ethical violations in psychology case study summary

The Monster Study (Summary, Results, and Ethical Issues)

Psychologists and scientists often go into their line of work for the betterment of mankind. Through their experiments and tireless work, they hope to discover information that will cure diseases, uncover the root of certain disorders, and improve the general health of the population. That being said, it has not always been approached in the best way. Experiments on humans, especially those in marginalized groups, often cross ethical lines. One of the most well-known, line-crossing experiments is The Monster Study.

The experiment is not called the Monster Study because it involves any monsters - but it did threaten to ruin the reputation of the psychologists behind it. The idea was so scary to fellow the psychologist’s peers that the results were hidden away for years.

What Is The Monster Study?

The Monster Study was conducted by Dr. Wendell Johnson (a speech pathologist) to learn more about why children developed a stutter. Johnson developed the Monster Study to see if stuttering was a result of learned behavior or Biology, however, there are many ethical problems with the study.

When Was the Monster Study Conducted?

Dr. Johnson conducted the Monster Study back in 1936 at the University of Iowa. Ethics were not prioritized as they are now in psychology and scientific experiments. If this experiment had been proposed today, the researcher may have been stopped before they could begin!

What Happened in the Monster Study?

Johnson chose 22 orphans as participants for The Monster Study. Some of the orphans had a stutter. (It’s not uncommon for young children to have a stutter and then naturally “get over” the stutter without treatment.) Some of the orphans didn’t have a stutter.

The orphans were split up into two groups, with stutterers and non-stutterers in both groups. One of these groups were labeled “normal speakers.” The others were labeled “stutterers.” Throughout the course of the experiment, the children were treated as such.

Johnson’s team met with the children every few weeks for five months to “evaluate” their speech. Children in the “normal” group were praised for their ability to speak well, even if they were actually stuttering or had problems speaking. Children in the “stuttering” group were told that they spoke poorly. They were told things like, “You must try to stop yourself immediately. Don't ever speak unless you can do it right.”

So what happened?

Results of The Monster Study

The children who were labeled “normal” weren’t affected much by the researchers’ praise. They saw improvement in only one child.

Children in the “stuttering” group fared a lot worse. Remember, not all of these children actually had a stutter - they were just told that they had a stutter. Of the six children that were falsely chastised for their speech, five developed speech problems. Reports show that these children became withdrawn and some stopped speaking altogether. These children were as young as five years old.

The study was created with good intentions. Johnson and his colleagues at the University of Iowa frequently conducted studies on themselves and willing adult subjects in the name of finding a cure for stuttering. But other colleagues worried that the use of orphans was crossing lines. Johnson wasn’t the only person conducting studies on marginalized groups in the name of science - Nazis were doing the same thing over in Germany. So the results of the study were never published.

The Impact of the Monster Study

Even in the 1930s, the Monster Study was crossing lines. Using orphans as test subjects is one thing - using minors in a study without their consent is another. Even the staff at the orphanage were unaware of what was really going on. This left many of the “stutterers” with unresolved psychological trauma. Researchers knew that this was a possibility. One member of Johnson’s team wrote “'I believe that in time they...will recover, but we certainly made a definite impression on them.”

She was right. The students’ schoolwork suffered and one ran away from the orphanage two years later. Later, she said that the study ruined her life.

Subjects didn’t know that they were a part of a study until sixty years after it happened. Only a handful of speech pathology students at the University of Iowa learned about the study after it was published. The information was useful - no one at the time had collected so much data about stuttering and how it developed. But the premise of the study was so horrifying that they nicknamed it “The Monster Study.”

The Monster Study didn’t become nationally infamous until 2001. The San Jose Mercury News published a series of articles about the study and commentary from speech pathologists. While some argued that the experiment crossed many ethical boundaries, others argued that it was just a result of its time. Some acknowledged the importance of the data, while others said that it didn’t come to any real conclusions.

At that point, Wendell Johnson had been dead for over 30 years. The University of Iowa issued a formal apology for the study. As all of this made national news, subjects started to learn the truth about what had happened to them.

The Lawsuit

The subjects sought justice. In the early 2000s, three of the subjects in the “stutterer” group sued the University of Iowa for emotional distress and fraudulent misrepresentation. The estates of three of the other “stutterers” were also included in the lawsuit. The plaintiffs claimed that the impact of the study had a lasting impact. One still “hates to talk.” Another, who says she now has a good life, said that she didn’t have many friends in the orphanage partly because she was so quiet.

They won their settlement and the University of Iowa paid over $1 million to the victims and their estates.

Importance and Infamy of The Monster Study

This study should never be repeated, but it shouldn’t be swept under the rug, either. The Monster Study is an important lesson about transparency and consent in experiments. If we don’t learn from these mistakes, we are bound to repeat them. Even 60 years later, it’s important to talk about The Monster Study, why it was wrong, and how psychology has evolved into a more ethical science.

Other Infamous Experiments in Social Psychology

The Monster Study is not the only controversial experiment in social psychology. It often ends up on lists besides experiments like the Stanford Prison Experiment and the Milgram Experiment.

The Stanford Prison Experiment

In the 1970s, psychologist Philip Zimbardo recruited a group of young men to pose as guards and prisoners. The guards received no formal training - just instructions to guard the prisoners. Although The Stanford Prison Experiment was meant to take place over the course of two weeks, it was cut short. The results were chilling, and have since been disputed.

Why did it get shut down? Allegedly, the guards took the role so seriously that they began to act cruelly toward the prisoners. Zimbardo asked the guards not to resort to physical violence, but they did. By the sixth day of the experiment, the prisoners had threatened to overthrow the guards. One prisoner stopped eating. Another had a breakdown. Yet, it took six days to call the whole experiment off. 

The Milgram Experiment 

Participants in the Milgram Experiment were faced with a choice: to shock (or not to shock) another participant. No electric shocks were actually administered, but the participants believed they would be. Researchers pressured the participants to administer the shock, despite the knowledge that the shocks were harmful or even deadly. Stanley Milgram put the experiment together to see how far people would go to obey the order of another. 

Robbers Cave Experiment 

This experiment was similar to the Stanford Prison Experiment, but with slightly younger participants. The Robbers Cave Experiment brought together two groups of boys at a summer camp. Researchers separated the two groups, assigned them names, and began to create conflict between them. Results were not as dramatic as the Stanford Prison Experiment, but similar criticisms have arisen. Also, like the Stanford Prison Experiment, the study only used young, white boys in the experiment, but made wide generalizations about social psychology. Excluding such a large portion of the population may be okay if you’re doing a study on one demographic, but this should be mentioned in the research. 

What do all of these experiments have in common? They all have the potential to cause great trauma. The events of the experiments may not be “real” to researchers, but they are “real” to participants. The participants in the Milgram experiment truly believed they were administering deadly shocks. Prisoners in the Stanford Prison Experiment were physically harmed. Those effects don’t “go away” when the experiment is over. And usually, a participant may not understand the premise of an experiment before they sign up. This is why ethical codes in psychology are especially important, both for the participants in research and for anyone who views the conclusions derived from the research.

How to Conduct Ethical Experiments in Psychology 

Ethics is more important nowadays than it was in the 1930s. But how do psychologists ensure that their experiments are ethically sound? Organizations like the American Psychological Association put together guidelines for psychologists and researchers to follow. Guidelines from the APA have been in place since the 50s, but they are constantly evolving. 

Principle A: Beneficence and Non-maleficence

This principle goes beyond being nice. The APA encourages professionals to care for the people who are subjects in their research. Eliminating biases and prejudices is just one way that psychologists can act with beneficence and non-maleficence.  (It’s important to note that subjects include humans and animals.) 

Principle B: Fidelity and Responsibility

Psychologists have a responsibility not only to consider the well-being of their subjects, but to ensure that colleagues are acting ethically, too. The psychologists working alongside Philip Zimbardo or Stanley Milgram also had a responsibility to inform their colleagues of the possible effects of their controversial experiments. 

Principle C: Integrity

Psychology research is supposed to reveal the truth about the way the mind works. Professionals may have an idea about how the study will turn out, but they must keep an open mind. If the results don’t match the psychologist’s hypothesis, they have to report that honestly. Skewing the results, or skewing the study in order to get certain results, is not ethical. 

There is controversy as to whether Philip Zimbardo, for example, skewed the Stanford Prison Experiment to make the guards more cruel to prisoners and the results more dramatic. But to find the expose that challenges his findings is harder than learning about the Stanford Prison Experiment itself! 

Principle D: Justice

Treating everyone equally is crucial to keeping psychology a just field. Patients should be held in the same esteem regardless of their background, age, education level, etc. They should also have access to important information in psychology that might benefit their lives and the lives of others. 

Principle E: Respect for People's Rights and Dignity

Finally, psychologists must show respect for the rights and dignity of all people. Maintaining confidentiality is one way to achieve this goal. Why? Think about the Milgram experiment. How would you feel knowing that, under the pressure of the experiment, you hit the “shock” button? People might tell you that you’re cruel. You might feel guilty already, and your guilt may be amplified if your identity were to get out. Confidentiality is key to dignity. 

Related posts:

• Stanley Milgram (Psychologist Biography)
• Philip Zimbardo (Biography + Experiments)
• Stanford Prison Experiment
• The Little Albert Experiment
• Human Experimentation List (in Psychology)

Reference this article:

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Introduction: Case Studies in the Ethics of Mental Health Research

Joseph millum.

Clinical Center Department of Bioethics/Fogarty International Center, National Institutes of Health, Bethesda, MD

This collection presents six case studies on the ethics of mental health research, written by scientific researchers and ethicists from around the world. We publish them here as a resource for teachers of research ethics and as a contribution to several ongoing ethical debates. Each consists of a description of a research study that was proposed or carried out and an in-depth analysis of the ethics of the study.

Building Global Capacity in Mental Health Research

According to the World Health Organization (WHO), there are more than 450 million people with mental, neurological, or behavioral problems worldwide ( WHO, 2005a ). Mental health problems are estimated to account for 13% of the global burden of disease, principally from unipolar and bipolar depression, alcohol and substance-use disorders, schizophrenia, and dementia. Nevertheless, in many countries, mental health is accorded a low priority; for example, a 2005 WHO analysis found that nearly a third of low-income countries who reported a mental health budget spent less than 1% of their total health budget on mental health ( WHO, 2005b ).

Despite the high burden of disease and some partially effective treatments that can be implemented in countries with weaker healthcare delivery systems ( Hyman et al., 2006 ), there exist substantial gaps in our knowledge of how to treat most mental health conditions. A 2007 Lancet Series entitled Global Mental Health claimed that the “rudimentary level of mental health-service research programmes in many nations also contributes to poor delivery of mental health care” ( Jacob et al., 2007 ). Its recommendations for mental health research priorities included research into the effects of interactions between mental health and other health conditions ( Prince et al., 2007 ), interventions for childhood developmental disabilities ( Patel et al., 2007 ), cost-effectiveness analysis, the scaling up of effective interventions, and the development of interventions that can be delivered by nonspecialist health workers ( Lancet Global Mental Health Group, 2007 ). All of these priorities require research in environments where the prevailing health problems and healthcare services match those of the populations the research will benefit, which suggests that research must take place all around the world. Similarly, many of the priorities identified by the Grand Challenges in Mental Health Initiative require focus on local environments, cultural factors, and the health systems of low- and middle-income countries. All the challenges “emphasize the need for global cooperation in the conduct of research” ( Collins et al., 2011 ).

Notwithstanding the need for research that is sensitive to different social and economic contexts, the trend of outsourcing to medical research to developing countries shows no sign of abating ( Thiers et al., 2008 ). Consequently, a substantial amount of mental health research will, in any case, take place in low- and middle-income countries, as well as rich countries, during the next few years.

The need for local research and the continuing increase in the international outsourcing of research imply that there is a pressing need to build the capacity to conduct good quality mental health research around the world. However, the expansion of worldwide capacity to conduct mental health research requires more than simply addressing low levels of funding for researchers and the imbalance between the resources available in rich and poor countries. People with mental health disorders are often thought to be particularly vulnerable subjects. This may be a product of problems related to their condition, such as where the condition reduces the capacity to make autonomous decisions. It may also result from social conditions because people with mental disorders are disproportionately likely to be poor, are frequently stigmatized as a result of their condition, and may be victims of human rights abuses ( Weiss et al., 2001 ; WHO, 2005a ). As a result, it is vitally important that the institutional resources and expertise are in place for ensuring that this research is carried out ethically.

Discussion at a special session at the 7th Global Forum on Bioethics in Research revealed the perception that many mental health researchers are not very interested in ethics and showed up a lack of ethics resources directly related to their work. This collection of case studies in the ethics of mental health research responds to that gap.

This collection comprises six case studies written by contributors from around the world ( Table 1 ). Each describes a mental health research study that raised difficult ethical issues, provides background and analysis of those issues, and draws conclusions about the ethics of the study, including whether it was ethical as it stood and how it ought to be amended otherwise. Three of the case studies are written by scientists who took part in the research they analyzed. For these cases, we have asked scholars independent of the research to write short commentaries on them. It is valuable to hear how the researchers themselves grapple with the ethical issues they encounter, as well as to hear the views of people with more distance from the research enterprise. Some of the ethical issues raised here have not been discussed before in the bioethics literature; others are more common concerns that have not received much attention in the context of international research. The case studies are intended to both expand academic discussion of some of the key questions related to research into mental health and for use in teaching ethics.

Case studies are an established teaching tool. Ethical analyses of such cases demonstrate the relevance of ethics to the actual practice of medical research and provide paradigmatic illustrations of the application of ethical principles to particular research situations. Concrete cases help generate and guide discussion and assist students who have trouble dealing with ethical concepts in abstraction. Through structured discussion, ethical development and decision-making skills can be enhanced. Moreover, outside of the teaching context, case study analyses provide a means to generate and focus debate on the relevant ethical issues, which can both highlight their importance and help academic discussion to advance.

People working in mental health research can benefit most from case studies that are specific to mental health. Even though, as outlined below, many of the same ethical problems arise in mental health research as elsewhere, the details of how they arise are important. For example, the nature of depression and the variation in effectiveness of antidepressive medication make a difference to how we should assess the ethics of placebo-controlled trials for new antidepressants. Moreover, seeing how familiar ethical principles are applied to one's own research specialty makes it easier to think about the ethics of one's own research. The cases in this collection highlight the commonalities and the variation in the ethical issues facing researchers in mental health around the world.

The current literature contains some other collections of ethics case studies that may be useful to mental health researchers. I note four important collections here, to which interested scholars may want to refer. Lavery et al.'s (2007) Ethical Issues in International Bio-medical Research provides in-depth analyses of ethically problematic research, mostly in low- and middle-income countries, although none of these cases involve mental health. Cash et al.'s (2009) Casebook on Ethical Issues in International Health Research also focuses on research in low- and middle-income countries, and several of the 64 short case descriptions focus on populations with mental health problems. Two further collections focus on mental health research, in particular. Dubois (2007) and colleagues developed short and longer US-based case studies for teaching as part of their “Ethics in Mental Health Research” training course. Finally, Hoagwood et al.'s (1996) book Ethical Issues in Mental Health Research with Children and Adolescents contains a casebook of 61 short case descriptions, including a few from outside the United States and Western Europe. For teachers and academics in search of more case studies, these existing collections should be very useful. Here, we expand on the available resources with six case studies from around the world with extended ethical analyses.

The remainder of this introduction provides an overview of some of the most important ethical issues that arise in mental health research and describes some of the more significant ethics guidance documents that apply.

Ethical Issues in Mental Health Research

The same principles can be applied in assessing the ethics of mental health research as to other research using human participants ( Emanuel et al., 2000 ). Concerns about the social value of research, risks, informed consent, and the fair treatment of participants all still apply. This means that we can learn from the work done in other areas of human subjects research. However, specific research contexts make a difference to how the more general ethical principles should be applied to them. Different medical conditions may require distinctive research designs, different patient populations may need special protections, and different locations may require researchers to respond to study populations who are very poor and lack access to health care or to significant variations in regulatory systems. The ethical analysis of international mental health research therefore needs to be tailored to its particularities.

Each case study in this collection focuses on the particular ethical issues that are relevant to the research it analyzes. Nevertheless, some issues arise in multiple cases. For example, questions about informed consent arise in the context of research with stroke patients, with students, and with other vulnerable groups. To help the reader compare the treatment of an ethical issue across the different case studies, the ethical analyses use the same nine headings to delineate the issues they consider. These are social value, study design, study population, informed consent, risks and benefits, confidentiality, post-trial obligations, legal versus ethical obligations, and oversight.

Here, I focus on five of these ethical issues as they arise in the context of international mental health research: (1) study design, (2) study population, (3) risks and benefits, (4) informed consent, and (5) post-trial obligations. I close by mentioning some of the most important guidelines that pertain to mental health research.

Study Design

The scientific design of a research study determines what sort of data it can generate. For example, the decision about what to give participants in each arm of a controlled trial determines what interventions the trial compares and what questions about relative safety and efficacy it can answer. What data a study generates makes a difference to the ethics of the study because research that puts human beings at risk is ethically justified in terms of the social value of the knowledge it produces. It is widely believed that human subject research without any social value is unethical and that the greater the research risks to participants, the greater the social value of the research must be to compensate ( Council for International Organizations of Medical Sciences [CIOMS], 2002 ; World Medical Association, 2008 ). However, changing the scientific design of a study frequently changes what happens to research participants, too. For example, giving a control group in a treatment trial an existing effective treatment rather than placebo makes it more likely that their condition will improve but may expose them to adverse effects they would not otherwise experience. Therefore, questions of scientific design can be ethically very complex because different possible designs are compared both in terms of the useful knowledge they may generate and their potential impact on participants.

One of the more controversial questions of scientific design concerns the standard of care that is offered to participants in controlled trials. Some commentators argue that research that tests therapeutic interventions is only permissible if there is equipoise concerning the relative merits of the treatments being compared, that is, there are not good reasons to think that participants in any arm of the trial are receiving inferior treatment ( Joffe and Truog, 2008 ). If there is not equipoise, the argument goes, then physician-researchers will be breaching their duty to give their patients the best possible care ( Freedman, 1987 ).

The Bucharest Early Intervention Project (BEIP) described in the case study by Charles Zeanah was a randomized controlled trial comparing foster care with institutional care in Bucharest, Romania. When designing the BEIP, the researchers wrestled with the issue of whether there was genuine equipoise regarding the relative merits of institutional and foster care. One interpretation of equipoise is that it exists when the professional community has not reached consensus about the better treatment ( Freedman, 1987 ). Childcare professionals in the United States were confident that foster care was superior, but there was no such confidence in Romania, where institutional care was the norm. Which, then, was the relevant professional community?

The equipoise requirement is justified by reference to the role morality of physicians: for a physician to give her patient treatment that she knows to be inferior would violate principles of therapeutic beneficence and nonmaleficence. As a result, the equipoise requirement has been criticized for conflating the ethics of the physician-patient relationship with the ethics of the researcher-participant relationship ( Miller and Brody, 2003 ). According to Miller and Brody (2003) , provided that other ethical requirements are met, including an honest null hypothesis, it is not unethical to assign participants to receive treatment regimens known to be inferior to the existing standard of care.

A subset of trial designs that violate equipoise are placebo-controlled trials of experimental treatments for conditions for which proven effective treatments already exist. Here, there is not equipoise because some participants will be assigned to placebo treatment, and ex hypothesi there already exists treatment that is superior to placebo. Even if we accept Miller and Brody's (2003) argument and reject the equipoise requirement, there remain concerns about these placebo-controlled trials. Providing participants with less effective treatment than they could get outside of the trial constitutes a research risk because trial participation makes them worse off. Moreover, on the face of it, a placebo-controlled trial of a novel treatment of a condition will not answer the most important scientific question about the treatment that clinicians are interested in: is this new treatment better than the old one? Consequently, in situations where there already exists a standard treatment of a condition, it has generally been considered unethical to use a placebo control when testing a new treatment, rather than using the standard treatment as an active-control ( World Medical Association, 2008 ).

Some psychiatric research provides scientific reasons to question a blanket prohibition on placebo-controlled trials when an effective intervention exists. For example, it is not unusual for antidepressive drugs to fail to show superiority to placebo in any given trial. This means that active-control trials may seem to show that an experimental drug is equivalent in effectiveness to the current standard treatment, when the explanation for their equivalence may, in fact, be that neither was better than placebo. Increasing the power of an active-control trial sufficiently to rule out this possibility may require an impractically large number of subjects and will, in any case, put a greater number of subjects at risk ( Carpenter et al., 2003 ; Miller, 2000 ). A 2005 trial of risperidone for acute mania conducted in India ( Khanna et al., 2005 ) was criticized for unnecessarily exposing subjects to risk ( Basil et al., 2006 ; Murtagh and Murphy, 2006 ; Srinivasan et al., 2006 ). The investigators' response to criticisms adopted exactly the line of argument just described:

A placebo group was included because patients with mania generally show a high and variable placebo response, making it difficult to identify their responses to an active medication. Placebo-controlled trials are valuable in that they expose the fewest patients to potentially ineffective treatments. In addition, inclusion of a placebo arm allows a valid evaluation of adverse events attributable to treatment v. those independent of treatment. ( Khanna et al., 2006 )

Concerns about the standard of care given to research participants are exacerbated in trials in developing countries, like India, where research participants may not have access to treatment independent of the study. In such cases, potential participants may have no real choice but to join a placebo-controlled trial, for example, because that is the only way they have a chance to receive treatment. In the Indian risperidone trial, the issue of exploitation is particularly stark because it seemed to some that participants were getting less than the international best standard of care, in order that a pharmaceutical company could gather data that was unlikely to benefit many Indian patients.

This is just one way in which trial design may present ethically troubling risks to participants. Other potentially difficult designs include washout studies, in which participants discontinue use of their medication, and challenge studies, in which psychiatric symptoms are experimentally induced ( Miller and Rosenstein, 1997 ). In both cases, the welfare of participants may seem to be endangered ( Zipursky, 1999 ). A variant on the standard placebo-controlled trial design is the withdrawal design, in which everyone starts the trial on medication, the people who respond to the medication are then selected for randomization, and then half of those people are randomized to placebo. This design was used by a Japanese research team to assess the effectiveness of sertraline for depression, as described by Shimon Tashiro and colleagues in this collection. The researchers regarded this design as more likely to benefit the participants because for legal reasons, sertraline was being tested in Japan despite its proven effectiveness in non-Japanese populations. Tashiro and colleagues analyze how the risks and benefits of a withdrawal design compare with those of standard placebo-controlled trials and consider whether the special regulatory context of Japan makes a difference.

Study Population

The choice of study population implicates considerations of justice. The Belmont Report, which lays out the ethical foundations for the United States system for ethical review of human subject research, says:

Individual justice in the selection of subjects would require that researchers … should not offer potentially beneficial research only to some patients who are in their favor or select only “undesirable” persons for risky research. Social justice requires that distinction be drawn between classes of subjects that ought, and ought not, to participate in any particular kind of research, based on the ability of members of that class to bear burdens and on the appropriateness of placing further burdens on already burdened persons. ( National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, 1978 )

Two distinct considerations are highlighted here. The first (“individual justice”) requires that the researchers treat people equally. Morally irrelevant differences between people should not be the basis for deciding whom to enroll in research. For example, it would normally be unjust to exclude women from a phase 3 trial of a novel treatment of early-stage Alzheimer disease, given that they are an affected group. Some differences are not morally irrelevant, however. In particular, there may be scientific reasons for choosing one possible research population over another, and there may be risk-related reasons for excluding certain groups. For example, a functional magnetic resonance imaging study in healthy volunteers to examine the acute effects of an antianxiety medication might reasonably exclude left-handed people because their brain structure is different from that of right-handed people, and a study of mood that required participants to forego medication could justifiably exclude people with severe depression or suicidal ideation.

The second consideration requires that we consider how the research is likely to impact “social justice.” Social justice refers to the way in which social institutions distribute goods, like property, education, and health care. This may apply to justice within a state ( Rawls, 1971 ) or to global justice ( Beitz, 1973 ). In general, research will negatively affect social justice when it increases inequality, for example, by making people who are already badly off even worse off. The quotation from the Belmont Report above suggests one way in which research might violate a requirement of social justice: people who are already badly off might be asked to participate in research and so be made worse off. For example, a study examining changes in the brain caused by alcohol abuse that primarily enrolled homeless alcoholics from a shelter near the study clinic might only put at further risk this group who are already very badly off. An alternative way in which research can promote justice or injustice is through its results. Research that leads to the development of expensive new attention deficit hyperactivity disorder medication is likely to do little, if anything, to make the world more just. Research on how to improve the cognitive development of orphaned children in poor environments (like the BEIP) is much more likely to improve social justice.

This last point suggests a further concern about fairness—exploitation—that frequently arises in the context of international collaborative research in developing countries. Exploitation occurs, roughly, when one party takes “unfair advantage” of the vulnerability of another. This means that the first party benefits from the interaction and does so to an unfair extent ( Wertheimer, 1996 ). These conditions may be met in international collaborative research when the burdens of research fall disproportionately on people and institutions in developing countries, but the benefits of research, such as access to new treatments, accrue to people in richer countries. A number of case studies in this collection raise this concern in one way or another. For example, Virginia Rodriguez analyzes a proposed study of the genetic basis of antisocial personality disorder run by US researchers but carried out at sites in several Latin American countries. One of the central objections raised by one of the local national research ethics committees with regard to this study was that there appeared to be few, if any, benefits for patients and researchers in the host country.

Risks and Benefits

Almost all research poses some risk of harm to participants. Participants in mental health research may be particularly susceptible to risk in several ways. First, and most obviously, they may be physically or psychologically harmed as a result of trial participation. For example, an intervention study of an experimental antipsychotic may result in some serious adverse effects for participants who take the drug. Less obvious but still very important are the potential effects of stopping medication. As mentioned above, some trials of psychoactive medications require that patients stop taking the medications that they were on before the trial ( e.g ., the Japanese withdrawal trial). Stopping their medication can lead to relapse, to dangerous behavior (like attempted suicide), and could mean that their previous treatment regimen is less successful when they attempt to return to it. Participants who were successfully treated during a trial may have similar effects if they do not have access to treatment outside of the trial. This is much more likely to happen in research conducted with poor populations, such as the Indian mania patients.

The harms resulting directly from research-related interventions are not the only risk to participants in mental health research. Participation can also increase the risks of psychosocial harms, such as being identified by one's family or community as having a particular condition. Such breaches of confidentiality need not involve gross negligence on the part of researchers. The mere fact that someone regularly attends a clinic or sees a psychiatrist could be sufficient to suggest that they have a mental illness. In other research, the design makes confidentiality hard to maintain. For example, the genetic research described by Rodriguez involved soliciting the enrollment of the family members of people with antisocial personality disorder.

The harm from a breach of confidentiality is exacerbated when the condition studied or the study population is stigmatized. Both of these were true in the case Sana Loue describes in this collection. She studied the co-occurrence of severe mental illnesses and human immunodeficiency virus risk in African-American men who have sex with men. Not only was there shame attached to the conditions under study, such that they were euphemistically described in the advertisements for the research, but also many of the participants were men who had heterosexual public identities.

Informed Consent

Many people with mental disorders retain the capacity (ability) and competence (legal status) to give informed consent. Conversely, potential participants without mental problems may lack or lose capacity (and competence). Nevertheless, problems with the ability to consent remain particularly pressing with regard to mental health research. This is partly a consequence of psychological conditions that reduce or remove the ability to give informed consent. To study these conditions, it may be necessary to use participants who have them, which means that alternative participants who can consent are, in principle, not available. This occurred in the study of South African stroke patients described by Anne Pope in this collection. The researcher she describes wanted to compare the effectiveness of exercises designed to help patients whose ability to communicate was compromised by their stroke. Given their communication difficulties and the underlying condition, there would inevitably be questions about their capacity. Whether it is permissible to enroll people who cannot give informed consent into a study depends on several factors, including the availability of alternative study populations, the levels of risk involved, and the possible benefits to participants in comparison with alternative health care they could receive.

In research that expects to enroll people with questionable capacity to consent, it is wise to institute procedures for assessing the capacity of prospective participants. There are two general strategies for making these assessments. The first is to conduct tests that measure the general cognitive abilities of the person being assessed, as an IQ test does. If she has the ability to perform these sorts of mental operations sufficiently well, it is assumed that she also has the ability to make autonomous decisions about research participation. A Mini-Mental State Examination might be used to make this sort of assessment ( Kim and Caine, 2002 ). The second capacity assessment strategy focuses on a prospective participant's understanding and reasoning with regard to the specific research project they are deciding about. If she understands that project and what it implies for her and is capable of articulating her reasoning about it, then it is clear that she is capable of consenting to participation, independent of her more general capacities. This sort of assessment requires questions that are tailored to each specific research project and cannot be properly carried out unless the assessor is familiar with that research.

Where someone lacks the capacity to give consent, sometimes a proxy decision maker can agree to trial participation on her behalf. In general, proxy consent is not equivalent to individual consent: unless the proxy was expressly designated to make research decisions by the patient while capacitated, the proxy lacks the power to exercise the patient's rights. As a result, the enrollment of people who lack capacity is only acceptable when the research poses a low net risk to participants or holds out the prospect of benefiting them. When someone has not designated a proxy decision maker for research, it is common to allow the person who has the power to make decisions about her medical care also to make decisions about research participation. However, because medical care is directed at the benefit of the patient, but research generally is not aimed at the benefit of participants, the basis for this assumption is unclear. Its legal basis may be weak, too. For example, in her discussion of research on South African stroke patients, Pope notes the confusion surrounding the legality of surrogate decision makers, given that the South African constitution forbids proxy decision making for adults (unless they have court-appointed curators), but local and international guidance documents seem to assume it.

Although it is natural to think of the capacity to give consent as an all-or-nothing phenomenon, it may be better conceptualized as domain-specific. Someone may be able to make decisions about some areas of her life, but not others. This fits with assumptions that many people make in everyday life. For example, a 10-year-old child may be deemed capable of deciding what clothes she will wear but may not be capable of deciding whether to visit the dentist. The capacity to consent may admit of degrees in another way, too. Someone may have diminished capacity to consent but still be able to make decisions about their lives if given the appropriate assistance. For example, a patient with mild dementia might not be capable of deciding on his own whether he should move in with a caregiver, but his memory lapses during decision making could be compensated for by having his son present to remind him of details relevant to the decision. The concept of supported decision making has been much discussed in the literature on disability; however, its application to consent to research has received little attention ( Herr, 2003 ; United Nations, 2007 ).

The ability to give valid informed consent is the aspect of autonomy that is most frequently discussed in the context of mental health research, but it is not the only important aspect. Several of the case studies in this collection also raise issues of voluntariness and coercion. For example, Douglas Wassenaar and Nicole Mamotte describe a study in which professors enrolled their students, which raises the question of the vulnerability of student subjects to pressure. Here, there is both the possibility of explicit coercion and the possibility that students will feel pressure even from well-meaning researchers. For various reasons, including dependence on caregivers or healthcare professionals and the stigma of their conditions, people with mental illnesses can be particularly vulnerable to coercion.

Post-Trial Obligations

The obligations of health researchers extend past the end of their study. Participants'data remain in the hands of researchers after their active involvement in a study is over, and patients with chronic conditions who enroll in clinical trials may leave them still in need of treatment.

Ongoing confidentiality is particularly important when studying stigmatized populations (such as men who have sex with men as discussed by Sana Loue) or people with stigmatizing conditions (such as bipolar disorder). In research on mental illnesses, as with many medical conditions, it is now commonplace for researchers to collect biological specimens and phenotypic data from participants to use in future research (such as genome-wide association studies). Additional challenges with regard to confidentiality are raised by the collection of data and biological specimens for future research because confidentiality must then be guaranteed in a long period of time and frequently with different research groups making use of the samples.

Biobanking also generates some distinctive ethical problems of its own. One concerns how consent to the future use of biological specimens should be obtained. Can participants simply give away their samples for use in whatever future research may be proposed, or do they need to have some idea of what this research might involve in order to give valid consent? A second problem, which arises particularly in transnational research, concerns who should control the ongoing use of the biobank. Many researchers think that biological samples should not leave the country in which they were collected, and developing country researchers worry that they will not be allowed to do research on the biobanks that end up in developed countries. This was another key concern with the proposed study in Latin America.

In international collaborative research, further questions arise as a result of the disparities between developing country participants and researchers and developed country sponsors and researchers. For example, when clinical trials test novel therapies, should successful therapies be made available after the trial? If they should, who is responsible for ensuring their provision, to whom should they be provided, and in what does providing them consist? In the case of chronic mental illnesses like depression or bipolar disorder, patient-participants may need maintenance treatment for the rest of their lives and may be at risk if treatment is stopped. This suggests that the question of what happens to them after the trial must at least be considered by those who sponsor and conduct the trial and the regulatory bodies that oversee it. Exactly on whom obligations fall remains a matter of debate ( Millum, 2011 ).

Ethics Guidelines

A number of important policy documents are relevant to the ethics of research into mental disorders. The WMA's Declaration of Helsinki and the CIOMS' Ethical Guidelines for Biomedical Research both consider research on individuals whose capacity and/or competence to consent is impaired. They agree on three conditions: a) research on these people is justified only if it cannot be carried out on individuals who can give adequate informed consent, b) consent to such research should be obtained from a proxy representative, and c) the goal of such research should be the promotion of the health of the population that the research participants represent ( Council for International Organizations of Medical Sciences, 2002 ; World Medical Association, 2008 ). In addition, with regard to individuals who are incapable of giving consent, Guideline 9 of CIOMS states that interventions that do not “hold out the prospect of direct benefit for the individual subject” should generally involve no more risk than their “routine medical or psychological examination.”

In 1998, the US National Bioethics Advisory Commission (NBAC) published a report entitled Research Involving Persons with Mental Disorders That May Affect Decision-making Capacity ( National Bioethics Advisory Commission, 1998 ). As the title suggests, this report concentrates on issues related to the capacity or competence of research participants to give informed consent. Its recommendations are largely consistent with those made in the Declaration of Helsinki and CIOMS, although it is able to devote much more space to detailed policy questions (at least in the United States context). Two domains of more specific guidance are of particular interest. First, the NBAC report considers the conditions under which individuals who lack the capacity to consent may be enrolled in research posing different levels of risk and supplying different levels of expected benefits to participants. Second, it provides some analysis of who should be recognized as an appropriate proxy decision maker (or “legally authorized representative”) for participation in clinical trials.

Finally, the World Psychiatric Association's Madrid Declaration gives guidelines on the ethics of psychiatric practice. This declaration may have implications for what is permissible in psychiatric research, insofar as the duties of psychiatrists as personal physicians are also duties of psychiatrists as medical researchers. It also briefly considers the ethics of psychiatric research, although it notes only the special vulnerability of psychiatric patients as a concern distinctive of mental health research ( World Psychiatric Association, 2002 ).

The opinions expressed are the author's own. They do not reflect any position or policy of the National Institutes of Health, U.S. Public Health Service, or Department of Health and Human Services.

Disclosure : The author declares no conflict of interest.

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Ethics & Psychology: Case Studies

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APA Code of Ethics: Principles, Purpose, and Guidelines

What to know about the APA's ethical codes that psychologists follow

Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania.

Mediaphotos / Getty Images

• What and Who the Code of Ethics Is For?
• The 5 Ethical Principles
• The 10 Standards
• What Happens If a Therapist Violates the APA's Ethical Codes?
• How Can I Report a Therapist?

Ethical Considerations

The APA Code of Ethics guides professionals working in psychology so that they're better equipped with the knowledge of what to do when they encounter some moral or ethical dilemma. Some of these are principles or values that psychologists should aspire to uphold. In other cases, the APA outlines standards that are enforceable expectations.

Ethics are an important concern in psychology, particularly regarding therapy and research. Working with patients and conducting psychological research can pose various ethical and moral issues that must be addressed.

Understanding the APA Code of Ethics

The American Psychological Association (APA) publishes the Ethical Principles of Psychologists and Code of Conduct which outlines aspirational principles as well as enforceable standards that psychologists should use when making decisions.

In 1948, APA president Nicholas Hobbs said, "[The APA Code of Ethics] should be of palpable aid to the ethical psychologist in making daily decisions."

In other words, these ethical codes are meant to guide mental health professionals in making the best ethical decisions on a regular basis.

When Did the APA Publish Its Code of Ethics?

The APA first published its ethics code in 1953 and has been continuously evolving the code ever since.

What's in the APA's Code of Ethics?

The APA code of ethics is composed of key principles and ethical standards:

• Principles : The principles are intended as a guide to help inspire psychologists as they work in their profession, whether they are working in mental health, in research , or in business.
• Standards : The standards outline expectations of conduct. If any of these are violated, it can result in professional and legal ramifications.

Who Is the APA Code of Ethics For?

The code of ethics applies only to work-related, professional activities including research, teaching, counseling , psychotherapy, and consulting. Private conduct is not subject to scrutiny by the APA's ethics committee.

APA's Ethical Codes: The Five Ethical Principles

Not all ethical issues are clear-cut, but the APA strives to offer psychologists guiding principles to help them make sound ethical choices within their profession.

The APA Code of Ethics' Five Principles

• Principle A : Beneficence and Non-Maleficence
• Principle B : Fidelity and Responsibility
• Principle C : Integrity
• Principle D : Justice
• Principle E : Respect for People's Rights and Dignity

Principle A: Beneficence and Non-Maleficence

The first principle of the APA ethics code states that psychologists should strive to protect the rights and welfare of those with whom they work professionally . This includes the clients they see in clinical practice, animals that are involved in research and experiments , and anyone else with whom they engage in professional interaction.

This principle encourages psychologists to strive to eliminate biases , affiliations, and prejudices that might influence their work. This includes acting independently in research and not allowing affiliations or sponsorships to influence results.

Principle B: Fidelity and Responsibility

Principle B states that psychologists have a moral responsibility to help ensure that others working in their profession also uphold high ethical standards . This principle suggests that psychologists should participate in activities that enhance the ethical compliance and conduct of their colleagues.

Serving as a mentor, taking part in peer review, and pointing out ethical concerns or misconduct are examples of how this principle might be put into action. Psychologists are also encouraged to donate some of their time to the betterment of the community.

Principle C: Integrity

This principle states that, in research and practice, psychologists should never attempt to deceive or misrepresent . For instance, in research, deception can involve fabricating or manipulating results in some way to achieve desired outcomes. Psychologists should also strive for transparency and honesty in their practice.

Principle D: Justice

The principle of justice says that mental health professionals have a responsibility to be fair and impartial. It also states that people have a right to access and benefit from advances that have been made in the field of psychology. It is important for psychologists to treat people equally.

Psychologists should also always practice within their area of expertise and also be aware of their level of competence and limitations.

Principle E: Respect for People's Rights and Dignity

Principle E states that psychologists should respect the right to dignity, privacy, and confidentiality of those they work with professionally . They should also strive to minimize their own biases as well as be aware of issues related to diversity and the concerns of particular populations.

For example, people may have specific concerns related to their age, socioeconomic status, race , gender, religion, ethnicity, or disability.

The APA Code of Ethics' Standards

The 10 standards found in the APA ethics code are enforceable rules of conduct for psychologists working in clinical practice and academia.

The 10 Standards Found in the APA Code of Ethics

• Resolving Ethical Issues
• Human Relations
• Privacy and Confidentiality
• Advertising and Other Public Statements
• Record Keeping and Fees
• Education and Training
• Research and Publication

These standards tend to be broad in order to help guide the behavior of psychologists across a wide variety of domains and situations.

They apply to areas such as education, therapy, advertising, privacy, research, and publication.

1: Resolving Ethical Issues

This standard of the APA ethics code provides information about what psychologists should do to resolve ethical situations they may encounter in their work. This includes advice for what researchers should do when their work is misrepresented and when to report ethical violations.

2: Competence

It is important that psychologists practice within their area of expertise. When treating clients or working with the public, psychologists must make it clear what they are trained to do as well as what they are not trained to do.

An Exception to This Standard

This standard stipulates that in an emergency situation, professionals may provide services even if it falls outside the scope of their practice in order to ensure that access to services is provided.

3: Human Relations

Psychologists frequently work with a team of other mental health professionals. This standard of the ethics code is designed to guide psychologists in their interactions with others in the field.

This includes guidelines for dealing with sexual harassment, and discrimination, avoiding harm during treatment and avoiding exploitative relationships (such as a sexual relationship with a student or subordinate).

4: Privacy and Confidentiality

This standard outlines psychologists’ responsibilities with regard to maintaining patient confidentiality . Psychologists are obligated to take reasonable precautions to keep client information private.

However, the APA also notes that there are limitations to confidentiality. Sometimes psychologists need to disclose information about their patients in order to consult with other mental health professionals, for example.

While there are cases where information is divulged, psychologists must strive to minimize these intrusions on privacy and confidentiality.

5: Advertising and Other Public Statements

Psychologists who advertise their services must ensure that they accurately depict their training, experience, and expertise. They also need to avoid marketing statements that are deceptive or false.

This also applies to how psychologists are portrayed by the media when providing their expertise or opinion in articles, blogs, books, or television programs.

When presenting at conferences or giving workshops, psychologists should also ensure that the brochures and other marketing materials for the event accurately depict what the event will cover.

6: Record Keeping and Fees

Maintaining accurate records is an important part of a psychologist’s work, whether the individual is working in research or with patients. Patient records include case notes and other diagnostic assessments used in the course of treatment.

In terms of research, record-keeping involves detailing how studies were performed and the procedures that were used. This allows other researchers to assess the research and ensures that the study can be replicated.

7: Education and Training

This standard focuses on expectations for behavior when psychologists are teaching or training students.

When creating courses and programs to train other psychologists and mental health professionals , current and accurate evidence-based research should be used.

This standard also states that faculty members are not allowed to provide psychotherapy services to their students.

8: Research and Publication

This standard focuses on ethical considerations when conducting research and publishing results .

For example, the APA states that psychologists must obtain approval from the institution that is carrying out the research, present information about the purpose of the study to participants, and inform participants about the potential risks of taking part in the research.

9: Assessment

Psychologists should obtain informed consent before administering assessments. Assessments should be used to support a psychologist’s professional opinion, but psychologists should also understand the limitations of these tools. They should also take steps to ensure the privacy of those who have taken assessments.

10: Therapy

This standard outlines professional expectations within the context of providing therapy. Areas that are addressed include the importance of obtaining informed consent and explaining the treatment process to clients.

Confidentiality is addressed, as well as some of the limitations to confidentiality, such as when a client poses an immediate danger to himself or others.

Minimizing harm, avoiding sexual relationships with clients, and continuation of care are other areas that are addressed by this standard.

For example, if a psychologist must stop providing services to a client for some reason, psychologists are expected to prepare clients for the change and help locate alternative services.

What Happens If a Therapist Violates the APA's Ethical Codes?

After a report of unethical conduct is received, the APA may censure or reprimand the psychologist, or the individual may have his or her APA membership revoked. Complaints may also be referred to others, including state professional licensing boards.

State psychological associations, professional groups, licensing boards, and government agencies may also choose to impose penalties against the psychologist.

Health insurance agencies and state and federal payers of health insurance claims may also pursue action against professionals for ethical violations related to treatment, billing, or fraud.

Those affected by ethical violations may also opt to seek monetary damages in civil courts.

Illegal activity may be prosecuted in criminal courts. If this results in a felony conviction, the APA may take further actions including suspension or expulsion from state psychological associations and the suspension or loss of the psychologist's license to practice.

How Can I Report a Therapist for Unethical Behavior?

While unfortunate, there are instances in which a therapist may commit an ethical violation. If you would like to file a complaint against a therapist, you can do so by contacting your state's psychologist licensing board.

How to Find Your State's Psychologist Board

Here is a list of the U.S. psychology boards . Choose your state and refer to the contact information provided.

Because psychologists often deal with extremely sensitive or volatile situations, ethical concerns can play a big role in professional life.

The most significant ethical issues include the following:

• Client Welfare : Due to the role they serve, psychologists often work with individuals who are vulnerable due to their age, disability, intellectual ability, and other concerns. When working with these individuals, psychologists must always strive to protect the welfare of their clients.
• Informed Consent : Psychologists are responsible for providing a wide range of services in their roles as therapists, researchers, educators, and consultants. When people are acting as consumers of psychological services, they have a right to know what to expect. In therapy, obtaining informed consent involves explaining what services are offered, what the possible risks might be, and the patient’s right to leave treatment. When conducting research, informed consent involves letting participants know about any possible risks of taking part in the research.
• Confidentiality : Therapy requires providing a safe place for clients to discuss highly personal issues without fear of having this information shared with others or made public. However, sometimes a psychologist might need to share some details such as when consulting with other professionals or when they are publishing research. Ethical guidelines dictate when and how some information might be shared, as well as some of the steps that psychologists should take to protect client privacy.
• Competence : The training, education, and experience of psychologists is also an important ethical concern. Psychologists must possess the skill and knowledge to properly provide the services that clients need. For example, if a psychologist needs to administer a particular assessment in the course of treatment, they should have an understanding of both the administration and interpretation of that specific test.

While ethical codes exist to help psychologists, this does not mean that psychology is free of ethical controversy today. Current debates over psychologists’ participation in torture and the use of animals in psychological research remain hot-button ethical concerns.

Frequently Asked Questions

You can read the APA's Code of Ethics on the American Psychological Association's website here .

If you would like to ask a question about the APA's ethical codes, you can do so on their website here .

American Psychological Association. Ethical Principles of Psychologists and Code of Conduct. Including 2010 and 2016 Amendments. Washington, DC: American Psychological Association 2020 https://www.apa.org/ethics/code

Hobbs N. The development of a code of ethical standards for psychology .  American Psychologist. 1948;3(3):80–84.https://doi.org/10.1037/h0060281

Conlin WE, Boness CL. Ethical considerations for addressing distorted beliefs in psychotherapy. Psychotherapy (Chic). 2019;56(4):449-458. doi:10.1037/pst0000252

Stark L. The science of ethics: Deception, the resilient self, and the APA code of ethics, 1966-1973. J Hist Behav Sci . 2010;46(4):337-370. doi:10.1002/jhbs.20468

Smith RD, Holmberg J, Cornish JE. Psychotherapy in the #MeToo era: Ethical issues . Psychotherapy (Chic). 2019;56(4):483-490. doi:10.1037/pst0000262

Erickson Cornish JA, Smith RD, Holmberg JR, Dunn TM, Siderius LL. Psychotherapists in danger: The ethics of responding to client threats, stalking, and harassment. Psychotherapy (Chic). 2019;56(4):441-448. doi:10.1037/pst0000248

American Psychological Association. Complaints regarding APA members .

American Psychological Association. Council Policy Manual. Policy Related to Psychologists' Work in National Security Settings and Reaffirmation of the APA Position Against Torture and Other Cruel, Inhuman, or Degrading Treatment or Punishment. Adopted by APA Council of Representatives, August 2013. Amended by APA Council of Representatives, August 2015. Washington, DC: American Psychological Association 2020 https://www.apa.org/about/policy/national-security

By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

Dual-Process Theories in Moral Psychology pp 139–158 Cite as

Psychology’s Contribution to Ethics: Two Case Studies

• Liz Gulliford 2  
• First Online: 22 March 2016

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This paper contends that psychology cannot replace ethics. However, it will be argued, with reference to two case studies, that the empirical investigation of human morality can offer an important contribution to ethics. First, an empirical approach can illuminate matters of definition. Normative ethicists often make distinctions between concepts that do not reflect lay usage, and may seek to refine or reclaim the ‘true’ meaning of words to prevent the erosion of conceptual distinctions. However, it might be argued that they should hold no privileged place when it comes to defining the terms of language as it is used. It is essential that philosophers take seriously the question of what laypeople understand by ethical concepts, partly because the cultural and social differences such analyses reveal are interesting in themselves, but also because there are implications for the relationship between laypeople and the academy. The first case study thus shows that psychology can make a contribution towards defining ethical concepts. Secondly, it will be shown that psychology can elucidate the processes by which ethically desirable ends might be facilitated. Psychological approaches to forgiveness may, for example, help to expedite a goal which may seem remote from the human dynamics of forgiveness. Psychological interventions focus not on when forgiveness is appropriate or fitting (as a normative ethical account might) but on how this goal can be promoted. These methods do not replace ethics, but they do complement it in elucidating how certain ethically desirable ends might be progressed.

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Gulliford, L. (2016). Psychology’s Contribution to Ethics: Two Case Studies. In: Brand, C. (eds) Dual-Process Theories in Moral Psychology. Springer VS, Wiesbaden. https://doi.org/10.1007/978-3-658-12053-5_7

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Counseling Ethics Code: 10 Common Ethical Issues & Studies

Despite their potentially serious consequences, ethical issues are common, and without preparation and reflection, many might be violated unwittingly and with good intentions.

In this article, you’ll learn how to identify and approach a variety of frequently encountered counseling ethical issues, and how a counseling ethics code can be your moral compass.

Before you continue, we thought you might like to download our three Positive Psychology Exercises for free . These science-based exercises explore fundamental aspects of positive psychology, including strengths, values, and self-compassion, and will give you the tools to enhance the wellbeing of your clients, students, or employees.

This Article Contains:

Counseling & psychotherapy ethics code explained, 7 interesting case studies, 3 common ethical issues & how to resolve them, ethical considerations for group counseling, a take-home message.

Most of us live by a certain set of values that guide our behavior and mark the difference between right and wrong. These values almost certainly influence how you approach your work as a counselor .

Following these values might feel natural and even intuitive, and it might feel as though they don’t warrant closer examination. However, when practicing counseling or psychotherapy, working without a defined counseling code of ethics is a bit like sailing a ship without using a compass. You might trust your intuitive sense of direction, but more often than not, you’ll end up miles off course.

Fortunately, there are a variety of professional organizations that have published frameworks to help counselors navigate the challenging and disorienting landscape of ethics.

Members of these organizations are often recommended or required to adhere to a framework, so if you belong to one of them and you’re not familiar with their respective code of ethics, this should be your first port of call. However, these ethical frameworks are also often available online for anyone to read, and so you don’t need to join an organization to adhere to its principles.

Each organization takes a slightly different approach to their code of ethics, so you may find it useful to view several to find one that resonates best with your practice. As an example, the British Association of Counselling and Psychotherapy (2018) has a framework that emphasizes aspiring to a variety of different values and personal moral qualities.

Those values include protecting clients, improving the wellbeing and relationships of others, appreciating the diversity of perspectives, and honoring personal integrity. Personal moral qualities include courage, empathy , humility, and respect.

These values and qualities are not meant to be strict criteria, and there is no wholly objective way to interpret them. For example, two counselors might display the same legitimate values and qualities while arriving at different conclusions to an ethical problem. Instead, they reflect a general approach to how a counselor should think about ethics.

Nevertheless, this approach to ethics may be overly prescriptive for you, in which case a looser and more general framework may be better suited to the nature of your practice. Most professional organizations recognize this, and there is a set of foundational principles that feature widely across different frameworks and refine the collection of different values and qualities described above into simpler terms.

These principles are autonomy , beneficence, non-maleficence, fidelity, justice, veracity, and self-respect (American Counseling Association, 2014; British Association for Counselling and Psychotherapy, 2018). They are largely consistent across frameworks aside from some minor variations.

• Autonomy is the respect for a client’s free will.
• Beneficence and non-maleficence are the commitment to improve a client’s wellbeing and avoid harming them, respectively.
• Fidelity is honoring professional commitments.
• Veracity is a commitment to the truth.
• Justice is a professional commitment to fair and egalitarian treatment of clients.
• Self-respect is fostering a sense that the counselor is also entitled to self-care and respect.

Putting these principles into practice doesn’t require a detailed framework. Instead, as the British Association for Counselling and Psychotherapy (2018) recommends, you can simply ask yourself, “ Is this decision supported by these principles without contradiction? ” If so, the decision is ethically sound. If not, there may be a potential ethical issue that warrants closer examination.

Regardless of whether you navigate using values, qualities, or principles, it’s important to be prepared for how they might be challenged in practice. As explained above, these are not intended to be strict criteria, and it’s good to foster a healthy amount of flexibility and intuition when applying your ethical framework to real-life situations.

You might also interpret challenges to other principles. There is no correct or incorrect interpretation to any of these cases (Cottone & Tarvydas, 2016; Zur, 2008).

For each, consider where you think the problem lies and how you would respond.

A counselor has been seeing their client for several months to work through substance use issues. A good rapport has been formed, but the client has not complied with meeting goals set during therapy and has not reduced their substance use.

The counselor feels they may benefit from referring the client to a trusted colleague who specializes in helping individuals with substance use issues who are struggling to engage with therapy. The counselor contacts the colleague and arranges an appointment within their client’s schedule.

When the client is informed, the client is upset and does not wish to be seen by the colleague. The counselor replies that rescheduling is not possible, and they should consider the appointment a necessary part of therapy.

Beneficence

A counselor working as part of a university service is assigned a client expressing issues with their body image. The counselor lacks any knowledge in working with these issues, but feels as though they may help the client, given the extent of their experience with other issues.

On reflection, the counselor decides to contact a colleague outside the university service who specializes in body image issues and asks for supervision and advice.

Non-maleficence

A counselor developing a new exposure-based form of anxiety therapy is working with a client with severe post-traumatic stress. There is promising evidence suggesting the therapy is effective for reducing mild anxiety, but it is unknown whether the therapy is effective in more extreme cases.

As a result, the counselor recognizes that this client in particular would provide a particularly valuable case study for developing the therapy. The counselor recommends this therapy to the client.

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A client with a history of depression and suicidal ideation has been engaging successfully with therapy for the last year. However, recently they have experienced an unfortunate coincidence of extremely challenging life events because of their unstable living arrangement.

The counselor has noticed problematic behaviors and thought patterns emerging, and is seriously concerned about the client’s mental health given the history.

In order to have the client moved from their challenging living environment, they decide to recommend that the client be hospitalized for suicidal ideation, despite there being no actual sign of suicidal ideation and their client previously expressing the desire to avoid hospitalization.

A school counselor sees two students who are experiencing stress regarding their final exams. The first is a high-achieving and popular student who is likable, whereas the second is a student with a history of poor attendance and engagement with their education.

The counselor agrees that counseling is appropriate for the first student, but recommends the second student does not attend counseling, instead addressing the “transient” exam stress by directing their energy into “working harder.”

A counselor is assigned a teenage client after both the client and their family consent to therapy for issues with low mood. After the first session together, it is apparent that the client has been withholding information about their mental health from their family and is showing symptoms typical of clinical depression.

The counselor knows that their client is a high-performing student about to enter a prestigious school and that the client’s family has high hopes for the future. The counselor reassures the family that there is no cause for serious concern in order to protect them from facing the negative implications of the client’s condition.

Self-interest

A counselor is working with a client who is a professional massage therapist. The client offers a free massage therapy session to the counselor as a gesture of gratitude. The client explains that this is a completely platonic and professional gesture.

The counselor has issues with close contact and also feels as though the client’s gesture may not be entirely platonic. The counselor respectfully declines the offer and suggests they continue their relationship as usual. However, the client discontinues therapy abruptly in response.

Ethics in counseling

Ethical issues do not occur randomly in a vacuum, but in particular situations where various factors make them more likely. As a result, although ethical issues can be challenging to navigate, they are not necessarily difficult to anticipate.

Learning to recognize and foresee common ethical issues may help you remain vigilant and not be taken unaware when encountering them.

Informed consent

Issues of consent are common in therapeutic contexts. The right to informed consent – to know all the pertinent information about a decision before it is made – is a foundational element of the relationship between a counselor and their client  that allows the client to engage in their therapy with a sense of autonomy and trust.

In many ways, consent is not difficult at all. Ultimately, your client either does or does not consent. But informed consent can be deceptively difficult.

As a brief exercise, consider what “informed” means to you. What is the threshold for being informed? Is there a threshold? Is it more important to be informed about some aspects of a choice than others? These questions do not necessarily have a clearcut answer, but nevertheless it is important to consider them carefully. They may determine whether or not your client has given sufficient consent (West, 2002).

A related but distinct challenge to informed consent is that it is inherently subjective. For example, your client may have as much knowledge about a decision as you do and feel as though they fully understand what a decision entails. However, while you have both experience and knowledge of the decision, they only have knowledge.

That is to say, to some extent, it is not possible for your client to be informed about something they have not actually experienced, as their anticipated experience based on their knowledge may be wholly different from their actual experience.

The best resolution to these issues is to avoid treating informed consent like a checkbox that needs to be satisfied, where the client is required to ingest information and then give their consent.

Instead, encourage your client to appreciate the importance of their consent, reflect on their decision, and consider the limitations of their experience. In doing so, while they may not be able to become fully informed in an objective sense, they will achieve the nearest approximation.

Termination of therapy

Another time of friction when ethical issues can surface is at the conclusion of therapy , when the counselor and client go their separate ways. When this termination is premature or happens without a successful resolution of the client’s goals, it is understandable why this time is difficult.

This can be a challenging transition even when therapy is concluded after a successful result. Like any relationship, the one between a counselor and client can become strained when the time comes for it to end.

Your client may feel uncertain about their ability to continue independently or may feel rejected when reminded of the ultimately professional and transactional nature of the relationship (Etherington & Bridges, 2011).

A basic preemptive action that can be taken to reduce the friction between you and your client during this time is ‘pre-termination counseling,’ in which the topic of termination is explicitly addressed and discussed.

This can be anything from a brief conversation during one of the concluding appointments, to a more formal exploration of termination as a concept. Regardless, this can give your client the opportunity to acclimatize and highlight any challenges related to termination that may be important to explore before the conclusion of therapy.

These challenges may involve features of your client’s background such as their attachment history, which may predispose them toward feelings of abandonment, or their experience of anxiety, which may influence their perceived ability to cope independently after therapy.

If you already have knowledge of these features of your client’s background, it may be worth considering these potential challenges well in advance of the termination of therapy.

Online counseling

Remote forms of therapy are becoming increasingly common. This has many obvious benefits for clients and counselors alike; counseling is more accessible than ever, and counselors can offer their services to a broad and diverse audience. However, online counseling is also fraught with commonly encountered ethical issues (Finn & Barak, 2010).

As remote practice frequently takes place outside the structured contexts more typical of traditional counseling, ethical issues commonly encountered in online counseling are rooted in this relative informality.

Online counseling lacks the type of dedicated ethical frameworks described above, which means e-counselors may have no choice but to operate using their own ethical compass or apply ethical frameworks used in traditional counseling that may be less appropriate for remote practice.

Research suggests that some online counselors may not consider the unique challenges of working online (Finn & Barak, 2010). For example, online counselors may feel as though they do not have the same responsibility for mandatory reporting, as their relationship with their clients may not be as directly involved as in traditional counseling.

For online counselors who are aware of their duty to report safeguarding concerns, the inherent anonymity of online clients may present a barrier. Anonymity certainly has the benefit of improved discretion, but it also means a counselor may be unable to identify their client if they feel they are threatened or otherwise endangered.

Online counselors may also be unclear regarding the limits of their jurisdiction, as qualifications or professional memberships attained in one region may not be applicable in others. It can often seem like borders do not exist online, and while to some extent this is true, it is important to respect that jurisdictions exist for a reason, and it may be unethical to take on a client who you are not licensed to work with.

If you work as an e-counselor, the best way to resolve or preemptively prepare for these issues is to acknowledge they exist and engage with them. A good place to start may be to develop a personal framework for your practice that has a plan for issues of anonymity and confidentiality, and includes an indication of how you will report safeguarding concerns.

In a group setting, clients may no longer feel estranged from society or alone in their challenges, and instead view themselves as part of a community of people with shared experiences.

Clients may benefit from insights generated by other group members, and for some individuals, group counseling may literally amplify the benefits of a one-to-one approach.

However, group settings can also bring unique ethical issues. Just as some groups can bring out the best in us, and a therapeutic context can foster shared insights, other groups can become toxic and create a space in which counter-therapeutic behaviors are enabled by the implicit or explicit encouragement of other group members.

Similarly, just as some group leaders can inspire others and foster a productive community, it is also all too easy for group leaders to become victims of their status.

This is true for any relationship in which there is an inherent imbalance of power, such as traditional one-to-one practice, but in a group context, the counselor is naturally invested with a greater magnitude of influence and responsibility. This can lead to the judgment of the counselor becoming warped and increase the risk of overstepping ethical boundaries (Mashinter, 2020).

As a group counselor, first and foremost, you should foster a diligent practice of self-reflection to ensure you are mindful of the actions you take and remain alert to any blind spots in your judgment.

If possible, it may also be useful to examine ethical issues related to your authority by referring to another authority, in the form of supervision with one of your colleagues.

Finally, to prevent counter-therapeutic dynamics from developing within your group of clients, it may be useful to develop a clear code of conduct that emphasizes a commitment to group beneficence through mutual respect (Marson & McKinney, 2019).

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Take a structured approach to preparing for and dealing with ethical issues, whether this is referring to a framework published by a professional organization or simply navigating by a set of core values.

Prepare for the most common types of ethical issues, while also keeping an open mind to the often complex nature of ethics in practice, as well as the specific ethical issues that may be unique to your practice. Case studies can be a useful tool for doing this.

If in doubt, refer to these five steps from Dhai and McQuiod-Mason (2010):

• Formulate the problem.
• Gather information.
• Consult authoritative sources.
• Consider the alternatives.
• Make an ethical assessment.

We hope you enjoyed reading this article. Don’t forget to download our three Positive Psychology Exercises for free .

• American Counseling Association. (2014). Ethical & professional standards . Retrieved July 22, 2021, from https://www.counseling.org/knowledge-center/ethics
• British Association for Counselling and Psychotherapy. (2018). BACP ethical framework for the counselling professions . Retrieved from https://www.bacp.co.uk/events-and-resources/ethics-and-standards/ethical-framework-for-the-counselling-professions/
• Cottone, R., & Tarvydas, V. (2016). Ethics and decision making in counseling and psychotherapy . Springer.
• Dhai, A., & McQuoid-Mason, D. J. (2010). Bioethics, human rights and health law: Principles and practice . Juta and Company.
• Etherington, K., & Bridges, N. (2011). Narrative case study research: On endings and six session reviews. Counseling and Psychotherapy Research , 11 (1), 11–22.
• Finn, J., & Barak, A. (2010). A descriptive study of e-counselor attitudes, ethics, and practice. Counseling and Psychotherapy Research , 10 (4), 268–277.
• Marson, S. M., & McKinney, R. E. (2019). The Routledge handbook of social work ethics and values . Routledge.
• Mashinter, P. (2020). Is group therapy effective? BU Journal of Graduate Studies in Education , 12 (2), 33–36.
• West, W. (2002). Some ethical dilemmas in counseling and counseling research. British Journal of Guidance & Counselling , 30 (3), 261–268.
• Zur, O. (2008). Bartering in psychotherapy & counseling: Complexities, case studies and guidelines. New Therapist , 58 , 18–26.

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I enjoyed the lessons

I was recently at a social gathering where a former chemical dependency group counselor also attended. I tried to be polite, however I felt stalked. I was speaking with another person at the event, and he was within earshot of the conversation and hijacked my intent and the conversation. I had to literally seek an escape route. Before the event was over, he knocked my food from my plate and then ran to take the seat intended for me. This person knew that I am a retired professional and had access to my mental and physical health files. To say I was triggered is an understatement. What else could I have done in the moment to protect my psyche from the collateral damage that his inappropriate behaviors caused me? Is there any recourse? Do I now have to avoid the venue for fear he may show up there again and harass me further? Thank you in advance for your prompt attention.

I’m truly sorry to hear about your distressing experience. No one should ever feel cornered or unsafe, especially in social settings. In the moment, prioritizing your safety and well-being is paramount. If you ever find yourself in a similar situation, consider:

– Seeking Support : Approach a trusted friend or event organizer to stay with you, making it less likely for the individual to approach. – Setting Boundaries : Politely yet firmly assert your boundaries if you feel safe to do so. Let the person know their behavior is unwelcome. – Seeking Professional Advice : Consider discussing the situation with a legal professional or counselor to understand potential recourse.

Remember, you have every right to attend venues without fear. If you’re concerned about future encounters, perhaps inform the venue’s management about your experience.

Warm regards, Julia | Community Manager

Thanks for the reminder that group counseling is also a whole different thing compared to a more typical counseling session. I’d like to look for professional counseling services soon because I might need help in processing my grief. After my dog died a month ago, it’s still difficult for me to get on with my life and get on with life normally.

https://www.barbarasabanlcsw.net/therapy-with-me

Thanks the topic is well explained have learnt alot from it

Very informative article. I particularly enjoyed the case studies on the ethical principles

Thanks a lot

Ngini Nairobi, Kenya

very useful article .thank u very much. from… Sri Lanka

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Stanford Prison Experiment: Zimbardo’s Famous Study

Saul Mcleod, PhD

Editor-in-Chief for Simply Psychology

BSc (Hons) Psychology, MRes, PhD, University of Manchester

Saul Mcleod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.

Learn about our Editorial Process

Olivia Guy-Evans, MSc

Associate Editor for Simply Psychology

BSc (Hons) Psychology, MSc Psychology of Education

Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.

On This Page:

• The experiment was conducted in 1971 by psychologist Philip Zimbardo to examine situational forces versus dispositions in human behavior.
• 24 young, healthy, psychologically normal men were randomly assigned to be “prisoners” or “guards” in a simulated prison environment.
• The experiment had to be terminated after only 6 days due to the extreme, pathological behavior emerging in both groups. The situational forces overwhelmed the dispositions of the participants.
• Pacifist young men assigned as guards began behaving sadistically, inflicting humiliation and suffering on the prisoners. Prisoners became blindly obedient and allowed themselves to be dehumanized.
• The principal investigator, Zimbardo, was also transformed into a rigid authority figure as the Prison Superintendent.
• The experiment demonstrated the power of situations to alter human behavior dramatically. Even good, normal people can do evil things when situational forces push them in that direction.

Zimbardo and his colleagues (1973) were interested in finding out whether the brutality reported among guards in American prisons was due to the sadistic personalities of the guards (i.e., dispositional) or had more to do with the prison environment (i.e., situational).

For example, prisoners and guards may have personalities that make conflict inevitable, with prisoners lacking respect for law and order and guards being domineering and aggressive.

Alternatively, prisoners and guards may behave in a hostile manner due to the rigid power structure of the social environment in prisons.

Zimbardo predicted the situation made people act the way they do rather than their disposition (personality).

To study people’s roles in prison situations, Zimbardo converted a basement of the Stanford University psychology building into a mock prison.

He advertised asking for volunteers to participate in a study of the psychological effects of prison life.

The 75 applicants who answered the ad were given diagnostic interviews and personality tests to eliminate candidates with psychological problems, medical disabilities, or a history of crime or drug abuse.

24 men judged to be the most physically & mentally stable, the most mature, & the least involved in antisocial behaviors were chosen to participate.

The participants did not know each other prior to the study and were paid $15 per day to take part in the experiment.

Participants were randomly assigned to either the role of prisoner or guard in a simulated prison environment. There were two reserves, and one dropped out, finally leaving ten prisoners and 11 guards.

Prisoners were treated like every other criminal, being arrested at their own homes, without warning, and taken to the local police station. They were fingerprinted, photographed and ‘booked.’

Then they were blindfolded and driven to the psychology department of Stanford University, where Zimbardo had had the basement set out as a prison, with barred doors and windows, bare walls and small cells. Here the deindividuation process began.

When the prisoners arrived at the prison they were stripped naked, deloused, had all their personal possessions removed and locked away, and were given prison clothes and bedding. They were issued a uniform, and referred to by their number only.

The use of ID numbers was a way to make prisoners feel anonymous. Each prisoner had to be called only by his ID number and could only refer to himself and the other prisoners by number.

Their clothes comprised a smock with their number written on it, but no underclothes. They also had a tight nylon cap to cover their hair, and a locked chain around one ankle.

All guards were dressed in identical uniforms of khaki, and they carried a whistle around their neck and a billy club borrowed from the police. Guards also wore special sunglasses, to make eye contact with prisoners impossible.

Three guards worked shifts of eight hours each (the other guards remained on call). Guards were instructed to do whatever they thought was necessary to maintain law and order in the prison and to command the respect of the prisoners. No physical violence was permitted.

Zimbardo observed the behavior of the prisoners and guards (as a researcher), and also acted as a prison warden.

Within a very short time both guards and prisoners were settling into their new roles, with the guards adopting theirs quickly and easily.

Asserting Authority

Within hours of beginning the experiment, some guards began to harass prisoners. At 2:30 A.M. prisoners were awakened from sleep by blasting whistles for the first of many “counts.”

The counts served as a way to familiarize the prisoners with their numbers. More importantly, they provided a regular occasion for the guards to exercise control over the prisoners.

The prisoners soon adopted prisoner-like behavior too. They talked about prison issues a great deal of the time. They ‘told tales’ on each other to the guards.

They started taking the prison rules very seriously, as though they were there for the prisoners’ benefit and infringement would spell disaster for all of them. Some even began siding with the guards against prisoners who did not obey the rules.

Physical Punishment

The prisoners were taunted with insults and petty orders, they were given pointless and boring tasks to accomplish, and they were generally dehumanized.

Push-ups were a common form of physical punishment imposed by the guards. One of the guards stepped on the prisoners” backs while they did push-ups, or made other prisoners sit on the backs of fellow prisoners doing their push-ups.

Asserting Independence

Because the first day passed without incident, the guards were surprised and totally unprepared for the rebellion which broke out on the morning of the second day.

During the second day of the experiment, the prisoners removed their stocking caps, ripped off their numbers, and barricaded themselves inside the cells by putting their beds against the door.

The guards called in reinforcements. The three guards who were waiting on stand-by duty came in and the night shift guards voluntarily remained on duty.

Putting Down the Rebellion

The guards retaliated by using a fire extinguisher which shot a stream of skin-chilling carbon dioxide, and they forced the prisoners away from the doors. Next, the guards broke into each cell, stripped the prisoners naked and took the beds out.

The ringleaders of the prisoner rebellion were placed into solitary confinement. After this, the guards generally began to harass and intimidate the prisoners.

Special Privileges

One of the three cells was designated as a “privilege cell.” The three prisoners least involved in the rebellion were given special privileges. The guards gave them back their uniforms and beds and allowed them to wash their hair and brush their teeth.

Privileged prisoners also got to eat special food in the presence of the other prisoners who had temporarily lost the privilege of eating. The effect was to break the solidarity among prisoners.

Consequences of the Rebellion

Over the next few days, the relationships between the guards and the prisoners changed, with a change in one leading to a change in the other. Remember that the guards were firmly in control and the prisoners were totally dependent on them.

As the prisoners became more dependent, the guards became more derisive towards them. They held the prisoners in contempt and let the prisoners know it. As the guards’ contempt for them grew, the prisoners became more submissive.

As the prisoners became more submissive, the guards became more aggressive and assertive. They demanded ever greater obedience from the prisoners. The prisoners were dependent on the guards for everything, so tried to find ways to please the guards, such as telling tales on fellow prisoners.

Prisoner #8612

Less than 36 hours into the experiment, Prisoner #8612 began suffering from acute emotional disturbance, disorganized thinking, uncontrollable crying, and rage.

After a meeting with the guards where they told him he was weak, but offered him “informant” status, #8612 returned to the other prisoners and said “You can”t leave. You can’t quit.”

Soon #8612 “began to act ‘crazy,’ to scream, to curse, to go into a rage that seemed out of control.” It wasn’t until this point that the psychologists realized they had to let him out.

A Visit from Parents

The next day, the guards held a visiting hour for parents and friends. They were worried that when the parents saw the state of the jail, they might insist on taking their sons home. Guards washed the prisoners, had them clean and polish their cells, fed them a big dinner and played music on the intercom.

After the visit, rumors spread of a mass escape plan. Afraid that they would lose the prisoners, the guards and experimenters tried to enlist help and facilities of the Palo Alto police department.

The guards again escalated the level of harassment, forcing them to do menial, repetitive work such as cleaning toilets with their bare hands.

Catholic Priest

Zimbardo invited a Catholic priest who had been a prison chaplain to evaluate how realistic our prison situation was. Half of the prisoners introduced themselves by their number rather than name.

The chaplain interviewed each prisoner individually. The priest told them the only way they would get out was with the help of a lawyer.

Prisoner #819

Eventually, while talking to the priest, #819 broke down and began to cry hysterically, just like two previously released prisoners had.

The psychologists removed the chain from his foot, the cap off his head, and told him to go and rest in a room that was adjacent to the prison yard. They told him they would get him some food and then take him to see a doctor.

While this was going on, one of the guards lined up the other prisoners and had them chant aloud:

“Prisoner #819 is a bad prisoner. Because of what Prisoner #819 did, my cell is a mess, Mr. Correctional Officer.”

The psychologists realized #819 could hear the chanting and went back into the room where they found him sobbing uncontrollably. The psychologists tried to get him to agree to leave the experiment, but he said he could not leave because the others had labeled him a bad prisoner.

Back to Reality

At that point, Zimbardo said, “Listen, you are not #819. You are [his name], and my name is Dr. Zimbardo. I am a psychologist, not a prison superintendent, and this is not a real prison. This is just an experiment, and those are students, not prisoners, just like you. Let’s go.”

He stopped crying suddenly, looked up and replied, “Okay, let’s go,“ as if nothing had been wrong.

An End to the Experiment

Zimbardo (1973) had intended that the experiment should run for two weeks, but on the sixth day, it was terminated, due to the emotional breakdowns of prisoners, and excessive aggression of the guards.

Christina Maslach, a recent Stanford Ph.D. brought in to conduct interviews with the guards and prisoners, strongly objected when she saw the prisoners being abused by the guards.

Filled with outrage, she said, “It’s terrible what you are doing to these boys!” Out of 50 or more outsiders who had seen our prison, she was the only one who ever questioned its morality.

Zimbardo (2008) later noted, “It wasn’t until much later that I realized how far into my prison role I was at that point — that I was thinking like a prison superintendent rather than a research psychologist.“

This led him to prioritize maintaining the experiment’s structure over the well-being and ethics involved, thereby highlighting the blurring of roles and the profound impact of the situation on human behavior.

Here’s a quote that illustrates how Philip Zimbardo, initially the principal investigator, became deeply immersed in his role as the “Stanford Prison Superintendent (April 19, 2011):

“By the third day, when the second prisoner broke down, I had already slipped into or been transformed into the role of “Stanford Prison Superintendent.” And in that role, I was no longer the principal investigator, worried about ethics. When a prisoner broke down, what was my job? It was to replace him with somebody on our standby list. And that’s what I did. There was a weakness in the study in not separating those two roles. I should only have been the principal investigator, in charge of two graduate students and one undergraduate.”

According to Zimbardo and his colleagues, the Stanford Prison Experiment revealed how people will readily conform to the social roles they are expected to play, especially if the roles are as strongly stereotyped as those of the prison guards.

Because the guards were placed in a position of authority, they began to act in ways they would not usually behave in their normal lives.

The “prison” environment was an important factor in creating the guards’ brutal behavior (none of the participants who acted as guards showed sadistic tendencies before the study).

Therefore, the findings support the situational explanation of behavior rather than the dispositional one.

Zimbardo proposed that two processes can explain the prisoner’s “final submission.”

Deindividuation may explain the behavior of the participants; especially the guards. This is a state when you become so immersed in the norms of the group that you lose your sense of identity and personal responsibility.

The guards may have been so sadistic because they did not feel what happened was down to them personally – it was a group norm. They also may have lost their sense of personal identity because of the uniform they wore.

Also, learned helplessness could explain the prisoner’s submission to the guards. The prisoners learned that whatever they did had little effect on what happened to them. In the mock prison the unpredictable decisions of the guards led the prisoners to give up responding.

After the prison experiment was terminated, Zimbardo interviewed the participants. Here’s an excerpt:

‘Most of the participants said they had felt involved and committed. The research had felt “real” to them. One guard said, “I was surprised at myself. I made them call each other names and clean the toilets out with their bare hands. I practically considered the prisoners cattle and I kept thinking I had to watch out for them in case they tried something.” Another guard said “Acting authoritatively can be fun. Power can be a great pleasure.” And another: “… during the inspection I went to Cell Two to mess up a bed which a prisoner had just made and he grabbed me, screaming that he had just made it and that he was not going to let me mess it up. He grabbed me by the throat and although he was laughing I was pretty scared. I lashed out with my stick and hit him on the chin although not very hard, and when I freed myself I became angry.”’

Most of the guards found it difficult to believe that they had behaved in the brutal ways that they had. Many said they hadn’t known this side of them existed or that they were capable of such things.

The prisoners, too, couldn’t believe that they had responded in the submissive, cowering, dependent way they had. Several claimed to be assertive types normally.

When asked about the guards, they described the usual three stereotypes that can be found in any prison: some guards were good, some were tough but fair, and some were cruel.

A further explanation for the behavior of the participants can be described in terms of reinforcement.  The escalation of aggression and abuse by the guards could be seen as being due to the positive reinforcement they received both from fellow guards and intrinsically in terms of how good it made them feel to have so much power.

Similarly, the prisoners could have learned through negative reinforcement that if they kept their heads down and did as they were told, they could avoid further unpleasant experiences.

Critical Evaluation

Ecological validity.

The Stanford Prison Experiment is criticized for lacking ecological validity in its attempt to simulate a real prison environment. Specifically, the “prison” was merely a setup in the basement of Stanford University’s psychology department.

The student “guards” lacked professional training, and the experiment’s duration was much shorter than real prison sentences. Furthermore, the participants, who were college students, didn’t reflect the diverse backgrounds typically found in actual prisons in terms of ethnicity, education, and socioeconomic status.

None had prior prison experience, and they were chosen due to their mental stability and low antisocial tendencies. Additionally, the mock prison lacked spaces for exercise or rehabilitative activities.

Demand characteristics

Demand characteristics could explain the findings of the study. Most of the guards later claimed they were simply acting. Because the guards and prisoners were playing a role, their behavior may not be influenced by the same factors which affect behavior in real life. This means the study’s findings cannot be reasonably generalized to real life, such as prison settings. I.e, the study has low ecological validity.

One of the biggest criticisms is that strong demand characteristics confounded the study. Banuazizi and Movahedi (1975) found that the majority of respondents, when given a description of the study, were able to guess the hypothesis and predict how participants were expected to behave.

This suggests participants may have simply been playing out expected roles rather than genuinely conforming to their assigned identities.

In addition, revelations by Zimbardo (2007) indicate he actively encouraged the guards to be cruel and oppressive in his orientation instructions prior to the start of the study. For example, telling them “they [the prisoners] will be able to do nothing and say nothing that we don’t permit.”

He also tacitly approved of abusive behaviors as the study progressed. This deliberate cueing of how participants should act, rather than allowing behavior to unfold naturally, indicates the study findings were likely a result of strong demand characteristics rather than insightful revelations about human behavior.

However, there is considerable evidence that the participants did react to the situation as though it was real. For example, 90% of the prisoners’ private conversations, which were monitored by the researchers, were on the prison conditions, and only 10% of the time were their conversations about life outside of the prison.

The guards, too, rarely exchanged personal information during their relaxation breaks – they either talked about ‘problem prisoners,’ other prison topics, or did not talk at all. The guards were always on time and even worked overtime for no extra pay.

When the prisoners were introduced to a priest, they referred to themselves by their prison number, rather than their first name. Some even asked him to get a lawyer to help get them out.

Fourteen years after his experience as prisoner 8612 in the Stanford Prison Experiment, Douglas Korpi, now a prison psychologist, reflected on his time and stated (Musen and Zimbardo 1992):

“The Stanford Prison Experiment was a very benign prison situation and it promotes everything a normal prison promotes — the guard role promotes sadism, the prisoner role promotes confusion and shame”.

Sample bias

The study may also lack population validity as the sample comprised US male students. The study’s findings cannot be applied to female prisons or those from other countries. For example, America is an individualist culture (where people are generally less conforming), and the results may be different in collectivist cultures (such as Asian countries).

Carnahan and McFarland (2007) have questioned whether self-selection may have influenced the results – i.e., did certain personality traits or dispositions lead some individuals to volunteer for a study of “prison life” in the first place?

All participants completed personality measures assessing: aggression, authoritarianism, Machiavellianism, narcissism, social dominance, empathy, and altruism. Participants also answered questions on mental health and criminal history to screen out any issues as per the original SPE.

Results showed that volunteers for the prison study, compared to the control group, scored significantly higher on aggressiveness, authoritarianism, Machiavellianism, narcissism, and social dominance. They scored significantly lower on empathy and altruism.

A follow-up role-playing study found that self-presentation biases could not explain these differences. Overall, the findings suggest that volunteering for the prison study was influenced by personality traits associated with abusive tendencies.

Zimbardo’s conclusion may be wrong

While implications for the original SPE are speculative, this lends support to a person-situation interactionist perspective, rather than a purely situational account.

It implies that certain individuals are drawn to and selected into situations that fit their personality, and that group composition can shape behavior through mutual reinforcement.

Contributions to psychology

Another strength of the study is that the harmful treatment of participants led to the formal recognition of ethical  guidelines by the American Psychological Association. Studies must now undergo an extensive review by an institutional review board (US) or ethics committee (UK) before they are implemented.

Most institutions, such as universities, hospitals, and government agencies, require a review of research plans by a panel. These boards review whether the potential benefits of the research are justifiable in light of the possible risk of physical or psychological harm.

These boards may request researchers make changes to the study’s design or procedure, or, in extreme cases, deny approval of the study altogether.

Contribution to prison policy

A strength of the study is that it has altered the way US prisons are run. For example, juveniles accused of federal crimes are no longer housed before trial with adult prisoners (due to the risk of violence against them).

However, in the 25 years since the SPE, U.S. prison policy has transformed in ways counter to SPE insights (Haney & Zimbardo, 1995):

• Rehabilitation was abandoned in favor of punishment and containment. Prison is now seen as inflicting pain rather than enabling productive re-entry.
• Sentencing became rigid rather than accounting for inmates’ individual contexts. Mandatory minimums and “three strikes” laws over-incarcerate nonviolent crimes.
• Prison construction boomed, and populations soared, disproportionately affecting minorities. From 1925 to 1975, incarceration rates held steady at around 100 per 100,000. By 1995, rates tripled to over 600 per 100,000.
• Drug offenses account for an increasing proportion of prisoners. Nonviolent drug offenses make up a large share of the increased incarceration.
• Psychological perspectives have been ignored in policymaking. Legislators overlooked insights from social psychology on the power of contexts in shaping behavior.
• Oversight retreated, with courts deferring to prison officials and ending meaningful scrutiny of conditions. Standards like “evolving decency” gave way to “legitimate” pain.
• Supermax prisons proliferated, isolating prisoners in psychological trauma-inducing conditions.

The authors argue psychologists should reengage to:

• Limit the use of imprisonment and adopt humane alternatives based on the harmful effects of prison environments
• Assess prisons’ total environments, not just individual conditions, given situational forces interact
• Prepare inmates for release by transforming criminogenic post-release contexts
• Address socioeconomic risk factors, not just incarcerate individuals
• Develop contextual prediction models vs. focusing only on static traits
• Scrutinize prison systems independently, not just defer to officials shaped by those environments
• Generate creative, evidence-based reforms to counter over-punitive policies

Psychology once contributed to a more humane system and can again counter the U.S. “rage to punish” with contextual insights (Haney & Zimbardo, 1998).

Evidence for situational factors

Zimbardo (1995) further demonstrates the power of situations to elicit evil actions from ordinary, educated people who likely would never have done such things otherwise. It was another situation-induced “transformation of human character.”

• Unit 731 was a covert biological and chemical warfare research unit of the Japanese army during WWII.
• It was led by General Shiro Ishii and involved thousands of doctors and researchers.
• Unit 731 set up facilities near Harbin, China to conduct lethal human experimentation on prisoners, including Allied POWs.
• Experiments involved exposing prisoners to things like plague, anthrax, mustard gas, and bullets to test biological weapons. They infected prisoners with diseases and monitored their deaths.
• At least 3,000 prisoners died from these brutal experiments. Many were killed and dissected.
• The doctors in Unit 731 obeyed orders unquestioningly and conducted these experiments in the name of “medical science.”
• After the war, the vast majority of doctors who participated faced no punishment and went on to have prestigious careers. This was largely covered up by the U.S. in exchange for data.
• It shows how normal, intelligent professionals can be led by situational forces to systematically dehumanize victims and conduct incredibly cruel and lethal experiments on people.
• Even healers trained to preserve life used their expertise to destroy lives when the situational forces compelled obedience, nationalism, and wartime enmity.

Evidence for an interactionist approach

The results are also relevant for explaining abuses by American guards at Abu Ghraib prison in Iraq.

An interactionist perspective recognizes that volunteering for roles as prison guards attracts those already prone to abusive tendencies, which are intensified by the prison context.

This counters a solely situationist view of good people succumbing to evil situational forces.

Ethical Issues

The study has received many ethical criticisms, including lack of fully informed consent by participants as Zimbardo himself did not know what would happen in the experiment (it was unpredictable). Also, the prisoners did not consent to being “arrested” at home. The prisoners were not told partly because final approval from the police wasn’t given until minutes before the participants decided to participate, and partly because the researchers wanted the arrests to come as a surprise. However, this was a breach of the ethics of Zimbardo’s own contract that all of the participants had signed.

Protection of Participants

Participants playing the role of prisoners were not protected from psychological harm, experiencing incidents of humiliation and distress. For example, one prisoner had to be released after 36 hours because of uncontrollable bursts of screaming, crying, and anger.

Here’s a quote from Philip G. Zimbardo, taken from an interview on the Stanford Prison Experiment’s 40th anniversary (April 19, 2011):

“In the Stanford prison study, people were stressed, day and night, for 5 days, 24 hours a day. There’s no question that it was a high level of stress because five of the boys had emotional breakdowns, the first within 36 hours. Other boys that didn’t have emotional breakdowns were blindly obedient to corrupt authority by the guards and did terrible things to each other. And so it is no question that that was unethical. You can’t do research where you allow people to suffer at that level.”

“After the first one broke down, we didn’t believe it. We thought he was faking. There was actually a rumor he was faking to get out. He was going to bring his friends in to liberate the prison. And/or we believed our screening procedure was inadequate, [we believed] that he had some mental defect that we did not pick up. At that point, by the third day, when the second prisoner broke down, I had already slipped into or been transformed into the role of “Stanford Prison Superintendent.” And in that role, I was no longer the principal investigator, worried about ethics.”

However, in Zimbardo’s defense, the emotional distress experienced by the prisoners could not have been predicted from the outset.

Approval for the study was given by the Office of Naval Research, the Psychology Department, and the University Committee of Human Experimentation.

This Committee also did not anticipate the prisoners’ extreme reactions that were to follow. Alternative methodologies were looked at that would cause less distress to the participants but at the same time give the desired information, but nothing suitable could be found.

Withdrawal 

Although guards were explicitly instructed not to physically harm prisoners at the beginning of the Stanford Prison Experiment, they were allowed to induce feelings of boredom, frustration, arbitrariness, and powerlessness among the inmates.

This created a pervasive atmosphere where prisoners genuinely believed and even reinforced among each other, that they couldn’t leave the experiment until their “sentence” was completed, mirroring the inescapability of a real prison.

Even though two participants (8612 and 819) were released early, the impact of the environment was so profound that prisoner 416, reflecting on the experience two months later, described it as a “prison run by psychologists rather than by the state.”

Extensive group and individual debriefing sessions were held, and all participants returned post-experimental questionnaires several weeks, then several months later, and then at yearly intervals. Zimbardo concluded there were no lasting negative effects.

Zimbardo also strongly argues that the benefits gained from our understanding of human behavior and how we can improve society should outbalance the distress caused by the study.

However, it has been suggested that the US Navy was not so much interested in making prisons more human and were, in fact, more interested in using the study to train people in the armed services to cope with the stresses of captivity.

Discussion Questions

What are the effects of living in an environment with no clocks, no view of the outside world, and minimal sensory stimulation?

Consider the psychological consequences of stripping, delousing, and shaving the heads of prisoners or members of the military. Whattransformations take place when people go through an experience like this?

The prisoners could have left at any time, and yet, they didn’t. Why?

After the study, how do you think the prisoners and guards felt?

If you were the experimenter in charge, would you have done this study? Would you have terminated it earlier? Would you have conducted a follow-up study?

Frequently Asked Questions

What happened to prisoner 8612 after the experiment.

Douglas Korpi, as prisoner 8612, was the first to show signs of severe distress and demanded to be released from the experiment. He was released on the second day, and his reaction to the simulated prison environment highlighted the study’s ethical issues and the potential harm inflicted on participants.

After the experiment, Douglas Korpi graduated from Stanford University and earned a Ph.D. in clinical psychology. He pursued a career as a psychotherapist, helping others with their mental health struggles.

Why did Zimbardo not stop the experiment?

Zimbardo did not initially stop the experiment because he became too immersed in his dual role as the principal investigator and the prison superintendent, causing him to overlook the escalating abuse and distress among participants.

It was only after an external observer, Christina Maslach, raised concerns about the participants’ well-being that Zimbardo terminated the study.

What happened to the guards in the Stanford Prison Experiment?

In the Stanford Prison Experiment, the guards exhibited abusive and authoritarian behavior, using psychological manipulation, humiliation, and control tactics to assert dominance over the prisoners. This ultimately led to the study’s early termination due to ethical concerns.

What did Zimbardo want to find out?

Zimbardo aimed to investigate the impact of situational factors and power dynamics on human behavior, specifically how individuals would conform to the roles of prisoners and guards in a simulated prison environment.

He wanted to explore whether the behavior displayed in prisons was due to the inherent personalities of prisoners and guards or the result of the social structure and environment of the prison itself.

What were the results of the Stanford Prison Experiment?

The results of the Stanford Prison Experiment showed that situational factors and power dynamics played a significant role in shaping participants’ behavior. The guards became abusive and authoritarian, while the prisoners became submissive and emotionally distressed.

The experiment revealed how quickly ordinary individuals could adopt and internalize harmful behaviors due to their assigned roles and the environment.

Banuazizi, A., & Movahedi, S. (1975). Interpersonal dynamics in a simulated prison: A methodological analysis. American Psychologist, 30 , 152-160.

Carnahan, T., & McFarland, S. (2007). Revisiting the Stanford prison experiment: Could participant self-selection have led to the cruelty? Personality and Social Psychology Bulletin, 33, 603-614.

Drury, S., Hutchens, S. A., Shuttlesworth, D. E., & White, C. L. (2012). Philip G. Zimbardo on his career and the Stanford Prison Experiment’s 40th anniversary.  History of Psychology ,  15 (2), 161.

Griggs, R. A., & Whitehead, G. I., III. (2014). Coverage of the Stanford Prison Experiment in introductory social psychology textbooks. Teaching of Psychology, 41 , 318 –324.

Haney, C., Banks, W. C., & Zimbardo, P. G. (1973). A study of prisoners and guards in a simulated prison . Naval Research Review , 30, 4-17.

Haney, C., & Zimbardo, P. (1998). The past and future of U.S. prison policy: Twenty-five years after the Stanford Prison Experiment.  American Psychologist, 53 (7), 709–727.

Musen, K. & Zimbardo, P. (1992) (DVD) Quiet Rage: The Stanford Prison Experiment Documentary.

Zimbardo, P. G. (Consultant, On-Screen Performer), Goldstein, L. (Producer), & Utley, G. (Correspondent). (1971, November 26). Prisoner 819 did a bad thing: The Stanford Prison Experiment [Television series episode]. In L. Goldstein (Producer), Chronolog. New York, NY: NBC-TV.

Zimbardo, P. G. (1973). On the ethics of intervention in human psychological research: With special reference to the Stanford prison experiment.  Cognition ,  2 (2), 243-256.

Zimbardo, P. G. (1995). The psychology of evil: A situationist perspective on recruiting good people to engage in anti-social acts.  Japanese Journal of Social Psychology ,  11 (2), 125-133.

Zimbardo, P.G. (2007). The Lucifer effect: Understanding how good people turn evil . New York, NY: Random House.

Further Information

• Reicher, S., & Haslam, S. A. (2006). Rethinking the psychology of tyranny: The BBC prison study. The British Journal of Social Psychology, 45 , 1.
• Coverage of the Stanford Prison Experiment in introductory psychology textbooks
• The Stanford Prison Experiment Official Website

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The Central Park Five

Despite the indisputable and overwhelming evidence of the innocence of the Central Park Five, some involved in the case refuse to believe it.

In 1989, a young woman jogging in New York’s Central Park was raped and beaten nearly to death.  This high-profile attack upon a white investment banker in the heart of the city was quickly called the “crime of the century.”  There was intense public pressure to solve the case and, indeed, the police quickly arrested five young (14 to 16 years old) men who were black and Latino.  They had been part of a larger group of young men harassing passersby in another part of the park.

After intense interrogations ranging from 14 to 30 hours in length, four of the five confessed to the crime.  The five were charged with the attack.  Importantly:

• The boys soon recanted their confessions which they blamed on police coercion.
• No physical evidence linked the young men to the crime.
• No physical evidence indicated that there was more than one attacker.
• The semen found in the victim did not match any of the young men.
• The four confessions were inconsistent with each other and with the physical evidence from the crime scene.

Nonetheless, the young men were convicted and sent to jail.  Real estate developer Donald Trump called for their swift execution in a full-page newspaper ad.

Thirteen years later, Matias Reyes, who was serving a life sentence for murder, confessed to the crime.  Indeed, his DNA matched the semen recovered from the victim.  His was the only semen recovered from the victim.  The attack on the jogger was carried out in a similar  manner to his other rapes, none of which involved any other perpetrator.

Eventually, the Central Park 5 settled a wrongful conviction lawsuit with the City of New York for $41 million. However, the indisputable and overwhelming evidence of their innocence did not change the minds of:

• The lead prosecutor, who claimed that the five young men were indeed still guilty and that Reyes was simply an additional perpetrator—an “unindicted co-ejaculator.”
• The head detective, who said: ‘This lunatic [Reyes] concocts this wild story and these people fell for it.”
• Donald Trump who in 2013 tweeted regarding Ken Burns’ award-winning documentary on the Central Park 5’s innocence: “The Central Park Five documentary was a one-sided piece of garbage that didn’t explain the horrific crimes of these young men while in park.”
• The second chair lawyer in the prosecution who in 2018 still finds the taped confessions “pretty compelling” notwithstanding their inconsistencies and the fact that of the first 325 DNA exonerations in the U.S., 27% involved false confessions.

Discussion Questions

1. Do you see instances of cognitive dissonance in this case study? Explain.

2. Why do you think the two prosecutors and the police officer found it difficult to accept the new evidence regarding Reyes’ guilt?

3. Why do you think Donald Trump finds it difficult to accept the new evidence regarding Reyes’ guilt?

4. Sears and colleagues suggest that the following factors can render cognitive dissonance especially acute. Were any of them at play in the Central Park 5 case?

• Irrevocable commitment—the stronger one is committed to a position, the more intense will be the dissonance stemming from evidence indicating that the position is wrong.

• Foreseeable consequences—the more easily foreseen the consequences of taking an erroneous position, the more acute will be the dissonance when evidence starts to arise that the position is wrong.

• Responsibility for consequences—the more someone feels personally responsible for the erroneous position take, the more acute he or she will feel the dissonance when evidence starts to arise that the position is wrong

• Effort—the more effort someone has put into taking the erroneous position, the more wedded he or she will be to it and the more they will resist new, inconsistent evidence.

5. Do you find it difficult to accept evidence indicating that a position you have publicly maintained in the past is wrong?

6. The Central Park 5 had been released from jail by the time Reyes confessed. If they had still been in jail, and prosecutors and police resisted their release despite Reyes’ confession and the supporting evidence, would that have been an unethical act on their part?

7. What factors discussed in other Ethics Unwrapped videos might have contributed to a “rush to judgment” by police and prosecutors in 1989?

Related Videos

Cognitive Dissonance

Cognitive dissonance is the psychological discomfort that we feel when our minds entertain two contradictory concepts at the same time.

Bibliography

Sarah Burns, The Central Park Five: A Chronicle of a City Wilding (2011). http://www.worldcat.org/oclc/753625952

Mark Godsey, Blind Injustice (2017). http://www.worldcat.org/oclc/1054834948

Jonathan Lowell, “Managers and Moral Dissonance: Self-Justification as a Big Threat to Ethical Management?, 105 Journal of Business Ethics 17 (2012). http://www.worldcat.org/oclc/765322154

Graham Rayman, “Central Park Five Prosecutor Breaks Silence, Says It Was a Mistake to Vacate Convictions and Pay Off Accused Teens,” Daily News, July 19, 2018. https://www.nydailynews.com/new-york/ny-news-tim-clements-central-park-five-20180713-story.html

Amy Davidson Sorkin, Donald Trump and the Central Park Five, The New Yorker, June 23, 2014. https://www.newyorker.com/news/amy-davidson/donald-trump-and-the-central-park-five

Sydney Schanberg, “When Justice Is a Game: A Journey Through the Tangled Case of the Central Park Jogger,” The Village Voice, Nov. 19, 2002. https://www.villagevoice.com/2002/11/19/a-journey-through-the-tangled-case-of-the-central-park-jogger/

David Sears et al., Social Psychology (1991). http://www.worldcat.org/oclc/984477314

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