Ethical Competence: an Analysis of Decision-Making in Clinical Psychology

This research aimed to develop understanding of ethical competence in clinical psychology by exploring responses to hypothetical ethical dilemmas presented in vignettes, developed for the present research. It investigated what psychologists considered to be appropriate justifications for ethical decisions; and how the ethical decision-making process occurred. A mixed-methods Delphi survey was employed using qualitative justifications for quantitative scores, in an iterative process. Ethical competence in clinical psychology is arguably socially constructed, largely within the discipline. Ethical decision-making was therefore assessed by exploring responses and consensuses to ethical dilemmas, from an opportunistic sample of experienced clinical psychologists, working in the UK (n = 31). Quantitative analyses indicated that the vignettes developed for this research were rated as realistic (72-79%) and relevant (75-85%) to UK clinical practice. Thematic analysis identified five themes within ethical decision-making: assessing, formulating, responding, influencing factors, and guiding principles. A model describing this process of ethical decision-making is presented; the first of its kind in clinical psychology to be empirically derived. Future research should assess whether this is seen by the wider profession as a competent way of making ethical decisions. It is argued that this research has important implications for clinical psychology, including for ethical instruction (as the vignettes and model can be used for research or teaching), and for those using clinical psychology services.