individual builds structure
and Stage III is entered. The structure can be conceptualized as containing
all of those bits and pieces of new behavior so recently acquired. Schedules
for various work activities are established, reading and other supportive
activities are undertaken, and networks of contacts and issues all take shape.
By the end of the first six months, the process of adaptation is well under-
way. Basic building blocks, action schemata, preoperational, and opera-
tional strategies are in place and consistently employed.
Stage III ends as the structure solidifies and consistently aids the indi-
vidual. Then Stage IV begins. The new structure must be integrated with
the rest of the person. A new organism, holistically encompassing both the
old and the new, greater than both the old and the new, must be forged.
Each of those parts begins to lose the independence that was so character-
istic of Stage II. Prioritizing and goal-setting strategies are often employed
as the psychologist slowly discovers the extent of the colleague, supervisor,
and clinician behaviors required for survival. Tension levels increase dra-
matically as resource limitations are systematically confronted and depen-
dencies discovered. The challenge of doing what must be done extremely
well and doing the rest as well as you are able becomes a daily routine with
conflicts over attending to different tasks becoming highlighted and ago-
nized over. If, through this stage, the individual gathers a clearer notion of
goals and priorities, a gradual change will occur. The parts will truly
become subordinate to the whole and a clearer picture of the future will
emerge. Energy will be concentrated in certain areas. Decisions about
resource allocations become easier as the future goal and clearer gaze allow
those decisions to be evaluated systemmatically in a broader context. The
psychologist enters the final stage of transformation or emergence.
What began as an enthusiastic, energetic, capable, individual has
emerged into a focused, experienced, goal-oriented, diSCiplined profes-
sional. The process can take years or decades. Steps along the way often
assume the attributes of traps that are set for the unwary or naive. Failure
to master the nuances of any of the aspects of the niche can lead to rejection
of either the niche or the individual. Figure 1 also indicates that new cycles
of transformation can be initiated when one is complete. Indeed, the suc-
cessful completion of multiple transformations leads down the path of opti-
mization toward actualization. An individual can stop well short of actual-
ization and still fit nicely into a given niche. Or a given niche may become
too confining as the process leads the individual beyond what is reqUired
for maximal performance there. At each step along the way, there are deci-
sions to be faced and made. At times they are explicit: "Do I take that job?"
at others they are implicit: "What am I interested in reading?" The molding

and shaping forces are operating constantly as the individual and the envi-
ronment interact.
Implicit in the transition from stage to stage is the notion of evaluation.
For the individual this will be experienced at times as a vague sense of
doubt or wonder about how things are going. At certain critical junctures
these vague questions will erupt into full-blown attempts to deliberately
determine where one should be moving to next or where things began to
go badly. Certainly, this is a difficult process as the individual owns both
the problems and the solutions with no hope of achieving detachment or
objectivity. After all, it is his or her life. At these times, a person frequently
will reach out to others for support, guidance, or simple affirmation of exis-
tence. Careful attention to who is sought out and what advice seems most
meaningful can often prefigure new developments in the transformational
process. An important step can be made When you realize that the process
is inevitable and endless. Consequently, periods for formal evaluation and
decision-making can be built into the process deliberately. Experience can
lead to appropriate timing for such periods, as it begins to "feel like" it is
time to take stock or reassess one's commitments.
Aldrich and Pfeffer (1976) present a natural selection model of orga-
nization-environment interaction that they use to describe how organiza-
tions grow and develop. Since we are assuming that an individual can be
an organization, the model becomes relevant background for the transfor-
mational process described above. For Aldrich and Pfeffer, the organization
and the environment tend to produce a number of random and planned
variations in behavior. "The general principle is that the greater the heter-
ogeneity and number of variations, the richer the opportunities for a close
fit to the environmental selection criteria" (p. 85). At each stage in the trans-
formational process, the psychologist and the environment niche produce
behavioral variations. Some are primitive action schemata while some rep-
resent complex, formal operational processes. The wider the variation, the
more choices are possible. For an experienced professional working in a
newly forming organization this is often experienced as an almost unlim-
ited series of opportunities to use previously developed knowledge and
skill or to develop new approaches to the problems presented. For the
professional working on a back ward of a state hospital with a chronic and
aged population, the opportunities for variation may not be as numerous
but there will be some.
Once the variations are produced, the process of selection begins imme-
diately. This influencing, experimenting, evaluating, decisioning process
involves extremely complex learning adaptations. The individual tries new
behaviors on old problems, old behaviors on new problems, and varieties
of permutations and combinations. The effect of the selected behaviors on
the problem confronted influences how that behavior is evaluated. Behav-
iors that are judged to have solved problems, produced effective adapta-
tions, and increased the probabilities of survival in the niche are evaluated
as successful. The most successful behaviors are repeated and retained.

Retention of successful behaviors represents the final characteristic of the
model. These behavior patterns often become very stable structures which
are maintained by constant environmental pressures to perform and
repeated success in adaptation. Adaptational failures are not selected repeat-
edly or retained, unless some type of behavioral pathology is operating.
For the professional in any environmental niche, the application of this
model can be seen and understood readily. A psychologist who has just
started a private practice confronts an amazing array of necessary behav-
ioral problems. The establishment and management of a fee policy is among
the most crucial of these problems. The factors that must be considered in
developing this policy include: the desired level of income; the optimum
workload for the individual; the demand for the person's services; the usual
and customary fee practices of colleagues; third party payor policies and
limitations; laws and regulations; and finally, the individual's overhead
expenditures. The new practitioner may begin with a targeted annual
income of $30,000, overhead expenses of $5,000 to $6,000 annually, a case-
load of 12 to 15 clients, and a desire to provide no more than 40 billable
hours of service a week. An informal survey of peers finds fees ranging
from $25 to $50 per hour. The professional does some preliminary calcula-
tions and finds that if all 40 hours are billed at $25 per hour he or she will
only need to work 36 weeks a year to pay the overhead and take home the
desired income.
The fee policy thus being scientifically selected by the production of
hypothetical variations in environmental and individual behaviors, the nov-
ice opens for the first client. The initial evaluation is performed, a contract
established, and the psychologist tells the client the amount of the fee, usu-
ally at the end of the first hour. The client states he does not have insurance
coverage, cannot afford $25 per hour, and could only continue with the
contract if the fee were $15 per hour. The professional confronts a new vari-
ation and is forced to decide whether to retain the fee policy (behavior) or
not. If the policy is retained, the client may be lost. If the policy is changed
the whole assumed and selected set of behaviors must be modified. Any
changes will necessitate a whole series of further adaptations.
Imagine then the first week of practice in which contracts and fees are
determined for each of 15 clients that produce far less than the projected
and desired level of income, number of billable hours of service, and so
forth. Literally, an entire new system of behaviors will be needed if the
practice is to survive. Additional weeks of practice, advertising, professional
contacts, etc. will produce new variations that require different behaviors.
After a year or two of successful and unsuccessful trials, a rather firm fee
policy may coalesce. In all likelihood, it will be extremely different than
that produced by the first set of hypothetical variations.
Thus far, I have described the major elements and processes in this con-
ceptual approach to the management of professional behavior. BaSically, the
individual psychologist is seen as being in a dynamically interactive process
with an environment. Adaptation to that environment is promoted by a

sequence of behavioral variations that are selected and retained if they have
survival value. The transformational process of variation, selection, and
retention is systemmatically experienced regardless of the individual or
environmental niche under study.
This complex organizational structure that we have identified as a
professional psychologist evolves progressively as a result of and in
response to the pressures and processes I have attempted to describe. The
role of acquired experience cannot be overestimated as the professional
develops and integrates new knowledge and skills. This approach gives us
a firm foundation with which we can explore some of the basic managerial
roles that are crucial to the effective solution of these developmental prob-
lems. Although most of these roles have evolved in response to the needs
of people responsible for the management of other people and resources in
order to achieve a set of organization goals, they are, as we shall see, equally
applicable for the individual professional.
SOME BASIC MANAGEMENT ROLES
Most psychologists do not think of themselves as managers. Adminis-

tration as a topic of discussion conjures up images of bloated bureaucracies
that steal resources from where they are needed and undermine the basic
humanity that unites us all. Managers themselves often are viewed as nar-
row-minded, little gnomes whose sole purpose in life is to make things alto-
gether miserable for everyone else. This distorted picture is the result of the
systematic perception of having been on the receiving end of management.
Psychologists who do not hold official positions as managers rarely expe-
rience themselves as the initiators of administrative behaviors and yet, as
we shall see, much of their professional lives are spent doing management.
Mintzberg (1973) has described beautifully 10 basic management roles.
What follows is a review of these roles with an attempt to focus on their
relevance for the psychologist. Mintzberg states that there are three major
categories of roles: interpersonal, informational, and decisional. In the
interpersonal category, the psychologist acts as a figurehead, leader, and liai-
son. In the informational category, he or she is a monitor, disseminator, and
spokesperson. In the decisional category, the professional plays the roles of
entrepreneur, resource allocator, negotiator, and disturbance handler. Let us look
at each in some detail.
As the figurehead in an organization, a manager functions as a symbol
of what that organization represents. A variety of activities are required in
this role including officially signing documents, presiding at ceremonial
occasions, and lending prestige, status, and power to subordinates at appro-
priate times. The figurehead is the person people look up to in an organi-
zation and he or she is the person sought after by those outside of the orga-
nization who avidly seek to influence it in some ways. This role is fairly
obvious and self-explanatory for a psychologist who directs an agency,

manages a private firm employing others, or is elected president of a state
psychological association. It also is an important function for the individual
psychologist who may have an independent practice or who is working as
part of a service unit in a state hospital. The key involves understanding
the symbolic nature of this function.
At all times, a psychologist presents him or herself to the outside world
in a variety of ways. Others perceive the image that is established for them
and levels of professional and personal competence often are judged on the
basis of the perception of the psychologist as figurehead. Certainly, the case
is easily made for a psychologist who is sitting with a U.S. senator and rep-
resenting his or her state psychological associaton's position on a series of
legislative matters. This function is extremely important yet it is never prac-
ticed formally in training except in certain narrow and mislabeled cate-
gories. For example, a student presenting the results of an evaluation to a
first client represents a symbolic authority figure to that client. It is his or
her opinion as a psychologist that is being sought. Speaking as a practi-
tioner, one always represents oneself and psychology as a profession, yet
this is realized infrequently.
Preparation for and conduct of this role requires experience and effec-
tive, knowledgeable models. Training and employment opportunities that
will enable the psychologist to observe others in this role and provide for
discussion of the activities that are observed should be sought out. Atten-
dance at public meetings, staff conferences, and other group functions can
lead to systemmatic exposure to such models.
According to Mintzberg (1973), when the manager acts as a leader he
or she is performing in one of the most important roles for an organization.
As leader, a manager creates the zeitgeist in which others live and work.
He or she provides the aspiration and incentives for effective functioning.
Some of the most important behavioral components of leadership include
"staffing-hiring, training, judging, remunerating, promoting and dismiss-
ing subordinates ... motivating-advising, directing, recognizing, encour-
aging, and chastizing employees ... and meddling" (p. 61)-scanning the
activities of the organization and acting to keep activities goal-oriented. In
leading an organization, a psychologist should act to pull the efforts of the
components of the organization into a coherent and collaborating whole.
The psychologist exercises the formal and informal power and authority
that stems from the position. Most importantly, the leader tries to "effect an
integration between individual needs and organizational goals" (p. 62).
Psychologists working as the directors of community mental health
centers, managing agencies of local, state, and federal government, or
administering a unit of a human service agency will recognize readily the
demands of leadership. Subordinates throughout an organization con-
stantly test themselves against the attitudes and affects of the leader. They
determine who they are and where they are going based on their percep-
tions of how the leader views them. Words of support and actions that
reward subordinates are extremely powerful tools that a manager must use
wisely and in the best interest of the individual and the organization. Pun-
ishment and strict direction are even more powerful tools and demand the
utmost tact and knowledge when they are applied. It is hard to imagine that
people will hang on every word you say looking for nuances of meaning
that could affect them and yet "leader-watching" occupies a central place in
the life of every organization.
Psychologists in independent practice certainly have considerable
experience with the functions of leadership in their own organizations.
Often a leader's capacity to pick out a key problem or issue to focus on per-
mits the energies of a group or organization to be concentrated and to
become productive. This seemingly simple task enables an outpouring of
resources and a rewarding of investment for everyone involved. The leader
who directs and motivates the activities of others with simple words of com-
fort and support or who reminds people of promises made and tasks to be
performed is engaged in some of the most delicate human behavior possi-
ble. The success or failure of almost every human venture rides on what is
said or left unsaid, done or left undone. Professionals who perform well
have an understanding of the leadership function and they are able to
apply it broadly on behalf of many people and in the service of a variety of
issues.
The last role in the interpersonal triad is that of liaison. According to
Mintzberg (1973) a crucial aspect of managerial behavior involves devel-
oping a reciprocating network of human and professional relationships.
This network becomes a central resource in the working life of any profes-
sional, for life usually consists of what other people bring to you. Infor-
mation, job offers, political contacts, opportunities to grow or decay, prob-
lems, battles, friendship, trust, love, and hate are all part of what the liaison
role brings to a psychologist. In any environment, in any niche, a psychol-
ogist must deliberately and self-consciously develop and maintain a net-
work of relationships. To do so is to further guarantee the probability of
success and survival.
As an example, let us take the professional who is opening a private
practice, described earlier. He or she began with 15 clients and numerous
problems, dreams, and skills. Where are additional sources of income to be
found? How can more referrals, contracts, etc. be developed? A significant
part of the answer to these questions comes from the liaison function. The
psychologist in this situation can begin with the local or state psychological
association. Volunteering to serve on a committee or work on a project
brings immediate returns in the establishment of relationships with other
psychologists, many of whom also may have a practice. Discrete questions
and answers can lead to discoveries of referral sources, opportunities for
contracts, etc. One also learns more about the services available in the com-
munity and about problems, populations, or areas that may be lacking in
services or expertise. If, for example, there are not many psychologists
working with people going through divorce, children with learning disa-
bilities, or the parents and families of the developmentally disabled, the

professional has discovered significant opportunities for service delivery.
Particularly in rural or semirural settings, merely expressing an interest in
such problems often leads to referrals. Professional judgment and ethical
behavior are called for when the psychologist does not possess the needed
skills or knowledge at that moment. Continuing education, supervision,
and consultation can provide necessary support in these difficult situations.
In addition to the professional association, the professional may offer
his or her time and energy to the board of one or more local human service
agencies. There, additional contact with the human service community and
its problems, priorities, and capacities are assured. Not only will the psy-
chologist be performing a valuable service to the community, but infor-
mation and opportunities are bound to surface. Over a two- or three-year
period, several organizations may be covered and a large network of people
cultivated. Again, simple human contact can lead to the solution of the
problems of too few referrals and nowhere to turn.
The flow of information, requests for services, and resources in such a
network is dynamic and multidirectional. You cannot expect to enmesh
yourself without sometimes giving more than you will receive. But without
the network and mature, responsible, liaison work, the professional in
question stands a lesser chance of survival as an independent practitioner.
Mintzberg's second triad concerns the informational roles of managers.
For most professionals, a significant portion of their time and energy
resources are spent processing information. Performing these functions effi-
ciently and effectively provides one of the most important sets of tools any-
one can use.
When acting as a monitor, the professional seeks to ascertain the state
of the internal and external environment. This overlaps with the liaison
role. Mintzberg states that managers usually receive information in five
major categories or areas: internal operations, external events, analyses,
ideas and trends, and pressures. Internal operating information is derived
from the reports of employees, examinations of work in progress, standard
reports, etc. External events involve information on market opportunities,
capacities of competitors, sources of capital and other supplies, and feed-
back from clients. Analyses are more detailed reports concerning areas of
special interest. Ideas and trends are self-explanatory but include examina-
tions of technological, demographic, political, economic, and social devel-
opments likely to impact the organization. Finally, pressures involve
demands, power tactics, and various social and economic strategies
employed in organizational settings.
If the psychologist performs the liaison role well, information concern-
ing external events, ideas, and trends can be obtained easily. Data on inter-
nal operations and pressures, and from analyses can be obtained from a
variety of formal and informal systems. For example, program planning and
management information systems can provide organized, cost-effective
reports on the status of an organization. These technologies will be
described briefly a little later. Without accurate information, any profes-

sional can be reduced to operating like the superstitious pigeons in Skin-
ner's experiments. Reliable and valid data are the foundation of psycholog-
ical science and psychological practice.
Although obtaining information constitutes a vital part of the manag-
er's functioning, transmitting information within the system maintains
those open boundaries so characteristic of successful, adaptive organiza-
tions. As a disseminator, the psychologist seeks to communicate both the fac-
tual and evaluative material that was obtained from the monitoring role to
other employees working inside the organization.
Factual information consists of reports of what was said or done in dif-
ferent situations by different people and can include written and/or oral
documentation of events. The data can be corroborated to a good degree
and therefore are usually readily observable by several parties. In addition,
value information is often comprised of opinion, interpretation, gossip,
rumor, and speculation. It usually focuses on what was the meaning of the
factual information. It also can be obtained without substantiating facts and
often is when gossip or rumors are flying in an organization.
Both types of information are important to understand. And, particu-
larly for psychologists in large organizations, it can become critical to be
close to major disseminators in that organization. For example, perhaps the
director's secretary or a favored employee will be entrusted with informa-
tion on certain key ideas. Perhaps a reorganization is being planned or a
source of funding is developing problems. This information will be dissem-
inated into an organization at a fairly rapid rate. Any lead time in obtaining
such data provides an additional competitive edge when working in large
institutions. When the psychologist has information to disseminate, the
same processes are at work. How the information is shared and with whom
can increase or decrease the adaptive capacity of an organization and hence
alter its survival ability.
When the psychologist directs the flow of information outside of the
organization, he or she operates as spokesperson. If the individual occupies a
formal position of power in an agency, the role of spokesperson becomes a
ritual in many respects, with liaisons from other organizations systemati-
cally seeking his or her opinions, analyses, and so forth. These liaisons
include a board or committee within complex, democratically operated
associations or one person in a straight-line bureaucratic hierarchy, as well
as suppliers, referral sources, funding and other agencies, and professionals.
When competiton is keen, some managers employ strategies of deliberately
misinforming the public or superiors in an effort to gain an advantage.
Because of the power of information, this can be an extremely successful if
devious and deceitful exercise.
As an example, take a psychologist who attends a state association
meeting and discovers that a government agency will fund two contracts
in a certain program area for the coming year. A friendly bureaucrat lets
the information drop in a conversation and hints that public notification
SIO RICHARD R. KILBURG
will be forthcoming shortly but that the period for proposal development
and submission will be short. Armed with this new information, the psy-
chologist disseminates it to key individuals in his or her home agency and
a proposal is initiated. Several days later another agency director calls to
chat about the latest developments on the state level and asks if the psy-
chologist has any new information. The psychologist says that there may
be some new initiative but that it is only a rumor. The other director rings
off with some information and some misinformation.
Questions of ethics and honesty raised by such an example are obvi-
ously central to the management of information. Although the psychologist
in the above example did not deliberately mislead the other professional,
information was withheld to maintain an advantage. These decisions are
crucial for the survival of any organization and they occur very frequently.
Functioning as an effective spokesperson obviously can playa critical part
in the adaption of an individual or an organization and should always take
place within a strong moral and ethical framework.
The last, and perhaps most important, tetrad of management roles con-
cerns the decision-making functions in an organization. The results of a
professional'S decisions determine success or failure, transformation or
decay, survival or death in various aspects of his or her career. Each of us
represents, in large measure, the outcome of most decisons that we have
made. Genetic and environmental factors play an extremely important role
in a person's development, but in the end, it is what a person chooses to do
with what heredity and environment offer that determines the kind of
human being that individual will turn out to be.
This element of choice is seen in the lives of individual professionals.
Decisions concerning vocational pathways, courses, supervisors, and most
importantly job opportunities will shape the professional as surely as does
genetic inheritance. A student choosing coursework in program evaluation,
behavioral assessment, biofeedback, and behavior modification is clearly
designing a map of his or her future knowledge, skills, and professional
area of interest. Saying yes to these areas and no to psychodynamics, psy-
choanalytic psychotherapy, and projective testing will give a clear picture
of the intentions, abilities, and theoretical affinities of the future profes-
sional. Similarly, choosing to work in a rural community mental health cen-
ter will yield a different career path than choosing an academic job. For
these reasons, decision making is one of the most crucial skill areas for a
professional to develop.
Mintzberg delineates a continuum of strategic decisions confronted by
an organization. At one extreme are entrepreneurial decisions characterized
as having long-range and far-reaching consequences for an organization.
They are systematically planned and implemented with an eye toward max-
imizing constructive change. On the other hand of the continuum are
crises. These are relatively short-term disturbances that are managed as
swiftly as possible with the goal of immediate resolution of the difficulties.
In the middle are a wide variety of problems with varying degrees of com-
plexity and effects on the organization. The decisional roles focus on the
type of decisions being made.
As an entrepreneur, the professional uses the data collected as a monitor
and liaison to develop a clear picture of the demands and needs in the envi-
ronment and his or her capacities as a psychologist to meet those demands
and needs. Based on this cognitive map, the professional plans and imple-
ments strategies designed to change the organization and to maximize the
possibilities for survival and the process of actualization. When working
with others, the functions of delegation and supervision are subsumed
under this role. In this capacity, the professional seeks to implement deci-
sions through the work of others.
Returning to our earlier example of the budding private practitioner
with 15 clients, large overhead costs, and magnificent aspirations, this
professional obviously has some entrepreneurial decisions to make. Let us
assume that he or she discovers through newly formed linkages with other
professionals that there are serious gaps in the service delivery network for
the elderly and the handicapped. Other, traditional areas have more than
adequate coverage. What can he or she do?
After determining the magnitude and nature of the needs of these pop-
ulations, the professional then examines his or her own technical capacity
to meet those needs. Attitudes and motivations to work in the areas are
assessed along with the economic possibilities. Gaps in knowledge and
skills are identified and an education and training program may be under-
taken. Simultaneously, the professional may initiate public relations and
collaboration efforts in those areas for which the person already has skill.
After providing some services, the process of transcendence or transfor-
mation is well underway and almost automatic. Referrals and contractual
opportunities may well depend on the capacity to perform excellently.
However, the problem of how to obtain new referrals and thus resolve
finan:ial difficulties has been replaced by the problem of what really needs
to be done and how competent the individual is to do it.
The direction-setting entreprenuerial decisions merely set the stage for
the role of resource allocator. Mintzberg defines this as the core of any orga-
nization's strategy-making function. The professional controls a network of
possible resources from which to draw. Chief among these are time, energy,
capital, and expertise. Equipment, material, reputation, and in organizations
with more than one employee, the resources of subordinates also are under
the professional's direction. Achievement of the goals of any set of entre-
preneurial decisions depends in large measure on the efficiency and effec-
tiveness with which the resources are managed to reach those goals. Mintz-
berg states that some of the more important components include careful
scheduling of time, authorization of actions, planning and programming
work activities, budgeting, accounting and evaluation, and modeling or
role-playing alternative scenarios. These key processes by which resource
allocation is accomplished will be discussed in more detail later.
A third decisional role for the professional is as a negotiator. This is an
extremely important function for anyone seeking to survive and actualize

in an interdependent world. It assumes that no one is self-sufficient in all
things nor totally dependent on others for every need. This capacity to meet
some needs and demands but not others creates the ideal circumstances for
negotiations.
The process of negotiation involves systematic communication with
the goal of exchanging real resources in real time. That is, what is
exchanged will have value for all parties in the process and the exchange
will be sufficiently timely to be useful to all parties. Because the professional
can speak as the figurehead, liaison, and spokesperson for him or herself as an
organization, this offers the flexibility and power to conduct negotiations,
make commitments, and follow through on these decisions.
The final decisional role is that of disturbance-handler. This is another
topic that will receive considerable coverage later. For now, however, it is
important to note that this role involves keeping one's career and whatever
job is being completed at the moment within a given set of limits. This
could involve moderating the disputes of subordinates in a complex orga-
nization; meeting the new demands that a suicidal patient places on you;
reestablishing an equilibrium after a major shift in direction, etc.
The training in a graduate program in professional psychology obvi-
ously provides basic knowledge of human behavior and helping skills with
which to aid clients in crises. Of all of the managerial roles a professional
is expected to play, he or she is best prepared in this area. And yet, even
here, there are some basic approaches that have been developed for mana-
gerial problems that may be extremely useful to psychologists in practice.
Mintzberg's managemeI:\t role structure thus provides the behavioral
foundations upon which professional psychologists can build. To adapt to
the realistic problems of survival, actualization, interdependence, etc., one
must master these interpersonal, informational, and decisional aspects of
professional functioning. However, our exploration of management behav-
iors has merely begun with the exposure to these role sets. The next section
will focus on other aspects of professional behavior that are just as impor-
tant to learn because they often shape one's performance as surely as ade-
quate performance of the appropriate roles.
CHARACTERISTICS OF PROFESSIONAL WORK
Assuming that the basic management roles are understood and can be
referred to, we shall now turn to the managerial characteristics of profes-
sional work. Here again we will follow the discussion of Mintzberg (1973)
closely, adapting it where appropriate. He describes six sets of work char-
acteristics that we will address here: "(1) the quantity and pace of the man-
ager's work, (2) the patterns of his/her activities, (3) the relationship, in his/
her work between action and reflection, (4) his/her use of different media,
(5) his/her relationship to a variety of contacts, and (6) the interplay

between his/her rights and duties" (p. 28).
Professionals with full-time commitments usually work at a very high
pace. Evenings and weekends are seldom free from intrusions from the
professional's responsibilities. The pace of graduate school, while grueling
and difficult, is merely a warm-up for the dizzying, often frantic schedule
that full-time employment thrusts upon the unwary.
For professionals in clinical or organizational practice, there are the all-
encompassing demands from clients. The clinic or private practice setting
will involve contact with 5 to 10 individual clients, groups and/or families
per day. The actual contact hours account for the majority of time but by no
means all of it. Telephone calls, clinic meetings, record keeping, and han-
dling the mail and the business details of a practice all consume great
amounts of resources. Professional obligations including liaison and mon-
itoring work in other organizations, work on committees of the psycholog-
ical association, report writing, and continuing education all result in a
schedule that leaves the professional breathless and fatigued at best,
burned-out and used-up at worst. The responsibilities of a family often add
to and complicate the demands of a career.
This is not to say that the pace is uncontrollable or aU-consuming in
every case. It does mean that both the fledgling profeSSional and the old
pro must be able to gauge carefully the demands of any job and the level
of resources necessary for adequate performance. The expectation that there
will be adequate time for reflection and study as was the case in graduate
school is extremely unrealistic in the harsh glare of fuU-time professional
employment. It is of utmost importance because of this that one be careful
about saying yes to opportunities that come along. The yes decisions
quickly fill any schedule with commitments to clients, organizations, con-
tracts, etc. A rule of thumb is that it will take anywhere from 33 to 200%
more resources to accomplish any job than you plan on, so discretion must
be exercised.
Mintzberg states that the chief characteristics of managerial work are
brevity, variety, and fragmentation. This description certainly holds for
psychologists in middle or upper level managerial positions in agencies,
industry, or government. The typical pattern involves shifting one's atten-
tion, mood, and energy to adapt to the constant tumult of the environment.
Most managers choose to keep their schedules this way. It provides them
with a constant flow of information about the status of the organization.
Thus, telephone calls interrupt meetings, the mail constantly threatens to
overcome everything, and subordinates are always dropping in with prob-
lems, suggestions, or questions. When these activities are not occuring
spontaneously, the effective manager seeks to create them by placing the
telephone calls, touring the facility, initiating mail, etc. In the background
of this seemingly incoherent sequence of activities, the professional assem-
bles a picture of his or her organization. How is the budget preparation
going? What is the status of that new program? Are the new employees
settling in? What do the funding patterns look like for the next year? The
questions and the possible answers are endless.
This type of activity is somewhat less chaotic for the full-time practi-
tioner, although there are special circumstances involving the mental sets
concerning each client that must be maintained. The intimate details of the
lives of up to 50 to 70 persons at one time must be competently managed
so that each individual feels unique and attended to. This is the main task
of practice and a formidable one to even the most experienced practitioners.
Here again the capacity to shift attention, mood, and resources quickly and
efficiently is crucial. The demands of a person with an anxiety-ridden neu-
rotic problem will vary a great deal from those of a hyperaggressive person
with a paranoid character disorder. Yet each must be met with empathy,
patience, wisdom, and understanding. This is an incomparable human
accomplishment when it is done well. When done poorly it can be life-
threatening to client and psychologist alike.
Graduate school is an environment that rewards reflective thinkers and
planners. Those persons who have the capacity to absorb information and
integrate it carefully, with time to extend many collateral lines of thought,
are typically successful academicians. In professional practice, the nee<;ls
and demands of the work setting and clients make careful reflection a chi-
mera dancing on the wind produced by the next meeting. While there is
clearly a place for reflection in the decisional roles in particular, the pace of
professional activity constantly leaves one with the feeling that there is
more to be done. This fact and feeling breeds an adaptive preference for
action over thought, doing vs. being.
In school, papers and reports are drafted and redrafted as facts, impres-
sions and metaphors are honed to a fine point of communication. In full-
time practice, one often has time to say things once and even then in an
abbreviated form. The desires for perfection and craftmanship are con-
stantly played off against the needs of the other client in the waiting room,
the parents or school on the telephone, the bills that must be paid, etc. This
tension is palpable by every psychologist. Those who thrive on variety,
adaptability, and not looking back seem to adjust more readily to the
demands than more narrow-minded and rigid types of people, especially
where the environment demands more generalist kinds of functions and
services. The latter psychologists can protect themselves by narrowing their
fields of interest and specializing. This permits a greater degree of control
but sacrifices a broad scan of activities. To survive in a managerial capacity,
one surely must enjoy the action, for it is typically nonstop.
According to Mintzberg, "the manager uses five basic media: the mail
(documented communication), the telephone (purely verbal), the unsched-
uled meeting (informal face-to-face), the scheduled meeting (formal face-
to-face), and the tour (visual)" (p. 38). Here again the parallel is clear for
psychologists in formal managerial roles. Typically, the mail is treated in as
brief a time period as possible. Telephone calls are short and numerous as
are unscheduled meetings. Scheduled meetings take the majority of time

and usually involve spokesperson-figurehead, entrepreneurial, problem-
solving, and negotiation functions. Tours allow a controllable sample of
behaviors and data to be obtained from any component of the organization.
For the professional in practice, there may be more emphasis on formal
meetings, usually where services are delivered, and on telephone and mail
interaction.
For the most part, however, professionals use verbal rather than writ-
ten exchanges. This tends to optimize time and energy resources. It repre-
sents a very different focus from training programs which emphasize per-
formance through written media. This is not to say that a well crafted letter,
report, or case summary is not called for repeatedly. It does emphasize,
however, that the information gathered from the job environment and
techniques for such acquisition are somewhat different than what is expe-
rienced in school. Verbal skills and auditory /listening skills are of premier
importance in professional practice with the capacity to persuade and argue
articulately with understanding, emphathy, and sensitivity being critical to
success and survival.
The fifth attribute of managerial work focuses on the boundary-span-
ning functions. We have described the figurehead, liaison, monitor, spokes-
person, and disseminator roles that professionals must play effectively to
maximize their chances for actualization. While performing these functions
the psychologist systematically positions him or herself or organization to
take maximum advantage of the environment or niche available. The cen-
tral aspect of this attribute involves the acquisition and use of information.
Any change in the environment will produce information which is availa-
ble in a variety of places and forms. Seeking out this information allows a
professional to plan and problem-solve more effectively. This can result in
a better fit between the professional and the organization. Failure to obtain
the information or to use it in an efficacious manner will result in a reactive,
defensive posture in which the environment forces the adaptation or
accommodation in the Piagetian sense. Boundary-spanning permits antici-
pation, proactive postures, and assimilation approaches to adaptation.
Another aspect of this attribute deals with the advantages of linking to
professional associations and other organizations to develop information
sources. Let us return once again to our fledgling private practitioner who
has begun an assessment of service needs and demands in his or her envi-
ronment and discovers that the elderly and developmentally disabled are
underserved in the community in which the practice is being undertaken.
Suppose the practitioner expresses an interest in serving on the board of
the local area agency on aging. Since community agencies are seeking active
volunteers constantly, it is extremely likely that the psychologist in ques-
tion will gain ready acceptance into the organization. Once on the board,
the key decisions and issues confronting the elderly in that community will
systematically be reviewed. What better place to ntake a meaningful con-
tribution to the community while simultaneously developing knowledge,
a resource base, and a communication network for his or her own practice?
Sources of funding, newly developing programs, opportunities to develop
linkages that may serve as referral sources, and possible contracts for con-
sultation are available as a function of the liaison and monitoring role.
Thus, the psychologist's relationship to a variety of contacts is central to
survival and growth.
The final characteristic of managerial work applicable to professional
practice deals with the blend of rights and duties that professional psy-
chology thrusts upon the practitioner. As the psychologist moves into fully
autonomous functioning and leaves behind the system of supervisory
checks and balances that are the hallmark of training settings, there is a
brief moment in which an exhilarating sense of freedom and capacity for
meaningful personal expression is experienced. To be sure, there is a real-
istic base to this experience. To a certain extent the psychologist can now
say yes or no without necessarily seeking permission. In particular, accord-
ing to Mintzberg, "(1) the manager is able to make a set of initial decisions
that define many of his own long term commitments and (2) he can take
advantage of these obligations" (pp. 51-52). In reality, however, each yes
decision brings a host of confining and delimiting restrictions on the indi-
vidual's freedom to act. Thus, accepting the offer of a full-time job imme-
diately constricts opportunities and focuses abilities and resources into a
much narrowed domain. Although this is perfectly normal and fits within
the context of our conceptual approach to profeSSional development and
transformation, if the decisions are not made wisely there can be serious,
long-term consequences. In addition to the constraints of the job and set-
ting, the professional soon learns the lessons of resource availability and
allocation. There is never enough time or energy to do what is needed.
Finally, a third area of limitation centers on the regulatory restrictions of
various governmental laws, regulations, and policies and the policies and
standards of the profession of psychology.
Thus the new psychologist trades the constraints of the training insti-
tution for the constraints of the society, the marketplace, and the profession.
It is definitely arguable as to where the most time or opportunities for
actualization occur. The wonderful moment of freedom is quickly replaced
by the chronic frustrations of short resources, interdependency, and life as
a creative process full of struggle. For the commitment to this career, society
does reward the professional psychologist with certain status, prestige, and
authority, and there are the rights that achievement brings to the individ-
ual. Simultaneously, however, society imposes duties and responsibilities
to insure insofar as practicable that the rights are not abused.
The picture I have presented is one of a maturing, complex, dynamic
organism/organization (a psychologist) interacting with an environment or
niche and struggling with the issues of survival, organization, optimization
and actualization, resource allocation, and interdependence. In order to
promote efficient and effective professional development, I have employed
an overview of Mintzberg's descriptions of managerial roles and character-
istics of managerial work and attempted to demonstrate how the practicing
psychologist can and does perform management work and functions while
serving as a psychologist. This has been done to familiarize you, the reader,
with some basic tenets of management and to convince you of the impor-
tance of effective management skills for professional psychologists.
What follows is an overview of 10 principles of management that are
drawn from Sherman (1966) in order to provide some of the basic rules of
thumb that guide most managers. I shall then proceed to a somewhat more
detailed presentation of several of the most difficult problems in manage-
ment and professional practice.
Sherman's principles are as follows:
1. "The number of individuals reporting to one supervisor should not

be more or less than can be effectively coordinated and motivated"
(p. 197). This is the span of control principle and also can be applied
to issues, contracts, clients, etc. Smaller spans tighten the control,
facilitate communication, and increase the likelihood of better
overall supervision performance.
2. "Unnecessary duplication and overlapping of functions should be
avoided" (p. 198). The key here is the word unnecessary. Certain
forms of redundancy increase reliability, sometimes create new
solutions to old problems, and are necessary in hierarchically struc-
tured organizations. Too much duplication is expensive, unproduc-
tive, and a function of overanxious administrators who fear loss of
control.
3. "Responsibility for a function should be matched by the authority
to perform that function" (p. 198). Here the nuances of power and
authority interface with creativity, productivity, and profeSSional
growth. As described above there always is or should be a balance
between rights and duties.
4. "Authority and responsibility should to the greatest extent pOSSible
be decentralized to those actually performing the operations" (p.
199). This is a crucial principle for psychologists in administrative
and/or supervisory positions to understand. Growth occurs only
when there is an opportunity for responsible decision making and
feedback on performance. Without sensitivity as to just how much
room to give someone on a project, professionals will be criticized
constantly for being too loose or too tight. It is understood that
certain key decisions and decision processes always are referred to
the highest management echelons.
5. "No member of an organization should be accountable to more
than one supervisor" (p. 200). This principle is less applicable in
certain types of organizations, particularly those that have com-
plex, nonhierarchically organized structures that change quickly
and confront volatile environments.
6. "Throughout the organization, each member should know to
whom he/she reports and who reports to him/her" (p. 200).
Knowledge of the formal chain of command is vital to productive
decision making. Being able to circumvent the system when called

for is just as important as using it effectively in routine matters.
7. "Every necessary function of an organization should be assigned
to a unit of that organization" (p. 201). It is central to survival that
the highest priority tasks are done well in any organization. This
enhances accountability and productivity. When accountability
measures outstrip the organization's performance, the structure
should be reviewed and perhaps loosened a bit.
8. "The responsibilities assigned to each unit should be clear cut" (p.
201). This area is perhaps the most obvious since one clearly can
even delegate the responsibility to be creative to a component of
an organization. Care should be taken not to overdelegate and thus
destroy the opportunities to create that exist on the boundaries of
any organization.
9. "Uniform methods and procedures should be installed when nec-
essary or desirable for efficiency, economy, or consistency" (p. 201).
Knowing when the need for standardization arises is crucial to
effective professional performance. Particularly in clinical work,
care must be taken to see each individual client as unique and to
treat them with respect while performing the necessary services as
efficiently as possible.
10. All principles have their limits. Because life is a dynamic and ever
changing process and structure, professional psychology tends to
mirror those characteristics.
These principles can guide the professional in asking or framing other
crucial questions facing the individual or his or her colleagues in any orga-
nization. In particular, broad policy issues such as who should make a given
decision; how large the organization should be; and what is the best struc-
ture for accomplishing the work can be settled more readily by referring to
these principles. These questions and issues are omnipresent in human
organizations and, of necessity, must be resolved repeatedly and success-
fully if the organization is to actualize.
KEY PROBLEMS IN MANAGEMENT
There are four major areas of management that typically produce sig-
nificant problems for psychologists-planning and problem solVing,
power-dependency relations, resource allocation, and conflict management.
This overview is a difficult and dangerous undertaking because each of the
topics is extremely complex and has merited lengthy treatment by many
authors. In condensing these areas, it is necessary to oversymplify and over-
generalize, thus distorting the richness of the available resources. Refer-
ences for additional reading will be provided for the four areas and I urge
you to continue your exploration.
PLANNING AND PROBLEM SOLVING
This is the most important set of concepts and skills for any profes-
sional to master. Planning and problem solving functions are involved in
literally every phase of a psychologist's job. Each of the management roles
and characteristics of professional work is based on planning and problem-
solving abilities.
Figure 2 presents a flow chart outlining the various facets of planning
and problem-solving processes. Here again, we see the basic parameters of
systems theory in operation, as the figure delineates the major elements of
a planning structure and specifies their relationships. Assuming that you
want to achieve a given set of goals or objectives, which is not always the
case, then this model provides a way of approaching and accomplishing
change in an organized framework.
In Step 1 of this model, the interaction between the environment niche
and the professional produce a set of needs and constraints directly related
to the major issues of survival, organization, etc. outlined earlier. These
needs and constraints can be characterized as a set of factors that usually
produce a number of opportunities, necessities, and/or problems. The
opportunities relate directly to those aspects of the niche and professional
that lead to an increased probability of actualization. The necessities relate
to the minimal set of circumstances that result in a sufficient fit so that the
Step 1. ENVIRONMENTAL AND PROFESSIONAL NEEDS AND CONSTRAINTS

PRODUCE
Step 2.
+
OPPORTUNITIES, NECESSITIES AND PROBLEMS WHICH INITIATE
Step 3.
+
PLANNING PROBLEM·SOLVING CYCLES
---
~
3a. Analyze Environment·Organization Status
3b. Ide~tifY Key Opportunities andlor Problems

+
--
3c. Specify general goals
+
3d. Specify assumptions underlying goals
-
3e. SpJify major objectives and criteria
+
--
3f. Evaluate alternative strategies for achieving objectives
and goals '
3g.
+
Select optimal or maximal strategies
+
-
3h. Specify action plan (behavioral statement of who, what, when,
where, how, cost, etc.)
3i.
+
Implement and monitor phase·by·phase
3j.
+
Evaluate outcome(s)
FIGURE 2. A planning and problem-solving model.

niche can be used by that professional to survive. The problems result from
both necessities and opportunities, as the psychologist organizes to meet
these challenges.
The primary cognitive and behavioral skills that are used involve a
cycle of planning-problem solving activities usually applied to large and
small problems alike. The average professional typically will be engaged in
simultaneous cycles on any number of problems or opportunities. Often
multiple cycles are required on particularly thorny problems. These multi-
ple problem exercises occur seemingly without major effort in areas in
which the individual possesses considerable expertise or experience. New
or complex problems more frequently produce a conscious sense of work-
ing on or through difficult issues or times.
The opening step of a problem-solving cycle should consist of an anal-
ysis of the status of the environment and organization (psychologist). This
roughly corresponds to the needs assessment phase of any project (Bell et.
al., 1976; Kilburg, 1978) or the force field analysis outlined by Lippitt, Wat-
son, and Westley (1958). Briefly stated, the professional attempts to identify
the key factors, problems, needs, restraining and driving forces, and capac-
ities that are present in the professional-niche interface at a given time.
Norville (1978) presented formats for organizational and functional self-
evaluation that provide a useful series of questions with which to approach
this assessment task. Such questions as: (1) "What are the present strengths
of the organization?" (2) "What are the present weaknesses of the organi-
zation?" (3) "What major threats will the organization face in the next five
years?", (4) "What is the fundamental purpose of our organization?" (pp.
26-27), can lead to very important insights concerning the status of the
organization-environment. When conducted properly, this assessment will
result in a fairly detailed picture that almost automatically presents views
of key opportunities and/or problems. This leads into the next phase of the
cycle.
Since most assessments acquire data only at selected times and on lim-
ited dimensions, some sort of prioritizing procedure is usually employed
either implicitly or explicitly. Often this limited data set must be further
defined in light of the more specific values, attitudes, or opinions of the
professional. Prioritizing and delimiting the raw data should produce a
clear set of problems and/or opportunities. If clarity is not obtained, then
the process of analysis should continue.
Assuming for the moment that obvious problems and/ or opportunities
exist, then the next stage of the cycle should be entered. The problems and/
or opportunities are translated into broadly formulated and stated goals.
There may be one or more of these goals.
Often overlooked in many planning models, the assumptions upon
which these goals are founded must be identified and clearly set forth.
Clear goals cannot be set with an inadequate understanding of their foun-
dations. Explicitly stating these assumptions often leads either to modifi-
cation or elimination of goals and/ or to more detailed specification of objec-
tives or targeted subgoals. The criteria by which an objective judgement of
achievement can be made should be understood and accepted by all parties

and should lead to easy application of evaluation methods.
This, then, leads to the next phase of the cycle in which the profes-
sional must anticipate the best routes to achieve the goals and objectives.
Role playing and creating alternative scenarios are effective techniques for
developing and evaluating different strategies. Here again, the optimiza-
tion-actualization process provides a value structure that directly influ-
erices the various possibilities. The optimal or maximal strategies are
selected considering all of the assumptions, alternative objectives, etc. This
creates the need for a detailed action plan that is a behavioral statement of
who will do what, when, where, and how, and at what cost in resources.
This statement becomes the blueprint by which one judges progress as the
action plan is implemented. Systematic monitoring of implementation is
necessary for determining the accuracy and effectiveness of the strategies
being employed. Any changes in the implementation plan must be based
on data obtained as the implementation unfolds in order to accomplish the
objectives. A complete evaluation of the outcomes of the implementation
should be made in light of the stated goals and objectives and the originally
defined needs and constraints.
At various points in this cycle of events, feedback loops have been
inserted to illustrate that this is not a univector process proceeding in one
direction. Especially in the analysis, goal setting, strategy development, and
implementation many opportunities exist for returning to other steps or
phases in the process. Thus, careful development of strategies may neces-
sitate a modification of the basic assumptions. The analysis of the environ-
ment-organization status may result in the realization that what was
thought to be a large problem is not. Or, delineating the basic assumptions
underlying goals may require that some goals be dropped or modified, or
new goals added. It is important that the process be conceptualized as open
and flexible. All of the stages need not be enacted to achieve a successful
outcome. On many problems there will be no necessity to write any of the
details down; a clear, simple plan can be retained cognitively. However, the
model is useful in that it elucidates the major features of a good planning
process and therefore can be used to trouble shoot in particularly sticky or
complex situations. Usually, a careful look at a particular situation while
considering the model will yield some useful and obvious remedies.
For an example of the model in action, let us return to the private prac-
titioner described previously who is laboring to increase his or her case
load, improve cash flow, and survive in a newly selected niche. After col-
lecting the first months receipts, the psychologist realizes that the goals of
a $30,000 per year income and the number of hours worked may need to
be modified unless some things change. In fact, the receipts do not even
cover basic expenses. Clearly something must be done, the question is
what?
Looking at our model, the first thing that should be done is to examine
the needs and constraints. How much revenue really is needed to survive?
How much time and energy can be invested and for what periods of time?
What is the psychologist really good at and poor at? What services are avail-
able in the community? Which populations are underserved? The answers
to these questions should lead to the definition of opportunities, necessities,
and problems in the situation. For example, the necessities are to meet the
$500 per month requirements for overhead and an additional $800 a month
for personal expenses. This $1,300 per month is the economic baseline for
survival. Let us assume that the 15 clients provide a gross income per month
of approximately $900, leaving the practitioner $400 in the red. One prelim-
inary conclusion the professional reaches is the need for from four to eight
new clients to break even. The question is how to obtain the necessary
referrals.
This necessity and its attendant problems lead the professional into a
planning-problem solving cycle. Assuming that some of the steps men-
tioned earlier already have been taken, if the individual belongs to the local
or state psychological association, is actively participating, and has
reviewed the local human service scene carefully, he or she may discover
that there are inadequate services for the elderly and developmentally dis-
abled and their families along with a number of other smaller opportuni-
ties. The professional problems identified center on a lack of specific knowl-
edge and skills and a complete absence of professional ties to these
populations. An examination of personal and professional preferences and
environmental opportunities leads to the decision to develop a special pro-
ficiency in geriatric psychology as a way of providing a long-term solution
to the financial problem. No immediate solution to the short run cash flow
problem is seen.
The goal can be stated then as: (1) financial independence and profes-
sional stability, (2) increasing cash flow, and (3) developing a special pro-
ficiency. The key assumptions include: (1) the professional in question has
sufficient skill, motivation, and knowledge to survive in private practice; (2)
the community has sufficient need for psychological services to provide
support; (3) the professional has sufficient resources to experiment for six
months; (4) there are opportunities to contact the human service agencies
relating to the elderly. These goals and assumptions result in the following
specific objectives: (a) review the major literature in geriatric psychology
during the next three months of evenings, (b) informally alert friends and
acquaintances of professional availability, (c) obtain a position on the board
of a local agency serving the elderly, (and d) investigate availability of
supervision and training opportunities.
Clearly the planning process has taken a basic need for more clients
and increased cash flow and a set of environmental constraints and yielded
a set of four fairly specific objectives to achieve as a way of meeting the
needs within those constraints. Let us now briefly examine how the objec-
tives can be converted into action.
When considering alternative courses of action a large number of vari-
ables should be included. Le Breton and Henning (1961) state that any plan
has 13 dimensions: complexity, significance, comprehensiveness, time,
specificity, completeness, flexibility, frequency, confidential nature, formal-

ity, authorization, ease of implementation, and ease of control. Without
reviewing the specifics, it is clear that alternative strategies and action plans
contain numerous features. Many are somewhat esoteric for the purposes
of this example. However, the professional does want a strategy and an
action plan that are timely, significant, flexible, and easy to implement and
control. Complexity, comprehensiveness, specificity, and frequency are less
important and would consume more resources than are available.
Let us assume that, in light of the four stated objectives, the practitioner
decides that regular sessions in the library are indicated to review the lit-
erature. Furthermore, as a way of working on the immediate crisis, he or
she decides to contact personally at least 10 professional colleagues to estab-
lish contacts and alert them as to his or her availability to accept referrals.
After these steps are initiated, telephone calls to the directors of three local
agencies will be used to explore opportunities to serve on governing boards
and committees. The final objective of exploring supervision and training
opportunities will be confined to scans of various newsletters and profes-
sional journals.
Our managing professional implements the action plan with 10 calls to
colleagues that result in an increase in knowledge and ease in communi-
cating availability but lead to no immediate referrals. A committment is
made to spend three evenings a week in the library for the foreseeable
future. Newsletters are scanned for training opportunities. The status quo
prevails for two weeks until a colleague calls with a referral. Some success
adds motivation and a meeting of the local Psychological Association pro-
vides an opportunity for socialization and informal communication. Some
useful information about service agencies is obtained and two likely can-
didates for contact are identified. After another week of reading, the indi-
vidual has grasped many of the key issues in serving the elderly. A call to
an agency is made and meets with a helpful reply and some additional peo-
ple to call. A second referral comes in and the crisis begins to ease some-
what two months into the plan.
After the additional calls are made, the professional makes a committ-
ment to attend a board meeting. There, additional contacts are established
and a discussion of the problems of the local elderly population provides
an opportunity to exercise some of the new concepts and knowledge. A
commitment is made to serve on a committee of the board that is focusing
on developing a counseling service for widows. The professional is off and
running as two more referrals are received in the next several weeks and
the bills are being met.
Six months into the plan, the professional evaluates his or her progress
in a somewhat formal process. He or she now sits on the agency's' Board of
Directors. A substantial amount of new knowledge about the elderly has
been obtained and service has been initiated to two elderly clients. New
referrals are beginning to come in more regularly as clients tell other clients
and colleagues judge that this person is reliable and proficient. A confer-
ence on services to the elderly is being held in a distant city and the prac-
titioner has made arrangements to attend. The initial need and constraints
have been met as the goals and objectives were achieved. However, the two
elderly clients have led to the realization of several areas of skill and knowl-
edge deficiency. New plans need to be made. The process continues as a
transformation has begun.
In this brief and successful example, we see all of the major factors in
planning and problem-solving operating. These are real issues for thou-
sands of psychologists in widely differing settings. Although much of the
content may vary from person to person and situation to situation, the par-
adigm remains as a valid, generic approach to professional problems. With-
out these organized models, each new situation is often treated as com-
pletely unique. In fact the structure and process usually are similar across
problem situations and that should be the key lesson of this section.
Although some references have been cited in the foregoing pages, the
reader may wish to consult Bennis, Benne, and Chin (1969); Brady (1973);
Burgwall, Reeves, and Woodside (1973); Davis (1978); Drucker (1973); Fried-
man (1967); Holland (1976); Littlestone (1973); McConkey (1972); and Zee-
man (1976) for further information.
POWER-DEPENDENCY RELATIONS
Power is a second major problem area, one of the central.issues in all

of human behavior. No other issue seems to draw people into a discussion
the way the use or abuse of power does. Salancik and Pfeffer (1977) define
power as "simply the ability to get things done the way one wants them to
be done" (p. 4). Power then would seem to be crucial to the maintenance
of survival and to the achievement of actualization by any professional. The
aim of this section is to overview the major aspects of power and to suggest
some alternatives for acruing and wisely using it.
Emerson (1962) presented a classic paper on the theory of power in
social relations. For him, the basic issues centered on the mutual dependen-
cies of any parties (party A and party B) in a social relationship. Thus,
"dependence (Dab) of actor A upon actor B is (1) directly proportional to
A's motivational investment in goals mediated by B, and (2) inversely pro-
portional to the availability of those goals to A outside of the A-B relation"
(p. 32). Similarly, "the power (Pab) of actor A over actor B is the amount of
resistance on the part of B which can be potentially overcome by A. This is
expressed symbolically by the equations: Pab = Dba and/ or Pba = Dab" (p.
32).
Roughly translated, this means that the power of any professional is
directly proportional to the extent that person is dependent on the
resources of others to perform the tasks crucial for survival and/or actuali-
zation. Strategies, skills, resources, and capacities that reduce dependency
on others or create dependencies on the psychologist will increase that
power and vice versa. Emerson (1962) further detailed four basic types of
operations that are used when power relations are unbalanced. If actor B
perceives that he or she is weaker in a relationship, balance can be restored:
"1) If B reduces motivational investment in goals mediated by A" (p.
35). (B can withdraw from A)
"2) If B cultivates alternative sources for gratification of those goals"
(p. 35). (B develops new relations apart from A )
"3) If A increases motivational investment in goals mediated by B" (p.
35). (B gives status to A)
"4) If A is denied alternative sources for achieving those goals" (p. 35).
(B forms a supportive group or coalition.)
Kotter (1978) expands on these principles and suggests that the tech-
nique of "power / dependence analysis" (PDA) can be used to identify job
dependencies and the power strategies necessary to manage them. He sug-
gests a list of questions that can be used to delineate the power-dependence
features of any position. They are as follows:
1. Who are and what does the profeSSional depend upon?
2. How important is each dependency?
3. What is the basis of each dependency?
4. Are any of the dependencies inappropriate or dysfunctional?
5. If they are dysfunctional what has created the pattern?
6. How much effective power-oriented behavior does the profes-
sional engage in?
7. Is that behavior sufficient to manage the dependencies?
8. If the behavior is not sufficient, what changes need to be made?
9. Is the professional capable of the change?
10. Does the professional's generation and use of power have negative
consequences for him or her?
11. If there are consequences, what are they? (p. 39)
Kotter (1979) went on to outline the basic forms of effective power
behavior. Briefly, and consistent with power-dependence theory, he sug-
gests the following types of behavior:
1. Gain control of tangible and/or scarce resources-budgets, employ-
ees, buildings, equipment, decision-making responsibilities, referral
sources, etc. All of these can provide realistic power bases for the
professional to employ in the struggle for survival.
2. Obtain and control information-that is the most frequently used
power strategy of professionals. Most often, information is acquired
via the expertise of the psychologist. After appropriate manipula-
tion, the information is used ethically for the benefit of the c1ient(s)
and/or the psychologist.
3. Establish favorable relationships-building friendships, establish-
ing interpersonal obligations or achieving sufficient expertise so as
to be recognized. All can serve to decrease dependence and increase

power.
4. Fostering identification and dependence-in the main, this involves
using what sources of power are available to control the resources
others need, and, then shaping others perceptions so that they are
aware of this capacity for and use of power.
5. Persuasion and indirect influence-this involves the use of infor-
mation that is important to the goals of others to modify their atti-
tudes, values and behavior. Structuring the environments of people
and/ or events also can have extreme effects on the power that a per-
son exercises in a situation.
As is always the case, extreme caution and care should be exercised by
any professional deliberately seeking to accumulate and to exercise power
or to reduce dependency. The use of power mandates a strong set of values,
principles, and ethical behavior because power, for professionals, always
carries a degree of responsibility for the consequences of its use. Although
courage, risk-taking, and assertiveness should be valued and employed as
one develops power, they must be accompanied by equal amounts of wis-
dom, temperance, and respect for the human rights of others.
Illustrations of many of these issues can be obtained from the detailed
planning example outlined earlier. Switching from the planning-problem
solving orientation into the power-dependence model allows us to use the
same set of facts, problems, and proposed solutions to examine the power
features of the situation. Using some of the questions from Kotter's PDA,
we find that the psychologist in question currently is solely dependent
upon the 15 clients with whom he or she entered practice. Simultaneously,
the practitioner is dependent upon a cash flow of $1,300 per month to meet
the basic demands of the environment. Each client is vitally important
because of the economic dependencies. The degree of this dependency is
dysfunctional in that the basic economic needs are not being met. Yet, since
the situation at the outset was defined by the professional, hopefully it is
modifiable.
Initially, we see that the psychologist engages in effective power-ori-
ented behavior with the clients so that $900 of the needed $1,300 per month
is generated. One could debate the effectiveness of the fee policy but, again,
assume that all appropriate steps were taken. At this point in the PDA it is
clear that the existing power behaviors are insufficient to generate $1,300
per month that represents one of the basic dependencies and without
which survival cannot be guaranteed. In identifying the goals, specifying
objectives, and designing an action plan, the professional has specified in
detail the changes that must be made to reduce the dependencies and
increase his or her power. In Emerson's terms, the psychologist/actor has
decided to employ strategies in which he or she cultivates alternative
sources to achieve the identified goals and simultaneously denies the exist-
ing dependencies alternatives for maintaining the status quo. In this case,
the other actors in the situation assume neutral stances toward the plans
and actions of the professional.
Thus, the psychologist attempts to obtain and control information
regarding the psychology of aging, the local elderly population and their
needs, and the existing sources of aid for them. Furthermore, he or she tries
to establish favorable relationships with colleagues through telephone calls
and participation in the activities of the psychological association. Finally,
relationships with the agency board are formalized. The professional uses
the new information to influence decisions indirectly as legitimate new
expertise is brought to bear in the situation. The new referrals result in both
a planning and a power success as the approach enables the psychologist to
pay the bills and reduce the dependency on the existing clients.
In this case, the professional was capable of making the appropriate
changes. In addition, the increase in power was obtained at no particular
negative cost to any other single actor. The new relationships and new
referrals are managed with an attitude of mutuality, as effective services are
exchanged for money and information. Such successful, nonmalignant out-
comes are not associated with all instances of power generation and use by
professionals. In fact, many critics, including professionals themselves,
complain bitterly that the accumulation of power by professionals does not
result in effective outcomes for people in many instances. These critics
claim that the information, resources, relationships, and ability to generate
identification, pursuasion, and indirect influence are seldom used for the
benefit of the clients or society at large. Strategies and tactics aimed at spe-
cific individuals and/or groups must be scrutinized from a variety of per-
spectives before they are implemented. To do otherwise could well be
unethical in the extreme.
This view of power-dependence should not be taken as the last word
on the subject. However, as the example indicates virtually every major type
of human interaction has aspects of power-dependence in it. Regardless of
the service setting, the organizational configuration and/or mission, and
the personal attributes of the individuals involved, it is vital to understand
these aspects of human behavior and to be able to initiate effective changes
when assessment calls for them. For those working groups and organiza-
tions, this need often is obvious. It is hoped that our example illustrates that
these facets of behavior are equally crucial for practitioners in any setting.
RESOURCE ALLOCATION
This is the third problem area. As outlined earlier, resource allocation

is a primary management task. It requires the integration of a wide variety
of skills, concepts, and technologies. It is a topic that spans the issues of
needs assessment, market analysis, planning, budgeting, accounting, eval-
uation, decision making etc. Because of the scope, we will only outline some
of the basic principles involved. These will then be illustrated with an

example involving the allocation of time, the most critical resource for any
human being.
This chapter already has provided overviews of the behavioral char-
acteristics of the roles involved in resource allocation, outlined the theoret-
ical foundations for its use, and focused on two of its most critical compo-
nents, planning and power-dependency relations. The elementary issues
involved in outlining one's dependencies and planning to manage them in
order to survive and actualize are well understood. We can now focus on
those aspects of the planning cycle where the processes of resource alloca-
tion should be employed.
The major aspects of a rational resource allocation procedure include
cost analysis, budgeting, accounting, auditing, and evaluation. These last
two elements are included because I feel it is crucial to go beyond effective
planning and decision-making processes and to focus on the acutal out-
comes of these efforts. Are goals and objectives actually reached? If they are
not, then why?
To begin a cost analysis procedure, one first decides, or establishes,
what kinds of major categories of activity typically absorb the resources of
the organization. In an institution, this will involve identification of the
programs, departments or work centers which comprise the activities of the
organization. For the individual psychologist, the principle is the same. A
professional begins by listing most of the behaviors or activities he I she usu-
ally performs. These can be lumped together into useful categories accord-
ing to a variety of strategies. The key issue is to outline those areas of activ-
ity that encompass the major dependencies and work areas that are crucial
for survival.
Table 1 presents a somewhat simplified list that we will use in our
example. Our new practitioner has developed a list according to the best
estimate of what is important and where to spend time. Four major cate-
gories or cost centers are established, with three subdivisions of the service
delivery center. Sorensen and Phipps (1972) and Smith and Sorensen (1974)
outline a variety of techniques for allocating costs to cost centers. For our
purposes, the exact time or estimated time approach would be the simplest
and most direct method. According to it, some reasonably accurate measure
TABLE 1
List of Professional Cost Centers
1. Service delivery
(a) Evaluation
(b) Therapeutic services
(c) Consultation
2. Environmental relations
3. Professional development
4. Business management
DAILY PROFESSIONAL TIME LOG FROM TO
M T W T F S S TOTALS
ACTIVITY CENTER
1. SERVICE DELIVERY
(a) Evaluation
fbI Therapeutic
Services
Ie) Consultation
2. ENVIRONMENTAL
RELATIONS
3. PROFESSIONAL
DEVELOPMENT
4. BUSINESS
MANAGEMENT
TOTALS
FIGURE 3. Daily professional time log.
or estimate of the time the professional spends in each of these categories

must be available. This would be provided in a variety of ways. For exam-
ple, the professional could decide that an ideal proportion of the total time
to be invested is as follows:
1. Direct Services 75%
2. Environmental Relations 5%
3. Professional Development 15%
4. Business Management 5%
Assuming a 40-hour work week, 2 hours should be devoted to environ-
mental relations and business management, 6 hours to professional devel-
opment, and 30 hours to service delivery.
By stating his or her goals in this way, the professional has basically
established a budget for the expenditure of the 40 hours to be allocated for
the practice. In order to determine how he or she is performing, some type
of record-keeping system must be devised. This can be as simple as main-
taining a daily time log for these cost centers. Figure 3 presents an outline
of the weekly time log kept by this psychologist. This form is filled in daily,
if possible, with the best possible estimate of the number of hours spent in
each category. Monthly, quarterly, or semiannual summaries of the time
actually spent provide the accounting and auditing functions of this
resource allocation procedure. Comparison of the periodic summaries to the
initial time budget allows the psychologist to evaluate whether the goals
set for the use of this most precious resource are being accomplished.
Following along with our example, let us assume that the professional
has kept a daily record since the first day the practice began. At the end of
the first full month of practice, the summary of the activity resembles Fig-
ure 4.
PROFESSIONAL COST CENTERS

TOTAL HOURS OF PRACTICE 200
IMONTHlY SUMMARY
COST CATEGORY TOTAL HOURS PERCENTAGE
1. SERVICE DELIVERY 80 40
tal Evaluation 10
(b) Therapeutic 5o,i.e. 70
leI Consultation 0
2. ENViRONMENTAL RELATiONS 80 40
3. PROFESSIONAL DEVELOPMENT 0
4. 8USINESS MANAGEMENT 40 20
TOTALS 200 hours 100%
TOTAL INCOME $900

TOTAL EXPENSES $1300
FIGURE 4. Professional cost centers: Monthly summary.
It is obvious from the report that this psychologist has fallen far short
of the initial goals set. In line with our earlier discussions, this is readily
explained by the lack of solid referral sources, problems in establishing a
business, and need to focus on developing excellent relations with the
human service community. If the data continued to look like this every
month, one could predict that drastic changes would be necessary after six
or nine months. Cost accounting with fiscal, as opposed to temporal,
resources would reveal either a picture of rapidly accumulating debts or
rapidly declining financial reserves as cash flow consistently proved unable
to meet the basic monthly expenditures.
The data presented earlier revealed a monthly net of $900 for this 80
hours of service ($12.50 per hour). The strategy that was designed to solve
this problem was implemented after this first month. The quarterly report
shown in Figure 5 reveals the temporal and financial results of the plan.
A pattern of improvement in the percentage of time spent in direct
services and increases in the revenue is readily apparent. Although a deficit
of $600 was incurred during this first quarter, two-thirds of it occurred dur-
ing the first month. The plan successfully generated sufficient income to
meet the deficit and gave evidence that indicated that the practice was soon
to move into the black. Other strategies for increasing the efficiency and
effectiveness of the management strategies are discussed thoroughly by
Mackenzie (1972).
The concepts and techniques described above, along with the rudimen-
tary examples of their implementation, represent basic approaches to these
most difficult problems. Regardless of the focus of activities, every profes-
sional psychologist continues to confront significant problems in planning,
power-dependency relations, and resource allocation throughout his or her
career. Solving these problems means the difference between success and
failure, survival and growth as a professional, or decay and ultimately death
PROFESSIONAL COST CENTERS/QUARTERLY SUMMARY

TOTAL HOURS OF PRACTICE 600
COST CATEGORY HOURS PERCENTAGE
1. SERVICE DELIVERY 350 56

(a) Evaluation 20
(b) Therapeutic Services 320
(e) Consultation 0
2. ENVIRONMENTAL RELATIONS 200 33
3. PROFESSIONAL DEVELOPMENT 5 1
4. BUSINESS MANAGEMENT 45 8
TOTALS 600 hours 100%
TOTAL INCOME S 3300

TOTAL EXPENSES $ 3900
FIGURE 5. Professional cost centers: Quarterly summary.
of these aspirations. What is frequently so clear and obvious for a corpora-

tion or major institution is often murky and arcane for the individual prac-
titioner. The above presentation was designed to expose the basic issues and
approaches that can be used, and hopefully illustrated their usefulness to
the problems of an individual professional psychologist.
CONFLICT MANAGEMENT
Our last major problem area is one about which most psychologists
know a great deal, human conflict and its management. I am therefore,
assuming that a broad theorectical discussion of the issues is unnecessary.
Instead, I will focus on a model that emphasizes those practical and opera-
tional features of conflict management that the individual professional can
identify and master. This discussion will follow closely those of Watson
(1969) and Bernstein (1965).
Figure 6 presents a flow chart that outlines the stages of a typical con-
flict. As has been discussed, the environmental context, for us the psychol-
ogist-niche interface, presents many de facto opportunities and probabili-
ties for conflict. Indeed, the adaptational process of transformation almost
CONFLICT
BARRIERS f---o RESULTS
~
ENVIRONMENTAL
CONTEXT f- ISSUES -- - -- CONFLICT
BEHAVIORS - - - --
COSTS &
TRIGGERS f---o BENEFITS I-
1 1
FIGURE 6. Stages of a conflict (adapted from Walton, 1969).
demands that conflict be generated and resolved for successful growth to

occur. But, and this is a crucial point, conflict can result in decay and dys-
function just as easily as in growth and actualization. It therefore behooves
every professional to have a firm grasp of the intra- and interpersonal
aspects of conflict and its management.
The context then leads to the development of what Watson identified
as issues. Figure 7 presents a chart for differentiating the types and the focus
of conflicting issues. Globally, two major types of issues are seen as gener-
ating conflict. First, substantive issues create conflict. They usually are easy
to identify and often are discussed openly and heatedly. The second issues
are emotional in nature. They spring from the feelings that individuals
bring to and/or take away from any given interaction. These two types of
issues can be manifest in any situation and thus be visible and accessible to
one or more of the involved parties. Or, they can be latent, either uninten-
tionally or by design, and be inaccessible by any direct means yet still play
a major role in any conflict.
These issues can have a variety of foci, which Figure 7 also outlines.
The conflict can be inside of the individual (intrapersonal) or between any
two people (interpersonal). Conflict can be between members of groups or
subsystems of an organization. It can surface between competing organi-
zations and/or groups or be reflected in the activities of larger social sys-
tems such as neighborhoods or communities. Globally, conflict also can, and
often does, occur in large scale environments such as cultures, societies, or
groups of these that compete with each other in a variety of ways. It is
unnecessary to fill in every cell of this figure. An average psychologist often
will become enmeshed in a number of different types of conflicts with dif-
ferent foci simultaneously. An understanding of the issues and process will
be central to the task of survival.
TYPE
SUBSTANTIVE EMOTIONAL
MANIFEST LATENT MANIFEST LATENT

FOCUS OF CONFLICTING ISSUES
INTRAPERSONAL
INTERPERSONAL
ORGANIZATIONAL/GROUP
INTERORGANIZATIONAL/INTERGROUP
LARGER SOCIAL SYSTEM
ENVIRONMENT
FIGURE 7. Characteristics of conflicting issues (adapted from Walton, 1969).

Examples of conflict-producing issues include disagreements over pol-

icies or practices between individuals or groups. Competition over scarce
resources is a major source of conflict on any level. Often, incompatible per-
sonal needs or opinions or differing conceptions of roles and role relation-
ships create a climate where conflict festers and evolves into open struggle.
Negative feelings between individuals or groups of actors, such as anger,
distrust, envy, resentment, anxiety, and rejection also frequently lead to
conflict behavior. Role invasion, where one individual or organization
attempts to control part or all of another's environmental niche, is a fre-
quent cause of conflict in large organizations. Such organizations can foster
conflict deliberately by supporting incentive structures that encourage
internal competition. Finally, various types of deprivation can turn human
beings into voracious marauders, seeking to satisfy deeply felt yearnings or
long-delayed wishes. In short, almost any feeling can serve as the spawning
ground for conflict behavior. This degree of unpredictability and the mag-
nitude of the potential results of any conflict underscore the need to be able
to anticipate and cope with the frequent conflicts that every professional
confronts.
Continuing to follow the model presented in Figure 7, we see that each
type of issue has the potential for producing conflict. It also has associated
with it various personal and environmental forces that act either as barriers
that inhibit the overt expression of the conflict or as triggers that push it
into the open. The balancing of these barriers or inhibitors and triggers or
excitors will determine the degree to which a conflict is openly expressed.
This mix of forces also can shape the form and direction of any conflict and
thus become prime arenas for effective intervention and management.
Any' given event can act as either a barrier or a trigger. Walton (1969)
gives us some examples to consider. Task requirements can promote or
inhibit a conflict. Setting unrealistic time limits for certain activities can
facilitate conflict by increasing tension, frustration, fear, etc. Setting those
same time limits in a different situation can help people to be too busy to
fight. Group norms against or supportive of open fighting can cause or
eliminate any given battle. Similarly, perceptions of one's own vulnerabil-
ity or that of the other party and the public images of self that are related
to those perceptions, are frequent barriers or triggers. Physical obstacles
also can stop or start a fight, although in a world of global communications
and jet travel, these are easily overcome.
If the triggers in a particular situation have more weight than the bar-
riers, we can safely predict that some conflict behavior will manifest itself.
This kind of behavior is easy to identify when open acts of physical vio-
lence or verbal abuse are involved. In many cultures, these are taboo and
they are replaced by more subtle, but nonetheless destructive, forms of ver-
bal violence, alliance building, creating divisions, delays, or using authority
inappropriately. The range of possible conflict behaviors is as wide as one's
imagination.
In every case, conflict behaviors have results. As our model shows,

these results usually have costs and/ or benefits to the participants. The eval-
uation of the results, costs, and benefits in any conflict can lead to a variety
of outcomes. The outcomes can modify the environmental context so that
the issue has more or less relevance. They can modify the issue(s) itself,
making a fight more or less likely. Finally, the results can affect the triggers
or barriers. This is the main outcome of many battles and thus make a con-
flict more or less probable.
In all of these outcomes, we have assumed a natural sequence of events
in which no party actively intervenes to modify or prevent the conflict from
occurring. While this is often the case, I hope that the professional psy-
chologist so enmeshed can evaluate the situation and act in such a way as
to reduce the likelihood of destructive outcomes, resolve the conflicts, or
minimize the damages. The options for intervention are as great as the
number of contexts, issues, barriers, and/or triggers that operate in any
given situation.
Any point in the process just described can serve as an entree to a psy-
chologist seeking to alter a conflict. On the one hand, a context that is pro-
viding the fuel for a fight can be altered in a variety of ways. For example,
let us take an organization in which two psychologists are competing for
and fighting over a limited number of dollars for increasing their salaries.
The understanding of the two parties is that the one who is the "most pro-
ductive" will be rewarded. As a result, the atmosphere in the organization
becomes electric and the interpersonal and intraorganizational sparks begin
to create fires all over. The agency director has some straightforward
options available to change the context and modify the issues, thus elimi-
nating the root cause of the budding battle. These options include: (1) spec-
ifying the conditions (norms) for .the competition; (2) eliminating the com-
petition by changing the distribution pattern; or (3) developing a sufficient
resource base so that conflict is unnecessary. There are obviously additional
alternatives. Modifying the stimuli is a well-proven way of changing
behavior.
A second way of modifying the stimulus side of a conflict is to modify
either the foci or the type of issue. Perhaps the most frequent example of
this way of intervening comes from clinical or organizational settings
where there appear to be substantive policy differences between the parties
that have generated some conflict. This could range from parental disagree-
ments over a child's bedtime or eating habits to conflicts over the distribu-
tion of major resources in a corporation. Mter carefully exploring such
issues, a simpler and more latent explanation is often found. In the former
situation, one parent may feel the other is not supportive and that some
changes need to be made. In the latter, someone may feel slighted or threat-
ened and need reassurance. The answers are not always easy, but they can
be obtained in many situations.
For a manager, barriers and triggers present a unique opportunity to
regulate the flow of conflict in an organization. By establishing norms, rein-
forcing constructive behaviors, and punishing inappropriate behavior most

organizations' conflict situations can be taken care of with few casualties.
This occurs in situations where managers with the ability to influence a
conflict hold no vested interest in a particular outcome. Where this is not
true and the particular outcomes are of concern, conflict regulation becomes
more complex and difficult.
Conflict behaviors themselves are often difficult to change because of
the early and deep socialization of aggressive behaviors that most humans
experience. Yet, you can make it difficult to assault anyone verbally and can
insure against the vilest forms of retribution, insubordination or attack. The
more subtle forms of assualt, coalition building, rumor mongering, charac-
ter assassination etc. are harder to defend against or change.
The results of a conflict and the costs and benefits are also good places
for intervention since the reinforcement and punishment parameters are
easily applied once a conflict has occurred. The value of a conflict can be
carefully ascertained and various rewards or aversive conditions applied
depending on the nature of the outcome. Thus, firing "trouble making"
employees, rewarding problem solving and creating a positive climate in
an organization or a relationship are all behaviors which can be practiced
and learned.
Finally, much of what goes on in any cycle of conflict is heavily depen-
dent on the communication/feedback loops which allow a situation to recy-
cle endlessly in a sort of perpetual human conflict machine. However, the
same processes of feedback can become avenues for creative, constructive
change anywhere in the cycle. It is critical for a professional to be able to
evaluate the content and process of any conflict and to be able to intervene
on his/her own behalf as well as in defense of clients and/or organizations.
Although this final presentation is somewhat sketchy, a thorough reading
of Coser (1967), Fromm (1973), and Walton (1969) should provide a richer
background from which you can draw examples and more detail.
CONCLUSION
As complex and seemingly detailed as this chapter is, it only begins to

scratch the surface of most of the issues that professionals routinely con-
front in their managerial capacities. I have tried to highlight those issues
that seem to be easy to assimilate and are of critical importance in everyday
functioning. Striking the proper balance between conceptual material and
understandable examples is always difficult. Here, I have chosen to err on
the conceptual side and have emphasized structures and processes that are
applicable in a wide variety of contexts. If you have a desire for more exam-
ples, I urge you both to continue your reading and to take more of the
important aspects of your current professional life and use some of the flow
charts and questions presented here to further analyze the situation that
you currently face.
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VII
VALVES AND INTERESTS AFFECTING
PROFESSIONAL DECISION-MAKING
16
Psychology, Professional Practice, and the
Public Interest
GOTTLIEB C. SIMON
Implicit in the title of this chapter is the idea that there can be a gap-
potentially a very large one-between the interests of psychology as a
profession and the interests of our clients and society as a whole. To George
Bernard Shaw's contemporary followers, those who believe with him that
all professions are conspiracies against the laity, it hardly could be other-
wise. For many practicing psychologists, however, this idea may seem not
only unacceptable but unthinkable. To them, a profession, because it is
predicated on the service ethic, must perforce be in the public interest.
Nonetheless, professionals, like other people, are guided not only by our
desire to do good for others, but by our desire to do all right for ourselves.
There is more than one aspect to our motivation. We are influenced not only
by the public interest, but by our guild interests: the desire for increased
income, social acceptance, influence, and power. The problem for us, and
for SOciety, is that these separate interests can and do pull us in different
directions. When they do, which way will we turn? Former APA president
M. Brewster Smith (1976) has called attention to the "natural tendency" of
"APA lobbying and related activity ... to gravitate toward the guild rather
than the public interest component" (p. 2).
The emergence of the public interest movement in recent years is evi-
dence that many people, including some professionals, believe that profes-
sions have "gravitated" too far toward their guild interests. Professionals
are accused of overcharging clients, conspiring to eliminate competition,
perpetuating socially wasteful and inequitable arrangements, and generally
A portion of Part I appeared originally as an editorial in the Journal of Community Psy-

chology, 1978, 6, 294-297. Part III was developed initially for the Committee on Promoting
Public Interest Activities.
GOTTLIEB C. SIMON • 201 Eye Street S.w., Washington, D.C. 20024.
541
542 GoTTLIEB C. SIMON
placing their good and welfare before that of their clients and society as a
whole.
Yet, those psychologists who would gravitate toward the public inter-
est face many obstacles. One is our training. We have been socialized to
avoid controversy and conflict (e.g., Ad Hoc Committee on Advocacy, 1969).
If, despite this equivocating influence, we still are inclined to pursue
change, we find that we lack the necessary training and knowledge to be
effective. More importantly, those professionals who would nevertheless
follow their conscience, who would give their attention to individuals who
have the greatest need for their services; who would prevent problems
instead of rehabilitating the victims; who would expose official wrongdo-
ing, too often are forced to choose between their own job security, personal
advancement, or material comfort and their professional values.
The gap that exists between our efforts as professionals, individually
and collectively, will not close until we-or others-are able to alter the
"reward structure" that governs our behavior so that there is increased coin-
cidence and less conflict between our self-interests and the public interest.
This chapter, I hope, will provide some help both for the long-term goal of
modifying our reward structure and the more immediate needs of profes-
sionals who wish to serve the public interest more effectively. It contains
information that is intended to clarify the meaning of "professional activity
in the public interest"; articulate some of the more salient areas of conflict
between our guild interest and the public interest; and present some prac-
tical suggestions on increasing one's effectiveness as a professional in the
public interest.
TOWARD A DEFINITION OF "PSYCHOLOGY IN THE PUBLIC

INTEREST"
It may be helpful in understanding the relation of professional psy-

chology to the public interest to begin with an analysis of the public inter-
est. A definition of terms is de rigueur in an undertaking such as this.
The public interest, sometimes referred to as the public welfare or the
common good, is one of the oldest and most interesting concepts in Western
philosophy. Age, however, in this case, does not generate respect. From
time to time the concept has been attacked as vague, normative, and of no
analytical value. Many have recommended discarding it altogether-and
yet it endures.' So many different definitions have been offered for the pub-
lOne hundred years ago Bertham (1876) observed:
The interest of the community is one of the most general expressions that can occur in
phraseology of morals: no wonder that the meaning of it is often lost. When it has meaning,
it is this. The community is a fictitious body, composed of the individual persons who are
its members. The interest of the community then is-what? The sum of the interests of the
various members who compose it. (p. 3)
More recently ad writers for eitibank (1978) charge that:
Probably no phrase in the English language affords more ambiguity or opportunities for
demagoguery than "the public interest." (p. 016)
PSYCHOLOGY, PROFESSIONAL PRACfICE, AND THE PUBLIC INTEREST 543
lic interest (along with an increasing number of systems for classifying

them) that one of the few things that scholars can agree on is that there is
no generally accepted definition. Defenders of the public interest some-
times acknowledge that it is open to numerous interpretations; but then,
they say, so are concepts such as justice and beauty that we hardly could do
without. The public interest "even though it lacks precision," says one
defender, "is as valuable as it is inescapable" (Pennock, 1960).
The public interest is an inescapable, and controversial, concept
because it "plugs" into the central issues of political and social life: What is
the purpose of community? How should decisions be made? Who should
make them? Who should benefit? What is the relation of the individual to
the community? Various combinations of answers are possible. As a result
there are not only a multitude of different definitions but a number of
diverse systems for classifying them and a sizeable scholarly literature ana-
lyzing the differences. Listed below are some of the more common and
influential definitions of the public interest. Since this listing is intended
to illustrate the range and diversity of meaning that can be attached to the
public interest, the different meanings may overlap. The reader interested
in typologies of the public interest should consult: Banfield (1955), Cochran
(1974), Flathman (1966), Friedrich (1962), Held (1970), Mitnick (1976), and
Schubert (1960).
1. The public interest is the "sum of the interests of the various members who
compose it." Definitions of this sort are variously referred to as "preponder-
ance," "aggregationist," or "individualistic." ("Individualistic" is used in
the sense of "atomistic," as opposed to "organismic"; see item 3 below.) The
utilitarianism of Jeremy Bentham is the best known and classic statement
of this approach. In order to decide whether a given policy is in the public
interest, you simply add up its positive and negative effects on each mem-
ber of the community. If the positive effects outnumber the negative, the
policy is in the public interest. A policy may affect only one person, but if
the end result is positive it is in the public interest. 2 In the case of several
competing policies (or programs or products), the one with the most
"pluses" is the one that is most in the public interest. In their purest form
preponderance definitions treat everyone alike. Other formulations allow
different weights to be attached to the interest of different people (e.g., the
very young, the aged, the handicapped, etc.) before summing to the public
interest in order to take their special needs into account. Other definitions
introduce still other modifications of the basic idea. The important feature
of definitions of this sort is that they equate the public interest with the
2Known as the Pareto criterion or Pareto optimality, Held (1970) summarizes the concept:
Assuming that only individuals themselves are able to assign values to their own utilities,
Pareto asserts that the "welfare" of a group of individuals may be considered to increase if
at least one individual in the group is made better off-in terms of their utility values-
without anyone being made worse off. Then, of any social state, if it is not posSible to make
a change without making at least one individual worse off, the state may be defined as
being Pareto-optimal. And any change may be Pareto-optimal if it benefits at least one
other individual and harms none. (pp. 107-108)
544 GOTTLIEB C. SIMON
majority interest; the public interest has no standing-and no meaning-

apart from the sum of the interests of individuals.
2. The public interest is that which (potentially, at least) benefits everyone. This
definition differs from the preceding one by restricting the range of activ-
ities that can be related to the public interest to those matters that are
shared, or are common, to many people. For instance, everyone has a stake
in preventing epidemics or in enjoying decent, affordable housing. Pro-
grams that contribute to such common or shared interests are in the public
interest. An alternate way of expressing this meaning of the public interest
is the call for impartiality. This is particularly relevant for times of scarcity.
Simply stated, if something is in everyone's interest, then it should be
shared by everyone, and if it can't be shared by everyone then everyone
should have an equal chance to enjoy it. There is thus an interest common
to all to see to it that scarce goods are distributed as fairly as possible, that
is, disinterestedly. To do otherwise would allow one person or group to
benefit at the expense of others.
Once a program (or policy or product) is judged to be in the public
interest, some philosophers hold that it must, by definition, be in every-
one's interest. They maintain that it is impossible for a person to have a
legitimate interest that is in conflict with the public interest, that those who
think that their individual interests are different from the public interest
are simply mistaken. At the same time it is possible for a few people to have
a common or a shared interest without implying anything with regard to
the public interest if the interest is not one that could not at least potentially
affect all or nearly all.
It is difficult when talking about the public interest, to say, for example,
that program X is in the public interest without also implying that such a
program should be public policy. Nevertheless, we all know that showing
that a program is in the public interest does not mean that it will be imple-
mented; it does not even mean that most people will prefer it over other
alternatives. For example, lower prices benefit everyone. If, however, I am
a producer of say, eyeglasses, I (and other opticians) have a special interest
in charging as much for my eyeglasses as I can. My interest in increasing
my profit is greater and more immediate than my interest in seeing prices
in general held down. 3 An additional aspect of this problem is that although
3The conflict between actions that promote one's special interest and those that maximize
one's shared interests has received considerable attention in environmental circles as the
tragedy of the commons (see Hardin, 1968; Bardin & Baden, 1977). The "tragedy" occurs when
there is unlimited access to a common property-range land, spring water, or clean air-
that is in limited supply. Unless everyone practices conservation, the "commons" will be
destroyed. However, in the absence of some form of social control, it is in each person's
(greatest) interest to go on using the commons to the fullest; to hold back would mean only
benefiting someone else who declines to conserve voluntarily. The ultimate result, of
course, is everyone's loss. Thus while it would be in everyone's interest to restrict the use
of the commons by the public as a whole, it is in no one's interest to reduce their use
unilaterally.
PSYCHOLOGY, PROFESSIONAL PRACTICE, AND THE PUBLIC INTEREST 545
the total amount of money that producers extract from consumers may be
immense, the extra amount paid by any individual consumer is too small to
motivate him or her to organize and fight back. 4 The increased recognition
of this state of affairs has fueled the consumer movement and the demand
for consumer / public representatives on licensing boards, public service
commissions, and other bodies in order to counter the influence of special
interests.
3. The public interest is what benefits the public as a thing in itself. This
approach regards the public interest as something other, or more, than the
sum of its constituent parts. This type of definition is typically labelled
"organismic" or "unitary" and carries a "mystical" connotation. (Inasmuch
as the public is regarded as an emergent characteristic, this also might be
called a "gestalt" definition.) Examples are not that readily generated. Ulti-
mately though, the public interest is the preservation and well-being of the
community "as a fellowship of common norms and common life, for it is
this form of order which gives meaning to human existence" (Cochran,
1974). Significantly, it is possible to argue from this perspective that the
continuity of the community, as an identifiable organization (organism),
over time should take precedence over the continued existence of even a
majority of its current members. In this case the conflict of individual and
The problem of the commons is the problem of "externalities," the consequences of

your actions on someone else. Unless a cost can be attached to these externalities, someone
concerned with maximizing profits will ignore them. Thus many companies have polluted
the environment or sold unsafe or unwholesome products. Public interest advocates have
decried this behavior. Given the current "rules of the game," however, many people appar-
ently condone such corporate behavior. That is Armstrong's (1977) finding in a series of
role-playing experiments in which students were asked to pretend they were members of
the board of directors of Upjohn Company, a drug manufacturer. The "directors" had to
decide what the company should do about Panalba, an Upjohn drug with serious side
effects, including death. According to Armstrong none of his mock boards were in favor of
removing the drug from the market. with attendant stockholder losses. "In fact," he reports,
"79% of these groups took active steps to prevent its removal"{p. 185). Armstrong concludes
that his results support previous evidence that indicates that corporate managers will "bring
serious harm to others in situations where they feel it is proper (sic) behavior for their role."
(p.205)
'The economist Milton Friedman (1962) comments upon this problem:
Each of us is a producer and also a consumer. However, we are much more specialized and
devote a much larger fraction of our attention to our activity as a producer than as a con-
sumer. We consume literally thousands if not millions of items. The result is that people
in the same trade, like barbers or physicians, all have an intense interest in the specific
problems of this trade and are willing to devote considerable energy to doing something
about them. On the other hand, those of us who use barbers at all, get barbered infre-
quently and spend only a minor fraction of our income in barber shops. Our interest is
casual. Hardly any of us are willing to devote much time going to the legislature in order
to testify against the iniquity of restricting the practice of barbering. The same point holds
for tariffs. The groups that think they have a special interest in particular tariffs are con-
centrated groups to whom the issue makes a great deal of difference. The public interest is
widely dispersed. In consequence, in the absence of any general arrangements to offset the
pressure of special interests, producer groups will invariably have a much stronger influ-
ence on legislative action and the powers that be than will the diverse, widely spread con-
sumer interest. (p. 143)
public interests could be recognized as a valid conflict since majoritarian

considerations do not define the public interest. This definition thus goes
further than the preceding one on this issue and is totally at variance with
the preponderance definition.
4. The public interest is official government policy-or whatever contributes to
it. Philosophers label this a formal, as opposed to a substantive definition.
As such it is readily understood and identified. "Nader's Raiders" fre-
quently have employed this definition of the public interest in their inves-
tigations of government agencies. Taking the agencies' enabling legislation
as their starting point, these public interest monitors have compared the
agencies' performance with their statutory purpose. Given this perspective,
whatever contributes to the effective and efficient execution of the agency's
purpose is in the public interest; what interferes is not. During times of
consensus this approach has widespread acceptance. On the other hand,
when widespread public support for governmental policy is lacking, a sim-
ple identification of governmental policy with the public interest may not
be possible. The war in Vietnam is an illustration.
5. The public interest is conformity with commonly held values and sensibilities.
This definition has received less attention than the others in this listing.
The reason is that it does not involve questions of material benefit or polit-
ical power. The key concern is with subjective matters and "spiritual" val-
ues. For example, according to this definition it would not be in the public
interest to show a movie on television if it ridicules a popular national fig-
ure on the day of the person's funeral. Similarly, the use of scatological
language in public or the public display of obscene material may be
opposed on the grounds that it will be offensive to many people or because
it may undermine respect for authority and the norms governing an orderly
community. Of course, an alternate conception of the public interest might
impel individuals to be irreverent and to violate public sensibilities in order
to promote what they believe to be desirable social change.
6. The public interest is whatever emerges from a duly-sanctioned decision-
making process. The definitions described up to this point are focused on out-
come. They describe the public interest in terms of a preferred state of
affairs (e.g., public sensibilities are protected, a preponderance of society is
benefited, etc.). In other words they are concerned in varying degrees with
what should be. In philosophical terms they are "normative" definitions.
Many contemporary scholars, embarrassed by the open show of values,
have embraced a procedural approach. Rather than taking a normative, or
advance, position on what the public interest is, they focus on means for
reaching it. If the correct procedures are followed, then the result, whatever
it is and whomever it benefits, will be in the public interest. If a majority
benefits, that is fine. If a minority is benefited, even at the expense of the
majority, that, too, is all right provided the proper procedures were used in
coming to a policy decision.
Implicit in this approach is the view that society is made up of com-
peting interest groups.s (In this way it is more like preponderance defini-
tions than organismic ones.) In order for society to function an acceptable
balance must be found among these contending groups. This in turn
implies the need for a decision-making process that allows each interest a
fair hearing; but it does not imply that each group will receive anything
more than a hearing or due consideration. In some cases the definition may
assume that only the active participants in a dispute need to be involved;
in other cases the interests of "third parties" are explicitly considered a part
of the process, for example, the interest of consumers in a labor-manage-
ment dispute. In some cases the public interest is said to be represented by
the private interests in toto; in others, it is believed necessary to consider a
residual interest, that is, the public interest, that is left over when all of the
purely private interests are considered. Thus in many states a special office
such as The People's Counsel has been set up to represent the public inter-
est in utility rate hearings. The peculiar result is that the public interest is
simultaneously one of the parties in the process as well as the result of the
process.
In considering the public interest as one of the interests that must be
viewed in a proper process, the question arises as to the status of commonly
called "public interest groups." It is charged, for example, that"Any orga-
nized group of people constitutes a special interest-by definition" (Citi-
bank, 1978, p. DI6). Similarly, "it is conceivable that everyone from Plato's
philosopher-king to Ralph Nader is only doing what makes him feel good,
and any talk about the common welfare is so much window dressing"
(What is the public interest? 1974, p. 60). The thrust of these criticisms is
that the public interest is "just another special interest."6 Without trying to
5Cochran (1974) is highly critical of this approach. He feels strongly that the public interest
is more than a process:
The public interest must have a moral content. It is not a procedure, but a pronouncement
on the result of a procedure, an indication of good and evil. (p. 346)
He decries, moreover, the current preference for the public interest over the older term,
the common good. The use of this term, Cochran claims, is "itself an indication of just how
fundamental has been the shift in the assumptions underlying the contemporary ideas of
the purpose of politics" (p. 353).
6Mobil (1979), one of the large oil companies that has been heavily criticized by public inter-
est groups for its anti-consumer policies, placed advertisements in papers around the coun-
try to promote the idea that public interest groups are really special interest groups repre-
senting "an extremely selective" interest-that of college-educated, middle-class people:
We are delighted that the media seem to be growing more aware that the interests
advanced by many of the public interest lobbies are actually 'special' interests-limited
interests, often held by extremely small groups who are in obvious disagreement with the
American majority. Some are "no-growth" or even negative growth advocates, repelled by
the American lifestyle; many dislike the market economy, and the unruly freedom it
entails, others want to bring business firmly under government's thumb ....
We welcome this new skepticism about the 'public interest' label, and about who is
really entitled to it. We think the media should be especially careful about granting it to
small groups who are-on the record-anti-growth, anti-business, anti-energy, and dedi-
548 GoITLIEB C. SIMON
deny the sociological truth that organizations have self-interests, it must be

observed that there are significant differences between public interest
groups and special, or private interest groups. The most significant is their
relationship to the policy that they advocate. Berry (1976) explains this dif-
ference in his definition of a public interest group as "one that seeks a col-
lective good, the achievement of which will not selectively and materially
benefit the membership or activists of the organization." Put another way,
these criticisms are based on a primitive theory of motivational egoism that
is unable to differentiate between individual interests that are self-regard-
ing and those that are other-regarding. As Flathman (1966) put it, "If I have
an other-regarding interest, it is my interest, but my interest is in the profit,
advantage, or welfare of others." Certainly this is different from an interest
in one's own profit, advantage, or welfare.
7. The public interest is whatever is fundamentally "right" or "good." This is
one of the oldest meanings of the public interest. It is a meaning used by
the ancient Greek philosophers who treated the public interest as an ethical
concept and term of approbation. Some modern writers continue to regard
it in this way:
When an action is in the public interest, it is worthy of approval; when an
action is not in the public interest, it deserves our disapproval. ... The public
interest is a standard of goodness by which political acts can be judged; action
in the public interest, therefore, deserves approval because it is good. It has
been suggested that the concept is useless as a "tool of analysis" or an "aid to
scientific study," and that thus it should be abandoned. This statement is quite
irrelevant. The public interest is an ethical concept, has functions quite different
from those of analytic models, such as bureaucracy and federalism, and stan-
dards of measurement, such as efficiency and popularity. (Cassinelli, 1962, pp.
45-46)
Other writers have used or recognized its function as "a general commend-
atory concept" (Flathman, 1966). Thus, it has been described as a "hair-
shirt" that "has offered many a public servant and citizen an uncomfortable
and persistent reminder of the unorganized and unrepresented (or under-
represented) interests in politics" (Sorauf, 1962, p. 639); and it has been
called a "spur to conscience ... and a reminder that private interests are not
exhaustive of the public interest" (Pennock, 1962, p. 182). Although it is,
perhaps, the least precise, this meaning may have the most general, com-
mon usage.
In summary, to say that something is in the public interest means var-
iously that: it benefits everybody, or most people, or that it does not benefit
cated to an elitist, big-government view of America. That's a very small, very special inter-
est, a long way removed from the goals and ideals of the American people. (p. C2)
Berry's (1976) definition of a public interest group is relevant. Rather than defining the pub-
lic orientation of a group by the number of its members, Berry looks at the beneficiaries of
its program. Does it seek a collective good, or one that selectively benefits its members
(stockholders, employees, etc.)?
a few at the expense of many others, or that everyone's interests are taken
into account before a decision is made, or that it is consistent with deeply
held customs or beliefs, or that it contributes to government policy, or that
it is government policy, or that it has emerged out of a proper decision-
making procedure, or that it is necessary for the survival of the community
qua community and the well-being of future generations, or simply that it
is "right" and "good."
It might seem from the foregoing that the problem in defining the pub-
lic interest is largely a lack of agreement at the theoretical level. Actually,
most writers, if pressed, would probably admit that they shared Walter
Lippman's (now unfashionable) definition of the public interest as "what
men would choose if they saw clearly, thought rationally, acted disinter-
estedly and benevolently" (Lippman, 1955, p. 42). The difficulty is deciding
if people have acted clearly, rationally, disinterestedly and benevolently.
That is to say, how does one validly operationalize any given definition?
Even the proceduralists who attempt to avoid the pitfalls of substantive and
normative definitions are left with the job of determining which particular
procedure best reveals the public interest in fact.
One may agree theoretically that the public interest is the sum of all
individual interests but still argue that the expressed preferences of the
majority are not a "true" statement of their aggragate interests. Thus, some
years ago, when Newton Minow was chairman of the Federal Communi-
cations Commission he informed the broadcasting industry that: "I am here
to protect the public interest," which he went on to explain was not the
same as "what interests the public" (quoted in Held, 1970, p. 86). (Concom-
itant with the effort to define the public interest, as opposed to individual
or special interests, is the problem of defining the concept of interest and
distinguishing it from wants and preferences.) It is not hard to recognize
that we all do things-eat too much, drink too much, watch TV too much-
that we enjoy but are not good for us. It is one thing, of course, to experi-
ence this as individuals and another as a society. What happens when we,
the public, want something that is not in our collective interest? Who deter-
mines that it is not in our interest? Does the present generation have the
right to make choices for succeeding generations? Definitions of the public
interest do not by themselves answer these questions. Our ambivalence in
answering these questions is reflected in our readiness at times to praise
public officials for following their conscience in voting against a politically
popular program and at other times to accuse such officials of paternalism
and elitism for trying to thrwart the popular will. Let us therefore examine
the concept of the public interest as used in practice.
PUBLIC INTEREST ACTIVITY IN PRACTICE
The problems in defining the public interest reported by scholars have

not stopped public interest advocates from going about their work. It is
apparent that most regard a universal definition of the public interest as

unnecessary, or as self-evident. The problems in universal, comprehensive
definitions drop away, some suggest, as concrete cases are examined. Here,
they maintain, the public interest is clearly revealed by its stark contrast
with private, special interests. 7 What we commonly call public interest activ-
ity, therefore, reflects no single theoretical orientation but a variety of
approaches. For instance, auto safety and consumer protection suggests a
preponderance perspective (i.e., the interests of consumers should preVail
over those of the manufacturers whom they outnumber). Efforts to protect
the environment or raise the quality of public television imply a unitary
orientation, with concern for our mutual survival and growth. Finally,
efforts to protect whistle-blowers or establish people's counsels to represent
the public interest before utility regulators reflect a procedural point of
view.
It may help, therefore, in understanding what the public interest is and
its relation to psychology to look at the activity of public interest groupings
that have emerged in various disciplines since the mid-1960s. Best known,
of course, is the public interest bar. According to a definitive American Bar
Foundation study (Marks, Leswing, & Fortinsky, 1972), public interest law
is rooted in the adversarial concept of justice, which, in tum, implies a pro-
cedural definition of the public interest. Here justice is regarded as the
result of opposing interests pitted against each other. Lawyers serve justice,
and the public interest, not by aiming their efforts directly toward the com-
mon good, but through single-minded devotion to the interests of their
clients. To do otherwise would be "unethical." "Service to the public,"
Marks et al. (1972) write, "is necessarily a by-product of the adversary sys-
tem." (p. 52) But for the system to work, all parties to a dispute must have
representation-even the devil is due an advocate. The inability of many
people to pay for a lawyer thus presents a problem. The legal profession,
therefore, developed the tradition of pro bono publico (literally "for the pub-
lic good") representation, charging little or no fee to clients who otherwise
could not afford a lawyer. In this way "pro bono" and "free" have become
synonymous.
"Pro Bono" representation also has become institutionalized in orga-
nizations such as the Legal Aid SOciety, the Public Defender's Office, the
7Consider this exchange between Ralph Nader and two Washington Post reporters ("Ralph
Nader Assesses," 1979):
Q. Who is the so-called consumer that you represent? And when you say you are working
in the public interest, just who's public interest is that?
A. In some cases, that can be pretty black and white. Most consumers don't like lemon cars,
they like cars to be corrected when they are faulty. They don't like to be cheated in their
insurance policies because of jargon and obscure provisions in the policy such as cancer
insurance policies. In the more difficult issues, it's a matter of judgement. How much a
group really represents the consumer is determined by a track record ... if you are dealing.
with a very sophisticated issue with lots of shades of gray, then you'd have to look at it
and make your own judgement. But we are looking at many issues of black and white, like
the Love Canal situation, that just common sense and common observation would make
you conclude that a particular issue is pro-consumer. (p. F2)
American Civil Liberties Union, and the NAACP Legal Defence Fund.
What identifies them as pro bono organizations is not their nonprofit status
or concern for indigent clients, but their commitment to providing a voice
for people or policies that might otherwise go unheard. s According to
Green (1975), a prominent member of the public interest bar, those who
identify themselves as "public interest" lawyers "have taken the legal
defense fund models a step further." Instead of representing a specific vic-
timized minority, on issues of human rights, "today's public interest law-
yers," Green says, "represent a victimized majority on issues of economic
rights" (p. 21). (Green thus shifts from a strictly procedural perspective to a
preponderance orientation). Not all public interest lawyers would agree
with Green's stress on economic rights, but they would go along with his
description of public interest law as promoting "public policy causes and
causes that would otherwise go unrepresented" (p. 21). Marks et ai. (1972)
defined public interest law in a similar manner as "that which includes both
efforts to democratize participation in the legal processes and policy efforts
addressed to the overall good of the community" (p. 51).
Modeling themselves after public interest lawyers, economists and
accountants have developed their own versions of professional activity in
the public interest. Both the economists and accountants have been con-
cerned that special interests are able to dominate policy debates. Says one
accountant:
Our point of view is that financial data can be interpreted in a number of ways,
but if one side of a particular controversy doesn't have access to accounting
expertise, there may be only one interpretation available. (Accounting, News-
week 1974, p. 58)
The economists, similarly, charge that not only is the general welfare "typ-
ically neglected" but "those most affected by the outcome of public
debates-the aged, poor, workers, women, minorities and consumers-
"seldom have the technical information they need to defend their interests
(Jones, Washington Post 1973, p. L1). The Public Interest Economics Center
in Washington, D.C., tries to right this imbalance in two ways: by doing
contract research on selected problems and by doing free consulting with
other, issue-oriented public interest groups (including testifying before
congressional committees). Accountants for the Public Interest, based in Los
Angeles, also have conducted policy oriented studies (e.g., analyzing the
cost-effectiveness of institutional versus community care for problem chil-
dren) but in contrast with other public interest professionals, they do not
SIn Doe v. Scott, an Illinois abortion case, one group of public interest lawyers took a position
for a woman's right to elect abortion, a position that was opposed, in the name of all unborn
children, by another public interest group. In the last analysis, all effort by public interest
and private law firms-whether for regular or public interest clients-must be viewed
against a single ideal: the maximization of representation so that all relevant parties are
heard from on any issue touching on decisions of public policy (Marks, Lewsing, & Fortin-
sky, 1972).
engage in advocacy; they let the figures speak for themselves. In addition,
these accountants emphasize direct client services. Thus they provide free
or low-cost tax help to the poor and financial management aid to minority
business firms and nonprofit community groups (Aug, 1977; Wright, 1978).
The situation with public interest science is a bit different inasmuch as
scientists, in their roles as scientists, do not perform services for clients.
Thus, while there have been some suggestions that public interest scientists
should assist local, neighborhood groups who would not ordinarily have
access to scientific expertise (see Sullivan, 1975), those who call themselves
public interest scientists typically are involved in broad, policy issues of
national scope. The Center for Science in the Public Interest thus has
devoted most of its resources to preparing reports and educational materials
on a variety of consumer and technological issues from aerosol sprays and
asbestos to food additives and nuclear energy. Von Hippel and Primack
(1972), however, see public interest science as more than public education
on important scientific issues. It is education and advocacy that counterbal-
ances what they see as the inherent tendency of the federal government
and large corporations, with their enormous centralized power, to distort
information that threatens their interests. 9
The public interest movement in these other diSCiplines has helped to
inspire analogous activity within psychology. This activity has been wide-
ranging and is described in the following taxonomy:
1. Donate professional services to those otherwise unable to obtain them. The
expectation that an occupational group will provide some of its services for
free (i.e., on a pro bono basis) to needy individuals or causes is one of the
informal signs that it is considered a profession. This expectation develops
from the consensus that service to humanity is what distinguishes a profes-
sion from a technical occupation (see Goode, 1960). Accordingly, the Ethical
Standards of Psychologists (American Psychological Association, 1979)
specify that ethical psychologists "willingly contribute a portion of their
services to work for which they receive little or no financial return" (p. 5).
This standard is in keeping with the idea that client need comes before the
professional'S (financial) self-interest. Thus, in defining the characteristics
of psychology as a "good profession," the APA cites the commitment of
psychologists "to make their services accessible to all persons seeking such
services, regardless of social and financial considerations" (American Psy-
chological Association, 1968, p. 10).
9Critics sometimes charge that the members of the public interest movement are elitist, seek-
ing to substitute their preferences for those of the majority as expressed in the market place
or the ballot box. These critics confuse elitism with dissent. The work of Primack and von
Hippel (1974), for example, is best understood as a reaction against (technocratic) elitism, not
a case for it. Primack and von Hippel see public interest science not as a campaign to replace
one set of government scientists with another, but as an effort to demystify official science,
to open executive branch decision making to Congress and the public, and, thus, to demo-
craticize decisions involving science.
Although this expectation is held most commonly for clinical and

counseling psychologists, those in other applied specialties may be
included as well. Thus, for example, an industrial-organizational psychol-
ogist might assist a settlement house or United Way campaign to improve
its organizational effectiveness. An engineering psychologist might assist a
group of physically handicapped people in adapting various everyday
appliances to their special needs. A school psychologist might train a par-
ents' organization in the techniques for obtaining school system benefits
for their disabled children.
The idea that professional psychologists should donate some of their
services to those who otherwise would be unable to obtain them rests not
only on membership in a profession, and with its humanistic ideals, but also
on the requirements of justice. To withhold vital assistance solely on
account of an inability to pay may be considered offensive to our common
humanity and on that account not in the public interest. To serve only
members of a privileged minority also runs counter to the majoritarian con-
cept of the public interest.
2. Increase the responsiveness of psychological services to client and community
needs. A common criticism of health services in the United States is that they
are not distributed across the country on the basis of need, nor do service
providers necessarily devote their attention to the patients who most need
their services. Psychologists and other mental health workers are vulnera-
ble to the same criticism (see, for instance, Gottfredson & Dyer, 1978).
Accordingly, they have been urged to select areas of the country-and their
local communities-to work in on the basis of their need for service rather
than on their environmental or economic attractiveness. Similarly, they
have been urged to work in public institutions rather than going into more
lucrative and personally congenial private practice where they are less
likely to encounter seriously disabled individuals. Those who do elect pri-
vate practice over public or nonprofit practice have been encouraged to
arrange their hours and to locate their offices so that working class people,
as well as the well-to-do can readily use their services. More recently, con-
sumer advocates (cf. Adams & Orgel, 1975) have urged private practitioners
to give consumers more information to help them in selecting compatible
therapists and in getting their money's worth from therapy by listing per-
tinent information about their practice, including their fees, in consumer
directories; an additional suggestion is participation in consumer-therapist
contracts. Although these suggestions are directed toward mental health
providers, the notion that professional services should be organized and
delivered on the basis of social priorities, rather than on the basis of what's
best for the provider, is- relevant to all professional specialty areas in
psychology .
The maldistribution of professional services can be attributed in large
measure to social forces that are outside the control of individual psychol-
ogists or the profession as a whole (though psychologists may be able to
contribute to desirable reforms by joining with other concerned profes-
554 GOITLIEB C. SIMON
sional and lay groups ). But social forces, such as poverty or racial discrim-
ination, are not the only influences. There also are internal-guild-influ-
ences that interfere with the ability of psychologists to respond more fully
and promptly to consumer needs. During the turbulence of the 1960s and
early 1970s psychologists were encouraged to respond to changing social
conditions by developing new techniques (such as draft counseling and hot
lines), by modifying old ones (such as culturally biased tests) and learning
the culture and language of new and neglected client groups. Although
some psychologists sought training in new skills and modified their prac-
tices, others resisted these moves and adhered rigidly to the forms and con-
tent of prior professional training with its official imprimaturs. Still others
ignored certain needs because they did not seem to require the skills unique
to psychologists or because they threatened to blur the distinction between
psychologists and other professionals, or, worse, between psychologists and
nonprofessionals. The argument, from the point of view of the public inter-
est advocate, is that the need for appropriate and timely service should take
precedence over prior training and formal job descriptions in determining
what, where, and how psychologists do their work.
3. Apply technical expertise and knowledge to the identification and solution
of pressing social problems. Impetus for action of this sort is rooted in psy-
chology'S service orientation. Thus the bylaws of the American Psycholog-
ical Association (APA) state that the APA's purposes include advancing psy-
chology "as a means of promoting human welfare" while its Board of
Professional Affairs is to foster "the application of psychological knowledge
to the promotion of the public welfare at both state and national levels"
(American Psychological Association, 1975). Although considerable atten-
tion has been given in the last 10 to 15 years to solving significant social
problems (Korten, Cook, & Lacey, 1970), most of these efforts refer to psy-
chologists in their roles as scholars and scientists, not as practitioners. In so
far as applied psychology is concerned, the primary activity relates to the
formulation and evaluation of social policy. For example, psychologists are
urged to advise policymakers on the psychological implications of impor-
tant social policies. An important example of this work would be sugges-
tions concerning the relation of work motivation and welfare (Bauer, 1971;
Goodwin, 1975). The readiness of some psychologists to work with govern-
ment decision-makers in implementing policies aimed at resolving social
issues depends, of course, on whether they accept a definition of the public
interest as being equivalent to official policy. Although some apparently
regard program evaluation as intrinsfcally in the public interest, questions
have been raised here too. Thus, Krause and Howard (1976) refer to the
"evaluation of services in the public interest, where by 'public interest' we
mean only to indicate that the interests of all affected parties ought to be
taken into account" (pp. 4-5). Other possible activities for psychologists
seeking to serve the public interest by resolving social problems involve
the innovative application of established professional procedures. The use
of group dynamics in the late 1960s to reduce interracial conflict is one
example that illustrates this suggestion. Another was the use of personnel
selection methods to develop a personality profile for identifying potential
"skyjackers" (Daily & Pickrel, 1975); noteworthy also was the concern of the
authors for potential abuse of civil liberties in the application of the profile.
4. Withholding the application of professional skills and expertise. The con-
cern for the public welfare has led some psychologists and others to work
for more "relevant" and accessible services. On the other hand, still others
oppose the expansion of such services, particularly where public funding is
concerned. The latter have maintained that psychotherapy, for example, is
without demonstrable effectiveness and that private remuneration and
insurance reimbursement therefore constitute consumer and public "fraud"
(see Scriven, 1974). Other critics do not dispute that therapy may be effec-
tive in amerliorating individual suffering, but hold that such treatment pro-
duces undesirable social side effects. These side effects include (a) fostering
adaptation to an inherently unhealthy environment, (b) stigmatizing legit-
imate dissent as personal maladjustment, and (c) focusing personal and soci-
etal attention on intrapsychic phenomena instead of upon social structures,
all of which leads to (d) inhibiting socially beneficial change (Halleck, 1971;
Hurvitz, 1973; Ryan, 1971; Talbott, 1974).
An analogous situation exists with regard to "impersonal" services as
illustrated by the continuing controversy over the use of intelligence tests
with minority children. There is wide agreement among socially concerned
psychologists that educational tests developed and standardized on white
middle-class children are not appropriate for use with children of different
racial or class backgrounds. Therefore, some propose the use of special
norms or regression analyses when the tests are used with "disadvantaged"
students (Cleary et al., 1975). Others, however, maintain that the tests are
intrinsically deficient and serve racist and oppressive functions that are not
neutralized by technical refinements. Their position is that society is better
served by abandoning the use of the tests altogether (Bernal, 1975; Jackson,
1975).
It also has been argued that efforts by psychologists to use their exper-
tise to solve social problems may aggravate rather than ameliorate these
problems. Among the concerns that have been expressed are: (a) the pos-
sibility that contemporary psychological technology is inadequate to con-
tribute usefully to the solution of critical social problems and that its
attempted application will induce a false sense of security that allows our
problems to worsen; (b) the presence of psychologists in certain programs
will be exploited as "window dressing" and used to legitimize oppressive
social control functions; (c) that to the extent that psychological techniques
prove effective they will provide a small political and economic elite with
additional instruments for consolidating their power (e.g., personnel selec-
tion or the use of "social reinforcement techniques" in controlling campus
or ghetto riots); (d) due to their intrinsic psychogenic bias, psychological
interventions will lead to person-blaming strategies instead of attempts to
correct fundamental deficiencies in our social institutions; and (e) these
developments will culminate in undeserved responsibility being assumed

by psychologists with a tendency toward their emergence as a technocratic
ruling class (Caplan & Nelson, 1973; Kelman, 1970; Levine, 1974; Nietzel &
Moss, 1972; Nord, 1974). Consequently, psychologists who wish to work in
the public interest are cautioned to consider carefully the social impact of
their professional services and, if necessary, to withhold their application.
The concern that may lead psychologists to withhold certain services
in general, as discussed above, also may lead them to refuse to carry out
their professional duties in a given situation. This refusal may be termed
"conscientious noncompliance." For example, a human factors psychologist
might refuse to test a product for his employer until safety hazards were
corrected. A counseling psychologist in a private clinic might refuse to
record confidential information as long as unauthorized individuals were
allowed to examine confidential files. A correctional psychologist might
refuse to notify prison officials of the whereabouts of an escapee in order
to avoid compromising patient-therapist confidentiality. A clinical psy-
chologist might refuse an order to sign patient discharge papers until
decent, safe community placements are available. Clearly, actions such as
these should not be undertaken lightly since they may involve a violation
of law or expose a client to other harms. For instance, in refusing to "dump"
patients into inadequate and unhealthy community facilities are you con-
signing them to an even more debilitating institution? Perhaps "dumping"
is more harmful than continued institutionalization. Perhaps not. Which-
ever, it is the professional's responsibility as a professional to consider such
problems and then to act in accordance with his or her conscience.
5. Act as an advocate for clients. In contrast to the preceding sections
which are concerned with the conditions under which psychologists apply
their specialized skills, client advocacy involves meeting client (and public)
needs even if specialized skill and training is not required. The responsi-
bility for client advocacy ultimately is based on the professional's commit-
ment to service. In advocacy situations, the responsibility for action arises
from the psychologists' social role rather than from their special training.
Thus, while all citizens might be equally equipped to intervene on behalf
of someone, psychologists (and members of similar professions) have an
exceptional opportunity to become aware of certain human needs as a result
of their occupational and employment status. For example, a community
mental health center psychologist might discover that the family of a client
is not receiving their food stamps. As a result of this knowledge and the
psychologist'S status as a mental health center staff member, this psychol-
ogist is in a special position to contact the social welfare department. Sim-
ilarly, a correctional psychologist concerned about a client's well-being
might urge his or her release from solitary confinement; and an industrial
psychologist might attempt to persuade management to correct a factory
safety hazard that he or she observed in the course of other work. Those
who urge psychologiSts to engage in client advocacy when necessary do so,
implicitly, because guild interests of status and professional identity have
become in their view impediments to meeting human needs. We will

return to this topic in detail later in the chapter.
6. Participate in social action. When threats to client well-being are repet-
itive or systematic, it may be necessary to abandon (individual) client advo-
cacy in favor of policy advocacy or social action. In lieu of efforts under-
taken to obtain promised rights or services for specific individuals, social
action involves a "class action" approach to changing existing institutional
or social policies on behalf of all current or potential clients or others with
whom psychologists come in contact professionally. Illustrative actions
would include participation in a general strike against debilitating and defi-
cient mental institutions; the organization of a right to treatment suit; and
lobbying for repeal of laws that discriminate against homosexuals (E. Fried-
man, 1973; Marston, 1974; Simon, 1975).
Included here also would be advocacy of basic changes in housing,
education, and employment which some feel is a more effective means of
achieving professional goals (and serving the common good) than is tradi-
tional psychotherapy (Simon, 1970; Spaner, 1970). Social action, in the ser-
vice of professional goals e.g., reduction of psychological suffering, should
be distinguished from the application of professional skills to community
problems (see item 3 above). Because distinctively psychological skills are
not involved, other therapists regard social action or policy advocacy as
"unprofessional." They also maintain that as long as individuals experience
mental anguish and disability, psychologists should concentrate on helping
them as best they can and leave social action to those with more relevant
expertise. Their objection to social action is not absolute, however. They do
not object when it serves a guilt interest, such as licensure or health insur-
ance recognition. Indeed, they' claim a professional responSibility to enter
"into the social and political processes to help society recognize and supply
[professional] service" (Lawrence, 1970, p. 66).
7. Promote social justice within one's employment setting. The power to
influence others carries with it a responsibility for its use. This is well rec-
ognized in psychology. The preamble to the Ethical Standards of Psychol-
ogists (American Psychological Association, 1979) states that:
Psychologists respect the dignity and worth of the individual and honor the
preservation and protection of fundamental human rights .... They use their
skills only for purposes consistent with these values and do not knowingly per-
mit their misuse by others. (p. 1)
Given these values psychologists are expected to oppose discrimination in

hiring and promotion policies, in training, and in the acceptance and treat-
ment of clients (American Psychological Association, 1972, 1974).
Opposition to human rights violations may be based on technical
knowledge as well. Thus it is argued that the psychologist's "insight into
the complexities of human behavior will not allow him, as a professional,
to view, for example, the present inequality of opportunity for minority
groups as 'how it should be'" (Chein, 1972 ) . Active opposition to discrim-
ination is urged not only because psychologists know that it is based on

faulty knowledge of human behavior but because the failure to take action
inadvertently might legitimize immoral and illegal practices. Such a result
clearly would be against the public interest in terms of formal policy and
fundamental concepts of what is "right."
Generally, psychologists involvement in matters of social justice will
reflect personal temperament and ability to risk reprisals. In some cases,
there also may be guild interests that impede action in the public interest.
For instance, consider the issue of involuntary commitment to mental insti-
tutions in emergency situations. Psychiatrists and other physicians rou-
tinely are given the power by the law to commit individuals in such cir-
cumstances. Psychologists seldom are given similar power. Psychiatrists,
however, have no demonstrable superiority in predicting dangerous behav-
ior, the criterion for involuntary emergency commitment, over psycholo-
gists (or anyone else). Psychologists quite rightly resent this in vidious pref-
erence for psychiatry. Thus, it is not surprising that many psychologists
have asked their state legislatures to grant them commitment power.
Another way of providing psychologists status equality with psychiatry
would be to eliminate the power of any mental health profession to make
involuntary commitments. This approach also would conform to our
knowledge about mental health professionals inability to predict danger-
ousness accurately (see Chapter 12) and thus would be more appropriate in
fostering social justice. Yet, it also would diminish professional power gen-
erally. A case can be made, therefore, that in their status rivalry with psy-
chiatrists, psychologists have been insensitive to the injustice of involun-
tary commitment.
8. Expose unethical, illegal, immoral, and other socially deleterious practices.
Actions of this sort could more parsimoniously be considered under one or
more of the headings already discussed in this listing. However, "whistle
blowing" is not only distinctive, it often is considered as the epitome of
public interest activity. Exposing unsafe consumer products, fraudulent
practices, or illegal activity can involve the interests of everyone in an
immediate as well as a more abstract way. There is also the possibility of
taking a personal risk on behalf of a common good. Considerations of basic
justice and "goodness" also come into play. All of these elements are
strengthened in the case of a government employee since governmental
activity, by definition, affects all of us, and the true execution of govern-
ment policy has a prima facie identification with the public interest. As
noted earlier, von Hippel and Primack (1972) equate public interest science
with calling attention to institutionally supported wrongdoing or at least
inadequate concern for the public. According to this view, large govern-
mental and industrial organizations are prone to follow self-serving or spe-
cial interests. This then results in irresponsible decisions and "cover-ups"
that may seriously jeopardize the public welfare.
Psychologists and other professionals have a unique responsibility to
"blow the whistle" on illegal, wasteful, or harmful activity as a result of
their expert knowledge or insider status (see Edsall, 1975; Nader, Petkas, &
Blackwell, 1972). It should be noted that in contrast to the affirmative appli-
cation of professional expertise to the solution of pressing social prob-
lems-discussed in item 3 above-professional knowledge here operates as
a brake to counteract governmental and industrial mis-application of profes-
sional service and knowledge. Thus, a federally employed psychologist
might disclose that the government was illegally preparing personality pro-
files of political dissidents using information stolen from confidential clinic
files; a psychologist working for a pharmaceutical company might reveal
that data showing the adverse side effects of psychotropic drugs had been
suppressed by company officials; a school psychologist might expose the
waste of thousands of taxpayer dollars for obsolete educational materials;
and a Veterans Administration psychologist might go to a press conference
to complain that the well-being of elderly patients was jeopardized by
bureaucratic needs to reduce inpatient populations (Simon, 1978). As with
whistle blowing in general, these efforts are designed to protect the inter-
ests of innocent parties and to keep the "system" honest.
ADVOCACY FOR THE PUBLIC INTEREST: A MORE DETAILED

ANALYSIS
It is clear from the foregoing that it is the essence of the professional's

dedication to the public interest to advocate for change in service programs
so that they might better achieve their goals and so that those conditions or
practices that are harmful to society or particular individuals are eliminated.
These change efforts may be called internal advocacy, client advocacy, dis-
sent, individual initiative, whistle blowing, policy advocacy, change agen-
try, or professional responsibility.lO This section attempts to clarify the pri-
IOThe terms advocate and change-agent will be used interchangeably in this chapter. There are,
however, some significant conceptual distinctions that should be noted in labelling the
activity under discussion. Three dimensions in particular demand attention: First, is the
person who is offering the proposals under consideration "affiliated" or "unaffiliated" with
the organization that he or she is trying to influence (Hornstein, Bunker, Burke, Bindes &
Lewicki, 1971). Generally, this means, is he or she an authorized or a self-appointed change-
agent? The situation is complicated, however, when a private practitioner is asked by a
client to intervene on the client's behalf before some agency. In this case while the psy-
chologist is authorized by the client, he or she remains "unaffiliated" from the agency's
point of view. Second is the person a member of the organization or an outsider? Third,
are the proposals constructive and developmental or are they critical and restraining?
Although the term change-agent was proposed by Lippett (1958) to refer to an autho-
rized outside professional, hired to promote the organization's development, and while
much of the literature holds close to this usage, the term has been used widely to refer to
any type of social change, from psychotherapy to revolution. Patti (1974), seeking a more
restrictive term, suggests internal advocacy to describe the efforts of unauthorized, inside-
professionals who work:
in their roles as profeSSional employees ... for the purpose of changing the formal policies,
programs, or procedures of the agencies that employ them, in the interest of increasing the
mary conceptual, ethical, and other professional issues involved in these

efforts, and to suggest some possible rules of thumb for increasing the
professional's effectiveness in change situations. It is important to point out
at the outset that while a high degree of risk-taking and unilateral action
sometimes may be involved, professionally responsible conduct does not
involve an absolute choice between martyrdom and cowardice. Quite the
opposite. Underlying the present discussion are two central notions: (1)
there are many ways to contribute to professionally indicated change and
individual professionals should use the mode that is most compatible with
their personalities and their personal situations and (2) concerted, coordi-
nated effort involving other colleagues and concerned individuals is to be
preferred over solo performances. These thoughts are developed in the dis-
cussion below.
People often approach change situations with strong preferences for
one style of action over another. The events of the 1960s have left many
convinced that it is impossible to get action without loud public demon-
strations. Others are just as convinced that quiet behind-the-scenes diplo-
macy is the best approach. Both may be wrong. According to most of those
who have written on this subject, anyone who reflexively chooses one
approach over another without first considering the particulars of a given
situation makes a fundamental error. Different situations require different
responses.
effectiveness of the services provided or removing organizational conditions or practices

that are deleterious to the client populations served. (pp. 537-538)
(By way of reference, an ombudsman would be an authorized, internal critic.)
Finkler (1971) separates internal advocacy into "dissent" on one hand and "indepen-
dent initiative" on the other. The latter he defines as "a positive form of dissent which
involves the posing of alternatives, thinking unthinkable thoughts, and undertaking work
on previously uncovered topics" (p. 3). "Whistle blowing" is used to describe both the self-
appointed, internal dissenters who go over the heads of their supervisors (and even outside
the agency), as well as the external change-agents who take it upon themselves to call atten-
tion to objectionable organizational policies or practices.
Advocacy also can be described in terms of the range of people it is intended to benefit.
When pleadings are made on behalf of an individual, or many individuals taken one at a
time, the term client or patient advocacy is appropriate. When, however, the goal is to
improve the condition of an entire class of individuals, policy or cause advocacy (or social
action) is the appropriate term.
Finally, it should be acknowledged that the use of advocacy as a generic term, as in
this chapter, has been sharply criticized. Kutchins and Kutchins (1978), for instance, com-
plain about the "expansion of the meaning of advocacy to encompass the full range of social
action for worthy causes" (p. 21). They note that advocacy is used to refer to everything
from consumer education to community organization, civil rights protests, and programs
for the handicapped. Commenting on this they conclude:
One cannot formulate a coherent concept of ... advocacy from such an aggregation of def-
initions, descriptions, and postures. It must be seen simply for what it is-the Tower of
Babel. (p. 23)
A key issue in selecting a strategy for change, according to these writ-

ers, is the extent to which the advocate's proposal is likely to elicit cooper-
ation or oppression. For instance, Patti and Resnick (1972) caution that:
Too many change efforts £louder because change agents fail to consider in
advance the kind and intensity of opposition their proposals will encounter.
Often change agents are so certain that their goal is inherently right that they
assume others will agree. (p. 50)
In following this advice, advocates also should avoid the obverse error,
assuming automatically that the powers-that-be will reject their proposals.
This will avoid taking a defensive and, possibly, self-defeating posture. The
authors also suggest that this assessment not be limited to the formal head
of the organization. The actual decision-maker may be someone at a lower
echelon who acts as an "internal filter" or someone outside the organization
to whom the organization's titular head is beholden.
When it is not possible to predict the administration's likely attitude
with confidence in advance, the best strategy may be to act as if the admin-
istration will be cooperative, but at the same time to be prepared for antag-
onism. ll If the administration later proves hostile to new ideas or fails to act
in good faith, the cooperative strategy can be abandoned. In the meantime
the advocates will have built a record demonstrating their own reasonable-
ness and trusthworthiness. Finally, it should be understood that the con-
sensus-conflict dichotomy is employed for analytic convenience. Most real
situations will involve aspects of both consensus and conflict in a constantly
fluctuating combination.
COOPERATIVE STRATEGIES
If one assumes that the administration shares his or her basic values
about the professional activity in question, the advocate's strategy should
stress persuasion and education. Three major types of arguments have been
suggested for use under these conditions: (1) Appeals to the organization's
mission. This argument attempts to show how the advocate's proposal is
necessary if the organization is to meet the purpose it claims for itself. Thus,
for example, a correctional psychologist might argue against prolonged sol-
llThis is not to imply either that people in positions of authority are always against change
or that they are all of one mind; sympathetic members of the administration can be impor-
tant allies. Rather, administration (and decision-makers) is used in preference to target system,
which, in the specialized language of social change theorists, refers "to those persons who
directly influence or are formally responsible for making decisions on the changes pro-
posed by the action system" (Patti & Resnick, 1972, p. 54). Similarly, advocates will be used
in preference to action system which "means those persons or groups that consciously join
in planned collective activity to change some aspect of the organization's policy or practice"
(Patti & Resnick, 1972, p. 51).
itary isolation of a prisoner on the grounds that it interferes with the insti-
tution's stated goal of rehabilitating offenders; a school psychologist might
propose a school breakfast program on the grounds that hunger interferes
with the school's job of educating children. (2) Promises of increased effi-
ciency. Here, changes in policy are justified on the basis of their capacity
for saving the organization time or money that it could use for other activ-
ities. For example, expected reductions in absenteeism, increased employee
morale, and expanded productivity have persuaded a number of, organiza-
tions to adopt alternative work schedules such as four-day work weeks and
part-time employment. (3) Warnings of potential costs. This is really the
opposite of the preceding item. For example, a psychologist working in
industry was successful in eliminating the use of a psychological test battery
that did not meet professional standards only when he demonstrated to his
superiors that continued use of the test would make the company vulner-
able to job discrimination law suits.
Although arguments such as these can be helpful, it must be acknowl-
edged clearly that administrative decisions are not the products of a strictly
rational process (Whyte, 1969). Accordingly, advocates should avoid focus-
ing all of their efforts on demonstrating the objective costs or benefits of
the policies under discussion. They should also recognize that decision-
makers are influenced by affective and "political" considerations that may
not be immediately apparent. Thus, they should make some effort to iden-
tify and assess the hidden or "illogical" factors that may be relevant to their
proposals before they approach the decision-makers formally. Downs (1967)
has observed that:
The people who normally initiate or propose changes in a large organization
are not usually the ones who decide whether those changes will be carried out.
As a result, the conditions that cause an organization's lower-level officials to
make proposals for change are not necessarily the same ones that cause its
higher-level officials to adopt them. (p. 195)
A corollary of this observation, according to Downs, is that lower-level

members of the organization (and outsiders) are not in a position to see all
of the consequences their suggestions may have on other parts of the orga-
nization, and
because the proposers of change rarely perceive all the costs their suggestions
entail, they normally fail to "sweeten" their proposals with enough offsetting
benefits to assuage all the other officials who would be adversely affected. (p.
201)
In short, if you want to see your proposal accepted, and if you want to avoid
"spinning your wheels," you must pay attention to the "hidden agendas"
of the individuals in the organization you are trying to influence.
The contents of many of these agendas are summarized in a National
Institute of Mental Health (NIMH) sponsored "distillation" of principles of
planned change (1972). According to this study, program innovations are
most likely to be adopted when: (1) they seem relevant to recognized orga-
nizational needs; (2) they are compatible with existing values and ways of
doing things; (3) they offer more advantages, intrinsic or extrinsic, to the
organization and its staff; (4) the benefits are tangible and readily demon-
strated; (5) they are simple and easy to implement; (6) they can be reversed
if necessary; (7) they can be introduced gradually, one step at a time; (8)
they can be tried out on a pilot basis in one part of the organization; and
(9) they have high credibility, for example, the backing of highly respected
and trusted persons or groups.
On the other hand, innovations may be resisted to the extent that it
appears that they: (1) will result in a loss of status or prestige; (2) will dimin-
ish the importance attached to existing skill or knowledge; (3) will cause a
devaluation in perceived competence or ability; (4) are inconsistent with
the staff's values and job orientation; (5) will produce unpredictable and
unfamiliar situations; and (6) are being forced upon people. Internal advo-
cates must consider these issues in advancing their ideas.
Innovations also are more likely to be adopted when the nature and
implications of the changes are made clear. Accordingly, advocates should
ascertain the extent to which others appreciate and understand the specific
need for the proposed changes. In particular, every effort should be made
to dispel unfounded fears concerning job security and salaries. Concern that
change will affect job status and prestige negatively may be combatted most
effectively if it can be shown satisfactorily that change actually will enhance
status. It is also recommended that once a proposal for change is accepted
by the administration it be implemented with the collaboration of those
affected by it with ample opportunity for their feedback and modification
of the proposal as indicated.
The NIMH report placed heavy emphasis on the value of listening to
those who oppose the advocates' proposals:
It is often hard for the advocates of a new idea to emphathize with those who
don't go along. It is helpful to recognize the important social role of the defend-
ers who try to conserve valuable elements of the old in the face of a tumult of
change (Klein, 1968). Emphathizing with them, the progressives can enter a dia-
logue which may result in amendments which permit broader support of the
new idea. Failure to respect differences in values is likely to bring a backlash of
increased resistance. (p. 29)
Paradoxically the report proposes that change efforts are more successful
when an idea's shortcomings as well as its benefits are discussed:
It is particularly important that participants feel free to express their doubts and
negative feelings. Promoters of a change find it hard to believe that a frank
facing of disagreement and obstacles may win more converts than does elo-
quent exhortation in favor of their proposal. Yet this has been the experience
of many change consultants (Zander, 1962; Beene, 1962a; Glaser, 1966; Glasser
& Taylor, 1969). Conflict may be more creative than bland agreement. (p. 29)
The foregoing is a useful checklist of issues that should be considered

in starting a campaign for change. The usefulness of this listing would be
undermined, however, if it led the would-be advocate to regard change as

a highly organized, almost mechanical activity, possible under certain, spec-
ified unusual and demanding conditions. Fairweather, Sanders, and Tor-
natzky (1974) offer some "thoughts for the change agent" that should bal-
ance this perception. Their "thoughts" are derived from an experimental
and unusually comprehensive investigation of planned change. They say:
1. Don't worry about where the organization is. Cleveland is likely as
good as San Francisco to the limited extent that location effects
internal change.
2. Don't worry about how much money the institution has. If change
is possible, money will be found; if change isn't coming then
money is irrelevant.
3. Don't expect anything to be too systematic, predictable, or
organized.
4. Be very skeptical of verbal promises. Verbal change is not the same
as institutional social role and status change.
5. If you (or someone like you) don't change the organization, it
likely won't change by itself.
6. Make your initial forays into the organization limited in intensity
and scope, and then gradually increase the action and commitment
required.
7. Don't worry excessively about seducing the powers-that-be in the
organization. You may, or may not, need their support, but don't
focus exclusively on them.
8. Try to get a number of people and power blocks involved in dis-
cussion and consideration of the innovation. Maximize participa-
tion and then gradually focus toward concrete action.
9. Work to develop an adopting group, or focus attention on a pre-
existing group that could become the adopting group. Concentrate
on their viability as a group.
10. Your change activities will probably arouse the anxieties of some
persons within the organization. Try to alleviate this condition.
Where their jobs might be affected, a retraining program is a must.
11. While trying to ameliorate undue anxieties, do not yield to pressure
to modify the major dimensions of the innovation so that the end
product will be so watered-down it will not work well.
12. Develop a technique to quickly and effortlessly "pick yourself up
off the floor" when knocked down. Perseverance may not payoff
but change cannot occur without it.
13. Learn to lose gracefully.
14. Hope. (pp. 194-195)
Professionals who follow these suggestions stand a relatively good
chance of seeing their ideas adopted or at least of remaining on good terms
with influential people in the organization they are trying to influence-as
long as the ideas they are advocating do not challenge the basic function or
authority of the organization or those who run it. However, when a profes-
sional seeks to put an end to a deeply imbedded practice or attempts to
block the organization's introduction of a policy that he or she regards as
harmful, a very different situaton obtains, and some additional "thoughts
for the change agent" are in order.
CONFLICT SITUATIONS
Education and persuasion will be of little value if the decision-maker

that the advocate is addressing is fundamentally antagonistic to the values
and the stated benefits of the recommended course of action, or if the deci-
sion-maker lacks the resources or authority to implement the proposed pol-
icy. Continued advocacy under these conditions, moreover, may be a risky
undertaking. Suchotlif, Steinfeld, and Tolchin (1970) describe such a situa-
tion. The administrators of the mental hospital in which they worked could
not disagree with their goal of securing better treatment for the hospital's
patients and protection of their civil rights. At the same time, the admin-
istration, because of political constraints, could not implement the advo-
cates' recommendations. When these three psychologists persisted in their
patients' rights activities they were accused of engineering a "power play"
to increase their control over the hospital. They also lost many normal per-
quisites and were threatened with dismissal. Suchotlif et al. conclude from
this experience that when decision-makers cannot argue the merits of a pol-
icy, they will try to silence the critics and deflect attention away from the
crucial issues. Freedman (1971), who also attempted to promote patient
rights within the mental hospital in which he worked, echoes the warning
that "those who assume the role of advocate must expect attack from the
system under scrutiny and from those threatened by proposed reforms'(p.
94). These warnings apply whether the advocate is a member of the orga-
nization or an outside critic. General Motors's futile efforts to discredit a
critical Ralph Nader by finding-or contriving-some personally embar-
assing information is a classic illustration of this tactic (see Sanford, 1976).
Administrators have a wide variety of reprisals that they can use
against critics and nonconformists. Employees who protest too much or call
too insistently for program innovations may find themselves relegated to
unpopular assignments or given no work at all. They may be denied con-
vention travel funds, special leave for training, and permission for publi-
cation of their articles. They may be forced to travel extensively or transfer
to an undesirable location. Finally, they may be fired if they refuse these
orders (see Simon, 1978). Outside professionals, of course, are less vulner-
able to retaliation, but they too feel the sting of a vengeful administrator.
Access to the organization may be denied, referrals suddenly may stop, and
consulting contracts may be cancelled. Even invitations to participate on
professional committees unaffiliated with the organizations may be with-
held and other professional relationships interrupted.
The purpose of presenting these administrative punishments is not to

discourage advocacy-even the worst reprisals may be less painful than the
knowledge that one failed to act-but to underscore the seriousness of
action. Professionals who cannot accept the risks should not undertake
open advocacy; retreating at the first encounter of conflict or in the midst
of the battle may do more harm than doing nothing at all. In addition to
weighing the possible punishments they might suffer, prospective advo-
cates should also take stock of their ability to handle the interpersonal con-
flict that arises in an adversarial situation. Professionals who lack the dis-
position to endure personal confrontation or who are not in a position to
take personal risks should recognize those facts candidly. Recognition of
these constraints may mean abandoning the advocacy effort or, more likely,
dividing responsibilities with others in such a way that those with more
tolerance for conflict will take the lead when administrators must be con-
fronted. Thus, one person may be good at planning and designing effective
strategies for action, another may be good at arousing the interest or con-
cern of her or his colleagues and recruiting them to the cause. Change
efforts need not be advanced by a single "Lone Ranger." In fact, experience
indicates that this model often fails to produce desired change. There are
roles for many persons.
It is also important, in situations where conflict is likely, to assess one's
vulnerability to ad hominem attacks in advance and to look for skeletons in
one's own closet. Advocates who are considered lacking in competence to
carry out their duties as employees or whose political affiliations or private
social behavior is looked on with disfavor are liable to spend more time
defending their own good names than advancing the arguments for the
changes they want adopted. This is not pleasant for the professional, but it
is worse for the policy that is being proposed. If the opposition is successful,
the poposed policy changes not only will be unfairly discredited, but the
advocate will become the focal issue and the change proposal will be lost
in the ensuing controversy.
TAKING ACTION
Every change effort, whether cooperative or conflict, must have a

beginning. But where and how does one begin? Patti and Resnick (1972)
urge concerned professionals to begin informally:
In their experience with organizational change, the authors have observed that
agency workers usually think of change activities as occurring in formal con-
texts, both internal and external to the organization. Thus, practitioners often
believe that the only way to attempt change is to present their plan of action to
decision-makers through memos, letters, special meetings and conferences, or
the development of formal relationships between the organization and profes-
sional associations, educational institutions, and the like. As a result, the plan
of action surfaces prematurely, and the change effort languishes for lack of sup-
port. Informal contexts are used, but usually in an unsystematic way. (p. 56)
For several reasons, it also is important to go through regular channels,

even in conflict situations. First of all, it will forestall later criticism that the
advocates failed to exhaust their internal remedies before using nonlegitim-
ized internal channels or going "outside." This can be very damaging (and
damning) criticism. Being labeled as "disloyal" will make it harder to enlist
the assistance of co-workers and others. It will undermine the advocate's
credibility as a responsible and serious person and will lead to the diffusion
of the advocate's focus. The efforts of officers David Durk and Frank Serpico
to expose corruption in the New York City Police Department-the subject
of popular books and a film-are a case in point. According to Nader et al.
(1972):
Police corruption might not have been big news, but their repeated failures to
get action clearly was. And their credibility with the newspaper was enhanced
immeasurably by the fact that they had tried literally every recourse within the
department and within the city government before reaching outside. (p. 231)
Going through channels also may protect the (internal) advocates' job
security as well as their reputation and credibilityY It also is frequently
suggested that bringing one's grievances or suggestions to others in the
organization will help the advocates correct any errors in their analysis as
well as point out unexpected points of resistance before going to higher-
ups or outsiders. Such contact also may produce new information to buttress
existing arguments in favor of the proposal. Additionally, this process may
help to identify potential allies or supporters within the organization. Of
12This is particularly true of public employees. The courts have held that they may be fired,
under certain conditions, if their public criticism disrupts the smooth operation of their
agencies but not for making the same criticism in an internal petition even if it too creates
internal disruption. Thus government employees are protected against punitive actions
when their disclosure "took the form of a letter to an agency superior but not if it took the
form of a letter to a newspaper editor." (Eastman, 1975; Lindauer, 1975, p. 541)
The justification for limiting the freedom of speech of public employees, according to
the Supreme Court (Pickering v. Board of Education, 1968), is the need to take into consid-
eration "the interest of the State, as an employer, in promoting the efficiency of the public
services it performs through its employees" (p. 568). Clearly, much depends on how agency
efficiency is defined. For instance, a psychiatric nurse who had been dismissed on the
grounds that her public allegations that patients in her institution were sexually abused
and medically neglected created "staff anxiety," won her job back when the court found no
evidence that patient care had suffered (Lindauer, 1975). Moreover, Carl Goodman (1975),
General Counsel of the U.S. Civil Service Commission, has raised:
the question of whether agency efficiency can ever be damaged if the charge of unlawful
conduct or criminal actions is true ... it would seem that when an employee receives no
satisfaction from governmental channels and as a consequence goes public-and the
charges are in fact true-the employee's conduct should be protected. The efficiency of the
service would be benefitted by such conduct. (p. 16)
Although there would seem to be much merit to Goodman's argument, it must be noted
that, to date, it has not been authoritatively reviewed by the courts. Accordingly, while
there is some evidence of improvement (e.g., Matthews v. Washington, 1976), Miller's ear-
lier observation (1972) that "the law at present provides very little protection to the person
who would blow the whistle" (p. 25) remains generally true.
568 GOTILIEB C. SIMON
course, doing this also may drain the advocates' energy or make them vul-
nerable to administrative pressures to end their advocacy. After considering
these issues, particuarly the argument that the advocates have failed to
exhaust organizational channels, Suchotliff et al. conclude:
Even though we consider the channels lament to be an attempt to discredit dis-
senters, and deflect them from the basic issues, we would suggest that channels
be used when possible, in order to be certain in each case that they are not a
myth. (p. 234)
This advice to go through channels is not absolute. There are situations

where it would be unreasonable to expect concerned professionals to sub-
ject themselves to certain, and unjust, punishment. Further, if a situation
"poses such an imminent hazard to human life that any delay might result
in death or serious injury" Nader et al. (1972, p. 231) advise that appropriate
officials should be contacted immediately. In other words, where earlier
efforts or other data indicate that the advocates will be punished harshly
for going over the head of a supervisor13 or contacting outsiders, this vio-
lation of the organizational mores may be condoned; where public well-
being or safety is at stake, going out of channels becomes an ethical
requirement.
ApPLYING PRESSURE
If the advocates go through channels and inform the appropriate mem-

bers of the administration of their concerns and do not receive a positive
response, as is apt to be true in a conflict situation, they must be prepared
to use pressure-or give up. "Pressure" may be an offensive word to profes-
sionals who are committed to using reason in solving problems and to help-
ing people; nevertheless, there are situations in which there is no alterna-
tive to using pressure tactics. Suchotlif et al. (1970) comment that "through
bitter experience we learned that our administrator's desire for change
could be motivated primarily by the application of pressure, and only sec-
ondarily by an appeal to reason and morality" (p. 237).
Power can be exercised in a number of different ways. Suchotlif et al.
(1970) suggest that one effective way of pressuring a system to change is to
point out the discrepancy between the organization's stated goals and what
is actually occurring. In some cases just the threat to go public with this
information may be enough to produce. change. Another tactic is to resign
or threaten to resign. The value of this tactic, however, is directly related to
the administration's dependence upon the person who resigns. The threat-
130n occasion those in higher echelons in the organization will be much more receptive to
the concerned professional's complaints or suggestions than those superiors occupying
"middle management" positions. When this happens, there is, of course, no need to go
outside the organization.
ened resignation of an accomplished grant writer or a scarce credentialed

professional on the eve of an accreditation visit will carry more weight than
that of a more easily replaced individual. Unfortunately, the occasions in
which a psychologist would be indispensable are not many, and it is doubt-
ful this tactic could be repeated successfully against the same
administration.
When these efforts are inappropriate or ineffective, it may be necessary
to consider more direct tactics that disrupt the normal operation of the orga-
nization. Included here would be "job actions" involving slow downs and
strict interpretations of institution rules, strikes, picket lines, etc. Alinsky
(1971) has pioneered the use of imaginative tactics to force organizations
into respecting the rights of their otherwise powerless clients or employees
(and his work should be consulted for further guidance). The purpose of
this maneuvering is simply to convince the administrators that "it will be
more costly to ... adhere to the existing arrangement than to adopt the
proposed change and that the organization's failure to respond will be more
dysfunctional . .. than any negative consequences that may result from
instituting the plan" (Patti & Resnick, 1972). Although many of the exam-
ples up to this point have illustrated actions that might be undertaken by a
single individual, in the case of disruptive tactics, collective action at the
outset is vital; a single disrupting employee can be dismissed quickly,
figuratively as well as literally.
Although disruptive tactics automatically repel some people, they have
equally strong attraction for others. It is important therefore that the stra-
tegic implications of using, or not using, disruptive tactics be considered
carefully and thoughtfully. Specht (1969) has analyzed the circumstances,
or "stress" as he puts it, that lead up to this type of action and suggests that:
To use disruptive tactics, several questions must be considered by the
[advocates]: Is the stress that stimulated the use of these tactics recognizable to
the opponent? Is there support and reassurance to the opponent whose change
is desired that the extent of change is not unlimited? Have encounters opened
or closed communication between contending parties? Has there been an ade-
quate process of inquiry and exploration prior to the disruption? In the Gan-
dhian use of disruptive techniques, the major question asked or the satyagrahil4
is whether he has engaged the opponent in a manner designed to transform the
complexity of relationships so that ne~ patterns may emerge. (p. 12)
OTHER TACTICS
The decision to use disruptive tactics or to depend upon less militant

methods such as education and persuasion is a matter of strategy. Once a
set of tactics is decided upon, the question is how to implement them most
effectively. It is difficult to summarize the lessons different advocates have
l'One who practiCes Gandhian principles of passive resistance, or satyagraha.

drawn from using various tactics in widely differing locations under vary-
ing circumstances, however some generalizations appear possible.
Negotiations. When conducting negotiations advocates should try to
neutralize the psychological advantages enjoyed by those in opposition.
This might be accomplished by meeting on "neutral territory." Care also
should be taken that a strategy and spokesperson is decided upon before
the meeting. Henley (1973) provides some more specific suggestions on this
point. In general, advocates should try to keep in mind the opposition's
perception of the situation when carrying out their tactics. For example,
when conducting negotiations, Oppenheimer and Lakey (1965) recommend
that the negotiators try to do two things: "(1) describe the results of change
as less than the [opposition] suppose, and (2) describe the results of not
changing as more threatening than the results of change" (p. 24). Sometimes
the other side will try to get the advocates to see the situation from their
viewpoint as a way of co-opting the advocates. IS For instance, they may
assert that they are in sympathy with the advocates' objectives, but for var-
ious reasons insist that the time is not right for a decision. They may explain
their other problems and attempt to show how it is necessary not to "rush."
When this occurs, Oppenheimer and Lakey suggest that the advocates get
the administration to go on the (written) record as officially in favor of the
desired change in general. This wlll make it difficult for them to evade this
commitment. These writers also suggest that "The negotiators should try to
foresee all possible evasions which the opponent might introduce, and
anticipate them, using workshops and sociodrama to brief the negotiating
team" (Oppenheimer & Lakey, 1964, p. 25).
Token Offers. In the course of negotiations the opposition is likely to
make a token offer that gives the appearance of change without altering the
status quo in any substantial manner. This manuever can divide the ranks
of the advocates. Some will be willing to accept the token as a way of end-
ing the controversy and returning to normal activity. Others will want to
continue the pressure until the total change objective is achieved. Thus, the
opposition's move will be hailed simultaneously as evidence of good faith
or a first step to change and also as a sign of intransigence. Even if the offer
does not turn the advocates against each other, it still creates a problem. If
the token is accepted, the momentum for change may be dissipated. If it is
rejected, the opposition will be in a position to claim that the advocates
aren't being reasonable, aren't bargaining in good faith, or that they have
hidden motives. Suchotlif et al. (1970) had to confront this problem in pro-
15For instance, administrators may tell protesting employees to withhold publicizing their
critical views on the grounds that outside critics will use their criticisms to harm the entire
organization. The protesters, the administrators may argue, should realize that they share
a common enemy with the administrators and direct their efforts to the proper target. Con-
cerned professionals should consider arguments such as these seriously, but they also
should realize that they may be devices used by the administrators to defuse challenges to
their authority and silence criticism.
moting patients' rights in the state mental hospital where they worked.
They advise:
When responding to offers which appear to be tokens, we recommend the fol-
lowing: Accept whatever the system offers, be clear about the objectives you
wish to reach and set a time limit for reaching your goals utilizing the existing
structure. In short, we suggest that the minimal conditions for meaningful
reform must be operationally defined, and a time limit set in which this is to
occur. (emphasis added) (p. 234)
Whistle Blowing. Suppose normal channels have been exhausted, all the
time limits have expired, but conditions have not improved. At this point
it is likely that advocates will consider going "outside" for support. This
can be a very costly decision. Suchotlif et al. (1970) warn that "when one
seeks allies outside the system he must be prepared for very adverse con-
sequences since at the point where the issues are made public the battle
lines are drawn" (p. 238). Accordingly, this step should be taken only after
careful thought. Nader (1972) suggests that those considering blowing the
whistle on their organization ask themselves the following questions:
1. Is my knowledge of the matter complete and accurate?
2. What are the objectionable practices and what public interests do they harm?
3. How far should I and can I go inside the organization with my concern or
objection?
4. Will I be violating any rules by contacting outside parties and, if so, is whis-
tle blowing nevertheless justified?
5. Will I be violating any laws or ethical duties by not contacting external
parties?
6. Once I have decided to act, what is the best way to blow the whistle-anon-
ymously, ovet:tly, by resignation prior to speaking out, or in some other way?
7. What will be likely responses from various sources-inside and outside the
organization-to the whistle blowing action?
8. What is expected to be achieved by whistle blowing in the particular
situation?
Once the decision is made to go outside more thought should be given

to contacting the right people. Nader, Petkas, and Blackwell (1972) review
the most likely groups and offer some hints on how to communicate with
them most effectively. They note that there is often a government agency
that has authority in the problem area, and sometimes there are local citizen
groups. For example, Suchotlif et al. report that the state chapter of the
American Civil Liberties Union and the National Association for Mental
Health were powerful supporters in their fight for hospital reform. If there
is no existing organization, concerned professionals may wish to consider
organizing one to take up their concerns. (Practical guides for organizing
can be found in Kahn, 1970; League of Women Voters, 1976; O. M. Collec-
tive, 1971; Ross, 1971; Rothman, 1974; Specter, 1978; Warren & Warren,
1977). Assistance also may be sought in the courts. In recent years the judi-
ciary has been a major level for organizational reform in the criminal justice
and mental health systems. These efforts, however, may continue for years
and require considerable financial resources, even when legal services are
provided on a pro bono basis. Consequently, litigation is not likely to be

feasible without substantial organized support from others.
Media Contact. The idea of going outside the organization typically
implies contacting the press or electronic media, rather than initiating liti-
gation. In other words, the existence of unconscionable conditions or resis-
tance to needed innovation is "leaked" to a news reporter. There is more to
this, however, than simply sending out copies of some document to as many
reporters as possible. Nader et al. (1972), for instance, suggest that change
agents be selective in their initial media contacts, that they go local first,
and that they send out concise statements of the problem rather than volu-
minous monographs. They also indicate that face-to-face contact can be of
great importance in gaining media coverage.
Once the problem has been reported by the newspapers or on radio or
television, there is a tendency for the advocates to stop as though publicity
in and of itself will create a solution to the problem. This is rarely the case.
Nevertheless, many groups operate as though they have achieved their goal
when the press or the electronic media publicize their concerns. Unless the
advocates have a purely informative goal and do not also seek to produce
change, they must be prepared to follow through after their problems have
been reported. Accordingly, it is wise to consider exactly whom the media
attention is expected to influence. (A public official? Which one? Certain
influential private individuals? Other professionals? Other victims? The
community-at-Iarge?) How can the media attention be used to maintain or
channel the interest and assistance of other people in bringing about the
desired change? Thus, before contacting the media, an effort should be
made to relate this tactic to the overall change strategy and change agents
should have some ideas on how to follow up on the publicity they generate.
(Publicity also can be useful in maintaining the morale of the advocates and
their supporters. There is a tendency to believe that something is not impor-
tant or "real" unless it is reported in print or on the air, and vice versa.)
Allies. It also is important to stress the development of allies when
undertaking advocacy, be it internal or external. Allies can help advocates
offset their individual weakness vis a vis the organization by the strength
of their numbers. In addition, major tasks often will demand more than a
single individual is able to give, particularly over a long period of time.
Moreover, program innovation and organizational reform may not last
without the involvement of other professional and nonprofessional staff.
Sumpathetic colleagues also can assist the advocate in avoiding traps.
Finally, allies are extremely important to the advocates' ability to sustain
the strain of advocacy. The pressures upon the nonconformist are well-doc-
umented. Internal advocates and whistle blowers have reported the lone-
liness of their efforts and the crucial role played by colleagues who shared
their commitment to defend fundamental professional values.
Group effort may be essential, not only for strategic and emotional sup-
port, but to keep the advocates accountable to a constituency. The self-
appointed and self-directed advocate who operates without a constituency
may lose touch with the realities of others. This is especially likely when
the fight has been intense and the advocate begins to perceive herself or
himself as the lone target. He or she defines the situation as "bad" without
the perspective of others affected by the situation-especially those who are
most vulnerable to retaliation for unsuccessful change attempts. Advocates
need to be able to check their own tendency to view themselves as "mar-
tyrs" and to substitute their wishes for those of the people, colleagues, or
clients they want to help.
Finally, despite the best planning and the greatest diligence, the
change effort may fail. What should the advocate do then? One alternative
is to wait for another opportunity to press for change. In the interim it may
be possible to persuade a few more people. of the need for change or to
modify some related policies that will make it easier to achieve success the
second time around. For instance, the advocates may attempt to alter the
decision-making process so that it is more responsive to their concerns. But
if the gap between what the organization is doing and what it should be
doing is too great, concerned professionals may face a crisis of conscience,
especially if they are employed by the organization. Will they be endorsing
an unethical situation if they remain affiliated with the organization? And
if they leave what will happen to the people they leave behind? These ques-
tions will be considered in the next section.
ETHICAL DILEMMAS!6
It would be wrong to conclude from the preceding discussion that

advocacy is only, or primarily, a matter of technique, tactics, and strategy.
!6The nature, indeed the existence, of these dilemmas depends greatly on the nature of the
advocate-beneficiary relationship. AI; used in this chapter, advocate is synonymous with
helper, change-agent, pleader, and similar terms. This use must be distinguished from the
narrower, more technical, legal meaning. This meaning is the attorney-client relationship
that exists within an adversary system of decision making. As a result of the treatment-
rights movement, "advocacy" programs are emerging in a number of human service fields
(e.g., Kopolow & Bloom, 1977) with attendant ambiguity over the meaning of "advocate."
Thus Kutchins and Kutchins (1978) adopting the legal model of advocacy, criticize the idea
that advocates should "develop priorities among the needy." They are concerned about the
possibility that professionals will substitute their own judgment for that of their clients.
This tendency, they believe, grows out of "the notion that (the advocate) operates not on
behalf of anyone client, but in the public interest" (p. 27). Clearly, within the adversary
system, it is totally inappropriate for the "advocate" to do anything other than represent
his or her client's interests (the advocates' legal responsibility becomes less clear when the
clients' ability to perceive and express his or her interests on their own comes into question
(again, see Kopolow & Bloom, 1977). When one is working as a volunteer or self-appointed
protector or champion for people one sees in the course of human service activity (either
individually or as a group), the situation is different. The psychologist has no choice but to
resolve for him or herself what role, if any, he or she wishes to play.
Finally, it should be pointed out that Kutchins and Kutchins are reacting against ritu-
alistic invocation of the "public interest" that has been used to protect the status quo, or
more specifically, those who control the status quo. Thus they note that:
People began to realize a decade ago that programs carried out 'in the public interest' fre-
quently best serve the interest of those who control the program. So, for example, urban
Value preferences and ethical dilemmas must be confronted all along the
way. Where does one draw the line? What means may one use to oppose
deleterious conditions or policies? How does one strike a balance between
present problems and future possibilities? These problems are not limited,
obviously, to deciding whether to participate in advocacy efforts. Deciding
not to become an advocate involves the same issues. Advocacy thus is not
just a problem for a few self-appointed "zealots," it is a subject that is woven
inextricably throughout the fabric or professionalism, although this is not
always acknowledged (see Stein, 1974).
There always will be more to do than anyone person can accomplish
(Kohl, 1976). Consequently, there are continuously occasions when choices
must be made between alternate courses of action. Ironically, it is the person
who tries to make a difference who is apt to be criticized for not doing more,
while the other person who hangs back doing nothing goes unnoticed.
Concerned professionals should attempt to prepare themselves for this per-
verse situation and not be startled when bystanders have criticism instead
of compliments. The purpose of this section is to highlight some of the
choices implicit in professional practice and to ofer some suggestions to
stimulate further consideration of these issues.
1. Limited time and resources may force a choice between satisfying
immediate needs and achieving a long-range solution. For instance, a
school psychologist who works to convince the decision-makers to expand
services to children with learning problems may be criticized for failing to
take action to help this year's children. Those who undertake to provide
supplemental efforts for today's pupils will be open to the criticism that
they are doing nothing to improve an admittedly inadequate system and
thus may be contributing to its continuation. Clearly, doing something of
help to both present and future students would be the optimal solution. But
if one cannot help both groups simultaneously a choice must be made.
While it is impossible to say here that the needs of today's clients are any
more or any less important than those of tomorrow's clients, failing to make
a choice on behalf of either group is the least acceptable alternative.
2. A related problem concerns the institutionalization of advocacy ver-
sus reliance on short-term approaches. Although a serious problem will
invite the concerned professional to take unilateral action, the change effort
renewal programs in the public interest often prove to be of benefit to downtown business
interest and adverse to inner city ghetto interests. (p. 27)
They refer to this as the public interest fallacy. "One of the reasons," they write, "that many
professions embraced the concept of advocacy is that it provided an alternative to the public
interest fallacy .... The purpose of advocacy for the disadvantaged in a pluralistic society
is to promote the interests of individuals and groups which have heretofore lacked the
resources to make themselves heard" (p. 28). Without denying the validity of their analysis
of certain programs such as urban renewal, I believe that it is the intent of many committed
professionals to promote (Le., advocate) policies and programs that are, in fact, in the public
interest.
may collapse if the advocate should depart from the scene prematurely.
This may not only further delay remediation of the situation, if it occurs at
all, but may also lead to a delay in the development of effective methods
for reacting to future problems. Consequently, it is necessary to weigh the
costs of a slower, less efficient change with effort that will lead to longer-
lasting and regenerating efforts. All other things being equal, democratic
principles as well as expediency would recommend a broad-based effort
leading to the institutionalization of change over an individualistic and
more immediate approach (Havelock & Havelock, 1973).
3. Another sort of ethical dilemma arises when advocacy of one group's
interest may harm the interest of another equally deserving group. Pressure
on a government unit to improve an institution for the retarded might, for
example, result in a reduction of the budget intended for homemaker ser-
vices to the aged. Many similar conflicts can be imagined, particularly when
the economy is contracting. Government officials have been known to
exploit these situations and to playoff one group against another. Profes-
sionals concerned about the plight of a particular group with whom they
have come into contact as a result of their professional duties must consider
whether they will advocate a solution to the needs of that group exclusively
or consider the needs of other groups. A strategy that would satisfy the
needs of several groups simultaneously would not only resolve the ethical
problem here, but it would also allow the building of a strong coalition that
would have more "clout" than weaker individual constituencies.
4. Sometimes professionals feel an ethical conflict when their employer
and the direct recipient (or subject) of their services are in conflict. Is first
allegiance owed to the organization or to the "client"? Is it ethical, for
instance, to criticize one's employer in public for policies that are detrimen-
tal to service recipients? ("Client" is not the correct word to describe job
applicants, school children, prisoners, and others who are the objects of psy-
chologists' services, but who do not contract voluntarily for or select these
services.) The presumed ethical problem arises from the apparently conflict-
ing elements of the 1963 Ethical Standards of Psychologists. Psychologists
were admonished to "respect the rights and reputation of the institute or
organization with which (they are) associated" and also to "protect the wel-
fare of the person or group with whom (they are) working" (p. 3). The con-
flict between these principles was more apparent than real. No organization
has a right to harm human beings. Moreover, its reputation cannot take
precedence over human welfare, particularly when the manifest purpose of
the organization is the promotion of individual or community well-being.
The 1979 revision of the standards makes this clear. The principle relating
to responsibility to one's organization (7.d.) recognizes that psychologists
may find it necessary to disclose confidential information about the orga-
nization when this is in a client's interest. The principle asks only that the
concerned psychologist attempt to effect change within the organization
before releasing confidential information. The responsibility to blow the
whistle on an employer who uses professional services "in a way that is not
beneficial to the participants or to employees" (p. 5) is also recognized in

Principle 6.e.
5. A more real dilemma arises after professionals discover that an
unconscionable practice is allowed to exist within their organization. They
either can refuse to be associated with such an organization or they can stay
and attempt to fight it from within. Which is more ethical? There are prob-
lems in both responses:
One of the favorite ploys of ... supervisors and educators is to advise students
that when conditions become intolerable in agencies and they can no longer
support their administrator, they should resign and go elsewhere. This is too
easy, for it leaves those whom (professionals) are supposed to help to the tender
mercies of the inhumanity they themselves cannot stomach. (Russell E. Smith
quoted in Wineman &: James, 1969, p. 32)
The argument that concerned professionals have an obligation to remain in

an insupportable situation in order to mitigate its adverse impact on others,
however, can also be used as a rationalization for inaction and as a prelude
to cooptation:
Calculations of potential impact if one remains on the inside are especially
seductive for people on the rise in their careers.... One of the most powerful
weapons of organizations is that encouragement of the young person's hope
that he can do more tomorrow and tomorrow if he'll just hang on-by which
time he usually has so much invested and is so dependent that principled
impulses are forgotten or dismissed with a sigh. (Peters &: Branch, 1972, p. 281)
In order to avoid allowing one's impulse for direct action to be postponed

indefinitely, concerned professionals are advised to engage in "continuous
involvement in resistance behavior, however low key and invisible," as, for
example, contributing money anonymously to groups that are trying to
change and improve the situation (Howard & Somers, 1971, p. 286). Prin-
cipled resignation, on the other hand, is not apt to have any impact on the
policy, and even may make things worse, if it leads to one's replacement by
less qualified or less ethically sensitive individuals.
Thus, a principled resignation is not apt to be very effective when there
is relatively high professional unemployment or the position is considered
highly desirable. So if principle is the guiding reason for resignation, as
opposed, say, to a personal inability to suffer the situation any longer, the
professional may want to consider staying and fighting the situation from
within instead of resigning. This does not have to mean participating in
objectionable practices. One might, as Smith suggests, "not only refuse to
quit but also refuse to engage in unethical acts" (quoted in Wineman &
James, 1969, p. 32).
In one case a counseling psychologist working as a civilian at a military
installation discovered that military prosecutors were using information
from his intake interviews to prosecute enlisted men he was treating as
drug abusers. He protested the situation to his commanding officer, point-
ing out that not only was patient-therapist confidentiality being violated,
but that the men were being forced to testify against themselves or face
charges of disobeying orders. His protests were rejected. When he indicated

he could not cooperate with the policy he was assigned to other duties that
consisted of doing nothing. He decided that the only ethical course of
action open to him at that point was to resign, and he did. The military,
evidently pleased by his cooperativeness, gave him an excellent letter of
reference. He later discovered that by resigning voluntarily he had no legal
standing upon which to challenge the military's policy. Had he refused to
leave and been fired for not following what he felt were unethical and
unconstitutional orders he could have sued and, perhaps, have contributed
to the downfall of the policy that he opposed. Of course even had he con-
sulted a lawyer in time, he might not have wished to risk permanently dam-
aging his career.17
If circumstances or personal predilections dictate resigning rather than
staying, the resignation should be done publicly. There is, however, a cul-
tural pressure against doing this. According to Weisband and Franck (1976)
who have carried out a comparative study of American and English govern-
ment officials, Americans are highly influenced by the teamwork ethos and
are inclined to place organizational loyalty above most other values. As a
result, when conscience forces a break, the resignation is almost invariably
done quietly and without an indication of the true reasons. If dissenters do
speak up to criticize the policy that motivated their exit, they do so only
after a "respectable" period of time has elapsed. Because loyalty to the orga-
nization or to the "team" is placed above loyalty to the country, the public
is left unaware of serious issues of the day. If the resignation is to be max-
imally effective as a principled action, other people have to know what
caused it.IS
ADVOCACY AND PROFESSIONALISM
A troublesome issue that arises early in advocacy endeavors and grows

more acute as the need for more forceful tactics becomes more apparent is
17This situation illustrates the need for an APA Defense Fund for Professional and Scientific
Responsibility that would offer a range of services from free legal counsel to low interest
loans to psychologists whose employment is jeopardized or adversely affected by their con-
cern for the public interest. Defense funds of this sort are currently operated by the Amer-
ican Chemical Society, the National Association of Social Workers, and the National Edu-
cational Association.
18Weisband and Frank (1976) commenting on the reactions of government officials maintain
that:
If a course of action is perceived to be so wrong, so unethical or ill-advised, as to warrant
a person separating himself from those embarked upon it, is it not wrong-and undermin-
ing of faith in the whole system-to leave in such a way as to give the public the impres-
sion that all is well? The high government official who sees serious wrongdoing may justify
staying on if he can thereby mitigate the effects of the evil. Or he may quit and 'go public:
But to resign in silence or with false reassurance to the public that there is nothing wrong
may be the least ethically defensible course of all: the buying of a separate peace at the
expense of the entire process of responSible government. (p. 12)
the question: Is this a professional thing to do? Thus, for instance, carrying
a sign on a picket line is apt to be regarded by many people of high status
as "unprofessional" (Stein, 1974). Upon examination it appears that objec-
tions that advocacy efforts are unprofessional come down to saying that
these efforts do not involve specialized training or that they violate stan-
dard occupational etiquette. 19 It is important, therefore, when this issue
comes up, to ask in what sense is something labeled "unprofessional." Is
reference being made either to the professionals' purpose or to the quality
of their practice? Or is "unprofessional" being used as a synonym for
"uncouth" or, perhaps, "immature" behavior? Sometimes a rightful concern
for decorum may obscure more fundamental and important professional
interests, for example, the conditions of professional practice. Increasingly,
institutionally employed professionals, including lawyers and physicians,
are finding it necessary to walk picket lines and participate in other actions
usually associated with lower status employees when "their working con-
ditions do not permit them to be professionally responsible to their clients
and to themselves" (Hentoff, 1973, p. 31).
Sometimes the professional status of an advocacy effort is questioned,
not because it is considered vulgar in some way, but because it does not
require extensive training or use of specialized technology unique to
applied psychologists; as, for example, writing a letter to a public official.
According to this "technocratic" view, psychologists act as professionals
only when they do something that they alone can do by virtue of their
special training or their licenses. Those things that anyone can do are there-
fore not considered professional actions. But the fact that nonpsychologists
can perform a certain operation does not imply logically that psychologists
should not also do it. The absurdity of such an argument is readily apparent
when common experience is considered. Almost anyone can read a ther-
mometer and write, but it would make no sense to conclude that these
actions therefore lie outside the role of the phYSician, qua phYSician. There
are many acts that are relevant, or even integral, to being a competent
professional even though they do not require special expertise. For
instance, anyone who discovers an unsafe product can and should file a
report with the appropriate agency, but a psychologist who uncovers a haz-
ardous product in the course of conducting a market research on the prod-
uct has a special professional responsibility to make a report since the dis-
covery came as a consequence of being a professional.
Committed professionals will realize that the objections to advocacy
efforts noted above spring not from professionalism but for professionism,
which by analogy to scientism, is a tendency to emphasize the trappings
and conventions of professional activity rather than its purposes or goals.
19 A
less antagonistic position recognizes advocacy as a legitimate "professional" endeavor,
that is, one requiring specialized training and experience, but holds that psychologists
should not engage in advocacy since they rarely have the requisite preparation (e.g., see
Lawrence, 1970).
When professional is understood in terms of meeting human needs (See

American Psychological Association, 1968), then advocacy efforts that
advance legitimate client or organizational goals are as deserving of this
label as other professional efforts.
BATTLING BURNOUT
During the 1960s and early 1970s, professionals were challenged to

become part of the solution or resign themselves to being part of the prob-
lem. Many responded by working in alternative institutions or by fighting
within established institutions to provide more responsive and humane ser-
vices. Unfortunately, as has been the case in previous eras, some, despite
their intentions, or rather, precisely because of them, have become part of
the problem -cynical, uncaring, and hostile toward the very people they
set out to help. Unable to handle the unremitting and overpowering needs
of their clients they "burn out." Like a rubber band pulled too many times,
they no longer can respond sympathetically. In order to protect themselves
from overwhelming stress, they become emotionally indifferent toward
their work.
"Burnout" is not a new phenomenon, though the attention it is receiv-
ing as a subject of systematic study is relatively recent (Maslach, 1976).
Professionals starting new service programs or advocacy campaigns against
long odds will become familiar with the problem-either through their
own experience or through the research of others. To guard themselves
against its unhappy consequence, these professionals should regard burn-
out as an important professional problem. Although there is not an exten-
sive literature on the subject, Maslach (1976) and Freudenberger (1977) offer
some useful guides. They suggest that committed professionals (and non-
professionals) maintain an awareness of their own motivation and needs.
Freudenberger urges plenty of physical activity as part of a plan against
burnout. ''The use of physical exercise," he writes, "cannot be underesti-
mated" (p. 97).
Maslach, in a study of 200 professionals including lawyers, physicians,
and social workers as well as psychologists, found that burnout was most
apt to occur when the professional was asked to assist too many people for
too long at a stretch. What is noteworthy about her finding is that long
hours, by themselves, are not correlated with burnout. Long hours become
destructive "only when they involve continuous direct contact with
patients or clients" (p. 20). Administrators, in other words, do not suffer as
much risk of burnout. Maslach therefore advises (1) a limit on the number
of "cases" or "contact hours" and (2) the use of sanctioned "time-outs." In
contrast to coffee breaks or vacations, time-outs are not rest periods. They
are an opportunity to work on another, but less stressful aspect of the
"total" job. She also recommends the organization of support groups. These
groups serve several functions. They provide a means of working out the
arrangements for time-outs and caseload limits; give workers an opportu-

nity to let off some steam; and offer an opportunity to learn how others feel.
Many people in stressful service situations apparently are surprised to learn
others are having similar experiences.
ORGANIZATIONAL PSYCHOLOGY AND THE PUBLIC INTEREST: AN

EXAMPLE-LICENSING
The preceding sections have emphasized the contributions that indi-

vidual psychologists can make to the public interest. The idea of a psychol-
ogy in the public interest, however, is not restricted to the actions of psy-
chologists acting individually. It is concerned equally with our collective
activity as expressed, in the United States, through organizations such as
the APA, Association for the Advancement of Psychology (AAP), and the
various state associations. Here we collectively establish the norms of good
conduct for individual professionals and also develop strategies for influ-
encing the "outside" world. Moreover, the conflict between selfish and
altruistic motives that we experience as individuals exists at the organiza-
tional level as well. It has even been codified in the bylaws of the APA
(1976). According to the bylaws, the goals of the APA are "to advance psy-
chology as a science and a profession and as a means of promoting human
welfare" (emphasis added) (p. XI). Thus even in its bylaws APA recognizes
a separation between professional development and social betterment. The
idea of separation, or more precisely, conflict, between professional and
public interests is, of course, more commonly associated with the American
Medical Association. Unfortunately for the public, organized psychology
often has acted as if it wished to emulate the worst of organized medicine.
This section will consider one relevant example.
LICENSING
Organized psychology has maintained for a quarter of a century that

the licensing20 of psychologists is in the public interest as well as in the
20Laws that regulate who can use a particular job title traditionally have been called certifi-
cation laws. Those that regulate who can practice a certain occupation, whether or not the
person employs the usual job title, have been called licensing laws. Unfortunately, this
terminology has not always been followed by state legislatures. As a result Hogan (1979)
recommends that laws that regulate practice be called "practice" laws and those that reg-
ulate titles be called "title" laws. Laws that do not require a person to pass an examination
or meet other requirements, such as holding an academic degree, but do require listing
oneseif with a state agency, Hogan terms "registration" laws. Finally, due to the impreci-
sion that has developed, Hogan uses "licensing and licensure ... interchangeably ... (to)
include both title and practice acts and registration" (p. 238).
profession's interest. Many critics, on the other hand, argue that occupa-
tionallicensing laws, including psychology's, do not benefit the public and
in fact may cause some harm. This is an especially serious charge inasmuch
as the sole justification for government's regulating occupations is the con-
cern for the public interest (see American Psychological Association and
Conference of State Psychological Associations, 1955). Thus, the preamble
to virtually every psychology licensing or certification law cites the need to
protect "the public health, safety and welfare" as the basis for the legisla-
tion. Regulation is expected to provide this protection by (1) preventing
unqualified charlatans from posing as psychologists and (2) by deterring
unprofessional conduct on the part of bona fide psychologists. As we shall
see, critics deny that regulation achieves its purposes. Even if regulation is
effective, critics maintain that the costs of this "protection" outweigh its
benefits. Let us review these arguments.
Competence
The first aim of regulation is to assure that all persons holding them-
selves out as practitioners are, in fact, competent psychologists. 21 In pursuit
of this goal, state laws require that anyone seeking a psychology license
must have a doctorate in psychology and must pass an examination in psy-
chology. In most cases, candidates also must demonstrate that they are "of
good moral character" and have had a certain amount of "acceptable" expe-
rience. These requirements, and others that may be imposed, rest on the
assumption that they are necessary for the competent (and ethical) practice
of psychology. Unfortunately, there appears to be little evidence to support
this critical and fundamental assumption. For example, Hogan (1979), in his
21Statutory regulation is presented as a method for assuring competent practitioners. Along

the way it becomes understood by members of the profession as a means of assuring better
than competent providers as is noted by Combs (1953) who cautions psychology to avoid
this interpretation:
Some psychologists have seen licensing as a means by which we could raise the standards
of our profession. This is not a legitimate reason for seeking legislation .... Raising stan-
dards by legislation is not in the public interest. In the long run, it is probably not in the
profession's interest either. It is not the function of legislation to lead good practice. Like
most other democratic institutions, our laws can only follow existing practice. They repre-
sent a floor beneath which practice is not acceptable. The raising of standards is the profes-
sion's responsibility, not the legislature's. (p. 560)
Combs argues that standards in licensing laws should be set so the public has access to
competent practitioners, "At the same time," he adds, "they must not be so high as to
exclude from service practice persons who fill real public needs" (p. 560). The failure to
follow this advice, he warns, can result in a profession pricing itself out of the market. The
psychologists in one state insisted on standards for publicly employed psychologists that
were so high that the state could not find anyone who would accept the job at the salary
that the state was willing to pay. "The jobs still needed to be done, however, and several
hundred jobs are now filled by persons with little or no training in psychology whatever"
(p.560).
influential and comprehensive study of the regulation of psychotherapy,

reports that:
The emphasis on educational degrees, for instance, assumes that such degrees
are a valid and reliable measure of competence. The evidence ..., however,
argues against such an assumption. (p. 255)
Darlak (1979), who has reviewed the research literature comparing the
effectiveness of professionals and nonprofessionals in a variety of human
service situations, comes to a similar conclusion:
The central finding from these comparative studies is that the clinical outcomes
that paraprofessionals achieve are equal to or significantly better than those
obtained by professionals. (pp. 84-85)
The licensing examinations come off no better than degree require-

ments. Koocher (1979), for example, reports that "There are no empirical
data in print which demonstrates that extant licensing or speciality board
certification examinations correlate with successful treatment or diagnosis"
(p. 12). This is not a surprising finding in view of the strikingly few items
relating to clinical practice that have been employed over the years on the
widely used National Examination of Professional Practice in Psychology.
The use of licensing and certification requirements that are irrelevant
to assessing or assuring competence entails a variety of social costs. Some of
these are shared more or less equally. For instance, requiring a certain num-
ber. of years of education beyond what is actually necessary may increase
the drain on the public treasury in order to pay teachers and provide fel-
lowships for students. Similarly, administering examinations and screening
candidates using methods that are not related to competent practice may be
a waste of public funds. Other costs may fall disproportionately on the less
privileged and less powerful members of society. For example, the use of
irrelevant and gratuitous requirements may discriminate against them as
would-be practitioners and as the clients of such practitioners. AB Hogan
(1979) writes:
The argument for the existence of discrimination is rather simple. It runs as
follows. If academic credentials are required for entry into a profession and if
these credentials are not valid or reliable measures of competence, and if minor-
ities, women, the poor, and the aged have greater-than-normal difficulty in
obtaining these credentials, then it is reasonable to assume that discrimination
has taken place (whether intentional or not). (p. 281)
The lack of positive evidence for the validity of psychology'S exami-

nation is a matter of some concern and embarrassment to the profession (see
National written examination, 1978).22 Defenders of such examinations are
22The 1978 Annual Report on the Licensing Examination Program of the American Associa-
tion of State Psychology Boards, as excerpted in the AASPB Newsletter (National Written
Examination, 1978) states:
Not only must it be demonstrated that a test measures what it purports to measure, but also
empirical evidence must be provided to show that what it purports to measure is clearly
left to say only that those who "score low on a test easily mastered by most
of their peers should find some other name than 'psychologist' to describe
themselves" (Ricks, 1973, p. 5). This, of course, begs the central question of
whether "psychologists," as defined by state laws, are any more qualified
to practice psychology than those who are forced to use different labels to
identify themselves.23
But suppose that licensing and certification requirements, contrary to
available evidence, are effective in screening out unqualified practitioners.
What assurance is there that a person licensed 10 or 20 years ago is still a
competent practitioner? Licensure is supposed to guarantee that everyone
practicing a regulated activity is a competent practitioner, not just the newly
licensed. There are very few licensing laws, considering all professions, that
require evidence of continuing competence and few of these require reex-
amination. In most cases continued competence is presumed. In some states,
practitioners are required to continue their education, and hence maintain
their competence, by accumulating a specified number of "credits" through
attendance at conventions and other professional meetings. Rarely, how-
ever, must the practitioners demonstrate mastery of the new information to
earn their credit. Thus, if there is any reason to question the value of uni-
versity training programs, there is even more reason to question the value
of the less structured and less well organized continuing education pro-
grams. This state of affairs cannot help but foster the suspicion that licens-
ing and certification serve to promote professional goals and not the public
interest.
related to what people actually do in their jobs and how competently they do it. In the case
of licensure, the behavioral correlates of incompetence are as important to identify as those
of competence. In the case of psychology licensure in particular, all of those demands take
on a special urgency. It is to this field of professional expertise that others look for the tools
which will demonstrate the validity of their assessment techniques, and they have every
right to expect psychology to provide a workable methodological paradigm.
There has been no lack of awareness of this growing urgency on the part of state
boards or their Association.... The boards have pressed for evidence of validity which
meets current standards; the Executive Committee has pressed for planning and research;
and the Examination Committee, at a 1976 brainstorming session in consultation with the
Professional Examination Service (PES), came up with no less than sixteen study concepts.
At its meeting in March, 1977, the Examination Committee unanimously adopted a
resolution expressing its strong concern; that professional psychology has done less
research in validating its own licensing examination than is essential to maintain the integ-
rity of the examination, given the state of federal legislation and regulations in this area.
(p.12)
Stigall (1979) has turned this problem around. Commenting on the general absence of
competency-based measures of performance for the professions, he notes one reason for
this is the prohibitive cost. He then goes on to say, "Moreover, it has not been established
that education and training are unrelated to competent practice" (emphasis added) (p. 37).
23Paradoxically, the lack of validity for certification exams does not mean in and of itself that
we should do away with certification. Consumers have a right to know the contents of a
product-or the training of service person-whether or not the contents have demonstra-
ble value. Certification laws, then, might be compared to truth-in-packaging or truth-in-
menu laws. If consumers have a right to know whether they are getting a brand name
product, then it is hard to see why they would have any less right to know what kind of
"psychologist" they are seeing.
Enforcement
The self-serving nature of professional regulation, critics claim, is also
evident in the poor performance of regulating unethical practice. Yet, iron-
ically, such regulation is the other primary justification for licensing. Stud-
ies in a number of different professions indicate that disciplinary actions
are "insignificant" given the total number of practitioners. In addition,
there is "a tendency toward leniency even in the relatively few cases that
result in formal board action" (Department of Health, Education and Wel-
fare, 1971, p. 33). Psychology appears to conform to this pattern. According
to Hogan (1979), discipline by psychology boards is "virtually non-exis-
tent." He reports that complaints to psychology boards average roughly one
a year for each year that a board has been in existence. Up to 1972, he writes,
only five licenses had been revoked. Frequently, it appears that disciplinary
action is motivated by the desire to protect the profession's image and pre-
vent public criticism (that might undermine self-regulation) rather than by
the "ethical salience" of the misbehavior (Carlin, cited in Hogan, 1979, p.
260). Part of the boards' poor performance may be due to the fact, in the
view of most observers, that they generally have little money, are poorly
administered, and lack investigative skills.24 As Hogan (1979) and others
have noted, "The result is that the public is only protected from relatively
infrequent and extreme offenses" (p. 262). These offenses, moreover, typi-
cally are already covered by laws against fraud, theft, and physical assault,
including rape. It is not difficult to come to the conclusion that the function
of disciplinary bodies is not so much to protect the public against profes-
sional misconduct, per se, but to promote the perception-however incor-
rect-that there is an effective enforcement mechanism for misconduct.
The difficulties apparent in enforcing ethical conduct also can be seen
in preventing unqualified (i.e., unlicensed) individuals from practicing.25
24 Another explanation proferred by critics for the lack of enforcement efforts is that licensing
boards are typically "captured" by the profession they are established to regulate. Cum-
mings (1979), a past president of the District of Columbia Psychological Association
(DCPA), recalls his role in the establishment of the licensing board for the District of
Columbia and illustrates the capture phenomenon:
Only one thing remained to be done in the licensing sphere. A Board of Psychologist Exam-
iners had to be selected from the many nominations which Mayor Washington had
received, and Bill, as president of DCPA, was asked to direct the selection. I was happy to
say yes to his invitation to join him in this task. We arrived at the Mayor's office one late,
winter afternoon, and, with the help of several aids that the Mayor had put at our disposal,
we completed our nominations. (Our "slate" was named as the first Board of Psychologist
Examiners the next morning.) (p. 1)
25Strangely, advocates of occupational regulation do not always acknowledge the importance
of inhibiting the activities of "charlatans." Responding to Deutsch's claim (1958) that New
York's certification law had not curtailed the activities of charlatans in that state, Katzell
and Thompson (1958) two proponents of the law, responded:
We have come across little evidence that bears on either side of this argument; but in any
event, the direct effect on charlatans is only one of the public benefits anticipated.... At
least equally important are the eventually improved training standards for applied psy-
Since the economic interests of a licensed profession are promoted by pre-

venting unlicensed persons from practicing, it is somewhat surprising that
these efforts do not occur more regularly and more often. Nevertheless,
when boards do take action against unlicensed individuals economic inter-
ests predominate. Again, according to Hogan (1979), board actions are "fre-
quently aimed at curbing economic competition, rather than preventing
harmful practices, as when lawyers attempt to prevent real estate brokers
from writing contracts for the sale of land" (p. 348). Of course, it may be
argued that the sparse enforcement efforts of psychology boards are due to
the difficulty of demonstrating that harmful or unethical behavior
occurred.26 But if it is that difficult to demonstrate, how valuable is the pro-
tection vouchsafed the public by licensing?
Costs
Even if licensure could successfully insure competent and ethical prac-
tice, it would not follow automatically that it was in the public interest. It
would stlll be necessary to weigh the benefits of licensure against its costs.
According to standard economic theory, licensing unavoidably increases
the cost of professional services to the consumer. It does this in a number
of ways. By conferring a monopoly on one group of providers, licensing
reduces the number of providers and gives the licensed group the power to
further reduce the supply over time. Fewer providers mean each provider
can charge more. With lessened competition, consumers also will have less
access and influence over the services that are provided. Further, licensing
typically results in additional educational and other entry requirements. 27
As the length of training increases, cost also goes up. The cost of training,
and deferred income, must be picked up by the public through educational
chologists, the attraction of better qualified persons into a better-established profession,

and the more effective degree of legal and intraprofessional control on the public services
of a professional group made visible by certification. We submit that it is mainly on such
ground that the positive achievements of certification laws should be evaluated and that it
is still too early to render an authoritative judgment on the degree to which these objectives
are being attained. (emphasis added) (pp. 652-653)
260n this point Combs (1953) writes:
In a human relationship, just when is a person harmed? How can you prove it? These are
difficult questions to answer for the plain fact of the matter is that people are helped by
the damnedest things. Almost anything may help people to behave more effectively or to
feel happier given the right circumstances. (p. 558)
27 Among the requirements whose relevance to protecting public health, safety, and welfare
is best understood, presumably, by the legislators who approved them are residency, citi-
zenship, and loyalty requirements. The tenuousness and capacity for abuse in these require-
ments have been reviewed by Gellhorn (1956). He reports:
A junior high school teacher of music, having been forced to resign after being identified
as a Communist, had difficulty becoming a piano tuner in the District of Columbia because,
forsooth, he was "under Communist discipline." Veterinarians in the state of Washington
may not minister to an ailing cow or cat unless they have first signed a non-Communist
oath, thus assuring that they will not indoctrinate their four-legged patients. (p. 130)
586 GoTILIEB C. SIMON
subsidies and by higher fees when practice begins. It is important to point

out that this analysis does not require that licensing be sought by profes-
sionals in order to make more money. Whether intentionally or not, licens-
ing has the net effect of transferring dollars from the pockets of consumers
and taxpayers to the bank accounts of professionals (including academic
trainers).
Another licensing problem that fosters poor service (M. Friedman,
1962) is the increased difficulty in suing professionals for malpractice. This
difficulty is due to the reluctance of professionals to testify against each
other because of the monopoly powers held by their peers, conferred upon
them by licensing. After considering all of its effects, M. Friedman (1962),
writing about physicians, concludes that he is "persuaded that licensure has
reduced the quantity and quality of medical practice," (po 158) a rather star-
tling conclusion to most readers.
Perhaps even more startling is that Milton Friedman's opposition to
licensure ultimately is based on his concern for individual freedom, rather
than its possible negative effects on medical practice (see also Gellhorn,
1956). Friedman is not convinced that the need to protect consumers from
making mistakes (i.e., choosing incompetent or unethical providers) is as
important as allowing people to choose and to practice the services of their
choice. Although this might seem to invite a dangerous anarchy, Friedman
is confident that the discipline of the market will provide consumers appro-
priate protection. {The individual nature of these choices-what profeSSion
shall I practice? and which provider shall I seek out?-should be contrasted
with situations in which other people involuntarily suffer the consequences
of other people's mistakes {e.g., an incompetently designed or constructed
bridge).2B Since Friedman is such a wet! known spokesperson for "conser-
vative" or "right-wing" philosophies, it should be noted that others, on the
other end of the political spectrum, have been equally outspoken in their
opposition to occupational licensure and its undesirable social conse-
quences. In their view, licensing results from, and reinforces, a form of
professionalism that leads to elitism, undeserved privileges and reduced
accountability for therapists along with undesirable dependence for their
clients (see Agel, 1973; Glenn & Kunnes, 1973).
Solutions
Taken by themselves the criticisms of licensing and certification of psy-
chologists if valid support the conclusion that these laws should be repealed
28"The medical profession is often cited as a case where special costs are greater than private
costs. It is usually said that 'incompetent' physicians may diagnose a disease incorrectly and
thus start an epidemic. To complete the argument, it is necessary to contend that this is
more likely or more damaging than the possibility that, if the inexpensive medical practi-
tioner is made unavailable, the consumer will neglect to consult a physician at all, thus
starting an epidemic" (Moore, 1961, p. 110).
in the public interest. Unfortunately, psychology cannot be considered in

isolation. Both proponents and opponents of licensing generally agree that
the main consequence of removing licensing and certification laws for psy-
chology would be a strenghthening of the profeSSional hegemony of phy-
sicians. Unless licenSing is removed from all related occupations at the same
time-and that appears unlikely in the health field at the present time29-
the elimination of some laws will only increase the dominance of medicine,
a result that does not appear to be in the public interest.
As long as licensing laws appear to be unavoidable, the solution to the
licensing conundrum may lie in amending the laws. If possible, licensing
laws should be converted to certification laws, reversing the usual progres-
sion to more restrictive legislation. Efforts to move from certification to
licensure should be avoided. In addition, both kinds of laws should be
amended to require "professional disclosure." Offered originally as an alter-
native to licensing (Gross, 1977), professional disclosure is more pragmati-
cally regarded as a supplement and antidote to licensure and certification
(Hogan, 1979; Witmer, 1978). As part of a psychology law, profeSSional dis-
closure would mean that all covered practitioners would be required to fur-
nish potential clients with a written statement summarizing certain salient
features of their practice. In the case of clinical and counseling services,
such a statement would include information on the provider's "treatment"
philosophy, use of any unusual or hazardous procedures such as physical
abuse or sexual contact, the provider's qualifications and experience, areas
of special interest and skill, fee schedule, and how a client can report pos-
sible complaints about the practitioner.
The idea for professional disclosure is based on the model of the
informed consumer making independent judgments. The successful appli-
cation of this idea, however, does not require that individual consumers
have the intellectual or emotional capacity to assess a disclosure statement
at the time they want professional assistance any more than it is necessary
for every consumer to read the nutritional information now provided on
29The idea of professional licensure and self-regulation is so well-established today-per-

haps, entrenched would be a better word-that it is difficult to imagine doing without it. It
is surprising, therefore, to learn that many state legislatures in the early 19th century
repealed their licensing laws for physicians and lawyers, just as many legislatures in the
last few years have passed "sunset" laws. This opposition to licensing, as has been noted
(Gross, 1978), has a contemporary ring to it. According to Tabachnick (1976), Jacksonian
Populists complained that the professionals of their day were abusing their powers. Using
biased examinations and unnecessary entry requirements, they charged professional soci-
eties had established monopolies preventing competition. They also used their power,
according to the critics, to establish themselves as a privileged class; lawyers, for instance,
were practically exempt from serving in the militia. "Disadvantaged" citizens of the day
had little opportunity to join these guilded ranks. In addition, there were complaints that
the professions were undermining the ability of the average person to handle his or her
own affairs, medical or legal. Finally, medical critics, including practicing phYSicians,
claimed that licensing laws were being used to impede research and prevent the introduc-
tion of new treatments.
many food products. It is sufficient that practitioners give thought to some

of the items required on a disclosure form and know that their responses
may be scrutinized by someone. Consumer groups can then educate con-
sumers and pressure providers, as indicated, in the same way that Con-
sumer Reports and similar organizations influence the purchase and fabri-
cation of manufactured goods.
In some states, implementation of professional disclosure might be
effected through the issuance of regulations by the state licensing board.
The likelihood that this might be done probably depends on the status of
another proposed solution, the appointment of public members to licensing
and certification boards, since public members are more apt to be open to
disclosure. The theory is that nonprofessionals will be free of the guild
interests and prejudices that may cause professional members to ignore the
public interest. Such moves are in the right direction if they prepare the
way for publiC control of the board, rather than involve mere "participa-
tion." By themselves, however, one or two lay members are unlikely to
have much impact (Pfeffer, 1974), particularly if they are not accountable to
an organized constituency (Olley, 1976).
Conclusion
In the early 1950s psychologists were concerned about their profes-
sional survival. Statutory regulation was seen as a way of guaranteeing psy-
chology's independent existence which was then threatened by the pow-
erful medical profeSSion. Thus, Ellis (1953) advised his colleagues that
"Licensure offers psychologists maximum protection against minimal
changes in medical practice acts or other restrictive actions initiated by
other profeSSional groups" (p. 552). This opinion was widely shared. 30 Sig-
nificantly, Ellis (1953) also argued for licensure (practice laws) over certifi-
cation (title laws) by pointing out "The fact that psychiatrists and phYSicians
have officially advocated that psychologists be certified rather than licensed
shows that psychology would obviously benefit more from licensing than
certification" (p. 552). How licensure would "obviously" benefit the public
is not quite so clear.
In addition to its defensive value, statutory regulation also was
regarded as leading to a number of positive professional benefits. These
included psychologists being excused from jury duty, obtaining tax deduc-
tion rights for their clients, and protection of confidential communications
from their clients. Regulation, especially licensure, also has been seen as a
30The APA and CSPA (1955) committees on legislation also reported that:
Formal recognition implies that members of that occupation have the right to practice their
occupation; in a sense, then, their social role and their existence are protected. (p. 729)
Notice that the report refers to "formal recognition." It does not limit this benefit to licens-
ing or certification.
means of achieving increased dignity and social status.3! But, apart from
confidentiality, what are the benefits to the public? Virtually all of the pub-
lic benefits claimed for practice laws can be obtained with less restrictive
legislation such as title laws or registration, as Hogan (1979) has shown.
Nevertheless, psychology has consistently sought the most restrictive leg-
islation politically possible, regulation of practice over title, the doctorate
over the M.A., and so on. Why? To some critics, the answer is clear-greed.
Money may not be absent as a motive, but there are other guild motives
that also are operating. Professional autonomy and freedom from interfer-
ence and domination by others also are clearly involved. So is a concern for
status.
It is difficult to avoid coming to the conclusion, then, that psychology's
fear and envy of medicine, and its desire for the perquisites of full-fledged
professional status, have led to the placing of guild interests before the pub-
lic interest in the manner of licensure. Whether this is a fair and valid con-
clusion will be seen in psychology's willingness to support licensing
reforms such as professional disclosure in the years to come.
CONCLUSION
If service to humanity is taken as a defining characteristic of psychol-

ogy as a profession, as it is (see American Psychological Association, 1968,
1977; Goode, 1957), then "psychology in the public interest" should be an
unnecessary and redundant expression. Given that the purpose of psychol-
31A quarter century ago when the drive for licensure was moving into high gear the APA
and California State Psychological Association committees on legislation (1955)
commented:
The argument (for licensing psychologists) is frequently supported by references to the fact
that the medical profession is licensed. Such an argument obviously overlooks the fact that
this is also true of a host of other occupations with less prestige as, for example, beauticians
and barbers. (p. 739)
Deutsch (1958) has contrasted the fact that nuclear physicists with Ph.D.s are not licensed
while mechanics with only a high school education are. Goode (1960), in a sociological
analysis, argues that licensure and status are both the result of an occupation's accumulation
of specialized knowledge and its service orientation, that is to say, its crystalization as a
profession. Nevertheless, the belief remains strong among members of emerging profes-
sions that licensure produces status (see DHEW, 1971).
Perhaps, then, psychology's concern with regulation can be interpreted by analogy to
Weber's concept of the Protestant Ethic. According to Weber, the 17th century Calvinists
were driven to accumulate capital, not for its own sake, but because they were seeking a
sign that would tell them if they were among the Elect who would enter Heaven. In a
parallel fashion, psychologists may be motivated to achieve licensure or certification not
because of its presumed instrumental value in achieving higher social standing, but because
of its symbolic value in confirming their worth to society. This idea is evident in Deutsch's
observation (1958) that many of her colleagues regarded New York State's certification of
psychologiSts as a sign that "we've finally made it as a profession" (p. 646).
ogy as a profession is the promotion of human welfare, any activity of a

professional that does not contribute to this goal may not properly be con-
sidered a professional activity. To take an extreme example, the use of per-
sonality tests by a psychologist to select obedient concentration camp
guards should no more be considered a professional (albeit a technological)
act than the use of a scalpel by a physician to kill rather than heal.
The truth, of course, is that psychologists, as much as any other group
of human beings, are capable of acting at all times in perfect conformity
with the ideal of serving humanity. The desire for increased personal com-
fort, power, income, and social status, and so-called guild interests inevita-
bly compete with the needs of clients and society for our attention, with
the balance between guild and public interests shifting from time to time.
Thus, the expressions public interest psychology and professional activity in the
public interest are used to call attention to the gap between professional aspi-
rations and real accomplishments.
Professional activity in the public interest, then, is simply a fresh way
of expressing the old idea of "service ahead of gain.,,32 It is for all intents
and purposes equivalent to the concept of professional responsibility, incor-
porating those activities described under the separate headings of social
responsibility and ethical conduct. While all these terms are largely syn-
onymous, there are certain differences, some slight and some major. For
instance, ethical responsibility carries a stronger connotation of technical
competence and rectitude in dealing with colleagues and clients. Social
responsibility, on the other hand, takes technical competence for granted,
emphasizing the needs of society as a whole in the course of professional
practice. Although social and ethical responsibilities usually are comple-
mentary, they may involve incompatible expectations on occasion. Thus, in
the now famous Tarasoff case (1976) a psychologist was faced with a conflict
between the ethical obligation to keep a client's revelations confidential
and the social duty to warn the victim of the client's potential dangerous-
ness. Similarly, conformity to established standards of practice as demanded
by the ethical code may conflict with the public interest if the standards
themselves are inherently deleterious or exploitative. Finally, there are eth-
ical responsibilities such as assigning publication credit to colleagues in
proportion to their contributions which have no clear, direct consequences
for clients or the public.
The APA ad hoc Committee on Promoting Public Interest Activity
(1975) has summarized these relationships and the various suggested public
32 After a wide-ranging survey of public interest lawyers sponsored by the American Bar
Foundation, Marks, Lewsing, and Fortinsky (1972) conclude:
On analysis it turned out that what was needed was not a new definition of profeSSional
effort but simply a reassertion of the classic or traditional definition involving service
ahead of gain. This, however, might be "new" for the profession as organized today. (p.
52)
interest activities for psychologists by defining professional activity in the

public interest as:
(1) Excellence and dedication in meeting client/community needs ethically and
effectively (this would include individual initiative and innovation in the pro-
vision of services, client or policy advocacy, etc.); (2) efforts to assure that psy-
chological services are organized and delivered in a manner which is humane,
equitable and consistent with principles of social justice (this would include
refusing to serve in certain settings or to provide certain services, donating ser-
vices to those otherwise unable to obtain them, etc.); as well as (3) contributions
to the identification or solution of significant social problems through the appli-
cation of psychological principles or techniques. (pp. 1-2)
A similar trichotomy has been followed in the criteria for the APA
Award for Distinguished Contributions to Psychology in the Public
Interest:
(1) A courageous and distinctive achievement in the science or profession of
psychology which makes a material contribution to the solution of one of the
world's more intransigent social problems; (2) A distinctive and innovative con-
tribution which makes the science and/ or profession of psychology more acces-
sible in a positive manner to a greater number of persons; and, (3) An integra-
tion of the science and/or profession of psychology with social action in a
manner beneficial to all. (Conger, 1977, p. 433)
These definitions should be contrasted with what might be called

"naive" professionalism. This is the tendency (not restricted to psycholo-
gists, of course) to believe that the practice of one's profesSion, in and of
itself, is in the public interest. (It is implicit that such practice should do no
harm to anyone.) But there is more to professional activity in the public
interest than that. Thus Bandura (1976), discussing "the kind of profession-
alism our Association wishes to promote," observes in his outgoing editorial
as APA president that:
This is not a simple issue of public versus self-serving interests, since endeavors
that help people can be easily justified as serving the public interest, however
circumscribed their social impact. (p. 2)
The challenge that Bandura sets is one of maximizing psychology's contri-

butions to the public welfare.
Realizing this goal, however, is not a simple issue of doing more good
than the good we now do (see Gaylin, Glasser, Marcus, & Rothman, 1978).
For example, many hailed the community mental health centers as a way
to provide psychotherapy to people who had been denied mental health
services because of economic or racial barriers. Others, as has been noted,
oppose the expansion of psychotherapy in this manner on the grounds that
providing such assistance will divert attention and resources from needed
social change. Similarly, psychologists who have answered "the call" to
leave their laboratories and to apply their expertise to the solution of social
problems may be criticized for their willingness to apply methods of
unproven efficacy and for the allegedly harmful consequences of their "per-
son-centered" theories. Thus, Caplan and Nelson (1973) in their influential

article on the dangers of ''being useful" warn that "we must be wary of
uncritically accepting the idea that the promotion and dissemination of
social science knowledge is intrinsically good, moral, and wise" (p. 211).
Nonetheless, those who promote the psychological investigation of
social issues and those who question such efforts, along with those who
support and those who oppose the expansion of mental health services,
share one thing: They are. concerned with the social consequences of their
professional activity. They may disagree on what the consequences are, but
they are agreed that it is important to be concerned about them. And pre-
sumably they agree that client and community interests should come before
personal interests or those of the discipline. To the extent that reliable
information on the objective consequences of alternative courses of action
is unavailable, this interpretation of public interest activity offers both sides
in such controversies equal claim to be doing public interest work. This
orientation is to be contrasted with the concept of the professional as "hired
gun." As far as I know, a justification of this model on public interest
grounds exists only for the legal profession. Unfortunately, this tendency
to reduce scientific and professional activity to a purely technological place
free from issues of personal responsibility, what might be called the "tool-
box" syndrome, is widespread. 33
A stark illustration of this problem came to light in Reno, Nevada, a
few years ago. A woman, a military veteran and an honor graduate from
the state university, applied for a job as a jailer with the Reno police depart-
ment. As a part of the screening process she was given a battery of tests by
a local psychologist. Despite her superior academic record and having the
third highest score on the written examination, she was rejected by the
police department "for psychological reasons." She contacted the psychol-
ogist who tested her and asked for an explanation. She says that he told her
that she was rejected because he informed the police that she "differed from
the accepted standards for the Police Department by being more humble,
MIn professional practice, as in science, purpose, not technique, should be paramount. This
desideratum, however, may conflict with "guild" considerations, such as prestige, money,
and professional dominance. Commitment to a goal, be it increasing our understanding of
nature or giving service to the sick, is not as readily monopolized as is the use of a particular
technology. Since exclusive control over practice is both a goal and a condition for social
recognition, there is a great temptation for practitioners, particularly those in newly devel-
oping areas, to emphasize methodology above all else. Goode (1960) notes this development
in a discussion of this "newer type of profession" where:
there is no precise social definition of the juncture at which the client may properly call
on professional help, or even of the problems served by the profession. Rather there is a
definition of skills and knowledge, that is, of the field. The sociologist-professional cannot
identify his problem as the physician who says: "I heal the sick," but must identify his skill:
"I solve sociological problems" (p. 906)
The tendency to define one's activity exclusively by the contents of one's tool box may lead
to socially irresponsible practice. For its effect on science see Kaplan's (1964) discussion of
the "law of the instrument" and Chein (1972) on "scientism" in psychology. See also the
discussion of advocacy and professionalism on pp. 577-579.
more sober, and being more attached to society's rules and norms than the other
applicants, and the norms which are established" (personal communication
emphasis added). Puzzled why these attributes should disqualify her for the
job that she wanted, the young woman filed a complaint with the Reno
Civil Service Commission. According to local news reports (Barber, 1978, p.
12), the psychologist wrote to the Commission in defense of his actions:
I must say that police work is rather obviously not very "nice" work and if the
department wishes to choose persons possessing certain personality traits
which seem to be most consistent with the present constituency of the police
force and with the type of work to be done, then such a decision may seem
reasonable under the circumstances. This, however, must be a matter to be taken
up with the police chief and not with me, for as I explained, I am only an agent
carrying out with exactness and care the professional duties assigned to me. (emphasis
added)
This statement is as clear as it is unfortunate. The psychologist is not

claiming that the police department's standards are correct according to his
values or valid for their purpose, he is merely eschewing his responsibility
for implementing them. This attitude is totally at odds with the concept of
public interest activity that has been presented here.
Moreover, although psychologists can disagree about what particular
course of action will best contribute to our common goal of "promoting
human welfare," there must be an on-going sensitivity to the social impact
of social status and work rules and a readiness to take whatever action our
consciences and the situation indicate is necessary to assure that the inter-
ests of our clients and the community are well served (see Stein, 1974). To
act in the public interest requires that psychologists must be concerned not
only with doing their jobs well but also with conSidering what it is they are
doing and in whose interest they are doing it. 34
ACKNOWLEDGMENTS
The assistance of the Committee on Promoting Public Interest Activi-

ties-especially that of Lorraine Eyde and Gloria Levin-is gratefully
acknowledged.
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VIII
POLITICAL AND REGULATORY
PROCESSES
17
The Changing and Creating of Legislation
THE POLITICAL PROCESS
PATRICK H. DELEON
UNDERSTANDING THE LEGISLATIVE PROCESS: THE ISSUES
Although a primary objective embedded in the bylaws of the American Psy-

chological Association is to "advance psychology as a science and profes-
sion and as a means of promoting human welfare by the encourage:rp.ent of
psychology ... in the broadest and most liberal manner," (American Psy-
chological Association, 1981, p. xxii), it is only recently that psychologists
have, in any organized or systematic sense, begun to ask how we can have
a meaningful impact on our nation's various legislative bodies as they make
decisions affecting our profession and society. As professionals, we have
developed an extensive qody of knowledge regarding the .underlying moti-
vations of people. We possess the technical expertise to design comprehen-
sive evaluations as to how various proposed national policies might influ-
ence the lives of our citizens. Accordingly, psychology's potential
contribution is a most significant one. Yet, as a profession, psychologists
historically have abdicated any societal responsibility that they might have
in this area-in a pragmatic sense, to our colleagues in the legal and med-
ical professions; in a more philosophical or theoretical sense, to our col-
leagues in political science. In addition, as the costs of our nation's health
care programs and of our other social welfare endeavors continue to mount
steadily, we must expect that there will be ever increasing pressures on the
state and federal legislatures to be active participants in decisions regarding
both the delivery of actual services and the administration of the educa-
tional institutions that train our nation's health care and social service pro-
viders. Whether psychology is willing to accept the challenge of this forth-
PATRICK H. DELEON. Executive Assistant to U.S. Senator Daniel K. Inouye, Washington,

D.C. 20510.
601
602 PATRICK H. DELEON
coming governmental involvement is an open question. The opportunity,

however, will definitely soon be present, if it is not, in fact, already here.
In a nutshell, the legislative process is the political process. That is, leg-
islation and/or implementing rules and regulations are enacted or created
not because you or I as enlightened professionals think that they might be
beneficial. More often than not, they are created by politicians, responding
to political pressures and perceived political "realities." In a very real sense,
politics is the art of compromise; of creating immediate solutions to highly
complex problems; of getting a consensus among conflicting interests; in
short, of accomplishing the impossible.
It is a perhaps sad, but nevertheless very real, fact that the vast majority
of our nation's elected officials and their staff have no expertise in mental
health. In particular, they have no realistic conception of what a psycholo-
gist is or what training and expertise he or she might possess. Yet, it is
exactly these same individuals-the politicians-who do establish our
nation's health care priOrities. It is they, therefore, who eventually will
determine whether or not our profession should continue to exist, and if
so, under what conditions. It is therefore most appropriate for every psy-
chologist and every mental health practitioner to become an active partici-
pant in the legislative/political process. As a profession, psychology no
longer can afford the luxury of assuming that someone else will represent
its unique interests. As individual citizens, it is a societal responsibility we
must no longer ignore. In this chapter, I shall describe the step-by-step pro-
cedure that a state psychological association might pursue in order to have
a particular bill enacted into public law. The content of this proposed bill
might seem to be noncontroversal; however, by following its evolution
through the legislative process, I hope to provide the reader with a concrete
and intimate feeling for how to get our views enacted into law.
As one begins to study any legislative body, whether a city council, a
state legislature, or the Congress of the United States, it is often quite dif-
ficult for the uninitiated to appreciate the extent to which it is a highly
organized and intricately orchestrated entity. First impressions are often to
the contrary, with the proceedings seeming to be either utterly chaotic or
else overly simplistic. Yet, for the professional who is trained in working
with families and in studying their communicational patterns, the same
type of institutional and interpersonal processes soon become evident: self-
fulfilling prophecies, relationship defining messages, institutional "myths,"
and the ever repeating nonverbal communicational patterns. As with a typ-
ical family unit, there are a number of institutional "ground rules" that
must not be violated; yet, there also are acceptable ways to discuss "forbid-
den topics." Again, as in family "discussions," the process that occurs and
who says what to whom is often significantly more important than the con-
tent actually verbalized.
At the beginning of every legislative session, there is effort to organize
the elected membership in both the House and Senate under a superstruc-
ture of identifiable committees. Each of these theoretically possesses exclu-
THE CHANGING AND CREATING OF LEGISLATION 603
sive jurisdiction over their proclaimed subject matter. Individual legislators

are assigned to the various committees by their own party's elected lead-
ership, with an expressly conscious effort being made to maximize every-
one's "special interests." For example, if an individual legislator is espe-
cially interested in insurance matters, perhaps even because his election
was actively supported by the insurance lobby, every effort will be made to
place him on the committee that has jurisdiction over insurance legislation.
If this can be arranged, the elected official then will be appropriately "most
appreciative" of the leadership's cooperation and, naturally, will be even
more likely to be "supportive" of their suggestions for policy directions
later on during the legislative session.
As one readily can imagine, with the extent to which considerable
effort is spent from the very beginning in ensuring that every individual
legislator's personal interests are taken into account, when a bill finally is
reported to the House or Senate floor from the full committee, it represents
considerably more than just the expressed content of the bill. It has now
also become a "good faith" issue for the committee chairman, for his com-
mittee membership, and even for the majority party's leadership. Before a
bill ever reaches the floor for a final vote, at which time every legislator
must commit himself/or herself one way or the other in a highly public
and identifiable fashion, sufficient compromises should have been made so
that all who are intimately concerned with the basic issues involved will be
at least reasonably satisfied. Otherwise there is too much potential for overt
conflict and the resulting "hard feelings" that successful politicians actively
seek to avoid. It is true that bills do get defeated, or substantially modified
by floor amendments, or even once in a while referred back to committee,
but this is not the usual case. Unfortunately for psychology, it is at this final
juncture that our efforts have typically begun, much too late to have any
significant impact on the legislative process.
One explanation for our profession's generally naive behavior in the
political arena becomes readily apparent upon a cursory review of the psy-
chological literature. Although over the past three years there has been a
marked increase in the number of psycho-political addresses and work-
shops at state association meetings, there has been only minimal discussion
of the importance of politics to our profession in our more traditional lit-
erature. By far the most comprehensive treatment is that by Herbert Dorken
in his "Avenues to Legislative Success" (1977) and The Professional Psychol-
ogist Today: New Developments in Law, Health Insurance, and Health Practice
(1976). Similar themes also are voiced in "Psychologists and the Legislative
Process" by Peter McGinn (1978) and "Social Psychological Contributions
to a Legislative Subcommittee on Organ and Tissue Transplants" by
Michael Saks (1978). However, perhaps most significant is the publication
Psychology and National Health Insurance: A Sourcebook by Kiesler, Cummings,
and VandenBos (1979). This last publication represents a substantial effort
by the recognized leadership of the American Psychological Association
and as such, undoubtedly will become the catalyst for numerous future
publications on this subject matter in our traditional literature. With this

type of "professional acceptance," we now may expect more members of
our profession to become personally involved in the political process. In
fact, during the time that this Handbook has been in press, a rather dramatic
explosion of policy articles has begun to appear in the psychological liter-
ature (DeLeon & VandenBos, 1980; DeLeon, O'Keefe, VandenBos, & Kraut,
1982; Dorken, 1981; Kiesler, 1982; Metsky, 1978). Further, the American Psy-
chologist has recently begun an entirely new section entitled "psychology
in the Public Forum" to actively encourage this new interest (Pallak, 1982).
A PRACTICAL EXAMPLE: WORKING THROUGH THE LEGISLATIVE

PROCESS
At this point, I would like to focus in some detail upon a particular

issue that an individual psychologist very well might feel should be
addressed through legislation. In describing the process by which this
hypothetical psychologist might seek legislative relief, I hope to be able to
provide a realistic appreciation for the intricacies of the legislative process.
Clearly not all bills will go through the exact stages described; nevertheless,
they are fairly typical, regardless of the specifics of the issues.
Let us assume, for example, that Dr. Jane Doe, a clinical psychologist,
has come to the conclusion that patients being served by the state admin-
istered Community Mental Health Centers are not assured of quality psy-
chological treatment, primarily because the Psychology Licensing Act spe-
cifically exempts state employees from its provisions. If there is any
justification at all for the enactment of a psychology licensing act, then
holding state employees to the same minimum educational and training
standards as those practitioners in the private sector would clearly seem to
be in the best interest of the citizens of the state. Thus, Dr. Doe might
assume that her state legislature would appreciate this apparent "oversight"
being brought to their collective attention. Unfortunately, however, she
would soon find out that this is far from the case. Instead of an enthusiastic
reception, she would in all likelihood receive a rather brief interview with
a hurried and apparently uninterested representative or his/her designated
staff member, who would end their mutually unsatisfactory meeting with
an unconvincing promise to "look into the matter" or to "study it further."
Dr. Doe would essentially be back at "go" with no real idea of where to
turn next.
Dr. Doe's initial mistake was to assume that the provision exempting
state employees was an "oversight." Actual "oversights" are rather rare.
Instead, what Dr. Doe identified was undoubtedly one of the many com-
promises that had been agreed to prior to the enactment of the Psychology
Licensing Act. The enactment of any legislation, by definition, limits some-
one's rights. In this case, the State Mental Health AuthOrity probably
objected to any perceived infringement on their right to hire whomever
they pleased. Rarely are bills enacted into public law merely because they
are theoretically a "good idea." Politicians pass bills 'because they want to.
This does not mean that Dr. Doe cannot, or should not, now attempt to
modify the Psychology Licensing Act in order to bring state employees
under its provisions. It instead means that she must go about accomplishing
her objective in a slightly different fashion.
What Dr. Doe should have done was first to build a natural constitu-
ency of concerned individuals and organizations who eventually would
stand firmly and publicly behind her proposal. Note that at this initial stage
Dr. Doe should not worry about how actually to draft a bill. Nor should she
deliberate on the specifics of the modifications to the Psychology Licensing
Act that she will eventually propose. These particulars will, of necessity,
evolve at a later date. If Dr. Doe commits herself to specifics during the
preliminary stages, she will only create additional points for argument. In
addition, she should be aware that especially in her early attempts to
develop public support, she will repeatedly come across apparently well
intending individuals, including her psychologist colleagues, who will
enumerate the myriad of reasons why her proposal cannot be enacted into
law. Although this will be disheartening, she should persevere. Any pro-
posed change in the scheme of things is unsettling and even frightening
for some people. Dr. Doe's therapeutic and clinical skills should help her
in aSSisting her natural allies to overcome their initial apprehension.
There typically will be three distinct types of groups that potentially
will be affected by her efforts to modify the Psychology Licensing Act. The
first, and perhaps the most obvious, will be those that will directly benefit
from the proposed changes; for example, patients (who may not be inclined
to be involved) or psychologists who seek to enhance the prestige of their
profession. The second will be those that perceive themselves to be
adversely affected; that is, governmental employees who cannot now meet
the present requirements set forth under the Licensing Act. The third, and
probably the most influential group, consists of those "tangential" organi-
zations such as the Mental Health Association or the League of Women Vot-
ers who admittedly will not directly benefit from the actual substance or
content of Dr. Doe's bill even if it becomes law. However, these organiza-
tions can benefit from the process of being involved with Dr. Doe and her
colleagues in the legislative effort. Organizations such as the League of
Women Voters command considerable respect. They earn this respect by
being vocal spokespersons for legislative issues such as Dr. Doe's that are
found to be in the best interests of the state's citizenry. In essence, individ-
uals such as Dr. Doe provide substantive expertise; the League of Women
Voters provides legislative credibility. To the extent to which Dr. Doe is
successful in getting these three categories of "special interest" groups to
publicly endorse her proposal, her prospects of eventual legislative success
will be significantly enhanced.
In deciding how to approach the various potentially supportive indi-
viduals and organizations, Dr. Doe should think through, in as specific
terms as possible, exactly what benefits each of them might receive from
their involvement with her proposal. She also should attempt to identify a
particular member of each organization, preferably an individual on its leg-
islative committee, who would be willing to make the organization's
endorsement of the proposal his or her personal goal. It may seem obvious
that it is more difficult for an organization to refuse to endorse formally a
proposal that one of its own members is enthusiastically championing;
however, this point is often overlooked. For the local psychological associ-
ation, Dr. Doe's proposal would mean a chance to develop its legislative
contacts and hopefully have a successful accomplishment to discuss in its
meetings and to write about in its newsletter. It also would help solidify its
professional status. Dr. Doe also should arrange to be appointed to the asso-
ciation's legislative committee in order to be in an appropriate position to
sheperd her own bill through the various stages. For the private practition-
ers, the proposal would provide an additional opportunity to put pressure
on the state Mental Health Authority to examine the extent to which it can
afford to provide direct services, rather than contract these out to the private
sector. To the university faculties, this could mean both an opportunity for
their graduate students to obtain practical experience in being "social
change agents" by working directly on a legislative proposal and a chance
to develop a potentially increased audience for any continuing education
courses that the Psychology Licensing Act eventually might require.
For those "tangential" groups such as the Mental Health Association,
the League of Women Voters, and the other professional societies, includ-
ing the local Nurses and Social Worker Associations, Dr. Doe's proposal
provides a concrete vehicle for increased collegial collaboration. By sup-
porting the efforts of the local psychological association, each of these other
groups will in turn be developing a potential prestigious ally for similar
public expressions of joint support on a matter of more germaine interest
to their own membership. But probably of even greater practical signifi-
cance is the simple fact that Dr. Doe's proposal will provide their legislative
committees with a socially meaningful proposal that they then can debate
internally and eventually support publicly. One never should underesti-
mate the extent to which individuals who get themselves appOinted to var-
ious legislative committees thoroughly enjoy discussing proposals, taking
positive stands, and then being able to report back their actions to their own
constituencies.
Although the development of active support for the proposal by these
groups is absolutely essential, by itself it is not sufficient. To be successful
eventually, Dr. Doe also must undertake direct negotiations with those
individuals who potentially will be adversely affected by the proposal.
There is nothing more devastating to a bill's ultimate chances than to have
those who it would directly effect suddenly proclaim in a loud and highly
emotional manner, during public hearings that it was being "snuck by
them," or "railroaded down their throats," or that its proponents never had
bothered even to discuss it with them. To treat any group in such a cavalier
manner would be an overt violation of one of the "unspoken ground rules"

of the legislative process. Thus, such a charge, unless successfully contra-
dicted, would in itself be sufficient to kill a bill for that legislative session.
It is, for example, extremely important that Dr. Doe and her supporters
take the time to initiate a dialogue with those psychologists who are pres-
ently in the state system. This initial meeting will reveal a greater range of
misconceptions and suspicions than Dr. Doe or her supporters have fore-
seen. Those who will be directly affected by the proposal not only will have
misinterpreted her personal intentions, but also will not have understood
either the actual status of her idea, nor even the present wording of the
Psychology Licensing Act. Hopefully, a frank and open discussion will
allow the participants to get beyond the emotional reactions that well may
reflect underlying feelings of "legislative impotence" of the state
employees.
As the discussion between Dr. Doe and the state psychologists contin-
ues, it also may become evident that for every state psychologist who has
serious reservations, there will be a significantly larger number of probably
younger psychologists, who will enthusiastically endorse the concept once
they clearly understand it. This then becomes the appropriate time for Dr.
Doe to initiate the process of developing the specifics of her legislative pro-
posal. For example, what are the compromises that would allow those who
would be most affected by the bill to actively support the proposal? Is a
"grandfathering clause" necessary? Or perhaps a commitment from the psy-
chological association that it would press to include language (Le., to make
explicit provisions) that would specifically authorize "comp-time," some
time off for those state employees who would have to take continuing edu-
cation courses? As one now may begin to appreciate, to the extent that Dr.
Doe had, prior to this time, actually committed herself to any particular pro-
posals, she now necessarily would be on the defensive. If instead she now
is able to persuade the state psychologists to propose their own legislative
recommendations, the likelihood of eventual success becomes far greater.
This process of developing a viable and visible constituency of "grass-
roots" support for a particular legislative proposal can be a very time-con-
suming and drawn out process. As a purely practical matter, it may be phys-
ically impossible to complete this process in time to have an appropriately
drafted bill introduced during a particular legislative session. The legisla-
tive process, however, goes on continuously and in one sense there never
is a beginning or an end to the sessions. As Dr. Doe will learn, there is no
way to speed the process up. Although it is actually quite simple to have a
bill introduced, the above evolution and resulting consensus must develop
first if that particular bill is to become public law.
Now at the same time that Dr. Doe is developing the necessary "grass-
roots" support for her proposal with organizations outside of the legislature,
she also should begin to consider what particular strategies might be most
effective within the legislative body. For example, which legislator should
she approach to have introduce the bill? Would it be conceivable to have
her particular proposal incorporated as a segment of a more comprehensive

package that a politically more powerful entity might be backing? Or, is it
possible that the state administration itself might be the initiating sponsor?
Each of these strategies has different payoffs, but often the selection of one
or the other depends almost entirely upon the interpersonal contacts that
Dr. Doe or her supporters may have developed.
Within the state administrative structure, there always will be an iden-
tifiable mechanism whereby the governor and his cabinet appointees are
able to shape the composition of the Administration's annual legislative
program. The more far-reaching and controversial proposals will be dis-
cussed in the newspapers and often become the subject of radio and tele-
vision commentaries. However, for every major headline-generating pro-
posal, there will be as many minor "housekeeping" measures that the press
do not feel merit public scrunity. Yet, it is these housekeeping bills that may
prove the perfect vehicle for Dr. Doe's proposal.
Administration bills typically are introduced either by a member of the
majority party leadership or by the relevant committee chairman. On the
state level, they even may be marked with a capital "A" and thereby receive
at least the tacit support of the Administration's top lobbyists. As discussed
earlier, when these bills are introduced, they become a "good faith" issue
for the highest level of elected leadership in both the Administration and
the legislative body. The "housekeeping" bills are introduced not for pub-
licity purposes, nor to elicit public discussion or further study, but instead,
simply to be enacted into public law. Unlike the typical legislative proposal
in which the onus is frequently on the bill's proponent to justify why the
particular bill should be enacted, for these bills the onus is instead on the
legislative body to justify any inaction on them. This is a very substantial
difference.
If Dr. Doe's proposal is to be sponsored by the Administration, the state
employed psychologists must sheperd it as their bill through the Adminis-
tration's channels. This process must be started long before the opening of
the legislative session. The vast majority of psychologists, like other citi-
zens, do not even think of the legislature until the press starts to report on
their deliberations. However, the decision as to which bills will comprise
the Administration's legislative package is made significantly before the
beginning of the legislative session in order that it may be introduced en
masse in the opening days.
An unspoken legislative "ground rule" will soon become evident: "It
is easier to block a proposal than to support one-especially if you don't
understand it." Self-proclaimed "gate-keepers of the public trust" suddenly
will seem to appear from everywhere, each with an apparent veto power:
personnel specialists, senior mental health practitioners of other disci-
plines, and most importantly, lower-level staff of the state Office of Man-
agement and Budget or the Department of Finance. Often these particular
individuals do not seem to feel that it is necessary nor even appropriate to
justify their opposition. Even more frustrating is their failure to return tele-
phone calls from other state employees. However, if the expressed and
active support of the chief of the Mental Health Authority can be obtained,
and he or she is personally willing to press for the particular proposal being
included as a part of the department's and thus the Administration's legis-
lative package, then many (but unfortunately not all) of these self-pro-
claimed "gate-keepers" will focus their attention on other proposals that
seem to have less overt support.
If Dr. Doe has done her homework well and created a general consen-
sus of "grass-roots" support among the state psychologists, the chief of the
Mental Health Authority undoubtedly will endorse the proposal, if for no
other reason than to keep his employees happy. Keep in mind, however,
that if one decides to use the administrative route, once the proposal
becomes an Administration bill, it no longer belongs to Dr. Doe or to the
state psychologists, it is the Administration's bill. Unless the spokesmen of
the Administration believe in its merit and are sufficiently educated as to
its value, it will be expendable and vulnerable. Additionally, since political
circles are small circles, especially within any given content area such as
"health" or "mental health," the proposal undoubtedly will come to the
attention of all those individuals or organizations who have any related
"vested interests." Thus, in asking the Administration to introduce such a
bill, one should never try to conceal any supporting or opposing data that
might be available, since such information probably will be made public by
one of these other individuals or organizations which in turn would lead
to a breach of trust that may never be repairable.
If Dr. Doe decides against the Administration route and concludes that
she wants to maintain more direct control over the proposal's evolution, she
then must choose a legislator whom she will ask to introduce her bill. In
the best of all possible worlds, Dr. Doe would be a close personal friend of
the chairman of the committee that has jurisdiction over her proposal.
The chairman would then introduce the bill.
Usuaily, however, she will be faced with an entirely different choice:
either polling members of the local psychological association to find out if
anyone knows a particular legislator well enough to ask him or her to intro-
duce the bill as a personal favor, or sending a subgroup of the psychological
association's legislative committee to meet with the chair of the relevant
legislative committee to request that he or she introduce the bill on their
behalf. In either case, the chance of immediate success, or even success the
first year the bill is introduced is remote. As I suggested earlier, most leg-
islators, primarily due to their lack of mental health expertise, do not feel
comfortable discussing mental health legislation and as a result take a very
cautious approach in pressing for its enactment.
Earlier, I referred to the legislative process as being analogous to psy-
chotherapy with dysfunctional families. Like a family therapy session, the
legislative process must be orchestrated on two distinct tracks. One is based
on interpersonal relationships, where as many favors as possible are done for
one's "friends" or "contacts." The other track emphasizes the content, or
subject matter expertise, that a given committee chairman and his staff have
developed in order to pursue some long-range objective. (For example, the
health committee might want to increase the level of accountability evident
in the health services that are being provided in its state. To accomplish
this, whenever possible, they will recommend the enactment of bills that
will bring the "present state of things" closer to their ultimate objective.)
In conducting family therapy, awareness of these two levels, relationship
messages and communicational content, is essential. Successful therapy
requires that the content of what is being expressed be congruent with the
underlying interpersonal process. (For example, the expressed anger is
being directed by the member who is in fact frustrated, and that it is at the
person that he or she is really concerned about.) Similarly, when a partic-
ular legislative proposal is consistent with the objectives of both of the
interpersonal and the content tracks,. then there is maximum likelihood of
passage. Either one alone is generally not sufficient.
As Dr. Doe becomes more sophisticated with the intricacies of the leg-
islative process, she will begin to appreciate the importance of each proce-
dural step. She will, for example, learn that typically there is considerable
value in the mere step of having her bill introduced (Le, formally placed
on the appropriate committee's legislative agenda) even if it is only by a
member of the minority party or ''by request" (Le., the legislator presents
it not as his own proposal but as a favor for someone else). Admittedly,
under the latter two conditions, there is not a very significant likelihood of
the bill's enactment into law immediately. Yet, the introduction of a legis-
lative bill in itself is a concrete symbol of success for its supporters. A gen-
erally unexpected consequence is that such a step often carries sufficient
import to convince others of the proposal's worth. Those within the profes-
sion who previously had "serious concerns," often become the strongest
backers of the proposal and in so dOing, they may make special contribu-
tions in tightening and clarifying the rationale behind the endeavor. True,
many of Dr. Doe's professional colleagues will naively assume that the bat-
tle is won, although as we realize, the work has only just begun.
There are a number of possible steps that Dr. Doe and her colleagues
might wish to take next. The actual bill could serve as a specific focus for
the legislative efforts of the entire psychological association's membership.
Individual members could arrange meetings with the elected officials from
their own districts and ask them to support the bill. If the specific procedure
exists whereby the politician can formally "cosponsor" the bill, such sup-
port can be requested. He or she also can be requested to enter a similar bill
in his or her own name or to write the committee chair expressing personal
support. The advantage of these more formal endorsements is that they
clearly demonstrate legislative "grass-roots" support for the measure, which
significantly enhances the likelihood of the committee's eventual favorable
action. Cosponsorship is especially helpful if the legislator actually is a
member of the committee that has jurisdiction over the bill. As I alluded to
earlier, however, one of the specific functions that every committee is sup-
posed to serve is to act as a "natural buffer" for the entire legislative body
for bills within its jurisdiction. Once the majority of a committee recom-
mends passage, there is not supposed to be any more than token opposition.
For this system to function smoothly, each committee must accept the
responsibility of ensuring the legislature as a whole that few of their indi-
vidual constituents will strenuously object to the passage of a particular bill.
Thus, if a cpmmittee member's decision to recommend enactment is made
lightly, this very basic and absolutely crucial sense of trust will be seriously
compromised. The cosponsorship of a committee member is quite difficult
to obtain, but it is very Significant. Committee members speak for more than
just themselves as individuals, they also speak for the entire legislature.
Once a bill is formally introduced, there is typically a highly institu-
tionalized process through which it eventually must proceed in order to
become law. Each of these steps is really quite distinct and has a very dif-
ferent objective. Dr. Doe and her supporters can have input into every one
of the steps and, with appropriate preparation, their contribution can be
extremely Significant.
The first major hurdle for the proposal is the scheduling of public hear-
ings on its merits. Although this sounds like a fairly routine matter, it is
probably the most difficult to achieve. Without such hearings, it is only
under extremely rare circumstances that the proposal will advance. On bills
that would significantly alter present policy, it often takes one or two leg-
islative sessions, over the course of several years, before hearings are sched-
uled. This reluctance to schedule the hearings is difficult for most psychol-
ogists to understand. During their professional careers, psychologists tend
to develop a decision-making style that emphasizes the systematic gather-
ing of comprehenSive data before making final decisions. Thus, the public
hearing process would intuitively seem a most reasonable procedure with
which to obtain the basic information needed to decide on the proposal's
overall merits. However, to a legislator, the mere fact of holding hearings
is in itself almost a commitment to act favorably upon the bill. It is not a
mere data gathering exercise. This substantial difference in orientation is
one most psychologists do not appreciate.
Hearings are scheduled because the chair of the legislative committee
with jurisdiction authorizes them to be scheduled-not because they nec-
essarily should be scheduled. The best way for this scheduling to occur is
for the chair to want to chair the hearings, or for a ranking member of the
committee specifically to request that they be scheduled. If the chair decides
to schedule hearings on Dr. Doe's proposal this will be a substantial com-
mitment of valuable time: time to prepare for the hearing, time to actually
sit in the room and listen to the witnesses, time to sort through and evaluate
the testimony that will be presented, and time for subsequent discussion
and votes. By definition, this is time that must be taken away from other
proposals that may have more merit or more overt support (e.g., the Admin-
istration's program, or those bills being pushed by major labor unions). The
agreement to schedule hearings is no small concession.
If the committee chair does decide to hold hearings, there are a number
of useful things that Dr. Doe and her supporters can do. First, they can pro-
vide the committee staff with a detailed, but very straightforward "briefing
memo" of what the proposal would accomplish, what it would cost, and the
various pros and cons. This memo should evolve from at least one informal
meeting with the committee staff with whom Dr. Doe discusses the pro-
posal's merits and answers questions. These questions will indicate the
extent to which psychology has an educational job to do. They may include,
"What is a psychologist?" "How much training does he or she possess?"
"How do psychologists differ from medical doctors?" "Does the state uni-
versity have a psychology program?" "Isn't it a part of the medical school?"
During sessions such as these, psychologists will become aware of the
extent to which a single introductory psychology course seems to be the
basis of a not-too-favorable image of their profession in the minds of these
staff members. The staff may be recently graduated, aggressive young attor-
neys, eager to display their interrogratory skills. In some fortunate situa-
tions, much of this tedious baseline educational process already will have
been done by, for example, previous psychology advocates or by students
placed as interns with the legislative committee. Such familiarity should
not be assumed, however, nor does it preclude the need for a detailed jus-
tification of the proposal.
The next task for Dr. Doe is to help the committee staff think through
which witnesses should be invited to testify. On the one hand, once the
hearing data is scheduled and publicly announced, the major "special inter-
est" groups such as the medical association and the insurance lobby will
become aware of the proposal and will decide on their own whether or not
they want to testify. However, many groups that might be interested in
working in a collegial relationship with the psychological association typ-
ically are not in the mainstream of this communicational flow and may not
be aware of the hearings unless they are specifically alerted. This is not due
to any conscious effort to keep anyone uninformed, but because, as a prac-
tical matter, some groups rely on volunteers to serve on their legislative
committees rather than hire professional lobbyists, and these volunteers
usually simply do not have sufficient contacts to obtain the information
required. Although the necessary information is readily available at no cost,
one has to understand the legislative system in order to learn where to look
for it.
Dr. Doe and her supporters should do the leg work themselves to
ensure that an appropriate cross section of their expected supporters request
to testify, write, and have available the reqUired 30 or so copies of their
formal written testimony, and then actually show up at the hearings and
wait their turn to be called as interested parties. On an issue such as this
one, it would be useful to have some experienced mental health center
chiefs testify in support, to have the state psychological association presi-
dent emphasize the proposal's similarity with the national American Psy-
chological Association's recommendations, and to have former state-

employed psychologists express their view that they should have been
licensed when they were in the state system. Similar testimony from pres-
ent state psychologists, speaking on their own as concerned citizens and not
in a formal capacity, should be included. Similar supportive testimony from
the other mental health care professional associations, such as the nurses
and social workers, and the support of consumer groups such as the Mental
Health Association would also be impressive.
In a very real sense, it is the quantity and wide range of supportive
testimony, rather than its particular quality, that Dr. Doe should emphasize.
(Especially on more complex bills, testimony of high technical quality is
definitely important; however, this information often can more readily be
provided through the "briefing memos" described earlier.) For every
speaker who is willing to take the time and to come in to testify, the com-
mittee chair automatically will assume that there are 10 to a 100 interested
others who support his or her position. Even on such a narrowly focused
bill as this one, it would be useful if Dr. Doe would take the time to discuss
its merits with those newspaper reporters who cover the "health beat"
or happen to attend the hearings. Even a small (positively written) news-
paper article describing the bill in the daily edition is worth countless
hours of intraprofessional debate and discussions as to its impact on elected
officials.
The actual legislative hearing typically is considerably different than
the t:.xpectations of most citizens. What occurs is a natural consequence of
the unique role that these hearings have in the legislative process. The
hearing is a forum for the legislators and witnesses to take a public posture
for their own political constituencies. If the issue is sufficiently controver-
sial to ensure that television cameras will be present, the hearing room may
be packed and the majority of the committee members present. If not, it is
likely that only the committee chair or his or her appointee will actually be
present for the entire hearing, with the other members of the committee
wandering in and out of the room from time to time. In addition, it is not
uncommon for the legislator chairing the session to be reading other mate-
rials, whispering, or laughing while a witness is testifying. Even the phys-
icallayout of the room is often such that the witness may be put in an intim-
idated position by the largeness of the table he or she sits at or the position
of the committee members on a slightly raised platform above him/her.
Further, a committee member with an opposing point of view may wander
in the room in the midst of a prepared testimony and simply interrupt the
witness rather abruptly and begin asking aggressive but tangential ques-
tions such as "Why should you be seeing patients without a doctor's super-
vision anyway?" Even under these rather emotionally adverse conditions,
one should constantly remember that almost everything that occurs during
the hearings is primarily for public posturing purposes. The real decisions
are made behind the scene, and the witness will survive more effectively if
he/she does not feel personally threatened by the experience with the com-
mittee. Obviously, Dr. Doe should make a specific effort to ensure that each
of her allies is as comfortable as possible throughout the process.
In testifying, each witness should be urged to have a personal goal and
to engage whatever legislator happens to be in the room in an intimate
person-to-person discussion about the issues being discussed. To the extent
to which one can get a legislator interested enough in your issue that he or
she actually will raise a question-not matter how insignificant it may
seem-one has succeeded. One tactic that is especially effective in this
regard is to begin one's testimony by thanking the chair for allowing you
to take some time from his or her busy schedule, indicate that you would
like to have your written testimony submitted into the formal hearing
record, and then request permission merely to highlight your testimony in
an effort to save the committee time. The chair almost always will give
approval and will appreciate your thoughtfulness in doing this. You can
then emphasize the highlights of your argument and present them in as
cogent a manner as possible, looking directly at the chair all the time rather
than reading from a prepared text. If one does decide to employ this tactic,
it is helpful if you have already rehearsed this "spontaneous" presentation.
Utilizing this type of format also allows you to maximum opportunity to
respond in a personal manner to any unexpected or emotional issues that
earlier witnesses may have brought up. One should not feel constrained by
the actual prepared text of one's own testimony but instead should be will-
ing to respond spontaneously to the situation as it exists at that time.
If Dr. Doe has been successful during her briefing session with the
committee staff, the chair would have before him or her a series of "sug-
gested questions" that he or she might ask-questions that Dr. Doe actually
wrote out herself. These questions will be phrased to place controversial
issues in such a light that they will be most favorable to Dr. Doe's cause.
For example, "Dr. Doe, do you mean to tell me that there are no quality
controls on our state psychologists and that those who cannot afford private
psychologists or psychiatrists possibly receive lower quality services merely
because these practitioners do not have to meet the continuing education
requirements that our committee passed last year? That's incredible!" To the
spokesman for organized medicine who very well might be expected to
oppose the bill, the chair might ask "Would you please explain to me why
it is that organized medicine feels that they should oppose another profes-
sion's efforts. to upgrade the quality of its own services? Is it not a fact that
a similar effort is right now being made within your own profession to have
the medical licensing act modified in exactly the same manner?"
These types of questions have several purposes. First, they serve to edu-
cate the committee chair about the subtleties involved in the proposal while
personally involving him or her in the debate. As a result, he or she will
be more likely to follow through on his or her own initiative during the
forthcoming "mark up" sessions. To the extent to which the chair feels that
there are subtleties that he or she does not understand, he or she naturally
will be quite hesitant to recommend favorable action to the committee. Fur-

ther, the chair's questions tend to set the parameters of acceptable debate
on this issue before the committee. For any given proposal, there are var-
ious ways that one can proceed; that is, what is its cost-effectiveness, are
there humanitarian reasons, how does it effect other professional groups?
The tone of the chair's questions will define which areas are open for con-
sideration and which are not. In a more subtle sense, to the extent that the
chair asks the type of detailed questions that imply he or she is "on top" of
the issue, committee members will tend to defer to his or her expertise,
even if he or she is only superficially knowledgeable.
Finally, if at all possible, Dr. Doe and her supporters should make a
special effort to present a united and unified front. Again, is is often con-
trary to the way that psychologists think. We like to argue and debate, to
layout all sides of an issue. If, however, the end result is that the committee
chair becomes confused and believes that no one really knows what they
want, you must expect that the legislator will say: "Friends, please get your
own act together first. Come back with a proposal that you all can agree
upon." To do otherwise would cause the chair to make numerous unnec-
essary enemies and violate a cardinal rule of politics: "Seek comprodtise
wherever possible." This requirement of at least superficial consensual
agreement among those whom the bill would effect relates directly back to
the earlier comment that Dr. Doe should not tie herself to any particular
proposal until she has begun to negotiate the specifics with the state psy-
chologists. For if the final proposal can be viewed as everyone's bill, no one
whom the chair feels should be supportive will oppose it overtly.
Within a week or so after the hearings are over, Dr. Doe and her sup-
porters should sit down with the committee staff to find out how the chair
now feels about the bill's prospects. Dr. Doe should not attempt to debate
whether or not the bill is "good," but instead should use this meeting to
discover whether the performance that she orchestrated at the public hear-
ings generated sufficient support in the staff and the chair so that they will
recommend the bill's "mark up" and subsequent passage by the full legis-
lative body. During this stage, as well as in the scheduling arrangements, a
professional lobbyist can be extremely helpful. A lobbyist's strength is not
in explaining the specific content of a proposal to a legislator or his staff,
but in offering insight about the interpersonal track that is so important in
politics. Most effective lobbyists have been around the legislature for a con~
siderable period of time and know the individual legislators on a first name
basis. In essence, they provide psychology with some of the interpersonal
"chits" that could only be accrued by countless hours of door-to-door cam-
paigning or attendance at campaign cocktail functions.
A number of states have now enacted comprehensive "sunshine" laws
that mandate that each legislative "mark up" session must be open to public
scrutiny. In a "mark up" session, the full committee or, if appropriate, a
particular subcommittee, meets and formally discusses a bill in detail. Each
individual provision is either accepted or rejected by the committee, often
by a formal vote. Under some legislative rules, absent committee members

may give their "proxy" to a colleague; under others, only those actually
present may cast votes. Lobbyists and interested observers are allowed to
be present during these sessions; however, the time for public input has
passed and the only discussion heard is that of the chairman and the various
committee members.
After viewing one of these sessions, it becomes obvious that although
the actual "mark up" session is public, there has already been prior informal
discussions among the committee members. It also becomes apparent that
for a relatively noncontroversial proposal such as Dr. Doe's, probably only
one or two of the committee members will have attended the hearings or
read through the printed testimonies. Thus, the recommendations of the
chair, or the bill's chief sponsor, are especially significant. Other members
ma~T have a few questions, but these are generally superficial in nature and
as long as the chief sponsor remains supportive, there will be no substantial
opposition. There may be some discussion as to a few specific provisions
(e.g., whether the terms of the grandfathering clause or the continuing edu-
cation comp-time provision should be modified) but unless anyone has any
strong objections, the actual proposal as drafted will be adopted and staff
will be left to work out the specific wording of the bill so that it reflects the
committee's intent.
Assuming that there is no difficulty in scheduling time for a floor vote,
the bill should come before the full legislature fairly soon after the favor-
able committee vote. Again, legislatures have varying procedures, but on a
minor bill such as Dr. Doe's there will be only minimal debate and no
amendments. The committee chair or the floor manager will discuss the bill
briefly and the "oversight" that it seeks to rectify. There will then be a fairly
one-sided vote in favor of its enactment. Dr. Doe's bill then will be formally
transmitted to the other legislative body where essentially the same process
must be repeated.
Having passed one house, it is generally easier for a bill to be consid-
ered by the other, especially if the committee chair lets it be known to his
or her counterpart that he or she expects prompt attention to the measure.
Under the rules of some legislatures, it is also possible to attach the measure
to a different bill that has already been passed by the other body, and allow
the conferees (Le., those members of the House and Senate that have been
selected by their colleagues to work out the specifics of any differences in
the versions that passed their respective elective bodies) to to decide
whether or not to recommend its enactment. This can result in a substantial
saving of time, but requires the agreement of both committee chairs. For
example, the Rural Health Clinic bill that became Public Law 95-210 during
one of its stages was actually Title II of H.R. 422, "Duty-Free Treatment of
Aircraft Engines Used As Temporary Replacements For Aircraft Engines
Being Repaired In The United States, And Other Matters." Once a measure
has passed both houses, it is then forwarded to the chief executive for his
signature. A veto is possible, but on a bill such as Dr. Doe's this would be
highly unusual.
Once Dr. Doe's proposal has become public law, the question of its
actual administration remains. For example, now that the state psycholo-
gists are included, or rather not expressly excluded from the provisions of
the Psychology Licensing Act, who is going to put pressure on the present
employees of the mental health centers to take the examination? Further,
as a purely practical matter, what is to happen if one of them fails the test?
These questions deal with the issue of how the law is to be implemented
and administered. Generally, these matters are resolved through detailed
implementing "rules and regulations" rather than actual legislative
language.
Implementing rules and regulations are promulgated by the appropri-
ate regulatory board in compliance with the state's administrative proce-
dure act. As a minimum, this requires public notice, opportunity for com-
ment, and formal publication. Once issued, the regulations have the force
of law but are modifiable through the same process of public notice, hear-
ing, and republication. Although the administrative regulatory agencies
generally are conscientious about fulfilling their responsibilities, a formal
inquiry by Dr. Doe and her supporters would probably facilitate the imple-
mentation of the law. In a proposal as straightforward as Dr. Doe's there
should not be any difficulty as the agency staff will be as objective and non-
arbitrary as possible. However, there can be incidental slips unless an inter-
ested party is concerned enough to inquire and raise appropriate questions.
If progress is not made after a reasonable period of time, Dr. Doe should
ask the state attorney general to intervene and ensure that the intent of the
state's laws are fulfilled. For psychology this would be a rare situation; how-
ever, if necessary, Dr. Doe should pursue this avenue. Laws enacted by the
legislature ultimately rely on the executive and judicial branches for their
implementation. One is not being hostile by asking for this implementa-
tion; one is merely insisting on one's rights.
Another job remains for Dr. Doe and her colleagues. It relates to the
all-important interpersonal track that was referred to previously. Politicians
exist to serve their constituents. Having enacted a bill at Dr. Doe's request,
it is only fitting that the committee chair or the bill's prime sponsor recieve
the recognition that he or she deserves and expects. To put it bluntly, what
good is it to do psychologists a favor if they don't realize what you have
done for them? Accordingly, Dr. Doe and her supporters should ensure that
their supportive legislator knows that they are appreciative of the assistance.
There are a number of possible to convey this all-important message
effectively; for example, the local psychology newsletter could carry a for-
mal letter of appreciation and photograph of the legislator shaking hands
with Dr. Doe. The association's executive committee could ensure that the
legislator receives a formal "certificate of appreciation" at the next annual
convention with appropriate press coverage. One way that would be espe-
cially meaningful to the legislator would be for Dr. Doe and her supporters
to arrange a "coffee hour" for him or her. They could have 40 or 50 of their
friends who are in the legislator's own electoral district meet at a centrally
located home with coffee and light refreshments being provided by the
host. The elected official could then be formally introduced, appropriately
complimented, and provided with a forum to address his or her constituents
for 15 to 20 minutes. Following this, he or she could answer questions, min-
gle with the crowd, and generally get to meet those in attendance on an
informal basis. Although this may sound very Simplistic, these are the indi-
vidual voters who keep him or her in office, and it is their favor that he or
she wants. By providing the official with the opportunity to meet them on
such a positive note, Dr. Doe now has done the legislator a favor in turn.
Favorable publicity and voter satisfaction are the basis of getting reelected.
In the United States it increasingly is individual voters, not political parties,
who keep elected officials in office.
If Dr. Doe and her friends wished to become even more involved in
the political process, there are numero~ activities appropriate for them as
concerned citizens. For example, as election time draws near, politicians
look for volunteers to assist in door-to-door canvasing, sign waving, con-
ducting telephone polls, and preparing pOSition papers. Raising campaign
funds for the legislator's reelection is always helpful. Often, the amount
actually raised is not as important as the fact that a number of constitutents
have contributed. Once a potential voter contributes even a dollar, he or
she is much more likely to vote for the candidate. When legislators have
public fund raisers, there is no question that they do want to raise funds.
More important is the appearance of raising money and of having a room
filled with people that look like they are enjoying themselves. All too often,
psychologists only make their presence known to their elected officials
when they have specific guild concerns that are not readily resolvable.
There are a host of societal issues upon which psychologists could have a
Significant impact. As concerned citizens and as members of a learned
profession, it behooves us to become involved in these nonguild issues, if
only to avoid the image of being solely concerned with self-serving matters.
If Dr. Doe looks out for her supportive legislator, he or she in turn will
look out for her interests. If the legislator does not make a policy of doing
this, he or she will not be reelected.
The particular bill that we focused upon in this chapter was generally
a noncontroversal one. Yet, as psychologists become more actively involvetl
in the political process, we will undoubtedly eventually seek to implement
some rather major and thus, by definition, highly controversial legislative
changes. The underlying process remains the same, only the stakes and the
concurrent emotional involvement increase proportionately. In this
regard, a number of our larger states have found it especially useful to
develop a systematic statewide "legislative network" through which their
state association legislative committees can be assured that every elected offi-
cial will receive direct communications from psychologists in his or her own
district whenever a statewide alert becomes necessary. But again, the basic
legislative process is the same, regardless of how large a state may be or
how complex an issue may appear at first glance.
CONCLUSIONS
Psychologists often do not understand the underlying concepts of the

political process. Often, they do not make any routine efforts to modify the
legislative process. They assume that it is better to remain quiet and wait
until they "really need help" rather than to "bother" their legislator. The
better policy, however, is to be constantly visible and provide their legis-
lators with a concrete opportunity to be of direct assistance. Abstract prom-
ises to help in the future are to no one's benefit, and especially not to the
legislator who knows how fickle politics can be. Psychologists must never
forget that the legislative process is essentially an interpersonal one in
which favors constantly are being done for those who ask. One must
become actively involved in the process to understand it truly and to
develop the interpersonal relationships that are required to successfully
enact a bill or block a destructive one. If psychologists merely sit and phi-
losophize, the legislative process will continue, but without their input.
With their participation, the prospects for both psychology and the mental
health of the citizenry will be enhanced.
Our profession must learn that bills are not enacted into public law
merely because they are "good ideas." Considerable time and effort must
be expended developing necessary constituency support, shepherding the
bill through the hearing and "mark up" steps, and encouraging reasonable
compromises. Even after a bill is signed into law, there are many steps that
still must be taken to ensure effective implementation. The legislative pro-
cess is an ongoing one. One's work is never done.
REFERENCES
American Psychological Association. Directory of the American Psychological Association (Rev.

ed.). Washington, D.C.: Author, 1981.
DeLeon, PH., & VandenBos, G. R. Psychotherapy reimbursement in federal programs: Polit-
ical factors. In G. R. VandenBos (Ed.), Psychotherapy: Practice, research, policy. Beverley
Hills: Sage, 1980.
Deleon, P. H., O'Keefe, A. M., VandenBos, G. R., & Kraut, A. G. How to influence public
policy: A blueprint for activism. American Psychologist, 1982, 37, 476-485.
Darken, H. Avenues to legislative success. American Psychologist, 1977, 32, 738-745.
DlJrken, H. Coming of age legislatively: In 21 steps. American Psychologist, 1981, 36, 165-173.
DlJrken, H., & Associates. The professional psychologist today: New developments in law, health
insurance, and health practice. San Francisco: Jossey-Bass, 1976.
Kiesler, C. A. Mental hospitals and alternative care: Noninstitutionalization as potential pub-
lic policy for mental patients. American Psychologist, 1982,37,349-360.
Kiesler, C. A., Cummings, N. A., & VandenBos, G. R. Psychology and national health insurance:
A sourcebook. Washington, D.C.: American Psychological Association, 1979.
McGinn, P. Psychologists and the legislative process. SPAA Newsletter, 1978, 9, 1-2.
Metsky, M. Getting our feet wet in national politics. Clinical Psychologist, 1978, 31, 10.
Pallak, M. Psychology in the public forum (Editorial), American Psychologist, 1982, 37, 475.
Saks, M. Social psychological contributions to a legislative subcommittee on organ and tissue
transplants. American Psychologist, 1978, 33, 680-690.
IX
APPENDIXES
APPENDIX A
Standards for Providers of

Psychological Services
The Standards that follow are the first revision tinue to develop new knowledge, improved
of the national Standards for Providers of methods, and additional modes of psychologi-
Psychological Services originally adopted by cal service. These Standards have been estab-
the American Psychological Association lished by organized psychology as a means of
(APA) on September 4, 1974. 1 [Note: Foot- self-regulation to protect the public interest.
notes 2-24 appear at the end of the Stan- While these revised Standards contain a
dards. See pp. 11-14.] The intent of these number of important changes, they differ from
Standards is to improve the quality, effective- the original Standards in two major respects:
ness, and accessibility of psychological ser-
vices to all who require them. 2 I. They uniformly specify the minimally
These Standards represent the attainment of a acceptable levels of quality assurance and
goal for which the Association has striven for performance that providers of those
over 20 years, namely, to codify a uniform set psychological services covered by the Stan-
of standards for psychological practice that dards must reach or exceed. Care has been
would serve the respective needs of users, taken to assure that each standard is clearly
providers, and third-party purchasers and stated, readily measurable, realistic, and im-
sanctioners of psychological services. In addi- plementable.
tion, the Association has established a standing 2. The revised Standards apply to a more
committee charged with keeping the Standards limited range of services than the original
responsive to the needs of these groups and with Standards. The present Standards have been
upgrading and extending them progressively as restricted to applications in "human ser-
the profession and science of psychology con- vices" with the goal offacilitating more ef-
fective human functioning. The kinds of
1 Members of the Task Force on Standards for psychological services covered by the pres-
Service Facilities that submitted the original Stan- ent Standards are those ordinarily involved in
dards in September 1974 were Milton L. Blum, Jac-
the practice of specialists in clinical, counsel-
queline C. Bouhoutsos, Jerry H. Clark, Harold A.
Edgerton, Marian D. Hall, Durand F. Jacobs (Chair, ing, industrial-organizational, and school
1972-1974), Floyd H. Martinez, John E. Muthard, psychology. However, it is important to note
Asher R. Pacht, William D. Pierce, Sue A. Warren, that these Standards cover psychological
and Alfred M. Wellner (Chair, 197~1971). Staff functions and not classes of practitioners.
liaisons from the AP A Office of Professional Affairs
Any persons representing themselves as
were John J. McMillan (I97~1971), Gottlieb C.
Simon (1971-1973), and Arthur Centor (1973- psychologists, when providing any of the
1974). covered psychological service functions at
623
624 ApPENDIX A
any time and in any setting, whether public the mentally ill." ordered by the U.S. District
or private, profit or nonprofit, are required to Court in Alabama (Wyatt v. Stickney, 1972). In
observe these standards of practice in order concert with other APA committees, the Task
to promote the best interests and welfare of Force also represented the Association in
the users of such services. It is to be under- national-level deliberations with govemmental
stood that fulfillment of the requirements to groups and insurance carriers that defmed the
meet these Standards shaH be judged by qualifications necessary for psychologists in-
peers in relation to the capabilities for evalua- volved in providing health services.
tion and the circumstances that prevail in the These interim outcomes in vo Ived infl uence
setting at the time the program or service is by the Association on actions by groups of
evaluated. nonpsychologists that directly affected the
manner in. which psychological services were
Standards covering other psychological ser- employed, particularly in health and rehabilita-
vice functions may be added from time to time tion settings. However, these measures did not
to those already listed. However, functions and relieve the Association from exercising its re-
activities related to the teaching of psychology, sponsibility to speak out directly and authorita-
the writing or editing of scholarly or scientific tivelyon what standards for psychological prac-
manuscripts, and the conduct of scientific re- tice should be throughout a broad range of
search do not fall within the purview of the human service settings. It was also the respon-
present Standards. sibility of the Association to determine how
psychologists would be held accountable
should their practice fail to meet quality stan-
dards.
Historical Background In September 1974, after more than 4 years
of study and broad consultations, the Task
Early in 1970, acting at the direction ofthe As- Force proposed a set of standards, which the
sociation's Council of Representatives, the Association's Council of Representatives a-
Board of Professional Affairs appointed a Task dopted and voted td publish in order to meet
Force composed of practicing psychologists urgent needs of the public and the profession.
with specialized knowledge in at least one of Members of Council had various reservations
every major class of human service facility and about the scope and wording of the Standards as
with experience relevant to the setting of stan- initially adopted. By establishing a continuing
dards. Its charge was to develop a set of stan- Committee on Standards, Council took the first
dards for psychological practice. S;)on thereaf- step in what would be an ongoing process of
ter, partial support for this activity was obtained review and revision.
through a grant from the National Institute of The task of collecting, analyzing, and syn-
Mental Health. 3 thesizing reactions to the original Standards fell
First, the Task Force established liaison with to two successive committees. They were
national groups already active in standard set- charged similarly to review and revise the Stan-
ting and accreditation. It was therefore able to dards and to suggest means to implement them,
influence the adoption of certain basic princi- including their acceptance by relevant gov-
ples and wording contained in standards for emmental and private accreditation groups.
psychological services published by the loint The dedicated wolk of the psychologists who
Commission on Accreditation of Hospitals served on both those committees is gratefully
(lCAH) Accreditation Council for Facilities acknowledged. Also recognized with thanks
for the MentaHy Retarded (1971) and by the are the several hundred comments received
Accreditation Council for Psychiatric Fa- from scores of interested persons representing
cilities (lCAH, 1972). It also contributed professional, academic, and scientific psychol-
substantially to the "constitutionally required ogy, consumer groups, administrators of fa-
minimum standards for adequate treatment of cilities, and others. This input from those di-
STANDARDS FOR PROVIDERS OF PSYCHOLOGICAL SERVICES 625
rectly affected by the original Standards pro- under the law for those receiving privately de-
vided the major stimulus and much of the con- livered psychological services. On the other
tent for the changes that appear in this revision. hand, those receiving privately delivered
psychological services currently lack many of
the safeguards that are available in gov-
ernmental settings; these include peer review,
Principles and Implications consultation, record review, and staff supervi-
of Standards sion.
5. While assuring the user of the psycholo-
A few basic principles have guided the de- gist's accountability for the nature and quality
velopment of these Standards: of services rendered, standards must not con-
I. There should be a single set of standards strain the psychologist from employing new
that governs psychological service functions methods or making flexible use of support per-
offered by psychologists, regardless of their sonnel in staffmg the delivery of services.
specialty, setting, or form of remuneration. All
psychologists in professional practice should be
guided by a uniform set of standards just as they The Standards here presented have broad
are guided by a common code of ethics. implications both for the public who use
2. Standards should clearly establish mini- psychological services and for providers of
mally acceptable levels of quality for covered such services:
psychological service functions, regardless of I. Standards provide a firmer basis for a
the character of the users, purchasers, or mutual understanding between provider and
sanctioners of such covered services. user and facilitate more effective evaluation of
3. All persons providing psychological ser- services provided and outcomes achieved.
vices shall meet minimally acceptable levels of 2. Standards are an important step toward
training and experience, which are consistent greater uniformity in legislative and regulatory
and appropriate with the functions they per- actions involving providers of psychological
form. However, final responsibility and ac- services, and Standards provide the basis for
countability for services provided must rest the development of accreditation procedures
with psychologists who have earned a doctoral for service facilities.
degree in a program that is primarily psycholog- 3. Standards give specific content to the pro-
ical at a regionally accredited university or profession's concept of ethical practice.
fessional school. Those providing psychologi- 4. Standards have significant impact on to-
cal services who have lesser (or other) levels of morrow's training models for both professional
training shall be supervised by a psychologist and support personnel in psychology.
with the above training. This level of qualifica- 5. Standards for the provision of psycholog-
tion is necessary to assure that the public re- ical services in human service facilities influ-
ceives services of high quality. ence what is considered acceptable structure,
4. There should be a uniform set of stan- budgeting, and staffing patterns in these
dards governing the quality of services to all facilities.
users of psychological services in both the pri- 6. Standards are living documents that re-
vate and public sectors. There is no justification quire continual review and revision.
for maintaining the double standard presently
embedded in most state legislation whereby
providers of private fee-based psychological The Standards .illuminate weaknesses in the
services are subject to statutory regulation, delivery of psychological services and point to
while those providing similar psychological their correction. Some settings are known to re-
services under governmental auspices are usu- quire additional and/or higher standards for
ally exempt from such regulations. This cir- specific areas of service delivery than those
cumstance tends to afford greater protection herein proposed. There is no intent to diminish
626 ApPENDIX A
the scope or quality of psychological services geographic component of a larger gov-

that exceed these Standards. ernmental, educational, correction, health,
Systematically applied, these Standards training, industrial, or commercial organiza-
serve to establish uniformly the minimally ac- tional unit. 9
ceptable levels of psychological services. They C. A psychologist providing professional
serve to establish a more effective and consis- services in a multioccupational selling is re-
tent basis for evaluating the performance of in- garded as a psychological service unit.
dividual service providers, and they serve to D. A psychological service unit also may be
guide the organizing of psychological service an individual or group of individuals in a pri-
units in human service settings. vate practice or a psychological consulting
firm.
User includes:
Definitions A. Direct users or recipients of psychologi-
cal services.
Providers of psychological services refers to B. Public and private institutions, facilities,
the following persons: or organizations receiving psychological ser-
A. Professional psychologists. 4 Profes- vices.
sional psychologists have a doctoral degree C. Third-party purchasers-those who pay
from a regionally accredited university or pro- for the delivery of services but who are not the
fessional school in a program that is primarily recipients of services.
psychological S and appropriate training and
experience in the area of service offered. 6 Sanctioners refers to those users and nonus-
B. All other persons who offer psychologi- ers who have a legitimate concern with the ac-
cal services under the supervision of a profes- cessibility, timeliness, efficacy, and standards
sional psychologist. of quality attending the provision of psycholog-
ical services. In addition to the users, sanction-
Psychological services refers to one or more ers may include members of the user's family,
of the following: 7 the court, the probation officer, the school ad-
A. Evaluation, diagnosis, and assessment ministrator, the employer, the union represen-
of the functioning of individuals and groups in a tative, the facility director, etc. Another class
variety of settings and activities. of sanctioners is represented by various gov-
B. Interventions to facilitate the functioning ernmental, peer review, and accreditation
of individuals and groups. Such interventions bodies concerned with the assurance of quality .
may include psychological counseling, psycho-
therapy, and process consultation.
C. Consultation relating to A and B above.
D. Program development services in the
Standard 1. Providers
areas of A, B, and C above."
E. Supervision of psychological services.
1.1 Each psychological service unit offering
psychological services shall hal'e ami/-
A psychological service unit is the functional
able at least one professional psychologist
unit through which psychological services are
and as many more professional psycholo-
provided:
gists as are necessary to assure the quality
A. A psychological service unit is a unit that
of services offered.
provides predominantly psychological services
and is composed of one or more professional
psychologists and supporting staff. INTERPRETATION: The intent of this Stan-
B. A psychological service unit may operate dard is that one or more providers of psycho log-
as a professional service or as a functional or ical services in any psychological service unit
shall meet the levels of training and experience porting personnel whose qualifications and
of the professional psychologist as specified in skills (e,g .. language, cultural and experiential
the preceding definitions}O background, race, and sex) are directly relevant
When a professional psychologist is not to the needs and characteristics of the users
available on a full-time basis, the facility shall served.
retain the services of one or more professional
psychologists on a regular part-time basis to 1.4 When functioning as part of an organi;:a-
supervise the psychological services provided. tiona I setting, professional psychologists
The psychologist(s) so retained shall have au- shall bring their background and skills to
thority and participate sufficiently to enable bear whenel'er appropriate upon the goals
him or her to assess the needs for services, re- of the organi;:ation by participating in the
view the content of services provided, and as- planning and'development of overall ser-
sume professional responsibility and account- l'ices. 11
ability for them.
INTERPRETATION: Professional psycholo-
1.2 Prol'iders of psychological services who gists shall participate in the maintenance of
do not meet the requirements for the pro- high professional standards by representation
fessional psychologist shall be supervised on committees concerned with service deliv-
by a professional psychologist who shall ery,
assume professional responsibility and ac- As appropriate to the setting, these activities
countabilityfor the services provided, The may include active participation, as voting and
lel'el and extent of supervision may I'al}' as office-holding members on the facility's ex-
from task to task so long as the supervising ecutive, planning, and evaluation boards and
psychologist retains a sufficiently close committees.
supervisol}' relationship to meet this stan-
dard, 1.5 Psychologists shall maintain current
1.3 Wherever a psychological service unit knowledge of scientific and professional
exists, a professional psychologist shall be developments that are directly related to
responsible for planning, directing, and the services they render.
reviewing the provision of psychological
sen'ices. INTERPRET ATION: Methods through which
knowledge of scientific and professional de-
INTERPRET ATlON: This psychologist shall velopment may be gained include, but are not
coordinate the activities of the psychological limited to, continuing education, attendance at
service unit with other professional, adminis- workshops, participation in staff development,
trative, and technical groups, both within and and reading scienti fic publications. 12
outside the facility. This psychologist, who The psychologist shall have ready access to
may be the director, chief, or coordinator of the reference material related to the provision of
psychological service unit, has related respon- psychological services.
sibilities including, but not limited to, recruit- Psychologists must be prepared to show evi-
ing qualified staff, directing training and re- dence periodically that they are staying abreast
search activities of the service, maintaining a of current knowledge and practices through
high level of professional and ethical practice, continuing education.
and assuring (hat staff members function only
within the areas of their competency. 1.6 Psychologisis shall limit their practice to
In order to facilitate the effectiveness of ser- their demonstrated areas of professional
vices by increasing the level of staff sensitivity competence.
and professional skills, the psychologist desig-
nated as director shall be responsible for par- INTERPRETATION: Psychological services
ticipating in the selection of the staff and sup- will be offered in accordance with the provid-
628 ApPENDIX A
er's areas of competence as defined by verifi- example, a psychological service unit serving a
able training and experience. When extending predominantly low-income, ethnic, or racial
services beyond the range of their usual prac- minority group should have a staffing pattern
tice, psychologists shall obtain pertinent train- and service program that is adapted to the lin-
ing or appropriate professional supervision. guistic, experiential, and attitudinal charac-
teristics of the users.
1.7 Psychologists who wish to change their
service specialty or to add an additional 2.1.2 A description of the organization of
area of applied specialization must meet the psychological service unit and
the same requirements with respect to sub- its lines of responsibility and ac-
ject matter and professional skills that countability for the delivery of
apply to doctoral training in the new spe- psychological services shall be
cialty.13 available in written form to staff of
the unit and to users and sanction-
.INTERPRETATION: Training of doctoral- ers upon request.
level psychologists to qualify them for change
in specialty will be under the auspices of ac- INTERPRETATION: The description should
credited university departments or professional include lines of responsibility, supervisory rela-
schools that offer the doctoral degree in that tionships, and the level and extent of account-
specialty. Such training should be individual- ability for each person who provides psycho-
ized, due credit being given for relevant logical services.
coursework or requirements that have previous-
ly been satisfied. Merely taking an internship or 2.1.3 A psychological service unit shall
acquiring experience in a practicum setting is include sufficient numbers of pro-
not considered adequate preparation for becom- fessional and support personnel to
ing a clinical, counseling, industrial-organiza- achieve its goals, objectives, and
tional, or school psychologist when prior train- purposes.
ing has not been in the relevant area. Fulfill-
ment of such an individualized training pro- INTERPRETATION: The workload and
gram is attested to by the award of a certificate diversity of psychological services required and
by the supervising department or professional the specific goals and objectives of the setting
school indicating the successful completion of will determine the numbers and qualifications
preparation in the particular specialty. of professional and support personnel in the
psychological service unit. Where shortages in
personnel exist so that psychological services
cannot be rendered in a professional manner,
the director of the psychological service unit
Standard 2. Programs shall initiate action to modify appropriately the
specific goals and objectives of the service.
2.1 Composition and organization of a
psychological service unit: 2.2 Policies:
2.1.1 The composition and programs ofa 2.2.1 When the psychological service unit
psychological service unit shall be is composed of more than one per-
responsive to the needs of the person wherein a supervisory relation-
sons or settings served. ship exists or is a component of a
larger organization, a written
INTERPRETATION: A psychological service statement of its objectives and scope
unit shall be so structured as to facilitate effec- of services shall be developed and
tive and economical delivery of services. For maintained.
INTERPRETATION: The psychological ser- icy statements relevant to standards

vice unit shall review its objectives and scope of for professional services issued by
services annually ·and revise them as necessary the Association.
to insure that the psycho logical services offered
are consistent with staff competencies and cur-
rent psychological knowledge and practice. INTERPRETATION: Providers of psycholog-
This statement should be distributed to staff ical services, users, and sanctioners may order
and, where appropriate, to users and sanction- copies of these documents from the American
ers upon request. Psychological Association.
2.2.2. All providers within a psychologi- 2.2.4 All providers within a psychologi-
cal service. unit shall support the cal service unit shall conform to rel-
legal and civil rights of the user. 14 evant statutes established by fed-
eral, state, and local governments.
INTERPRET ATlON: Providers of psycholog-
ical services shall safeguard the interests ofthe
user with regard to personal, legal, and civil INTE RPRET ATlON: All providers of psycho-
rights. They shall continually be sensitive to the logical services shall be familiar with appropri-
issue of confidentiality of information, the ate statutes regulating the practice of psycho-
short-term and long-term' impact of their deci- logy. They shall also be informed about agency
sions and recommendations, and other matters regUlations that have the force of law and that
pertaining to individual, legal, and civil rights. relate to the delivery of psychological services
Concerns regarding the safeguarding of in- (e.g., evaluation for disability retirement and
dividual rights of users include, but are not lim- special education placements). In addition, all
ited to, problems of self-incrimination in judi- providers shall be cognizant that federal agen-
cial proceedings, involuntary commitment to cies such as the Veterans Administration and
hospitals, protection of minors or legal incom- the Department of Health, Education, and
petents, discriminatory practices in employ- Welfare have policy statements regarding psy-
ment selection procedures, recommendations chological services. Providers of psychological
for special education provisions, information services shall be familiar with other statutes and
relative to adverse personnel actions in the regUlations, including those addressed to the
anned services, and the adjudication of domes- civii and legal rights of users (e.g., those prom-
tic relations disputes in divorce and custodial ulgated by the federal Equal Employment Op-
proceedings. Providers of psychological ser- portunity Commission) that are pertinent to
vices should take affirmative action by making their scope of practice.
themselves available for local committees, re- It shall be the responsibility of the American
view boards, and similar advisory groups estab- Psychological Association to publish periodi-
lished to safeguard the human, civil, and legal cally those federal policies, statutes, and regu-
rights of service users. lations relating to this section. The state
psychological associations are similarly urged
to publish and distribute periodically appropri-
2.2.3 All providers within a psychologi- ate state statutes and regulations.
cal service unit shall be familiar
with and adhere to the American
Psychological Association's Ethi- 2.2.5 All providers within a psycholog-
cal Standards of Psychologists, ical service unit shall, where ap-
Psychology as a Profession, Stan- propriate, inform themfelves
dards for Educational and Psycho- about and use the network of
logical Tests, and other official pol- human services in their com-
630 ApPENDIX A
munities in order to link users should be prepared to provide a statement of

with relevant services and re- procedural guidelines in either oral or written
sources. form that can be understood by users as well as
sanctioners. This statement may describe the
INTERPRETATION: [t is incumbent upon current methods, forms, procedures, and tech-
psychologists and supporting staff to be sensi- niques being used to achieve the objectives and
tive to the broader context of human needs. In goals for psychological services.
recognizing the matrix of personal and societal This statement shall be communicated to
problems, providers shall, where appropriate, staff and, when appropriate, to users and
make available information regarding human sanctioners. The psychological service unit
services such as legal aid societies, social ser- shall provide for the annual review of its proce-
vices, employment agencies, health resources, dures for the delivery of psychological ser-
and educational and recreational facilities. The vices.
provider of psychological services shall refer to
such community resources and, when indi- 2.3.2. Providers shall develop a plan
cated, actively intervene on behalf of the user. appropriate to the provider's
professional strategy ofpractice
2.2.6 In the delivery of psychological and to the problems presented by
services, the providers shall the user.
maintain a continuing coopera-
tive relationship with colleagues INTERPRETATION: Whenever appropriate
and co-workers whenever in the or mandated in the setting, this plan shall be in
best interest of the user. IS written form as a means of providing a basis for
establishing accountability, obtaining informed
INTERPRETATION: It shall be the responsi- consent, and providing a mechanism for sub-
bility of the psychologist to recognize the areas sequent peer review. Regardless of the type of
of special competence of other psychologists setting or users involved, it is desirable that a
and of other professionals for either consulta- plan be developed that describes the psycholog-
tion or referral purposes. Providers of psycho- ical services indicated and the manner in which
logical services shall make appropriate use of they will be provided. 16
other professional, technical, and adminis- A psychologist who provides services as one
trative resources whenever these serve the best member of a collaborative effort shall partici-
interests of the user, and shall establish and pate in the development and implementation of
maintain cooperative arrangements with such the overall service plan and provide for its
other resources as required to meet the needs of periodic review.
users.
2.3.3 There shall be a mutually accept-
2.3 Procedures: able understanding between the
provider and user or responsible
2.3.1 Where appropriate, each psy- agent regarding the delivery of
chological service unit shall be service.
guided by a set of procedural
guidelines for the delivery of INTERPRETATION: Varying service settings
psychological services. If ap- call for understandings differing in explicitness
propriate to the setting, these and formality. For instance, a psychologist
guidelines shall be in written providing services within a user organization
form. may operate within a broad framework of
understanding with this organization as a condi-
INTERPRETATION: Depending on the nature tion of employment. As another example, psy-
of the setting, and whenever feasible, providers chologists providing professional services to
individuals in clinical, counseling, or school stance, psychologists in hospital settings shall

settings require an open-ended agreement, inform their patients that psychological infor-
which specifies procedures and their known mation in a patient's clinical record may be
risks (if any), costs, and respective respon- available without the patient's written consent
sibilities of provider and user for achieving the to other members of the professional staff as-
agreed-upon objectives. sociated with the patient's treatment or rehabili-
tation. Similar limitations on confidentiality of
2.3.4 Accurate, current, and pertinent psychological information may be present in
documentation shall be made of certain school. industrial, or military settings,
essential psychological services or in instances where the user has waived confi-
provided. dentiality for purposes of third-party payment.
When the user intends to waive confidential-
INTERPRET ATlON: Records kept of psycho- ity, the psychologist should discuss the implica-
logical services may include, but not be limited tions of releasing psychological information,
to, identifying data, dates of services, types of and assist the user in limiting disclosure only to
services, and significant actions taken. Provid- information required by the present cir-
ers of psychological services shall insure that cumstance.
essential information concerning services ren- Raw psychological data (e.g., test protocols,
dered is appropriately recorded within a rea- therapy or interview notes, or questionnaire re-
sonable time of their completion. turns) in which a user is identified shall be re-
leased only with the written consent of the user
2.3.5 Providers of psychological ser- or legal representative and released only to a
vices shall establish a system to person recognized by the psychologist as com-
protect confidentiality of their petent to use the data.
records. 17 Any use made of psychological reports, rec-
ords, or data for research or training purposes
INTERPRETATION: Psychologists are re- shall be consistent with this Standard. Ad-
sponsible for maintaining the confidentiality of ditionally, providers of psychological services
information about users of services whether ob- shall comply with statutory confidentiality re-
tained by themselves or by those they super- quirements and those embodied in the Ameri-
vise. All persons supervised by psychologists, can Psychological Association's Ethical Stan-
including nonprofessional personnel and stu- dards of Psychologists (APA, 1977).
dents, who have access to records of psycholog- Providers of psychological services should
ical services shall be required to maintain this remain sensitive to both the benefits and the
confidentiality as a condition of employment. possible misuse of information regarding in-
The psychologist shall not release confiden- dividuals that is stored in large computerized
tial information, except with the written con- data banks. Providers should use their influence
sent of the user directly involved or his or her to ensure that such information is used in a so-
legal representative. Even after the consent has cially responsible manner.
been obtained for release, the psychologist
should clearly identify such information as con-
fidential to the recipient of the information .18 If Standard 3. Accountability
directed otherwise by statute or regulations
with the force oflaw or by court order, the psy- 3.1 Psychologists' professional activity shall
chologist shall seek a resolution to the contlict be primarily guided by the principle of
that is both ethically and legally feasible and promoting human welfare.
appropriate.
Users shall be informed in advance of any INTERPRETATION: Psychologists shall pro-
limits in the setting for maintenance of confi- vide services to users in a manner that is consid-
dentiality of psychological information. For in- erate, effective, and economical.
632 ApPENDIX A
Psychologists are responsible for making eliminate discriminatory practices instituted for
their services readily accessible to users in a self-serving purposes that are not in the interest
manner that facilitates the user's freedom of of the user (e.g., arbitrary requirements for re-
choice. ferral and supervision by another profession).
Psychologists shall be mindful of their ac- They shall be cognizant of their responsibilities
countability to the sanctioners of psychological for the development of the profession, partici-
services and to the general public, provided that pate where possible in the training and career
appropriate steps are taken to protect the confi- development of students and other providers,
dentiality of the service relationship. In the pur- participate as appropriate in the training of
suit of their professional activities they shall aid paraprofessionals, and integrate and supervise
in the conservation of human, material, and fi- their contributions within the structure estab-
nancial resources. lished for delivering psychological services.
The psychological service unit will not with- Where appropriate, they shall facilitate the de-
hold services to a potential client on the basis of velopment of, and participate in, professional
that user's race, color, religion, sex, age, orna- standards review mechanisms. 22
tionalorigin. Recognition is given, however, to Psychologists shall seek to work with other
the following considerations: The professional professionals in a cooperative manner for the
right of psychologists to limit their practice to a good of the user and the benefit of the general
specific category of user (e.g., children, ado- pUblic. Psychologists associated with multidis-
lescents, women); the right and responsibility ciplinary settings shall support the principle
of psychologists to withhold an assessment that members of each participating profession
procedure when not validly applicable; the right shall have equal rights and opportunities to
and responsibility of psychologists to withhold share all privileges and responsibilities of full
evaluative, psychotherapeutic, counseling, or membership in the human service facility, and
other services in specific instances where con- to administer service programs in their respec-
siderations of race, religion, color, sex, or any tive areas of competence.
other difference between psychologist and
client might impair the effectiveness of the rela- 3.3 There shall be periodic, systematic, and
tionship.19 effective evaluations of psychological
Psychologists who find that psychological services. 23
services are being provided in a manner that is
discriminatory or exploitative to users and/or INTERPRETATION: When the psychological
contrary to these Standards or to state or federal service unit is a component of a larger organiza-
statutes shall take appropriate corrective action, tion, regular assessment of progress in achiev-
which may include the refusal to provide ser- ing goals shall be provided in the service deliv-
vices. When conflicts of interest ari'se, the psy- ery plan, including consideration of the effec-
chologist shall be guided in the resolution of tiveness of psychological services relative to
differences by the principles set forth in the costs in terms of time, money, and the availa-
Ethical Standards of Psychologists of the bility of professional and support personnel.
American Psychological Association and by Evaluation of the efficiency and effective·
the Guidelines for Conditions of Employment ness of the psychological service delivery sys-
of Psychologists (1972).20 tem should be conducted internally and, when
possible, under independent auspices.
3.2 Psychologists shall pursue their activities It is highly desirable that there be a periodic
as members of an independent, autonom- reexamination of review mechanisms to ensure
ous profession. 21 that these attempts at public safeguards are ef-
fective and cost efficient and do not place un-
INTERPRETATION: Psychologists shall be necessary encumbrances on the provider or un-
aware of the implications of their activities for necessary additional expense to users or
the profession as a whole. They shall seek to sanctioners for services rendered.
3.4 Psychologists are accountable for all as- As providers of services, psychologists have
pects of the services they provide and the responsibility to be concerned with the envi-
shall be responsive to those concerned ronment of their service unit, especially as it
with these services. 24 affects the quality of service, but also as it im-
pinges on human functioning in the larger unit
INTERPRETATION: In recognizing their re- or organization when the service unit is in-
sponsibilities to users, sanctioners, third-party cluded in such a larger context. Physical ar-
purchasers, and other providers, wherever ap- rangements and organizational policies and
propriate and consistent with the user's legal procedures should be conducive to the human
rights and privileged communications, psy- dignity, self-respect, and optimal functioning
chologists shall make available information of users, and to the effective delivery of ser-
about, and opportunity to participate in, deci- vice. The atmosphere in which psychological
sions concerning such issues as initiation, ter- services are rendered should be appropriate to
mination, continuation, modification, and the service and to the users, whether in office,
evaluation of psychological services. Ad- clinic, school, or industrial organization.
ditional copies of these Standardsfor Providers
of Psychological Services can be ordered from
the American Psychological Association. NOTES
Depending upon the settings, accurate and
full information shall be made available to pro- 2 The footnotes appended to these Standards rep-
spective individual or organization users re- resent an attempt to provide a coherent context of
other policy statements of the Association regarding
garding the qualifications of providers, the na- professional practice. The Standards extend these
ture and extent of services offered, and, where previous policy statements where necessary to reflect
appropriate, fmancial and social costs. current concerns ofthe public and the profession.
Where appropriate, psychologists shall in-
3 NIMH Grant MH 21696.
form users of their payment policies and their
willingness to assist in obtaining reimburse- • For the purpose of transition, persons who met
ment. Those who accept reimbursement from a the following criteria on or before the date of adoption
third party should be acquainted with the ap- ofthe original Standards on September 4, 1974, shall
propriate statutes and regulations and should also be considered professional psychologists: (a) a
master's degree from a program primarily psycholog-
instruct their users on proper procedures for ical in content from a regionally accredited university
submitting claims and limits on confidentiality or professional school; (b) appropriate education,
of claims information, in accordance with per- training, and experience in the area of service offered;
tinent statutes. (c) a license or certificate in the state in which they
practice, conferred by a state board of psychological
examiners. or the endorsement of the state psycholog-
ical association through voluntary certifICation, or,
for practice in primary and secondary schools, a state
Standard 4. Environment department of education certificate as a school psy-
chologist provided that the certificate required at least
two graduate years.
4.1 Providers of psychological services shall
promote the development in the service 5 Minutes of the Board of Professional Affairs
setting ofa physical, organizational, and meeting, Washington, D.C., March S-9, 1974.
social environment that facilitates opti-
6 This definition is less restrictive than Recom-
mal human functioning. mendation40fthe APA (1967) policy statement set-
ting forth model state legislation affecting the prac-
INTERPRETATION: Federal, state, and local tice of psychology (hereinafter referred to as State
requirements for safety, health, and sanitation Guidelines), proposing one level for state license or
certificate and "requiring the doctoral degree from an
must be observed. Attention shall be given to accredited university or college in a program that is
the comfort and, where relevant, to the privacy primarily psychological, and no less than 2 years of
of providers and users. supervised experience, one of which is subsequent to
634 ApPENDIX A
the granting of the doctoral degree. This level should The application of said princ iples and methods
be designated by the title of 'psychologist' .. (p. includes but is not restricted to: diagnosis, preven-
1099). tion, and amelioration of adjustment problems
The 1972 APA "Guidelines for Conditions of and emotional and mental disorders of individuals
Employment of Psychologists" (hereinafter referred and groups; hypnosis; educational and vocational
to as CEP Guidelines) introduces slightly different counseling; personnel selection and management;
shadings of meaning in its section on "Standards for the evaluation and planning for effective work and
Entry into the Profession" as follows: learning situations; advertising and market re-
search; and the resolution of interpersonal and so-
Persons are properly identified as psychologists cial conflicts.
when they have completed the training and experi- Psychotherapy within the meaning of this act
ence recognized as necessary to perform functions means the use of learning, conditioning methods.
consistent with one of the several levels in a career and emotional reactions, in a professional relation-
in psychology. This training includes possession ship, to assist a person or persons to modify feel-
of a degree earned in a program primarily ings, attitudes, and behavior which are intellectu-
psychological in content. In the case of psycholog- ally. socially. or emotionally maladjustive or inef-
ical practice. it involves services for a fee. appro- fectual.
priate registration. certification. or licensing as The practice of psychology shall be as defined
provided by laws of the state in which the practices above. any existing statute in the state of _ _ __
will apply. (APA. 1972. p. 331) to the contrary notwithstanding. (APA, 1967, pp.
109S-I099)
In some situations. specialty designations and
standards may be relevant. The National Register of
Health Service Providers in Psychology. which • The relation of a psychological service unit to a
larger facility or institution is also addressed indi-
based its criteria on this standard. identifies qualified
psychologists in the health services field. rectly in the CEP Guidelines. which emphasize the
roles. responsibilities. and prerogatives of the psy-
chologist when he or she is employed by or provides
7 As noted in the opening section of these Stan- services for another agency. institution. or business.
dards. functions and activities of psychologists relat-
ing to the teaching of psychology. the writing or edit-
ing of scholarly or scientific manuscripts. and the 10 This Standard replaces earlier recommen-
conduct of scientific research do not fall within the dations in the 1967 State Guidelines concerning
purview of these Standards. exemption of psychologists from licensure. Recom-
mendations 8 and 9 of those Guidelines read as fol-
lows:
8 These definitions should be compared to the
State Guidelines. which include definitions of psy- 8. Persons employed as psychologists by ac-
chologist and the practice of psychology as follows: credited academic institutions. governmental
agencies. research laboratories. and business cor-
A person represents himself to be a psychologist porations should be exempted. provided such
when he holds himself out to the public by any title employees are performing those duties for which
or description of services incorporating the words they are employed by such organizations. and
"psychology." "psychological," "psycholo- within the confines of such organizations.
gist •.• andlor offers to render or renders services as 9. Persons employed as psychologists by ac-
defined below to individuals. groups. organiza- credited academic institutions. governmental
tions. or the public for a fee. monetary or other- agencies. research laboratories. and business cor-
wise.
porations consulting or offering their researc h find-
The practice of psychology within the meaning ings or providing scientific information to like or-
of this act is defined as rendering to individuals,
ganizations for a fee should be exempted. (APA.
groups or organizations, or the public any psycho-
1967. p. 1100)
logical service involving the application of princi-
ples. methods. and procedures of understanding, On the other hand. the 1967 State Guidelines spe-
predicting. and influencing behavior. such as the cifically denied exemptions under certain conditions.
principles pertaining to learning. perception. as noted in Recommendations 10 and II:
motivation, thinking, emotions. and interpersonal
relationships; the methods and procedures of inter-
viewing. counseling. and psychotherapy; of con- 10. Persons employed as psychologists who
structing. administering. and interpreting tests of offer or provide psychological services to the pub-
mental abilities. aptitudes. interests. attitudes. per- lic for a fee. over and above the salary that they
sonality characteristics. emotion. and motivation; receive for the performance of their regular duties.
and of assessing public opinion. should not be exempted.
II. Persons employed as psychologists by or- IS Support for this position is found in the section
ganizations that sell psychological services to the in Psychology as a Profession on relations with other
public should not be exempted. (APA, 1967, pp. professions:
1100(1101)
Professional persons have an obligation to know
The present APA policy, as reflected in this Stan- and take into account the traditions and practices of
dard, establishes a single code of practice for psy- other professional groups with whom they work
chologists providing covered services to users in any and to cooperate fully with members of such
setting. The present minimum requirement is that a groups with whom research, service, and other
psychologist providing any covered service must functions are shared. (APA, 1968, p. 5)
meet local statutory requirements for licensure or cer-
tification. See the section Principles and Implications '6 One example of a specific application of this
of the Standards for an elaboration of this position. principle is found in Guideline 2 in APA's (1973b)
"Guidelines for Psychologists Conducting Growth
Groups":
" A closely related principle is found in the AP A
(1972) CEP Guidelines:
The following information should be made avail-
able in writing [italics added] to all prospective partic-
It is the policy of APA that psychology as an
ipants:
independent profession is entitled to parity with
(a) An explicit statement of the purpose of the
other health and human service professions in in-
group;
stitutional practices and before the law. Psycholo-
(b) Types of techniques that may be employed;
gists in interdisciplinary settings such as colleges
(c) The education, training, and experience of the
and universities, medical schools, clinics, private
leader or leaders;
practice groups, and other agencies expect parity
(d) The fee and any additional expense that may
with other professions in such matters as academic
be incurred;
rank, board status, salaries, fringe benefits, fees,
(e) A statem~nt as to whether or not a follow-up
participation in administrative decisions, and all
service is included in the fee;
other conditions of employment, private contrac-
(f) Goals of the group experience and techniques
tual arrangements, and status before the law and
to he used;
legal institutions. (APA, 1972, p. 333)
(g) Amounts and kinds of responsibility to he as:
sumed by the leader and by the participants. For
12 See CEP Guidelines (section entitled "Career example, (i) the degree to which a participant is free
Development") for a closely related statement: not to follow suggestions and prescr;ptions of the
group leader and other group memhers; (ii) any re-
Psychologists are expected to encourage institu- strictions on a participant's freedom to leave the
tions and agencies which employ them to sponsor group at any time; and.
or conduct career development programs. The (h) Issues of confidentiality. (p. 933)
purpose of these programs would be to enable psy-
chologists to engage in study for professional ad- 17 See again Principle 5 (Confidentiality) in Ethi-
vancement and to keep abreast of developments in cal Standards of Psychologists (APA, 1977).
their field. (APA, 1972, p. 332)
18 Support for the principle of privileged com-
I' This Standard follows closely the statement re- munication is found in at least two policy statements
of the Association:
garding "Policy on Training for Psychologists Wish-
ing to Change Their Specialty" adopted by the APA
In the interest of both the public and the client
Council of Representatives in January 1976. In-
and in accordance with the requirements of good
cluded therein was the implementing provision that
professional practice. the profession of psychology
"this policy statement shall be incorporated in the
seeks recognition of the privileged nature of confi-
guidelines of the Committee on Accreditation so that
dential communications with clients. preferably
appropriate sanctions can be brought to bear on uni-
through statutory enactment or by administrative
versity and internship training programs which vio-
policy where more appropriate. (APA, 1968. p. 8)
late [it]."
25. Wherever possible, a clause protecting the
14 See also APA's (1977) Ethical Standards of privileged nature of the psychologist-client rela-
Psychologists. especially Principles 5 (Confidential- tionship be included.
ity), 6 (Welfare of the Consumer), and 9 (Pursuit of 26. When appropriate, psychologists assist in
Research Activities); and see Ethical Principles in obtaining general "across the board" legislation
the Conduct of Research with Human Participants fo"uch privileged communications. (APA, 1967,
(APA.1973a). p. 1103)
636 ApPENDIX A
19 This paragraph is drawn directly from the CEP Z3 This Standard on program evaluation is based
Guidelines (APA,.1972, p. 333). directly on the following excerpts of two APA posi-
tion papers:
20 "It is recognized that under certain cir-
cumstances, the interests and goals of a particular The quality and availability of health services
community or segment of interest in the population should be evaluated continuously by hoth consum-
may be in conflict with the general welfare. Under ers and health professionals. Research into the ef-
such circumstances, the psychologist's professional ftciency and effectiveness of the system should be
activity must be primarily guided by the principle of conducted both internally and under independent
promoting human welfare." (APA, 1972, p. 334) auspices. (APA, 1971, p. 1025)
21 Support for the principle ofthe independence of The comprehensive community mental health
psychology as a professinn is found in the following: center should devote an explicit portion of its
budget to program evaluation. All centers should
As a member of a~ autonomous profession, a inculcate in their staff attention to and respect for
psychologist rejects limitations upon his freedom research findings; the larger centers have an obliga-
of thought and action other than those imposed by tion to set a high priority on basic research and to
his moral, legal, and social responsibilities. The give formal recognition to research as a legitimate
Association is always prepared to provide appro- part of the duties of staff members.
priate assistance to any responsible member who . . . Only through explicit appraisal of program
becomes subjected to unreasonable limitations effects can worthy approaches be retained and re-
upon his opportunity to function as a practitioner, fined, ineffective ones dropped. Evaluative
teacher , researcher, administrator, or consultant. monitoring of program achievements may vary, of
The Association is always prepared to cooperate course, from the relatively informal to the system-
with any responsible professional organization in atic and quantitative, depending on the importance
opposing any unreasonable limitations on the proof the issue, the availability of resources, and the
fessional functions of the members of that organi- willingness of those responsible to take the risks of
zation. substituting informed judgment for evidence.
This insistence upon professional autonomy has (Smith & Hobbs, 1966, pp. 21-22)
been upheld over the years by the afftrmative ac-
tions of the courts and other public and private 24 See also the CEP Guidelines for the following
bodies in support of the right of the psycho- statement: • A psychologist recognizes that . . . he
logist-and other professionals-to pursue those alone is accountable for the consequences and effects
functions for which he is trained and qualified to of his services, whether as teacher, researcher, or
perform. (APA, 1968, p. 9) practitioner. This responsibility cannot be shared,
delegated, or reduced" (APA, 1972, p. 334).
Organized psychology has the responsibility to
define and develop its own profession, consistent
with the general canons of science and with the
public welfare.
Psychologists recognize that other professions REFERENCES
and other groups will, from time to time, seek to
define the roles and responsibilities of psycholo- Accreditation Council for Facilities for the Mentally
gists. The APA opposes such developments on the Retarded. Standards for residential facilities for
same principles that it is opposed to the psycholog- the mentally retarded. Chicago, 111.: Joint Com-
ical profession taking positions which would de- mission on Accreditation of Hospitals, 1971.
fine the work and scope of responsibility of other American Psychological Association, Committee on
duly recognized professions. . . . (AP A, 1972, Legislation. A model for state legislation affecting
p.333) the practice of psychology 1967. American Psy-
chologist, 1967,22, 1095-1103.
22 AP A support for peer review is detailed in the American Psychological Association. Psychology as
following excerpt from the APA (1971) statement en- a profession. Washington, D.C.: Author, 1968.
titled "Psychology and National Health Care": American Psychological Association. Psychology
and national health care. American Psychologist,
All professions participating in a national health 1971,26,1025-1026.
plan should be directed to establish review American Psychological Association. Guidelines for
mechanisms (or performance evaluations) that in- conditions of employment of psychologists.
clude not only peer review but active participation American Psychologist, 1972.27, 331-334.
by persons representing the consumer. In situa- American Psychological Association. Ethical prin-
tions where there are fiscal agents, they should also ciples in the conduct of research with human par-
have representation when appropriate. (p. 1026) ticipants. Washington. D.C.: Author, 1973. (a)
American Psychological Association. Guidelines for Joint Commission on Accreditation of Hospitals.

psychologists conducting growth groups. Ameri- Accreditation manual for psychiatric facilities
can Psychologist. 1973.28. 933. (b) 1972. Chicago. III.: Author, 1972.
American Psychological Association. Standards for Smith, M. B., & Hobbs, N. The community and the
educational and psychological tests. Washington, community mental health center. Washington,
D.C.: Author. 1974. D.C.: American Psychological Association.
American Psychological Assoc~tion. Ethical stan- 1966.
dards of psychologists (Rev. ed.). Washington,
D.C.: Author, 1977.
APPENDIXB
Specialty Guidelines
for the Delivery of Services
COMMITIEE ON PROFESSIONAL STANDARDS
In September 1976, the APA Council of Representatives reviewed and commented

on the draft revisions of the Standards for Providers of Psychologtcal Services
prepared by the Committee on Standards for Providers of Psychological Services.
During that discussion, the Council acknowledged the need for standards in certain
specialty areas in addition to the generic Standards covered by the draft revision.
The Council authorized the committee to hold additional meetings to develop mul-
tiple standards in all specialty areas of psychology.
Following the adoption of the revised generic Standards in January 1977, the
committee, working with psychologists in the four recognized specialty areas of
psychology, spent the next three years revising the generic Standards to meet the
needs of clinical, counseling, industrial/organizational, and school psychologists. The
four documents produced by the committee went through extensive revisions. Con-
vention programs discussing these developments were held every year. Comments
were solicited from all major constituencies in psychology and from thousands of
individuals. The comments received and reviewed by the committee also numbered
in the thousands.
In January 1980, following this extensive process, the Council of Representatives
adopted the four documents (Specialty Guidelines for the Delivery of Services by
Clinical [Counseling, Industrial/Organizational, School] Psychologists) as APA policy
after making several modifications. As adopted by the Council of Representatives,
the intent of these Specialty Guidelines is "to educate the public, the profession,
and other interested parties regarding specialty professional practices . . . and to
facilitate the continued systematic development of the profession."
At the same meeting, the Council also approved a reorganization of the Board
of Professional Affairs' committee structure, which included the establishment of
the Committee on Professional Standards' to succeed the Committee on Standards
for Providers of Psychological Services. As directed by the Council at that meeting,
the Committee on Professional Standards is requesting comments on these Specialty
Guidelines. It is the responsibility of this committee to review all feedh;lck received
as it considers each set of Guidelines for revisions. The committee expects to submit
its proposed revisions of the Specialty Guidelines to the Council of Representatives
for approval in a timely manner. APA members and other interested individuals
or groups with comments or suggestions are requested to send them by October I,
1981, to the American Psychological Association, Committee on Professional Stan-
dards, 1200 Seventeenth Street, N.W., Washington, D.C. 20036.
I The current members of the Committee on Professional Standards are Murphy Thomas (Chair),
Juanita Braddock, Lorraine Eyde, Morris Goodman, Judy Han, John H. Jackson, and Milton Schwebel.
APA staff liaisons are Sharon A. Shueman and Pam Arnold.
The following persons also served on the committee during the time the Specialty Guidelines were
being revised, Gilfred Tanabe (1980 Chair), Dave Mills (Partial 1981 Chair), Nadine Lambert, and Joy
Burke (APA staff liaison).
639
640 ApPENDIXB
Specialty Guidelines for the Delivery

of Services by Clinical Psychologists
The Specialty GUidelines that follow are based on the ment of the conditions. credentials. and experience that
generic Standa,d. for Provide,. of Psych%g/cIJ/ Ser- contribute to competent professional practice. The APA
vices originally adopted by the American Psychological strongly encourages. and plans to participate in. efforts
Association (APA) in September 1974 and ""vised in Jan- to identify professional practitioner behaviors and job
uary 1977 (APA. 1974b. 1977b). Together with the ge- functions and to validate the relation between these and
neric Standard.. these Specialty Guidelines state the of- desired client outcomes. Thus. future revisions of these
ficial policy of the Association regarding delivery of Guidelines will increasingly retlect the results of such
serviceS by clinical psychologists. Admission to the prac- efforts.
tice of psychology is regulated by state statute. It is the These Guidelines follow the format and. wherever
position of the Association that licensing be based on applicable. the wording of the generic Standa,d..' (Note:
generic. and not on specialty. qualifications. Specialty Footnotes appear at the end of the Specialty Guidelines.
gUidelines serve the additional purpose of providing p0- See pp. 648-651.) The intent of these Guidelines is to
tential users and other interested groups with essential improve the quality. effectiveness. and accessibility of
information about particular services available from the psychological services. They are meant to provide guid-
several specialties in professional psycbology. ance to proViders. users. and sanctioners regarding the
Professional psychology specialties have evolved from best judgment of the profession on these matters. Al-
generic practice in psychology and are supported by tbough the Specialty Guidelines have been derived from
university training programs. There are now at least four and are consistent with the generic Standa,d.. they may
recognized professional specialties---c1inical. counseling. be used as separate documents. However. Standard. for
school. and industrial/organizational psychology. p,ooiders of P.ycholog/cIJ/ Service. (APA. 1977b) shall
The knowledge base in each of these specialty areas remain the basic policy statement and shall take pre-
has increased. refining the state of the art to the point cedence where there are questions of Interpretation.
that a set of uniform specialty gUidelines is now possible Professional psychology In general and clinical psy-
and desirable. The present Guidelines are intended to chology as a specialty have labored long and diligently
educate the public. the profession. and other interested to codify a uniform set of gnidelines for the delivery of
parties regarding specialty professional practices. They services by clinical psychologists that would serve the
are also intended to facilitate the continued systematic respective needs of users. providers. third-party pur-
development of the profession. chasers. and ..nctioners of psychological services.
The content of each Specialty Guideline reBects a con- The Committee on Professional Standards. established
sensw of university faculty and public and private prac- by the APA In January 1980. is charged with keeping
titioners regarding the knowledge base. services pro- the generic Standa,d. and the Specialty Guidelines re-
vided. problems addressed. and clients served. sponsive to the needs of the public and the profession.
Traditionally. all learned disciplines have treated the It is also charged with continually reviewing, modifying,
designation of specialty practice as a reBection of prep- and extending them progressively as the profession and
aration in greater depth in a particular subject matter. the science of psychology develop new knowledge. im-
together with a voluntary limiting of focus to a more proved methods. and additional modes of psychological
restricted area of practice by the professional. Lack of services.
specialty designation does not preclude general providers
The Specialty Guidelines for the Delivery of Services
of psychological services from wing the methods or deal-
by Clinical Psychologists that follow have been estab-
Ing with the populations of any specialty. except insofar
lished by the APA as a means of self-regulation to protect
as psychologists voluntarily refrain from providing ser-
the public interest. They guide the specialty practice of
vices they are not trained to render. It is the intent of
these Guidelines. however. that after the grandparenting
period. psychologists not put themselves forward as spe-
These Specialty Guidelines were prepared through the coop-
cIa/IBI. in a given area of practice unless they meet the erative eflortsof the APA Committee on Standards for Providers
qualifications noted in the Guidelines (see Mnitions). of Psychological Services (COSPOPS) and many professional
Therefore. these Guidelines are meant to apply only to clinical psychologists from the division. of APA. Including thooe
those psychologists who voluntarily wish to be designated involved in education and Iraining programs and in public and
private practice. Jules Barron, succeeded by Morris Goodman,
as clln/c4/ psychologist.. They do not apply to other
served as the clinical psychology representative on COSPOPS.
psychologists. The committee was chaired by Durand F. Jacobs; the Central
These Guidelines represent the profession's best judg- Of6ce liaisons were Arthur Centor and Richard Kilburg.
SPECIALTY GUIDELINES FOR THE DELIVERY OF SERVICES 641
clinical psychology by specifying important areas of 8. These Guidelines, while assuring the user of the
quality assurance and performance that contribute to the clinical psychologist's accountability for the nature and
goal of facilitating more effective human functioning. quality of services speciSed in this document, do not
preclude the clinical psychologist from using new meth-
ods or developing innovative procedures in the delivery
Princlple. and Implications of the Spectattl/ of clinical services.
Gvlclellnes
These Specialty Guidelines have broad implications
These Specialty Guidelines have emerged from and re- both for usen of clinical psychological services and for
affirm the same basic principles that guided the devel- providers of such services:
opment of the generic Standards for proo/den of Psy- 1. Guidelines for clinical psychological services pro-
chological Seroice. (APA, 1977b): vide a foundation for mutual understanding between
1. These Guidelines recognize that admission to the provider and user and facilitate more effective evalua-
practice of psychology is regulated by state statute. tion of services provided and outcomes achieved.
2. It is the intention of the APA that the generic Stan- 2. Guidelines for clinical psychologists are essential for
dartJa provide appropriate guidelines for statutory licens- uniformity in specialty credentialing of clinical psy-
ing of psychologists. In addition, although it is the p0- chologists.
sition of the APA that licensing he generic and not in 3. Guidelines give speciSc content to the professioo's
specialty areas, these Specialty Guidelines in clinical psy- concept of ethical practice as it applies to the functions
chology provide an authoritative reference for use in of clinical psychologists.
credentialing specialty providen of clinical psychological 4. Guidelines for cliuical psychological services may
services by such groups as divisions of the APA and state have signiScant impact on tomorrow's education aod
associations and by boards and agencies that Snd such training models for both professional and support per-
criteria useful for quality assurance. sonnel in clinical psychology.
3. A uniform set of Specialty Guidelines governs the 5. Guidelines for the provision of clinical psycholog-
quality of services to all usen of clinical psychological ical services in human service facilities inluence the
services in both the private and the puhlic seeton. Those determination of acceptable structure, budgeting. and
receiving clinical psychological services are protected by stafSng patterns in these facilities.
the same kinds of safeguards, irrespective of sector; these 6. Guidelines for clinical psychological services re-
include constitutional guarantees. statutory regulation, quire continual review and revision.
peer review, consultation, record review, and supervi-
sion. The Specialty Guidelines here presented are Intended
4. A uniform set of Specialty Guidelines governs clin- to improve the quality and delivery of clinical psycho-
ical psychological service functions offered by clinical logical services by specifying criteria for key aspects of
psychologists, regardless of setting or form of remuner- the practice setting. Some settings may require additional
ation. All clinical psychologists in professional practice andlor more stringent criteria for speciSc areas of service
recognize and are responsive to a uniform set of Specialty delivery.
Guidelines, just as they are guided hy a common code Systematically applied, these Guidelines serve to es-
of ethics. tablish a more effective and consistent basis for evalu-
5. Clinical psychology Guidelines establish clearly ar- ating the performance of individual service providen as
ticulated levels of quality for covered clinical psycho- well as to guide the organization of clinical psychological
logical service functions, regardless of the nature of the service units in human service settings.
usen, purchasen, or sanctionen of such covered services.
6. All penons providing clinical psychological services
meet specified levels of training and ex.perience that are Definition.
consistent with, and appropriate to, the functions they
perform. Clinical psychological services provided by per- ProokJeto. of c/lnfc<l/ psycho/op;c/ .eroIce.
refen to two
sons who do not meet the APA qualiScations for a profes- categories of persons who provide clinical psychological
sional clinical psychologist (see De&nitions) are super- services:
vised by a professional clinical psychologist. Final A. Professional clinical psychologists.' Professional
responsibility and accountability for services provide!! clinical psychologists have a doctoral degree from a re-
rest with professional clinical psychologists. gionally accredited university or professional school pro-
7. When providing any of the covered clinical psy- viding an organized, sequential clinical psychology pro-
chological service functions at any time and in any set- gram in a department of psychology in a university or
ting. whether public or private, proSt or nonproSt, clin- college, or in an appropriate department or unit of a
ical psychologists observe these Guidelines in order to professional school. Clinical psychology programs that
promote the best interests and welfare of the usen of are accredited by the American Psychological Associa-
such services. The extent to which clinical psychologists tion are recognized as meeting the deSnition of a clinical
observe these Guidelines is judged by peen. psychology program. Clinical psychology programs that
642 ApPENDIXB
are not accredited by the American Psychological As- B. Interventions directed at identifying and correct-
sociation meet .the definition of a clinical psychology ing the emotional conBicts, personality disturbances, and
program if they satisfy the following criteria: skill deficits underlying a person's distress and/or dys-
1. The program is primarily psychological in nature function. Interventions may reBect a variety of theoret-
and stands as a recognizable, coherent organizational ical orientations, techniques, and modalities. These may
entity within the institution. include, but are not limited to, psychotherapy, psych<>-
2. The program provides an integrated, organized analysis, behavior therapy, marital and family therapy,
sequence of study. group psychotherapy, hypnotherapy, social-learning ap-
3. The program has an identifiable body of students proaches, biofeedback techniques, and environmental
who are matriculated in that program for a degree. consultation and design.
4. There is a clear authority with primary respon- C. Professional consultation in relation to A and B
sibility for the core and specialty areas, whether or not above.
the program cuts across administrative lines. D. Program development services in the areas of A,
5. There is an identifiable psychology faculty, and B, and C ahove.
a psychologist is responsible for the program. E. Supervision of clinical psychological services.
In addition to a doctoral education, clinical psychol- F. Evaluation of all services noted in A through E
ogists acquire doctoral and postdoctoral training. Pat- above.
terns of education and training in clinical psychology'
are consistent with the functions to he performed and
the services to he provided, in accordance with the ages, A clinical rnychological service unit is the functional
populations, and problems encountered in various set- unit through which clinical psychological services are
tings. provided; such a unit may be part of a larger psych<>-
B. All other persons who are not professional clinical logical service organization comprising psychologists of
psychologists and who participate in the delivery of clin- more than one specialty and headed by a professional
ical psychological services under the supervision of a psychologist:
professional clinical psychologist. Although there may he A. A clinical psychological service unit provides pre-
variations in the titles of such persons, they are not re- dominantly clinical psychological services and is com-
ferred to as clinical psychologists. Their functions may posed of one or more professional clinical psychologists
be indicated by use of the adjective rnychological pre- and supporting staff.
ceding the noun, for example, rnychological4BsocIale, B. A clinical psychological service unit may operate
rnychological4Bsislanl, rnych%gicallechn/c1an, or rny- as a professional service or as a functional or geographic
chologica/ aide. Their services are rendered under the component of a larger multipsychological service unit
supervision of a professional clinical psychologist, who or of a governmental, educational, correctional, health,
is responsible for the designation given them and for training, industrial, or commercial organizational unit."
quality control. To he assigned such a designation, a C. One or more clinical psychologists providing
person has the background, training, or experience that professional services in a multidisciplinary setting con-
is appropriate to the functions performed. stitute a clinical psychological service unit.
D. A clinical psychological service unit may also be
one or more clinical psychologists in a private practice
Clinical P8l/Choiog/cQl 8ero/Ces refers to the applica- or a psychologicai consulting firm.
tion of principles, methods, and procedures for under-
standing, predicting, and alleviating intellectual, em<>-
tional, psychological, and bebavioral disability and U.er. of clinical rnychological .eroIce8 include:
discomfort. Direct services are provided in a variety of A. Direct users or recipients of clinical psychological
health settings, and direct and supportive services are services.
provided in the entire range of social, organizational, B. Public and private institutions, facilities, or orga-
and academic institutions and agencies.' Clinical psy- nizations receiving clinical psychological services.
chological services include the follOWing:' C. Third-party purchasers-those who pay for the
A. Assessment directed toward diagnosing the nature delivery of services but who are not the recipients of
and causes, and predicting the effects, of subjective dis- services.
tress; of personal, social, and work dysfunction; and of D. Sanctioners-those who have a legitimate concern
the psychological and emotional factors involved in, and with the accessibility, timeliness, efficacy, and standards
consequent to, pbysical disease and disability. Procedures of quality attending the provision of clinical psycholog-
may include, but are not limited to, interviewing, and. ical services. Sanctioners may include members of the
administering and interpreting tests of intellectual abil- user's family, the court, the probation officer, the schooi
ities, attitudes, emotions, motivations. personality char- administrator, the employer, the union representative,
acteristics, psychoneurological status, and other aspects the facility director, and so on. Sanctioners may also in-
of buman experience and behavior relevant to the dis- clude various governmental, peer review, and accredi-
turbance. tation bodies concerned with the assurance of quality.
Guideline 1 psychologist in individual and/or group face-to-face

PROVIDERS meetings.
In order to meet this Guideline, an appropriate num-
ber of hours per week are devoted to direct face-to-face
1.I Each clinical psychological service unit offering
supervision of each clinical psychological service unit
psychological services hos available at least one profes-
staff member. In no event is such supervision less than
sional clinical psychologist and as many more profes-
1 hour per week. The more comprehensive the psycho-
sional clinical psychologists as are necessary to assure
logical services are, the more supervision is needed. A
the adequacy and quality of services offered.
plan or formula for relating increasing amounts of su-
pervisory time to the complexity of professional respon-
INTERPRETATION. The intent of this Guideline is that one sibilities is to be developed. The amount and nature of
Ofmore providers of psychological services in any clinical supervision is made known to all parties concerned.
psychological service unit meet the levels of training and Such communications are in writing and describe and
experience of the professional clinical psychologist as delineate the duties of the employee with respect to
specified in the preceding definitions.' range and type of services to be provided. The limits of
When a facility offering clinical psychological services independent action and decision making are defined.
does not have a full-time professional clinical psychol- The description of responsibility also specifies the means
ogist available, the facility retains the services of one by which the employee will contact the professional clin-
or more professional clinical psychologists on a regular ical psychologist in the event of emergency or crisis sit-
part-time basis. The clinical psych010gist so retained di- uations.
rects and supervises the psychological services provided,
participates sufficiently to be able to assess the need for
1.3 W hereoor a clinical psycholOgical service unit exists,
services, reviews the content of services provided, and
a professional clinical psychologist is responsible for
has the authority to assume professional responsibility
planning, directing, and reviewing the provision of clin-
and accountability for them.
ical psycholOgical services. Wheneoor the clinical psy-
The psychologist directing the service unit is respon-
chological service unit is part of a larger professional
sible for determining and justifying appropriate ratios
psychological service encompassing various psycholog-
of psychologists to users and psychologists to support
staff, in order to ensure proper scope, accessibility, and
ical specialties, a
professional psychologist is the ad-
ministrative head of the service.
quality of services provided in that setting.
INTERPRETATION The clinical psychologist coordinates
the activities of the clinical psychological service unit
1.2 Providers of clinical psychological services who do with other professional, administrative. and technical
not meet the requirements for the professional clinical groups, both within and outside the facility. This clinical
psychologist are supervised directly by a professional psychologist, who may be the director, chief, or coor-
clinical psychologist who assumes professional respon- dinator of the clinical psychological service unit, has re-
sibility and accountability for the services provided. The lated responsibilities including, but not limited to, re-
leool and extent of supervision may vary from task to cruiting qualified staff, directing training and research
task so long as the supervising psycholOgist retains a activities of the service, maintaining a high level of
suffiCiently close supervisory relationship to meet this professional and ethical practice, and ensuring that staff
Guideline. Special proficiency training or supervision members function only within the areas of their com-
may be prOvided by a professional psychologist of an- petency.
other specialty or by a professional from another dis- To facilitate the effectiveness of clinical services by
cipline whose competence in the gioon area has been raising the level of staff sensitivity and professional skills,
demonstrated by previous training and experience. the clinkal psychologist designated as director is respon-
sible for participating in the selection of staff and support
INTEI{PHETATlON: In each clinical psychological ser~ice personnel whose qualifications and skills (e.g., language,
unit there may be varying levels of responsibility with cultural and experiential background, race, sex, and age)
respect to the nature and quality of services provided. are directly relevant to the needs and characteristics of
Support personnel are considered to be responsible for the users served.
their functions and behavior when assisting in the pro-
vision of clinical psychological services and are account- 1.4 When functioning as part of an organizational set-
able to the professional clinical psychologist. Ultimate ting, professional clinical psychologists bring their back-
professional responsibility and accountability for the ser- grounds and skills to bear on the goals of the organi-
vices provided require that the supervisor review and zation, wheneoor appropriate, by participation in the
approve reports and test protocols, review and approve planning and deoolopment of overall services'
intervention plans and strategies, and review outcomes.
Therefore, the supervision of all clinical psychological INTEI\PRETATION Professional clinical psychologists par-
services is proVided directly by a professional clinical ticipate in the maintenance of high professional stan-
644 APPENDIXB
dards by representation on committees concerned with qui red. Merely taking an internship in clinical psychol-
service delivery. ogy or acquiring experience in a practicum setting is not
As appropriate to the setting, their activities may inadequate preparation for becoming a clinical psychol<>-
clude active participation, as voting and as office-holding gist when prior education has not been in that area. Ful-
members, on the professional staffs of hospitals and other fillment of such an individualized educational program
facilities and on other executive, planning, and evalua- is attested to by the awarding of a certificate by the
tion hoards and committees. supervising department or professional school that in-
dicates the successful completion of preparation in clin·
ical psychology.
1.5 Clinical psychologists maintain current knowledge
of scientific and professional developments to preserve
and enhonce their professional competence. 9 1.8 ProfeSSional clinical psycholOgists are encouraged
to develop Innovative theorle$ and procedures and to
INTERPRETATION Methods through which knowledge of provide appropriate theoretical and/or empirical sup-
scientific and profeSSional developments may be gained port for their innovations.
include, but are not limited to, reading scientific and
professional publications, attendance at workshops, par- INTERPRETATION, A specialty of a profession rooted in
ticipation in staff development programs, and other a science intends continually to explore and experiment
forms of continuing education. The clinical psychologist with a view to developing and verifying new and im-
has ready access to reference material related to the pro- proved methods of serving the public in ways that can
vision of psychological services. Clinical psychologists are be documented.
prepared to show evidence periodically that they are
staying abreast of current knowledge and practices in
the field of clinical psychology through continuing ed-
ucation. Guideline 2
PROGRAMS
1.6 Clinical psychologists limit their practice to their
demonstrated areas of professional competence. 2_1 Composition and organization of a clinical psycho-
logical seroice unit:
INTERPRETATION Clinical psychological services are of-
fered in accordance with the proViders' areas of com- 2_1.1 The composition and programs of a clinical
petence as defined by verifiable training and experience. psycholOgical seroice unit are responsive to the nee.u
When extending services beyond the range of their usual of the persons or settings served.
practice, psychologists obtain pertinent training or ap-
propriate professional supervision. Such training or su- INTERPRETATION A clinical psychological service unit is
pervision is consistent with the extension of functions structured so as to facilitate effective and economical
performed and services provided. An extension of ser- delivery of services. For example, Ii clinical psychological
vices may involve a change in the theoretical orientation service unit serving predominantly a low-income, ethnic,
of the clinical psychologist, a change in modality or tech- or racial minority group has a staffing pattern and service
nique, or a change in the type of client and/or the kinds programs that are adapted to the linguistic, experiential.
of problems or disorders for which services are to be and attitudinal characteristics of the users.
provided (e.g., children, elderly persons, mental retar-
dation, neurological impairment). 2.1.2 A description of the organization of the clinical
psycholOgical service unit and its lines of responsi-
1.7 ProfeSSional psychologists who wish to qualify as bility and accountability for the delivery of psycho-
clinical psychologists meet the same requirements with logical services is available in written form to staff
respect to subject matter and professional skills thot of the unit and to users and sanctioners upon request.
apply to doctoral and postdoctoral education and train-
ing in clinical psychology. 10 INTEIU'RETATION The description includes lines of re-
sponsibility, supervisory relationships, and the level and
INTERPRETATION Education of doctoral-level psycholo- extent of accountability for each person who provides
gists to qualify them for specialty practice in clinical psychological services.
psychology is under the auspices of a department in a
regionally accredited university or of a professional 2_1.3 A clinical psycholOgical seroice unit includes
school that offers the doctoral degree in clinical psy- sufficient numbers of professional and support per-
chology. Such education is individualized, with due sonnelto achieve its goals, objectives, and purposes.
credit being given for relevant course work and other
requirements that have previously been satisfied. In ad- INTERPRETATION The work load and diversity of psy-
dition, doctoral-level training plus I year of postdoctoral chological services required and the specific goals and
experience supervised by a clinical psychologist is re- objectives of the setting determine the numbers and qual-
ifications of professional and support personnel in the INTERPRETATION Providers of clinical psychological ser-
clinical psychological service unit. Where shortages in vices maintain up-to-date knowledge of the relevant
personnel exist. so that psychological services cannot he standards of the American Psychological Association.
rendered in a professional manner. the director of the
clinical psychological service unit initiates action to rem- 2.2.4 All providers within a clinical psychological ser-
edy such shortages. When this fails. the director appro- vice unit conform to relevant statutes established by
priately modifies the scope or work load of the unit to federal. state. and local governments.
maintain the quality of the services rendered.
I~TERPRETATION All providers 01 clinical psychological
services are familiar with appropriate statutes regulating
2.2 Policies:
the practice of psychology. They observe agency regu-
2.2. I When the clinical psycholOgical service unit is lations that have the force of law and that relate to the
composed of more than one person or is a component delivery of psychological services (e.g .. evaluation for
of a larger organization, a written statement of its disability retirement and special education placements).
objectives and scope of services is developed, main- In addition, all provlders are cognizant that federal
agencies such as the Veterans Administration, the De-
tained. and reviewed.
partment of Education. and the Department of Health
INTERPRETATION The clinical psychological service unit and Human Services have policy statements regarding
reviews its objectives and scope of services annually and psychological services, and where relevant, providers
revises them as necessary to ensure that the psychological conform to them. Providers of clinical psychological ser-
services offered are consistent with staff competencies vices are also familiar with other statutes and regulations.
and current psychological knowledge and practice. This including those addressed to the civil and legal rights of
statement is discussed with staff, reviewed with the ap- users (e.g .• those promulgated by the federal Equal Em-
propriate administrator, and distributed to users and ployment Opportunity Commission), that are pertinent
sanctioners upon request, whenever appropriate. to their scope of practice.
It is the responsibility of the American Psychological
2.2.2 All providers within a clinical psychological ser- Association to maintain current files of those federal pol-
vice unit support the legal and civil rights of the icies, statutes, and regulations relating to this section and
users.11 to assist its members in obtaining them. The state psy-
chological associations and the state licensing boards pe-
INTERPRETATION Providers of clinical psychological ser-
vices safeguard the interests of the users with regard to
riodically publish and distribute appropriate state stat-
utes and regulations.
personal. legal. and civil rights. They are continually
sensitive to the issut' of confidentiality of information.
2.2.5 All providers within a clinical psycholOgical ser-
the short-term and long-term impacts of their decisions
vice unit inform themselves about and use the net-
and recommendations, and other matters pertaining to
work of human services in their communities in order
individual, legal. and civil rights. Concerns regarding the
to link users with relevant services and resources.
safeguarding of individual rights of users include, but
are not limited to, problems of self-incrimination in ju- lNTEHI'HET-\.TION Clinical psychologists and support staff
dicial proceedings, involuntary commitment to hospitals, are sensitive to the broader context of human needs. In
protection of minors or legal incompetents, discrimina- recognizing the matrix of personal and societal problems,
tory practices in employment selection procedures, rec- providers make available to users information regarding
ommendation for special education provisions, infor- human services such as legal aid societies, social services,
mation relative to adverse personnel actions in the armed employment agencies, health resources, and educational
services, and adjudication of domestic relations disputes and recreational facilities. Providers of clinical psycho-
in divorce and custodial proceedings. Providers of clin- logical st"fvices refer to such community resources and,
ical psychological services take affirmative action by when indicated, actively intervent" on behalf of the users.
making themselves available to local committees, review Community resources include the private as well as
boards, and similar advisory groups established to safe- the public sectors. Private resources include private
guard the human, civil, and legal rights of service users. agencies and centers and psychologists in independent
private practice. Consultation is sought or referral made
2.2.3 All providers within a clinical psychological ser- within the public or private network of services when-
vice unit are familiar with and adhere to the Amer- ever required in the best interest of the users. Clinical
ican Psychological Association's Standards for Pro- psychologists. in either the private or the public setting.
viders of Psychological Services. Ethical Principles of utilize other resources in the community whenever in-
Psychologists. Standards for Educational and Psycho- dicated because of limitations within the psychological
logical Tests. Ethical Principles in the Conduct of Re- serviCt" unit providing the services. Professional clinical
search With Human Participants. and other official psychologists in private practice are familiar with the
policy statements relevant to standards for profes- types of services offered through local community men-
sional services issued by the ASSociation. tal health clinics and centers. including alternatives to
646 ApPENDIXB
hospitalization, and know the costs and eligibility re- 2.3.4 Each clinical psychological service unit follows
quirements for those services. an established record retention and disposition
policy.
S.2.6 In the delivery of clinical psychological seroices, INTERPRETATION. The policy on record retention and
the "..oviders maintain a Caope1'dtioe relationship disposition conforms to federal or state statutes or ad-
with colleagues and co-workers in the best interest ministrative regulations wbere such are applicable. In
of the users. I! the absence of such regulations, the policy is (a) that the
INTERPRETATION. Clinical psychologists recognize the full record be retained intact for 3 years after the com-
areas of special competence of other professional psy- pletion of planned services or after the date of last contact
chologists and of professionals in other fields for either with the user, whicbever is later; (b) that a full record
consultation or referral purposes. Providers of clinical or summary of the record be maintained for an addi-
psychological services make appropriate use of other tional 12 years; and (c) that the record may be disposed
professional, research, technical, and administrative re- of no sooner than 15 years after the completion of
sources to serve the best interests of users and establish planned services or after the date of the last contact.
and maintain cooperative arrangements with such other whichever is later. These temporal gUides are consistent
resources as required to meet the needs of users. with procedures currently in use by federal record cen-
ters.
2.3 Procedures: In the event of the death or incapacity of a clinical
psychologist in independent practice, special procedures
2.3.1 Each clinical psychofogical service unit follows are necessary to ensure the continuity of active services
a set of procedural guidelines for the delivery of psy- to users and the proper safeguarding of inactive records
chological .eroices. being retained to meet this Guideline. Following ap-
proval by the affected user, it is appropriate for another
INTERPRETATION. Providers are prepared to provide a clinical psychologist, acting under the auspices of the
statement of procedural gUidelines, in either oral or writ- local professional standards review committee (PSRC),
ten form, in terms that can be understood by users, in- to review the records with the user and recommend a
cluding sanctioners and local administrators. This state- course of action for continuing professional service, if
ment describes the current methods, forms, procedures, needed. Depending on local circumstances, the review-
and techniques being used to achieve the objectives and ing psychologist may also recommend appropriate ar-
goals for psychological services. rangements for the halance of the record retention and
disposition period.
2.3.2 Providers of clinical psychological services de- This Guideline has been designed to meet a variety
oelop plans awoprlate to the JIf'OI'Itlers' professional of circumstances that may arise, often years after a set
pract1ces and to the "..ob/ems presented by the users. of psychological services has been completed. More and
more records are being used in forensic matters, for peer
INTERPRETATION. A clinical psychologist develops a plan review, and in response to requests from users. other
that describes the psychological services, their objectives, professionals, or other legitimate parties requiring ac-
and the manner in which they wiD be provided.I:l.I< This curate information ahout the exact dates, nature, course,
plan is in written form; it serves as a basis for obtaining and outcome of a set of psychological services. These
understanding and concurrence from the user and pro- record retention procedures also provide valuable base-
vides a mechanism for subsequent peer review. This plan line data for the original psychologist-provider when a
is, of course, modified as new needs or information de- previous user retlllTlS for additiona1 services.
velops.
A clinical psychologist who provides services as one
2.3.5 Providers of clinical psychological services
member of a collaborative effort participates in the de- maintain a system to "..otect confidentiality of the/r
velopment and implementation of the overall service records. IS
plan and provides for its periodic review.
INTERPRETATION· Clinical psychologists are responsible
2.3.3 Accurate, current, and pertinent documenta- for maintaining tbe confidentiality of information about
tion of essential clinical psychological serolces pro- users of services, from whatever source derived. All per-
oided is maintained. sons supervised by clinical psychologists, including non-
professional personnel and students, who have access to
INTERPRETATION. Records kept of clinical psychological records of psychological services are required to maintain
services may include, but are not limited to, identifying this confidentiality as a condition of employment.
data, dates of services, types of services, Significant ac- The clinical psychologist does not release con6~ential
tions taken. and outcome at termination. Providers of information, except with the written consent of the user
clinical psychological services ensure t\lat essential indirectly involved or his or ber legal representative. Even
formation concerning services rendered is recorded after consent for release has been ohtained, the clinical
within a reasonable time following their completion. psychologist clearly identifies such information as con-
lidential to the recipient of the information.'b II directed INTERPIIETATION Clinical psychologists provide services
otherwise by statute or regulations with the force of law to users in a manner that is considerate. effective. eco-
or by court order, the psychologist may seek a resolution nomical, and humane. Clinical psychologists make their
to the conflict that is both ethically and legally feasible services readily accessible to users in a manner that fa-
and appropriate. cilitates the users' freedom of choice.
Users 8ff" informed in advance of any limits in the Clinical psychologists are mindful of their account-
setting for maintenance of confidentiality of psycholog- ability to the sanctioners of clinical psychological services
ical information. For instanct>', clinical psychologists in and to the general public, provided that appropriate steps
hospital, clinic, or agency settings inform their patients are taken to protect the conlidel)tiality of the service
that psychological information in a patient's clinical rec- relationship. In the pursuit of their professional activities,
ord may be available without the patient's written con- they aid in the conservation of human, material, and
sent to other members of the professional staff associated financial resource-so
with the patient's treatment or rehabilitation. Similar The clinical psychological service unit does not with-
limitations on conlidentiality of psychological informa- hold services to a potential client on the basis of that
tion may be present in certain school, industrial, military, user's race, color, religion. gender, sexual orientation,
or other institutional settings, or in instances in which age, or national origin. Recognition is given, however.
the user has waived conlidentiality for purposes of third- to the follOWing considerations: the profeSSional right of
party payment. clinical psychologists to limit their practice to a specilic
Users have the right to obtain information from their category of users (e.g., children. adolescents, women);
psychological records. However, the records are the the right and responsibility of clinical psychologists to
property of the psychologist or the facility in which the withhold an assessment procedure when not validly ap-
psychologist works and are, therefore, the responsibility plicable; and the right and responsibility of clinical psy-
of the psychologist and subject to his or her control. chologists to withhold evaluative. psychotherapeutic.
When the user's intention to waive conlidentiality is counseling, or other services in specific instances in which
judged by the professional clinical psychologist to be their own limitations or client characteristics might im-
contrary to the user's best interests or to be in conflict pair the effectiveness of the relationship."·18 Clinical
with tbe user's civil and legal rights, it is the responsibility psychologists seek to ameliorate through peer review,
of the clinical psychologist to discuss the implications of consultation, or other personal therapeutic procedures
releasing psychological information and to assist the user those factors that inhibit the proviSion of services to par-
in limiting disclosure only to information required by ticular users. When indicated services are not available,
the present circumstance. clinical psychologists take whatever action is appropriate
Raw psychological data (e.g., questionnaire returns or 10 inform responsible persons and agencies of the lack
test protocols) in which a user is identified are released of such services.
only with the written consent of the user or his or her Clinical psychologists who lind that psychological ser-
legal representative and released only to a person rec- vices are being provided in a manner that is discrimi-
ognized by the clinical psychologist as qualilied and com- natory or exploitative to users and/or contrary to these
petent to use the data. Guidelines or to state or federal statutes take appropriate
Any use made of psychological reports, records, or corrective action, which may include the refusal to pro-
data for research or training purposes is consistent with vide services. When conBicts of interest arise, the clinical
this Guideline. Additionally, providers of clinical psy- psychologist is guided In the resolution of differences by
chological services comply with statutory conlidentiality the principles set forth in the American Psychological
requirements and those embodied in the American Psy- Association's Ethical PnflClples of Psychologists (APA,
chological Association's Ethictll PnflClples of Psycholo- 1981b) and "Guidelines for Conditions of Employment
gists (APA, 1981b). of Psychologists" (APA, 1972).
Providers of clinical psychological services remain sen-
sitive to both the benelits and the possible misuse of 3.2 Clinical psychologists pu,sue thei, activities as
information regarding individuals that is stored in large membe,s of the independent, autonomous profession
computerized data banks. Providers use their influence of psychology.'·
to ensure that such information is "used in a socially re-
sponsible manner. INTERPRETATION. Clinical psychologists, as members of
an independent profession. are responsible hoth to the
public and to their peers through established review
mechanisms. Clinical psychologists are aware of the im-
Guideline 3 plications of their activities for the profession as a whole.
ACCOUNTABILITY They seek to eliminate discriminatory practices insti-
tuted for self-serVing purposes that are not in the interest
3.1 The clinictll psychologist's pt'ofessWnalllCuvuy Is of the users (e.g., arbitrary reqUirements for referral and
guided pnmanly by the pnflClple of pt'OTROUng human supervision by another profession). They are cognizant
welfare. of their responsibilities for the development of the profes-
648 ApPENDIXB
sion. They participate where possible in the training and modi6cation, and evaluation of clinical psychological
career development of students and other providers, par- services.
ticipate as appropriate in the training of paraprofession- Depending on the settings, accurate and full infor-
als or other professionals, and integrate and supervise the mation is made available to prospective individual or
implementation of their contributions within the struc- organizational users regarding the quali6cations of pro-
ture established for delivering psychological services. viders, the nature and extent of services offered, and
Clinical psychologists facilitate the development of, and where appropriate, financial and social costs.
participate in, professional standards review mecha- Where appropriate, clinical psychologists inform users
nisms. 20 of their payment policies and their willingness to assist
Clinical psychologists seek to work with other profes- in obtaining reimbursement. Those who accept reim-
sionals in a cooperative manner for the good of the users bursement from a third party are acquainted with the
and the benefit of the general public. Clinical psychol- appropriate statutes and regulations and assist their users
ogists associated with multidisciplinary settings support in understanding procedures for submitting claims and
the principle that members of each participating profes- limits on con6dentiality of claims information, in ac-
sion have equal rights and opportunities to share all priv- cordance with pertinent statutes.
ileges and responsibilities of full membership in hospital
facilities or other human service facilities and to admin-
ister service programs in their respective areas of com-
petence. Guideline 4
ENVIRONMENT
3,3 There are periodic, systematic, and effective eool-
uatlDns of clinical psychological .eroIces. 21
4,1 Providers of clinical psychological serolce. promote
the development In the serolce setting of a physical,
INTERPRETATION, When the clinical psychological ser- organizational, and social enVIronment that facilitate.
vice unit is a component of a larger organi7.ation, regular opt/mal human functioning.
evaluation of progress in achieving goals is provided for
INTERPRETATION· Federal, state, and local requirements
in the service delivery plan, including consideration of
for safety, health, and sanitation are observed.
the effectiveness of clinical psychological services rela-
As providers of services, clinical psychologists are con-
tive to costs in terms of use of time and money and the
cerned with the environment of their service unit, es-
availability of professional and support personnel.
pecially as it affects the quality of service, but also as
Evaluation of the clinical psychological service deliv-
it impinges on human functioning when the service unit
ery system is conducted internally and, when possible,
is included in a larger context. Physical arrangements
under independent auspices as well. This evaluation in-
and organizational poliCies and procedures are condu-
cludes an assessment of effectiveness (to determine what
cive to the human dignity, self-respect, and optimal func-
the service unit accomplished), efficiency (to determine
tioning of users and to the effective delivery of service.
the total costs of providing the services), continuity (to
Attention is given to the comfort and the privacy of users.
ensure that the services are appropriately linked to other
The atmosphere in which clinical psychological services
human services), availability (to determine appropriate
are rendered is appropriate to the service and to tbe
levels and distribution of services and personnel), acces- users, whether in an office. cliniC, school. industrial or-
sibility (to ensure that the services are barrier free to
ganization, or other institutional setting.
users), and adequacy (to determine whether the services
meet the identi6ed needs for such services).
There is a periodic reexamination of review mecha- FOOTNOTES
nisms to ensure that these attempts at public safeguards I The footnotes appended to these Specialty Guidelines rep-
are effective and cost ef6cient and do not place unnec- resent an attempt to provide a coherent context of other policy
essary encumbrances on the providers or impose unnec- statements of the Association regarding professional practice.
The Guidelines extend these previow policy statements where
essary additional expenses on users or sanctioners for ser-
necessary to re8ect current concerns of the public and the
vices rendered. profession.
3.4 Clinical psychologists are accountable for all as- • The following two categories 01 professional psychologists
who met the criteria indicated below on or before the adoption
pects of the services they provide and are responsive to of these Specialty Guidelines on January 31, 1980, are also con-
those concerned w/th the.e .ervlce.... sidered clinical psychologists: Category I-persons who com-
pleted (a) a doctoral degree program primarily psychological
INTERPRETATION, In recognizing their responsibilities to in content at a regionally accredited university or professional
users, and where appropriate and consistent with the school and (b) 3 postdoctoral yean of appropriate education,
users' legal rights and privileged communications, clin- training. and experience in providing clinical psychological ser-
vices as de&ned herein, including a minimum of 1 year in a
ical psychologists make available information ahout, and clinical setting; Category 2-persons who on or before Septem-
provide opportunity to participate in, decisions concern- ber 4, 1974, <a) completed a master's degree from a program
ing such issues as initiation, termination, continuation, primarily psychological in content at a regionally accredited
university or professional school and (b) held a license or cer- Uons, in a professional relationship. to assist a person or per·
tificate in the state in which they practiced. conferred by a state sons to modify feelings, attitudes, and behavior which are
board of psychological examiners, or the endorsement of the intellectually, socially. or emotionally maladjustive or inef~
state psychological association through voluntary certification, fectual.
and who, in addition, prior to January 31, 1980, (c) obtained The practice 01 psychology shall be as defined above, any
5 post-master's years of appropriate education, training, and existing statute in the state of _ _ to the contrary notwith~
experience in providing clinical psychological services as de- standing. (APA, 1967, pp. 1098-1(99)
fined herein, including a minimum of 2 years in a clinical set-
ting. 6 The relation of a psychological service unit to a larger fa~
After January 31, 1980. professional psychologists who wish cility or institution is also addressed indirectly in the APA (1972)
to be recognized as professional clinical psychologists are re· "Guidelines lor Conditions 01 Employment 01 Psychologists"
rerred to Guideline 1.7. (hereinafter referred to as CEP Guidelines), which emphasizes
The definition of the professional clinical psychologist in these the roles, responsibilities. and prerogatives of the psychologist
Guidelines does not contradict or supersede in any way the when he or she is employed by or provides services for another
broader definition accorded the term clinical psycholOgist in agency, institution, or business.
the Federal Employees Health Benefits Program (see Access to
Psychologists and Optometrists Under Federal Health Bene~ 7 This Guideline replaces earlier recommendations in the
fits Program, u.s. Senate Report No. 93-961, June 25, 1974). 1967 state guidelines concerning exemption of psychologists
from licensure. Recommendations 8 and 9 of those guidelines
:3 The areas of knowledge and training that are a part of the
read as follows:
educational program for all professional psychologists have been
presented in two APA documents, Educati01l and Credential· Persons employed as psychologists by accredited academic
ing in Psychology II (APA, 1977a) and Criterla for Accredi- institutions, governmental agencies. research laboratories. and
tation of Doctoral Training Programs and Internships In business corporations should be exempted, provided such em~
Professional Psychology (APA, 1979). There is consistency in ployees are performing those duties for which they are em·
the presentation of core areas in the education and training of ployed by such organizations, and within the confines of such
all professional psychologists. The description of education and organizations.
training in these Guidelines is based primarily on the document Persons employed as psychologists by accredited academic
Education and Credentlaltng in Psychology l/. It is intended institutions, governmental agencies, research laboratories, and
to indicate broad areas of required curriculum, with the ex~ business corporations consulting or offering their research
peetation that training programs will undoubtedly want to in~ findings or providing scientific information to like organi~
terpret the specific content of these areas in different ways zations lor a lee should be exempted. (APA, 1967, p. 11(0)
depending on the nature, philosophy. and intent of the pro-
grams. On the other hand, the 1967 state gUidelines specifically de-
nied exemptions under certain conditions, as noted in Recom-
~ Functions and activities of psychologists relating to the mendations 10 and 11:
teaching of psychology, the writing or editing of scholarly or
scientific manuscripts, and the conduct of scientific research do Persons employed as psychologists who offer or provide
not fall within the purview of these Guidelines. psychological services to the public for a fee. over and above
the salary that they receive for the performance of their reg~
5 The definitions should be compared with the APA (1967) ular duties, should not be exempted.
guidelines for state legislation (hereinafter referred to as state Persons employed as psychologists by organizations that
guidelines), which define psychologist and the practice of psy~ sell psychological services to the public should not be ex-
chology as follows: empted. (APA, 1967, pp. 1100(1101)
A person represents himself (or herself] to be a psychologist
The present APA policy. as reHected in this Guideline, es-
when he [or she1 holds himself (or herself] out to the public
tablishes a single code 01 practice lor psychologists providing
by any title or description of services incorporating the words
covered services to users in any setting. The present position
.. psychology," .. psychological," "psychologist, ,. and/or offers
is that a psychologist providing any covered service meets local
to render or renders services as defined below to individuals.
statutory requirements for licensure or certi6cation. See the
groups, organizations, or the public for a fee, monetary or
section entitled Principles and Implications of the Specialty
otherwise.
Guidelines for an elaboration of this position.
The practice of psychology within the meaning of this act
is defined as rendering to individuals, groups, organizations,
, A closely related principle is lound in the APA (1972) CEP
or the public any psychological servi.ce involving the appli.
cation of principles. methods, and procedures of understand·
Guidelines:
ing, predicting, and inHuendng behavior, such as the prin- It is the policy of APA that psychology as an independent
ciples pertaining to learning, perception, motivation, thinking, profession is entitled to parity with other health and human
emotions and interpersonal relationships; the methods and service professions in institutional practices and before the
procedures of interviewing, counseling, and psychotherapy; law. Psychologists in interdisciplinary seHinp such as colleges
of constructing, administering, and interpreting tests of men· and universities, medical schools, clinics. private practice
tal abilities, aptitudes, interests, attitudes, personality char· groups, and other agencies expect parity with other profes-
acteristics, emotion, and motivation; and of assessing public sions in such matters as academic rank, board status, salaries,
opinion. fringe benefits. fees. participation in administrative decisions.
The application of said principles and methods includes. and all other conditions of employment, private contractual
but is not restricted to: diagnosis, prevention, and ameliora~ arrangements. and status before the law and legal institutions.
hon of adjustment problems and emotional and mental dis- (APA, 1972, p. 333)
orders of individuals and groups; hypnosis; educational and
vocational counseling; personnel selection and management; • See CEP Guidelines (section entitled Career Development)
the evaluation and planning for effective work and learning for a closely related statement:
situations; advertising and market research; and the resolution
of interpersonal and social conHicts. Psychologists are expected. to encourage institutions and
Psychotherapy within the meaning of this act means the agencies which employ them to sponsor or conduct career
use of learning, condiUoning methods, and emotional reac~ development programs. The purpose to these programa; would
650 ApPENDIXB
be to enable psychologists to engage in study for professional "across the board" legislation for such privileged communi-
advancement and to keep abreast of developments in their cations. (APA, 1987, p. 11(0)
field. (APA, 1972, p. 332)
,; This paragraph is directly adapted from the CEP Guide-
10 This Guideline follows closely the statement regarding line. (APA, 1972, p. 333).
"Policy on Training for Psychologists Wishing to Change Their
Specialty" adopted by the APA Council of Repr_ntatives in .. The CEP Guidelines also include the following:
January 1976. Included therein was the implementing provision
that "this policy statement shan be incorporated in the guide-. It is recognized that under certain circumstances, the in-
lines of the Committee on Accreditation so that appropriate terests and goals of a particular community or segment of
sanctions can be brought to bear on university and internship interest in the population may be in con8iet with the general
training programs that violate [It]" (Conger, 1976, p. 424). welfare. Under such circumstances, the psychologist's profes-
sional activity must be primarily guided by the principle of
"See also APA's (198lb) Eth/cG1 Principle. of P.ycholog/8ts, "promoting human welfare." (APA, 1972, p. 334)
especially Principles 5 (Confidentiality), 6 (Welfare of the Con·
sumer), and 9 (Research with Human Participants); and see 19 Support for the principle of the independence of psychol..
Eth/cG1 Principle. In the Conduct of R••••rch With Hu"",n ogy as a profession is found in the following:
P.rticipants (APA, 1973&). Also, in 1978 Division 17 approved
in principle a statement on "Principles for Counseling and Psy. As a member of an autonomous profession, a psychologist
chotherapy With Women," which was designed to protect the rejects limitations upon his lor her] freedom of thought and
interests of female users of clinical psychological' services. action other than those imposed by his [or her] moral, legal,
and social responsibilities. The Association is always prepared
1.2 Support for this position is found in Psychology as tJ Profes- to provide appropriate assistance to any responsible member
sion in the section on relations with other professions: who becomes subjected to unreasonable limitations upon his
[or her1 opportunity to function as a practitioner, teacher,
Professional persons have an obligation to know and take researcher, administrator, or consultant. The Association is
into account the traditions and practices of other professional always prepared to cooperate with any responsible profes-
groups with whom they work and to cooperate fully with sional organization in opposing any unreasonable limitations
members of such groups with whom research, service, and on the professional funetions of the members of that orga-
other functions are shared. (APA, 1968, p. 5) nization.
This insistence upon profeSSional autonomy has been up-
11 One example of a specific application of this principle is
held over the years by the affirmative actions of the courts
found in Guideline 2 in APA·s (1973b) '·Guidelines for Psy·
and other public and private bodies in support of the right
chologists Conducting Growth Groups":
of the psychologist-and other professionals-to pursue those
The following information should be made available in functions for which he [or she] is trained and qualified to
wrlting [italics added] to all prospective participant" perform. (APA. 1968, p. 9)
(0) An explicit statement of the purpose of the group: Organized psychology has the responsibility to define and
(b) Types of techniques that may he employed; develop its own profession, consistent with the general canons
(c) The education, training, and experience of the leader of science and with the public welfare.
or leaders: Psychologists recognize that other professions and other
(d) The fee and any additional expense that may he in· groups will, from time to time, seek to define the roles and
curred; responsibilities of psychologist. The APA opposes such de·
(e) A statement as to whether or not a follow-up service velopments on the same principle that it is opposed to the
is included in the fee: psychological profession taking positions which would define
(j) Goals of the group experience and techniques to he the work and scope of responsibility of other duly recognized
used; professions. (APA, 1972, p. 333)
(g) Amounts and kinds of responsibility to be assumed by
the leader and by the participants. For example, (I) the degree
lIO APA support for peer review is detailed in the following
to which a participant is free not to follow suggestions and
excerpt from the APA (l971) statement entitled "Psychology
prescriptions of the group leader and other group members; and National Health Care It:
(ii) any restrictions on a participant's freedom to leave the
group at any time; and All professions participating in a national health plan
(h) Issues 01 confidentiality. (p. 933) should be directed to establish review mechanisms (or per·
fonnance evaluations) that include not only peer review but
"See APA's (198la) APA/CHAMPUS Outpatient Psycho· active participation by persons representing the consumer.
10gictJl Provider Manual. In situations where there are fiscal agents, they should also
have representation when appropriate. (p. 1026)
"See Principle 5 (Confidentiality) in Ethlc.1 Prtnciples of
P.ycholog/8t, (APA, 1981b). 21 This Guideline on program evaluation is based directly on
the follOWing excerpts from two APA position papers:
Support for the principle of privileged communication is
If.
found in at least two policy statements of the Association:

The quality and availability of health services should be
In the interest of both the public and the client and in evaluated continuously by both consumers and health profes-
accordance with the requirements of good professional prac- sionals. Research into the efficiency and effectiveness of the
tice, the profession of psychology seeks recognition of the system should be conducted both internally and under in-
privileged nature of confidential communications with clients, dependent auspices. (APA, 1971. P. 1025)
preferably through statutory enactment or by administrative
The comprehensive community mental health center
policy where more appropriate. (APA, 1968, p. 8)
should devote an explicit portion of its budget to program
Wherever possible, a clause protecting the privileged na- evaluation. All centers should inculcate in their staff attention
tu,e of the psychologist-client relationship he included. to and respect for research Bndings; the larger centers have
When appropriate, psychologists assist in obtaining general an obligation to set a high priority on basic research and to
give formal recognition to research as a legitimate part of the conduct of research with humnn parH~pants. Washington,
duties of staff members. D.C., Author. 1973. (a)
. Only through explicit appraisal of program effects can American Psychological ~ssociation. Guidelines for psycholo-
worthy approaches be retained and refined, ineffective ones gists conducting growth groups. American PsycholOgist,
dropped. Evaluative monitoring of program achievements 1973.28. 933. (b)
may vary, of course, from the relatively informal to the sys- American Psychological Association. Standards for educational
tematic and quantitative, depending on the importance of and psycholOgical tests. Washington, n.G: Author, 1974.
the issue, the availablity of resources, and the willin~ness of (a)
those responsible to take risks of substituting informed. judg- American Psychological Association. Standards for providers
ment for evidence. (Smith & Hobbs. 1966. pp. 21-22) of psychological services. Washington. D.C., Author. 1974.
(b)
22 See also the CEP Guidelines for the following statement: American Psychological Association. Educatton and creden-
"A psychologist recognizes that. . he [or she1 alone is ac- Haling in psychology 11. Report of a meeting, June 4-5, 1977.
countable for the' consequences and effects of his [or herl ser- Washington. D.C., Author. 1977. (a)
vices, whether as teacher, researcher, or practitioner. This re- American Psychological Association. Standards for providers
sponsibility cannot be shared. delegated. or reduced" (APA. of psychological services (Rev. ed.). Washington. D.L Au-
1972. p. 334). thor. 1977. (b)
American Psychological Association. Criteria for accreditatton
of doctoral training programs and internships in profes-
REFERENCES sIoTull psf/Chology. Washington. D.C., Author. 1979 (amended
1980).
American Psychological Association. APAjCHAMPUS outpa-
American Psychological Association, CommiHee on Legislation. tient psf/Chological provider manual (Rev. ed.). Washington.
A model for state legislation affecting the practice of psy- D.C., Author. 1981. (a)
chology. Amencan PSf/ChoIogist. 1967.22. 1095-1100. American Psychological Association. Ethical princtples of psy-
American Psychological Association. Psychology as a profes- chologists (Rev. ed.). Washington. D.L Author. 1981. (b)
sion. Washington, D.G: Author, 1968. Conger, J. J. Proceedings of the American Psychological As-
American Psychological Association. Psychology and national sociation, Incorporated, for the year 1975: Minutes of the
health care. American PSf/Chologist. 1971.26. 1025-1026. annual meeting of the Council of Representatives. American
American Psychological Association. Guidelines for conditions Psychologist. 1976. 31. 406-434.
of employment of psychologists. American P'f/Chologist. Smith, M. 8., & Hobbs, N. The communHy and the community
1972. 27. 331-334. mental health center. Washington, D.G: American Psycho-
American Psychological Association. Etlrical prindples in the logical Association, 1966.
652 ApPENDIXB

of Services by Counseling Psychologists
The Specialty Guidelines that follow are based on the ment of the conditions. credentials. and experience that
generic Standards for Providers of Psychological Ser- contribute to competent profeSSional practice. The APA
vices originally adopted by the American Psychological strongly encourages, and plans to participate in, efforts
Association (APA) in September 1974 and revised in Jan- to identify professional practitioner behaviors and job
uary 1977 (APA. 1974b. 1977b). Together with the ge- functions and to validate the relation between these and
neric Standards, these Specialty Guidelines state the of- desired cHent outcomes. Thus, future revisions of these
ficial policy of the Association regarding delivery of Guidelines will increasingly reflect the results of such
services by counseling psychologists. Admission to the efforts.
practice of psychology is regulated by state statute. It is These Guidelines follow the format and. wherever
the position of the Association that licensing be based on applicable. the wording of the generic Standards. I (Note:
generic. and not on specialty. qualifications. Specialty Footnotes appear at the end of the Specialty Guidelines.
guidelines serve the additional purpose of providing po- See pp. 661-663.) The intent of these Guidelines is to
tential users and other interested groups with essential improve the quality. effectiveness. and accessibility of
information ~bout particular services available from the psychological services. They are meant to provide guid-
several specialties in professional psychology. ance to providers, users, and sanctioners regarding the
Professional psychology specialties have evolved from best judgment of the profession on these matters. Al-
generic practice in psychology and are supported by though the Specialty Guidelines have been derived from
university training programs. There are now at least four and are consistent with the generic Standards. they may
recognized professional specialties-clinical, counseling, be used as separate documents. However. Standards for
school. and industrial/organizational psychology. Providers of Psychological Services (APA. 1977b) shall
The knowledge base in each of these specialty areas remain the basic policy statement and shall take pre-
has increased, refining the state of the art to the point cedence where there are questions of interpretation.
that a set of uniform specialty guidelines is now possible Professional psychology in general and counseling psy-
and desirable. The present Guidelines are intended to chology as a specialty have labored long and diligently
educate the public. the profession. and other interested to codify a uniform set of guidelines for the delivery of
parties regarding specialty professional practices, They services by counseling psychologists that would serve the
are also intended to facilitate the continued systematic respective needs of users, providers, third-party pur-
development of the profession. chasers. and sanctioners of psychological services.
The content of each Specialty Guideline reflects a con-
The Committee on Professional Standards. established
sensus of university faculty and public and private prac-
by the APA in January 1980. is charged with keeping
titioners regarding the knowledge base. services proVided.
the generic Standards and the Specialty Guidelines re-
problems addressed. and clients served. sponsive to the needs of the public and the profession.
Traditionally. all learned disciplines have treated the
It is also charged with continually reviewing, mooifying,
designation of specialty practice as a reflection of prep-
and extending them progreSSively as the profession and
aration in greater depth in a particular subject matter,
the science of psychology develop new knowledge, im-
together with a voluntary limiting of focus to a more
proved methods. and additional modes of psychological
restricted area of practice by the professional. Lack of
services.
of psychological services from using the methods or deal- The Specialty Guidelines for the Delivery of Services
ing with the populations of any specialty, except insofar by Counseling Psychologists that follow have been es-
as psychologists voluntarily refrain from providing ser- tablished by the APA as a means of self-regulation to
vices they are not trained to render. It is the intent of protect the public interest. They guide the specialty prac-
these guidelines, however, that after the grandparenting
period. psychologists not put themselves forward as spe- These Specialty Guidelines were prepared by the APA Com-
c1alists in a given area of practice unless they meet the mittee on Standards for Providers of Psychological Services
(C,OSPOPS), chaired by Durand F. Jacobs, with the advice of
qualifications noted in the Guidelines (see Definitions). the officers and committee chairpersons of the Division of Coun-
Therefore. these Guidelines are meant to apply only to seling Psychology (Division 17). Barbara A. Kirlc: and Milton
those psychologists who voluntarily wish to be designated Schwebel served successively as the counseling psychology rep--
as counseling psychologists. They do not apply to other resentative of COSPOPS, and Arthur Centor and Richard Kil-
burg were the Central Office liaisons to the committee. Norman
psychologists. Kagan, Samuel H. Osipow, Carl E. Thoresen, and Allen E. Ivey
These Guidelines represent the profession's best judg- served successively as Division 17 preSidents.
tice of counseling psychology by specifying important of such services. The extent to which counseling psy-
areas of quality assurance and performance that con- chologists observe these Guidelines is judged by peers.
tribute to the goal of facilitating more effective human 8. These GUidelines, while assuring the user of the
functioning. counseling psychologist's accountability for the nature
and quality of services specified in this document, do not
Principles and Implications of the Specialty preclude the counseling psychologist from using new
GUidelines methods or developing innovative procedures in the de-
livery of counseling services.
These Specialty Guidelines emerged from and reaffirm
the same basic principles that gUided the development These Specialty Guidelines have broad implications
of the generic Standards for Provider. of Psychological both for users of counseling psychological services and
Serolces (APA, I977b): for providers of such services:
I. These Guidelines recognize that admission to the 1. Guidelines for counseling psychological services
practice of psychology is regulated by state statute. provide a foundation for mutual understanding between
2. It is the intention of the APA that the generic Stan- provider and user and facilitate more effective evalua-
dards provide appropriate guidelines for statutory li- tion of services provided and outcomes achieved.
censing of psychologists. In addition, although it is the 2. Guidelines for counseling psychologists are essential
position of the APA that licensing be generic and not in for uniformity in specialty credentialing of counseling
specialty areas, these Specialty Guidelines in counseling psychologists.
psychology provide an authoritative reference for use in 3. Guidelines give specific content to the profession's
credentialing specialty providers of counseling psycho- concept of ethical practice as it applies to the functions
logical services by such groups as divisions of the APA of counseling psychologiSts.
anll state associations and by boards and agencies that 4. Guidelines for counseling psychological services
find such criteria useful for quality assurance. may have siguificant impact on tomorrow's education
3. A uniform set of Specialty Guidelines governs the and training models for both professional and support
quality of services to all users of counseling psychological personnel In counseling psychology.
services in both the private and the public sectors. Those 5. Guidelines for the provision of counseling psycho-
receiving counseling psychological services are protected. logical services in human service facilities inBuence tbe
by the same kinds of safeguards, irrespective of sector; determination of acceptable structure, budgeting, and
these include constitutional guarantees, statutory regu- staffing patterns in these facilities.
lation. peer review. consultation. record review. and su- 6. Guidelines for counseling psychological services
pervision. require continual review and revision.
4. A uniform set of Specialty Guidelines governs coun-
seling psychological service funrtions offered by coun- The Specialty Guidelines here presented are Intended
seling psychologists, regardless of setting or form of re- to improve the quality and delivery of counseling psy-
muneration. All counseling psychologists in professional chological services by specifying criteria for key aspects
practice recognize and are responsive to a uniform set of the practice setting. Some settings may require ad-
of Specialty Guidelines, just as they are guided by a ditional and/or more stringent criteria for specific areas
common code of ethics. of service delivery.
5. Counseling psychology Guidelines establish clear, Systematically applied, these Guidelines serve to es-
minimally acceptable levels of quality for covered coun- tablish a more effective and consistent hasis for evalu-
seling psychological service functions, regardless of the ating the performance of individual service providers as
nature of the users, purchasers, or sanctioners of such well as to gUide the organization of counseling psycho-
covered services. logical service units in human service settings.
6. All persons providing counseling psychological ser-
vices meet specified levels of training and experience Definitions
that are consistent with. and appropriate to, the functions
they perform. Counseling psychological services pro- Providers of counseling psychological serolces refers to
vided by persons who do not meet the APA qualifications two categories of persons who provide counseling psy-
for a professional counseling psychologist (see Defini- chological services:
tions) are supervised by a professional counseling psy. A. Professional counseling psychologists.' Professional
chologist. Final responsibility and accountability for counseling psychologists have a doctoral degree from a
services provided rest with professional. counseling regionally accredited university or professional school
psychologists. providing an organized, sequential counseling psycbol-
7. When providing any of the covered counseling ogy program In an appropriate academic department in
psychological service functions at any time and in any a university or college, or in an appropriate department
setting, whether public or private, profit or nonprofit, or unit of a professional school. Counseling psychology
counseling psychologists observe these Guidelines in or- programs that are accredited by the American Psycho-
der to promote the best interests and welfare of the users logical Association are recognized as meeting the de6-
654 ApPENDIXB
nition of a counseling psychology program. Counseling A. Assessment, evaluation, and diagnosis. Procedures
psychology programs that are not accredited by the may include, but are not limited to, behavioral obser-
American Psychological Association meet the definition vation, interviewing, and administering and interpreting
of a counseling psychology program if they satisfy the instruments for tbe assessment of educational achieve-
following criteria: ment, academic skills, aptitudes, interests, cognitive
1. The program is primarily psychological in nature abilities, attitudes, emotions, motivations, psychoneuro-
and stands as a recognizable, coherent organizational logical status, personality characteristics, or any other
entity within the institution. aspect of human experience and behavior that may con-
2. The program provides an integrated, organized tribute to understanding and helping the user.
sequence of study. B. Interventions witb individuals and groups. Pr0ce-
3. The program has an identifiable body of students dures include individual and group psychological coun-
who are matriculated in that program for a degree. seling (e.g., education, career, couples, and family coun-
4. There is a clear authority with primary respon- seling) and may use a therapeutic, group process, or
sibility for the core and specialty areas, whether or not social-learning approach, or any other deemed to be ap-
the program cuts across administrative lines. propriate. Interventions are used for purposes of pre-
5. There is an identifiable psychology faculty, and vention, remediation, and rehabilitation; they may in-
a psychologist is responsible for the program. corporate a variety of psychological modalities, such as
The professional counseling psychologist's doctoral psychotherapy, behavior therapy, marital and family
education and training experience' is defined by the in- therapy, biofeedback techniques, and environmental
stitution offering the program. Only counseling psy- design.
chologists, that is, those who meet the appropriate ed- C. Professional consultation relating to A and B above,
ucation and training requirements, have the minimum for example, in connection with developing in-service
professional qualifications to provide unsupervised coun- training for staff or assisting an educational institution
seling psychological services. A professional counseling or organization to design a plan to cope with persistent
psychologist and others providing counseling psycholog- problems of its students.
ical services under supervision (described below) form
D. Program development services in the areas of A,
an integral part of a multilevel counseling psychological B, and C above, such as assisting a rehabilitation center
service delivery system. to design a career-counseling program.
B. All other persons who proVide counseling psycho-
E. Supervision of all counseling psychological services,
logical services under the supervision of a professional
such as the review of assessment and intervention activ-
counseling psychologist. Although there may be varia-
ities of staff.
tions in tbe ,titles of such persons, tbey are not referred
to as counseling psychologists. Their functions may be F. Evaluation of all services noted in A through E
indicated by use of the adjective psychological preceding above and research for the purpose of their improve-
ment.
the noun, for example, psychological IJ8soclate, psycho-
logical assistant, psychological technfc/4n, or psycho-
logical aide. A coumeljng psycholOgical service unit is the func-
tional unit through which counseling psychological ser-
Counseling psychologkal seroice& refers to services vices are provided; such a unit may be part of a larger
provided by counseling psychologists that apply princi- psychological service organization comprising psychol-
ples, methods, and procedures for facilitating effective ogists of more than one specialty and headed by a profes-
functioning during the life-span developmental pro- sional psychologist:
cess. <.. In providing such services, counseling psychol- A. A counseling psychological service unit provides
ogists approach practice with a Significant emphasis on predominantly counseling psychological services and is
positive aspects of growth and adjustment and with a composed of one or more professional counseling psy-
developmental orientation. These services are intended chologists and supporting staff.
to help persons acquire or alter personal-social skills, B. A counseling psychological service unit may op-
improve adaptability to changing life demands, enhance erate as a functional or geographic component of a larger
environmental coping skills, and develop a variety of multipsychological service unit or of a governmental,
problem-solving and decision-making capabilities. Coun- educational, correctional, health, training, industrial, or
seling psychological services are used by individuals, cou- commercial organizational unit, or it may operate as an
ples, and families of all age groups to cope with problems independent professional service.·
connected with education, career choice, work, sex, mar- C. A counseling psychological service unit may take
riage, family, other social relations, health, aging, and the form of one or more counseling psychologists pr0-
handicaps of a social or physical nature. The services are viding professional servil'e5 in a multidisciplinary setting.
offered in such organizations as educational, rehabilita- D. A counseling psychological service unit may also
tion, and health institutions and in a variety of other take the form of a private practice, composed of one or
publiC and private agencies committed to service in one more counseling psychologists serving individuals or
or more of the problem areas cited above. Counseling groups, or the form of a psychological consulting firm
psychological services include the following: serving organizations and institutions.
Users of counseling psychological sermces include: gist of another specialty or by a professional from an-
A. Direct users or recipients of counseling psycholog- other discipline whose competence in the given area
ical services. has been demonst<ated by premous training and ex-
B. Public and private institutions, facilities, or orga- perience.
nizations receiving counseling psychological services.
C. Third-party purchasers-those who pay for the INTERPRETATION In each counseling psychological ser-
delivery of services but who are not the recipients of vice unit there may be varying levels of responsibility
services. with respect to the nature and quality of services pro-
D. Sanctioners-those who have a legitimate concern vided. Support personnel are considered to be responsible
with the accessibility, timeliness, efficacy, and standards for their functions and behavior when assisting in the
of quality attending the provision of counseling psycho- provision of counseling psychological services and are
logical services. Sanctioners may include members of the accountable to the professional counseling psychologist.
user's family, the court, the probation officer, the school Ultimate professional responsibility and accountability
administrator, the employer, the union representative. for the services provided require that the supervisor re-
the facility director, and so on. Sanctioners may also in- view reports and test protocols, and review and discuss
clude various governmental, peer review, and accredi- intervention plans, strategies, and outcomes. Therefore,
tation bodies concerned with the assurance of quality. the supervision of all counseling psychological services
is provided directly by a profeSSional counseling psy-
chologist in a face-to-face arrangement involving indi-
vidual and/or group supervision. The extent of super-
vision is determined by the needs of the providers, but
Guideline 1
in no event is it less than 1 hour per week for each
PROVIDERS
support staff member providing counseling psychologi-
cal services.
1.1 Each counseling psycholOgical semce unit offering To facilitate the effectiveness of the psychological ser-
psychological semces has available at least one profes- vice unit, the nature of the supervisory relationship is
sional counseling psychologist and as many more communicated to support personnel in writing. Such
professional counseling psychologists as are necessary communications delineate the duties of the employees,
to assure the adequacy and quality of SeTmees offered. describing the range and type of services to be provided.
The limits of independent action and decision making
INTERPRETATION, The intent of this Guideline is that one
are defined. The description of responsibility specifies
or more providers of psychological services in any coun-
the means by which the employee will contact the profes-
seling psychological service unit meet the levels of train-
sional counseling psychologist in the event of emergency
ing and experience of the profeSSional counseling psy-
or crisis situations.
chologist as specified in the preceding definitions.'
When a professional counseling psychologist is not
available on a full-time basis, the facility retains the ser- 1.3 WhereVeT a counseling psychological sermee unit
vices of one or more professional counseling psychologists exists, a professional counseling psychologist is respon-
on a regular part-time basis. The counseling psychologist sible for planning, directing, and reviewing the prom-
so retained directs the psychological services, including sion of counseling psychological sermces. Whenever the
supervision of the support staff, has the authority and counseling plf1Jchological semce unit Is part of a larger
participates sufficiently to assess the need for services, professional psychological sermee encompassing various
reviews the content of services provided, and assumes psychological specialties, a professional psychologist
professional responsibility and accountability for them. shall be the administrative head of the serlJice.
The psychologist directing the service unit is respon-
sible for determining and justifying appropriate ratios INTERPRETATION, The counseling psychologist who di-
of psychologists to users and psychologists to support rects or coordinates the unit is expected to maintain an
staff, in order to ensure proper scope, accessibility, and ongoing or periodic review of the adequacy of services
quality of services provided in that setting. and to formulate plans in accordance with the results 01
such evaluation. He or she coordinates the activities of
1.2 P<OtJiIkrs of counseling psycholOgical services who the counseling psychology unit with other professional,
do not meet the requirements for the professional coun- administrative, and technical groups, both within and
seling psychologist are supemsed directly by a profes- outside the institution or agency. The counseling psy-
sional counseling psychologist who assumes p<ofes- chologist has related responsibilities including, but not
sional responsunlity and accountability for the ser1Jices limited to, directing the training and research activities
prOtJilkd. The level and extent of supemsion may vary of the service, maintaining a high level of professional
from task to task so long as the supervising psychologist and ethical practice, and ensuring that staff members
retains a sufficiently close supervisory relationship to function only within the areas of their competency.
meet this Guideline. Special proficiency training or 8U- To facilitate the effectiveness of counseling services
perlJision may be promded by a profeSSional psycho/o- by raising the level of staff sensitivity and professional
656 ApPENDIXB
skills. the counseling psychologist designated as director with respect to .ubJect matter and profelSlonal .kll"
is responsible for participating in the selection of staff thot apply to doctoral edlJC(Jtion and Iraining in coun·
and support personnel whose quali6cations and skills sellng PlliChology.10
(e.g.• language. cultural and experiential background.
INTERPRETATION, Education of doctoral· level psycholo-
race. sex. and age) are relevant to the needs and cbar-
acteristics of the users served. gists to qualify them for specialty practice in counseling
psychology is under the auspices of a department in a
regionally accredited university or of a professional
1.4 When funclloning tJ8 part of an organizational set·
school that offers the doctoral degree in counseling psy.
ling. professional counseling PI""hologists bring their
backgrounds and .kll" to bear on the goa"
of the or·
chology. Such education is individualized. with due
credit being given for relevant course work and other
ganlzation, whene1ler appropriate. by parljcjpation In
requirements tbat bave previously been satis6ed. In ad·
the planning and development of overaU sertJlces.·
dition. doctoral-level training supervised by a counseling
INTERPRETATION, Professional counseling psychologists psychologist is required. Merely taking an internship In
participate In the maintenance of high professional.tan· counseling psychology or acquiring experience in a prac-
dards by representation on committees Concerned with ticum setting is not adequate preparation for becoming
service deliVery. a counseling psychologist wben prior education has not
As appropriate to the setting. their activities may in· been In tbat area. Ful6l1ment of such an individualized
c1ude active participation. as voting and as of6ee-holding educational program is attested to by tbe awarding of
members. on the facility's professional staff and on other a certificate by the supervising department or profes-
executive. planning. and evaluation boards and com· sional school that indicates the successful completion of
mittees. preparation In counseling psychology.
I.S Counseling PI""hologist. maintain current knowl· I.S ProfelSional counseling psychologist. are encour-
edge of scientific and professional developments to pre. aged to develop innooatlve theories and procedure. and
serve and enhance their professional competence. to provlde appropriate theoretictJI and/or emp/rictJlsup-
port for their Innooatlons.
INTERPRETATION, Methods through which knowledge of
scienti6c and professional developments may be gained INTERPRETATION, A specialty of a profession rooted in
include, but are not limited to, reading scIenti6c and a science intends continually to explore and experiment
professional publications, attendance at professional with a view to developing and verifying new and im-
workshops and meetings, participation in staff devel· proved ways of serving the public and documents tbe
opment programs, and other forms of continuing edu· innovations.
cation.' The counseling psychologist bas ready access to
reference material related to the provision of psycholog·
ical services. Counseling psychologists are prepared to
show evidence periodically that they are staying abreast
of current knowledge and practices in the 6eld of coun· Guideline 2
seling psychology through continuing education. PROGRAMS
1.8 Counseling PI""hologist. limit their pracllce to 1.1 Compoaition and organization of a counseling PI"-
their demonstrated areas of profes_al competence. chologictJI.ervice unit:
INTERPRETATION, Counseling psychological services are
2.1.1 The compoaition and programs of a counseling
offered in accordance with tbe providers' areas of com- PlychoiogictJl seroIce unit are responsive to the need.
petence as de6ned by veri6able training and experience. of the per.ons or settings served.
When extending services beyond the range of their usual
practice, counseling psychologists obtain pertinent train· INTERPRETATION, A counseling psychological service unit
ing or appropriate professional supervision. Such training is structured so as to facilitate effective and economical
or supervision is consistent with the extension of functions delivery of services. For example, a counseling psycho-
performed and services prOVided. An extension of ser- logical service unit serving predominantly a low-income,
vices may involve a cbange in the theoretical orientation ethnic, or racial minority group bas a staf6ng pattern
of the counseling psychologist, in the modality or tech· and service programs that are adapted to the linguistic.
niques used. in the type of client. or In tbe kinds of experiential. and attitudinal characteristics of the users.
problems or disorders for which services are to be pro-
vided.
I.U A description of lhe organization of lhe coun-
.ellng PI""hologictJI service unit and III lines of re-
1.7 Profe._al PI""hologists who WlBh to qualif" III sponsibility and GCCOUntabUit" for the delivery of
counseling Plychologisll meet the lllme requirement. PI!JCh%gic4l.ertJlces ill available in written form to
.taff of the unit and 10 users and sanctioners upon pitals, protection of minors or legal incompetents, dis-
request. criminatory practices in employment selection pr0ce-
dures, recommendation for special education provisions,
INTERPRETATION, The description includes lines of re-
information relative to adverse personnel actions in the
sponsibility, supervisory relationships, and the level and armed services, and adjudication of domestic relations
extent of accountability for each penon who provides disputes in divorce and custodial proceedings. Providers
psychological services. of counseling psychological services take affirmative ac-
tion by making themselves available to local committees
2.1.3 A counseling psychological .ervice unit In- review boards, and similar advisory groups establisheci
cludes suffictent numbers of profe.stonaland support to safeguard the human, civil, and legal rights of service
personnel to achfeoe It. goo/8, obJectllle8, and pur- users.
poses.
INTERPRETATION, The work load and diversity of psy- 2.2.3 All prootders wllhln a counseling psychological
chological services required and the specific goals and service unit are familiar with dnd adhere to the
objectives of the setting determine the numbers and qual- Amerlcan P.ychologlcal Assoctatlon's Standards for
ifications of professional and support personnel in the Providers of Psychological Services, Ethical Principles
counseling psychological service unit. Where shortages of Psychologists, Standards for Educational and Psy-
in personnel exist, so that psychological services cannot chological Tests, Ethical Principles In the Conduct of
he rendered in a professional manner, the director of the Research With Human Participants, and olher offictal
counseling psychological service unit initiates action to policy statement. relet>ant to standards for profes-
remedy such shortages. When this fails, the director ap- stonal.erv1ce8 issued by the AsBOClatlon.
propriately modifies the scope or work load of the unit
INTERPRETATION, Providers of counseling psychological
to maintain the quality of the services rendered and, at
services maintain current knowledge of relevant stan-
the same time, makes continued efforts to devise alter-
dards of the American Psychological Association.
native systems for delivery of services.
2.2.4 All prooitle1'. wllhln a counseling psl/Chological

2.2 Po/tetes:
service unll conform to relet>ant .'atu'es estIJblished
by federal, state, and local governments.
2.2.. 1 when lhe counseling psychological service unil
is composed qf more thon one person or is a com- INTERPRETATION, All providers of counseling psycholog-
ponenl of a larger organl%4tlon, a written stalemenl ical services are familiar with and conform to appro-
of Its obJeclllle8 and scope of services is developed, priate statutes regulating the practice of psychology.
maintained, and reviewed. They also observe agency regulations that have the force
INTERPRETATION, The counseling psychological service of law and that relate to the delivery of psychological
unit reviews its objectives and scope of services annually services (e.g., evaluation for disability retirement and
and revises them as necessary to ensure that the psycho- special education placements). In addition, all providers
logical services offered are consistent with staff com- are cognizant that federal agencies such as the Veterans
petencies and current psychological knowledge and prac- Administration, the Department of Education, and the
tice. This statement is discussed with staff, reviewed with Department of Health and Human Services have policy
statements regarding psychological services. providers
the appropriate administrator, and distributed to users
and sanctioners upon request, whenever appropriate. are familiar as well with other statutes and regulations,
Including those addressed to the civil and legal rights of
users (e.g., those promulgated by the federal Equal Em-
1.2.2 All prootders within a counse/Ing psycholofPcG/ ployment Opportunity Commiasion), that ano pertinent
.ervice unit support the legal and clot! fights of lhe to their scope of practice.
users. 1I It Is the responsibility of the American Psychological
Association to maintain current files of those federal pol-
INTERPRETATION, Providers of counseling psychological
Icies, statutes, and regulations relating to this section and
services safeguard the interests of the users with regard
to assist its members In obtaining them. The state psy-
to personal, legal, and civil rights. They are continually
chological associations and the state licensing boards pe-
sensitive to the issue of confidentiality of information,
riodically publish and distribute appropriate state stat-
the short-term and long-term impacts of their decisions
utes and regulations, and these are on BJe In the
and recommendations, and other matters pertaining to
counseling psychological service unit or the larger mul-
individual, legal, and civil rights. Concerns regarding the
tipsychological service unit of which it Is a part.
safeguarding of individual rights of users Include, but
are not limited to, problems of access to professional
records in educational institutions, self-incrimination in 11.1.& All prooIders within d counseling Psychologlctll
judicial proceedings, involuntary commitment to has- .ervice unit Inform Ihemsellle8 about IJnd use the
658 ApPENDlxB
network of human services in their communities in slanal pract1ces and to the problems presented by the
order to link users with relevant services and re- users.
sources.
INTERPRETATION, A counseling psychologist, alter initial
INTERPRETATION, Counseling psychologists and support assessment, develops a plan describing the objectives of
staff are sensitive to the broader context of human needs. the psycholOgical services and the manner in which they
In recognizing the matrix of personal and social prob- will be provided." To illustrate, the agreement spells out
lems, providers make available to clients information the objective (e.g., a career decision), the method (e.g.,
regarding human services such as legal aid societies, s0- short-term counseling), the roles (e.g., active participa-
cial services, employment agencies, health resources, and tion by the user as well as the provider), and the cost.
educational and recreational facilities. Providers of coun- This plan is in written form. It serves as a basis for ob-
seling psychological services refer to such community taining understanding and concurrence from the user
resources and. when indicated, actively intervene on and for establishing accountability and provides a mech-
behalf of the users. anism for subsequent peer review. This plan is, 01 course,
Community resources include the private as well as modified as changing needs dictate.
the public sectors. Consultation is sought or referral made A counseling psychologist who provides services as one
within the public or private network of services when- member 01 a collaborative effort participates in the de-
ever required in the best interest of the users. Counseling velopment, modification (if needed), and implementa-
psychologists, in either the private or the public setting, tion of the overall service plan and provides for its pe-
utilize other resources in the community whenever in- riodic review.
dicated because of limitations within the psychological
service unit providing the services. Professional coun-
seling psychologists in private practice know the types 2.3.3 Accurate, current, and perUnent documenta-
of services offered through local community mental tion of essentw.l counseling psychological services
health clinics and centers, through family-service, career, prot>kled is maintained.
and placement agencies, and through reading and other
educational improvement centers and know the costs and INTERPRETATION, Records kept of counseling psycholog-
the eligibility requirements for those services. ical services include, but are not limited to, identifying
data, dates of services, types of services, significant ac-
2-2.6 In the delivery of counseling psychologicalser- tions taken. and outcome at termination. Providers of
vice., the providers maintain a cooperative relation- counseling psychological services ensure that essential
ship with colleagues and co-workers in the best in- information concerning services rendered is recorded
terest of the users." within a reasonable time following their completion.
INTERPRETATION. Counseling psychologists recognize the

areas of special competence of other professional psy- 2.3.4 Each counseling psychological service unit fol-
chologists and of professionals in other fields for either 10W8 an e8lablished record retention and disposition
consultation or referral purposes. Providers of counseling policy.
psychological services make appropriate use of other
professional, research, technical, and administrative re- INTERPRETATION, The policy on record retention and
sources to serve the best interests of users and establish disposition conforms to state statutes or federal regula-
and maintain cooperative arrangements with such other tions where such are applicable. In the absence of such
resources as required to meet the needs of users. regulations, the policy is (a) that the full record be main-
tained intact for at least 4 years after the completion of
2.3 Procedure.: planned services or after the date of last contact with the
user, wbichever is later; (b) that if a full record is not
2.3.1 Each counseling psychological service unjt is retained, a summary of the record be maintained lor an
guided by a set of procedural guidelines for the de- additional 3 years; and (c) that the record may be dis-
livery of psychological services. posed of no sooner than 7 years after the completion of
planned services or after the date of last contact, which-
INTERPRETATION, Providers are prepared to provide a ever is later.
statement of procedural guidelines, in either oral or writ- In the event of the death or incapacity of a counseling
ten form, in terms that can be understood by users, in- psychologist in independent practice, special procedures
cluding sanctioners and local administrators. This state- are necessary to ensure the continuity of active service
ment describes the current methods, forms, procedures, to users and the proper safeguarding of records in ac-
and techniques being used to achieve the objectives and cordance with this Guideline. Following approval by the
goals lor psychological services. affected user, It is appropriate for another counseling
psychologist, acting under the auspices 01 the proles-
2.3.2 Prooders of counseling psycholOgical services sional standards review committee (PSRC) of the state,
develop plans appropriate to the prot>klers' profe.- to review the record with the user and recommend a
course of action for continuing professional service, if property of the psychologist or the facility in which the
needed. Depending on local circumstances, appropriate psychologist works and are, therefore, the responsibility
arrangements for record retention and disposition may of the psychologist and subject to his or her control.
also be recommended by the reviewing psychologist. When the user's intention to waive confidentiality is
This Guideline has been designed to meet a variety judged by the professional counseling psychologist to be
of circumstances that may arise, often years after a set contrary to the user's best interests or to be in conflict
of psychological services has been completed. Increas- with the user's civil and legal rights, it is the responsibility
ingly, psychological records are being used in forensic of the counseling psychologist to discuss the implications
matters, for peer review, and in response to requests from of releasing psychological information and to assist the
users, other professionals. and other legitimate parties user in limiting disclosure only to information required
requiring accurate information about the exact dates, by the present circumstance.
nature. course, and outcome of a set of psychological Raw psychological data (e.g., questionnaire returns or
services. The 4-year period for retention of the full record test protocols) in which a user is identified are released
covers the period of either undergraduate or graduate only with the written consent of the user or his or her
study of most students in postsecondary educational in- legal representative and released only to a person rec-
stitutions, and the 7-year period for retention of at least ognized by the counseling psychologist as qualified and
a summary of the record covers the period during which competent to use the data.
a previous user is most likely to return for counseling Any use made of psychological reports, records, or
psychological services in an educational institution or data for research or training purposes is consistent with
other organization or agency. this Guideline. Additionally, providers of counseling psy-
chological services comply with statutory confidentiality
2.3.5 Providers of coonseling psycholOgical services requirements and those embodied in the American Psy-
maintain a system to protect confidentiality of their chological Association's Ethical Principles of Psycholo-
records. 14 gists (APA, 1981b).
Providers of counseling psychological services who use
INTERPRETATION. Counseling psychologists are respon- information about individuals that is stored in large com-
sible for maintaining the confidentiality of information puterized data banks are aware of the possible misuse
about users of services, from whatever source derived, of such data as well as the benefits and take necessary
All persons supervised by counseling psychologists, in- measures to ensure that such information is used in a
cluding nonprofessional personnel and students, who socially responsible manner.
have access to records of psychological services maintain
this confidentiality as a condition of employment and/
or supervision.
The counseling psychologist does not release confi-
dential information, except with the written consent of Guideline 3
the user directly involved or his or her legal represen- ACCOUNTABILITY
tative. The only deviation from this rule is in the event
of clear and imminent danger to. or involving, the user. 3.1 The promotion of human welfare Is the primary
Even after consent for release has been obtained, the prine/pie guiding the professional octiotty of the COUn-
counseling psychologist clearly identifies such informa- seling psychologist and the counseling psychological
tion as confidential to the recipient of the information. 15 service unit.
If directed otherwise by statute or regulations with the
force of law or by court order, the psychologist seeks a INTERPRETATION, Counseling psychologists provide ser-
resolution to the conflict that is both ethically and legally vices to users in a manner that is considerate, effective,
feasible and appropriate. economical, and humane. Counseling psychologists are
Users are informed in advance of any limits in the responsible for making their services readily accessible
setting for maintenance of confidentiality of psycholog- to users in a manner that facilitates the users' freedom
ical information. For instance, counseling psychologists of choice.
in agency clinic, or hospital settings inform their clients
I Counseling psychologists are mindful of their account-
that psychological information in a client's record may ability to the sanctioners of counseling psycbological ser-
be available without the client's written consent to other vices and to the general public, provided that appropriate
members of the professional staff associated with service steps are taken to protect the confidentiality of the service
to the client. Similar limitations on confidentiality of relationship. In the pursuit of their professional activities,
psychological information may be present in certain ed- they aid in the conservation of human, material, and
ucational, industrial. military, or other institutional set- financial resources.
tings, or in instances in which the user has waived con- The counseling psychological service unit does not
fidentiality for purposes of third-party payment. withhold services to a potential client on tbe basis of that
Users have the right to obtain information from their user's race, color, religion, gender. sexual orientation,
psychological records. However, the records are the age, or national origin; nor does it provide services in a
660 ApPENDIXB
discriminatory or exploitative fashion. Counseling psy- support the principle that members of each participating
chologists who find that psychological services are being profeSSion have equal rights and opportunities to share
provided in a manner that is discriminatory or exploit- all privileges and responsibilities of full membership in
ative to users and/or contrary to these Guidelines or to human service facilities and to administer service pro-
state or federal statutes take appropriate corrective ac- grams in their respective areas of competence.
tion, which may include the refusal to provide services.
When conllicts of interest arise, the counseling psychol-
ogist is guided in the resolution of differences by the 3.3 There are periodic, systematic, and effective eval-
principles set forth in the American Psychological As- uations of counseling psychological servfces."
sociation's Ethical Principles of Psychologist. (APA,
INTERPRETATION, When the counseling psychological ser-
1981b) and "Guidelines for Conditions of Employment
vice unit is a component of a larger organization, regular
of Psychologists" (APA, 1972).16
evaluation of progress in achieving goals is provided for
Recognition is given to the following considerations
in the service delivery plan, including consideration of
in regard to the withholding of service: (a) the profes-
the effectiveness of counseling psychological services rel-
sional right of counseling psychologists to limit their
ative to costs in terms of use of time and money and the
practice to a specific category of users with whom they
availability of profeSSional and support personnel.
have achieved demonstrated competence (e.g., adoles-
Evaluation of the counseling psychological service de-
cents or families); (b) the right and responsibility of coun-
livery system is conducted internally and, when possible,
seling psychologists to withhold an assessment procedure
under independent auspices as well. This evaluation in-
when not validly applicable; (c) the right and responsi-
cludes an assessment of effectiveness (to determine what
bility of counseling psychologists to withhold services in
the service unit accomplished), effiCiency (to determine
specific instances in which their own limitations or client
the total costs of providing the services), continuity (to
characteristics might impair the quality of the services;
ensure that the services are appropriately linked to other
(d) the obligation of counseling psychologists to seek to
human services), availability (to determine appropriate
ameliorate through peer review, consultation, or other
levels and distribution of services and personnel), acces-
personal therapeutic procedures those factors that inhibit
sibility (to ensure that the services are barrier free to
the provision of services to particular individuals; and
users), and adequacy (to determine whether the services
(e) the obligation of counseling psychologists who with-
meet the identified needs for such services).
hold services to assist c1ients in obtaining services from
There is a periodic reexamination of review mecha·
other sources,li
nisms to ensure that these attempts at public safeguards
are effective and cost efficient and do not place unnec-
3,2 Counseling psycholOgists pursue their activities as essary encumbrances on the providers or impose unnec-
members of the independent, autonomous profession essary additional expenses on users or sanctioners for ser·
of psychology. ,. vices rendered.
INTERPREHTION· Counseling psychologists, as members
of an independent profession, are responsible both to the 3,4 Counseling psychologists are accountable for all
public and to their peers through established review aspects of the servfces they provide and are responsive
mechanisms. Counseling psychologists are aware of the to those concerned with these services"
implications of their activities for the profession as a
whole. They seek to eliminate discriminatory practices INTERPRETATION· In recognizing their responsibilities to
instituted for self-serving purposes that are nol in the users, sanctioners, third-party purchasers, and other pro-
interest of the users (e.g., arbitrary requirements for re- viders, and where appropriate and consistent with the
ferral and supervision by another profession). They are users' legal rights and privileged communications, coun-
cognizant of their responsibilities for the development seling psychologists make available information about,
of the profession, partiCipate where possible in the train- and provide opportunity to partiCipate in, decisions con·
ing and career development of students and other pro- cerning such issues as initiation, termination, continua·
viders, participate as appropriate in the training of para· tion, modification, and evaluation of counseling psycho-
professionals or other professionals, and integrate and logical services.
supervise the implementation of their contributions Depending on the settings, accurate and full infor-
within the structure established for delivering psycho- mation is made available to prospective individual or
logical services. Counseling psychologists facilitale the organizational users regarding the qualifications of pro-
development of, and participate in, professional stan- viders, the nature and extent of services offered, and
dards review mechanisms,I9 where appropriate, financial and social costs.
Counseling psychologists seek to work with other Where appropriate, counseling psychologists inform
professionals in a cooperative manner for the good of the users of their payment policies and tbeir willingness to
users and the benefit of the general public. Counseling assist in obtaining reimbursement. To assist their users,
psychologists associated with multidisciplinary settings those who accept reimbursement from a third party are
acquainted with the appropriate statutes and regulations, After January 31. 1980. profeSSional psychologists who wish
the procedures for submitting claims, and the limits on to be recognized as professional counseling psychologists are
confidentiality of claims information, in accordance with referred to Cuideline 1.7.
pertinent statutes. .1 The areas of knowledge and training that are a part of the
educational program for all professional psychologists have been
presented in two APA documents, Education and Credential-
ing in Psychology II (APA. 1977a) and Criteria for Accredi-
tation of Doctoral Training Programs and Internships in
Guideline 4 Pro!es:.ional Psychology (APA, 1979). There is conSistency in
the prewntation of core areas in the education and training of
ENVIRONMENT all profeSSional p!oychologists. The description of education and
training in these Guidelines is based primarily on the document
Education and Credenttaling in Psychology 11. It is intended
4.1 Providers of counseling psychological services pro- to indicate broad areas of required curriculum, with the ex-
mote the development in the service setting of a phys- pt>.(·tation that training programs will undoubtedly want to in-
ical, organizational, and social environment that facil- terpret the spt"cific content of theSt" areas in diHerent ways
itates optimal human functioning. dt'pending on the nature. philosophy. and intent of the pro-
~rams.
INTERPRETATION. Federal, state, and local requirements

for safety, health, and sanitation are ohserved. " Functions and activities of counseling psychologists relating
to the teaching of psychology, the writing or editing of scholarly
As providers of services, counseling psychologists are or scientific manuscripts, and the conduct of scientific research
concerned with the environment of their service unit, dn not fall within the purview of theSt" Cuidelines.
especially as it affects the quality of service, but also as
it impinges on human functioning in the larger context. S These definitions should be compared with the APA (1967)
Physical arrangements and organizational policies and guidelines for state legislation (hereinafter referred to as state
procedures are conducive to the human dignity, self-re- gUidelines), which define psychologist (i.e., the generic profes-
sional psychologist, not the specialist counseling psychologist)
spect, and optimal functioning of users and to the ef- and the practice of psychology as follows:
fective delivery of service. Attention is given to the com·
fort and the privacy of providers and users. The A person represents himself [or herself] to be a psychologist
atmosphere in which counseling psychological services when he [or she] holds himself [or herself] out to the public
by any title or description of services incorporating the words
are rendered is appropriate to the service and to the
"psychology,'· "psychological," "psychologist,'· and/or oilers
users, whether in an office, clinic, school, college. uni- to render or renders services as defined below to individuals,
versity, hospital. industrial organization, or other insti- groups, organizations, or the public for a fee, monetary or
tutional setting. otherwise.
The practice of psychology within the meaning of this act
is defined as rendering to indiViduals, groups, organizations,
FOOTNOTES or the public any psychological service involving the appli-
cation of principles, methods, and procedures of understand-
I The footnotes appended to these Specialty Guidelines rep- ing, predicting, and influencing behavior, such as the prin-
resent an attempt to provide a coherent context of other policy ciples pertaining to learning, perception. motivation, thinking,
statements of the Association regarding profeSSional practice. emotions. and interpersonal relationships; the methods and
The Guidelines extend these previous policy statements where procedures of interviewing, counseling. and psychotherapy;
necessary to reflect current concerns of the public and the of constructing, administering, and interpreting tests of men-
profession. tal abilities, aptitudes. interests, attitudes, personality char~
acteristics, emot'ion, and motivation; and of assessing public
2 The fonowing two categories of profeSSional psychologists
opinion.
who met the criteria indicated below on or before the adoption The application of said principles and methods includes,
of these Specialty Guidelines on January 31, 1980, are also con- but is not restricted to: diagnosis, prevention, and ameliora-
sidered counseling psychologists: Category l-persons who tion of adjustment problems and emotional and mental dis-
completed (a) a doctoral degree program primarily psycholog- orders of individuals and groups; hypnosis; educational and
ical in content at a regionally accredited university or profe<i- vocational counseling; personnel selection and management;
sional school and (b) 3 postdoctoral years of appropriate edu- the evaluation and planning for effective work and learning
cation. training. and experience in providing counseling situations; advertising and market research; and the resolution
psychological services as defined herein, including a minimum of interpersonal and social conOicts.
of 1 year in a counseling setting; Category 2-persons who on Psychotherapy within the meaning of this act means the
or before September 4, 1974, (a) completed a master's degree use of learning, conditioning methods, and emotional reac-
from a program primarily psychological in content at a re- tions, in a profeSSional relationship, to assist a person or per-
gionally accredited university or professional school and (b) held sons to modify feelings, attitudes, and behavior which are
a license or certificate in the state in which they practiced, intellectually, SOCially, or emotionally maladjustive or inef-
conferred by a state board of psychological examiners. or the fectual.
endorsement of the state psychological association through vol- The practice of psychology shall be as defined above, any
untary certification. and who, in addition, prior to January 31, exisHng statute in the state of _ _ to the contrary not-
1980, (c) obtained 5 post-master's years of appropriate educa- withstanding. (APA. 1967. pp. 1098-1099)
tion, training, and experience in providing counseling psycho-
logical services as defined herein, including a minimum of 2 f:i The relation of a psychological service unit to a larger fa-
years in a counseling setting. cilityor institution is also addressed indirectly in the APA (1972)
662 ApPENDIXB
"Guidelines for Conditions of Employment of Psychologists" that "this policy statement shan be incorporated in the guide-
(hereinafter referred to as CEP Guidelines). which emphasize lines of the Committee on Accreditation so that appropriate
the roles. responsibilities. and prerogatives of the psychologist sanctions can be brought to bear on university and internship
when he or she is employed by or provides services for another training programs that violate [it]" (Conger. 1976. p. 424).
agency, institution, or business.
"See also APA's (1981bj Ethlcol Principle. of P.ycIw/ogl<ts.
1This Guideline replaces earlier recommendations in the especially Principles 5 (Con6dentiality). 6 (Welfare of the Con-
sumer), and 9 (Research With Human Participants); and see
1967 state guidelines ooncerning exemption of psychologists
from licensure. Recommendations 8 and 9 of those guidelines Ethlcol Principles In lhe Conducl of Re.e4rch Wllh Humsn
read as follows: Parlicl""nt. (APA. 1973a). Also, in 1978 Division 17 approved
in principle a statement on "Principles for Counseli~g and Psy-
Persons employed as psychologists by accredited academic chotherapy With Women," which was designed to protect the
institutions. governmental agencies, research laboratories, and interests of female users of counseling psychological services.
business corporations shoold be exempted. provided such em-
ployees are performing those duties for which they are em- U'Support for this position is found in the section on.relations
ployed by such organizations. and within the confines of such with other professions in Psychology as a ProJeul.on:
organizations.
Persons employed as psychologists by accredited academic Professional persons have an obligation to know and take
institutions, governmental agencies, research laboratories, and into account the traditions and practices of other professional
bwiness corporations consulting or offering their research groups with whom they work and to cooperate fully with
6ndings or providing scientific information to Iflee organi- members of such groups with whom research. service, and
.ations for a fee should be exempted. (APA. 1967. p. 11(0) other functions are shased. (APA. 1968. p. 5)
On the other hand. the 1967 state guidelines speci6cally de- 13 One example of a specific application of this principle is
nied exemptions under certain conditions, as noted in Recom- found in APA's (198la) revised APA/CHAMPUS OutpGtient
mendations 10 and 11: P.yclwlog1c4/ Provider Manual. "'nother example. quoted be-
Persons employed as psychologists who offer or provide low. is found in Guideline 2 in APA', (1973b) "Guidelines for
psychological services to the public for a fee. over and above Psychologists Conducting Growth Groups":
the salary that they receive for the performance of their reg- The following information should be made available In
ular duties. should not be exempted. writing [italics added] to all prospective partiCipants:
Persons employed as psychologists by organizations that (a) An explicit statement of the purpose of the group;
sell psychological services to the public should not be ex- (b) Types of techniques that may be employed;
empted. (AP.... 1967. pp. 1100(1101) (c) The education. training. and experience of the leader
or leaders;
The present AP... policy. as reHected in this Guideline. es-
(d) The fee and any additional expense that may be in-
tablishes a single code of practice for psychologists proViding
curred;
covered services to users in any setting. The present position
(e) A statement as to whether or not a follow-up service
is that a psychologist providing any covered service meets local
statutory requirements for licensure or certification. See the is included in the fee;
(f) Goals of the group experience and techniques to be
section entitled Principles and ImplicatiOns of the Specialty
Guidelines for further elaboration of this point.
used;
(g) ... mounts and kinds of responsibility to be assumed by
.... closely related principle is found in the APA (1972) CEP the leader and by the participants. For example. (I) the degree
to which a participant is free not to follow suggestions and
Guidelines:
prescriptions of the group leader and other group members;
It is the policy of AP... that psychology as an independent (It) any restrictions on a participant's freedom to leave the
profession is entitled to parity with other health and human group at any time; and
service professions in institutional practices and before the (h) Issues of con6dentiality. (p. 933)
law. Psychologists in interdisciplinary settings such as colleges
and universities, medical schools. clinics, private practice "See Principle 5 (Confidentiality) in Elh/col Principle. of
groups, and other agencies expect parity with other profes- Psychologl<ts ("'PA. 198Ib).
sions in such matters as academic rank, board status, salaries,
fringe beneSts., fees. partiCipation in administrative decisions. IS Support for the principles of privileged communication is
and all other conditions of employment, private contractual found in at least two policy statements of the Association:
arrangements. and status before the law and legal institutions.
(AP.... 1972, p. 333) In tbe interest of hoth the public and the client and in
accordance with the requirements of good professional prac-
9 See CEP Guidelines (section entitled Career Development) tice, the profession of psychology seeks recognition of the
for a closely related statement: privileged nature of con6dential communications with clients.
preferably through statutory enactment or by adminbtrative
Psychologists are expected to encourage institutions and polley wbere more appropriate. ("'PA. 1968. p. 8)
agencies which employ them to sponsor or conduct career Wherever possible. a clause protecting the privileged na-
development program. The purpose of these programs would ture of the psychologist-client relationship be included.
be to enable psychologists to engage in study for professional Wben appropriate. psychologists assist in obtsining general
advancement and to keep abreast of developments in their "across the board" legislation for such privileged communi-
6eld. (AP.... 1972. p. 332) cations. (APA. 1967. p. 1103)
11.1 This Guideline follows closely the statement regarding .. The CEP Guidelines include tbe following;
"Policy on Training for Psychologists Wishing to Change Their
Specialty" adopted by the APA Council of Representatives in It is recognized that under certain circumstances, the in-
January 1976. Included therein was the implementing provision terests and goals of a particular community or segment of
interest in the population may be in con8ict with the general give formal recognition to research as a legitimate part of the
welfare. Under such circumstances, the psychologist's profes-- duties of staff members.
sional activity must be primarily guided by the principle of . Only through explicit appraisal of program effects can
"promoting human welfare," (APA. 1972, p. 334) worthy approaches be retained and refined, ineffective ones
dropped. Evaluative monitoring of program achievements
11 This paragraph is adapted in part from the CEP Guidelines may vary, of course, from the relatively informal to the sys-
(APA, 1972, p. 333). tematic and quantitative, depending on the importance of
the issue, the availability of resources, and the willingness of
"Support lor the principle of the independence of psychol- those responsible to take risks of substitlJting informed judg-
ogy as a profession is found in the following: ment for evidence. (Smith & Hobbs, 1966, pp. 21-22)
As a member of an autonomous profession, a psychologist 21 See also the CEP Guidelines for the following statement:
rejects limitations upon his [or her] freedom of thought and .. A psychologist recognizes that . . . he [or she] alone is ac-
action other than those imposed by his [or her] moral, legal, countable for the consequences and effects of his [or her] ser-
and social responsibilities. The Association is always prepared vices, whether as teacher, researcher, or practitioner. This re-
to provide appropriate assistance to any responsible member sponsibility cannot be shared, delegated, or reduced" (APA,
who becomes subjected to unreasonable limitations upon his 1972, p. 334).
[or her) opportunity to function as a practitioner, teacher,
researcher, administrator, or consultant. The Association is
REFERENCES
always prepared to cooperate with any responsible profes-
sional organization in opposing any unreasonable limitatiON American Psychological Association, Committee on Legislation.
on the professional functions of the members of that orga- A model for state legislation affecting the practice of psy-
nization. chology. American P.ychologisl, 1967, 22, 1095-1103.
This insistence upon professional autonomy has been u~ American Psychological Association. Psychology as a profes-
held over the years by rhe affirmative actions of the courts .Jon. Washington, D.C., Author, 1968.
and other public and private bodies in support of the right American Psychological Association. Psychology and national
of the psychologist-and other professionals-to pursue those health care. American P.ychologisl, 1971,26, 1025-1026.
functions for which he [or she] is trained and qualified to American Psychological Association. Guidelines for conditions
perform. (APA, 1968, p. 9) of employment of psychologists. American P.ychologisl,
Organized psychology has the responsibility to define and 1972,27,331-334.
develop its own profession, consistent with the general canons American Psychological Association. Ethical prlndples in the
of science and with the public welfare. conduct of research with hUr1UJn participants. Washington,
Psychologists recognize that other professions and other D.C., Author, 1973. (a)
groups will, from time to time, seek to define the roles and American Psychological Association. Guidelines for psycholo-
responsibilities of psychologists. The APA opposes such de- gists conducting growth groups. American Psychologisl,
velopments on the same principle that it is opposed to the 1973, 28,933. (b)
psychological profession taking positions which would define American Psychological Association. Standards for educatwnal
the work and scope of responsibility of other duly recognized and ".ychologlcal lesl•. Washington, D.C., Author, 1974.
profession. (APA, 1972, p. 333) (a)
American Psychological Association. Standarch Jor provtden
19 APA support for peer review is detailed in the following of ".ychologlcfJl ..me... Washington, D.C., Author, 1974.
excerpt from the APA (1971) statement entitled "Psychology (b)
and National Health Care": American psychological Association. Education and creden-
llallng In psychology 11. Report of a meeting, June 4-5, 1977.
All professions participating in a national health plan Washington, D.C., Author, 1977. (a)
should be directed to establish 'review mechanisms (or per- American Psychological Association. Standards for providen
formance evaluations) that include not only peer review but of psychologlcal service. (Rev. ed.). Washington, D.L Au-
active participation by persons representing the consumer. thor, 1977. (b)
In situations where there are fiscal agents. they should also American Psychological Association. Criteria for accreditation
have representation when appropriate. (p. 1026) of doctoral Iralnlng p1'ograms and Inlernshlps In profes-
sional psychology. Washington, D.C., Author, 1979 (amended
:zo This Guideline on program evaluation is based directly on 1980).
the following excerpts from two APA position papers: American Psychological Association. APAjCHAMPUS oul"..-
t;enl psychologlcfJl p1'outder manual (Rev. ed.). Washington,
The quality and availability of health services should be D.C., Author, 1981. (a)
evaluated continuoU5ly by both consumers and health profes- American Psychological Association. Ethical pnnctples of psy-
sionals. Research into the efficiency and effectiveness of the chologists (Rev. ed.). Washington, D.C., Author, 1981. (b)
system should be conducted both internally and under in-
Conger, J. 1- Proceedings of the American Psychological As-
dependent auspices. (APA, 1971, p. 1025)
sociation, Incorporated, for the year 1975: Minutes of the
The comprehensive community mental health center annual meeting of the Council of Representativ~. Americdn
should devote an explicit portion of its budget to program P.ychologist, 1976,31, 406-434.
evaluation. All centers should inculcate in their staff attention Smith, M. B., 6: Hobbs, N. The community and thecommunUy
to and respect for research findings; the larger centers have mental health center. Washington, D.C.: American Psycho-
an obligation to set a high priority on basic research and to logical Association, 1966.
664 ApPENDIXB
Specialty Guidelines
for the Delivery of Services by
Industrial/ Organizational Psychologists
The Specialty Guidelines that follow are supplements to vices they are not trained to render. It is the intent of
the generic Standards f{JT Providers of Psychological these Guidelines, however, that after the grandparenting
Services, originally adopted by the American Psycho- period, psychologists not put themselves forward as spe-
logical Association (APA) in September 1974·and revised cialists in a given area of practice unless they meet the
in January 1977 (APA, 1974b, 1977). Admission to the qualifications noted in the Guidelines (see Definitions).
practice of psychology is regulated hy state statute. It is Therefore, these Guidelines are meant to apply only to
the position of the Association that licensing be based on those psychologists who voluntarily wish to be designated
generic, and not on specialty, qualifications. Specialty as Industrial / {JTganlzatlonal psychologist•. They do not
guidelines serve the additional purpose of providing p0- apply to other psychologists.
tential users and other interested groups with essential These Guidelines represent the profession's best judg-
information about particular services available from the ment of the conditions, credentials, and experience that
several specialties in professional psychology. Although contribute to competent professional practice. The APA
the original APA Standards were designed to fill the strongly encourages, and plans to participate in, efforts
needs of several classes of psychological practitioners and to identify professional practitioner behaviors and job
a wide variety of users, the diversity of professional prac- functions and to validate the relation between these and
tice and the use of psychological services require spe- desired client outcomes. Thus, future revisions of these
cialty gUidelines to clarify the special nature of both Guidelines will increasingly reflect the results of such
practitioners and users. These Specialty Guidelines for efforts.
the Delivery of Services by Industrial/Organizational Like the APA generic Standards, the I/O Specialty
(I/O) Psychologists are designed to define the roles of Guidelines are concerned with improving the quality,
I/O psychologists and the particular needs of users of 1/ effectiveness, and accessibility of psychological services
o psychological services. for all who require benefit from them. These Specialty
Professional psychology specialties have evolved from Guidelines are intended to clarify questions of interpre-
generic practice in psychology and are supported hy tation of the APA generic Standards as they are applied
university training programs. There are now at least four to I/O psychology.
recognized professional specialties-clinical. counseling, This document presents the APA's position on I/O
school, and industrial! organizational psychology. practice. Ethical standards applicable to I/O psycholo-
The knowledge base in each of these specialty areas gists are already in effect, I as are other documents that
has increased, refining the state of the art to the point provide guidance to I/O practitioners in specific appli-
that a set of uniform specialty guidelines is now possible cations of I/O psychology.' (Note; Footnotes appear at
and desirable. The present Guidelines are intended to the end of the Specialty Guidelines. See p. 669.)
educate the public, the profession, and other interested The Committee on Professional Standards established
parties regarding specialty professional practices. They by the APA in January 1980 is charged with keeping the
are also intended to facilitate the continued systematic generic Standards and the Specialty Guidelines respon-
development of the profession. sive to the needs of the public and the profession. It is
The content of each specialty guideline reflects a con- also charged with continually reviewing, modifying, and
sensus of university faculty and public and private prac-
titioners regarding the knowledge base, services pro-
vided, problems addressed, and clients served. These Specialty Guidelines were prepared through the coop-
Traditionally, all learned disciplines have treated the erative efforts of the APA Committee on Standards for Providers
designation of specialty practice as a reflection of prep- of Psychological Services (COSPOPS), chaired by Durand F.
Jacobs, and the APA Division of Industrial and Organizational
aration in greater depth in a particular subject matter, Psychology (DiviSion 14). Virginia Ellen Schein and Frank
together with a voluntary limiting of focus to a more Friedlander served as the 1/0 representatives on COSPOPS,
restricted area of practice by the professional. Lack of and Arthur Centor and Richard Kilburg served as the Central
specialty designation does not preclude general providers Office liaisons to the committee. Thomas E. Tice and C. J.
Bartlett were the key liaison persons from the Division 14
of psychological services from using the methods or deal- ProfeSSional Affairs Committee. Drafts of these Guidelines were
ing with the populations of any specialty, except insofar reviewed and commented on by members of the Division 14
as psychologists voluntarily refrain from proViding ser- Executive Committee.
SPECIALTY GUIDEUNES FOR THE DEUVERY OF SERVICES 665
extending them progressively as the profession and the eration the capabilities for evaluation and the circum-
science of psychology develop new knowledge, improved stances that prevail in the setting at the time the program
methods, and additional modes of psychological services. or service is evaluated.
The Specialty Guidelines for the Delivery of Services 8. These Guidelines, while assuring the user of the
by Industrial/Organizational Psychologists that follow I/O psychologist's accountability for the nature and qual-
have been established by the APA as a means of self- ity of services rendered, do not preclude the providers
regulation to protect the public interest. They gUide the of I/O psychological services from using new methods
specialty practice of I/O psychology by specifying im- or developing innovative procedures in the delivery of
portant areas of quality assurance and performance that such services.
contribute to the goal of facilitating more effective hu-
man functioning. These Specialty GUipelines have broad implications
both for users of I/O psychological services and for pro-
viders of such services:
Principles and Implications of the Specialty I. Guidelines for I/O psychological services provide
Guidelines a basis for a mutual understanding between provider and
These Specialty Guidelines have emerged from and re- user and facilitate effective evaluation of services pro-
affirm the same basic principles that guided the devel- vided and outcomes achieved.
opment of the generic Standards for PrOlJklers of Psy- 2. Guidelines for I/O psychological services make an
chological Services (APA, 1977): important contribution toward greater uniformity in leg-
I. These Guidelines recognize that where the practice islative and regulatory actions involving I/O psycholo-
of I/O psychology is regulated by federal, state, or local gists. Guidelines for providers of I/O psychological ser-
statutes, all providers of I/O psychological services con- vices may be useful for uniformity in specialty
form to such statutes. credentialing of I/O psychologists, if such specialty cre-
2. A uniform set of Specialty Guidelines governs I/O dentialing is required.
psychological service functions offered by I/O psychol- 3. Although guidelines for I/O psychological services
ogists, regardless of setting or form of remuneration. All may have an impact on tomorrow's training models for
I/O psychologists in professional practice recognize and hoth professional and support personnel in I/O psy-
are responsive to a uniform set of Specialty Guidelines, chology, tbey are not intended to interfere with inno-
just as they are gUided by a common code of ethics. vations in the training of I/O psychologists.
3. The I/O Specialty Guidelines establish clearly ar- 4. Guidelines for I/O psychological services require
ticulated levels of quality for covered I/O psychological continual review and revision.
service functions, regardless of the nature of the users,
purchasers, or sanctioners of such covered services. The Specialty Guidelines bere presented are intended
4. All persons providing I/O psychological services to improve tbe quality and delivery of I/O psychological
meet specified levels of training and experience that are services by specifying criteria for key aspects of tbe prac-
consistent with, and appropriate to, the functions they tice setting. Some settings may require additional and/
perform. Persons providing such services who do not or more stringent criteria for specific areas of service
meet the APA qualifications for a professional I/O psy- delivery.
cholOgist (see Definitions) are supervised by a psychol-
ogist with the requisite training. This level of qualifi- Definitions
cation is necessary to ensure that the public receives
services of high quality. Final responsibility and ac- A fully qualified I/O psychologist has a doctoral degree
countability for services provided rest with professional earned in a program primarily psycholOgical in nature.
I/O psychologists. This degree may be from a department of psychology
5. These Specialty Guidelines for I/O psychologists or from a school of business, management, or adminb-
are intended to present the APA's position on levels for trative science in a regionally accredited university. Con-
training and professional practice and to provide clari- sistent with the commitment of I/O psychology to the
fication of the APA generic Standards. scientist-professional modeL I/O psychologists are thor-
6. A uniform set of Specialty Guidelines governs the oughly prepared in basic scientific methods as well as in
quality of I/O psychological services in both the private psychological science; therefore, programs that do not
and the public sectors. Those receiving I/O psychological include training in basic scientific methods and research
services are protected by the same kinds of safeguards, are not considered appropriate educational and training
irrespective of sector. models for I/O psychologists. The I/O psychology doc-
7. All persons representing themselves as I/O psy- toral program provides training in (a) scientific and
chologists at any time and in any setting. whether public professional ethics, (b) general psychological science, (c)
or private, profit or nonprofit, observe these Guidelines research design and methodology, (d) quantitative and
in order to promote the interests and welfare of the users qualitative methodology, and (e) psychological measure-
of I/O psychological services. Judgment of the degree ment, as well as (f) a supervised practicum or laboratory
to which these Guidelines are observed take into consid- experience in an area of I/O psychology, (g) a field ex-
666 APPENDIxB
perience in the application and delivery of I/O services, F. Design and optimization of work environments.
(h) practice in the conduct of applied research, (i) train- Services include designing work environments and op-
ing in other areas of psychology, in business, and in the timizing person-machine effectiveness.
social and behavioral sciences, as appropriate, and (j)
preparation of a doctoral research dissertation'
Although persons who do not meet all of the above
quali6cations may provide I/O psychological services, Guideline I
such services are performed under the supervision of a PROVIDERS
fully quali6ed I/O psychologist. The supervising I/O
psychologist may he a full-time member of the same
organization or may be retained on a part-time hasis. Staffing and Qualifications of Staff
Psychologists so retained have the authOrity and partic-
ipate suf6ciently to assess the need for services, to review 1.1 ProfeSSional 1/0 psychologist. maintain CIJ"ent
the services provided, and to ensure professional respon- knowledge of ~cientific and profeSSional developments
sibility and accountability for them. Special pro6ciency thot are related to the seraiee. they render.
training or supervision may be provided by professional INTERPRETATION, Methods through which knowledge of
psychologists of other specialties or by professionals of scienti6c and professional development may be gained
other disciplines whose competencies in the given area include, but are not limited to, continuing education,
have been demonstrated by previous training and ex- attendance at workshops, participation in staff devel-
perience. opment, and reading scienti6c publications.
The I/O psychologist has ready access to reference
IndustritJl/organlzational psycholOgical serotces in- material related to the provision of psychological ser-
volve the development and application of psychological vices.
theory and methodology to problems of organizations
and problems of individuals and groups in organizational
1.2 Professional 1/0 psycholOgists limit thelr practice
settings. The purpose of such applications to the assess-
to thelr demonstrated areas of professional competence.
ment, development, or evaluation of individuals, groups,
or organizations is to enhance the effectiveness of these INTERPRETATION· I/O psycholOgical services are offered
individuals, groups, or organizations. The following areas in accordance with the providers' areas of competence
represent some examples of such applications: as de6ned by veri6able training and experience.
A. Selection and placement of employees. Services When extending services beyond the range of their
include development of selection programs, optimal usual practice, professional I/O psychologists obtain per-
placement of key personnel, and early identi6cation of tinent training or appropriate professional supervision.
management potential.
B. Organization development. Services include ana- 1.3 ProfeSSional psycholOgists who wish to chonge thelr
lyzing organizational structure, formulating corporate speclalty to 1/0 areas meet the same requirements with
personnel strategies, maximizing the effectiveness and respect to ..wJect matter and professional skills thot
satisfaction of individuals and work groups, effecting apply to doc!oral training in the new speclalty.
organizationaJ change. and counseling employees for
INTERPRETATION, Education and training of doctoral-
purposes of improving employee relations, personal and
level psychologiSts, when prior preparation has not been
career development. and superior-subordinate relations.
in the I/O area, includes education and training in the
C. Training and development of employees. Services
content, methodology, and practice of I/O psychology.
include identifying training and development needs; for-
Such preparation is individualized and may be acquired
mulating and implementing programs for technical in a number of ways. Formal education in I/O psy-
training. management training. and organizational de-
chology under the auspices of univerSity departments
velopment; and evaluating the effectiveness of training
that offer the doctoral degree in I/O psychology, with
.and development programs in relation to productivity certification by the supervising department indicating
and satisfaction criteria.
competency in I/O psychology, is recommended. How-
D. Personnel research. Services include continuing ever, continuing education courses and workshops in
development of assessment tools for selection, placement, I/O psychology, combined with supervised experience
classi6cation, and promotion of employees; validating as an I/O psychologist. may also he acceptable.
test instruments; and measuring the effect of cultural
factors on test performance.
1.4 Professional 1/0 psychologists are encouraged to
E. Improving employee motivation. Services in-
develop innovative procedures and theory.
clude enhancing the productive output of employees,
identifying and improving factors associated with job INTERPRETATION, Although these Guidelines give ex-
satisfaction, and redesigning jobs to make them more amples of I/O psychologist activities, such activities are
meaningful. not limited to those provided. I/O psychologists are en-
couraged to develop innovative ways of approaching structional or personnel screening uses; interviews, such
problems. as employment or curriculum advisory interviews, that
do not involve the assessment of individual personality
characteristics; the design, administration, and interpre-
tation of opinion surveys; the design and evaluation of
Guideline It person-machine systems; the conduct of employee de-
PROFESSIONAL CONSIDERATIONS velopment programs; the counseling of employees by
supervisors regarding job performance and working re-
lationships; and the teaching of psychological principles
Protecting the User
or techniques that do not involve ameliorative services
2.l 1/0 psychologlcol practice supports the legal and to individuals or groups.
ciml rights of the user.
INTERPRETATION, Providers of I/O psychological services

Planning O1'ganizattonal Goals
safeguard the interests of the user with regard to legal
2.4 Prooiders of I/O psycholOglcol sermces state ex-
and civil rights. I/O psychologists are especially sensitive
plicitly what can and cannot reasonably be expected
to issues of confidentiality of information: In the case of
from the sermces.
dual users (e.g., individuals and organizations), I/O psy-
chologists, insofar as possible, anticipate possible conRicts INTERPRETATION, In marketing psychological services,
of interest and clarify with both users how such conDicts the I/O psychologist realistically appraises the chances
might be resolved. In addition, I/O service providers of meeting the client's goal(s) and informs the client of
make every elfort to safeguard documents and files con- the degree of success that can be anticipated. Since the
taining confidential information. user may or may not possess sophistication in psych.,.
logical methods and applications, the limitations are
2.2 All promders of 1/0 psychologlcolsermces abide by stated in terms that are comprehensible to the user.
policies of the American Psychologlcol Association that In presenting statements of reasonable anticipation,
are releoont to 1/0 psychologists. the I/O psychologist attempts to be accurate in all re-
gards. This guideline also applies to statements of per-
INTERPRETATiON, While many offiCial APA policies are sonal competency and of the competency and experience
relevant to I/O psychology, such as those embodied in of the psychological service unit that the I/O psychologist
the Ethical Principles oj'Psychologists (APA, 1981) and represents. Statements and materials do not make claims
the Standards of Educational and Psychologlcol Tests or suggest benefits that are not supportable by scientif-
(APA, 1974a), it is recognized that some speci6c poliCies ically acceptable evidence. Since the I/O psychologist
which apply only to certain subspecialties (e.g., health may stand to gain 6nancially through the recommen-
care providers) may not be applicable to I/O psychol- dation of a given product or service, particular sensitivity
ogists. to such issues is essential to avoid compromise of profes-
sional responsibilities and objectives.
2.3 All promders UJjthln an I/O psycholOglcol sermce
unit are famtlllJr UJjth releoont statutes, regulations, 11.5 Promders of I/O psychological sermces do not seek
and legal precedents established by federal, state, and to gain competitive adtJantage through the use of priv-
local gO!lemmental groups. Ileged Information.
INTERPRETATION, Insofar as statutes exist relevant to the INTERPRETATION, In the course of work with a user,
practice of the I/O psychological service prOVider, the I/O practitioners may become aware of the management
provider is familiar with them and conforms to the law. practices, organizational structure, personnel policies, or
In addition, the prOVider is familiar with statutes that 6nancial structure of competing units. Since such infor-
may govern activities of the user as they relate to services mation is usually revealed in a privileged context, it is
provided. For example, an I/O psychologist who estab- not employed for competitive advantage. Similarly,
lishes selection systems for a user is aware of and con· practitioners may be called on to review the proposal of
forms to the statutes governing selection systems for that a competing unit. Information so gained is not used to
user. This guideline does not imply that inappropriate gain competitive advantage.
statutes, regulations, and legal precedents cannot be op-
posed through legal processes. 2.6 Prooiders of 1/0 psychologlco/ .ermce. who pur-
Although I/O psychologists may he required by law chase the sermces of another psychologist promde a
to be licensed or certified, most I/O psychological ser-
clear stalement of the role of the purchaser.
vices can be provided by persons who are not licensed
or certi6ed. Examples of such services are the adminis- INTERPRETATION, When an I/O psychological service
tration of standardized group tests of mental abilities, unit purchases the services of another such unit, the pur-
aptitudes, personality characteristics, and so on for in- chasing unit states in advance whether it perceives its
668 ApPENDIXB
role as that of a collaborator, a technical advisor, a sci- quirements and those embodied in the American Psy-
entific monitor, or an informed layperson. The purchaser chological Association's Ethical Princtples of Psy-
clearly de6nes its anticipated role, speci6es the extent clwlogists (APA, 1981).
to which it wishes to be involved in various aspects of Providers of I/O psychological services remain sensi-
program planning and work definition, and describes tive to both the hene6ts and the possible misuse of in-
how differences of opinion on technical and scientific formation regarding individuals that is stored in com-
matters are to be resolved. Members of the staff of both puterized data banks. Providers use their influence to
the unit purchasing services and the unit providing ser- ensure that such information is used in a socially re-
vices are made fully aware of the various role definitions. sponsible manner.
Deferring all major project decisions to the purchaser is
not necessarily considered appropriate in scientific de-
velopment.
Guideline 3
2,7 Proo/ders of I/O psyclwloglcalseroices establish a ACCOUNTABILITY
system to protect confident/lJljjy of their records.
INTERPRETATION· I/O psychologists are responsible for Evaluating I/O PsycholOgical Services
maintaining the confidentiality of information about
users of services, whether obtained by themselves or by 3.1 The professIonal activities of providers of I/O psy-
those they supervise. All persons supervised by I/O psy- clwlOgicalsemces are guIded primarily by the princtple
chologists, including nonprofessional personnel and stu- of promoting human welfare.
dents, who have access to records of psycholOgical ser-
vices are required to maintain this confidentiality as a INTERPRETATION: I/O psychologists do not withhold ser-
condition of employment. vices to a potential client on the basis of race, color,
The I/O psychologist does not release confidential in- religion, sex, age, handicap, or national origin. Recog-
formation, except with the written consent of the user nition is given, however. to the following considerations:
directly involved or the user's legal representative. Even the professional right of I/O psychologists to limit their
after the consent for release has been obtained, the I/O practice to avoid potential conflict of interest (e.g., as
psychologist clearly identifies such information as con- between union and management, plaintiff and defen-
fidential to the recipient of the information. If directed dant, or business competitors); the right and responsi-
otherwise by statute or regulations with the force of law bility of psychologists to withhold a procedure when it
or by court order, the psychologist seeks a resolution to is not validly applicable; the right and responsibility of
the conflict that is both ethically and legally feasible and I/O psychologists to withhold evaluative, diagnostic, or
appropriate. change procedures or other services where they might
Users are informed in advance of any limits in the be ineffective or detrimental to the.achievement of goals
setting for maintenance of confidentiality of psycholog- and fulfillment of needs of individuals or organizations.
ical information. I/O psychologists who find that psychological services
When the user intends to waive confidentiality, the are being provided in a manner that is discriminatory
psychologist discusses the implications of releasing psy- or exploitative to users and/or contrary to these Guide-
chological information and assists the user in limiting lines or to state or federal statutes take appropriate cor-
disclosure only to information required by the present rective action, which may include the refusal to provide
circumstances. services. When conflicts of interest arise, the I/O psy-
Raw psychological data (e.g., test protocols, interview chologist is guided in the resolution of differences by the
notes, or questionnaire returns) in which a user is iden- principles set forth by the American Psychological As-
tified are released only with the written consent of the sociation in the Ethical Princtples of Psyclwlogisfs (APA,
user or the user's legal representative and released only 1981) and the "Guidelines for Conditions of Employ-
to a person recognized by the I/O psychologist as qual- ment of Psychologists" (APA, 1972).
ified and competent to use the data. (Note: The user may
be an individual receiving career counseling, in which 3.2 There are per/odIc, systemaUc, and effect/ve eool-
case individual confidentiality must be maintained, or uat/ons of psychological services.
the user may be an organization, in which case individual
data may be shared with others within the organization. INTERPRETATION Regular assessment of progress in
When individual information is to be shared with others, achieving goals and meeting needs is provided in all
e.g., managers, the individual supplying the information I/O psychological service units. Such assessment includes
is made aware of how this information is to be used.) both the validation of psychological services designed to
Any use made of psychological reports, records, or predict outcomes and the evaluation of psychological
data for research or training purposes is consistent with services designed to induce organizational or individual
this Guideline. Additionally, providers of I/O psycho- change. This evaluation includes consideration of the
logical services comply with statutory confidentiality re- effectiveness of I/O psychological services relative to
costs in terms of use of time and money and the avail- tion, including a minimum of 2 years in an organizational set-
ability of professional and support personnel. ting, and (c) received a license or certificate in the state in which
Evaluation of the efficiency and effectiveness of the they practiced, conferred by a state board of psychological ex-
aminers; Category 2-persons who completed <a) a doctoral
I/O psychological service delivery system is conducted degree from a program primarily psychological in content at
internally and. when possible. under independent aus- a regionally accredited university and (b) 3 postdoctoral years
pices as well. of appropriate education. training. and experience in providing
It is clearly explained to the user that evaluation of 1/0 services as defined herein in the Definitions section, in-
cluding a minimum of 1 year in an organizational setting.
services is a necessary part of providing I/O psycholog-
ical services and that the cost of such evaluation is jus- REFERENCES
tified as part of the cost of services.
American Psychological Association. Guidelines for conditions
of employment of psychologists. American Psyclwloglst.
1972,27.331-1334.
FOOTNOTES American Psychological Association. Standards for eduC6tWnaI
and psychological te.t•. Washington, D.C., Author, 1974.
I See Ethical Princlpl.. of P'ycholOglst. (APA. 1981). (a)
American Psychological Association. Standards for "rovk1ers
• See Principia for the Validation and V.e of Personnel of psychological .emce•. Washington, D.C., Author, 1974.
Selection Procedu... (APA Divi.ion of Industrial and Orga- (b)
nizational Psychology. 1980). American Psychological Association. Standards for ".,ooklers
of psychological .ervIces (Rev. ed.J. Washington, D.C., Au-
:I The following two categories of persons who met the criteria thor, 1977.
indicated below on or before the adoption of these Specialty American Psychological Association. Division of Industrial and
Guidelines on January 31,1980, shall also he considered profes- Organizational Psychology. Principles for the validation and
sional I/O psychologists: Category I-persons who on or before use of personnel ,election procedure. (2nd ed.). Berkeley,
September 4, 1974. (aJ completed a master's degree from a Cali£., Author, 1980. (Copies may he ordered from Lewis E.
program primarily psychological in content at a regionally ac- Albright, Kaiser Aluminum & Chemical Corporation. 300
credited university. (b) completed 5 post-master', yean of ap- Lakeside Drive-Room KB 2140, Oakland, California 94643.)
propriate education, training. and experience in providing I/O American Psychological Association. Elh/c61 principles of psy-
psychological services as defined herein in the Definitions sec- chologist, (Rev. ed.). Washington, D.C., Author, 1981.
670 APPENDIXB

of Services by School Psychologists
The Specialty Guidelines that follow are based on the contribute to competent professional practice. The APA
generic Standards for Proolders of Psychological strongly encourages, and plans to participate in, efforts
Serofces originally adopted by the American Psycholog- to identify professional practitioner behaviors and job
ical Association (APA) in September 1974 and revised functions and to validate the relation between these and
in January 1977 (APA, 1974b, 1977b). Together with the desired client outcomes. Thus, future revisions of these
generic Standards, these Specialty Guidelines state the Guidelines will increasingly re8ect the results of such
official policy of the Association regarding delivery of efforts.
services by school psychologists. Admission to tbe prac- These Guidelines follow tbe format and, wherever
tice of psychology is regulated by state statute. It is the applicable, the wording of the generic Standards.' (Note:
position of the Association that licensing he based on Footnotes appear at the end of the Specialty Guidelines.
generic, and not on specialty, qualifications. Specialty See pp. 67~1.) The intent of these Guidelines is to
guidelines serve the additional purpose of providing p0- improve the quality, effectiveness, and accessibility of
tential users and other interested groups with essential psychological services. They are meant to provide guid-
information about particular services available from the ance to proViders, users and sanctioners regarding the
several specialties in professional psychology. best jndgment of the profession on these matters. Al-
Professional psychology specialties have evolved from though the Specialty Guidelines have been derived from
generic practice in psychology and are supported by and are consistent with the generic Standards, they may
university training programs. There are now at least four be used as a separate document. Standards fm- Proo/den
recognized professional specialties---<!linical, counseling, of Psychological Seroices (APA, 1977h), however, shall
school, and industrial/organizational psychology. remain the hasic policy statement and shall take pre-
The knowledge base In each of these specialty areas cedence where there are questions of interpretation.
has increased, refining the state of the art to the point Professional psychology in general and school psy-
that a set of uniform Specialty guidelines is now possible chology in particular have had a long and difficult history
and desirable. The present Guidelines are intended to of attempts to establish criteria for determining guide-
educate the public, the profession, and other interested lines for the delivery of services. In school psychology,
parties regarding specialty professional practices. They state departments of education have traditionally had a
are also intended to facilitate the continued systematic strong in8uence on the content of programs required for
development of the profession. certification and on minimum competency levels for
The content of each Specialty Guideline reOects a con- practice, leading to wide variations in requirements
sensus of university faculty and public and private prac- among the many states. These national Guidelines will
titioners regarding the knowledge base, services provided, reduce confusion, clarify important dimensions of spe-
problems addressed, and clients served. cialty practice, and provide a common basis for peer
Traditionally, all learned disciplines have treated the review of school psychologists' performance.
designation of specialty practice as a re8ection of prep- The Committee on Professional Standards established
aration in greater depth in a particular subject matter, by the APA in January 1980 i. charged with keeping the
together with a voluntary limiting of focus to a more generic Standards and the Specialty Guidelines respon-
restricted area of practice by the professional. Lack of
of psychological services from using tbe methods or deal- These Specialty Guidelines were prepared through the coop-
erative efforts of the APA Committee on Standards for Providers
ing with the populations of any specialty, except insofar of Psychologiesl Services (COSPOPS) and the APA Professional
as psychologists voluntarily refrain from providing ser- Affairs Committee of the Division of School Psychology (Di-
vices they are not trained to render. It is tbe intent of vision 16). Jack I. Bardon .nd Nadine M. Lambert served as
these Guidelines, however, that after the grandparenting the school psychology representatives of COSPOPS, and Arthur
Centor and Richard Kilburg were the Central Office liaiso...
period, psychologists not put themselves forward as ape-
to the committee. Durand F. Jacobs served as chair of COS-
c14lists in a given area of practice unless they meet the pops, and Walter B. Pryzwansky chaired the Division 16 com-
qualifications noted in the Guidelines (see Definitions). mittee. Drafts of the school psychology Guidelines were re-
Therefore, these Guidelines are meant to apply only to viewed and commented on by memben of the EJ:ecutive
those psychologists who wish to be designated as school Committee of Division 16, representstives of the National As-
sociation of School Psychologists, state departments of educa-
psychologist•. They do not apply to other psychologists. tion, consultsnts in school psychology, and many professional
These Guidelines represent the profession's best judg- school psychologists in training programs and in practice in the
ment of the conditions, credentials, and experience that schools.
sive to the needs of the public and the profession. It is quality of services specified in this document, do not
also charged with continually reviewing, modifying, and preclude the school psychologist from using new methods
extending them progressively as the profession and the or developing innovative procedures for the delivery of
science of psychology develop new knowledge, improved school psychological services.
methods. and additional modes of psychological services.
The Specialty Guidelines for the Delivery of Ser- These Specialty Guidelines for school psychology have
vices by School Psychologists ha ve been established by broad implications both for users of school psychological
the APA as a means of self-regulation to protect the services and for providers of such services:
public interest. They gUide the specialty practice of I. Guidelines for school psychological services provide
school psychology by specifying important areas of qual- a foundation for mutual understanding between provider
ity assurance and performance that contribute to the goal and user and facilitate more effective evaluation of ser-
of facilitating more effective human functioning. vices provided and outcomes achieved.
2. Guidelines for school psychological services are es-
sential for uniformity of regulation by state departments
Principles and Implications of the Specialty of education and other regulatory or legislative agencies
GUidelines concerned with the provision of school psychological ser-
vices. In addition, they provide the basis for state ap-
These Specialty Guidelines have emerged from and re- proval of training programs and for the development of
affirm the same basic principles that guided the devel- accreditation procedures for schools and other facilities
opment of the generic Standards for Providers of Psy- providing school psychological services.
cholOgical Services (APA, 1977b), 3. Guidelines give specific content to the profession's
I. These Guidelines recognize that admission to the concept of ethical practice as it applies to the functions
practice of school psychology is regulated by state statute. of school psychologists.
2. It is the intention of the APA that the generic Stan- 4. Guidelines for school psychological services have
dards provide appropriate guidelines for statutory li- significant impact on tomorrow's education and training
cenSing of psychologists. In addition, although it is the models for both professional and support personnel in
position of the APA that licensing be generic and not in school psychology.
specialty areas, these Specialty Guidelines in school psy- 5. Guidelines for the provision of school psychological
chology should provide an authoritative reference for use services influence the determination of acceptable struc-
in credentialing specialty providers of school psycholog- ture, budgeting, and staffing patterns in schools and other
ical services by such groups as divisions of the APA and facilities using these services.
state associations and by boards and agencies that find 6. Guidelines for school psychological services require
such criteria useful for quality assurance. continual review and revision.
3. A uniform set of Specialty Guidelines governs
school psychological service functions offered by school The Specialty Guidelines presented here are intended
psychologists, regardless of setting or source of remu- to improve the quality and the delivery of school psy-
neration. All school psychologists in professional practice chological services by specifying criteria for key aspects
recOgnize and are responsive to a uniform set of Specialty of the service setting. Some school settings may require
Guidelines, just as they are guided by a common code additional and/or more stringent criteria for specific
of ethics. areas of service delivery.
4. School psychology Guidelines establish clearly ar- Systematically applied, these Guidelines serve to es-
ticulated levels of training and experience that are con- tablish a more effective and consistent basis for evalu-
sistent with, and appropriate to, the functions performed, ating the performance of individual service providers as
School psychological services provided by persons who well as to guide the organization of school psychological
do not meet the APA qualifications for a professional service units.
school psychologist (see Definitions) are to be supervised
by a professional school psychologist. Final responsibility Definitions
and accountability for services provided rest with profes-
sional school psychologists. Providers of school psychological services refers to two
5. A uniform set of Specialty Guidelines governs the categories of persons who provide school psychological
quality of services to all users of school psychological services:
services in both the private and the public sectors. Those A. Professional school psychologists.'" Professional
receiving school psychological services are protected by school psychologists have a doctoral degree from a re-
the same kinds of safeguards, irrespective of sector; these gionally accredited university or professional school pro-
include constitutional guarantees, statutory regulation, viding an organized, sequential school psychology pro-
peer review, consultation, record review, and staff su- gram in a department of psychology in a university or
pervision. college, in an appropriate department of a school of ed-
6. These Guidelines, while assuring the user of the ucation or other similar administrative organization, or
school psychologist's accountability for the nature and in a unit of a professional school. School psychology pro-
672 ApPENDIXB
grams that are accredited by the American Psychological cation, for the protection and promotion of mental health
Association are recogoized as meeting the definition of and the facilitation of learning:'
a school psychology program. School psychology pro- A. Psychological and psychoeducational evaluation
grams that are not accredited by the American Psycho- and assessment of the school functioning of children and
logical Association meet the definition of a school psy- young persons. Procedures include screening, psycholog-
chology program if they satisfy the following criteria: ical and educational tests (particularly individual psy-
1. The program is primarily psychological in nature chological tests of intellectual functioning, cognitive de-
and stands as a recognizable, coherent organizational velopment, affective behavior, and neuropsychological
entity within the institution. status), interviews, observation, and behavioral evalua-
2. The program provides an integrated, organized tions, with explicit regard for the context and setting in
sequence of study. which the professional judgments based on assessment,
3. The program h.. an identifiable body of students diagnosis, and evaluation will be used.
who are matriculated in that program for a degree. B. Interventions to facilitate the functioning of indi-
4. There is a clear authority with primary respon- viduals or groups, with concern for how schooling influ-
sibility for the core and specialty areas, whether or not ences and is influenced by their cognitive, conative, af-
the program cuts across administrative lines. fective, and social development. Such interventions may
5. There is an identifiable psychology faculty, and include, but are not limited to, recommending, planning,
a psychologist is responsible for the program. and evaluating special education services; psychoedu-
Patterns of education and training in school psychol- cational therapy; counseling; affective educational pro-
ogy' are consistent with the functions to be performed grams; and training programs to improve coping skills·
and the services to be provided, in accordance with the C. Interventions to facilitate the educational services
ages, populations, and problems found in the various and child care functions of school personnel, parents, and
schools and other settings in which school psychologists community agencies. Such interventions may include,
are employed. The program of study includes a core of but are not limited to, in-service school-personnel edu-
academic experience, both didactic and experiential, in cation programs, parent education programs, and parent
basic areas of psychology, includes education related to counseling.
the practice of the specialty, and provides training in D. Consultation and collaboration with school person-
assessment, intervention, consultation, research, program nel and/or parents concerning specific school-related
development, and supervision, with special emphasis on problems of students and tbe professional problems of
school-related problems or school settings.' staff. Such services may include, but are not limited to,
Professional school psychologists who wish to represent assistance with the planning of educational programs
themselves as proficient in specific applications of school from a psychological perspective; consultation with
psychology that are not already part of their training are teachers and other school personnel to enhance their
required to have further academic training and super- understanding of the needs of particular pupils; modi-
vised experience in those areas of practice. fication of classroom instructional programs to facilitate
B. All other persons who offer school psychological children's learning; promotion of a positive climate for
services under the supervision of a school psychologist. learning and teaching; assistance to parents to enable
Although there may be variations in the titles and job them to contribute to their children's development and
descriptions of such persons, they are not called school school adjustment; and other staff development activi-
psychologists. Their functions may be indicated by use ties.
of the adjective psychological preceding the noun. E. Program development services to individual schools,
1. A speciali81 in school psychology has successfully to school administrative systems, and to community
completed at least 2 years of graduate education in school agencies in such areas as needs assessment and evaluation
psychology and a training program that includes at least of regular and special education programs; liaison with
1,000 hours of experience supervised by a professional community. state, and federal agencies concerning the
school psychologist, of which at least 500 hours must be mental health and educational needs of children; coor-
in school settings. A specialist in school psychology pro- dination, administration, and planning of specialized
vides psychological services under the supervision of a educational programs; the generation, collection. orga·
professional school psychologist.· nization, and dissemination of information from psycho-
2. Titles for others who provide school psycholog- logical research and theory to educate staff and parents.
ical services under the supervision of a professional school F. Supervision of school psychological services (see
psychologist may include school psychological examiner, Guideline 1.2, Interpretation).
school psychological lechnician, school psychological
assi8lanl, school psychomelri8I, or school psychomelric A school psychological service unil is the functional
assi8lanl. unit through which school psychological services are pro-
vided; any such unit has at least one profeSSional school
School psychological serotces refers to one or more of psychologist associated with it:
the following services offered to clients involved in ed- A. Such a unit provides school psychological services
ucational settings, from preschool through higher edu- to individuals, a school system, a district, a community
agency, or a corporation, or to a consortium of school INTERPRETATION, The intent of this Guideline is that one
systems, districts. community agencies. or corporations or more proViders of psychological services in any school
that contract together to employ providers of school psy- psychological service unit meet the levels of training and
chological services. A school psychological service unit experience of the professional school psychologist spec-
is composed of one or more profeSSional school psy- ified in the preceding definitions.
chologists and, in most instances, supporting psycholog- When a professional school psychologist is not avail-
ical services staff. able on a full-time hasis to proVide school psychological
B. A school psychological service unit may operate as services, the school district obtains the services of a
an independent professional service to schools or as a profeSSional school psychologist on a regular part-time
functional component of an administrative organiza- hasis. Yearly contracts are desirable to ensure continuity
tional unit, such as a state department of education, a of services dUring a school year. The school psychologist
public or private school system, or a community mental so retained directs the psychological services, supervises
health agency. the psychological services provided by support personnel,
e. One or more professional school psychologists pro- and participates sufficiently to be able to assess the need
viding school psychological services in an interdisciplin- for services, review the content of services prOVided, and
ary or a multidisciplinary setting constitute a school psy- assume professional responsibility and accountability for
cholOgical service unit. them. A professional school psychologist supervises no
D. A school psychological service unit may also be one more than the equivalent of 15 full-time specialists in
or more professional psychologists offering services in school psychology and/or other school psychological per-
private practice, in a school psychological consulting sonnel.
firm, or in a college- or university-hased facility or pro- Districts that do not have easy access to professional
gram that contracts to offer school psychological services school psychologists because of geographic considera-
to individuals, groups, school systems, districts, or cor- tions, or because professional school psychologists do not
porations. live or work in the area employ at least one full-time
specialist in school psychology and as many more support
Users of school psycholOgical services include: personnel as are necessary to assure the adequacy and
A. Direct users or recipients of school psychological quality of services. The following strategies may be con-
services, such as pupils. instructional and administrative sidered to acquire the necessary supervisory services
school staff members, and parents. from a professional school psychologist:
B. Public and private institutions, facilities, or orga- A. Employment by a county, region, consortium of
nizations receiving school psychological services, such as schools, or state department of education of full-time
boards of education of public or private schools, mental supervisory personnel in school psychology who meet
health facilities, and other community agencies and ed- appropriate levels of training and experience, as speci-
ucational institutions for handicapped or exceptional fied in the definitions, to visit school districts regularly
children. for supervision of psychological services staff.
C. Third-party purchasers-those who pay for the B. Employment of profeSSional school psychologists
delivery of services but who are not the recipients of who engage in independent practice for the purpose of
services. providing supervision to school district psychological ser-
D. Sanctioners-such as those who have a legitimate vices staff.
concern with the accessibility, timeliness, efficacy, and e. Arrangements with nearby school districts that em-
standards of quality attending the provision of school ploy professional school psychologists for part-time em-
psychological services. Sanctioners may include members ployment of such personnel on a contract hasis specifi-
oj the useis family, the court, the prohation officer, the ca\ly for the purpose of supervision as described in
school administrator, the employer, the facility director, Guideline I.
and 50 on. Sanctioners may also include various govern- The school psychologist directing the school psycho-
mental, peer review, and accreditation bodies concerned. logical service unit, whether on a full- or part-time hasis,
with the assurance of quality. is responsible for determining and justifying appropriate
ratios of school psychol~gists to users, to specialists in
school psychology, and to support personnel, in order to
ensure proper scope, accessibility, and quality of services
Guideline I provided in that setting. The school psychologist reports
PROVIDERS to the appropriate school district representatives any
findings regarding the need to modify psychological ser-
1.1 Each school psycholOgiCal service unIt offering vices or staf6ng patterns to assure the adequacy and
school psychological services has avaIlable at least one quality of services offered.
professional school psychologist and as many additional
professlanalschool psychologists and support personnel
as are necessary 10 assure Ihe adequacy and quallly of 1.2 Providers of school psychologiCal services who do
services offered. nol meel the requirements for the professional school
674 ApPENDlxB
psychologist are supervised directly by a professional director or coordinator of the school psychological ser-
school psychologist who assumes professional respon- vices and is supervised by a professional school psy-
sibility and accountability for the serotces pracided. The chologist employed on a part-time basis, for a minimum
level and extent of superotsion may oary from task to of 2 hours per week.
task so long as the supervising psychologist retains a
sufficiently close supervisory relationship to meet this 1.4 When functioning as part of an organizationalset-
Guideline. Special proficiency training or supervision ting, professional school psychologists bring their back-
may be pracided by a professional psychologist of an- grounds and skills to bear on the goals of the organi-
other specialty or by a professional from another dis- zation, whenever appropriate, by participating in the
cipline whose competency in the given area has been planning and development of overall serotces.
demonstrated'
INTERPRETATION Professional school psychologists par-
INTERPRETATION: Professional responsibility and ac-
ticipate in the maintenance of high professional stan-
countability for the services provided require that the
dards by serving as representatives on, or consultants to,
supervisor review reports and test protocols; review and
committees and boards concerned with service delivery,
discuss intervention strategies, plans, and outcomes;
especially when such committees deal with special ed-
maintain a comprehensive view of the school's proce-
ucation, pupil personnel services, mental health aspects
dures and special concerns~ and have sufficient oppor-
of schooling, or other services that use or involve school
tunity to discuss discrepancies among the views of the
psychological knowledge and skills.
supervisor. the supervised, and other school personnel on
As appropriate to the setting, school psychologists' ac-
any problem or issue. In order to meet this Guideline,
tivities may include active participation, as voting and
an appropriate number of hours per week are devoted
as office-holding members, on the facility's executive,
to direct face-ta-face supervision of each full-time school
planning. and evaluation boards and committees.
psychological service staff member. In no event is this
supervision less than one hour per week for each staff
member. The more comprehensive the psychological ser- 1.5 School psychologists maintain current knowledge
vices are, the more supervision is needed. A plan or for- of scientific and professional developments to preserve
mula for relating increasing amounts of supervisory time and enhance their professional competence.
to the complexity of professional responsibilities is to be INTERPRETATION Methods through which knowledge of
developed. The amount and nature of supervision is spec-
scientific and professional developments may be gained
ified in writing to all parties concerned.
include, but are not limited to. (a) the reading or prep-
aration of scientific and professional publications and
1.3 Wherever a school psychological serotce unit exists, other materials, (b) attendance at workshops and pre-
a professional school psychologist is responsible for sentations at meetings and conventions, (c) participation
planning, directing, and remewing the provision of in on-the-job staff development programs, and (d) other
school psychological sermces. forms of continuing education. The school psychologist
INTERPRETATION, A school psychologist coordinates the and staff have available reference material and journals
activities of the school psychological service unit with related to the provision of school psychological services.
other professionals, administrators, and community School psychologists are prepared to show evidence pe-
groups, both within and outside the school. This school riodically that they are staying abreast of current knowl-
psychologist, who may be the director, coordinator, or edge in the Seld of school psychology and are also keep-
supervisor of the school psychological service unit, has ing their certification and licensing credentials up-to-
related responsibilities including, but not limited to, re- date.
cruiting qualified staff, directing training and research
activities of the service, maintaining a high level of 1.6 School psychologists limit their practice to thetr
professional and ethical practice, and ensuring that staff demonstrated areas of professional competence.
members function only within the areas of their com-
petency. INTERPRETATION: School psychological services are of·
To facilitate the effectiveness of services by raising the fered in accordance with the providers' areas of com·
level of staff sensitivity and professional skills, the psy- petence as defined by verifiable training and experience.
chologist deSignated as director is responsible for partic- When extending services beyond the range of their usual
ipating in the selection of staff and support personnel practice, school psychologists obtain pertinent training
whose qualifications are directly relevant to the needs or appropriate professional supervision. Such training or
and characteristics of the users served. supervision is consistent with the extension of functions
In the event that a professional school psychologist is performed and services provided. An extension of ser-
employed by the school psychological service unit on a vices may involve a change in the theoretical orientation
basis that affords him or her insufficient time to carry of the practitioner, in the techniques used, in the client
out full responsibility for coordinating or directing the age group (e.g., children, adolescents, or parents), or in
unit, a specialist in school psychology is designated as the kinds of problems addressed (e.g., mental retardation,
neurological impairment, learning disabilities, family erence groups are utilized in the practice of school psy-
relationships). chology.
1.7 Psychologists who wish to qualify as school psy- 2,\.2 A description of the organiZl.ltion of the school
chologists meet the same requirements with respect to psychological service unit and its lines of responsi-
subject matter and professional skills that apply to doc- bility and accountability for the delivery of school
toral training in school psychology. I. psychologlcal services is available in written form to
instructional and administrative staff of the unit and
INTERPRETATION Education of psychologists to qualify to parents, students, and members of the community.
them for specialty practice in school psychology is under
INTERPRETATION The description includes lines of re-
the auspices of a department in a regionally accredited
sponsibility, supervisory relationships, and the level and
university or of a professional school that offers the doc-
extent of accountability for each person who provides
toral degree in school psychology, through campus- and/
school psychological services.
or field-based arrangements. Such education is individ-
ualized. with due credit being given for relevant course
2,1,3 A school psychologlcal service unit includes suf-
work and other requirements that have previously been
ficient numbers of professional and support person-
satisfied. In addition to the doctoral-level education spec-
nel to achieve its goals, objectives, and purposes.
ified above, appropriate doctoral-level training is re-
quired. An internship or experience in a school setting INTERPRETATION· A school psychological service unit in-
is not adequate preparation for becoming a school psy- cludes one or more professional school psychologists, spe-
chologist when prior education has not been in that area. cialists in school psychology, and other psychological ser-
Fulfillment of such an individualized training program vices support personnel. When a professional school
is attested to by the awarding of a certificate by the psychologist is not available to provide services on a full-
supervising department or professional school that in- or part-time baSis, the school psychological services are
dicates the successful completion of preparation in school conducted by a specialist in school psychology, super-
psychology. vised by a professional school psychologist (see
Guideline 1.2).
1.8 ProfeSSional school psychologists are encouraged to The work load and diversity of school psychological
services required and the specific goals and objectives of
develop innovative theories and procedures and to pro-
the setting determine the numbers and qualifications of
vide appropriate theoret/cal and/or empirical support
professional and support personnel in the school psycho-
for their innovations.
logical service unit. For example, the extent to which
INTERPRETATION, A specialty of a profession rooted in services involve case study, direct intervention, and/or
science intends continually to explore, study, and con- consultation will be significant in any service plan. Case
duct research with a view to developing and verifying study frequently involves teacher and/or parent confer-
new and improved methods of serving the school pop- ences, observations of pupils, and a multi-assessment re-
ulation in ways that can be documented. view, including student interviews. Similarly, the target
populations for services affect the range of services that
can be offered. One school psychologist, or one specialist
in school psychology under supervision, for every 2,000
pupils is considered appropriate. I I
Guideline 2 Where shortages in personnel exist, so that school psy-
PROGRAMS chological services cannot be rendered in a professional
manner, the director of the school psychological service
2.1 Composition and organization of a school psycho- unit informs the supervisor/administrator of the service
10glcal service unit: about the implications of the shortage and initiates action
to remedy the situation. When this fails, the director
2,1,1 The composition and programs of a school psy- appropriately modifies the scope or work load of the unit
chalOgiCal service unit are responsive to the needs of to maintain the quality of services rendered.
the school population that is served.
2,2 Policies:
INTERPRETATION: A school psychological service unit is
structured so as to facilitate effective and economical
2,2,1 When the school psycholOgiCal service unit is
delivery of services. For example, a school psychological
composed of more than one person or is a component
of a larger organization, a written statement of its
service unit serving predominantly low-income, ethnic,
objectives and scope of services is developed, main-
or racial minority children has a staffing pattern and
service programs that are adapted to the linguistic, ex- tained, and reviewed.
periential, and attitudinal characteristics of the users. INTERPRETATION, The school psychological service unit
Appropriate types of assessment materials and norm ref- reviews its objectives and scope of services annually and
676 APPENDlxB
revises them as necessary to ensure that the school psy- quirements and other agency regulations that have the
chological services offered are consistent with staff com- force 01 law and that relate to the delivery 01 school
petencies and current psychological knowledge and prac- psychological services (e.g.. certi6cation of. eligibility
tice. This statement is discussed with staff, reviewed by for, and placement in, special education programs). In
the appropriate administrators, distributed to instruc- addition, all providers are cognizant that lederal agencies
tional and administrative staff and school board mem- such as the Department of Education and the Depart-
bers, and when appropriate. made available to parents. ment of Health and Human Services have policy state-
students, and members 01 the community upon request. ments regarding psychological services. Providers of
school psychological services are familiar as well with
1l.1l.2 All providers within a school psychologiCal ser- other statutes and regulations, including those addressed
""'e unit support the legal and civil rights of the to the civil and legal rights of users (e.g., Public Law 94·
USets. lt 142, The Education for All Handicapped Children Act
of 1975). that are pertinent to their scope of practice.
INTERPRETATION, Providers of school psychological ser- It is the responsibility 01 the American Psychological
vices safeguard the interests 01 school personnel, students. Association to maintain 61es 01 those lederal policies,
and parents with regard to personal, legal. and civil statutes, and regulations relating to this section and to
rights. They are continually sensitive to the issue 01 con- assist its members in obtaining them. The state psycho-
6dentialityof inlormation. the short-term and long-term logical associations, school psychological associations, and
impacts of their decisions and recommendations. and state licensing boards periodically publish and distribute
other matters pertaining to individual, legal, and civil appropriate state statutes and regulations.
rights. Concerns regarding the saleguarding 01 individ-
ual rights 01 school personnel, students, and parents in- 2.2.5 All prOviders within a school psycholOgical ser-
clude, but are not limited to. due-process rights 01 parents vice unit inform themselves about and use the net-
and children, problems of sell-incrimination in judicial work of human services in their commun/ties in order
proceedings, involuntary commitment to hospitals. child to link users with relevant services and resources.
abuse, Ireedom 01 choice, protection 01 minors or legal
INTERPRETATION, School psychologists and support staff
incompetents, discriminatory practices in identi6cation
are sensitive to the broader context of human needs. In
and placement, recommendations lor special education
recognizing the matrix of personal and societal problems,
.provisions, and adjudication 01 domestic relations dis-
providen; make available to clients information regard-
putes in divorce and custodial proceedings. Providers 01
ing human services such as legal aid societies. social ser-
school psychological services take al6rmative action by
vices, health resources like mental health centers, private
making themselves available to local committees, review
practitioners, and educational and recreationallacilities.
boards, and similar advisory groups established to safe-
School psychological staff formulate and maintain a file
guard the human, civil. and legal rights of children and
of such resources for reference. The speci6c information
parents.
provided is such that users can easily make contact with
the services and freedom of choice can be honored. Pro-
2.2.3 All providers within a school psychological ser-
viders of school psychological services refer to such com-
oIce unit are familiar with and adhere to the Amer-
munity resources and, when indicated, actively intervene
ican PsychologiCal Association's Standards lor Pro-
on hehalf of the users. School psychologists seek oppor-
viders of Psychological Services. Ethical Principles of
tunities to serve on boards of community agencies in
Psychologists, Standards for Educational and Psycho-
order to represent the needs of the school population in
logical Tests. Ethical Principles in the Conduct of Re-
the community.
search With Human Participants, and other official
policy statements relevant to standards for profes- 2.2.6 In the delivery of school psychological services,
sionalserolces issued by the Association. providers maintain a cooperative relationship with
colleagues and co-workers in the best interest of the
INTERPRETATION A copy of each 01 these documents is mers.
maintained by providers of school psychological services
and is available upon request to all school personnel and INTERPRETATION. School psychologists recognize the
officials. parents. members of the community, and where areas of special competence of other psychologists and
applicable. students and other sanctioners. of other professionals in the school and in the community
for either consultation or referral purposes (e.g.• school
2.2.4 All providers within a school psycholOgical ser· social workers, speech therapists, remedial reading teach-
""'e unit conform to relevant statutes established by ers, special education teachers, pediatricians. neurolo-
federal, state, and local gooemments. gists, and public health nurses). Providers of school psy-
chological services make appropriate use of other
INTERPRETATION All providers of school psychological professional. research, technical, and administrative re-
services are lamiliar with and conlorm to appropriate sources whenever these serve the best interests of the
statutes regulating the practice of psychology. They also school staff, children. and parents and establish and
are inlormed about state department 01 education re- maintain cooperative and/or collaborative arrangements
with such other resources as required to meet the needs are maintained separately from the child's cumulative
of users. record folder. Once a case study is completed and/or an
intervention begun, records are reviewed and updated
2.3 Procedures: at least monthly.
2.3.1 A school psychological sermce unit follows a set
of procedural guidelines for the delivery of school 2.3.4 Each school psychological seroices unit fol-
psychological sermces. lows an established record retention and disposition
policy.
INTERPRETATION. The school psychological service staff
is prepared to provide a statement of procedural guide- INTERPRETATION. The policy on maintenance and review
lines in written form in terms that can be understood by of psychological records (including the length of time
school staff, parents, school board members, interested that records not already part of school records are to be
members of the community, and when appropriate, stu· kept) is developed by the local school psychological ser-
dents and other sanctioners. The statement describes the vice unit. This policy is consistent with existing federal
current methods, forms, case study and assessment pr<r and state statutes and regulations.
cedures, estimated time lines, interventions, and evalu-
ation techniques being used to achieve the objectives and
2.3.5 Provjders of school psychological .ermce. main-
goals for school psychological services.
tain a system to protect confidentiality of their rec-
This statement is communicated to school staff and
ords.
personnel, school board members, parents, and when
appropriate, students or other sanctioners through what- INTERPRETATION. School psychologists are responsible for
ever means are feasible, including in-service activities, maintaining the confidentiality of information about
conferences, oral presentations, and dissemination of users of services, from whatever source derived. All per-
written materials. sons supervised by school psychologists, including non-
The school psychological service unit provides for the professional personnel and students, who have access to
annual review of its procedures for the delivery of school records of psychological services maintain this confiden-
psychological services. tiality as a condition of employment. All appropriate
staff receive training regarding the confidentiality of
2.3.2 Providers of school psycholOgical seroices de- records.
velop plans awroprlate to the providers' profesBional Users are informed in advance of any limits for main-
practices and to the' problems pre.ented by the users. tenance of confidentiality of psychological information.
There Is a mutually acceptable understandtng be- Procedures for obtaining informed consent are devel-
tween provjders and school staff, parents, and .tu- oped by the school psychological service unit. Written
dots or responsible agents regarding the goals and informed consent is obtained to conduct assessment or
the delivery of seroices. to carry out psychological intervention services. Inform-
INTERPRETATION. The school psychological service unit ing users of the manner in which requests for information
notifies the school unit in writing of the plan that is will be handled and of the school personnel who will
adopted for use and resolves any points of difference. share the results is part of tbe process of obtaining con-
The plan .includes written consent of guardians of stu- sent.
dents and, when appropriate, consent of students for the The school psychologist conforms to current laws and
services provided. Similarly, the nature of tbe assessment regulations with respect to the release of confidential
tools that are to be used and the reasons for their inclusion information. As a general rule. however, the school psy-
are spelled out. The objectives of intervention(s) of a chologist does not release confidential information, e.-
psychological nature as well as the procedures for im- cept with the written consent of the parent or, where
plementing the intervention(s) are specified. An estimate appropriate. the student directly involved or his or her
of time is noted where appropriate. Parents and/or stu- legal representative. Even after consent for release has
dents are made aware of the various decisions that can been obtained, the school psychologist clearly identifies
be made as a result of the service(s), participate in ac- such information as confidential to the recipient of the
counting for decisions that are made, and are ioformed information. When there is a connict with a statute, with
of how appeals may be instituted. regulations with the force of law, or with a court order,
the school psychologist seeks a resolution to the conBict
that is both ethically and legally feasible and appropriate.
2.3_3 Accurate, current, and pertinent documenta- Providers of school psychological services ensure that
tion of essential school psychological sermces pro-
psychological reports which will become part of the
vided Is maintained.
school records are reviewed carefully so that confiden-
INTERPRETATION. Records kept of psychological services tiality of pupils and parents is protected. When the
may include, but are not limited.. to, identifying data, guardian or student intends to waive confidentiality, the
dates of services, names of providers of services, types school psychologist discusses the implications of releasing
of services, and Significant actions taken. These records psychological information and assists the user in limiting
678 ApPENDIXB
disclosure to only that information required by the pres- that employers can make decisions regarding their em-
ent circumstance. ployment. assignment of their duties. and so on; (b) the
Raw psychological data (e.g.• test protocols, counseling right and responsibility of school psychologists to with-
or interview notes, or questionnaires) in which a user is hold an assessment procedure when not validly appli-
identified are released only with the written consent of cable; (c) the right and responsibility of school psy-
the user or his or her legal representative. or by court chologists to withhold evaluative. psychotherapeutic.
order when such material is not covered by legal con- counseling. or other services in specific instances in which
fidentiality. and are released only to a person recognized their own limitations or client characteristics might im-
by the school psychologist as competent to use the data. pair the effectiveness of the relationship; and (d) the
Any use made of psychological reports. records, or obligation of school psychologists to seek to ameliorate
data for research or training purposes is consistent with through peer review. consultation. or other personal ther-
this Guideline. Additionally. providers of school psycho- apeutic procedures those factors that inhibit the provision
logical services comply with statutory confidentiality re- of services to particular users. In such instances. it is
quirements and those embodied in the American Psy- incumbent on school psychologists to advise clients about
chological Association's Ethical Principles of Psy- appropriate alternative services. When appropriate ser-
chologists (APA. 1981). vices are not available. school psychologists inform the
Providers of school psychological services remain sen- school district administration and/or other sanctioners
sitive to both the benefits and the possible misuse of of the unmet needs of clients In all instances. school
information regarding individuals that is stored in large psychologists make available information. and provide
computerized data banks. Providers use their in8uence opportunity to participate in decisions. concerning such
to ensure that such information is managed in a socially issues as initiation. termination. continuation, modifica-
responsible manner. tion. and evaluation of psychological services. These
Guidelines are also made available upon request.
Accurate and full information is mad" available to
prospective individual or organizational users regarding
the qualifications of providers. the nature and extent of
Guideline 3 services offered. and where appropriate. the financial
ACCOUNTABILITY costs as well as the benefits and possible risks of the pro-
posed services.
3.1 The promotion of human welfaTe Is the primary Professional school psychologists offering services for
princjple guiding the professional acjlt1ity of the school a fee inform users of their payment policies, if applicable.
psychologist and the schoof psychoiog/cQl service unIt. and of their willingness to assist in obtaining reimburse-
ment when such services have been contracted for as an
INTERPRETATION, School psychological services staff pro- external resource.
vide services to school staff members. students. and par-
ents in a manner that is considerate and effective. 3.2 School psychologists pursue thetr acjlt>ltle. as mem-
School psychologists make their services readily ac- ber. of the Independent. autonomous profe83ion of psy-
cessible to users in a manner that facilitates the users' chology.'·
freedom of choice. Parents. students. and other users are
made aware that psychological services may be available INTERPRETATION, School psychologists are aware of the
through other public or private sources. and relevant implications of their activities for the profession of psy-
information for exercising such options is provided upon chology as a whole. They seek to eliminate discrimina-
request. tory practices instituted for self-serving purposes that are
School psychologists are mindful of their accountabil- not in the interest of the users (e.g.. arbitrary require-
ity to the administration. to the school board. and to the ments for referral and supervision by another profession)
general public. provided that appropriate steps are taken and to discourage misuse of psychological concepts and
to protect the confidentiality of the service relationship. tools (e.g.• use of psychological instruments for special
In the pursuit of their professional activities. they aid in education placement by school personnel or others who
the conservation of human. material. and financial re- lack relevant and adequate education and training).
sources. School psychologists are cognizant of their responsibilities
The school psychological service unit does not with- for the development of the profession and for the im-
hold services to children or parents on the basis of the provement of schools. They participate where possible
users' race. color. religion. gender. sexual orientation. in the training and career development of students and
age. or national origin. Recognition is' given. however. other providers; they participate as appropriate In the
to the follOWing considerations: (a) the professional right training of school administrators. teachers, and parapro-
of school psychologists. at the time of their employment. fessionals; and they integrate. and supervise the imple-
to state that they wish to limit their services to a specific mentation of. their contributions within the structure
category of users (e.g., elementary school children. ex- established for delivering school psychological services.
ceptional children. adolescents). noting their reasons so Where appropriate. they facilitate the development of.
and participate in, professional standards review mech- Guideline 4

anisms. ENVIRONMENT
School psychologists seek to work with other profes-
sionals in a cooperative manner for the good of the users
and the benefit of the general public. School psychologists 4.1 Providers of psycholOgical services pronwte devel-
associated with special education or mental health teams opment in the school setUng of a physical, organiza-
or with multidisciplinary settings support the principle tianal, and social enVironment that facilitates optimal
that members of each participating profession have equal human functioning.
rights and opportunities to share all privileges and re- INTERPRETATION· Federal, state, and local requirements
sponsibilities of full membership in the educational or for safety, health, and sanitation are observed.
human service activities or facilities and to administer As providers of services. school psychologists are con-
service programs in their respective areas of competence. cerned with the environment of their service units, es-
(Refer also to Guideline 2.2.5, Interpretation.) pecially as it affects the quality of service, but also as
it impinges on human functioning in the school. Atten-
tion is given to the privacy and comfort of school staff,
3,3 There are periodic, systematic, and effective eval- students, and parents. Parent and staff interviews are
uations of sclwol psychological services. conducted in a professional atmosphere, with the option
for private conferences available. Students are seen under
INTERPRETATION· When the psychological service unit conditions that maximize their privacy and enhance the
representing school psychology is a component of a larger possibility for meaningful intervention; for example,
organization (e.g., school system, county or state regional
they should have the opportunity to leave their classroom
district, state department of education), regular evalu- inconspicuously and should be free from interruptions
ation of progress in achieving goals is provided for in the when meeting with the psychologist. Physical arrange-
service delivery plan, including consideration of the ef- ments and organizational policies and procedures are
fectiveness of school psychological services relative to conducive to the human dignity, self-respect, and opti-
costs in terms of use of time and money and the avail- mal functioning of school staff, students, and parents and
ability of professional and support personnel. to the effective delivery of service.
Evaluation of the school psychological service delivery
system is conducted internally and, when possible, under
independent auspices as well. This evaluation includes
an assessment of effectiveness (to determine what the FOOTNOTES
service unit accomplished), efficiency (to determine the
costs of providing the services), continuity (to ensure that 'The footnotes appended 10 these Specialty Guidelines rep-
resent an attempt to provide a coherent context of earlier APA
the services are appropriately linked to other educational policy statements and other documents regarding professional
services), availability (to determine the appropriateness practice. The Guidelines extend these previous policy state-
of staffing ratios), accessibility (to ensure that the services ments where necessary to reBeet current concerns of the public
are readily available to members of the school popula- and the profession.
tion), and adequacy (to determine whether the services
I There are three categories of individuals who do not meet
meet the identified needs of the school population). the definition of professional school p<ychologist but who can
It is highly desirable that there be a periodic reex- be considered professional school psychologisls if they meet
amination of review mechanisms to ensure that these certain criterta.
attempts at public safeguards are effective and cost ef- The folloWing two categories of professional psychologists
ficient and do not place unnecessary encumbrances on who met the criteria indicated below on or before the adoption
of these Specialty Guidelines on January 31, 1980, are consid-
the providers or impose unnecessary expenses on users ered prolessionalschooll"'ychologists: Category I-those who
or sanctioners for services I'endered. completed (a) a doctoral degree program primarily psycholog-
ical in content. but not in school psychology, at a regionally
accredited univenity or professional school and (b) 3 postdoc-
toral yean of appropriate education, training, and experience
3.4 School psychologist. are accountable for all aspect. in providing school psychological services as defined herein,
of the services they prooide and are respanslve to those including a minimum of 1,200 hours in school settings; Category
concerned with the.e services. 2-those who on or before September 4, 1974, (a) completed
a master's degree (rom a program primarily psychological in
content at a regionally accredited university or professional
INTERPRETATION, In recognizing their responsibilities to
school and (b) held a license or certificate in the state in which
users, sanctioners, and other providers, and where ap- they practiced, conferred by • state board of psychological ex-
propriate and consistent with the users' legal rights and aminers. or the endorsement of 8 state psychological association
privileged communications, school psychologists make through voluntary certification, and who, in addition, prior to
available information about, and provide opportunity to lanusry 31, 1980, (c) obtained 5 post-master's years of appro-
priate education, training. and experience in providing school
participate in. decisions conCerning such issues as initi- psychological services as defined herein, including a minimum
ation, tennination. continuation, modification. and eval- of 2.400 hours in school settings.
uation of school psychological services. After lanuary 31, 1980, professional psychologists who wish
680 ApPENDIXB
to be recognized as professional school psychologists are referred peetation that training programs will undoubtedly want to in-
to Guideline 1.7. terpret the speeific content of these areas in different ways
The APA Council of Representatives passed a "Resolution on depending on the nature, philosophy, and intent of the pro-
the Master's-Levellssue" in January 1977 containing the fol- grams.
lowing statement. which influenced the development of a third
category of professiooal school psychologist" S Although specialty education and training guidelines have
not yet been developed and approved by APA, the foDowing
The title "Professional Psychologist" has heen used so description of education and training components of school
widely and by persons with such a wide variety of training psychology programs represents a consensus regarding specialty
and experience that it does not provide the information the training in school psychology at this time.
public deserves, The edlJCtltlon of school psychologists encompasses the equiv-
As a consequence, the APA takes the position and makes alent of at least 3 rears of full-time graduate academic study.
it a part of its policy that the use of the title "Professional While instructiona formats and course titles may vary from
Psychologist," and its variations such as "Clinical Psycholo-- program to program, each program has didactic and experi-
gist," "Counseling Psychologist," "School Psychologist," and ential instruction (a) in scientific and professional areas com-
"Indwtrial Psychologist"· are reserved for those who have mon to all professional psychology programs, such as ethics and
completed 8 Doctoral Training Program in Psychology in a standards, research design and methodology, statistics, and psy-
university, college, or professional school of psychology that chometric methods, and (b) in such substantive areas as the
is APA or regionally accredited. In order to meet this stan- biological bases of behavior, the cognitive and affective bases
dard. a transition period will be acknowledged for the use of behavior, the social, cultural, ethnic, and sex role bases of
of the title "School Psychologist," so that ways may he sought behavior, and individual differences. Course work includes s0-
to increase opportunities for doctoral training and to improve cial and philosophical bases of education, curriculum theory
the level of educational codes pertaining to the title, (Conger, and practice, etiology of learning and behavior disorders, ex-
1977, p, 426) ceptional children, and special education. Organization theory
and administrative practice should also be included in the pro-
For the purpose of transition. then. there is still another cat- gram. This list is not intended to dictate specific courses or a
egory of persons who can he considered professional school sequence of instruction. It is the responsibility of programs to
psychologists for practice in elementary and secondary schools. determine how these areas are organized and presented to stu-
Category 3 consists of persons who meet the following criteria dents. Variations in educational format are to be expected.
on or before, but not beyond, January 31, 1985, (a) a master's The training of school psychologists includes practicum and
or higher degree, requiring at least 2 years of full-time graduate field experience in conjunction with the educational program.
stndy in school psychology, from a regionally accredited uni- In addition, the program includes a supervised internship ex-
venity or professional school; (b) at [east 3 additional yean of perience beyond practicum and 6eld work, equivalent to at
training and experience in school psychological services. in- least 1 academic school year, but in no event fewer than 1,200
cluding a minimum of 1,200 hours in school settings; and (c) hours, in schools or in a combination of schools and community
a license or certi6cate conferred by a state board of psycholog- agencies and centers. with at least 600 hours of the internship
ical examiners or a state educational agency for practice in in the school setting. An appropriate number of hours per week
elementary or secondary schools. should be devoted to direct face-to-face supervision of each
Preparation equivalent to that described. in Category 3 en- intern. In no event is there less than 1 hour per week of direct
tities an individual to use the title profe.sional school psychol- supervision. Overall professional supervision is provided by a
ogtst in school practice, but it does not exempt the Individual professional school psychologist. However, supervision in spe-
from meeting the requirements of licensure or other require- d6c procedures and techniques may be provided by others,
ments for which a doctoral degree is prerequisite. with the agreement of the supervising professional psychologist
and the supervisee. The training experiences provided and the
, A professional school psychologist who is licensed by a state
competencies developed occur in settings in which there are
or District of Columbia board of examiners of psychology for
opportunities to work with children, teachers, and parents and
the independent practice of psychology and who has 2 yean
to supervise others providing psychological services to children.
of supervised (or equivalent) experience in health services, of
which at least 1 year is postdoctoral, may be listed as a "Health 6 In order to implement these Specialty Guidelines, it will be
Service Provider in Psychology" in the National Hegg,n oj necessary to determine in each state which non-doctoral-level
Health Service Prouiderr in Psychology, school psychologists certified by the state department of edu-
cation are eligible to he considered profesalonal school psy-
A Health Service Provider in Psychology is de6ned as a
chologists for practice in elementary and secondary schools. A
psychologist, certified/licensed at the independent practice
national register of all professional school psychologists and spe-
level in his/her state, who is duly trained and experienced
cialists in school psychology would be a useful and efficient
in the delivery of direct, preventive, assessment and thera-
means by which to inform the public of the available school
peutic intervention services to individuals whose growth, ad-
psychological services personnel.
justment, or functioning is actually impaired or is demon-
strably at high risk of impairment. (Council for the National 1 Functions and activities of school psychologists relating to
Register of Health Service Providers in Psychology, 1980, the teaching of psychology, the writing or editing of scholarly
p, xi) or scientiDc manuscripts, and the conduct of scientific research
do not fall within the purview of these Guidelines.
4 The areas of knowledge and training that are a part of the
educational program for all professional psychologists have been 'Nothing in these Guidelines precludes the school psychol-
presented in two APA documents, EduC4tfon and Credentlal- ogist from being trained beyond the areas described herein {e.g.,
ing in Psychology 1/ (APA, 1977a) and CrlterltJ for Accredi- in psychotherapy for children, adolescents. and their families
tation of Doctoral Training Programs and Internships in in relation to school-related functioning and problems) and,
Professtonal Psychology (APA, 1979), There i. consistency in therefore, from providing services on the basis of this training
the presentation of core areas in the education and training of to clients as appropriate.
all professional psychologist' The description of education and
training in these Guidelines is based primarily on the document II In some states, a supervisor's certi6cate is required in order
EdlJCtltlon and Cretknttaling In Psychology 1/, It is intended to use the title 8Upervtsor in the public schools. Supervision of
to indicate broad areas of required curriculum, with the ex- providers of psychological services by a professional school psy~
chologist does not mean that the school psychologist is thereby sional organization in opposing any unreasonable limitations
authorized or entitled to offer supervision to other school per- on the professional functions of the members of that orga-
sonnel. Supervision by the school psychologist is con6ned to nization.
those areas appropriate to his or her training and educational This insistence upon profeSSional autonomy has been up-
background and is viewed as part of the school psychologist's held over the years by the affirmative actions of the courts
professional responsibilities and duties and other public and private lxxlies in support of the right
The following guidellne for supervision has been written by of the psychologist-and other professionals-to pursue those
the Executive Committee of the Division of School Psychology: functions for which he [or she] is trained and qualified to
perform. (AP .... 1966. p. 9)
In addition to heing a professional school psychologist. the
person who supervises school psychological services and/or Organized psychology has the responsibility to define and
school psychological personnel shall have the following qual- develop its own profession, consistent with the general canons
m.cations: broad undentanding of diagnostic assessment. COR- of science and with the public welfare.
sultation, programming, and other intervention strategies; Psychologists recognize that other professions and other
skills In supervision; the ability to empathize with supervisee" groups will, from time to time, seek to define the roles and
and commitment to continuing educati.on. The supervising responsibilities of psychologists. The APA opposes such de-
school psychologist also sball have had the equivalent of at velopments on the same principle that it is opposed to the
least 2 years of satisfactory full-time. on-the-job experience psychological profession taking positions which would define
as a school psychOlogist practicing directly In the school or the work and scope of responsibility of other duly recognized
deallng with school-related problems in independent prac- professions. ("'PA. 1972. p. 333)
tice.
REFERENCES
,. This Guideline follows closely the statement regarding
"Policy on Training for Psychologists Wishing to Change Their American Psychological Association. Psychology .. a profeo-
Specialty" adopted by the APA Council of Representatives in lion. Washington. D.C.: "'uthor. 1968.
January 1976. Included therein was the implementing provision American Psychological Association. Guidelines for conditions
that "this polley statement shall he incorporated in the guide- of employment of psychologists. Amerlcan Psyclwlopl.
lines of the Committee on Accreditation 50 that appropriate 1972, 27. 331-334.
sanctions can be brought to bear on university and internship American Psychological Association. Ethical prindpks In the
training programs that violate [it)" (Conger. 1976. p. 424). conducl of ,o.eorch wllh humon pa,ljcjpanls. Washington.
D.C.: Author. 1973.
" Two surveys of school psychological practice provide a ra- ...merican Psychological ...ssociation. Standa,ds for educalional
tionale for the speci&catlon of this Guideline (Farling & Hoedt. and psychological lolls. Washington. D.G: ... uthor. 1974.
1971; Kicklighter. 1976). The median ratios of psychologists to (a)
pupils were 1 to 9.000 in 1966 and 1 to 4.000 in 1974. Those American Psychological Association. Standards for provUlers
responding to Klcklighter's survey projected that the ratio of of psyclwlog/cal ,ervIce•. Washington. D.C.: Author, 1974.
psychologists to pupils would he 1 to 2.500 in 1980. These data (b)
were collected before the passage of Public Law 94-142. the American Psychological Association. Education and creden-
Education for All Handicapped Children ...ct of 1975. The reg- llalingln psyclwlogy 11. Report 01 a meeting. June 4-5.1977.
ulations for implementing this act require extensive identifi- Washington. D.G: Author. 1977. (a)
cation. assessment, and evaluation services to children, and it American Psychological Association. Standards for prootder8
is reasonable in 1981 to set an acceptable ratio of psychologists of psyclwlog/cal.ervices (Rev. ed.). Washington. D.C.: "'u-
to pupils at 1 to 2.000. thor. 1977. (b)
American Psychological Association. Criteria for accreditation
"See also Elhlcal Pnnclples of P.yclwlopl. ("'PA. 1961). of docloral I,ainlng programs and Inlem.hlps in profe.-
especially Principles 5 (Con8dentiality), 6 (Welfare of the Con- aionaI psychology. Washington. D.C.: Author. 1979 (amended
sumer). and 9 (Research With Human Participants). and Elhlcal 1980).
Pnndp/es In lhe Conducl of lleBeorch With HUmBn Partjcj- American Psychological Association. Elhlcal pnndple. of psy-
panl. (APA. 1973). Also. in 1978 Division 17 approved in prin- elwlopts (Rev. ed.). Washington. D.C.: Author. 1961.
ciple a statement on "Principles for Counseling and Psycho- Conger. J. j. Proceedings of the American Psychological .....
therapy With Women." which was designed to protect the seciation. Incorporated, for the year 1975: Minutes of the
interests of female users of counseling psychological services. annual meeting of the Council of Representatives. American
Psycholopl. 1976. 31. 406-434.
13 Support for the principle of the independence of psychol- Conger, J. j. Proceedings of the American Psychological As-
ogy as a profession is found in the following: sociation, Incorporated, for the year 1976: Minutes of the
annual' meeting of the Council of Representatives. American
As a member of an autonomous profession. a psychologist P.yclwlopt. 1977. 32. 408-438.
rejects limitations upon his [or her) freedom of thought and Council for the National Register of Health Service Providers
action other than those imposed by his [or her) mora!; legal. in Psychology. NatIonal ,eple, of heallh .ervice proWl."
and social responsibilities. The Association is always prepared in psychology. Washington. D.C.: Author. 1980.
to provide appropriate assistance to any responsible member Farling. W. H .• & Hoedt. K. C. National.urvey of .ehool psy-
who becomes subjected to unreasonable limitations upon his elwlopl•. Washington. D.C.: Department 01 Health. Edu-
[or her) opportunity to function as a practitioner. teacher, cation, and Welfare, 1971.
researcher, administrator. or consultant. The Association is Kicklighter. R. H. School psychology in the U.S.: A quantitative
always prepared to cooperate with any responsible profes- survey. Journal of School P.yclwlogy. 1976. 14. 151-156.
APPENDIX C
Ethical Principles of Psychologists

PREAMBLE ethnic. socioeconomic. or other social groups. In pub-
lishing reports of their work. they never suppress dis-
Psychologists reSJHlcl the dignity and worth of the In- confirming data. and they acknowledge the existence of
dividual and strive for the preservation and protection alternative hypotheses and explanations of their findings.
of fundamental human rights. They are committed to Psychologists take credit only for work they have actually
Increasing Imowledge of human behavior and of peo- done.
ple's understanding of themselves and others and to b. Psychologists clarify in advance with all appropri-
the utllizalion of such Imowledge for the promatlon of ate persons and agencies the expectations for sharing and
human welfare. While pursuing these objectives, they utilizing research data. They avoid relationships that may
make every effort to protect the welfare of those who limit their objectivity or create a conOiel of interest. In-
seek their serolces and of the research participants thai terference with the milieu in which data are collected
may be lhe object of study. They use their skills only is kept to a minimum.
for purpases consistent with these values and da not c. Psychologists have the responsibility to attempt to
/mowIngly permit their misuse by others. While de- prevent distortion. misuse. or suppression of psycholog-
manding for themselves freedam of inquiry and com- ical findings by the institution or agency of which they
munication. psychologists accept the responsibility this are employees.
freedom requires: competence. objectivity In the appll- d. As members of governmental or other organiza-
calion of skills. and concern for lhe best Interests of tional bodies. psychologists r.emain accountable as indi-
clients. colleagues. student•• research participants. and viduals to the highest standards of their profession.
society. In the pursuit of these Ideals. psychologists sub- e. As teachers. psychologists recognize their primary
scribe to principles In the following areas: 1. Respon- obligation to help others acquire knowledge and skill.
sibillty.2. Competence. 3. Moral and Legal Standards. They maintain high standards of scholarship by pre-
4. Pub/Ic Statements. 5. Confidentiality. 6. Welfare of senting psychological information objectively. fully. and
the Consumer. 7. Professional Relationships. B. Assess- accurately.
ment Techniques, 9. Research With Human Partici- f. As practitioners. psychologists know that they bear
pants. and 10. Care and Use of Animals. a heavy social responsibility because their recommen-
Acceptance of membership in the American Psycho- dations and professional actions may alter the lives of
logical Association commits the member to adherence others. They are alert to personal. social. organizational.
to these principles. financial. or political situations and pressures that might
Psychologists cooperate with duly constituted com- lead to misuse of their inOuence.
mittees of the American Psychological Association. in
particular. the Committee on Scientific and Profes-
This version of the Ethical Principles 01 Psychologists (formerly
sional Ethics and Conduct. by responding to inquiries entitled Ethical Standards of Psychologists) was adopted by the
prompt/y and completely. Members also respond American Psychological Association's Council of Representa-
prompt/y and completely to inquiries from duly con- tives on January 24. 1981. The revised Ethical Principles contain
stituted state association ethics commillees and profes- both substantive and grammatical changes in each of the nine
ethical principles constituting the Ethical Standards 01 Psy-
slanalstandards review committees.
chologiSts previously adopted by the Council of Representatives
in 1979. plus a new tenth principle entitled Care and Use of
Principle I Animals. Inqutrie5 concerning the Ethical Principles of Psy-
RESPONSIBILITY chologists should be addressed to the Administrative Of6cer for
Ethics. American Psychological Association. 1200 Seventeenth
In providing serolces. psycholOgists maintain the high- Street. N.W .• Washington, D,C. 20036.
est standards of their profession. They accept respon- These revised Ethical Principles apply to psychologists, to
students of psychology. and to others who do work 01 a psy-
sibility for the consequences of their acts and make chological nature under the supervision of a psychologist. They
every effort to ensure that their services are used ap- are also intended for the guidance of nonmemben of the As-
propriately. sociation who are engaged in psychological research or practice.
a. As scientists, psychologists accept responsibility for Any complaints of unethical conduct Bled after January 2-«.
1981. shali be governed by this 1981 revision. However. conduct
the selection of their research topics and the methods (a) complained about after January 24. 1981. but which 0c-
used in investigation. analysis, and reporting. They plan curred prior to that date. and (b) not considered unethical under
their research in ways to minimize the possibility that prior versions of the principles but considered unethical under
their findings will be misleading. They provide thorough the 1981 revision. shali not be deemed a violation 01 ethical
principles. Any complaints pending as of January 2-«. 1981. shall
discussion of the limitations of their data. especially be governed either by the 1979 or by the 1981 version 01 the
where their work touches on social policy or might be Ethical Principles. at the sound discretion of the Committee on
construed to the detriment of persons in specific age. sex. ScientiBe and Professional Ethics and Conduct.
683
684 ApPENDIXC
Principle 2 tive to prevailing community standards and to the pos-

COMPETENCE sible impact that conformity to or deviation from these
standards may have upon the quality of their perfor-
mance as psychologists. PsycholOgists are also aware of
The maintenance of high standards of competence is
the possible impact of their public behavior upon the
a responsibility shared by all psychologists in the in-
ability of colleagues to perform their professional du-
terest of the public and the profession as a whole. Psy-
ties.
chologists recognize the boundaries of their competence
a. As teachers, psychologists are aware of the fact that
and the limitations of their techniques. They only pro-
vide services and only lISe techniques for which they
their personal values may affect the selection and pre-
sentation of instructional materials. When dealing with
are qualified by training and e%pel'ience. In those areas
topics that may give offense, they recognize and respect
in which recognized standards do not yet emt, psy-
the diverse attitudes that students may have toward such
chologists talee whatever precautions are necessary to
materials.
protect the welfare of their clients. They maintain
b. As employees or employers, psychologists do not
knowledge of current scientific and professional infor-
engage in or condone practices that are inhumane or that
mation related to the services they render.
result in illegal or unjustifiable actions. Such practices
a. Psychologists accurately represent their compe-
include, but are not limited to, those based on consid-
tence, education, training, and experience. They claim
erations of race, handicap, age, gender, sexual prefer-
as evidence of educational qualifications only those de-
ence, religion, or national origin in hiring, promotion,
grees obtained from institutions acceptable under the
Bylaws and Rules of Council of the American Psycho- or training.
c. In their professional roles, psychologists avoid any
logical Association.
b. As teachers, psychologists perform their duties on action that will violate or diminish the legal and civil
rights of clients or of others who may be affected by
the basis of careful preparation so that their instruction
is accurate, current, and scholarly.
their actions.
d. As practitioners and researchers, psychologists act
c. Psychologists recognize the need for continuing ed-
ucation and are open to new procedures and changes in in accord with Association standards and gUidelines re-
expectations and values over time.
lated to practice and to the conduct of research with
human beings and animals. In the ordinary course of
d. Psychologists recognize differences among people,
events, psychologists adhere to relevant governmental
such as those that may be associated with age, sex, ..,..
laws and institutional regulations. When federal state
cioeconomic, and ethnic backgrounds. When necessary,
provincial, organizational, or institutional laws, ;egula:
they obtain training, experience. or counsel to assure
tions, or practices are in conDict with Association stan-
competent service or research relating to such persons.
e. Psychologists responsible for decisions involving in- dards and guidelines, psychologists make known their
commitment to Association standards and guidelines and,
dividuals or policies based on test results have an un-
wherever possible, work toward a resolution of the con-
derstanding of psychological or educational measure-
ment, validation problems, and test research. Diet. Both practitioners and researchers are concerned
with the development of such legal and quasi-legal reg-
f. Psychologists recognize that personal problems and
ulations as best serve the public interest, and they work
conflicts may interfere with professional effectiveness.
toward changing existing regulations that are not ben-
Accordingly, they refrain from undertaking any activity
in which their personal problems are likely to lead to eficial to the public interest.
inadequate performance or harm to a client, colleague,
student, or research participant. If engaged in such ac-
tivity when they become aware of their personal prob-
lems, they seek competent professional assistance to de- Principle 4
termine whether they should suspend, terminate, or limit PUBLIC STATEMENTS
the scope of their professional and/or scientific activities.
Public statements, announcement. of service', adver-
tising, and promotionlJllJciivities of psychologist. rerve
the purpose of helping the public maIce inf0rtn8d judg-
Principle 3 ments and choices. Psychologists repreBB1lt accuratelll
MORAL AND LEGAL STANDARDS and objectivelll their profe88Ion1JI qualifications, affill-
ations, and functions, as well as those of the institutions
Psychologists' moral and ethical standards of behavior or organizations with which thell or the statements mall
are a pef'8onal matter to t/·, same degree as they are be /JSSociated. In public statement. providing psycho-
for any other citizen, except as these may compromise logical information or professional opinions or provid-
the fulfillment of their professional respons1bllities or ing information about the availability of psychological
reduce the public tTIISt in psychology and psychologists. praducts, publications, and Service', psychologist. brue
Regarding their own behavior, psychologists are sensi- their statements OR scientifically acceptable psycholog-
ETHICAL PRINCIPLES OF PSYCHOLOGISTS 685
/cal findings and techniques with full recognition of the to ensure that announcements and advertisements are
limits and uncertaintie8 of such evklence. presented in a professional, scienti6cally acceptable, and
a. When announcing or advertising professional ser- factually informative manner.
vices, psychologists may list the following information f. Psychologists do not participate for personal gain
to describe the provider and services provided: name, In commercial announcements or advertisements rec-
highest relevant academic degree earned from a region- ommending to the public the purchase or use of pro-
ally accredited institUtion, date, type, and level of cer- prietary or single-source products or services when that
tification or licensure, diplomate status, APA member- participation Is based solely upon their identification as
ship status, address, telephone number, of6ce hours, a psychologists.
brief listing of the type of psychological services offered, g. Psychologists present the science of psychology and
an appropriate presentation of fee information, foreign offer their services, products, and publications fairly and
languages spoken, and policy with regard to third-party accurately, avoiding misrepresentation through sensa-
payments. Additional relevant or important consumer tionalism, exaggeration, or superficiality. Psychologists
information may be included if not prohibited by other are guided by the primary obligation to aid the public
sections of these Ethical Principles. in developing Informed judgments, opinions, and choices.
b. In announcing or advertising the availability of h. As teachers, psychologists ensure that statements in
psychological products, publications, or services, psy- catalogs and course outlines are accurate and not mis-
chologists do not present their affiliation with any or- leading, particularly in terms of subject matter to be
ganization in a manner that falsely implies sponsorship covered, bases for evaluating progress, and the nature
or certification by that organization. In particular and of course experiences. Announcements, brochures, or
for example, psychologists do not state APA membership advertisements describing workshops, seminars, or other
or fellow status in a way to suggest that such status im- educational programs accurately describe the audience
plies specialized professional competence or quali6ca- for which the program is intended as well as eligibility
tions. Public statements include, but are not limited to, requirements, educational objectives, and nature of the
communication by means of periodical, book, list, di- materials to be covered. These announcements also ac-
rectory, television, radio, or motion picture. They do not curately represent the education, training, and experi-
contain (i) a false, fraudulent, misleading. deceptive, or ence of the psychologists presenting the programs and
unfair statement; (ii) a misinterpretation of fact or a any fees involved.
statement likely to mislead or deceive because in context i. Public announcements or advertisements soliciting
it makes only a partial disclosure of relevant facts; (iii) research partiCipants in which clinical services or other
a testimonial from a patient regarding the quality of a professional services are offered as an inducement make
psychologists' services or products; (Iv) a statement in- clear the nature of the services as well as the costs and
tended or likely to create false or unjustified expectations other obligations to be accepted by participants In the
of favorable results; (v) a statement implying unusual, research.
unique, or one-of-a-kind abilities; (vi) a statement in- j. A psychologist accepts the obligation to correct oth-
tended or likely to appeal to a client's fears, anxieties, ers who represent the psychologist's professional quali-
or emotions concerning the possible results of failure to fications, or associations with products or services, in a
obtain the offered services; (vii) a statement concerning manner incompatible with these gnldelines.
the comparative desirability of offered services; (viii) a k. Individual diagnostic and therapeutic services are
statement of direct solicitation of individual clients. provided only in the context of a professional psycho-
logical relationship. When personal advice is given by
c. Psychologists do not compensate or give anything
means of public lectures or demonstrations, nllwSpaper
of value to a representative of the press, radio, television,
or magazine articles, radio or television programs, mail,
or other communication medium in anticipation of or
or similar media, the psychologist utilizes the most cur-
in return for professional publicity In a news item. A paid
rent relevant data and exercises the highest level of
advertisement must be identified as such, unless it is ap-
professional judgment.
parent from the context that It Is a paid advertisement.
I. Products that are described or presented by means
If communicated to the public by use of radio or tele-
of public lectures or demonstrations, newspaper or mag-
vision, an advertisement is prerecorded and approved
azine articles, radio or television programs, or similar
for broadcast by the psychologist, and a recording of the
media meet the same recognized standards as exist for
actual transmission is retained by the psychologist.
products used in the context of a professional relation-
d. Announcements or advertisements of "personal ship.
growth groups," clinics, and agencies give a clear state-
ment of purpose and a clear description of the experi-
ences to be provided. The education, training. and ex- Principle 5
perience cl the staff members are appropriately speci6ed.
CONFIDENTIALITY
e. Psychologists associated with the development or
promotion of psychological devices, books, or other prod- P,ychologfBI' haoe /J primary obllgtJUOO 10 reapect lhe
ucts offered for commercial sale make reasonable efforts confident/tdlly of Informallon obIdiDIld from persons
686 ApPENDIXC
in the course of their work as psychologists. They reveal chologists to violate these Ethical Principles, psycholo-
such information to others only with the consent of the gists clarify the nature of the conflict between the de-
person or the person's legal representative. except in mands and these principles. They inform all parties of
those unusual circumstances in which not to do so psychologists' ethical responsibilities and take appropri-
would result in clear danger to the person or to others. ate action.
Where appropriate, psychologists inform their clients d. Psychologists make advance financial arrangements
of the legal limits of confidentiality. that safeguard the best interests of and are clearly under-
a. Information obtained in clinical or consulting re- stood by their clients. They neither give nor receive any
lationships, or evaluative data concerning children. stu- remuneration for referring clients for professional ser-
dents, employees, and others, is discussed only for profes- vices. They contribute a portion of their services to work
sional purposes and only with persons clearly concerned for which they receive little or no financial return.
with the case. Written and oral reports present only data e. Psychologists terminate a clinical or consulting re-
germane to the purposes of the evaluation, and every lationship when it is reasonably clear that the consumer
effort is made to avoid undue invasion of privacy. is not benefiting from it. They offer to help the consumer
b. Psychologists who present personal information ob- locate alternative sources of assistance.
tained during the course of professional work in writings,
lectures, or other public forums either obtain adequate
prior consent to do so or adequately dISguise all identi-
fying information.
Principle 7
c. Psychologists make provisions for maintaining con-
PROFESSIONAL RELATIONSHIPS
fidentiality in the storage and disposal of records.
d. When working with minors or other persons who
are unable to give voluntary, informed consent, psy- PsycholOgists act with due regard for the needs, special
chologists take special care to protect these persons' best competencies, and obligations of their colleagues in
interests. psychology and other professions. They respect the pre-
rogatioes and obligations of the institutions or orga-
nizations with which these other colleagues are asso-
ciated.
a. Psychologists understand the areas of competence
Principle 6 of related professions. They make full use of all the
WELFARE OF THE CONSUMER professional, technical, and administrative resources that
serve the best interests of consumers. The absence of
PsycholOgists respect the integrity and protect the wel- formal relationships with other professional workers does
fare of the people and groups with whom they work. not relieve psychologists of the responsibility of securing
When conflicts of interest arise between clients and for their clients the best possible professional service, nor
psychologists' employing Institutions, psychologists does it relieve them of the obligation to exercise foresight,
clarify the nature and direction of their loyalties and diligence, and tact in obtaining the complementary or
responsibilities and keep all parties informed of their alternative assistance needed by clients.
commitments. Psychologists fully inform consumers as h. Psychologists know and take into account the tra-
to the purpose and nature of an evaluatioe, treatment, ~itioru and practices of other professional groups with
educational, or training procedure, and they freely ac- whom they work and cooperate fully with such groups.
knowledge that clients, students, or participants in re- If a person is receiving similar services from another
search haoe freedom of choice with regard to partici- professional, psychologists do not offer their own services
pation. directly to such a person. If a psychologist is contacted
a. Psychologists are continually cognizant of their own by a person who is already receiving similar services
needs and of their potentially influential position vis-a- from another professional, the psychologist carefully con-
vis persons such as clients, students, and subordinates. siders that professional relationship and proceeds with
They avoid exploiting the trust and dependency of such caution and sensitivity to the therapeutic issues as well
persons. Psychologists make every effort to avoid dual as the client's welfare. The psychologist discusses these
relationships that could impair their professional judg- issues with the client so as to minimize the risk of con-
ment or increase the risk of exploitation. Examples of fusion and conflict.
such dual relationships include, but are not limited to, c. Psychologists who employ or supervise other profes-
research with and treatment of employees, students, su- sionals or professionals in training accept the obligation
pervisees, close friends, or relatives. Sexual intimacies to facilitate the further profeSSional development of these
with clients are unethical. individuals. They provide appropriate working condi-
b. When a psychologist agrees to provide services to tions, timely evaluations, constructive consultation, and
a client at the request of a third party, the psychologist experience opportunities.
assumes the responsibility of clarifying the nature of the d. Psychologists do not exploit their professional re-
relatioruhips to all parties concerned. lationships with clients, supervisees, students, employees,
c. Where the demands of an organization require psy- or research participants sexually or otherwise. Psychol-
ETHICAL PRINCIPLES OF PSYCHOLOGISTS 687
ogists do not condone or engage in sexual harassment. spect the right of clients to have full explanations of the
Sexual harassment is defined as deliberate or repeated nature and purpose of the techniques in language the
comments, gestures, or physical contacts of a sexual na- clients can understand, unless an explicit exception to
ture that are unwanted by the recipient. this right has been agreed upon in advance. When the
e. In conducting research in institutions or organiza- explanations are to be provided by others, psychologists
tions, psychologists secure appropriate authorization to establish procedures for ensuring the adequacy of these
conduct such research. They are aware of their obliga- explanations.
tions to future research workers and ensure that host b. Psychologists responsible for the development and
institutions receive adequate information about the re- standardization of psychological tests and other assess-
search and proper acknowledgment of their contribu- ment techniques utilize established scientific procedures
tions. and observe the relevant APA standards.
f. Publication credit is assigned to those who have c. In reporting assessment results, psychologists indi-
contributed to a publication in proportion to their profes- cate any reservations that exist regarding validity or re-
sional contributions. Major contributions of a professional liability because of the circumstances of the assessment
character made by several persons to a common project or the inappropriateness of the norms for the person
are recognized by joint authorship, with the individual tested. PsychologiSts strive to ensure that the results of
who made the principal contribution listed first. Minor assessments and their interpretations are not misused by
contributions of a professional character and extensive others.
clerical or similar nonprofessional assistance may be ac- d. Psychologists recognize that assessment results may
knowledged in footnotes or in an introductory statement. become obsolet.e. They make every effort to avoid and
Acknowledgment through specific citations is made for prevent the misuse of obsolete measures.
unpublished as well as published material that has di- e. Psychologists offering scoring and interpretation
rectly inDuenced the research or writing. Psychologists services are able to produce appropriate evidence for the
who compile and edit material of others for publication validity of the programs and procedures used in arriving
publish the material in the name of the originating group, at interpretations. The public offering of an automated
if appropriate, with their own name appearing as chair- interpretation service is considered a professional-to-
person or editor. All contributors are to be acknowledged professional consultation. Psychologists make every ef-
and named. fort to avoid misuse of assessment reports.
g. When psychologists know of an ethical violation by f. Psychologists do not encourage or promote the use
another psychologist, and it seems appropriate, they in- of psychological assessment techniques by inappro-
formally attempt to resolve the issue by bringing the priately trained or otherwise unqualified persons through
behavior to the attention of the psycbologist. If the mis- teaching, sponsorship, or supervision.
conduct is of a minor nature and/or appears to be due
to lack of sensitivity, knowledge, or experience, such an
informal solution is usually appropriate. Such informal
corrective efforts are made with sensitivity to any rights
Principle 9
to confidentiality involved. If the violation does not seem
amenable to an informal solution, or is of a more serious RESEARCH WITH HUMAN PARTICIPANTS
nature, psychologists bring it to the attention of the ap-
propriate local, state, and/or national committee on TM decisjon 10 unde1'take research resls upon a con-
professional ethics and conduct. side1'ed Judgmenl by 1M individual psychologisl aboul
how besl 10 conlribute 10 psychological science and hu-
man welfare. Having made 1M decision to conducl re-
search, the psychologist consUkr. ailem4t1ce directions
in which research ene1'gies and resources mighl be in-
Principle 8 vested. On tM basis of Ihis Conside1'allon, 1M psychol-
ASSESSMENT TECHNIQUES oglsl carries OUI 1M investlgallon wllh respecI and con-
cern for tM dignily and welfare of tM people who
In 1M developmenl, publlcallon, and utilizallon of psy- partlcipale and with cognizance of fede1'al and slale
chological assessmenl lechnlques, psychologlsls make regulalions and professional slandards governing tM
""""J efforl 10 promole 1M welfare and besl inle1'ests conduct of research wilh human participants.
of tM client. TMy guard against tM misuse of _ess- a. In planning a study, the investigator has the re-
ment resu/ls. TMy respect tM client's rlghl to know sponsibility to make a careful evaluation of its ethical
1M resu/ls, 1M inlerprelations made, and tM bases for acceptability. To the extent that the weighing of scien-
their conclusions and recommendations. PsycholOgisls tific and human values suggests a compromise of any
make every efforl to mainlain tM securlly of lesls and principle, the investigator incurs a correspondingly se-
olhel' assessment techniqueS within limits of legal man- rious obligation to seek ethical advice and to observe
dates. TMII slrlve 10 ensure 1M aJl1lropriale use of as- stringent safeguards to protect the rights of human par-
sessmenl lechnlques by olhel's. ticipants.
a. In using assessment techniques, psychologists re- b. Considering whether a participant in a planned
688 ApPENDIXC
study will be a "subject at risk" or a "subject at minimal h. After the data are collected, the investigator pro-
risk," according to recognized standards. is of primary vides the participant with information about the nature
ethical concern to the investigator. of the study and attempts to remove any misconceptions
c. The investigator always retains the responsibility that may have arisen. Where seienti6c or humane values
for ensuring ethical practice in research. The investigator justify delaying or withbolding this information, the in-
is also responsible for the ethical treatment of research vestigator incurs a special responsibility to monitor the
participants by collaborators, assistants, students, and research and to ensure that there are no damaging cOn-
employ_, all of whom, however. incur similar obliga- sequences for the participant.
tions. i. Where research procedures result in undesirable
d. Except in minimal-risk research. the investigator consequences for the individual participant, the inves-
establishes a clear and fair agreement with research par- tigator has the responsibility to detect and remove or
ticipants, prior to their participation, that clarl6es the correct these consequences, including long-term effects.
obligations and responsibilities of each. The investigator j. Information obtained about a research participant
has the obligation to honor all promises and commitments during the course of an investigation is con6dential unless
included in that agreement. The investigator informs the otherwise agreed upon in advance. When the possibility
participants of all aspects of the research that might rea- exists that others may obtain access to such information.
sonably be expected to inlluence willingness to partici- this possibility. together with the plans for protecting
pate and explains all other aspects of the research about con6dentiality, is explained to the participant as part of
which the participants inquire. Failure to make full dis- the procedure for obtaining informed consent.
closure prior to obtaining informed consent requires ad-
ditional safeguards to protect the welfare and dignity of
the research participants. Research with children or with
participants who have impairments that would limit un- Principle 10
derstanding and/or communication requires special safe- CARE AND USE OF ANIMALS
guarding procedures.
e. Methodological requirements of a study may make An investigator of animal behavior .trlve. to advance
the use of concealment or deception necessary. Before understanding of basic behavioral principles and/or to
conducting such a study, the investigator has a special contribute to the improvement of human health and
responsibility to (i) determine whether the use of such welfare. In seeking these ends, the investigator ensures
techniques is justi6ed by the study's prospective seien- the welfare of animals and treat. them humanely. Laws
ti6c. educationaL or applied value; (ii) determine whether and regulations notwithstanding, an animar. imme-
alternative procedures are available that do not use con- dtate protection depends upon the scientist's own con-
cealment or deception; and (iii) ensure that the partic- sctence.
ipants are provided with suf6cient explanation as soon a. The acquisition, care, use. and disposal of all ani-
as possible. mals are in compliance with current federal, state or
f. The investigator respects the individual's freedom provincial, and local laws and regulations.
to decline to participate in or to withdraw from the re- b. A psychologist trained in research methods and
search at any time. The obligation to protect this freedom experienced in the care of laboratory animals closely
requires careful thought and consideration when the in- supervises all procedures involving animals and is re-
vestigator is in a position of authority or influence over sponsible for ensuring appropriate consideration of their
the participant. Such positions of authority include. but comfort. health, and humane treatment.
are not limited to, situations in which research partici· c. Psychologists ensure that all individuals using ani-
pation is required as part of employment or in which mals under their supervision have received explicit in-
the participant is a student. client. or employee of the struction in experimental methods and in the care. main·
investigator. tenance. and handling of the species being used.
g. The investigator protects the participant from phys- Responsibilities and activities of individuals partiCipating
ical and mental discomfort. harm. and danger that may in a research project are consistent with their respective
arise from research procedures. If risks of such conse- competencies.
quences exist, the investigator informs the participant of d. Psychologists make every effort to minimize dis-
that fact. Research procedures likely to cause serious or cemfort. illness, and pain of animals. A procedure sub-
lasting harm to a participant are not used unless the jecting animals to pain, stress, or privation is used only
failure to use these procedures might expose the partic- when an alternative procedure is unavailable and the
ipant to risk of greater harm. or unless the research has goal is justi6ed by its prospective seienti6c, educational.
great potential bene6t and fully informed and voluntary or applied value. Surgical procedures are performed un-
consent is obtained from each participant. The partici- der appropriate anesthesia; techniques to avoid infection
pant should be informed of procedures for contacting and minimize pain are followed during and after sur-
the investigator within a reasonable time period follow- gery.
ing participation should stress. potential harm. or related e. When it is appropriate that the animal's life be
questions or concerns arise. terminated, it is done rapidly and painlessly.
APPENDIX 0
standards
FOR EDUCATIONAL
&PSYCHOLOGICAL
TESTS
Prepared by ajoint committee of the

American Psychological Association
American Educational Research Association
National Council on Measurement in Education
Frederick B. Davis. Chair
689
690 ApPENDIXD
INTRODUCTION
In March. 1954. the American those related to validity and reliability,

Psychological Association issued the are necessarily technical. These two sec-
Techllical Recommelldatiolls .lor tions should be meaningful to readers
Psychological Tests alld Diagnostic who have training approximately equiv-
Techniques. endorsed by the American alent to a level between the master's
Educational Research Association and degree and the doctorate in education
the National Council on Measurement or psychology. However, the remaining
in Education. In January. 1955. the lat- sections-the greater part of the docu-
ter two organizations published a fur- ment-are generally nontechnical and
ther document. Technical Recom- may be read with profit by all users.
l1lendations .for Achievel1lellf Tests. The authors of the 1966 Standards
Subsequently. a joint committee of the declared that a test producer has an
three organizations consolidated. obligation to provide enough in-
modified. and revised the two documents formation about a test so that a
and in 1966. throug~ the American qualified user will know what reliance
Psychological Association. published can safely be placed on it; they also
the Standards .lor Educational and provided statements of consensus con-
Psychological Tests and Manuals. The cerning the information that should be
present document is both a revision and in a manual. It now appears desirable
an extension of the 1966 Standards. It to provide similar statements of con-
presents standards for test use as well as sensus concerning competency in
for test manuals; it is intended to guide testing practices.
both test developers and test users. Part of the stimulus for revision is an
A test user is one who chooses tests, awakened concern about problems like
interprets scores, or makes decisions invasion of privacy or discrimination
based on test scores. (People who do against members of groups such as
only routine administration or scoring minorities or women. Serious misuses of
of tests are not included in this tests include, for example, labeling
definition, although test users often do Spanish-speaking children as mentally
both.) Test users include clinical or in- retarded on the basis of scores on tests
dustrial psychologists, research direc- standardized on "a representative sam-
tors. school psychologists, counselors, ple of American children," or using a
employment supervisors, teachers, and test with a major loading on verbal
various administrators who select or in- comprehension without appropriate
terpret tests for their organizations. The validation in an attempt to screen out
audience for the Standards is, large numbers of blacks from
therefore, broad and cuts across publics manipulative jobs requiring minimal
with varying backgrounds and different verbal communication.
training in measurement and statistics. These are specific examples of a
Sections of the Standards. particularly general problem of test appro-
STANDARDS FOR EDUCATIONAL & PSYCHOLOGICAL TESTS 691
priateness. A test score describes but it behavior when presented under stan-
does not explain a level of performance. dardized conditions and to yield scores
Test performance may be influenced by that will have desirable psychometric
many factors such as amount and properties such as high reliability and
quality of certain kinds of training, dis- high validity.
tractions during testing, sensory de- Tests include standardized aptitude
fects, inability to hear instructions
because of poor administration, inap- and achievement instruments, diag-
propriate language in instructions or in nostic and evaluative devices, interest
the test, inability to read, brain inventories, personality inventories,
damage, motivation level, illumination projective instruments and related
level, cultural background of the clinical techniques, and many kinds of
examinee, or test-taking strategies. personal history forms. It was pointed
Some unfairness may be built into a out in the 1966 Standards that the same
test, for example. requiring an inor- general types of information are needed
dinately high level of verbal ability to for all these varieties of published
comprehend the instructions for a non- diagnostic, prognostic, and evaluative
verbal test. Many of the social ills at- devices. It is equally appropriate to
tributed to tests, however. seem more a point out that unpublished assessment
result of the ways in which tests have devices can be better used if the same
been used than of characteristics of the kind of information is available to
tests themselves; for example. errors in users.'
administration. failure to consider the
appropriateness of normative data. I It is sometimes suggested in response to per-
failure to choose an appropriate test. ceptions of test abuse and unfair uses of tests that
use of incorrect assumptions about the a moratorium on testing be observed until better
and more appropriate instruments are developed
causes of a low or deviant test score. or and more equitable procedures can be instituted.
administrative rigidity in using test The suggestion of such an extreme measure may
scores for making decisions. be indicative of the growing sense of frustration
and indignation felt particularly by some minority
group members who sense that testing has had a
disproportionately negative impact on their op-
portunities for equal access to success in
Tests and Test Uses to Which education and employment. This suggestion.
These Standards Apply although well intended. seems futile for several
reasons:
Hrst. it fails to consider unfairness resulting from
It is intended that these standards the mIsuses of tests. If new and better tests were
apply to any assessment procedure. subject to the same sorts of misuse. they might
well produce the same sorts of errors (or errors of
assessment device. or assessment aid; the same magnitudes) in the decisions based on
that is. to any systematic basis for them.
making inferences about characteristics Second. it requires a corresponding but
unlikely moratorium on decisions. Employers will
of people. continue to make employment decisions with or
A test is a special case of an without standardized tests. Colleges and univer-
assessment procedure. It may be sities will still select students. some elementary
pupils will still be recommended for special
thought of as a set of tasks or questions education. and boards of education will continue
intended to elicit particular types of to evaluate the success of specific programs. If
692 ApPENDIXD
There are wide variations in the dards). he will find the standards useful
sophistication of assessment tech- guides for developing information
niques. At one extreme is the test that similar to that in good test manuals: the
has gone through several revision.s based principles are as relevant to him as to
on many research studies. Such a test the professional test developer. If he
may provide normative data based on chooses to use a test that has been
thousands of cases classified into developed by someone else. he may find
dozens of subpopulations. At the other the standards helpful in evaluating
extreme is the casual interview that alternatives from which he may choose;
provides assessments based on varying moreover. the standards may help in
and unsystematically observed cues. developing a program of application.
These standards are written There are many dimensions along
specitically to apply to standardized which measuring instruments can be
tests. They apply in varying degrees. c1assitied. Some are designed to
however. to the entire range of measure abilities. some to measure ac-
assessment techniques. If it is required complishments. others to measure at-
that a relationship be demonstrated titudes or interests. Some are in-
between scores (assessments) on an em- ventories. interview aids. biographical
ployment test and subsequent per- data forms. and experimental
formance on a job. the requirement diagnostic devices. and are not called
should in principle also apply to the tests. Generally. however. the word
judgments (assessments) of the em- "test" is used in these standards to ap-
ployment interviewer. It may not be ply to all kinds of measurement. What
possible to apply the standards with the these different kinds have in common is
same rigor. but the kind of judgments that scores with desirable psychometric
the interviewer is to make can be iden- properties may be derived from each.
tified: the time and procedures for These standards also apply to
developing and recording them can be criterion measures. Studies evaluating
standardized; and they can be validated uses of well-developed tests too often
in the same ways that scores are employ inadequate criterion data. A
validated. When someone who makes criterion measure should have the
personnel decisions developes his own psychometric properties expected of
assessment techniques (a practice not any other measurement. such as
discouraged intentionally in these stan- validity. including in special instances
some form of criterion-related validity.
those responsible for making decisions do not use for example. the relationship of an im-
standardized assessment techniques. they will use mediate criterion measure to an in-
less dependable methods of assessment. termediate or more nearly ultimate
Third. tests are often useful for finding talent
but are too often used only as devices for rejecting measure. Criterion development should
those with low scores; they can also be used to be guided by the standards guiding test
discover potential for performance that might not development.
otherwise be observed. In this way. the use of tests
may sometimes improve the prospects of minority Some assessment techniques are used
group members and women. as il)terview aids. The intent of such use
is an idiographic analysis of an in- statistical claim and should be held to the

dividual-an approach to assessment usual rules for supporting it. Moreover,
which places special reliance on the when on the basis of projective test
skil\ of the clinician. It is often argued data, biographical information, or
that this use is so unlike the use of other various behavioral cues elicited during
testing procedures that it cannot be an interview the interviewer makes a
judged by essential\y psychometric statement such as "this man will fail or
standards. The qualitative nature of the be subject to severe depression if placed
assessment is less the point at issue than in this situation," he is making a
the distinction that can be made be- prediction based on his assessment and
tween clinical and actuarial prediction. should be held to the standards for
When tests, projective or otherwise, are demonstrating the validity of his
used as aids to an interviewer's prediction.
assessment, the interviewer is himself A comment also seems appropriate
the final assessment device, and his about hidden tests (such as an inter-
assessments become the "scores." viewer's systematic attempt to assess a
These assessments can and should be trait within the context of the interview)
validated like other psychometric or other unobtrusive or observational
measures. measures. Some of these may raise
Component bits of information may ethical problems, but they do not differ,
be analyzed somewhat as items are in principle, from other tests, and the
analyzed. Proposals for arriving at standards apply as much to these un-
idiographic interpretations are almost seen or unrecognized tests as to those
always based partial\y upon a more clearly perceived by the examinee."
nomothetic premise; for example, that Therefore, the psychologist who counts
a Rorschach determinant correlates examples of a specific type of response
with a specified internal factor. The in a behavior-modification setting is as
usual standards can be applied to much responsible for the validity of his
premises of this kind. Therefore, interpretations of change or the basic
although interview aids can present reliability of his observations as is any
unusual problems, their user requires other test user.
the same information about them that In short, the standards are intended
he requires for any test score, and his to be widely applicable both to stand-
use of them is subject to some of the ardized tests and a wide variety of
same psychometric considerations (e.g., other assessment techniques. The
reliability) applicable to other test degree of applicability of individual
scores. standards to nontest assessments will
The developer of such an interview vary; developers and users of such
aid need not indicate his test's validity assessment procedures should at least
by correlating it with any simple observe the spirit of the standards.
criterion. But if he goes so far as to Tests are used for basic research pur-
make any generalization about what poses as well as for practical purposes.
"most people see" or what "schizo- Although these standards were not writ-
phrenics rarely do," he is making a ten with research purposes in mind, the
694 ApPENDIXD
qualified investigator should be able to in a supplementary handbook. What-

determine the manner in which they ap- ever the form. the prospective test user
ply to his research. must have available to him the infor-
These standards cannot replace in- mation needed for making whatever
structional material on test develop- judgments his use of the test requires.
ment; therefore. there are no specific Even when the test (or test battery) is
developed for use within a single
statements directly related to such
organization, a manual can often be
procedures as item writing or item helpful; preparation of a manual helps
analysis. the test developer organize his thinking.
codify his procedures. and communi-
cate his ideas and intentions to his
Information Standards as a assistants.
Guide to Test Developers It is not appropriate for this
publication to call for a particular level
For each test there should be a test of validity or reliability. or otherwise to
manual. perhaps with supplements. to establish technical test specifications
provide enough information for a for specific tests. but it is appropriate to
qualified user to make sound jUdgments ask that any test manual provide the in-
regarding the usefulness and inter- formation necessary for a test user to
pretation of test scores. Research is re- decide whether the consistency. relevance.
quired prior to the release of the test or or standardization of a test makes it
test scores for operational use. suitable for his purpose. These stan-
A manual is to be judged not merely by dards need not prescribe minimum
its literal truthfulness. but by the im- statistical specifications. Rather. their
pression it leaves with the reader. If the intent is to describe in an explicit and
typical professional user for whom the conveniently available form the in-
manual is prepared is likely to obtain formation required by test users. In
an inaccurate impression of the test arriving at those requirements. it has
from the manual. the manual is poorly been necessary to judge what is a
written. The standards apply to the reasonable compromise between pres-
spirit and tone of the manual (or sup- sures of cost and time, on the one
plemental publication) as well as to its hand. and the ideal. on the other. The
literal statements. test producer ordinarily spends large
A manual must often communicate sums of money in developing and stan-
information to many different groups. dardizing a test. Insofar as these recom-
Many tests are used by people with mendations indicate the kind of in-
limited training in testing. These users formation that is most valuable to test
may not follow technical discussion or users, authors and publishers can more
understand detailed statistical in- efficiently allocate funds for gathering
formation. Other users are mea- and reporting data of greatest value.
surement specialists; they seek informa- Some provisions are more applicable
tion on which to judge the technical than others in any specific case. The
adequacy of the test. Sometimes completion of predictive validity studies
technical information can be presented related to job criteria. for example. is
essential before a vocational interest in- sifications. or otherwise conform to the

ventory can be used properly. but it may purposes of his testing. These stand-
be only desirable for a values inventory ards of practice are written more as
and irrelevant for an inventory designed guidelines than as commandments. It is
to diagnose mental disorders. These as necessary to make cost-benetit com-
standards. therefore. represent an at- promises in test use as in test develop-
tempt to state what type of studies ment. These standards provide useful
should be completed before a test is guidelines for test users as well as for
ready for release to the profession. They test developers.
can serve as a similar guide for those
who are developing tests for their own Three Levels of Standards
use.
Manuals can never give all the in-
formation. and test users can never
Procedural Standards as a Guide
follow all the procedures that might be
to Test Users
desirable. At the same time. restricting
The test user. in selecting. ad- this statement of recommendations
ministering. scoring. or interpreting a ~olely to essential or indispensable in-
test. should know his purposes. what he formation and practices might tend to
is doing to achieve those purposes. and discourage development and reporting
their probable consequences. It is not of additional information. The stan-
enough to have benign purposes; the dards are. therefore. grouped in three
user must know the procedures levels: Essential, Very Desirable, and
necessary to maximize effectiveness and Desirable. Each proposed requirement
to minimize unfairness in test use. He is judged based on its importance and
must evaluate the many factors that the feasibility of attaining it.
may have influenced test performance The statements listed as Essential
in light of his purposes. Where he finds are intended to represent the consensus
that certain factors would unfairly in- of present-day thinking concerning
fluence performance. his procedures for what is normally required for com-
using the test and interpreting the petent use of a test. Any test or testing
scores should be designed to minimize situation may present some unique
such influences. problems; it is undesirable for the stan-
Competence in test use is a com- dards to be treated as unduly rigid; for
bination of knowledge of psychometric exam pIe. they should not bind the
principles. knowledge of the problem producer of a novel test to an inap-
situation in which the testing is to be propriate procedure or form of repor-
done. technical skill. and some wisdom. ting. The Essential standards indicate
Although it is not appropriate to tell a what information or practices will be
test user that he needs particular levels needed for most tests in most ap-
of validity and reliability. it is applications. When a test developer or test
propriate to ask him to ascertain that user fails to satisfy these requirements.
his procedures result in reasonably he should do so only as a considered
valid predictions or reliable c1as- judgment. In any single test or testing
696 ApPENDIX 0
situation, there may be some Essen- some function and in some situations.
tial standards that do not apply. It but even the best test can have
should be noted that many of these damaging consequences if used inap-
standards require thought rather than propriately. Therefore. the primary
specific action as an outcome of responsibility for the improvement of
thought; for example. "A test user testing continues to rest on the
should consider .... " In most cases. shoulders of test users. It is hoped that
such statements are listed as Essential. these standards will be used to extend
If some type of Essential in- the professional training of many test
tormation is not available on a given users who are not now being trained ap-
test. it is important to help the reader propriately. Professional training of
recognize that the research on the test is personnel managers, school admin-
incomplete in this respect. A test istrators' and classroom teachers
manual should include clear statements should prepare them to better under-
of what research has been done and stand information about tests, test in-
avoid misleading statements. terpretations. and these standards.
The category Very Desirable is used to Such training will do much to improve
draw attention to types of in- the quality of test use and to minimize
formation or practices that contribute the extent of test misuse. The standards
greatly to the user's understanding of draw attention to recent developments
the test and to competence in its use. in thinking about tests. test analysis.
Standards in this category have not and test use. A com parison of these
been listed as Essential if their standards with those in earlier editions
usefulness is debatable. should remind test developers and test
The category Desirable includes users that testing is a stable but not a
information and practices that are help- static enterprise and that. in fact. there
ful but not Essential or Very Desirable. is room for improvement in the quality
When a test is widely used. the of assessments that are being made.
developer has a greater responsibility Tests are often developed and used in
for investigating it thoroughly and circumstances that lead to maintaining
providing more extensive reports about less than the highest standards of
it than when the test is limited in use. technical excellence. We do not intend
Large sales make research financially to discourage those who must make
possible. Therefore. the developer of a assessments of people from doing the
popular test can add information in best they can with whatever training
subsequent editions of the manual. For and collaborative resources are
tests having limited sales. it is available to them. These standards.
unreasonable to expect that as much in- however. are written to promote ex-
formation will be furnished. cellence. They provide a kind of checklist
of factors to be considered in designing.
Cautions To Be Exercised in the standardizing. validating. scoring. and
Use of These Standards interpreting tests. They may help test
developers and test users decide what
Almost any test can be useful for studies are needed and how those
studies might best be recorded in jection to a statement that one has

manuals or in validation reports. Test "taken into account or considered"
users who are not going to do in- these standards.
dependent research on a test should A final caveat is necessary in view of
refer to these standards for guidance in the prominence of testing issues in
the choice, administration, scoring, and litigation. This document is prepared as
interpretation of tests. a technical guide for those within the
It is conceivable that a test developer sponsoring professions; it is not written
could fulfill most of the standards as law. What is intended is a set of stand-
presented and still produce a test that ards to be used in part for self-
would fall short of his intended or evaluation by test developers and test
stated objectives. Care should be exer- users. An evaluation of their com-
cised to adhere, both in test develop- petence does not rest on the literal
ment and test use, to the spirit as well as satisfaction of every relevant provision
to the letter of these standards. Because of this document. The individual stand-
of the possibility of misunderstanding ards are statements of ideals or goals,
or misinterpretation, it would not be some having priority over others. In-
appropriate for test developers or test stead, an evaluation of competence
users to state that a manual or depends on the degree to which the in-
procedure "satisfies" or "follows" tent of this document has been satisfied
these standards. There would be no ob- by the test developer or user.
698 ApPENDIXD
STANDARDS FOR TESTS, MANUALS, AND REPORTS
Tests vary in the amount of make the information available for

knowledge and research required to public scrutiny.
develop them. Much background work The development of a test or testing
is needed for a test that is published or program is based .on research; the
otherwise distributed for widespread report of that research is often
use. Less work need be done for a test contained in a manual. These
developed for local use. At any level. standards. therefore. concentrate on the
however. better tests and testing can be manual (and any supplementary
expected where test developers have publication) as the full and proper
been guided by fundamental consideraT report of what was done in test
tions and have demonstrated this in development; they specify standards of
writing. reporting from which one may infer
A test user needs information de- standards for research.
scribing a test's rationale. development.
technical characteristics, administra-
tion, and interpretation. Such in- A. Dissemination of Information
formation is ordinarily expected in a A test user needs information to help
test manual or in its supplements. This him use the test in standard ways and to
information is also needed by those evaluate a test relative to others he
using a test or test battery that has not might select for a given purpose. The
been published but which is used within information that he needs to select a
an organization to aid in making test or to use it must come. at least in
decisions. For these uses, a properly part. from the test developer. Practices
prepared manual reports to local users of authors and publishers in furnishing
and to other interested persons information have varied. Sometimes the
(colleagues in other organizations, rep- test manual offers only vague directions
resentatives of governmental agencies, for administering and scoring. norms of
representatives of citizen's groups, etc.) uncertain origin. and perhaps nothing
the procedures followed in construction more. In contrast. some manuals
of the test, in its use, and in the furnish extensive information on test
interpretation of scores derived from it. development. validity. reliability. bases
In certification or selection programs, a for normative information. appropriate
manual can present information about kinds of interpretations and uses. and
the program as a whole as well as about they present all such information in
component tests. Data supporting detail.
claims for the program, procedures
followed, kinds of tests used, and AI. When a test is published or other-
related information should be recorded wise made avallable for operational use,
not only to provide an adequate basis It should be accompanied by a manual
for the proper use of tests but also to {or other published or readily avallable
information) that makes every reason- should satisfy the intent of standard A I
able effort to follow the recommen- by pointing out the absence and
dations of these standards and, in importance of this information.
particular, to provide the information Essential
required to substantiate any claims that
have been made for its use. Essential Al.2. Where the information is too
[Comment: The term "operational
extensive to be fully reported in the
use" refers to making practical
manual. the essential information
decisions about the evaluation or
should be summarized and
handling of individuals. groups.
accompanied by references to other
curricula. therapeutic treatments, and
soon. sources of information. such as
The term "manual" refers to technical supplements. articles. or
documents describing procedures of books. Very Desirable
test development. use. interpretation. [Comment: Developers of some well-
relevant research. normative data. and known tests provide extensive technical
related information. Depending on manuals. make further research data
such things as the amount of available through other sources (such as
information to report and the diversity the Education Resources Information
of uses and users. the term may Center), prepare annotated bibliog-
designate a document entirely within raphies, or include relevant information
one cover or a series of separately in technical books which users are
bound pamphlets. This term might also encouraged to consult. In other in-
be extended to include procedural stances, the essential information is
manuals governing the use of tests or of given in the manual sold with the
test batteries in. for example. selection instrument, along with references to
situations; the wording and importance other useful sources.
of many of these standards would be Publications by persons other than
different for a procedural manual. but the author of the test frequently fulfill
the principles applicable to test many functions of a manual. If a book
manuals would at least, therefore, be about a test is designed to serve as a
analogous. manual. its author and publisher have
Not all of the standards in this report the same responsibility in preparing it
will apply to anyone particular test. A as do the author and publisher of a
standard may be ignored if it is test.]
irrelevant in light of the purpose of the
test and the claims made for it. but it AI.2.I. When information about a
may not be ignored merely because it is test is provided in a separate
difficult to meet or has not usually been publication. that publication should
met by a similar test. J meet the same standards of accuracy
and freedom from misleading impres-
ALl. If information needed to sions that apply to the manual.
support interpretations suggested in the Essential
manual cannot be presented at the time
the manual is published, the manual AI.2.2. Promotional material for a
700 ApPENDIXD
test should be accurate and should not the need for maintaining necessary test
give the reader false impressions. security. Very Desirable
Essential [Comment: For example, a manual
[Comment: One publisher presents might describe some acceptable
an extensive and complete bibliog- coaching practices. If so, it would be
raphy, without comment or annotation, appropriate to add warnings against
of research involving a test; he does not unacceptable practices that might
mention that many of the entries are jeopardize test security.]
studies with negative findings. The
A2.3. A test manual or supple-
impression is one of extensive use, not
mentary document should provide rep-
of limitations to the usefulness of the
resentative sample items and a state-
test.]
ment of the intended purpose of the test
A1.2.3. Informational material dis- in a form that can be made available to
tributed within a using organization those concerned about the nature and
should be accurate, complete for the quality of a testing program. Very
purposes of the reader's need, and writ- Desirable
ten in language that will not give the [Comment: The evaluation of a test
reader a false impression. Essential may not fall exclusively to those who are
[Comment: Such information is often technically trained. Examinees, mem-
given in brief memoranda. In preparing bers of citizen panels, civil rights advo-
these brief reports, the technical cates, and parents are among those who
capability of the readers may be kept in may have reason to make judgments
mind, but this does not suggest that about the appropriateness of a test.
essential information be either omitted Their right to do so need not contlict
or distorted in the interest of simplicity. with the necessity to maintain test
Where a reader may be expected to security if descriptive and explanatory
receive such reports regularly, efforts materials are made available.
can be made to increase his ability to One publisher of educational tests
understand technical detail.] has published descriptive material in
nontechnical language for a wide
A2. A test manual should describe
variety of tests; pamphlets include
fully the development of the test: the
information on test development and
rationale, specifications followed in
rationale as well as examples of items
writing items or selecting observations,
and suggestions on test-taking strate-
and procedures and results of item
gies.]
analysis or other research. Essential
A2.4. The identity and professional
A2.1. Data gathered during the
qualifications of item writers and
process of developing a test before it is
editors should be described in instances
in final form should be clearly
where they are relevant; for example,
distinguished from data pertaining to
when adequacy of coverage of a subject-
the test in tinal form. Essential
matter achievement test cannot appro-
A2.2. A test manual should specify priately or practically be measured
against any external criterion. increase the probability that test users
Desirable have current information.]
A3. The test and its manual should A3.2.1. If a short form of a test is
be revised at appropriate intervals. The prepared by reducing the number of
time for revision has arrived whenever items or organizing a portion of the test
changing conditions of use or new into a separate form. new evidence
research data make any statements in should be obtained and reported for
the manual incorrect or misleading. that shorter test. Essential
Very Desirable [Comment: It is especially important
[Comment: The technical charac- to report the reliability and other
teristics and the appropriateness of a technical data for the test in its shorter
test may change as social conditions form. since placing items in a new
and attitudes. job definitions. context may alter responses to them.
educational pressures. or the composi- In the manual for one test that has
tion of relevant school populations two alternate forms, the validity data
change.] presented were obtained using the sum
of the scores of the two forms. It would
A3.1. Competent studies of the test have been more appropriate to have
following its publication. whether the presented the data for each form
results are favorable or unfavorable to independently. ]
the test. should be taken into account in
A3.2.2. When a short form is
revised editions of the manual or its
prepared from an established test. the
supplementary reports. Pertinent stud-
manual should present evidence that
ies by investigators other than the test
the items in the short form represent
authors and publishers should be
the items in the long form or measure
included. Very Desirable
the same characteristics as the long
[Comment: The developer of one test form. Very Desirable
has published a comprehensive review
[Comment: When no short form of a
of validity studies of the test covering a
test has been prepared but there is
IS-year period.]
reason to believe that it is commonly
A3.2. When the test is revised or a used in a shortened form. the manual
new form is issued. the manual should should remind the reader that data in
be suitably revised to take those the manual may not be applicable to
changes into account. In addition. the results of administration of a shortened
nature and extent of the revision and form.
the comparability of data from the old One revision of a long-established
test and the revised test should be achievement test battery illustrates a
explicitly stated. Essential desirable practice by listing all previous
[Comment: It is useful for publishers editions and then describing in detail
to identify revisions of test manuals in the relation of the new revision to the
their catalogs and to take other steps to previous editions.]
702 ApPENDIXD
B. Aids to Interpretation should warn against common misuses.

Essential
The responsibility for making
inferences about the meaning and 81.1. Names given to published
legitimate uses of test results rests tests, and to parts within tests, should
primarily with the user. In making such be chosen to minimize the risk of
judgments, however, he must depend in misinterpretation by test purchasers
part on information about the test and subjects. Essential
made available by its developer. [Comment: It is desirable that names
The manual or report form from a carry no unwarranted suggestion as to
scoring service cannot fully prepare the the characteristics measured. Such
user for interpreting the test. He will descriptions as "culture-free," "intel-
sometimes have to make judgments ligence," "introversion," "creativity,"
that have not been substantiated by "primary mental abilities," or "produc-
published evidence. Thus, the vo- tivity quotients" are questionable for
cational counselor cannot expect to published tests, unless there is ap-
have validity data available for each job propriate evidence of construct validity,
about which he makes tentative since they may suggest interpretations
predictions from test scores. The going beyond the demonstrable mean-
counselor or employment interviewer ing of the scores.]
will have examinees who do not fit into
any group for which normative or 81.1.1. Devices for identifying in-
validity data are available. The teacher terests and personality traits through
will have to evaluate the content of an self-report should be entitled "inventor-
achievement test in terms of his ies," "questionnaires," or "checklists"
instructional goals and emphasis. The rather than "tests." Very Desirable
clinician must bring general data and [Comment: In referring to such
theory into his interpretation of data instruments In textual material,
from a personality inventory. The however, as in these standards, the
degree to which the manual can be word "test" may be used to simplify the
expected to prepare the user for language even where it is properly
accurate interpretation and effective avoided in the title.]
use of the test varies with the type of test
and the purpose for which it is used. It 81.2. The manual should draw the
is the test developer's responsibility to user's attention to data that especially
provide the information necessary for need to be taken into account in the
good judgment; in fact, developers interpretation of test scores. Very
should make tests as difficult to misuse Desirable
and to misinterpret as they can. [Comment: Many test manuals point
out variables that should be considered
81. The test, the manual, the in the interpretation of a test score,
record forms, and other accompanying such as information about school
material should help users make correct record, recommendations, or clinically
interpretations of the test results and relevant history.
A personality assessment manual that interest does not necessarily imply

may provide data to show that the ability and is only one of many factors
psychologist should consider such facts to be considered in choosing among
as the sex and age of the subject. occu pations.]
whether his parents are dead or
separated. the ages and sexes of his B2. The test manual should state
siblings. or his vocational or marital explicitly the purposes and applications
status.] for which the test is recommended.
Essential
B1.3. The manual should call
attention to marked influences on test [Comment: A clear statement of a
scores known to be associated with test's purposes will help prevent the
region. socioeconomic status. race. misapplication of test scores. It will
creed. color. national origin. or sex. alert the user to the kind and extent of
Essential evidence he should expect to find in the
[Comment: Social or cultural factors manual in support of the claims made
known to affect performance on the test for the test by the author and publisher.
differentially. administrator errors that For example. if an achievement test is
are frequently repeated. examiner- recommended as a survey test of what
examinee differences. and other factors students know. an accurate description
that may result in spurious or unfair of its content is important. If. on the
test scores should. for example. be other hand. it is recommended as a
clearly and prominently identified in diagnostic test or one that predicts
the manual.] performance. data on its relationship
with one or more criteria are required.
B1.4. The manual should draw See Section E on validity.]
attention to. and warn against. any
serious error of interpretation that is B2.1. If a test is intended for
known to be frequent. Essential research use only and is not distributed
for operational use. that fact should be
[Comment: Some users of general
prominently stated in the accompany-
intelligence tests think of the score as a
ing materials. Essential
direct measure of inherent native
ability. given and unchanging; manuals [Comment: If the developer of a new
of such tests may be expected to caution device (e.g .. for studying personality)
against this interpretation and to do so releases his instrument for studies by
with reference to appropriate data. other investigators before he considers
They should clearly warn users against it ready for operational use. it is
unwarranted assumptions about the appropriate to print "distributed for
generality of normative data. par- research use only" on the test package.
ticularly avoiding the impression on the cover of the booklet of directions.
that national norms are genuinely and in any catalog where it is listed.
representative when in fact they are not. This cautions against premature use of
Manuals for interest inventories can the instrument In guidance or
apply this standard by stressing the fact selection. )
704 APPENDlxD
B3. The test manual should describe [Comment: One manual differen-
clearly the psychological, educational, tiates psychologists who work with
or other reasoning underlying the test children from those who work only with
and nature of the characteristic it Is adults in identifying qualifications
intended to measure. Essential needed to use an individually adminis-
tered test for children. Another offers
(Comment: There ordinarily are specifications for administering the test
explicit reasons for setting up the test as to non-English-speaking students.
it has been done; it may be assumed
that certain psychological processes are User qualifications might be
required in taking the test and that described in terms of special training
certain traits are being measured as a generally thought necessary to achieve
result. The identification of these competence. It may be possible for
processes may be based on a theory. some test manuals to identify the most
empirical research. or empirical frequent sources of error in test use and
processes internal to the test itself. In to specify the kind of user training
any case. a clear description of the necessary to eliminate these common
construct or content and of the manner errors.
of measurement enables a user to judge B4.1. The test manual should not
the test by its conformity to his own imply that a test is "self-interpreting."
psychological or educational insight as It should specify information to be
well as by statistical evidence of its given about test results to persons who
efficacy.) lack the training usually required to
interpret them. Essential
B3.1. In the case of tests developed
for content-referenced interpretation. (Comment: It is not ordinarily de-
special attention should be given to sirable to entrust interpretation of
defining the content domain in scores to an untrained person. There
operational terms. In the case of a are. of course. tests that can be scored
mastery test, the test developer's by the examinee. and it is often useful
rationale for any cutting score that he to give scores to students or parents.
suggests should be specified. or the Where these practices are followed. the
procedures that the user might employ sense of this standard is that interpre-
to establish mastery levels should be tative aids should also be given.
described. Essential The manual should indicate what
(Comment: The test user needs such may be done by untrained persons and
information so that he can compare his what should not be done. The manual
concept of mastery or competence with for one well-known interests test, for
that of the test author.) example, indicates that examinees may
perform the mechanics of scoring their
B4. The test manual should identify own tests but properly stresses that they
any special qualifications required to need the help of a trained teacher or
administer the test and to interpret it counselor in making interpretations
properly. Essential and future plans.)
84.2. Where a test is recommended "Bizarre responses may indicate

for a variety of purposes or types of schizophrenic tendencies." Such state-
inference, the manual should indicate ments by themselves are quantitatively
the amount of training required for inadequate. In what proportion of cases
each use. Essential giving bizarre responses has schizo-
phrenia been shown to develop? How
84.3. The manual should draw the
much has architectural success been
user's attention to references with
found to depend upon spatial ability?
which he should become familiar before
Numerical data relating the test scores
attempting to interpret the test results.
to definite criteria would help to pro-
Very Desirable
vide the answers.]
[Comment: The references might be
to books or articles dealing with related 85.2. Statistical procedures that
psychological theory or with the are well known and readily interpreted
particular test in question.] should be preferred for reporting any
quantitative information. Any uncom-
85. Evidence of validity and mon statistical techniques should be
reliability, along with other relevant explained, and references to descrip-
research data, should be presented in tions of them should be given. Essentiar
support of any claims being made.
Essential [Comment: Publishers need not
[Comment: Standards for validity uniformly adhere to the procedures
and reliability are extensive. Moreover, commonly used for reporting data, but
they are as applicable to research terminology and procedures should be
reports prepared by test users as to test sufficiently common in practice to
manuals. For these reasons, and be- permit adequate judgment by
cause of their overreaching importance, reasonably competent users.
a major section of this document This standard is an elaboration of the
presents standards for reports of re- principle that data presented in a
search on validity and reliability. manual should not be misleading. For
Adherence to the intent ofthis standard example, it is misleading to show the
requires adherence to the appropriate value of combining tests in a battery in
standards in that section.] a regression equation by using data
where intercorrelations are lower than
85.1. Statements in the manual those reported elsewhere in the
reporting relationships are by impli- manuaL]
cation quantitative and should be 85.3. When the statistical sig-
stated as precisely as the data permit. If nificance of a relationship is re-
data to support such statements have ported, the statistical report should
not been collected, that fact should be be in a form that makes clear the
made clear. Essential sensitivity or power of the significance
[Comment: Writers sometimes say, test. Essential
for example, "Spatial ability is required
for architectural engineering," or, [Comment: Statistical significance
706 ApPENDlXD
that has no practical usefulness can possible the storage and recall of large
often be obtained by using a very large amounts of data; test interpretation can
number of cases. For example. a well- be greatly assisted by the use of
known inventory yields statistically computer data banks. Computer
significant differences between large scoring services may provide lengthy
samples of males and of females. but printouts of descriptive and prognostic
the differences are too small to be of information from individual profiles on
practical importance. Conversely. one a test battery or personality inventory.
who uses an insensitive statistical test The user of such printouts needs to
can falsely conclude that there is no know the reasoning and the evidence
difference of practical importance. In supporting the suggested interpreta-
general. it is more appropriate in tions because they are as fallible as
reporting test data to state a confidence other SUbjective interpretations.]
interval or the likelihood function for
C. Directions for Administration
the parameter of interest than to report
and Scoring
only that the null hypothesis can or
cannot be rejected.] Interpretations of test and measure-
ment techniques, like those of experi-
85.4. The manual should differen- mental results, are most reliable when
tiate between an interpretation that is the measurements are obtained under
applicable only to average tendencies of standardized or controlled conditions.
a group and one that is applicable to an To be sure, there are circumstances in
individual within the group. Very testing where it may be important to
Desirable change conditions systematically for
85.5. The manual should state maximum understanding of the
clearly what interpretations are in- performance of an individual. For
tended for each subscore as well as for example, an examiner may system-
the total test. Essential atically modify procedures in successive
[Comment: Where subscores are readministrations of a test to explore
obtained only for convenience in the limits of a child's mastery of a
scoring the test. and no interpretation is specific content area such as a set of
intended, this should be made clear. concepts. Nevertheless, the test deve-
For some tests. keys are provided for loper should provide a standard pro-
subscores that have possible research cedure from which modifications can be
use but are not intended to be made. Without standardization, the
interpreted; this should be made clear.] quality of interpretations will be
reduced, to whatever extent differences
86. Test developers or others in procedure influence performance.
offering computer services for test For most purposes, great emphasis is
interpretation should provide a manual properly placed on strict standard-
reporting the rationale and evidence in ization of procedures for adminis-
support of computer-based interpreta- tering a test and reciting its instruc-
tions of scores. Essential tions. If a test is to be used for a wide
[Comment: A computer makes range of subpopulations, these pro-
cedures should be wholly compre- casionally, or only those things he

hensible to all examinees in each would like to do and does regularly.]
subpopulation.
Cl.l.l. The directions should clear-
ly point out such critical matters as
Cl. The directions for adminis-
instructions on guessing. time limits,
tration should be presented in the test
and procedures for marking answer
manual with sufficient clarity and
sheets. Essential
emphasfi so that the test user can dupli-
cate, and will be encouraged to dupli- CI.1.2. The directions to the test ad-
cate, the administrative conditions ministrator should include guidance for
under which the norms and the data on dealing with questions from examinees.
reliability and validity were obtained. Very Desirable
Essential
CL2. If expansion or elaboration of
[Comment: Because persons ad- instructions described in the test
ministering tests in schools and in- manual is permitted, the conditions un-
dustry sometimes may not follow in- der which this may be done should be
structions rigidly and may not un- clearly stated either in the form of
derstand the need for doing so, it is general rules or in terms of giving
necessary that the manual be insistent numerous examples, or both. Essential
and persuasive on this point. Some tests
are fully administered by tape record- C2. Instructions should prepare the
ings to insure standardization of examinee for the examination: Sample
procedure.] material, practice use of answer sheets
or punch cards, sample questions, etc.,
C1.l. The directions published in the should be provided. Desirable
test manual should be complete enough [Comment: The extent and nature of
that persons tested will understand the such material depends on expected
task as the author intended. Essential levels of knowledge among examinees.
[Comment: For example, in a per- For example, extensive practice
sonality inventory, it may be intended material might be wasteful if developed
that the subject give the first response for frequently tested school children
that occurs to him. If so, this ex- and for a commonly encountered type
pectation should be made clear in the of test; it may be very important for a
directions read by or to the subject. novel test format to be administered to
Directions for interest inventories older job applicants.)
should specify whether the person is to C3. The procedures for scoring the
mark what things he would ideally like test should be presented in the test
to do or whether he is also to consider manual with a maximum of detail and
the possibility that he would have the clarity to reduce the likelihood of
opportunity and ability to do them. scoring error. Essential
Likewise, the directions should specify
whether the person is to mark those C3.1. The test manual should fur-
things he would like to do and does oc- nish scoring instructions that maximize
708 ApPENDIXD
the accuracy of scoring an objective test validity of the test or the applicability of
by outlining a procedure for checking the test norms.)
the obtained scores for computational
C3.4. If an unusual or complicated
or clerical errors. Very Desirable
scoring system is used. the test manual
C3.2. Where sUbjective processes should indicate the approximate
enter into the scoring of a test, evidence amount of time required to score the
on the degree of agreement between in- test. Desirable
dependent scorings under operational C3.S. "Correction-for-guessing"
conditions should be presented in the formulas should be used with multiple-
test manual. If such evidence is not choice and true-false items when the
provided, the manual should draw at- test is speeded. Desirable
tention to scoring variations as a
possible significant source of errors of D. Norms and Scales
measurement. Very Desirable Interpretations of test scores tradi-
tionally have been norm referenced;
C3.2.1. The bases for scoring and that is. an individuals score is inter-
the procedures for training scorers preted in terms of comparisons with
should be presented in the test manual scores made by other individuals. Alter-
in sufficient detail to permit other native interpretations are possible.-
scorers to reach the level of agreement Content-referenced interpretations are
reported in studies of scorer agreement those where the score is directly inter-
given in the manual. Very Desirable preted in terms of performance at each
point on the achievement continuum
C3.2.2. If persons having various being measured. Criterion-referenced
degrees of supervised training are ex- interpretations are those where the
pected to score the test, studies of the score is directly interpreted in terms of
interscorer agreement at each skill level performance at any given point on the
should be presented in the test manual. continuum of an external variable. An
Desirable external criterion variable might be
grade averages or levels of job
C3.3. If the test is designed to use
performance. 2
more than one method for the
examinee's recording of his reponses, 'Current usage in educational measurement
such as hand-scored answer sheets, or commonly refers to "criterion-referenced" in-
terpretations for both alternatives to in-
entering of responses in the test terpretations requiring norms. The different
booklet, the test manual should report meanings of the word "criterion," however,
data on the degree to which results from produce some confusion; some measurement
specialists have therefore turned to the term "con-
these methods are interchangeable. tent referenced" and this usage is adopted here.
Essential The word "criterion," as it is used in the phrase
"criterion-related" validity (that is, an external
[Comment: The different amounts of variable) has suggested a similar but
time required for responding to items in distinguishable alternative to normative in-
terpretation; therefore, "content-referenced and
forms adapted to different scoring criterion-referenced" are not interchangeable terms
methods may affect the reliability or as used in this document.)
The standards in this section refer "populations" are plural; in nearly all
principally to tests intended for norm- instances of tests developed for other
referenced test interpretations rather than purely local use, the user needs to
than for content-reterenced interpre- know the applicability of the test to dif-
tations. ferent groups. For tests developed with
a view to widespread use in schools or
Dl. Norms should be published in
industry, information is needed about
the test manual at the time of release of
differences or similarities of normative
the test for operational use. Essential
data for appropriate subgroups such as
D1.1. Norms should be established sex, ethnic, grade, or age groups. Users
even for a test developed only for local need to be alert to situations when norms
use or only for predictive purposes. are less extensive for one group than
Desirable another.
[Comment: It is sometimes forgotten For example, the manual for an oc-
that norms tables provide infor- cupational interest inventory, or for an
mation useful for purposes other than aptitUde test particularly useful in cer-
comparing one individual with group tain occupations, should point out that
data. For example, a test user can a person who has a high degree of in-
derive information from a normative terest or aptitude in a curriculum or oc-
table about the score levels at which the cupation when compared to people in
discrimination power of the measure- general will usually have a lower degree
ment is good or poor.] of interest or aptitude compared to per-
sons actually engaged in that field.
D1.2. Even though a test is ex- Thus, a high percentile score on a scale
pected to be used primarily with local reflecting musical interest, in which the
norms, the test manual should never- examinee is compared with people in
theless provide normative data to aid general, may be equivalent to a low per-
the interpreter who lacks local norms. centile where the examinee is compared
Very Desirable with professional musicians.]
[Comment: The manual for one in-
D2.1. Care should be taken to avoid
strument designed to measure employee misleading impressions about the
aptitude stresses the value of local norms
generality of normative data. Essential
but also includes norms based on a
wide variety of occupational and [Comment: Truly representative na-
educational classifications.] tional norms, for example, are rarely if
ever obtained; normative data
D2. Norms presented in the test collected from people or schools with
manual should refer to defined and specific characteristics, however, are
clearly described populations. These frequently used as if they were taken
populations should be the groups with from a representative national group.
whom users of the test will ordinarily Thus, we have test users who may say
wish to compare the persons tested. that an examinee's performance is at a
Essential "tenth-grade reading level," without
[Comment: It should be noted that qualification when the norms are in fact
710 ApPENDIXD
obtained only from superior schools complete enough so that the user can
voluntarily participating in the test judge its appropriateness for his use.
research. It is an error of interpretation The description should include number
to assume that the norms of the volun- of cases, classified by one or more of
teer group of schools apply to schools in such relevant variables as ethnic mix,
general; the incidence of such erros may socioeconomic level, age, sex, locale,
be reduced by manuals that clearly and educational status. If cluster
define the characteristics of the norma- sampling is employed, the description
tive populations.] of the norms group should state the
number of separate groups tested.
D2.1.1. The test manual should
Essential
report the method of sampling from the
population of examinees and should [Comment: Manuals often use too
discuss any probable bias in this sam- gross a classification system in
pling procedure. Essential describing their normative data. For
example, the manual for one employee
D2.1.2. Norms reported in any test aptitude test provides a variety of
manual should be based on well- normative data for many occupational
planned samplings rather than on data and educational groupings. However,
collected primarily because it is readily the lack of information as to sex, ethnic
available. Any deviations from the plan origins, age, education, and experience
should be reported along with levels within these groupings consider-
descriptions of actions taken or not ably reduces the usefulness of the
taken with respect to them. Essential norms.]
[Comment: Occupational and educa- D2.2.1. The popUlations upon
tional test norms have often been based which the psychometric properties of a
on scattered groups of test papers, for test were determined and for which
authors sometimes have requested that normative data are available should be
all users mail in results for use in subse- clearly and prominently described in
quent reports of norms. Distributions the manual. Any accompanying report
so obtained are subject to unknown de- forms should provide space for
grees and types of biases. Hence. the identifying the normative groups used
methods of obtaining such samples in interpreting the scores. Essential
should be clearly described.] [Comment: The intent of this
D2.1.3. In addition to reporting the standard is to provide a warning to
consumers (users and examinees)
number of individuals in a set of
against unwarranted interpretations. If
normative data, the manual should also
a standard report form results in
report the number of sampling units
from which those individuals were percentile-rank or standard-score
interpretations by consistently using the
drawn along with the numbers of
same normative population, the
individuals in each unit. Essential
definition of that popUlation, with an
D2.2. The description of the norms indication of the time period of data
group in the test manual should be collection, would be sufficient.]
D2.3. lfthe sample on which norms and variability always should be

are based is small or otherwise reported. Essential
undependable. the user should be
cautioned explicitly in the test manual D3.I. In the case of tests used for
regarding the possible magnitude of prediction. expectancy tables or
errors arising in the interpretation of experience tables translating obtained
scores. Very Desirable scores into probabilities of success or
into proficiency levels should be
D2.4. Norms on subtests or groups included whenever possible. Desirable
of test items should be reported in the
test manual only if the validity and D4. Local norms are more
reliability of such subtests or groups of important for many uses of tests than
items are also indicated. Essential are published norms. A test manual
should suggest using local norms in
[Comment: The test user is justified
such situations. Very Desirable
in assuming that. when norms are given
for part of a test. the author implies DS. Derived scales used for
their usefulness for interpreting reporting scores should be carefully
performance. The reliability and described in the test manual to increase
validities of such scores should be the likelihood of accurate interpretation
reported.] of scores by both the test interpreter
D2.S. The significant aspects of and the examinee. Essential
conditions under which normative data [Comment: It would be helpful if the
were obtained should be reported in the number of kinds of derived scales could
test manual. Essential be reduced to a few with which testers
[Comment: Some tests are can become familiar. The present
standardized on job-applicant groups. variety makes description necessary in
others on groups that have requested each manual. In part the problem is
vocational guidance. and. still others. that many different systems are now
on groups that realized that they were used that have no logical advantage
experimental subjects. While precise over others; some may have outlived
description of levels is probably not their usefulness. New scaling methods
always possible. motivation for taking may be used in attempts to overcome
tests. test-taking attitudes. abilities. presumed difficulties with older ones.
and personality characteristics often The variety of scales for reporting test
differ within these groups and from scores can create confusion and
group to group.] misinterpretation unless the scales
recommended for a given test are
D3. In reporting norms, test clearly and fully explained.]
manuals should use percentiles for one
or more appropriate reference groups DS.I. Derivation of any scale from
or standard scores for which the basis is normative data should be clearly and
clearly set forth; any exceptional type of unambiguously described in terms
score or unit should be explained and likely to prevent user misinterpretations
justified. Measures of central tendency or overgeneralization. Essential
712 ApPENDIXD
[Comment: Derived scores can be error of measurement. The former scale

very useful for drawing inferences. Too suggests a greater degree of precision
often, however, they are treated as if than the latter, but this implication is
they had absolute meaning independent unwarranted.]
of a particular test or normative
DS.2.3. Interpretive scores that lend
population. An example is the IQ; it is
themselves to gross misinterpretations,
often simply a standard score, but it is
such as mental-age or grade-equivalent
frequently reified and interpreted as
scores, should be abandoned or their
representing an unchanging and
use discouraged. Very Desirable
unchangeable characteristic of the
person tested. Grade-equivalent scores [Comment: When, despite this
or even percentile ranks may also be recommendation, such scores are
misinterpreted as absolute entities included in a manual, their relationship
unless the manual makes clear the to standard scores or percentile ranks,
reference group on which they were within each category and within an
based.] appropriate norm group, should also be
provided in tabular form. For example,
DS.2. When standard scores are the table might show, in addition to a
used, the system should be consistent grade-equivalent score, the cor-
with the purposes for which the test is responding percentile rank within
intended and should be described in the examinee's own age or grade level
detail in the test manual. The reasons for each raw score. At the high school
for choosing one scale in preference to level. norms within courses (for
another should also be made clear in example, second-year Spanish) may be
the manual. Very Desirable more appropriate than norms within
DS.2.1. The manual should specify grades.]
whether standard scores are linear DS.3. When it is suggested in the
transformations of raw scores or are test manual that percentile ranks are to
normalized. Essential be plotted on a profile sheet, the profile
DS.2.2. The choice of a standard sheet should be based on the normal
scale should be based upon either the probability scale or some other
standard error of measurement of raw appropriate nonlinear transformation.
scores or on some other basis that is Very Desirable
clearly defined. Desirable DS.4. Normative data should be
[Comment: There are many stan- provided in a form that emphasizes the
dard-score scales in use. The scale for fallibility of an obtained score. Very
reporting scores on one widely used test Desirable
is so designed that each unit of the scale [Comment: Some publishers provide
is equal to about one thirtieth of the norms showing ranges of standard
overall standard error of measurement; scores or percentile ranks that have
a different test used for similar pur- designated probability levels including
poses is scaled so that one unit is equal the true score. A norms table might
to about one third the overall standard show for each raw score, not only the
associated standard score or percentile important respects from earlier

rank but also the values for raw scores editions, and the demand for continuity
at plus and at minus one standard error may require that the scales for
of measurement for each raw score. reporting scores be equated. There is
some doubt as to whether meaningful
D6. If scales are revised, new forms
comparability of scores is possible with
added, or other changes made, the
changed content, however, and a user
revised test manual should provide
should be able to evaluate claims of
tables of equivalence between the new
equivalency in terms of the kinds of
and the old forms. This provision is
content changes that have occurred.]
particularly important in cases where
data are recorded on cumulative D6.2. The manual sh()uld describe
records. Desirable the method used to establish equivalent
[Comment: New forms of a test or comparable scores and should in-
should be equated to recent(v clude an assessment of the accuracy of
determined standard-score scales of the equating procedure. Very Desirable
other forms, in order that the user may D7. Where it is expected that a test
be confident that the scores furnished will be used to assess groups rather than
by the new forms are comparable with individuals (i.e., for schools or
those of earlier forms.] programs), normative data based on
D6.1. When a new form is equated group summary statistics should be
with an older form of a test, the revised provided. Essential
manual should describe the content of [Comment: For example, it IS
both old and new forms and the nature inappropriate to evaluate schools by
of the norms group for each form. using norms developed for the
Essential evaluation of individuals. It is also
[Comment: Changes in knowledge, inappropriate to compute group means
technology, or curricula may require for nonlinear scales such as percentile
that new editions of a test differ in ranks derived for individual norms.
714 ApPENDIXD
STANDARDS FOR REPORTS OF RESEARCH

ON RELIABILITY AND VALIDITY
A test developer must provide The second question inquires into the
evidence of the reliability and validity of
usefulness of the measurement as an
indicator of some other variable as a
his test; it is usually reported in the test
manual. Many test users should do predictor of behavior. In this context,
similar research on their own the essential problem is to reach some
application of the test. Their reports conclusion about how well scores on the
often differ from those in test manuals test are related to some other
by being more detailed or more specific performance, and it is appropriate to
to a particular problem, or by speak of the closeness of the
validating test batteries rather than relationship.
individual tests. Despite such dif- The two questions are not necessarily
ferences, the standards of research, and independent. For example, where the
of research reporting, should be gen- test is a sample of the "other behavior,"
erally similar in the two situations. the answer is the same for either
question. Moreover, answers to both
E. Validity questions may require a knowledge of
Questions of validity are questions of the interrelationships between the test
what may properly be inferred from a scores and other variables. A thorough
test score; validity refers to the understanding of validity may require
appropriateness of inferences from test many investigations. The investigative
scores or other forms of assessment. processes of gathering or evaluating the
The many types of validity questions necessary data are called validation.
can, for convenience, be reduced to two: There are various methods of
(a) What can be inferred about what is validation, and all, in a fundamental
being measured by the test? (b) What sense, require a definition of what is to
can be inferred about other behavior? be inferred from the scores and data to
The first question inquires into the show that there is an acceptable basis
intrinsic nature of the measurement for such inferences.
itself. The measuring instrument is an It is important to note that validity is
operational definition of a specified itself inferred, not measured. Validity
domain of skill or knowledge, or of a coefficients may be presented in a
trait, of interest to the test developer or manual, but validity for a particular
user. The essential problem in this aspect of test use is inferred from this
context is to reach some conclusion as collection of coefficients. It is, there-
to how faithfully the scores represent fore, something that is judged as ade-
that domain, and it is appropriate to quate, or marginal, or unsatisfactory.
speak of the validity of the mea- The kinds of validity depend upon
surement. the kinds of inferences one might wish
to draw from test scores. Four evaluate construct validity, all know-
interdependent kinds of inferential ledge regarding validity is relevant. A
interpretation are traditionally de- reading comprehension test. for
scribed to summarize most test use: the example. may be used and validated for
criten'on-related validities (predictive all three types of inference: how well it
and concurrent); content validity; and predicts future academic perfonnance.
construct validity.' (So-called "face" how well it samples a defined content
validity, the mere appearance of vali- area of material to read, and how well it
dity, is not an acceptable basis for inter- measures the construct of compre-
pretive interferences from test scores.) hension.
These aspects of validity can be Criterion-Related Validities
discussed independently, but only for
Criterion-related validities apply
convenience. They are interrelated
when one wishes to infer from a test
operationally and logically; only rarely
score an individual's most probable
is one of them alone important in a
standing on some other variable called
particular situation. A thorough study
a criterion. Statements of predictive
of a test may often involve information
validity indicate the extent to which an
about all types of validity. In developing
individual's future level on the criterion
or choosing a test for prediction. one
can be predicted from a knowledge of
should first postulate the constructs
prior test performance; statements of
likely to provide a basis for useful
concurrent validity indicate the extent
prediction of the variable of interest;
to which the test may be used to esti-
the measures chosen should have
mate an individual's present standing
adequate construct validity. The
on the criterion. The distinction is
content universe from which items are
important. Predictive validity involves a
sampled may also be an important early
time interval during which something
step in producing a predictive test. in
may happen (e.g., people are trained. or
evaluating a test considered for use as a
gain experience. or are subjected to some
predictor. or in developing the criterion
treatment). Concurrent validity reflects
measure to be predicted. Even if the
only the status quo at a particular time.
accuracy of prediction is good.
Under appropriate circumstances. data
information about construct validity
obtained in a concurrent study may be
may make a test more usefuL To
used to estimate the predictive validity
of a test. However. concurrent validity
'Many other terms have been used. Examples should not be used as a substitute for
include synthetic validity. convergent validity. predictive validity without an approp-
job-analytic validity. rational validity. and fac-
torial validity. In general. such terms refer to riate supporting rationale.
specific procedures for evaluating validity rather For many test uses, such as for
than to new kinds of interpretive inferences. Any
specially-named procedures. including these
selection decisions or assignment to
examples. should meet the standards of in· treatment, predictive validity provides
vestigation contained in this section. These stan· the appropriate model for evaluating
dards apply generally to the various statistics or
procedures that might be used in support of one
the use of a test or test battery. In
or more classes of inferences from test scores. employment testing, for example. use of
716 ApPENDIXD
any procedure implies prediction to are validated against any available

some degree. Whether one uses a criterion with no corresponding
carefully developed test or casual investigation of the criterion itself. The
judgments of interviewers. their use for merit of a criterion-related validity
selection purposes assumes that study depends on the appropriateness
applicants who obtain high scores will and quality of the criterion measure
become better employees than appli- chosen. In applied research. the
cants who obtain low scores. criterion should be chosen with
Other forms of validity are not reference to the problem at hand. and
substitutes for criterion-related validity. the test or other assessment technique
In choosing a test to select people for a should be chosen with reference to the
job. for example. an abundance of criterion. If the study is done primarily
evidence of the construct validity of a to enhance understanding of what a test
test of flexibility in divergent thinking. measures. criteria should be selected in
or of the content validity of a test of terms of beliefs about the nature of the
elementary calculus. is of no predictive construct reflected by the test scores. In
value without rea..'IOD to believe that either case. the adequacy of the study
flexibility of thinking or knowledge of depends on the adequacy of the
calculus aids performance on that job. criterion. Criterion-related validity
The model of predictive validity should studies based on the "criterion at
guide thinking about validity in such hand." chosen more for availability
applications even where circumstances than for a place in a carefully reasoned
preclude an actual criterion-related hypothesis. are to be deplored.
validation study. Whatever other Third. the logic of criterion-related
validity information a manual may validity assumes that the sample is truly
include. one or more studies of representative of the population for
criterion-related validity must be which the later inferences are to be
included for any test developed for drawn. In practice. samples are often
prediction and for many tests intended nonrepresentative because of, for ex-
for diagnosis; otherwise. such tests can ample, restricted range, preselection, or
only be regarded as experimental. attrition before a predictive study can
Many factors may make a single. be eompleted.
obtained validity coefficient ques- Fourth. in many practical situations
tionable. First. the conditions of a vali- validity studies cannot be done with
dation study are never exactly re- adequate numbers of cases, and the
peated. Rapidly changing conditions investigators must do the best they can
may limit the usefulness of a predictive "Yith the data at hand. It may be better
study. The logic of predictive validation to try to investigate criterion-related
assumes that conditions existing at the validity. even if imperfectly. than to
start of the time sequence will exist accept totally untested hypotheses.
again after the study is completed. However, "doing something" is not
Second. the logic of criterion-related necessarily better than doing nothing;
validity assumes that the criterion the results of an inadequate study may
poss{''ises validity. All too often. tests be quite misleading. Results of
validation studies with severely restricted objectives. the performance domain

ranges or small Ns are especially open might be defined as all addition
to question. problems of three to five single-integer
Content Validity addends. The total number of problems
Evidence of content validity is and the relative frequency of occurrence
required when the test user wishes to of specific integers or pairs of integers
estimate how an individual performs in within that total are known. and the
the universe of situations the test is representativeness of any sample of
intended to represent. Content validity such problems can be easily judged.
is most commonly evaluated for tests of If a test is used to estimate
skill or knowledge; it may also be achievement in American history in
appropriate to inquire into the content Grade 12. the performance domain is
validities of personality inventories. less objectively defined. Given agree-
behavior checklists. or measures of ment on instructional objectives. it
various aptitudes. The present discus- could be defined in terms of the types
sion will be directed toward the more and quantities of the skills. facts. and
typical case of achievement testing. concepts of American history. as
To demonstrate the content validity determined by the pooled judgments of
of a set of test scores. one must show authorities. experienced teachers. and
that the behaviors demonstrated in competent curriculum makers in that
testing constitute a representative field. A definition of the total universe
sample of behaviors to be exhibited in a might well be tempered by the specific
desired performance domain. Defini- instructional objectives accepted by the
tions of the performance domain. the panel. A definition appropriate for
users' objectives. and the method of evaluation of performance at the end of
sampling are critical to claims of the year of study would differ from the
content validity. An investigation of definition appropriate for developing
content validity requires that the test an examination over knowledge of the
developer or test user specify his colonial period. Within such limits. the
0bjectives and carefully define the performance domain requires defi-
performance domain in light of those nition so carefully detailed that rules for
objectives. The definition should item writing will assure appropriate
ordinarily specify the results of learning representation of all facets of the defini-
rather than the processes by which tion. It should be noted that an achieve-
learning is either acquired or demon- ment test so constructed would not
strated. It should be sufficiently de- necessarily constitute a representative
tailed and organized to show the de- sample of the skills, facts, and concepts
gree to which component tasks make taught by any particular teacher during
up the total domain. any particular year. Consequently, a
Definition of the performance definition of the performance domain
domain is relatively simple where it is of interest must always be provided by a
finite and unambiguous. as in a simple test user so that the content of a test
test of addition for elementary-school may be checked against an appropriate
use. Depending upon instructional task universe.
718 ApPENDIXD
It is appropriate to inquire into the test developer or user is accountable for

content validity of many employment the adequacy of his definition. An
tests. Examples would include tests of employer cannot justify an employment
typing skill, driving ability, or test on grounds of content validity if he
knowledge of certain regulatory laws. cannot demonstrate that the content
The performance domain for published universe includes all, or nearly all,
~ests might be defined by the pooled important parts of the job.
Judgments of job designers, incum-
bents, and supervisors. Test users might Construct Validity
define the performance domain of
A psychological construct is an idea
interest to them in terms of
developed or "constructed" as a work
judgments of similar people in their
of informed, scientific imagination;
own organizations or, preferably, in
that is, it is a theoretical idea developed
terms of appropriately detailed and
to explain and to organize some aspects
comprehensive job analyses. The
of existing knowledge. Terms such as
question of objectives would again enter
"anxiety," "clerical aptitude," or
into the definition; unless only fully
"reading readiness" refer to such
trained and experienced people are to
constructs, but the construct is much
be hired, applicants cannot be expected
more than the label; it is a dimension
to demonstrate proficiency in all facets
understood or inferred from its network
of a job. The performance domain
of interrelationships. 4 It may be
would need definition in terms of the
necessary to postulate several different
objectives of measurement, restricted
constructs to account for the variance in
perhaps only to critical, most frequent,
any given set of test scores. Moreover,
or prerequisite work behaviors.
different constructs may be required to
It should be clear that content
account for the variance in different
validity is quite different from face
tests ofthe same general type. or a given
validity. Content validity is determined
test may provide evidence relating to
by a set of operations, and one evaluates
several constructs. For example, given
content validity by the thoroughness
proper evidence. scores on vocabulary
and care with which these operations
tests might be used to infer (a) the level
have been conducted. In contrast, face
of present vocabulary; (b) the existence
validity is a judgment that the
of pathology, interests, or values; or (c)
requirements of a test merely appear to
intellectual capacity.
be relevant. The writing of items in
Construct validity is implied when
terms used in a particular job or by a
one evaluates a test or other set of
particular subgroup of the population
operations in light of the specified
may give an appearance of relevance
construct. Judgments of construct
while contributing nothing to content
validity or indeed to any other useful
validity information (although such 'This is an admittedly restricted statement of
items may serve a useful public- the natur~ .of scientific constructs. which may in-
clude entities as well as dimensions. Constructs of
relations function). in~eres~ in the present context are. however.
In defining the content universe. a primarily quantitative.
validity are useful in efforts to improve theses, the investigator increases his
measures for the scientific study of a understanding of the qualities mea-
construct. They are also useful when a sured by the test. Through the process
test developer or test user wishes to of confirmation or disconfirmation, test
learn more about the psychological revision, and new research on the
qualities being measured by a test than revised instrument, he improves the
can be learned from a single criterion- usefulness of the test as a measure of a
related validity coeffficient. construct.
Evidence of construct validity is not It is important to note in this that the
found in a single study; rather, investigation of construct validity refers
judgments of construct validity are to a specific test and not necessarily to
based upon an accumulation of any other test given the same label.
research results. In obtaining the Evidence of construct validity may
information needed to establish also be inferred from the procedures
construct validity, the investigator followed in developing a test. For
begins by formulating hypotheses about example, in a measure of mechanical
the characteristics of those who have interest, a double item analysis may be
high scores on the test in contrast to used to reduce the effect of verbal
those who have low scores. Taken ability. A preliminary item analysis
together, such hypotheses form at least might be done using a standard verbal-
a tentative theory about the nature of comprehension test as an external
the construct the test is believed to be criterion. Those items with a very low
measuring. In a full investigation, the discrimination index in this analysis
test may be the dependent variable in could then be subjected to a second
some studies and the independent item analysis, a conventional internal-
variable in others. Some hypotheses consistency analysis. Only those items
may be "counterhypotheses" suggested with a low discrimination index in the
by competing interpretations or first analysis and a high discrimination
theories. index in the second analysis would be
Such hypotheses or theoretical included in the final item pool.
formulations lead to certain predictions Although evidence of construct
about how people at different score validity may be developed on the basis
levels on the test will behave on certain of a series of criterion-related studies, it
other tests or in certain defined is important to note that evidence ofthe
situations. If the investigator's theory construct validity of a test is not
about what the test measures is adequate evidence of the usefulness of
essentially correct, most of his the construct in specific further
predictions should be confirmed. If they hypotheses. In the selection of
are not, he may revise his definition of salespersons, for example, it is often
the construct, or he may revise the test hypothesized that success is a function
to make it a better measure of the of sociability. If one has a measure of
construct he had in mind. Through the sociability with generally acceptable
process of successive verification, evidence of its validity as a measure of
modification, or elimination of hypo- that construct, he may expect to find it
720 ApPENDlxD
useful as a predictor of sales success; research reported elsewhere. either by

perhaps some of the evidence of the the test developer or by others.
construct validity ofthat measure came. Preferably. the manual will report on
in fact. from confirmation of such an individual studies and provide
expectation. However. the test may have summaries of validity data for various
no predictive validity against the kinds of interpretations or inferences.)
criterion of success in an engineering
El.l. Statements about validity
sales job. In such a case it is not the
should refer to the validity of particular
construct validity of the sociability
interpretations or of particular types of
measure that is to be questioned.
decisions. Essential
General Principles [Comment: It is incorrect to use the
unqualified phrase "the validity of the
A test developer. or anyone who test." No test is valid for all purposes or
conducts validation research. should in all situations or .for all groups ~(
provide as much validity information as individuals. Any study of test validity is
possible so the user can evaluate the test pertinent to only a few of the possible
or the research for his own purposes. A uses of or inferences from the test
test manual can provide evidence that scores.
will enable the user to evaluate the If the test is likely to be used
appropriateness of the item content. to incorrectly for certain areas of decision.
determine whether the test is an the manual should include specific
acceptable measure of a specified warnings. For example. the manual for
construct. and to decide whether the a writing-skills test stated that the test
test has provided useful predictive apparently was not sufficiently difficult
validities in situations similar to his to discriminate among students "at
own. An adequate research report can colleges that have selective admis-
help the user decide whether to go sions.")
ahead with the use of the test or to seek
another predictor. E1.2. Wherever interpretation of
subscores. score differences. or profiles
El. A manual or research report is suggested. the evidence justifying
should present the evidence of validity such interpretation should be made
for each type of inference for which use explicit. (See also 85.5.) Essential
of the test is recommended. If vaUdity El.2.1. If the manual suggests that
for some suggested interpretation has the user consider an individual's
not been investigated, that fact should responses to specific items as a basis for
be made clear. Essential assessment. it should either present
[Comment: Validation studies are a evidence supporting this use or call
part of the process of test development; attention to the absence. of such data.
test users expect them to be reported in The manual should warn the reader
detail by the developer. preferably in that inferences based on responses to
the manual itself. At the very least. the single items are subject to extreme
manual should summarize competent error. Hence. they should be used only to
direct further inquiry, perhaps in a inventories and biographical-data

counseling interview. Essential forms, scoring keys should be reevalu-
ated after relatively brief periods of
El.3. To insure the continued
time.]
correct interpretation of scores, the
validity of suggested interpretations El.4. Correlations of item scores
should be rechecked periodically; test with total scores on the test in which the
developers should report results in item is included (or a parallel form of
subsequent editions of the manual. that test) may be presented as item-
Very Desirable discrimination coefficients, but they
[Comment: Job duties, conditions of should not be presented or used as
work, and the types of individuals item-validity coefficients. Essential
entering an occupation often change [Comment: Item-discrimination co-
materially with the passage of time. eficients are useful in reasoning about
Similarly, the meanings of clinical construct validity, and such
categories, the nature of therapeutic information is appropriately included
treatment, and the objectives of in a manual. However, they are indica-
academic programs change. The tors of internal consistency, not of
difficulty and psychological meaning of validity.]
test items will also change. Hence, the
E2. A test user is responsible for
reader should be in a position to judge
marshalling the evidence in support of
the extent to which tests are obsolete.]
his claims of validity and reJiabUity.
El.3.1. If factors that may affect The use of test scores in decision rules
test performance or the validity of a should be supported by evidence.
suggested test interpretation have Essential
changed, and validity studies have not [Comment: It is a basic responsibility
been repeated for the changed of a test user to read, understand, and
conditions, the test should be evaluate the manual. the research, and
withdrawn from general sale and the literature to show the
distributed, if at all, only to persons appropriateness of the test for the
who wiJI conduct their own validity intended use. A large-scale user may
studies. Very Desirable have the added responsibility for
[Comment: It should be noted that empirical research bearing on his
no specific time interval is mentioned. claims of test validity. Evidence of
Test developers and publishers should validity is needed for all bases for
know the relevant conditions and decision. not merely those that are easy
should be able and willing to obtain to study. It is a peculiar paradox that
new validity information when such many employers and schools are
conditions have changed. It is not abandoning the use of standardized
necessary to repeat every part of the tests and are turning instead to casual
validation; what is needed is a repetition assessment techniques likely to be less
ofthose studies most likely to have been valid. Many employers use procedures
rendered obsolete. In the case of some with no validity. or biased selection
722 ApPENDIXD
procedures of unknown validity rather be described completely and accurately.

than objective procedures for which The manual or research report should
evidence of validity could have been comment on the adequacy of a
assembled.] criterion. Whenever feasible, it should
draw attention to significant aspects of
E2.1. Test users are responsible for
performance that the criterion measure
gathering data on the validity and
reliability of their assessment tech· does not reflect and to irrelevant
factors likely to affect it. Essential
niques. Very Desirable
[Comment: Desirable practices are
[Comment: For many individual test
illustrated in a manual for a test
users, this may be a nearly impossible
designed to measure abstract
requirement. It would seem, however,
intelIigence. Several validity studies
that a test user has an obligation to
relating this instrument to criteria are
gather data, at least on an informal
teported, some involving concurrent
basis, in an effort to evaluate his work.
In even the most difficult circum- measures and others involving
predictions over periods of time.
stances. a test user can be alert to data
Limitations of the studies are
suggesting possible lack of validity.]
recognized, ana it is stated that "no one
E2.2. If a user wants to use a test in criterion is uniquely appropriate." The
a situation for which the use of the test value of local norms is stressed. and an
has not been previously validated, or for example of a local expectancy table is
which there is no supported claim for provided.
validity, he is responsible for validation. In the case of interest measures, it is
Very Desirable sometimes not made clear whether the
[Comment: He who makes the claim criterion indicates satisfaction, success,
for validity is responsible for providing or merely continuance in the activity
the evidence. Evidence of validity under examination. When criterion
sufficient for test use may often be groups include people in a given
obtained in a well-documented manual. occupation and when a comparison of
If the test user wishes to claim that the such groups is made to people in
validity generalizes beyond the evidence general, the manual should point out
for the kinds of situations reported in the distinction between working in an
the manual, it is his responsibility to occupation and success in it or
demonstrate it.] satisfaction with it.]
E2.3. When a test user plans to E3.I. When the validity of a test for
make a substantial change in test predicting occupational performance is
format. instructions, language. or reported, the manual should describe
content, he should revalidate the use of the duties of the workers as well as give
the tests for the changed conditions. their job titles. Very Desirable
Essential [Comment: The principle is that
information should be given from which
Criterion-Related Validity
the reader can make judgments of the
E3. All measures of criteria should relevance of the criterion. The
description of a criterion is often For example. an investigation of

incomplete without such information.] possible sex differences in criterion
E3.1.1. Where a wide range of ratings might show significant
differences between men and women.
duties is subsumed under a given
That fact in itself. however. is not
occupational label. the test user should
sufficient evidence of criterion
be warned against assuming that only
contamination; it might reflect actual
one pattern of interests or abilities is
sex differences in performance.]
compatible with the occupation.
Essential E4.1.1. The criterion score should be
E4. A criterion measure should determined independently of test
itself be studied for evidence of validity scores. The manual should describe
and that evidence should be presented precautions taken to avoid contami-
in the manual or report. Very Desirable nation of the criterion or should warn
the reader of possible contamination.
[Comment: Criterion measures are Essential
forms of assessment and are subject to
the same standards governing the [Comment: When the criterion is
based on judgment. the manual should
development and use of any assessment
state whether the test data were
technique. For many employment and
available to the judge or were capable of
educational purposes. the ideal
criterion may be an achievement test or influencing the judgments in any other
work sample judged acceptable in way. If the test data could have
terms of content validity. Supervisory or influenced the criterion rating. the user
instructor ratings are more common should be warned that the reported
validities are likely to be spuriously
but may be questioned in terms of
high.]
construct validity. For example. a
rating of proficiency may be defined to E4.2. The basis for judgments of cri-
include elements of both speed and terion relevance should be clearly set
accuracy. but to exclude elements of forth. Essential
dependability. A judgment of accep-
E.4.3. Criterion-related validation
table construct validity might be based
should ordinarily consider more than a
on evidence of high correlations of the
single global criterion. Very Desirable
ratings with production data or work
samples and of independence from [Comment: In most situations where
seniority or attendance data.] decision rules based on testing are
worthwhile. performance falls along
E4.1. Particular attention should many dimensions that may be
be gh:en to potential sources of criterion independent. Combining unrelated
contamination; results of investigations aspects of behavior into a single
of contamination should be reported. composite criterion may obscure
Essential important relationships and reduce a
[Comment: Results of such in- test user's opportunity to identify and
vestigations are often ambiguous. and understand valid test interpretations.
readers should be warned of this fact. A problem exists in that single
724 ApPENDIXD
decisions must frequently be made on measure. the form-to-form agreement

multivariate bases. Nevertheless. it is or the reliability reported by the test's
preferable to find a decision rule for author may be used as a basis for
combining predictions than to use a evaluating the criterion. due regard
decision rule for combining predictors being given to the effect of differences
of ambiguous validity.] between the present sample of persons
and the original sample.]
E4.4. In criterion-related valida-
E4.4.2. When validity is appraised
tion. it is important that the criterion
by agreement of test results with
measure have substantial reliability.
psychiatric diagnoses, the diagnostic
Very Desirable
terms or categories should be defined
specifically and described clearly. Very
[Comment: Since corrections for
Desirable
unreliability of a criterion can be made
with generally reasonable statistical [Comment: For example. "paranoid
assumptions. the degree of reliability of schizophrenia. chronic" is preferable as
a criterion is perhaps less important a category to "schizophrenia." Since
than the degree of reliability of the the types of patients included in specific
predictor. Nevertheless. reliability is not diagnostic classifications depend to
a trivial consideration; reasonable some extent on the point of view of the
effort should be made to assure a level classifying psychiatrist. an amplified
of reliability such that statistical description of each diagnostic category
corrections are unlikely to change used in the validity study should be
interpretations markedly.] presented.]
E4A.3. When validity is appraised
E4.4.1. Since the criterion measure by the agreement of test results with
is a sample of all possible measures of psychiatric judgments, the training.
the same criterion construct. reliability experience. and professional status of
should be reported in terms of the the judge(s) should be stated. and the
agreement of that sample with other nature and extent of his contacts with
similar samples where feasible. If such the patients and other factors
evidence cannot be given. the author influencing the interaction should be
should make this clear and should reported. Very Desirable
discuss the probable extent of
agreement of the sample with other E.S. The manual or research report
samples as judged from indirect should provide information on the
evidence. Very Desirable appropriateness of or limits to the
generalizability of validity information.
[Comment: When validity is
Very Desirable
measured by agreement of the test with
psychiatric judgment. for example. the ES.l. A test manual should report
degree of agreement among judges evidence of validity for each type of
should be described. Where a published criterion about which a recom-
achievement test is used as a criterion mendation is made. If validity for some
recommended interpretation has not differ from one locality to another or

been tested, that fact should be made from one institution to another, no
clear. Essential published validity data can serve aJl
[Comment: This principle should not localities. For example, the validity of a
be interpreted as license to present as certain test for predicting grades at a
validity information various corre- college with a unique kind of
lations with irrelevant variables. Data curriculum may be quite different from
should be presented with reference to the published validities of the same test
recommended interpretations, either based on a more conventional curri-
supporting those interpretations or sug- culum.
gesting limitations to them.] Some publishers have ma(je available
advice on local validation studies,
including information on the pre-
ES.2. For any type of prediction, a
paration of expectancy tables.]
test manual should report criterion-
related validities for a variety of E6. The sample employed in a
institutions or situations. Where validity study and the conditions under
validity studies have been confined to a which testing is done should be
limited range of situations, the manual consistent with recommended test use
should remind the reader of the risks and should be described sufficiently for
involved in generalizing to other types the reader to judge its pertinence to his
of situations. Essential situation. Essential
E6.1. Any selective factor deter-
ES.2.1. Validity coefficients are
mining the composition of the vali-
specific to the situations in which they
dation sample should be indicated in a
are obtained. Ifthe manual is to suggest
manual or research report. The sample
generalization of validity for prediction
should be described in terms of those
of a given kind of criterion construct, it
variables known as thought to affect
must present data ~uggesting the
validity, such as age, sex, socioeconomic
limits of generalizability regarding
status, ethnic origin, residential region,
population or sample characteristics.
level of education, or other demo-
situational context variables. or
graphic or psychological char-
variations in criterion measurement.
acteristics. Essential
Very Desirable
[Comment: If a validity study uses
ES.2.2. Local collection of evidence patients as subjects. the diagnoses of
on criterion-related validity is fre- the patients would usually be important
quently more useful than published to report. The severity of the diagnosed
data. In such cases the manual should condition should be stated when
suggest appropriate emphasis on local feasible. For tests used in industry the
validity studies; and test users should, employment status. occupational
where feasible, conduct such studies. experience. and the sex and ethnic
Desirable composition of the sample should be
[Comment: In cases where criteria described. For tests used in educational
726 ApPENDIXD
settings. relevant information may E6.1.2. If an ability test is to be used

include community characteristics or for educational or occupational
any selection policies.] selection. its validity should be
established using subjects who are
E6.1.1. Evidence of validity should actual candidates and who are therefore
be obtained for subjects who are of the ordinarily motivated to perform well. If
same age or in the same educational or the subjects used in a validity study are
vocational situation as the persons for volunteers or were told that their test
whom the test is recommended. Any scores would not be used in making
deviation from this requirement should decisions about them. this fact should
be described in the manual or research be made clear. Very Desirable
report. Essential [Comment: Widespread use is made
[Comment: Validity information for in industrial selection of the "present-
tests intended for guidance should employee method" of validation.
generally be determined on subjects Typically. this involves administering
tested prior to or near the time when the tests to present employees who are
they are making educational or told that their performance on the test
vocational choices. will not influence their employment
One interest inventory was first situation. The motivational difference
standardized on men currently may distort sample characteristics in
employed in the occupation in question. that it introduces a completely new
The ability of these scales to variable to the testing situation.]
differentiate between occupational groups
did not. in and of itself. warrant using E6.2. Basic statistics should be
the inventory in the counseling of high reported in describing the sample,
school or college students. Better evi- including numbers of cases (and the
dence was obtained later by admin- reasons for any eliminated cases) and
istering the inventory to students. deter- measures of central tendency and
mining the nature of their later employ- variability. A description of the
ment. and then establishing the relation distribution, perhaps with measures of
between preoccupational score and skewness and kurtosis, should also be
later occupation. included. Very Desirable
If an interest inventory uses a [Comment: The smaller the number
criterion of enrollment or nonen- of cases in a validation sample, the less
rollment in a certain occupation. the reliable the statistics. Consider, for
sample used in its validation should example, the etl'ect of the number of
include only the range of mental ability cases on the 95% confidence interval
appropriate to the occupational group. when the obtained correlation coef-
For example. college students are not ficient is .30. With 2SO pairs of obser-
suitable subjects with whom to estimate vations. the interval runs from .18 to
the validity of an inventory of interest in .41. Where N = SO. the interval runs
manual skills. even though some of from .02 to .53; where N = 25. the in-
them later enter manual occupations.] terval runs from -.10 to +.62.
When N is very smaIl. an obtained hired in a period when the rejection

correlation coefficient of zero may ratio was very high. resulting in a
result in the erroneous rejection of a serious restriction of range. However.
valid test.} the passage of time brought with it
changes in performance standards and
E6.2.1. If the distribution of test
in recruiting activities; the variance was
scores in a validation sample is
greater and the mean was lower in a
markedly different from the
new sample than in the sample used in
distribution of scores in the group with
the validation study. The situational
whom the test is ordinarily used. data
and psychometric facts together
based on these scores. including
identify a change in groups more
estimates of population parameters.
important than differences in variance
should be interpreted with great
alone. and a "correction" based on
caution. Reports of parameter
sample variances is therefore
estimates should cite the original
inappropriate.
statistics. the distribution charac-
teristics used in making the new esti- In this situation it would be more
appropriate to replicate the study with
mate. and the statistical procedures em-
the new applicant popUlation than to
ployed. Essential
"correct" data obtained from the old
[Comment: The reader of the manual population for restriction of range.}
or research report needs to evaluate any
adjustments made because of atypical E7. The collection of data for a
sample characteristics. The assump- validity study should follow procedures
tions underlying such adjustments are consistent with the purposes of the
frequently ignored; the resulting errors study. Essential
are of undetermined size and direction.
E7.1. Where feasible. a test should
Despite such difficulties. an estimate of not be used as a basis for decision while
the appropriate statistic is often its proposed use is being validated.
needed. The reported validitv coef- Desirable
ficient. for example. should reflect the
predictive power of a test in the group [Comment: In many practical
situations. decisions must be made
to which it will be applied.}
whether or not there is a validated basis
E6.2.2. Statistical corrections. such for them. In some circumstances. high
as those for restriction of range. should costs may necessitate the use of a test
not be made in situations where mean even though it has not been validated.
performance in the sample in the but great caution should then be
validation study is so different from the exercised. In a selection situation. for
mean performance of the population in example. decisions should not be so
which it is to be used as to suggest highly selective that restriction of range
differences in parent populations. Very makes discovery of validity impossible.
Desirable Wherever possible. at least some
[Comment: A validation study was validation research should be done
conducted on a sample of applicants before a test is put to use as a decision
728 ApPENDIXD
instrument. and further data should be E7.4.1. Validation reports should be

gathered subsequently.] clearly dated. with the time interval
given during which the data were
E7.2. If the validity sample is made
collected. Essential
up of records accumulated haphazardly
or voluntarily submitted by test users. [Comment: Validity may deteriorate
this fact should be stated in the manual over time; in employment testing. for
or research report. and the test user example. changes in jobs. work aids.
should be warned that the group is not and in the ability levels of applicant
a systematic or random sample of any populations tend to change the
specifiable population. Probable circumstances in which validity infor-
selective factors and their presumed mation is developed.]
influence on the test variable should be
E7.4.2. In general. a test user should
stated. Essential
be cautious in making long-term
[Comment: While it is entirely predictions. Essential
appropriate to include in the manual
[Comment: Short-term predictions
such phrases as "the author and
are much more likely to be valid than
publisher of this test would welcome
are long-term predictions because they
additional data derived from its use." it
are less subject to influences other than
is difficult to judge the quality and
the characteristics measured.]
representativeness of most of the
resulting reports.]
E7.4.3. If a test is recommended for
E7.3. In collecting data for a long-term predictions, but comparisons
validity study. the person who interprets with concurrent criteria only are
the test results should have only that presented. the manual should empha-
information about the examinees that is size that the validity of long-term
ordinarily expected to be available in predictions is undetermined. Essential
practical use of the test. or he should be
sufficiently trained and disciplined dis- E7.4.4. The amount and kind of any
regard information ordinarily not avail- experience or training received by the
able to him. If there is any possible subjects between the time of testing and
contamination associated with prior the time of criterion measurement
favorable or unfavorable knowledge should be stated. Very Desirable
about the examinees. the manual
E7.4.5. When validity for predicting
should discuss its effect on the outcome
grades in a course is reported.
of the study. Very Desirable
reasonably clear information should be
E7.4. The time elapsing between provided regarding the types of
the test administration and the performance required in the course. the
collection of criterion data should be nature of the instructional method. and
reported in the manual. If the criterion the way in which performance is
data are collected over a period of time. measured. If the test was administered
beginning and ending dates should be after the course was started. this fact
included. Essential should be made clear. Very Desirable
E8. Any statistical analysis of to communicate validity information

criterion·related validity should be clearly.)
reported in the manual in a form that
ES.!'!' Errors of prediction should
enables the reader to determine how
be estimated and reported; a validity
much confidence is to be placed in
coefficient should be supplemented
judgments or predictions regarding the
with reports of the regression slope and
individual. Essential
intercept and of the standard error of
ES.1. A report of criterion-related estimate. Very Desirable
validity should give full information
[Comment: The required information
about the statistical analysis and should
could be presented in an expectancy
ordinarily include. in addition to such
table showing the range of possible
basic descriptive statistics as means and
criterion values for each of several
standard deviations. one or more of the
points on the score range. The standard
following: (a) one or more correlation
error of estimate at different points
coenicients of a familiar type. (b)
along the score range is often helpful.
descriptions of the eniciency with which
For a dichotomous criterion. this
the test separates criterion groups. (c)
objective might be achieved by
expectancy tables. or (d) charts that
indicating the proportion of hits.
graphically illustrate the relationship
misses. and false inclusions at various
between test and criterion. Essential
cutting scores.)
[Comment: Full information includes
data on the reliability. the strength. and ES.!.2. For some users, analysis of
the nature of the relationship. In test variance according to the following
correlational terms. this would imply sources is appropriate: variance
information about the statistical relevant to the criterion. variance
significance and magnitude of the explained as form-to-form or trial-to-
correlation coefficient and about the trial inconsistency. and a reliable but
regression equation. irrelevant remainder. Very Desirable
Reports solely of differences between [Comment: Such an analysis is more
group means give inadequate complete and less subject to
information regarding validity; if misinterpretation than a correlation
variance is large. classification may be coefficient, including even a "cor-
inaccurate even if means differ rected" validity coefficient, or a com-
considerably. The strength of the parison of group means.)
relationship may be indicated by des-
cribing the amount of misclassification ES.1.3. The methQd of statistical
or of overlapping. Expectancy tables analysis should be chosen with due
may provide information about the consideration of the characteristics of
nature of the predictions. the data and of the assumptions of the
In general. since manuals and method. Essential
research reports are often directed to [Comment: Data may often depart
test user~ who have limited statistical from the assumed characteristics with
·knowledge. every effort should be made little ill effect. Some violation of
730 ApPENDIXD
assumptions may. however. be seriously comparison is improper. in part.

misleading. For example. the use of because the test author compared
predictions based on the assumption of augmented coefficients with uncor-
a normal bivariate correlation surface rected coefficients for ability tests.]
may seriously overestimate the mean
performance of high-scoring candidates ES.2.1. Where correlation coeffi-
if the data are markedly heteroscedastic cients are corrected for attenu-
(as in triangular scatter distributions). ation or restricted range. full infor-
In such cases. a method of analysis not mation relevant to the correction should
based on assumptions about the be presented. If such corrections are
bivariate distribution would present a made. significance tests should be made
more accurate statement of validity.] with the uncorrected correlation coeffi-
cients. Essential
ES.2. If validity coefficients are
corrected for errors of measurement ill [Comment: Corrections should be
the criterioll. the computation of the applied only to obtained coefficients. It
reliability coefficient of the criterion is ordinarily unwise to make sequential
should be explained. and both correc.tions. as in applying a correction
corrected and uncorrected coefficients for attenuation to a coefficient already
should be reported. Essential corrected for restriction of range.
Chains of corrections may be useful in
[Comment: Coefficients corrected for
considering possible further research.
errors of measurement in the test are
but their results should not be seriously
not estimates of the criterion-related
reported as estimates of population
validity for the existing test and should
correlation coefficients.]
not be reported. Corrections for
attenuation are very much open to ES.3. If validity is demonstrated by
misinterpretation. especially if based on comparing groups that ditfer on the
obtained correlation coefficients that criterion. the manual should report
are very low or from a small or whether and by how much the groups
otherwise inappropriate sample; if differ on other available variables that
misinterpreted. they give an are relevant. Very Desirable
unjustifiably favorable impression of
[Comment: Since groups that differ
the validity of the test scores. The
on a criterion may also differ in other
hazard is illustrated in the manual for
respects. the test may be discriminating
an adjustment inventory. The author
on a quality other than that intended.
reported correlation coefficients
Types of mental disorders. for instance.
between inventory scores and criterion
are associated with age. education. and
ratings; also reported were estimated
length of time in the hospital.
coefficients between "true" inventory
Confounding of this sort should be
and criterion scores. He then
taken into account when the usefulness
commented that the augmented
of a test for diagnosis is appraised.)
correlation coefficients "are as high as
those often secured between college ES.3.1. If a test is suggested for the
aptitude tests and college grades." The differential diagnosis of patients. the
manual should include evidence of the ES.4. When information other than
test's ability to place individuals in the test scores is known to have an
diagnostic groups rather than merely to appreciable degree of criterion-related
separate diagnosed abnormal cases validity and is ordinarily available to
from the normal population. Essential the prospective test user. the user
[Comment: When a test is shOUld consider both the validity of the
recommended for the purpose of other information and the resulting
assigning patients to discrete cate- mUltiple correlation when the new test
gories. such statistics as contingency information is combined with it.
coefficients. phi coefficients. or dis- Essential
criminant functions should be sup- [Comment: Whether a test should be
plemented by a table of misclassi- used for prediction and classification
fication rates giving. for example. the when other information is readily
proportion of patients falsely included available sometimes depends not on the
in a category or falsely excluded from it. validity of the test but on its
Such proportions should be compared "incremental validity." that is. what it
with base rates. that is, the proportions adds to the soundness of the judgment
of correct classifications made possible that would otherwise be made.
by a mere knowledge of the sizes of the For a questionnaire intended to
categories.] predict marital success. delinquency.
E8.3.2. If validity is demonstrated and similar behavioral variables. the
by comparing groups that differ on the investigator should find out how much
criterion (e.g.. where one group is the questionnaire enhances prediction
identified as a high-performanc~ group over that provided by base rates
and another as a low-performance developed from demographic variables
group). all cases should be assigned to such as socioeconomic status.)
one or the other of the groups. Very ES.5. Where more than one test is to
Desirable be used. validity information should
[Comment: The most reliable report the validity of the combination
statistics are obtained if all cases are actually used. Where composite scores
used; validity coefficients derived from are developed. the basis for weighting
extreme groups may be misleading. In (e.g.. multiple regression equations)
some situations. analyses using extreme should be given. Essential
groups may be useful for identifying [Comment: In one organization. a
predictors. but generally the validity composite was developed and validated
reported for any given predictor should by multiple regression in which the
be based on all cases. If the use of optimal weighting of one test was
extreme groups is deemed necessary or negative. Nevertheless. the organization
appropriate to a particular study. added unweighted scores to form a
appropriate estimates of correlatio~ different composite for use in making
should be used. The typical product- decisions. The multiple correlation
moment and biserial estimates are lIot coefficient did not. therefore. describe
appropriate in this situation.) the validity of the test battery as it was
732 ApPENDIX 0
actually used. Where a given method of explore the question of fairness.

combination is to be used. that method Evidence of differential validity is
should be validated. developed by comparing. for example.
When mUltiple regression is used correlation coefficients. regression
and one predictor in a battery is equations. and means and variances for
evaluated. the beta weight is a better each variable.
index of its contribution to the validity The proper statistical test for such a
of the test in that combination than is difference is. for any parameter. the test
its original validity coefficient.] of the hypothesis of no true difference
between the groups. for example. a test
E9. A test user should investigate
of no difference between correlation
the possibility of bias in tests or in test
coefficients. slopes, or intercepts. Some
items. Wherever possible, there should
investigators have attempted to ex-
be an investigation of possible
amine such differences by comparing in
differences in criterion-related validity
each subgroup independently the vali-
for edmic, sex, or other subsamples that
dity statistic (e.g .• the correlation coef-
can be identified when the test is given.
ficient> to a postulated true value of
The manual or research report should
zero. This is not a proper procedure; it
give the results for each subsample
does not answer the question at issue of
separately or report that no differences
differences in the characteristics of
were found. Essential
validity. It is impossible to demonstrate
[Comment: For many uses, regula- such differences by showing that one
tions published pursuant to civil rights correlation coefficient. for example. is
legislation require that validity studies significantly different from zero while
be performed separately on samples dif- the other is not.
fering in national origin. race, sex. or Users should routinely investigate
religious affiliation, when technically differences in validity when it is tech-
feasible. nically feasible to do so. that is, when N s
The concept of fairness may involve are sufficient for reliable comparisons
other sources of inappropriate discrimi- and when criteria are reasonably valid
nation. For example. placing a hand-- in each group. Users should be aware.
dexterity test on a low table may un- however. that a too-hasty acceptance of
fairly bias the test against tall people. bias or of differential validity. if used in
The test user should try to identify po- decision making. may be as likely to
tentially unfair influences on test scores produce unfair test use as is failure to
in his situation. Variables which may consider the possibility.
contribute inappropriate variance may For example. to avoid unfairness in
be used for subgrouping in investi- test use for blacks. an employer may
gation of fairness. investigate the possibility of differential
However. caution must be exercised validity and find not only differences in
in evaluating the possibility of bias. A means between black and white
simple difference in group means does applicants but also differences in
not by itself identify an unfair test. intercepts of the regression. Some
although it should stimulate research to definitions of fairness require that
predictions for applicants in either the test with other variables, the state-
group should be based on the regressi6n ment of the validity of the composite
line developed for his own group. If the should be based on a crossvalidation
differences in intercepts are statistical sample. Essential
artifacts (due. for example. to
[Comment: Cross-validation is par-
unreliability). the result might be
ticularly necessary when the number of
considered unfair to blacks (if they have
predictors entering the study (not the
the lower regression line) since their
final equation) is greater than 4 or 5
performance might be systematicaIly
under predicted. The effect can, of and when the sample size is less than
200.]
course, work both ways depending
on the direction of differences in
regression. EIO.1.1. When the scoring of tests
It is important to recognize that there in a battery is based on regression
are different definitions of fairness, and coefficients, negative scoring weights
whether a given procedure is or is not should be used only if they have been
fair may depend upon the deiinition verified by cross-validation in large
accepted. Moreover, there are statisti- samples and if their use will not be
cal and psychometric uncertainties invalid (and thus unfair) to one or more
about some of the sources of apparent subgroups in the population to be
differences in validity or regression. tested. Essential
Unless a difference is observed on
samples of substantial size, and unless EIO.2. If it is proposed that
there is a reasonably sound psycho- decisions be based on a complex
logical or sociological theory upon nonlinear combination of scores, it
which to explain an observed dif- should be shown that this combination
ference, the difference should be viewed has greater validity than a simpler
with caution. linear combination, that the equation
Bias is not necessarily detected by can be logically explained, and that the
criterion-related validity alone; cf. procedures for combining scores have
EI2.12l. been cross validated. Essential
[Comment: The use of "moderator
EIO. When a scoring key, the
variables," for example, is to be
selection of items, or the weighting of
recommended only where a moderator
tests is based on one sample, the
is shown to produce a clear
manual should report validity
improvement in validity in a cross-
coefficients based on data obtained
validation sample. Similarly, when it is
from one or more independent cross-
proposed that some pattern of scores
validation samples. Validity statements
(e.g., high standing in scores on both
should not be based on the original
Variables 2 and 5) is an indicator of
sample. Essential
success, it is necessary to show that the
EIO.1. If the user recommends proportion of successful persons in the
certain regression weights for com- group so identified is higher than would
bining scores on a test or for combining be expected from the regression of
734 ApPENDIXD
frequency of success on a linear situations, the test manual should give a

combination of Variables 2 and 5.] clear definition of the universe repre-
sented and describe the procedures
Ell. To the extent feasible, a test
followed in the sampling from it.
user who intends to continue employing Essential
a test over a long period of time should
develop procedures for gathering data [Comment: The definition of the
for continued research. Desirable universe of tasks represented by the test
scores should include the identification
[Comment: Validity data may
of that part of the content universe
become obsolete. The relationship
represented by each item. The
between test performance and criterion
definition should be operational rather
performance may be influenced by
than theoretical. containing specifica-
many factors. such as changes in
tions regarding classes of stimuli. tasks
populations. recruiting sources, the
to be performed and observations to be
economy, organizational charac-
scored. The definition should not
teristics. processes, or tasks. More-
involve assumptions regarding the psy-
over, validity studies are often based on
chological processes employed since
relatively few cases. A plan for the
these would be matters of construct
systematic collection of further data
rather than of content validity.]
after the test has been placed into
operational use may be useful both for EI2.I. When experts have been
the development of a more reliable data asked to judge whether items are an
base and for information on changes in appropriate sample of a universe or are
the trends of relationships over time. correctly scored. the manual should
Operational use may. however, result describe the relevant professional
in severe restriction of range. Contin- experience and qualification of the
uing research may be less necessary if experts and the directions under which
the original data are based on a rela- they made their judgments. Very
tively large sample. if the bases for Desirable
generalizing validity are well estab-
lished, and if evidence shows a relatively Ell.I.I. When items are selected by
slight rate of change in variables likely experts. the extent of agreement among
to limit the generizability of validity in- judges should be reported. Desirable
formation. When these favorable condi- Ell.I.2. Test content should be
tions do not exist, it may be possible to examined for possible bias. Essential
plan for small replications from time to
time rather than for a continuous pro- [Comment: Bias may exist where
gram of research.] items do not represent comparable
tasks and therefore do not sample a
common performance domain for the
Contellt Validity various subgroups (ct'. B1.3). One may
Ell. If test performance is to be investigate such bias in terms of
interpreted as a representative sample carefully developed expert judgments;
of performance in a universe of studies of the attitudes or
interpretations of items in different common to students. The manual for

subgroups might also present useful this checklist properly reports the date
information (although care must be when the list was assembled. From time
taken to assure that the investigation is to time. it will be necessary to determine
clearly directed to an analysis of content whether student problems have
in relation to an adequately detined changed and. if so. to change the test
performance domain). The judgment of accordingly.
bias may itself be biased; the principle It should be recognized that this
here is that. when it is possible. such standard implies that definitions of a
judgments should be supported by content universe are subject to change
data.) as jobs. society. or curricula change.)
Ell.2. In achievement tests of EI2.4. When a test is represented
educational outcomes. the manual as having content validity for a job or
should report the classification system class of jobs. the evidence of validity
used for selecting items. Desirable should include a complete description
of job duties. induding relative
Ell.2.t. When an achievement test
frequency. importance. and skill level of
has been prepared according to a two-
such duties. Essential
way content-by-process outline. that
outline should be presented in the
manual. with a list of the items Construct Validi~"
identified with each cell of the outline. EI3. If the author proposes to
Very Desirable interpret scores on a test as measuring a
EI2.3. Any statement in the theoretical variable (ability, trait, or
manual of the relation of items to a attitude), his proposed interpretation
course of study (or other source of should be fully stated. His theoretical
content) should mention the date when construct should be distinguished from
the cour£e of study was prepared. interpretations arising on the basis of
Essential other theories. Essential
[Comment: In achievement testing. it [Comment: For example. if a test is
is frequently the practice to identify intended to measure the construct of
significant topics for items by a careful anxiety. the test author should
sampling from textbooks. Textbooks distinguish his formulation of the
and courses of study change. however. construct from other possible meanings
and the test that was once an excellent of the term and should relate his
sample becomes out of date. The concept to measures of anxiety
manual might therefore report such discussed in the literature.
information as the range and median of The description of a construct may be
copyright dates of the textbooks as simple as the identification of
examined. or the date at which the "creativity" with "making many
experts judged the items to be original contributions." Even this
representative. definition provides some basis for
One checklist concerns problems judging whether various pieces of
736 ApPENDIXD
empirical evidence support the pro- constructs other than those proposed by
posed interpretation. Ordinarily, how- the author account for variance in
ever, the test author will have a more scores on the test. Very Desirable
elaborate conception. He may wish to [Comment: Although it is unrea-
rule out such originality as derives only sonable to require a test author to anti-
from a large and varied store of infor-
mation. He may propose explicitly to cipate or to include every counterinter-
identify the creative person as one who pretation in a test manual, he ought to
produces numerous ideas, whether of present data relevant to those counter-
high or low quality. He may propose to hypotheses most likely to account for
distinguish the ability to criticize ideas variance in the test scores.]
from the ability to be "creative." He
may go on to hypothesize that the E13.2.1. The manual for any
person who shows originality in iden- specialized test or inventory used in
tifying or describing pictures will also educational selection and guidance
have unconventional preferences in should report the correlation of scores
food and clothing. All such charac- derived from it with well-established
terizations or hypotheses are part of the measures of verbal and quantitative
author's concept of "what the test mea- ability in an appropriately represen-
sures" and are needed in designing and tative popu!ation. Very Desirable
in drawing conclusions from empirical
investigations of the psychological [Comment: Verbal and quantitative
interpretation of the construct. ] abilities are specified here because their
importance in educational performance
E13.1. The manual should indicate is recognized. because they often
the extent to which the proposed account for much of total test variance.
interpretation has been substantiated and because numerous tests of these
and should summarize investigations of abilities are already available. To be of
the hypotheses derived from the theory. practical value. a new test designed to
Essential measure other constructs <e.g .• spatial
abilities) must not closely duplicate the
measurement of verbal and quantitative
E13.1.1. Each study investigating a ability.)
theoretical inference regarding the test
should be summarized in a way that E13.2.2. If a test has been included
covers both the operational procedures in factorial studies that indicate the
of the study and the implications of the proportion of the test variance
results for the theory. Very Desirable attributable to widely known reference
factors. such information should be
E13.1.2. The manual should report presented in the manual. Desirable
correlations between the test and other E13.2.3. For inventories such as
relevant tests for which interpretations personality. interest. or attitude
are relatively clear. Very Desirable measures. evidence should be presented
of the extent to which scores are
E13.2. The manual should report susceptible to an attempt by the
evidence about the extent to which examinee to present a socially desirable.
conforming. or false picture of himself. E13.2.S. Where differences in test-

or to which the scores may reflect other taking strategies that might influence
response sets or styles. Such response the interpretation of scores are
patterns should be studied for associated with identifiable subgroup
identifiable subgroups rather than for a characteristics. this information should
more general sample. Very Desirable be clearly presented or its absence
[Comment: Correlational or experi- clearly noted. Very Desirable
mental studies might be reported.
E13.2.6. Where a low correlation or
Appropriate evidence of acquiescence
small difference between groups is
might, for example, be the proportion
advanced as evidence agaillst some
of the total test variance in the number counterinterpretation, the manual
of yes responses to the test. or by the should report the confidence interval
correlation of the test scores with one or
for the parameter. The manual should
more independent measures of the also correct for or discuss any errors of
acquiescence tendency, or by experi- measurement that may have lowered
mental procedures designed to induce the apparent relationship. Desirable
acquiescence.]
E13.2.4. If a test given with a time F. Reliability and
limit is to be interpreted as measuring a Measurement Error
hypothetical psychological attribute not Reliability refers to the degree to
specifically related to speed. evidence which the results of testing are
should be presented in the manual attr ibutable to systematic sources of
concerning the effect of speed on the variance. Classical methods of
test scores and on their correlation with estimating reliability coefficients call
other variables. Essential for correlating at least two sets of
[Comment: The most complete similar measurements.
evidence of the effect of speed would be One method of obtaining the two sets
the comparison of scores on one form. of measurements is by retesting with the
using the usual time limit. with scores identical test. Aside from practical
on another form having unlimited time. limitations. theoretically. retesting is
The correlation of scores at the end of not ordinarily a desirable method of
the usual time with scores obtained with estimating reliability because the
extra time on the same trial is of limited examinee may remember his or her
meaning because the two scores are not responses to items from one testing to
independent. Less complete evidence the next. Hence. memory becomes a
would consist of data on the percentage systematic source of variance and the
of examinees who attempt the last item correlation of the two sets of scores may
or some item very near the end of the be higher than the correlation of two
test. If the percentage is below 90. a sets of scores based on two different but
more penetrating study is needed to parallel sets of items drawn from the
show that individual differences on the population of items in the same way.
test do not reflect speed to any great If we want to eliminate memory as a
extent.) systematic source of variance and to
738 ApPENDIXD
include the effects of item sampling and clear that d(f.t'erent methods of
response variation over time as sources estimating reliability take account of
of variance. we may use two sets of different sources of error. Thus. from
items developed or selected according one testing to the other. the result is
to the same specifications. These are affected not only by random response
called parallel forms of the test. variability and changes in subjects over
If the effect of content sampling time but also by differences in
alone is sought without the effects of administration (especially if different
memory or response variability over persons administer the test on the two
time. or if it is not practical to occasions). Reliability coefficients
administer two parallel forms with based on a single administration of a
separate time limits. reliability can be test exclude response variability over
estimated from a single administration time; these effects on scores do not
of an unspeeded test. The test may be appear as errors of measurement.
divided into two sets of items of equal. Hence. "reliability coefficient" is a
or approximately equal. length that are generic term. It can be based on various
judged by competent authorities to types of evidence; each type of evidence
sample as nearly as possible the same suggests a different meaning. It is
functions. Any items based on the same essential that any method used to
source of data (such as a reading estimate reliability be clearly described.
passage) must be assigned to the same The estimation of clearly labeled
set. Then the correlation between scores components of score variance is the
on the two parallel halves is a matched- most informative outcome of a
half coefficient from which an estimate reliability study. both for the test
of the parallel-forms reliability developer wishing to improve the
coefficient for the total test may be reliability of his instrument and for the
obtained by a procedure that does not user desiring to interpret test scores
assume that the numbers of items or the with maximum understanding. The
variances of the two sets are exactly analysis of score variance calls for the
equal. use of an appropriate experimental
Estimates of reliability from a single design. There are many different
administration may also be obtained by multivariate designs that can be used in
analysis-of-variance procedures. Such reliability studies; the choice of design
estimates will be spuriously high if the for studying a particular test is
test is speeded or if the items are not determined by its intended inter-
independent of each other. On the other pretation and by practical limitations.
hand. for unspeeded tests. such It is recommended that test authors
estimates will tend to be lower than describe the meanings of any
matched-half coefficients because they coefficients they report as accurately
constitute. given certain assumptions. and precisely as possible. It is
the mean of coefficients obtained by informative to say. for example. "This
correlating scores on all possible pairs coefficient indicates the stability of
of halves ofthe test. measurement of equivalent scores
From the preceding discussion. it is based on parallel forms of the test
administered 7 days apart, without major identifiable components; namely.

intervening practice or instruction." inconsistency in responses of the
Although lengthy. such a description is subject; inconsistency or hetereogeneity
reasonably free from ambiguity. within the sample of test content (such
Reliability coefficients have limited as the stimulus items. questions. and
practical value for test users. The situations); inconsistencies in admin-
standard error of measurement istration of the test; inconsistency
ordinarily is more useful; it has great among scorers, raters, or units of appa-
stability across populations since it is ratus; and mechanical errors of scoring.
relatively independent of range of Desirable
talent. and it may be used to identify [Comment: In general, the desired
limits that have a defined probability of
analysis wi\1 not be feasible unless
including the true score. Test users mayscores are expressed in quantitative. as
use reliability coefficients in comparing
distinguished from categorical or
tests. but they use standard errors of nonparametric. terms and the design of
measurement in interpreting test data col1ection includes the necessary
scores. Information in a test manual controls.
about a standard error of measurement With group tests of school
may often be more important than achievement. the principal sources of
information about a reliability coef- error to be evaluated usua\1y include:
ficient. (a) inconsistency of test content;
(b) inconsistencies in test adminis-
General Principles tration; and (c) inconsistency in re-
sponses of the examinee over time. that
Fl. The test manual or research is. instability. The co\1ection of data
report should present evidence of should be designed to permit evaluation
reliability, including estimates of the of these three factors. Fluctuation or
standard error of measurement, that inconsistency in the responses of the
permits the reader to judge whether subject may be an important variable
scores are sufficiently dependable for by itself; it is often a major source of
the intended uses of the test. If any of random error to be evaluated. Inconsis-
the necessary evidence has not been tency among scorers or raters should
collected, the absence of such also be evaluated.]
information should be noted. Essential
F1.2. Standard errors of measure-
[Comment: It is most helpful to the ment and reliability coefficients should
user when several types of reliability be provided for every score. subscore. or
estimates are reported. Reports of combination of scores (such as a sum.
standard errors of measurement in difference. or quotient) that is recom-
different groups are also helpful.] mended by the test manual (either ex-
Fl.l. The test manual should plicitly or implicitly) for other than
furnish. insofar as feasible. a merely tentative or pilot use. Essential
quantitative analysis of the total in- F1.3. For instruments that yield a
consistency of measurement into its protile having a low reliability of
740 Ai'PENDIXD
differences between scores, the manual F2.1. Any identifying charac-

should explicitly caution the user a- teristics of the sample that may be
gainst interpretation of such differ- related to consistency of performance
ences, except as a source oftentative in- on the test should be described in the
formation requiring external verifi- test manual. Essential
cation. Essential
[Comment: Demographic informa-
Fl.4. The manual should state the tion, such as distributions of the sub-
minimum difference between two scores jects with respect to age, sex, socio-
ordinarily required for statistical economic level, intellectual level, locale,
significance at a designated level. Very employment status or history, and
Desirable minority group membership should be
[Comment: A nomograph or table given in the test manual. For stand-
for determining the significance of any ardized tests, the samples used to com-
given score difference would be a very pute reliability coefficients and stand-
useful addition to a test manual. ard errors of measurement should be
"Change" or "growth" scores require drawn at random from the norms
careful attention to Standards Fl.3 and groups.)
FI.4.) F2.2. If reliability coefficients are
F2. The procedures and samples corrected for restriction of range, both
used to determine reJiabUity coefficients the uncorrected and the corrected
or standard errors of measurement coefficients should be reported in the
should be described sufficiently to test manual together with the standard
permit a user to judge the applicabUity deviations of the group actually tested
of the data reported to the individuals and of the group to which the corrected
or groups with which he is concerned. coefficients are applicable. Essential
Essential [Comment: When variances differ
[Comment: The mean and variance and there seem to be other justifications
of the sample and information about its for such a correction, the superiority of
composition should be provided. the standard error of measurement
Reliability data should be obtained should be noted; it is largely unaffected
from "natural" groups such as by differences in variance.)
examinees of a single age or grade level.
Estimates of the reliability of a test to F2.3. When a test is recommended
be used in selecting employees should or ordinarily employed in homogeneous
be based on scores of applicants for subsamples, the reliability and
positions rather than scores obtained by standard error of measurement should
testing college students or workers be independently investigated within
already employed. each subsample and reported in the test
If a test claims to be appropriate for manual. Essential
groups from the fourth grade through [Comment: The mechanical rea-
graduate school, the manual should soning section of a well-known aptitude
provide reliability data for each grade test yields scores that have significantly
or age level.) different reliability coefficients for boys
and for girls. The manual reports the described, with references to their
reliability coefficients for each sex in development. Essential
each grade.] [Comment: Test authors and
F2.3.1. At least one estimate of the publishers should avoid unconventional
standard error of measurement should statistics unless conventional statistics
be provided in the manual for every are inappropriate. If unusual statistical
group for which reliability data are analyses are presented, explanations
given. Essential should minimize the likelihood of
misinterpretation.]
[Comment: When it is specifically
recommended that scores be trans-
formed to a particular metric, the stan- Comparability o.lForms
dard errors should be presented in that
F4. H two or more forms of a test
metric.]
are published for use with the same
F2.3.2. The test manual should examinees, information on means,
report the standard errors of mea- variances, and characteristics of items
surement at different score levels. in the forms should be reported in the
Desirable test manual along with the coefficients
[Comment: The manual for one test of correlation among their scores. H
of college aptitude reports standard necessary evidence is not provided, the
errors of measurement for three score test manuaI should warn the reader
levels: the mean, one standard against assuming equivalence of
deviation above the mean, and one scores. Essential
standard deviation below the mean. [Comment: Information to be
Since more important changes in the examined would include a summary of
standard error of measurement are item statistics for each form, such as a
associated with extreme scores, it might frequency distribution of item
be better to use more widely separated difficulties and of indices of item
score levels if the number of cases discrimination. Content analyses of
available justifies this action. each of the forms should be presented.
Thus, both frequency distributions of
F2.4. Item statistics (such as
item statistics and a tabulation of items
difficulty or discrimination indices, etc.)
by categories of subject-matter content
should be presented in at least
and of behavioral or instructional
summary form in a test manual.
objectives should be furnished.
Desirable
The forms should represent different
F3. Reports of reliability studies samples of items within each category
should ordinarUy be expressed in the of content. Insofar as one's concern is
test manual in terms of variances of for error arising from sampling a
error components, standard erron of content universe, the forms to be
measurement, or product-moment compared should have been developed
reliability coefficients. Unfamiliar from a common universe according to
expressions of data should be clearly an appropriate plan. An artificially
742 APPENDIxD
close similarity between forms will should be described so the reader will
result from item-by-item matching or be able to understand them in relation
by creating a second form merely by to more conventional estimates.]
rephrasing items on a first form. A
reliability coefficient based on forms FS.2. Internal reliability estimates
created in this way will be spuriously should not be obtained for highly
high because it does not properly take speeded tests. Essential
into account sampling error in drawing
items from the universe ofitems.]
F5.3. When a test consists of
separately scored parts or sections, the
Internal Consistency
correlation between the parts or sec-
FS. Evidence of intemal consis· tions should be reported in the test
tency should be reported for any un- manual along with relevant reliability
speeded test. Very Desirable estimates, relevant means, and relevant
standard deviations. Very Desirable
(Comment: Internal consistency is
important if items are viewed as a
sample from a relatively homogeneous FS.3.1. If a test manual reports the
universe, as in a test of addition with correlation between a subtest and a
integers, a test of general high school total score, it should call attention to
vocabulary, or a test presumed to the fact that the coefficient is spuriously
measure introversion. Nevertheless, high because it is based partly on the
estimates of internal consistency should perfect correspondence of identical
not be regarded as a substitute for other errors of measurement in the subtest
measures.] and in the total score. Essential
FS.l. Estimates of internal consis- FS.4. If several questions within a

tency should be determined by mat- test are experimentally linked so that
ched-half or random-half methods or the reaction to one question influences
by analysis or variance procedures, if the reaction to another, the entire group
these can properly be used with the of questions should· be assigned to one
data. Any additional measure of inter- of the two halves of the test when
nal consistency that the author wishes random-half or matched-half pro-
to report should be carefully explained cedures are used. Very Desirable
in the test manual. Very Desirable [Comment: In a reading test. several
(Comment: Matched-half coefficients questions about the same paragraph
reflect expert judgment and tend to be are ordinarily experimentally depen-
higher in value than random-half dent. All of these questions should be
coefficients. Analysis of variance placed in the same half test in using the
procedures tend to yield lower values split-half method. The fact that the test
than matched-half procedures. In halves do not have exactly equal num-
unusual circumstances, special coef- bers of items need not be troublesome if
ficients may provide useful infor- an appropriate step-up procedure is
mation; if used, such coefficients used.
Comparisons Over Time on the very day the test is given.

Realistically. one must recognize that
F6. The test manual should pragmatic decisions are being made
indicate to what eldent test scores are from test data which are meaningful
stable, that is, how nearly constant the only in terms of at least days. and
SCOftS are likely to be if a panIIeI form of a usually weeks or months of therapy. If
test is administered after time has elapsed. scores on a certain test are found to be
The manual should also describe die etfect
highly unstable from day to day. this
of any such vartadon on die usefaIneIs of
die test. The time Interval to be consiclelecl· evidence casts doubt upon the utility of
depends on die nature of die test and on the test for most purposes .. even if some
what Inferpretadon of die test SCOftS is fluctuation might be explained by the
recommended. &sential hypothesis of trait inconstancy. An
investigator may be concerned with a
[Comment: For many purposes. psychological characteristic or
reliability coefficients and standard educational effect which changes
errors of measurement should be based rapidly over a short period of time. In
on parallel-forms procedures. with a this instance it is important not to
period of perhaps 2 to 4 weeks confuse the inconstancy of the trait with
elapsing between the administration of the instability of the measuring
two parallel forms. In some situations, instrument. ]
when test scores are obtained for
changing characteristics of individuals. F6.1. Determination of the stability
reliability coefficients or standard of scores by repeated testing should
errors of measurement based on the make use of parallel forms of the test to
administration of parallel forms on minimize recall of specific answers,
successive days or weeks may be especially if the time interval is short.
desirable. A reading-readiness test used Very desirable
only for initial tentative assignment of F6.2. The report in a test manual of
first-grade pupils to instructional a study of consistency of scores over
groups is an example. In experiments time should state what period of time
on the effects of drugs, it may be elapsed between tests and should give
desirable to measure changes in two the mean and standard deviation of
sets of test scores obtained before and scores at each testing as well as the
after a time lapse of only a few minutes. correlation coefficient. Essential
It seems reasonable to require an
assessment of stability for projective F6.3. If it is reasonable to expect
techniques and other devices for scores on a test to change significantly
assessing personality dynamics, even over some time interval in response to
though it is recognized in some developmental or educational influ-
instances that low stability of scores ences, the manual should call the test
over a substantial period may reflect user's attention to this possibility and
true trait fluctuation. Oinical practice advise care in the use of old scores. Very
rarely presumes that the inferences Desirable
from projective tests are to be applied [Comment: Since some schools
744 ApPENDIXD
administer aptitude, achievement, or test manual should describe relevant

interest tests only at intervals of 2 or 3 experience, education. or treatment
years. the manual for such tests should intervening between administrations of
report correlations and changes in the test. if known. Desirable
means and standard deviations between
tests administered 1 year apart. 2 years
F6.4. Where a test is to be used to
apart, and 3 years apart. From these
compare groups rather than
data the user can learn how rapidly test
individuals. standard errors and
records become obsolete with the
standards errors of measurement of
passage of time.]
group means and related statistics
F6.3.1. In reporting on stability. the should be presented. Essential
STANDARDS FOR THE USE OF TESTS

There are many kinds of test use. As designated standard. that a person is
one example. test scores are used for qualified to perform certain skilled
decisions to select or to reject applicants tasks. that a child is qualified for a
for jobs. schools. or other opportunities. remedial program. or that a defendant
In such use. the test score is a basis for a can stand trial.
prediction. one that is either explicit or The basic use oftests is descriptive or
strongly implied. The test score is used evaluative. A test score provides a
to estimate or predict a likely level of description of the individual who
performance on some criterion variable obtained it and can help the test user to
external to the test itself. understand. analyze. or help that
Another use is as a prescriptive aid individual. Test scores may be used by a
where different scores imply different counselor to help a student make a
treatments. For example. elementary vocational choice or to help a couple in
school pupils may be classified marriage counseling communicate
according to reading ability on the basis more clearly with each other. They may
of test scores; they may be assigned to help a teacher work more effectively
different books or to different kinds of with a pupil. These are clinical.
instruction. Job applicants may be diagnostic. and individualistic uses of
classified as marginally employable and tests in a continuing relationship
assigned to programs of remedial between a test user and an individual.
vocational training on the basis of test Because the relationship is a continuing
scores. Disturbed persons with one one. tentative decisions or judgments
profile of scores may be assigned to can be modified as new information is
treatments different from those for accumulated.
people with different profiles. Each of Test scores may constitute the
these examples implies a hypothesis dependent variable or criterion measure
that people with a specific set of in an institutional research study. A
attributes will perform a task or achieve program may be continued or
a goal more effectively with one form of terminated on the basis of test results;
treatment than with another. The test an institution may receive more or less
user in an applied setting may not have funding because of test results; test
the power. the resources. or the training results may be considered in
to carry out the necessary experimental organizational analysis or in making
work for testing these hypotheses; he program changes. These Standards do
may simply accept them as part of the not deal fully with these problems; their
prevailing scientific or professional emphasis is more on the interpretation
body of knowledge and use tests of scores of individuals. A companion
accordingly. volume is planned dealing with
A test score may be used to certify standards for test use in program
that an individual has met some evaluation. policy-related research. and
746 ApPENDIX 0
curriculum evaluation; it will also which mastery can be demonstrated.

address issues of research design and of Interpretation of test scores in such
data analysis. cases is not made in terms of norms but
The standards in the present volume in terms of a counselor's analysis of
are to varying degrees directed to all what mastery of a particular skill
forms of use. As the use of tests moves entails (even a social skill, not likely to
along a continuum from the description be measured by tests ordinarily used for
of a single individual, in a situation content-referenced interpretations). In
allowing for corrections of erroneous short, exploration of an individual case
interpretations, making decisions about is different from standardized testing.
large numbers of people, the test user The user who develops test embellish-
must apply more of the ments must know the difference; that
standards and, perhaps, apply them is, he must have a clear rational~ for
more rigorously. Such decisions may what he is doing when he departs from
profoundly influence the lives of those standard procedure, and he must be
tested, such as decisions for em- able to apply that rationale consistently
ployment or for attendance at col- and sensibly. Such individualized test-
lege, or decisions to assign a person ing does not require less skill than does
to one treatment or opportunity rather testing broadly for institutional deci-
than to another (e.g., tracking in a sions; it requires a different kind of
school system), or decisions to continue skill (cf. 11).
or terminate a program or to regulate The standards necessary for using
its funds. The cost of error, in money tests for making decisions are not different
and in human suffering, may be great. from the standards necessary when tests
A test user cannot abdicate the are used simply for understanding, but the
responsibilities described in these emphasis within a standard may be dif-
standards by subscribing to external ferent. A test user should be familiar with
testing services or test suppliers. the standards governing test use in gen-
The standards of test use may not eral, and he should pay particular atten-
have to be so rigidly followed when the tion to those standards most nearly fitting
his own specific type of application.
purpose of testing is the understanding
of an individual. Sometimes such In doing so, he should realize that the
testing is less standardized than is standards are intended to apply, in
usually recommended. For example, a principle, to allforms of assessment. In
school counselor may be interested in choosing from alternative methods of
assessing the maximum performance assessment, the test user should
capability of a single student. To get a consider the differences in the ease of
full understanding of that student, he applying these standards.
must be able to elicit new information,
perhaps even through an em- G. Qualifications and Concerns
bellishment of a standardized test, to of Users
seek the broadest possible under-
standing of the level of mastery and of Assessing others is an occupational
the generalizability of the situations in activity for teachers, parents,
clergymen, shopkeepers, correction of- to interpret an obtained test score. He

ticers, etc. Some people assess with should realize that there are alternative
remarkable skill; others are inept and explanations for a given score and
have little or no training to help them. should have a pool of knowledge from
Users of educational and psychological which to evaluate some of the alter-
tests in schools, places of employment, natives.]
clinics, laboratories, prisons, and other
places where educators and psy- G1.1. A test user should know his
chologists work should have had at least own qualifications and how well they
some formal training. match the qualifications required for
A test user, for the purposes of these the uses of specific tests. Essential
standards, is one who chooses tests, in-
terprets scores, or makes decisions G2. A test user should know and
based on test scores. He is not understand the literature relevant to the
necessarily the person who administers tests he uses and the testing problems
the test following standard instructions with which he deals. Very Desirable
or who does routine scoring. Within this [Comment: A broad connotation is
definition, the basic user qualifications intended for this standard. The test
(an elementary knowledge of the user should have some acquaintance
literature relating to a particular test or with the relevant findings of behavioral
test use) apply particularly when tests sciences, such as those related to the
are used for decisions, and such uses roles of heredity and environment,
require additional technical quali- when using aptitude tests; some un-
fications as well. A recurring phrase in derstanding of physiology is useful
discussions about testing is "the when one is using tests of motor skills.
legitimate uses of a test." One cannot A very narrow interpretation of "the
competently judge whether his intended literature relevant to the test" is
use is among those that are "legiti- inadequate.
mate" (however defined) without the Unfortunately, it seems that ignorance
technical skill and knowledge necessary of the literature requires that old in-
to evaluate the validity of various types formation be rediscovered. For over 40
of inferences. years, for example, it has been known
that children with limited or restricted
Gl. A test user should have a cultural exposure, such as children on
general knowledge of measurement canal boats or in isolated mountain
principles and of the limitations of tqt communities, make low scores on in-
interpretations. Essential telligence tests standardized on more
[Comment: The required level of advantaged populations. The point has
knowledge will vary with the complexity been made repeatedly in research
of the evaluations to be made and the reports and textbooks. Nevertheless,
responsibility of the user. At a minimum, many black and Spanish-speaking
the user must be knowledgeable about children with limited cultural exposure
testing principles, understand the con- who receive low scores on intelJigence
cept of measurement error, and be able tests standardized on more advanta(!ed
748 ApPENDIXD
groups are improperly classified as not to test. to approve or to disapprove

mentally retarded.] specific assessment procedures, to ap-
G3. One who has the responsibUity propriate funds for necessary research.
for decisions about individuals or or to decide how test or research results
poncies that are based on test results will be used in the organization. Similar
should have an understanding of knowledge is needed by compliance of-
psychological or educational measure- ficers who may have a detrimental in-
ment and of validation and other test tluence on testing programs because of
research. Essential unreasoned and unreasoning demands
for interpretation of data. who might
[Comment: A test user should have disapprove of a testing program without
acquired the technical understanding adequate consideration of the alter-
appropriate to his responsibilities. Test natives. or who. might approve faulty
users within organizations or regulatory and unfair uses of tests out of igno-
agencies should have enough technical rance.]
knowledge to be able to evaluate com-
petently the tests and testing G3.1.1. A test user should have suf-
procedures relevant to the decisions ficient tec~nical knowledge to be
they must make. If their technical prepared to evaluate claims made in a
training is limited. they should seek test manual. Very Desirable
refresher training or work under the [Comment: A test user must accept
guidance of another test user whose some responsibility for the choice when
training is adequate.] a test is chosen. The user must also be
able to exercise some judgment con-
G3.1. The principal test users
cerning descriptions of intended
within an organization should make
populations that appear in a manual. If
every effort to be sure that all those in
he is using the test to evaluate a
the organization who are charged with
remedial program for low-performing
responsibilities related to test use and
pupils in the fourth grade. it is not
interpretation (e.g.• test administrators)
necessarily appropriate to select a test
have received training appropriate to
standardized on "children in Grades 4
those responsibilities. Essential
through 6."]
[Comment: Serious misuse and
distortion in interpretation may occur G3.2. Anyone administering a test
when people are not properly trained to for decision-making purposes should be
carry out their responsibilities. The competent to administer that test or
level of training needed varies with the class oftests. If not qualified. he should
complexity of a testing program. the seek the necessary training regardless of
level of the individual's responsibility his educational attainments. Essential
for it. and the nature and intensity of [Comment: Some tests are easily ad-
possible adverse consequences. Test ministered, and a brief explanatiQn of
users should provide at least a basic the instructions and of the necessity for
orientation for administrators or. standardization may be sufficient
executives who decide whether to test or training for administering them. The
use of other tests or assessment administration. the modes of assess-

procedures may require more specific ment. the bases for inferences drawn
or unique kinds of training. for exam- from test scores. and the relative quality
ple. individually administered in- of various validation strategies.]
tellectual or personality measures or
some work samples_ It should be H. Choice or Development
recognized that the administration and of Test or Method
scoring of a test may not require any
Standardized tests constitute one
specific academic degree; conversely.
class of assessment procedures
possession of a degree is not necessarily
available to the user. He may also
evidence of qualifications to administer
choose various kinds of ratings.
a particular test.]
personal history information. reference
G4. Test users should seek to avoid information. or "unobtrusive meas-
bias in test selection, administration, ures." He may also elect to develop his
and interpretation; they should try to own tests. His choice depends upon
avoid even the appearance of what is available for assessing the
discriminatory practice. Essential characteristics of concern. ethical con-
[Comment: This is a difficult stan- siderations. and his own knowledge and
dard to apply. Sources of item or test competency. Among standardized tests
bias are neither well understood nor there are usually many alternatives:
easily avoided. The very definition of different dimensions to be measured.
bias is open to question. The competent different methods of measurement. and
test user will accept the obligation to different forms of tests. Choices should
keep abreast of developments in the be made as deliberately and carefully as
literature and. at the very least. to circumstances permit; test users should
demonstrate a sensitivity to the problem not use habitually the same test or
and to the feelings of examinees.] method of assessment for all purposes;
neither should they ass~ss only those
GS. Institutional test users should characteristics that are easily or con-
establish procedures for periodic veniently assessed and fail to consider
internal review of test use. Essential other, possibly more important, charac-
[Comment: The competent use of teristics. Standards refer to the process
tests and test scores requires regular of choice, not to the choices themselves.
review of procedures and of concepts
that may change with the advent of new HI. The choice or development of
knowledge. A practice that might have tests, test batteries, or other assessment
been considered acceptable or ap- procedures should be based on clearly
propriate at an early period may be formulated goals and hypotheses.
found to be either harmful or ineffective Essential
in light of subsequent findings in
psychometric theory or criticisms of test [Comment: There is usually an
use. The review should examine the assumption that one's goals are good.
soundness of procedures used in test and that the method of assessment
750 ApPENDIXD
chosen will help one achieve those what is to be learned about a person,
goals. In choosing or building a test one and why, there will be no clear direction
should be able to articulate such in the counseling relationship.
assumptions and values. As a general One's purposes in developing a
rule, the assumptions take the form of testing program define his criteria, and
at least an implicit hypothesis: "If I the nature of the criteria should suggest
come to a clearer understanding of this to the informed user hypotheses, that is,
individual, in terms ofthe characteristic test variables, that might be associated
or set of characteristics assessed, I will with them. Such hypotheses should be
be able to infer something about his reasonable. There is no clear reason, for
vocational success, or his academic example, to use a mechanical-aptitude
problems, or his prognosis in marriage, test to try to predict performance in
or whatever." English classes. Similarly, it is not easy
The use of a test in a decision context to see what purpose is intended when a
implies a hypothesis of the form that a vocabulary test is adopted for use in the
designated outcome is a function of the selection of rolling-mill employees.
test variable. A test user should be able Some hypotheses are much more
to state clearly the desired outcome, the easily justified than others. Few people
nature of the variables believed to be will quarrel with the suggestion that
related to it, and the probable applicants who type rapidly with few
effectiveness of alternative methods of errors will become preferred employees
assessing those variables. in a stenographic pool. The hypotheses
The purpose of administering a test that those who are likely to work with
should be explicit. In some school greater persistence at a routine,
systems, it has been alleged, tests are manipulative task can be identified by
routinely administered with no purpose scores on a very long but easy
other than an apparent hope that they perceptual speed and accuracy test may
will someday be useful. Such routine require a more detailed explanation of
testing is unwise.] the logic and background data.)
81.1. The test user should 81.2. The test user should consider
formulate goals clearly enough so that the possibility that different hypotheses
he can later evaluate his success in may be appropriate for people from dif-
achieving them and can communicate ferent populations. Essential
that evaluation to other qualified
persons. Very Desirable H2. A test user should consider
[Comment: In a clinical or counseling more than one variable for assessment
situation. there is a continuing and the assessment of any given
relationship with a person who has been variable by more than one method.
tested. If a test user has clear purposes, Essential
later events can provide evidence of [Comment: For most purposes. the
some success in achieving goals or evaluation of a person requires descrip-
information for changing inferences or tion that is both broad and precise; a
procedures. Without a clear idea of single assessment or assessment
procedure rarely provides all relevant varying the sources and increasing the
facets of a description. amount of information on which the in-
Decisions about individuals should ferences are made. In addition to tests.
ordinarily be based on assessment of one might consider ratings. references.
more than one dimension; when observations of actual performance. etc.
feasible. all major dimensions related to Of these. a test is probably most valid.
the outcome of the decision should be If the others add to the validity of an
assessed and validated. This is the prin- assessment. they should be
ciple of multivariate prediction; where systematically considered in statistical
individual predictors have some validity prediction; otherwise. they should be
and relatively low intercorrelations. the ignored. Frequently. however. one will
composite is usually more valid than not have enough confidence in test in-
prediction based on a single variable. It terpretations to justify overlooking
is not a,lways possible to conduct the other data. In particular. when using a
empirical validation study (certainly not given test with minorities. one may
in working with problems of individuals question the validity of test inferences
one at a time). but the principle can be for those populations and want to get as
observed. much additional information as
In any case. care shQuld be taken that possible before making decisions.]
assessment procedures focus on im- H2.1. In choosing a method of
portant characteristics; decisions are assessment. a test user should consider
too often based on assessment of only his own degree of experience with it and
those dimensions that can be convenient- also the prior experience of the test
ly measured with known validity. For taker. Essential
example. mental retardation is often
[Comment: Inexperience of the test
defined as both deficiency in tested in-
user can be alleviated by reading. prac-
telligence and poor adaptive behavior.
tice. and training. Warm-up tests or
If both parts of this definition are ac-
other methods of acclimatization are
cepted. then both variables should be
advocated to alleviate the inexperience
considered in deciding whether an in-
dividual is to be classified as a mental of test takers. In addition. attention
should be given to the degree of in-
retardate. even though it is much more
teraction between test user and test
difficult to measure adaptive behavior
taker; there may be special sources of
than to find an acceptable scale for
anxiety in situations where they are of
testing intelligence.
different cultural or ethnic back-
Test users should also consider more
ground.]
than one method of assessment. Even a
test yielding generally valid scores may 82.2. The choice or development of
in an individual case be susceptible to a test or test procedure. or the addition
idiosyncratic errors of interpretation. of a test or test procedure to existing
and a pattern of confirming or assessments. should involve con-
modifying assessments may be useful. sideration of the relationship between
Confidence in inferences drawn from the cost of the choice and the benefit ex-
assessments may be increased by pected. Very Desirable
752 ApPENDIXD
[Comment: Both costs and benefits This standard caBs for a general
may involve broader considerations evaluation of the validity of the
than the specific problem at hand. proposed use of a test. Such an
Although quantification may be dif- evaluation includes evaluation of the
ficult and even unreliable, costs and procedures folIowed in the development
benefits to the individuals tested and to of the test and of the quality and
the broader society should enter into relevance of the research that has been
consideration.) done with it.)
H3. In choosing an existing test, a H4. In general a test user should try
test user should relate its history of to choose or to develop an assessment
research and development to his in- technique in which "tester-effect" is
tended use of the instrument. Essential minimized, or in which reliability of
[Comment: A school system was assessment across testers can be
faced with the necessity of reducing its assured. Essential
faculty. Reductions in force, according [Comment: In general, the less the
to policy, were to be based on teacher influence of the tester on scores, the
competence. However, decisions were in fairer the test. The influence of the
fact based on scores on a test that had tester is obviously greater in an un-
been developed to eval uate the structured interview than in a struc-
educational backgrounds of new tured one, and there may be more tester
teachers-col1ege graduates. Nothing effect in a structured interview than in a
about the test established its validity as structured personal history form. Tester
a measure of classroom effectiveness, effect is most likely to be minimized by
nor was any local research conducted standardized testing. In using tests,
on this point. Its choice was, therefore, some organizations have turned to tape-
inappropriate. recorded instructions in an effort to
In a different situation, a decision minimize further possible tester effect.]
had been made to use a standard
achievement test to evaluate pupil HS. Test scores used for selection or
progress. Upon investigation of the other administrative decisions about an
test's development, it was found in- individual may not be useful for in-
consistent with the curriculum ob- dividual or program evaluation and vice
jectives of that school. Other tests were versa. Desirable
examined and an alternative test was [Comment: The purposes of in-
chosen that more closely matched the stitutional testing and of evaluative
curriculum content. (In some cases, testing are not always compatible.
closely matching curriculum content Whereas the typical evaluative use is in-
may not be advantageous since it tended to help the individual (or
prevents one from knowing the extent program), institutional decisions
to which pupils may be deficient in frequently have the apparent effect of
skills or knowledge not deliberately hurting, even if the decision may have
specified in the local curriculum ob- unseen long-term benefits to the in-
jectives') dividual (such as avoidance of an un-
necessary failure experience). These standardized procedures are numerous.

seemingly contradictory functions may In one organization, when test supplies
prevent effective interpretation in either were depleted. mimeographed versions
instance.] of uneven quality were prepared. (In ad-
dition to being a violation of copyright
I. Administration and Scoring laws, the result was a markedly changed
A test user may delegate to someone set of stimulus materials). One test
else the actual task of administering or administrator tnied to relieve the
scoring tests. but he retains the respon- monotony of the repeated verbatim in-
sibility for these activities. In particular. structions by giving a shorter and varied
he has the responsibility for ascer- version.]
taining the qualifications of such agents. 11.1. A test user must fully un-
Standards for administration apply derstand the administrative procedures
not only to the act of testing but also to to be followed. Essential
more general matters of test ad-
[Comment: The test user should be
ministration. The basic principle is
fully trained to do whatever is required
standardization; when decisions are
for competent administration of the
based on test scores. the decision for
test. The administration of many tests
each individual should be based on data
requires nothing more than the ability
obtained under circumstances that are
to read and understand routine in-
essentially alike for all.
structions, that of others requires ex-
11. A test user is expected to follow tensive supervised practice. Whatever
carefully the standardized procedures the requirement. the test user lacking
described in the manual for ad- such training should seek it.]
ministering a test. Essential
11.2. A test user should maintain
[Comment: It may in rare cases be consistent conditions for testing. Very
necessary to modify procedures. When Desirable
there is any deviation from standard
[Comment: Situational variables
practice. it should be duly noted, and
should be reasonably controlled. For
interpretations of scores should not be
example. there should be no great
made in terms of normative data
variation in temperature or humidity;
provided in the manual. Modifications
noises and other distractions should be
may be standardized for specific pur-
as nearly eliminated as possible. In-
poses. For example, modifications were
teradministrator reliability should be
necessary for testing a group of deaf
high. In general, testing conditions
mutes. but the modified procedures
should minimize variations in the
were applied in the same way to all
testing proced ure.]
children in the group.
Standardization of procedure is par- 11.3. A test user should make
ticularly important when decisions are periodic checks on material. equip-
based on test scores. Nevertheless, ment. and procedures to maintain
known examples of failure to follow standardization. Essential
754 ApPENDlXD
[Comment: This standard refers, for examinees. especially when the tester
example, to the constancy of graphics and the examinee differ in race, sex, or
and of printing. or the accuracy of stop status. A testing situation contains
watches. It also seeks the elimination of elements that are nonrecurring and
bad habits that may creep into ad- unique to the persons tested. Although
ministrative procedures. It applies par- these may have negligible effects on test
ticularly to any testing procedures that reliability, they may include events per-
make use of physical equipment which ceived as denigrating or questioning of
is subject to wear. Such equipment the worth of the individual. A complete
should be regularly examined to assure catalog of such events is not possible or
that its characteristics remain within easily described. In general. however.
acceptable tolerances; for example, a the social amenities of respect,
pegboard should be replaced if holes politeness. and due regard for ex-
become enlarged or beveled through tenuating circumstances are relevant
use.] guides for insuring the dignity of per-
son&. While it m.ay not be demonstrated
12. The test administrator is
that abuse of these principles leads to
responsible for establishing conditions,
poor test performance, such abuse is
consistent with the principle of stan-
not likely to enhance performance.
dardization, that enable each examinee
It is often difficult to maximize the
to do his best. Essential
motivation of the examinees. The at-
[Comment: In a negative sense, the tempt is important; a major source of
goal of this standard is that conditions error may arise when examinees do not
inhibiting maximum performance like or trust the test. tester. or test
should be avoided. The principle can be situation, and therefore make no
followed in part simply by being sure special effort to do well in it.]
that all materials-such as answer
sheets, pencils, and erasers-are on 12.1. Procedures manuals should be
hand and that precautions have been prepared for use in organizations when
taken to avoid distractions. In a more there is repeated testing. Very Desirable
positive sense. the administrator should [Comment: Just as a manual is
be sure that the examinee understands needed for a test. a manual is needed
the tasks involved in taking the test: for a testing program. Changes in per-
what kinds of responses are to be made sonnel or lapses in memory make a
and on what answer sheets. the im- record of procedures developed and
plications for test-taking strategy of followed necessary for standardization.
erasures or multiple marking or Such a manual might indicate ap-
guessing, and how to know whether the propriate circumstances for testing or
test has been completed. for referral for testing, standard
The tester should try to create a sequences of tests, or guides to in-
nonhostile environment; standardized terpretations of test batteries in ad-
procedures are impersonal. but the test dition to instructions for administering
administrator must avoid being either and scoring tests tal en or adapted from
patronizing or unresponsive to the individual test manuals.]
13. A test user is responsible for ac· data used in the continuing research
curacy in scoring, checking, coding, or program.]
recording test results. Essential
13.2. When test scoring requires
[Comment: Any agent of the user jUdgment, the test user should deter-
shares this responsibility. The clerk who mine inters corer or intrascorer
scores a test must understand and ac- reliability. Very Desirable
cept the necessity for accuracy. The test
[Comment: When the test user does
user. who mayor may not do the actual
his own scoring, he should make
scoring. nevertheless has the respon-
periodic comparisons of scores he has
sibility to be sure that procedures are
determined against scores on the same
established and followed for verifying
sets of responses determined by other
accuracy. It is unfair to individuals or
scorers or by himself at other times.]
organizations when decisions are based
on avoidable error.] 14. If specific cutting scores are to
be used as a basis for decisions, a test
13.1. When test scoring equipment user should have a rationale,
is used. the test user should insist on justification, or explanation of the cut·
evidence of its accuracy; when feasible. ting scores adopted. Essential
he should make spot checks against [Comment: When a cutting score is
hand scoring or develop some other adopted, the effect is to reduce scoring
system of quality control. Essential to a scale of only two points: pass and
[Comment: The frequency of such fail. The validity of the test scored in
checks will depend on what is known of this way is different at different cutting
the procedures on checking within the scotes and. in general, is different from
scoring service. Commercial scoring the validity found with continuous
services may be queried about their scores.
procedures if they have not already an- The test user should have some
nounced them; if the procedures seem justifiable reason for the adoption of a
well designed. such spot checks may be given cutting score. Many kinds of
needed only infrequently. Some com- arguments might be used. In a content-
puter services, on the other hand, may referenced interpretation of a mastery
be less meticulous, and some hand test, such a score might be determined
scoring may be required in each batch as the obtained score at which one can
of tests scored by machine. One test reject. at a preselected level of prob-
user in a certification program, where ability, the hypothesis that a pre-
machine analysis of answers not only designated confidence interval for that
yields individual scores but also sup- score includes the perfect score on
plies data for analysis prior to revisions, the test. If interpretations are referenced
has adopted the policy of hand scoring against an external criterion, the
as well as machine scoring each test. cutting score might be one where there
This assures the accuracy of every score is a designated probability of achieving
used in individual decisions, and it also a specified level of success (e.g., "We do
assures the accuracy of the computer not admit students who have less than a
756 ApPENDIXD
30 per-cent chance of graduating"). different subgroups of an applicant

Decision theory principles can be used population. cutting scores should be
to find a cutting score that will established with great caution to avoid
maximize the discrimination between unfairness to members of one or more
high- and low-criterion groups. One of the subgroups. Essential
might base the cutting score simply on a
distribution of scores in a "predicted- [Comment: There are many defen-
yield" situation; for example. the sible definitions of "unfairness" in the
proportion of job applicants who accept literature. and techniques have been
offered employment. the number of new developed for setting cutting scores to
employees who will be needed. predic- minimize "unfairness" as defined in
tions of growth or reduction in force. these ways. Test users should keep
and related information can be used to abreast of the rapidly developing
determined the "predicted yields" of literature on this topic.]
new employees at different cutting 15. The test user shares with the test
scores. The determination of a cutting developer or distributor a responsibility
score on this basis may result in using for maintaining test security. Essential
the test in a range where it is less than [Comment: Test security is a problem
maximally effective; its validity should whenever a lapse in security can result
be determined in light of its actual use. in changing an individual's score
This standard does not anempt to without making a change in his true
recommend a specific procedure for score. For some kinds of tests a lapse of
developing cutting scores where they security would not be serious. If one is
are to be used. The intent is to recom- to be tested for achieved skill. for
mend that test users avoid the practice example. knowing and practicing the
of designating purely arbitrary cutting test samples might be highly
scores they can neither explain nor recommended. In many cases. however.
defend. Cutting scores adopted with prior knowledge oftest items or scoring
reference to those used in another procedures could destroy validity. The
organization or for another purpose. or problem is not simply one of cheating.
by a casual glance at normative tables. Security may be compromised where
are usually unsatisfactory.] examinees have had much prior experi-
14.1. A validity coefficient for each ence with a popular test. have been
criterion for which a predictor test is taught specific test items. or have heard
recommended should be provided at a lot about the test.
each one of several points on the score 15.1. Where a probable breach of
continuum that may be used as cutting security may invalidate test inferences.
scores. Very Desirable the test user should employ other
methods of assessment; that is. he
14.1.1. If examinees are to be selected
should seek a basis for more valid in~
on the basis of a set of scores that
ferences. Very Desirable
displays different regression lines for
use in predicting the same criterion in 15.2. All reasonable precautions
should be taken to safeguard test should not be interpreted as some ab-

material. Essential solute characteristic of the examinee or
[Comment: The use of locked files is as something permanent and gen-
a minimal requirement in maintaining eralizable to all other circumstances.
test security. It is important to know the Essential
JI.I. A test user should consider the
recipient whenever tests are out of the
filing cabinets. In a test-taking total context of testing in interpreting
an obtained score before making any
situation, examinees should be proc-
decisions (including the decision to ac-
tored. When a test is mailed out to
cept the score). Essential
other locations. the recipient should be
known and trusted. The ubiquitous [Comment: The standard is that one
copying machine has intensified the must avoid the abdication of respon-
problem of safeguarding test materials.] sibility by relying exclusively on an ob-
tained score. Users should, in par-
15.3. The test user should avoid ticular, look for contaminating or
basing decisions on scores obtained irrelevant variables that may have in-
from insecure tests. Very Desirable fluenced obtained scores; for example,
[Comment: A test may be designated in testing to classify school children,
insecure because it is known that scores may be influenced by behavior
unauthorized copies have gone astray. problems, visual or hearing defects,
Another test might be considered in- la.nguage problems, and racial or
secure because it is so widely used that a cultural factors, as well as by ability.]
test taker may have had ample op- J2. Test scores should ordinarily be
portunity to practice it in other test- reported only to people who are quali-
taking situations previously and be able fied to Interpret them. If scores are
to recognize items. Some employment reported, they should be accompanied
tests, for example, are so widely used by explanations sufficient for the recipi-
that a job applicant may have taken ent to interpret them correctly. Desir-
them several times while applying to able
various employers.] [Comment: There are difficult
problems associated with the question
J. Interpretation of Scores of who should have access to test scores
within an organization. Certainly,
Standards in this section refer to the
curious peers should not have access to
interpretation of a test score by the test
them. An individual who must make
user and to reports of interpretations.
the ultimate decision to admit or to
Reports may be made to the person
reject or to hire or to reject, or to certify
tested, to his agent, or to other affected
or not to certify. must have the in-
people: Teachers, parents, supervisors,
terpretation. One useful (and unan-
and various administrators and
swered) question is whether such a per-
executives.
son who lacks the training necessary for
J1. A test score should be in- the interpretation of scores should be
terpreted as an estimate of performance given that training or should be given
under a given set of circumstances. It only the interpretations of scores. J
758 ApPENDIXD
J2.1. An individual tested (or his J2.2.1. Scores should ordinarily be

agent or guardian) has the right to interpreted in light of their confidence
know his score and the interpretations intervals rather than as specific values
made. In some instances, even scores on alone. Very Desirable
individual items should be made
12.3. In general, test users should
known. Desirable
avoid the use of descriptive labels (e.g.,
[Comment: Strictly speaking, this is retarded) applied to individuals when
an ethical standard rather than a stan- interpreting test scores. Desirable
dard of competent test use; it is stated
[Comment: The standard applies to
here because it conflicts with technical
the use of summary diagnoses in
considerations of test security. If the
general. For nearly all purposes, it is
standard is followed, test in-
better to describe behavior and to dif-
terpretations and their foundations will
ferentiate such description from in-
be made available to those with a "need
ference. Summary labels tend to be in-
to know"; certainly, the individual
ferences treated as if they were descrip-
whose future is affected by the decision
tions.
is among those with a "need to know."
The use of a summary label generally
The test user should take any
connotes value judgments; un-
precautions he can, when the demand
fortunately, most are words used in
for information is severe, to protect test
everyday language and therefore sub-
security, but he should not do so at the
ject to inaccurate interpretation. A test
expense of an individual's right to un-
maker may know precisely what he
derstand the bases for decisions that af-
means when he uses the term "retard-
fect him adversely. Such understanding
ed," but he has no influence over the
may be better promoted, with less
interpretation of the same word by a
threat to test security, by using
judge, teacher, parent, or child.)
qualified persons sympathetic to the in-
dividual's interests. For example, when J3. The test user should recognize
there is a civil-rights issue, it would be that estimates of reliability do not in·
most useful to have items examined by dicate criterion· related validity. Essen-
a qualified testing specialist who is tial
known to be both concerned and [Comment: Reliability is a necessary
knowledgeable. ) but not a sufficient condition of
J2.2. A system of reporting test validity. Reliability coefficients are per-
results should provide interpretations. tinent to validity in the negative sense
Essential that unreliable scores cannot be valid;
but reliable scores are by'no means ipso
[Comment: Although the form of a
facto valid.)
report will differ for different audiences
(examinees, teachers, parents, super- J4. A test user should examine
visors), it should communicate the in- carefuUy the rationale and validity of
terpretation in a form that will be clear computer.based interpretations of test
and easily understood.) scores. Essential
[Comment: The user of a special ser- isolation>, skill and experience in the
vice has the obligation to be thoroughly use of standard English, interests, or
familiar with the principles on which similar variables which may seem to be
such interpretations are derived, and he related to sex or racial differences in
should have the ability to evaluate a test performance.]
computer-based interpretation of test
performance in light of other evidence J5.1. It is usually better to interpret
he may have. scores with reference to a specified norms
group in terms of percentile ranks or
J5. In norm-referenced interpre-
standard scores than to use terms like
tations, a test user should interpret an
IQ or grade equivalents that may falsely
obtained score with reference to sets of
imply a fully representative or national
norms appropriate for the individual
norms group. Essential
tested and for the intended use. Essen-
tial J5.2. Test users should avoid the
[Comment: The reverse is also a stan- use of terms such as IQ, IQ equivalent,
dard of competent test use: The test or grade equivalent where other terms
user ordinarily should not interpret an provide more meaningful in-
obtained score with reference to a set of terpretations of a score. Essential
norms that is inappropriate for the in- [Comment: Such scores are ob-
dividual tested or for the purposes of jectionable for several reasons. Most
the testing. This is a relatively simple important, they generally involve
standard to state, but it often is difficult spurious projections of growth. They in-
to apply. Contemporary social problems volve an interpretation which is at best
suggest that men and women or mem- awkward. (To illustrate: It is much sim-
bers of different ethnic groups should pler to ask, in interpreting a score,
for some purposes be evaluated in terms "Where does this person stand in
of several norms groups. For other pur- relation to specific norm groups?" than
poses, such as vocational counseling, to ask, "What group is this person's
students should know how they stand performance like the average of?" The
relative to those in or entering a semantic awkwardness of the latter
relevant occupation, regardless of their question illustrates its psychometric
ethnic background. Of course, women awkwardness as well.> They are labels to
or members of minority groups should which the general public attaches many
not be counseled to avoid non- different inappropriate meanings.
traditional occupations (e.g., women in Some of these scores, such as mental
engineering> merely for lack of ap- age or grade equivalent scores, involve
propriate norms. severe technical problems. For exam-
It is by no means certain that sex or ple, serious misinterpretations occur
race is the crucial variable in in- when grade levels are extrapolated
terpreting a given score. It may well be beyond the range for which the test is
that more important variables for dif- designed. Moreover, it should be
ferential norms would be breadth of recognized that the standard error of
cultural exposure (or degree of cultural measurement for some widely used
760 ApPENDlxD
standardized achievement tests may be simply because of the absence of an ap-

equal to one grade level. propriate standardized instrument.]
If a test user, either because of his
J5.4. Local normative data or ex-
own limitations or because of rigid in-
pectancy tables should ordinarily be
stitutional policies, feels that he must
developed, if possible, when ad-
use such terms, he should be sure that
ministrative decisions are based on test
interpretations are also given in stan-
scores. Very Desirable
dard scores or percentile ranks with
reference to the specific norms group [Comment: Expectancy tables may
used in deriving them_ The specific test, be more useful than norms. When
test form, time of testing, and nature of decisions are based on test scores (with
the test situation should be included in the possible exception of content-
the statement.] referenced interpretations), the test user
has ordinarily hypothesized that some
J5.3. A test user should examine outcome on an external criterion is
differences between characteristics of a related to performance on the test.
person tested and those of the Decision makers wiIJ have a more useful
population on whom the test was interpretation of a test score if it is ex-
developed or norms developed. His pressed in terms of an expected level of
responsibility inel udes deciding performance on the criterion than if it is
whether the differences are so great that expressed in terms of relative standing.]
the test should not be used for that per-
son. Essential J5.5. Ordinarily, normative in-
terpretations of ability-test scores
J5.3.1. If no standardized approach should not be made for scores in the
to the desired measurement or chance range. Essential
assessment is available that is ap-
propriate for a given individual (e.g., a [Comment: On one reading test for
child of Spanish-speaking migrant elementary school students, a child who
workers), the test user should employ a cannot read, and therefore gives truly
broad-based approach to assessment random responses, would be most likely
using as many methods as are available to obtain a grade-equivalent score, ac-
to him. Very Desirable cording to the norms, of 2.2; that is,
second month of second grade. Quite
[Comment: The standard is to do the apart from the usual difficulties with
best one can. This may perhaps include grade-equivalent scores, the example
the use of a test, even though no ap-
demonstrates the impropriety of trying
propriate normative data are available,
to make a normative interpretation of a
simply as a means of finding out how
test score obtained in a chance range.
the individual approaches the task of
One test manual tor a widely used test
the test. It might include references, ex- of general mental ability has provided a
tensive interviews, or perhaps some ad
useful guide to the interpretation of
hoc situational tasks. Efforts to help
"range-of-chance" scores.]
solve educational or psychological
problems should not be abandoned J6. Any content-referenced inter-
pretation should clearly indicate the do· SUbjectivity can reduce rather than
main to which one can generalize. enhance validity. The intent is to avoid
Essential a mechanical rigidity in using test
scores of imperfect validity. See also
J7. The test user should consider H2.]
alternative interpretations of a given
score. Essential J7.2. A person tested should have
[Comment: In a sense, a test-score in- more than one kind of opportunity to
terpretation implies the hypothesis that qualify for a favorable decision.
the score obtained is a function of the Desirable
trait level "really" possessed. Alter- [Comment: In some situations, a can-
native hypotheses can be suggested. didate might be given the option to
The obtained score might be a function qualify on the basis of characteristics
of anxiety, prior knowledge of the test. other than those measured by the test.
inadequate understanding of the in- If a person with a score so low that his
structions. a general sort of test best prognosis is academic failure.
wiseness, deliberate faking. or any of nevertheless succeeds in college, he may
several other possibilities. The test user have demonstrated qualities necessary
needs to consider more than the obvious for success other than those measured
interpretation and to have the skill and by the test, and the fact might well be
sensitivity necessary to develop alter- considered.
native explanations and to evaluate Again. the standard must be
them.] judiciously applied. In general. the
most valid methods available should
J7.1. Where cutting scores are
guide decisions; the SUbjective use of in-
established as guides for decision. the
formation not validated can reduce
test user should retain some degree of
validity. When compelling information
discretion over their use. Desirable
exists. however, it should not be ignored
[Comment: The point bears in individual cases. It should be noted
repeating that a test user cannot ab- that it would be unethical as well as in-
dicate the responsibility for the decision valid to invoke this principle in the ap-
to use the test. In most circumstances. plication of particular biases of the test
there are alternatives. Despite the fact user.]
that a given test may have a high
predictive validity for a specific func- J7.3. A procedure for reporting test
tion, it may represent a trait which is results should include checks on ac-
not the only path to success in the curacy and make provision for
predicted venture; and its validity for a retesting. Desirable
given individual. tested at a particular [Comment: Errors in procedures and
time and under particular cir- in test scoring occur; procedures should
cumstances, may be in doubt. be available for checking. Retesting is
This standard may not be taken as a one form of checking results. There
license to discriminate; it is to be used should be some limits to a retesting
sparingly in recognition that excessive provision. The number of allowable
762 ApPENDIX 0
retests may be limited by the number of statistical significance of differences

parallel forms available. Certain types between scores. Very Desirable
of assessments (e.g., personal-history [Comment: A test user may observe
data) are inappropriate for "retesting." differences in scores made by two in-
Moreover, a true score is likely to be dividuals on the same test. There may
closer to the mean than is its correspond- be differences in the scores made by an
ing obtained score. This fact has im- individual on a pretest and a posttest
portant implications for extremely low after some intervening treatment or
scores; they will tend to be increased in training. He may be interested in com-
a retest. paring the individual's performance on
In general, however, opportunities one test with the same person's per-
for retesting should be permitted formance on still another test. In such
without major obstacles. The principle cases, the test user should know how
is that no one should be a victim, much confidence to place in an ob-
without recourse, of an adverse decision served score difference.]
on the basis of faulty and correctable
psychological assessment. Nor should J9. A test user should develop
such decisions be permanent; over a procedures for systematically elim·
period of time, individuals should have inating from data mes test-score in-
a chance for reevaluation on the basis of formation that has, because of the lapse
new learning or new experience.] of time, become obsolete. Essential
[Comment: Data should not even be
available for consideration in decision
J8. The test user should be able to
making after an invalidating period of
interpret test performance relative to
time. Scores on early achievement tests
other measures. Very Desirable
in areas where later learning or forget-
[Comment: For many uses, one ting is to be expected (e.g.. an old
should be able to interpret test scores in typing-test score) are no longer likely to
terms of external criteria. The necessary be valid.
data may be in a test manual; manuals Not all data are equally susceptible to
for some academic aptitude tests obsolescence. Information of a highly
provide expectancy charts useful for SUbjective nature might be judged to
such interpretations. When an become obsolete in a shorter time than
assessment of performance on an ex- more objective items of information. In-
ternal criterion is also available, and formation about young children might
when there is a wide discrepancy be-
be judged to become obsolete in a shorter
tween actual and predicted criterion per-
period of time than comparable kinds
formance, the test user should in- of information about adults.
vestigate possible reasons for the
In the case of data that have poten-
discrepancy. Furthermore, there should
be no a priori assumption that either tial value for research or for survey pur-
the test or the criterion is the instru- poses, the purging may consist of
ment in error.] destroying the link between a person's
name and the information relevant to
J8.1. A test user should be able to the test rather than destroying the in-
use and interpret data regarding the formation itself.]
APPENDIX D INDEX
Achievement tests checking validity of, E

classification ofitems, E12.2 content referenced, B3.l
content-by· process outline, E12.2.l computer· based, B6, J4
validity, intro. to, E12.2, E12.2.l elTect of test names, Bl.l1T
Administration of tests, CItT, I1 IT error, B1.3, B1.4
Answer sheets misuse, prevention of, BllT
directions to subjects, C.2 stability, F6
interchangeability of dilTerent types, C3.3 subscores, BS.S
Interpretation, aids to, BIT, El IT
Bias in sampling, E9 Interpretive scores, DS.2.3
Instruction to SUbjects, I1
Central tendency Items
norms, D3 description of items used, E9
validity of sample, E6.2 interpretation, E9, EI.4
Consistency relationship to other items, EB.32, ES.4, EB.S
internal, FSff writers, A2.4
overtime, see Stability Item·test correlations, E12.l
see also Reliability
Construct validity, see Validity, construct Local norms, see Norms
Contamination of criterion, E4.l, E4.1.l, E7.3 Long·term prediction, E7.4.3, E7.4.4
Content validity, see Validity, content
Content reference, J6 Manual, AlIT
Corrected coefficients absence of information, ALl
of validity, ES.2.1 administration of tests, Clff
of reliability, F3 information too extensive for, A1.2
Correlation contents of, A2IT, Bl IT
item score, El.4 norms, Dl
with other tests measuring the specialized tests, E13.2.1
same attribute, E13.1.2 purpose of, AIT
see also Validity, Regression, Reliability revision, A3IT
Criterion data short form, A3IT
Cross-validation, ElOff Measurement error
Data, continue collection, Ell correction for, ES.2.1, E13.2.6
Date for dilTerent groups, F2.3.l, F6.4
establishment of content validity, E7.4.l for dilTerent score levels, D2.3.2, F6.3
testing and collection of criterion general principles, F
data, E7.4, Ell inconsistencies, Fl.l
Directions for administration, C1.l, GIT for short form of test, A3.2.l, A3.3.2
Directional diagnosis, ES.3.1 in test interpretation, B1.3, B1.4, JIT
procedures and samples, F2IT
Error in test interpretation, B1.4
see also Interpretation of scores, Names of tests, B1.1 IT
Measurement error Nature oftests, B3IT
Experimental or research test, B2.1 Norms, D
description of norms group, D2IT, DS.4
Factorial studies, E13.2.2 local norms, Dl.l, D1.2, D4
method of deriving, D2. 1.1 , D2.1.2
Group vs. individual interpretation of scores, D7 revision, A3.2IT
Guessing, correction for, C3.S user interpretation, JSff
Internal consistency, FSff
Interpretation of scores, B Obsolescence
case studies used in, Bl.3 scores, J9
763
764 ApPENDIXD
tests and interpretation, Iff Self-interpreting tests, B4.1

Organizational use of material, Al.2.3 Short form, A3.2.1, A3.2.2
validity, A3.2.2
Percentile scores, 03, 05.3 Significance
Personality inventories degree, BS.3
names, B1.1 difference between two scores, Fl.4, F6.3
Procedures, standardization of, Cff validity studies, E13.2.6
Promotional material for tests, A1.2.!, A1.2.2 Speeded tests, EI3.2.4
Psychiatric diagnosis Stability, intro. to, Fff
agreement with a test, E4.4.2, E4.4.3 scores over time, F6, F6.3ff
Purposes oftests, B2ff time between measures, F6
Qualifications Standard error of measurement, 05.2.2,
test administrators, B4ff, G3.! Fl, F1.2
see also Users Standard scores, 03, OS.2ff, EB.1.l
Quantitative information, reporting of, BS.1 Standard deviation, see Variance
Statistical techniques, EB.1.3
References useful to test user, B4.3 Subgroups
Regression information, 14.11 validity, E13.2.3, EI3.2.S
cross-validation, EIO.l.1 Subjects
Relial>i1ity comparability of, E6.1.1
coefficients, F1.2, F6.2 comparison with reference groups, E6.1.2
corrected for range, F2.2 description, E6.2ff
of the criterion, E4.4ff, Fff experience between testings, E7.4.4
description of procedures and samples, F2ff Subscores
of differences between scores, F6ff interpretation, BS.S, E1.2
express of, F3
evidence of, BS Terminology in reporting statistical
information on test speededness, FS.2 procedures, F3
item-test correlations, F2.4 Test, short form of, A3.2ff
across testers, H4
types, F Users, types of, G
alternative forms, F4 alternative interpretation, J7ff
intercorrelation of parts, F3 assessment of variables, H2ff, H3ff
split-half, FS.4 costs, H2.2
test-retest, F6.1 experience, H2.1
user interpretation, J3 formulation of goals, HI ff
see also Internal consistency, Measurement individual interpretation JS.3ff
error. and Stability research on experi- institutional use, GS, 12.1
mental tests, B2.1 interpretation of test, Jff
Revision, A3 method of choice oftests, H
short form, A3.2.1, A3.2.2 qualifications of, Glff, G2ff, G3ff, G4
reporting test scores, J2
Sampling error, see Measurement error validity, E2ff
Sampling methods, 02.1.2 use oftest, HS
adequacy of, in determining content
validity, E see also SUbjects
Scales, OS, D6 Valid ity, Eff
Scores, use of, G construct intro. to, E, El3
Scoring of tests theoretical, E13ff, see also Manual. E12.!
basis for, C3.2 content validitv
instructions, C3ff, 13.1 ff item-course of study. E12.3
methods for checking, C3.2.1, C3.2.2, item-selection. EI2.!, E12.1.1
I3.1ff, J7.3 job selection, E12.4
error, C3.2 coefficient of. ES.2.!. EB. 1.1 , EB.2. EIO. 14.1
system used, C3.2.1, C3.2.2, C3.2.3 group comparison, EB.3.2
Security, ISff combination factors. EB.S
criterion· related intro. to, E, E3, E4, Validity sample, E6, EI2
E4.4, ES.l, EB collection of data. E7. E12
general principles, E, EB.4 cross·validation E1 Off
local studies, ES.2.2 description, E6.2ff. E8.3ff
predictive vs. concurrent, E7.4.2, E7.4.3 interpretation of El.l ff, E1.3, El.3.1
occupational E3.1, E3.1.1 other relevant attributes, E12.1ff
revision ofvalidity claims, E6ff subsamples. El
content, intro. to E, E1.2ff
corrected vs. uncorrected EB.2.1 Variance
proof of, BS for actual and corrected samples, E12.1
psychiatric agreement. E4.4.2. E4.2.3 for scores, E7.4.1, E13.2
report of. in manual, E3.1, ESff, E7.2, E8 for subgroups, E9, ElO.l.l, E13.2.3, E13.i.S
types. intro. to. El in validity studies, E7.4ff
Index
Accountability Advocacy (Cont.)

ethics and, 43 public interest and, 556-557, 559-580
public concern with, 53-55 See also Public interest
standards implementation, 60 Aetna Insurance Company, 229, 237, 255
sunset review laws, 331, 332 Alcoholism, 265
supervision, 53 Alinsky, Saul, 569
Accountants, 551 American Association of Applied
Accountants for the Public Interest, 551- Psychology (AAAP), 159
552 American Association of State Psychology
Accreditation Boards (AASPB), 319, 320
advantages and functions of, 204-206 accreditation, 215
American Psychological Association, licenSing, 286
37-38, 171-172 national register and, 189, 198
developments in, 209-219 professional standards, 5
internship, 211-215 American Bar Association (ABA)
licensing and, 215-216, 289, 318-323 developmental disabilities law, 429-430
process of, 206-209 discrimination, 450
quality control and, 56 mentally disabled, 440
rehabilitation psychology, 22 American Bar Foundation, 550
specialty practices, 216-220 American Board of Professional
standards implementation, 60-61 Psychology (ABPP), 189, 196,303,
training programs, 8, 203-221 304
withdrawal of, 208-209 American Civil Liberties Union (ACLU),
Actualization, 497-498 551, 571
Addington v. Texas, 348, 358, 367, 394, 413 American Educational Research
Administrative services only (ASO), 272 Association, 6
Advertising American Insurance Association, 273
product endorsement, 93-94 American Law Institute, 363
review of, 90 American Medical Association (AMA), 256
psychologists utilizing, 90-93 American Mutual Insurance Alliance, 273
Supreme Court (U.S.) and, 454-455 American Personnel and Guidance
Advocacy, 13 Association, 325
burnoutand,579-580 American Psychiatric Association, 232,
developmental disabilities law, 428-431, 461-462
443 American Psychological Association
ethical dilemmas in, 573-577 (APA),161-178
group efforts in, 572-573 accountability, 54-55
organizational interests and, 580-589 accreditation and, 203, 204, 206, 210,
professionalism and, 577-579 211,214,216-217,218
767
768 INDEX
American Psychological Association Antitrust regulation, 63

(Cont.) Architectural Barriers Act (1968), 432
advertising standards, 91, 92-93 Aristotle, 360
Board of Convention Affairs, 168-169 Armed Forces, 159, 203, 212
Board of Professional Affairs, 172-173 Assault and battery, 480-482
Board of Scientific Affairs, 169-171 Assessment. See Tests and testing
Board of Social and Ethical Association for the Advancement of
Responsibility, 173-175 Psychology (AAP), 580
central office of, 176-178 Association of Psychology Internship
Committees on Ethics, 80-86 Centers (APIC), 214
competency and, 51 Attorneys. See Counsel; Lawyers
continuing education, 328 Autism, 425
Council of Representatives, 161-167
educational requirements, 291 Bacon v. Bacon, 482
Education and Training Board, 171-172 Bandura, A., 591
ethical standards, 43, 77, 78-80 Bartley v. Kremens, 351
expulsion from, 86 Behavioral transformation process, 501
future standards policy, 65-69 Behavior modification, 309, 467
health insurance and, 252, 253, 258, 259, Behavior therapy, 309
264 Bellah v. Greenson, 485-486
history of, 157-161 Bentham, Jeremy, 543
industrial-organizational psychology, Berger v. Board of Psychologist Examiners,
141-148 321
inquiry standards, 105 Berger v. District of Columbia, 197-198
legal considerations in standards, 62-64 Bias, 120, 397, 398
licensing and, 187,286-287,288-289 Biofeedback therapy, 252-253, 309-310
national register and, 189, 198, 199 Birnbaum, Morton, 374
operation of, 178-183 Birth control, 445-446
organization of, 161-178 Blue Cross/Blue Shield, 234, 250, 275
peer review, 228-229, 230, 232 CHAMPUS and, 254
Policy and Planning Board, 167-168 claim forms, 256, 283-284
professionalism and, 4,180-183 FEHBA and, 255
"professional psychologist" definition, state plans and, 268-270
46-50 Board of Convention Affairs (APA), 168-
professional's guide to, 157-184 169
professional standards,S, 6, 7, 8, 12, 19, Board of Professional Affairs (APA), 172-
20, 21, 22-28 173
Publications and Communications Board of Scientific Affairs (APA), 169-171
Board,175-176 Board of Social and Ethical Responsibility
public interest and, 541, 552, 557, 580, (APA),173-175
589-591 Bogust v. Iverson, 474
specialty practice, 69, 70-72, 216-217, Breach of contract, 486-489
324 Britain, 361-362, 368
standards (1974), 29-31, 48, 53 Brown v. Moore, 469
standards (1977), 31-34, 48, 49, 50, 55 Burger v. Board of Psychologist Examiners,
standards (1980), 34-42 181
standards implementation, 55-61 Burnout, 579-580
state psychological associations and, 176 Business skills. See Management
state statutes and, 319, 320, 322-323,
324,325 Canada
sunset review laws and, 332-333 examination, 303-304, 310
testing standards, 111, 112-113, 118, licensure, 285, 286, 290, 291, 297-298,
119, 120, 122, 123, 124, 127, 131, 301-302,305,307-308
136-137 medical profession and, 309
American Sociological Association, 310,314 standards implementation, 60
INDEX 769
Center for Science in the Public Interest, Committee on Standards for Providers of
552 Psychological Services (COSPOPS).
Certification See American Psychological
licensure contrasted, 287 Association
See also Licensing and certification Compensation neurosis, 393
CHAMPUS. See Civilian Health and Competence (mental)
Medical Plan of the Uniformed civil rights, 373-374
Services (CHAMPUS) right to refuse treatment, 382-383, 385
Child abuse and neglect, 442, 443-444, Competency (professional)
484 ethical standards, 87-88
Children, 349-351, 443-444 legislative process, 604
Christian Science, 381 licensure and certification, 309, 327-329,
Christy v. Salitermann, 461 581-583
Civil commitment self-regulation, 330-331
adults, 344-349 standards, 65-66
bases of, 343 testing standards, 131
competency to stand trial, 358 training and, 50-51
considerations in, 11 Competency to stand trial
deinstitutionalization, 355 basis of, 343
initiation, 347 developmental disabilities law, 448-449
insanity defense, 365, 366 expert testimony, 400-401
least restrictive alternatives, 351-355 legal considerations in, 10
malpractice liability, 481 mental health law, 357-359
mental health law, 341 C<!ncurrent review, 224, 225
minors, 349-351 Confidentiality
public interest, 558 casual attitude toward, 100-101
release from, 367 death of psychologist, 100
rights of committed, 372-373 ethical concerns, 94-101, 106
right to refuse treatment, 384, 388 expert testimony, 399, 400
sexually dangerous persons, 370 health insurance, 254
standards for, 346 malpractice liability, 483-486
treatment, 380 peer review, 231, 234
Civilian Health and Medical Program of privelege contrasted, 96-99. See also
the Uniformed Services Privilege
(CHAMPUS), 231-237, 251-255, recordkeeping and, 52
261,275,279-282 right to refuse treatment, 381
Civil rights, 373-374 test security, 132
Civil Rights Act (1964), 450 third-party access, 99-100
Client regulation, 11 Conflict management, 531-535
Clients Conflict situations, 565-566
retention of, 104-105 Consent. See Informed consent
rights safeguarded, 106-107 Conservatorship. See Guardianship and
Client solicitation. See Advertising conservatorship
Client welfare Content bias, 120
advocacy and, 575 Content domain, 119-120
ethical concerns, 104-105 Content-referenced interpretations, 118
Clinical psychology, 251-252, 255 Continuing education, 7-8
Cobbs v. Grant, 465, 466 licensing, 327 -329
Colleagues See also Education and training
ethical concerns, 101-106 Contracts
referral generation, 276 breach of contract, 486-489
Commission on Accreditation of client retention, 104
Rehabilitation Facilities (CARF), ethical standards, 95-96
56 mental health law, 341, 390-391
Commitment. See Civil commitment "Control" test, 361-362
770 INDEX
Convention planning, 168-169 Disabilities law. See Developmerital

Cooperative strategies, 561-565 disabilities law
Cost analysis procedure, 528 Disability
Council of Representatives (APA), 161- determination of, 260-261
167 mental health law, 392-393
Counsel (legal) rehabilitation, 256
civil commitment, 348 Discrimination
competency to stand trial, 358 developmental disabilities law, 450-454
expert testimony, 396 industrial-organizational psychology,
psychologists and, 413-414 151-153
right to refuse treatment, 382 public interest, 557-558, 592-593
Counseling, 325-326 Dismissal (from position), 565, 566
Criminal justice system, 10 Disordered persons. See Mental health law
dangerousness and, 346 Disseminator role, 509
developmental disabilities law, 446-450 Disturbance-handler role, 512
Criminally insane, 366 Dixon v. Weinberger, 353
Criterion-referenced interpretations, 118 Doctoral degree
Criterion-related validation, 125-127 accreditation, 326
Cross validation, 127-129 health insurance, 264
industrial-organizational psychology,
Dangerousness 145-146
commitment, 343, 345, 346 licensure and certification, 288-289, 291
definitions of, 346 national register listings, 195, 196, 197-
expert testimony, 407-408 198,199-200
malpractice liability, 474-475 Ph.D. and, 209-210
right to refuse treatment, 384 professional psychologist definition, 48,
Darling v. Charleston Community Memorial 49,50
Hospital, 463 See also Education and training
Death penalty, 365 Documentation. See Recordkeeping
Decision making, 12-13 Doe v. Gallinot, 347, 348
management roles, 510 Domain-referenced interpretations, 118
public interest and, 546-548 Donaldson v. O'Connor, 375-376
Definitions, operational, 115-116 Donation of services, 552-553
Deinstitutionalization, 355 Darken, Herbert, 249-284, 603
DeLeon, Patrick H., 601-620 Drope v. Missouri, 357
Department of Health, Education and Due process
Welfare (U.S.), 224, 323, 435 civil commitment, 348, 349
Developmental disabilities law, 423-455 competence to stand trial, 357
advocacy, 428-431 minor's commitment, 350
criminal justice process and, 446-450 right to treatment, 376-377
defined,424-426 Durham rule, 362-363
discrimination prohibition, 450-454 Dusky v. United States, 357
education, 433-438 Dyslexia, 425
environmental barriers, 431-433
knowledge about, 10 Eagleton, Thomas, 99
marriage and family rights, 441-446 Ecological-systems theory, 499-505
origin of, 423-424 Economists, 551
psychologists and, 427-428 Education
zoning, 438-441 accreditation and, 220, 320, 326-327
Diagnosis, malpractice liability, 468-470 accredited programs, 203-204
Diagnostic and Statistical Manual of Mental advertising standards, 92
Disorders, 407 APA and, 171-173, 180-181
Diminished capacity, 368-369 certification and, 321
Direct Recognition/Freedom of Choice competency measures, 50-51
(FOC) legislation, 263-265, 266-267 developmental disabilities law, 433-438
INDEX 771
Education (Cant.) Ethics (Cant.)

ethical concerns, 89, 106 public interest and, 546, 552, 557, 573-
health insurance, 255, 264 577,592-593
industrial-organizational psychology, public statements, 89-94
145-146 self-regulation, 330-331
licensing and certification and, 216, sexual relations, 471
288-289,291,319 standards and, 6, 42-44, 57 -58
national register listings, 191-192, 193- test and research data, 106
194,197-200 Evaluation standards (tests), 122-129
professionalism and, 3, 5, 20, 21 Examination, 303
"professional psychologist" definition Examination for Professional Practice in
and,46,47,48-50 Psychology, 286, 303-305, 329, 582-
specialty practice, 324 583
standards in, 22, 23 Experience, 123
supervision, 53 Experimental Medical Care Review
See also Continuing education; Doctoral Organization (EMCRO), 224
degree; Training programs Experts and expert testimony
Education and Training Board (APA), civil commitment, 349
171-172,206 competency to stand trial, 358
Elderly, 276 insanity defense, 361, 362, 363, 365
Electroshock treatment mal practice liability, 479
malpractice liability, 461-462, 466, 489 mental health law, 342, 394-413
right to refuse treatment, 388, 389 public interest and, 554-555
Emergency commitment, 347-348 reform proposal for, 405-413
Employee Retirement Income Security Act
(ERISA), 272, 273 False imprisonment, 482-483
Employment Family planning, 445-446
client retention, 104-105 Fault,477
ethical standards, 94-95 Federal Employee Compensation Act
licensure exemptions, 288 (FECA), 261, 273
Entrepreneur role, 511 Federal Employee Health Benefit Act
Equal Opportunity Specialist, 153 (FEHBA),255-256
Equal Rights Amendment, 168 Federal government, 203
Estelle v. Smith, 400 APA and, 158
Ethics, 12-13 criminal law , 447
advertising, 454 developmental disabilities law, 423, 424,
APA, 77, 173-175 425-426,429
areas of concern in, 87-107 discrimination, 450
committees (APA) responsible in, 80-86 funding, 160
confidentiality and, 94-101 handicapped and, 432-433
coping with problems in, 82-86 health insurance, 229, 250, 251-262
defined,82 Health Maintenance Organizations, 270
developmental disabilities law, 435 individual practice association, 271
enforcement of, 81-82, 83, 584-585 industrial-organizational psychology,
historical perspective on, 78-79 144, 150-153
human subject committee (APA), 170- licensing and, 322-323
171 national register and, 196-197
implementation of, 59-60 peer review, 224
industrial-organizational psychology, professional regulation, 219
148 quality control, 55-56
malpractice liability, 462, 485, 489-491 self-insured, 272, 273
personal responsibility in, 87-89 Federal Trade Commission, 63, 69, 90
professional organizations, 26 Federation of Associations of Health
professional relationships, 101-106 Regulatory Boards (FAHRB), 323
publications on, 79-80 Fees, 504
772 INDEX
Fee-splitting, 103-104 Health Insurance (Cont.)

Feldman, W. S., 458 federal plans, 251-262
Fernandez v. Baruch, 473 fraud,87
Figurehead role, 505-506 hospitalization, 250
Finder's fees, 104 national register and, 189, 196, 197
Forms peer review, 224, 228-229, 230, 234,
Blue Cross/Blue Shield, 283-284 235-237
CHAMPUS, 279-282 practice trends in, 274-277
Fraud,87 prepayment, 249
quality control, 56
Gable, R. Kirkland, 457-491 recordkeeping, 67
Geddes v. Daughters of Charity, 483 reimbursement, 7, 8, 9
Genetics, 441, 442 self-regulation and, 68, 69
Geographic mobility specialty practice, 69
licensure, 289 standards implementation, 61
reciprocity,334 state laws, 262-268
Grandparenting provisions, 40-41, 49 state plans, 268-274
examination, 303 supervision and, 53
health insurance, 252, 255 third-party reimbursements, 187-188
industrial-organizational psychology, Health Insurance Association of America
146 (HIAA), 228-229, 252, 264
national register listings, 191-192 Health Maintenance Organizations
Grants, 205 (HMOs), 173, 256, 269, 270-272
Group efforts, 572-573 Hearings
Group homes, 439 civil commitment, 347, 348, 349
Guardianship and conservatorship developmental disabilities law, 437
basis of, 343 ethical standards enforcement, 85-86
mental health law, 355-357 legislative process, 611
minor civil commitment, 350 minor's civil commitment, 350
Guilty but mentally ill verdict, 369-370 right to refuse treatment, 382
Guion, Robert M., 111-140 Hearst, Patty, 405
Hewlett-Packard,272-273
Habeas corpus, 348 Hicks v. United States, 485
Halderman v. Pennhurst, 353-354, 355 Hinkley, John W., Jr., 364, 405
HalL G. Stanley, 157 Homicide
Hammer v. Rosen, 470, 478 expert testimony, 411
Hammonds v. Aetna Casualty and Surety Co., insanity defense, 364
63 malpractice liability, 473-476
Handicapped Homogeneity requirement, 115, 120, 121
developmental disabilities law, 425, Homosexuality, 174, 175
426. Hospital insurance, 250
See also Developmental disabilities Hospitalization
law competence to stand trial, 358, 359
discrimination against, 451-452 insanity defense, 360, 366
education, 434-438 peer review, 225
legal considerations, 10 release from, 367
Hawaii Health Care Act, 268 rights of hospitalized, 372-389
Hawaii Medical Service Association, 275 right to treatment, 374-380
HCPOPs, 224, 226, 227 See also Civil commitment
Health insurance, 25, 249-284 Hospital practice, 274
APAand,182 See also Institutional practice
confidentiality and, 99-100 Hospitals
coverage, 250-251 license exemptions, 314
Federal Employee Health Benefit Act malpractice liability, 463
(FEHBA), 255-256 reforms in, 571
INDEX 773
Illegal activities, 88-89 Johnston v. Rodis, 489

Imminent danger concept, 97 Joint Commission on Accreditation of
Income, 504 Hospitals, 23, 24-25, 56, 60, 61
See also Fees Juries, 363, 369
Incompetence to stand trial. See
Competency to stand trial
Kaiser Permanente Medical Care program,
Incorporation, 276
256,271,274,275
Individual Education Program (IEP), 436-
Kilburg, Richard R., 157-184,495-537
437
Kindred, Michael, 423-455
Individual Practice Association (IPA), 256,
Knecht v. Gillman, 381
269,271,272
Koocher, Gerald P., 77-109
Industrial-organizational psychologists
Kurz, Ronald B., 203-221
and psychology
APA outline of, 141-143
APA standards, 144-148 Law. See Legal considerations
content of, 41-42 Lawyers, 550-551
governmental regulation, 150-153 See also Counsel
licensing, 148-150 Leader role, 506-507
public interest, 553 Least restrictive alternative, 351-355
standards, 6-7,141-154 Legal Aid Society, 550
Informed consent, 461, 464-468, 471 Legal considerations, 8-9
Inquiries, 105-106 business regulation, 9
In re McDonald, 444 client regulation, 11
In re Oakes, 356 confidentiality, 96-99
In re Roger S., 350 criminal law, 10
Insanity defense developmental disabilities law, 10. See
abolition of, 363-364 also Developmental disabilities law
competence to stand trial contrasted, licensure and certification, 287
357 mal practice law, 10-11. See also
expert testimony, 399-400, 405 Malpractice liability
mental health law, 360-367 privileged communications, 96
Institutionalization, 438-439 professional regulation, 9-10
See also Civil commitment; specialty standards, 27-28
Hospitalization standards and, 44-45, 62-64
Institutional practice, 22-25, 47, 274, 314 standards implementation, 59-60
Insurance. See Health insurance See also Developmental disabilities law;
Intelligence testing, 135 Malpractice liability; Mental health
See also Tests and testing law
Interdependence, 498-499 Legislative process, 601-620
Internships issues in, 601-604
accreditation and, 211-215 in practice, 604-619
license exemptions, 310 Lessard v. Schmidt, 348, 352
licensure, 303 Liaison role, 507
Interpretation, testing, 118-119, 133-134 Licensing and certification, 9-10, 285-337
Involuntary commitment. See Civil accreditation and, 215-216, 220, 318-323
commitment; Hospitalization APA and, 160, 180, 181, 187
1-0 psychology. See Industrial- certification contrasted from licensing,
organizational psychology 287
"Irresistible impulse" test, 361-362 competence and, 51, 88, 581-583
Item analysis, 120-121 continuing education, 327-329
ethical standards, 82
Jackson v. Indiana, 358, 359, 378 exemptions from, 288, 310, 311-313,
Jacobs, Durand F., 19-75 314,315-317
Job actions, 569 federal regulation, 322-323
Johnson v. United States, 475 health insurance, 252
774 INDEX
Licensing and certification (Cont.) Management (Cont.)

industrial-organizational psychology, problems in, 518-535
148-150 resource allocation, 527-531
issues and prospects in, 318-334 Mandatory Minimal Mental Health
legislative process, 604-619 Insurance (MMMHI), 265, 268
medical profession and, 182 Manuals, 129-130
model for legislation, 286-289 Marriage, 441-443
national register and, 190, 191, 192, Mass media. See Media
197-200 Master's degree
professional psychologist definition, accreditation, 326
46-47 professional psychologist definition, 49,
professional regulation, 330-331 50
public interest and, 580-589 Material risks, 465-466
quality control, 56 Mathew v. Nelson, 346
reciprocity, 334 Measurement. See Tests and testing
research and teaching, 331 Media, 90, 572
self-regulation, 68-69 Medicaid and Medicare, 257-260
specialty practice, 69, 306-308, 309, 323- duplication of benefits, 254-255
327 payments, 276
state requirements for, 299-302 peer review, 224
state statutes and, 262-263, 285-286 Medical care evaluation (MCE), 224, 225,
state statutes surveyed, 290-318 227
sunset laws, 44-45, 331-334 Medical model, 341
See also Certification Medical profession
Lifestyle, 502 peer review, 223-224, 225, 226
Lobbying, 603 psychologists and, 181-182, 188,274-
Locality rule, 460 275,276
psychology internships, 214
Malpractice liability, 10-11,457-491 psychotherapy and, 305, 309
assault and battery, 480-482 See also Physicians; Psychiatrists
breach of contract, 486-489 Medication
concept of, 458-459 civil commitment, 351
confidentiality and privacy, 483-486 malpractice liability, 461
dereliction of duty, 464-476 right to refuse treatment, 381-382, 384,
duty to patient, 459-464 385
ethics and, 489-491 Meetings, 514-515
false imprisonment, 482-483 Meier v. Combs, 483
homicide, 473-476 Melville v. Sabbatino, 350
improper diagnosis, 468-470 Mental health law, 10, 339-422
informed consent, 464-468 civil commitment, 344-355
injury or harm to patient, 476-480 civil competence and rights, 373-374
physical contact and sexual relations, competence to stand trial, 357-359
470-473 contracts, 390-391
public interest and, 592-593 diminished capacity, 368-369
standards and, 63 guardianship and conservatorship, 355-
suicide, 473-476 357
Management, 11-12, 495-537 guilty but mentally ill verdict, 369-370
basic roles in, 505-512 insanity defense, 360-367
conceptual foundations of behaviors, nature and assumptions of, 340-342
499-505 psychologist's role in, 394-413
conflict management, 531-535 quasi-Criminal commitment, 370-372
issues and principles in, 496-499 recovery or transfer payments, 392-393
planning and problem solving, 519-524 rights of hospitalized, 372-389
power-dependency relations, 524-527 right to treatment, 374-380
principles of, 517-518 right to refuse treatment, 380-389
INDEX 775
Mental health law (Cont.) National Register of Health Care

structure of, 342-344 Providers in Psychology (Cont.)
substantive and procedural, 342-393 background of, 186-189
testation, 390-391 credentialing, 320
Mental hospitals, 25 criteria for listing in, 191-194
Mentally disordered sex offenders, 370 education and credentialing, 197-200
Mental retardation health insurance and, 228, 253, 255
developmental disabilities law, 424, 425, listings in, 194-196
426 origins of, 189-190
marriage, 441 provider definition, 190-191
rehabilitation, 256 recognition and utilization of, 196-197
Merchants National Bank & Trust Co. v. Negligence, 458, 459
United States, 474 See also Malpractice liability
Midwestern Psychological Services, Inc. et al. Negotiations, 570
v. Potts and Potts, 69 Negotiator role, 511-512
Mills v. Rogers, 384, 386-387 Nicholson v. Han, 472,488-489
Minority rights, 174-175 Noel v. Proud, 487
Minors. See Children Norm-referenced interpretations, 118
Minow, Newton, 549 Null hypotheses, 123
M'Naghten case, 361, 362, 363
Model Psychologist Direct Recognition
O'Connor v. Donaldson, 352
Bill,264
Old Age, Survivors and Disability
Monitor role, 508
Insurance (OASDI), 260-261
Moore v. Metropolitan, 250
O'Neil v. State, 469
Morality
Operational definitions, 115-116
insanity defense, 361, 364
Optimization, 497-498
mental health law, 341, 343
Organization, 496-497
See also Ethics
Ortelere v. Teachers' Retirement Board, 341
Morse, Stephen J., 339-422
Multiple therapists, 101-102
Mutual of Omaha, 234 Pain control, 274
Pallak, Michael S., 157-184
NAACP Legal Defense Fund, 551 Paraprofessionals, 53, 67-68
Nader, Ralph, 546, 547, 565, 567, 568, 571, Parens patriae rule, 382
572 Paternalism, 348
National Association for Mental Health, Pate v. Robinson, 357
571 Patient rights, 565
National Association of School Peer review, 20, 25, 223-245
Psychologists (NASP), 50, 55, 217, CHAMPUS, 231-237
326 ethical standards, 82
National Commission on Accreditation of health insurance, 253
Teacher Education (NCATE), 217, "outpatient mental health treatment
218,326 report" form, 243-245
National Commission on Education and Professional Standards Review
Credentialing in Psychology, 320 Committees, 228-231
National Council on Measurement in quality control, 58
Education, 6 recordkeeping, 52,67
National health insurance, 188,268 self-regulation, 59-60, 61
National Institute of Mental Health, 205, standards and, 26
232,562-563 systems compared, 237-241
National Labor Relations Board (NLRB), Pennhurst v. Halderman, 353
132 People ex reI. Rogers v. Stanley, 348
National Register of Health Care People v. Silver, 341
Providers in Psychology, 185-200, Physical abuse and injury, 470-473, 476-
322 480
776 INDEX
Physicians Psychosurgery, 381, 388,389

civil commitments, 347 Psychotherapy, 288, 305,309
minor's civil commitment, 350 Psychotropic drugs, 351, 381
psychologists and, 181-182 competence to stand trial, 358
See also Medical profession; right to refuse treatment, 381-382, 384,
Psychiatrists 385
Planning, 519-524 Publications and Communications Board
Police, 447-448 (APA),175-176
Policy and Planning Board (APA), 167- Public Defender's Office, 550
168 Public interest
Political process, 13 advocacy, 559-580
See also Advocacy; Legislative process; allies in, 572-573
Public interest competency, 581-583
Power, 568 definitions of, 542-549
Power-dependency relations, 524-527 ethical dilemmas in, 573-577
,Pressure tactics, 568-569 licensing and, 580-589
Preventive detention, 341 media contacts and, 572
Privacy, 483-486 negotiations, 570
Private practice, 276 organizational interests and, 580-589
Privilege practice and, 549-559
confidentiality contrasted, 96-99. See pressure tactics, 568-569
also Confidentiality professionalism and, 577-579
expert testimony, 398-399 token offers, 570-571
right to refuse treatment, 381 whistle blowing, 571-572
Problem solving, 519-524 Public Interest Economics Center, 551
Pro bono publico, 550, 572 Public interest law, 550
Product endorsement, 93-94 Public statements, 89-94
Professionalism
advocacy and, 577-579 Qualifications. See Competency
APA and, 180-183 (professional)
education and, 3 Quality control, 8, 55
health insurance and, 7 Quasi-criminal commitment, 370-372
knowledge and skills required, 4-15
licensure and certification, 9-10 Reagan, Ronald, 364
practical questions in, 3-4 Recordkeeping, 51-52, 67
standards and, 5-7 Regulation, 9, 13
Professional organizations, 7 clients, 11
malpractice liability and, 461-462 federal government, 150-153
self-regulation and, 26, 44 self-regulation, 20, 68-69
Professional psychologist definition, 46- standards and, 5-6
50 Rehabilitation, 256-257
Professional schools, 209, 210 Rehabilitation psychology, 22-23
Professional Standards Review Reliability, 124
Committees (PSRCs), 228-231 Religious institutions, 211
Professional Standards Review Rennie v. Klein, 381
Organizations (PSROs), 56, 223-228 Reports, 129-130
Profile analysis, 224, 225 Research, 331
Proximate cause, 479 Research data, 106, 129
Psychiatrists Resignation, 568-569, 576-577
expert testimony, 395, 403 Resource allocation, 498, 527-531, 553
malpractice liability, 461, 462-463, 468- Resource allocator role, 511
469 Revision, 130
Medicare, 257-258 Robbins v. Footer, 460
psychotherapy and, 309 Rogers v. Okin, 382-384
See also Medical profession; Physicians Role playing, 521
Psychometricians, 314 Ross-Loos program, 271
INDEX 777
Roston, R. A., 464 Specialty practice (Cont.)

Roy v. Hartogs, 471, 477 licenSing and certification, 323-327
malpractice liability, 460-461
Sales, Bruce Dennis, 3-15 recordkeeping requirements, 52
Sammons v. Neymandi, 482 standards for, 6, 26-28, 69-72,141-154
Sampling, 125 standards implementation, 55-6l
School psychologists and psychology, 48, state statutes, 187
49-50 Spokesperson role, 509
accountability, 55 Stachulak v. Coughlin, 341
accreditation, 217-218, 326-327 Standard Oil, 272
licensing, 309, 314 Standards, 5-7
Schwartz v. Thiele, 486 accountability, 53-55
Scientists, 552 APA,173
Score interpretation, 129-130 civil commitment, 346
Scoring, 132-133 competence to stand trial, 357, 358
Second opinions, 101 content review, 28-34
Self-incrimination, 348 development of, 22-28
Self-insureds, 272-273 distinguishing features of, 21
Self-regulation, 20 ethics and, 42-44. See also Ethics
intramural standards implementation future policy of, 65-69
through, 59-60 implementation of, 55-6l
law and, 44 law and, 44-45, 62-64
licensing and, 289, 330-331 on-going concerns in, 45-64
regulation and, 68-69 overviewof,19-20
standards, 22-23, 26 paraprofessionals and, 67-68
voluntary standards implementation, professional psychologist definition,
58-59 46-50
Sex discrimination, 451 professions and, 20-21
Sex education, 442 psychological measurement. See
Sexually dangerous persons, 370-372 Measurement
Sexual relations, 470-473 recordkeeping,51-52,67
Shakow Report, 212 regUlation of practice, 68-69
Shaw, George Bernard, 541 specialties, 26-28, 69-72
Shelton v. Tucker, 352 statutory implementation, 62
Sherrer, C. W., 464 supervision, 53
Simon, Gottlieb c., 541-598 treatment needs, 347
Sirhan, Sirhan, 405 Standards for Providers of Psychological
Skills, 4-5 Services, 19, 25
Smith, M. Brewster, 541 Standards-referenced interpretations, 118
Social psychologists, 310, 314 State ex reI. Hawks v. Lazaro, 348
Social Security Act, 257, 258 State ex reI. Memel v. Mundy, 349
mental health law, 392 State governments, 56
OASDI, 260-261 See also State statutes
peer review, 224, 227 State psychological associations
Solicitation of clients. See Advertising APAand,176
Southeastern Community College v. Davis, 453 establishment of, 160
Sparks, C. Paul, 141-154 ethical standards enforcement, 84
Special interests, 603, 605 expulsion from, 86
Specialty practice legislative process and, 604-619
accountability,55 national register and, 190
accreditation and, 216-219, 220 peer review, 59, 229
APA,34-42 public interest and, 580
industrial-organizational psychology, quality control, 55
141-154. See also Industrial- State psychology boards
organizational psychologists and accreditation and, 215
psychology licensing and, 286
778 INDEX
State psychology boards (Cant.) Supreme Court (U.S.) (Cant.)

organization of, 290, 292-298 confidentiality, 400
self-regulation and, 330-331 death penalty, 365
training programs and, 318, 319 discrimination prohibition, 452-453
State statutes expert testimoney, 394, 413
accreditation and, 319 insanity defense, 364
APA and, 180, 181 least restrictive alternative rule, 352,
civil commitment, 349 353,354
criminal law, 447 marriage rights, 441
developmental disabilities law, 424-425, minor's commitment, 351
426,429,433 police and, 447-448
discrimination and, 450 procreation right, 446
education, 434-435, 436 right to refuse treatment, 384, 386-387
ethics, 82 right to treatment, 376-378
expert testimony, 395 self-regulation, 26, 68
family planning, 445-446 sexually dangerous persons, 371
health insurance, 262-268 zoning restrictions, 439
industrial-organizational psychology, Survival skills, 496
143-144, 148-150 Suzuki v. Alba, 347
licensing and certification, 46-47, 285-
286,290-318 Taig v. State, 469
licensure legislation model, 286-289 Tarasoff v. Regents of the University of
malpractice liability, 461 California, 98-99, 484-485
marriage, 441, 443 Tarshis, C. B., 462, 477
paraprofessionals, 68 Tax deductions, 261-262
reciprocity (licensing), 334 Teaching, 331
right to refuse treatment, 387 Testation, 390-391
specialty practice, 187,324-325 Testimony, 612
standards implementation, 62 See also Experts and expert testimony
sunset review laws, 331-334 Tests and testing, 6
State v. Rand, 358 APA and, 112-113, 158, 169-170
State v. Sanchez, 352 construction standards, 113-115, 119-
Statutes. See State statutes 122
Sterilization, 446 content domain, 119-120
Stigall, Tommy T., 285-337 content sampling, 121-122
Stone v. Proctor, 461 ethical concerns, 106-107
Stowers v. Wolodzko, 481 evaluation standard, 122-129
Stricker, George, 223-245 expert testimony, 411
Strikes, 569 industrial-organizational psychology,
Suicide, 473-476 150-151
Sunset legislation, 44-45, 181 intelligence testing, 135
APAand,160 item analysis, 120-121
licensing and certification, 331-334 legal considerations, 10
Sunshine legislation, 615-616 manuals and reports, 129-130
Supervision planning, 115-119
accreditation and, 320 procedures in construction, 113-115
ethical problems, 103 professional practice and, 111-112
industrial-organizational psychology, psychological measurement procedures,
146 130-134
licensure, 291, 303, 310 security in, 132
standards flnd, 53 standard procedures, 122
Supreme Court (U.s.) users, 130-134
advertising and, 454-455 Time allocation and management, 498,
civil commitment, 348, 349 513-514,529
competence to stand trial, 357, 359, 449 Token offers, 570-571
INDEX 779
Training programs Validity coefficient, 128

accreditation of, 203-221 Values. See Ethics
competence and, 50-51, 88 Vecchione v. Wohlgemuth, 344
licensure and, 318-323 Veterans, 261
paraprofessionals, 67-68 Veterans Administration, 203, 205
professional developments, 8 internships, 212
professional psychologist definition, 46, quality control, 56
48,50 Voluntary commitment, 344-345, 350
supervision and, 53
See also Education
Washington v. United States, 342, 362
Transfer payments, 392-393
Wellner, Alfred M., 185-200,203-221
Transportation of handicapped, 433
Whistle blowing, 571-572
Traweek v. Alabama Board of Examiners in
Whitesell v. Green, 472
Psychology, 320-321
Wills, 390-391
Treatment
Winters v. Miller, 381
civil commitment, 347, 351
Witmer, Lightner, 158
involuntary commitment, 345
Women, 174
least restrictive alternative, 354-355
Worker's compensation, 261, 273-274
malpractice liability, 466-467, 481
Written reports. See Recordkeeping
minor's civil commitment, 351
Wyatt v. Ireland, 379
right to, 374-380
Wyatt v. Stickney, 25, 314, 375
right to refuse, 380-389
Tyron, W. W., 467
X-ray machines, 479
United Auto Workers Union, 269-270
United States v. Brawner, 363 Yerkes, Robert, 158
Youngberg v. Romeo, 354-355, 376-377, 379,
Validation and validity
387
industrial-organizational psychology,
151-152
testing standards, 125-129 Zimet, Carl N., 185-200
users, 131-132 Zipkin v. Freeman, 471

Bruce Dennis Sales (Auth.), Bruce Dennis Sales J.D., Ph.D. (Eds.) - The Professional Psychologist's Handbook (1983, Springer US)

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Bruce Dennis Sales (Auth.), Bruce Dennis Sales J.D., Ph.D. (Eds.) - The Professional Psychologist's Handbook (1983, Springer US)

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The Professional

Springer Science+ Business Media, LLC

Main entry under title:

The Professional psychologist's handbook.

ISBN 978-1-4899-1027-1 ISBN 978-1-4899-1025-7 (eBook)

© 1983 Springer Science+Business Media New York

All rights reserved

N o part of this book may be reproduced, stored in a retrieval system, or transmitted

PATRICK H. DeLEON, J.D., Ph.D., M.P.H., is Executive Assistant to U.S.

HERBERT DORKEN, Ph.D., is former adjunct Professor and Research Psy-

R. KIRKLAND GABLE, J.D., Ed.D., currently Associate Professor of Psy-

ical School. He has been a member of the Board of Directors of the

ROBERT M. GUION, Ph.D., is Professor of Psychology at Bowling Green

DURAND F. JACOBS, Ph.D., Chief of Psychological Services at Jerry L. Pet-

member of the Conference on Training and Credentialing in Psychol-

RICHARD R. KILBURG, Ph.D., is presently Administrative Officer for

MICHAEL KINDRED, J.D., is Professor of Law and former Associate Dean

GERALD P. KOOCHER, Ph.D., Unit Chief for Inpatient Psychological Ser-

Vice-Chair and member of the American Psychological Association's

RONALD B. KURZ, Ph.D., is Chairman of the Department of Pediatric Psy-

STEPHEN J. MORSE, J.D., Ph.D., is Orrin B. Evans Professor of Law at the

MICHAEL S. PALLAK, Ph.D., is currently Executive Officer of the Ameri-

BRUCE DENNIS SALES, J.D., Ph.D., is Professor of Psychology and Head

GOTTLIEB C. SIMON, Ph.D., is currently the director of a neighborhood

C. PAUL SPARKS is former President of the Division of Industrial-Orga-

of an advisory committee to the Secretary of Labor during preparation

TOMMY T. STIGALL, Ph.D., is Manager of Psychology and Training for the

GEORGE STRICKER, Ph.D., Professor and Assistant Dean of the Institute of

CARL N. ZIMET, Ph.D., is Professor of Clinical Psychology and Head of the

The editor is grateful to the American Psychological Association for grant-

From "Standards for Providers of Psychological Services." Copyright

From "Specialty Guidelines for the Delivery of Services" by the Com-

From "Ethical Principles of Psychologists," American Psychologist, 1981,

From "Standards for Educational & Psychological Tests" prepared by a

1. The Context of Professional Psychology 3

II. STANDARDS OF PROFESSIONAL PRACTICE

2. The Development and Application of Standards of Practice for

III. PROFESSIONAL ORGANIZATIONS

6. A Professional's Guide to the American Psychological

IV. OTHER PROFESSIONAL DEVELOPMENTS

8. Accreditation of Professional Training Programs in Psychology 203

V. LAWS AFFECTING PROFESSIONAL PRACTICE

10. Health Insurance and Third-Party Reimbursement 249

VI. MANAGERIAL AND BUSINESS SKILLS

15. The Psychologist as a Manager 495

VII. VALUES AND INTERESTS AFFECTING PROFESSIONAL

16. Psychology, Professional Practice, and the Public Interest 541

VIII. POLITICAL AND REGULATORY PROCESSES

A. Standards for Providers of Psychological Services 623

From the time we start as undergraduate majors in psychology, we are

BRUCE DENNIS SALES. Department of Psychology, University of Arizona, Tucson, Ari-

be done? In fact, what is the client's welfare? Who determines whether we

THE NEEDED SKILLS AND KNOWLEDGE BASES

SUBSTANTIVE'pSYCHOLOGICAL KNOWLEDGE AND SKILLS

Clearly, the basis for profeSSional practice in psychology is a thorough

have we just begun our education? Professionals cannot afford to terminate

KNOWLEDGE OF STANDARDS OF PROFESSIONAL PRACTICE

According to APA and the American Association of State Psychology

is a firm understanding of the organizational standards that regulate our

(U.S. Equal Employment Opportunity Commission et a1., 1978; U.S. Depart-

KNOWLEDGE of PROFESSIONAL ORGANIZATIONS

A second area that forms part of the context of professional psychology

KNOWLEDGE OF PROFESSIONAL DEVELOPMENTS