Gordon, R.M. (2006a) “The APA Ethics Code as a Projective Test.” Psychologist-Psychoanalyst,  XXVI, 1, 67-68.

The APA Ethics Code as a Projective test

Robert M. Gordon, Ph.D., ABPP

I am working on using the APA Ethics Code as a projective test. How is that possible? Well we all know that the Rorschach inkblots have great projective value, but so can written statements. MMPI-2 statements have a projective aspect to them. For example, the MMPI-2 question, “I have often met people who were supposed to be experts who were no better than I” is a frequent response of workshop participants. Research has found that the very same people who said “True” to this item also get panic attacks when they present.

Similarly, I have noticed how much I can tell about a psychologist’s personality by how the psychologist interprets APA’s Ethical Principles of Psychologists and Code of Conduct. That insight has inspired me to develop a projective test of ethical reasoning.

A good test should be anchored to a good theory. In the noble tradition of psychology, I stole key concepts from others and relabeled them. I have rejected the concept of “Superego”. This gives the impression that I am smarter than Sigmund Freud, which makes me feel important. I based my ethical levels of reasoning on what I call “anal strength”. I challenge anyone to measure “ego strength” physiologically, but anal strength can be easily empirically validated by sphincter’s ability to snap a pencil. This also proves that empirical validation works best in anal situations.

I will now move beyond my operational definition to the actual imagined constructs. These are the Gordon’s Levels of Ethical Reasoning. The Schizoid/ Clueless sphincter level is characterized by an inability to even recognize ethical issues and to distinguish one’s own sphincter from a hole in the ground. A very tight sphincter characterizes the Paranoid/Cynical sphincter level. These are the Torquemadas who rigidly and cynically interpret the ethics code to persecute others. The Narcisstic sphincter level is characterized by sphincter expulsion on others. They feel above the societal demands for toilet training and ethics codes. The Masochistic sphincter level is characterized by sphincter receptivity. They end up getting into trouble since they secretly wish to be spanked by the Ethic Committee. The clean but impractical sphincter characterizes the Obsessive-Compulsive sphincter level. They may follow the letter of every standard to the point of absurdity, while totally missing the bowl. The Normal-Befuddlement level has an appreciation that there is more to it than meets the eye. The highest level is the Wise Sphincter Thinker. They are characterized by understanding the spirit and intent of ethical behavior: “shit happens- so try to keep others from stepping in it.”

Next in the development of my projective test, I had to determine the projective value of each ethical standard. For example, 10.05 “Sexual Intimacies with Current Therapy Clients/Patients” is only a sentence long, with a clear “do not” in it. It is too unambiguous to have much projective value except in determining acute psychotic states.

On the other hand, the standard, 3.05 “Multiple Relationships” requires a tolerance for ambiguity and ethical reasoning. The standard provides a definition of “Multiple Relationships” since this term is so confusing that some psychologists fear having more than one friend. It even provides a test to determine if there is a problem:

“A psychologist refrains from entering into a multiple relationship if the multiple relationship could reasonably be expected to impair the psychologist’s objectivity, competence, or effectiveness in performing his or her functions as a psychologist, or otherwise risks exploitation or harm to the person with whom the professional relationship exists.”

This test requires the opinions of what most reasonable psychologists would expect to occur from the arrangement. This is where my new assessment would come in handy. I propose we first screen for reasonable psychologists before a determination is made.

The standard also includes a statement that multiple relationships per se are not unethical.

“Multiple relationships that would not reasonably be expected to cause impairment or risk exploitation or harm are not unethical.”

This is of great help, since the concept of “multiplicity” can be easily be confused by many psychologists with the concept of “harm”.

Since 3.05 has such high projective value I used it as my first test item.

I made up the following vignette and I presented it to several psychologists.

Dr. R’s wife was accepted into a doctoral program in psychology. He was proud of her and placed an announcement in their local newspaper and sent a copy to her parents. The announcement also stated that the wife would be working in the husband’s practice under his supervision. His role as “supervisor” would be one of responsibly and overseeing and not one of evaluative authority. He would not be supervising his wife as part of a requirement to fulfill hours for licensing or certification or for the purposes of a course or fulfillment of a practicum or internship. He would be taking legal and professional responsibility for his wife’s work with a few patients on Saturdays when he was the most consistently available psychologist if something went wrong.

Soon after, the wife received a call from her university. Dr. R’s former wife had sent a letter to the department chair with a copy of the announcement. The X-wife (also a psychologist) complained that Dr. R. and his wife were in a “clearly unethical dual relationship”. What do you think of this situation?

Here are examples of how I scored some psychologists responses to this vignette. Can you tell their level of development?

“Another reason not to advertise,” = 0.

“It’s unethical as long as he is still having sex with his wife. He has to choose which is more ethical,” = 0.

“It’s OK to have sex with his wife and be in the position of responsibility as long as they are not occurring at the same moment,” =1.

“The key factor in this particular situation is that Dr. R is not in an evaluative role with his wife so there is no unethical role conflict. Only a cynical or obsessive-compulsive psychologist would expect impairment, exploitation or harm to come from this situation. The former wife is a Torquemada,” = 2, (because of the level of ethical reasoning and any response of mine is a 2.)

Ongoing education and consultation in ethical reasoning can improve the scores but only to a point. Anality is destiny.