ETHICAL CHALLENGES IN MILITARY PSYCHOLOGY

 

Since World War II, militaries have employed psychologists in a range of important roles - job classification, morale studies, military research, and the provision of mental health services. As warfare changes, psychologists increasingly have been embedded in military units to address dynamic mental health needs.

Military psychologists often find themselves compelled to compromise their professional ethics. The military environment presents several unique situations infrequently encountered in most traditional healthcare settings, creating the potential for several conflicts. Ethical challenges in military psychology are multifaceted and include issues related to confidentiality, informed consent, potential harm to participants, and the dual loyalty dilemma where psychologists may be torn between their duty to the military and their ethical obligations to individual well-being. A breach of the provider-client relationship compromises the objectivity and effectiveness of the helping professional. Violations of this nature often result in emotional damage to the client, and additionally, impact the reputation of the profession, which could influence others’ willingness to seek treatment. Complicating this picture further for psychologists working within a military setting, is the recognition that in many instances the client is considered to be the government. Decision-making for the military psychologist is also often difficult given the potential conflict that arises when considering the needs of multiple clients simultaneously (the individual and the organization). 

The ACA (American Counseling Association) Code of Ethics 2014 outlines ethical standards and principles for counselors. It covers areas such as client confidentiality, informed consent, counselor competence, and avoiding conflicts of interest. The code emphasizes the importance of respecting clients’ autonomy, promoting their well-being, and maintaining professional boundaries. It serves as a guide for ethical decision-making and behavior in the counseling profession. With regards to military psychology, it provides a framework for ethical conduct and decision-making in a challenging context. Adhering to the ACA Code helps ensure military psychologists maintain ethical standards when dealing with sensitive issues such as trauma and the emotional well-being of service members. This is crucial for building trust with military clients, safeguarding their rights, and promoting the overall ethical practice of military psychology.

Despite service members experiencing unprecedented rates of diagnosable mental health concerns, many directly related to military trauma,  only less than half of them seek mental health services. The military hierarchy and standard procedures present barriers for service members who may be in considerable need of psychological services. The military, while acknowledging the mental health needs of service members, has created a cultural climate that undermines the goal of caring for individual soldiers.

 

Even if service members can trust their psychologists, they cannot trust the system. Often, it completely disregards patients’ rights to confidentiality and authorization for disclosure of medical records in the name of “Quality Assurance Investigation”, misusing their authority. Further, the stifled communication between patients and therapists stems from a fear that any disclosure of wrong-doing, major or minor, could potentially be reported to the soldier’s command. The unit commanders, though not psychologists, are ultimately responsible for treating psychologist’s professional duties, and are positioned to be the first point of contact, offering guidance and support for the mental health professionals in their units. Thus, the commander’s obligation to the overall military mission can interfere with the psychologist’s ethical obligations to their patients. 

A military psychologist subsumes multiple relationships/roles when interacting with an individual service member. The nature of the military organization makes abiding by ethical standards impossible. Mental health providers may be embedded in the unit with the enlisted service members who are carrying out the day-to-day missions. This quickly leads to the ethical dilemma of multiple relationships as a psychologist lives, eats, sleeps, and recreates with the service members to whom she or he is providing mental health services. This context calls for extreme role fluidity for the military psychologist.

The psychologist’s working environment and the chain of command also place them in multiple relationships with the commander. During the consultation process, the psychologist may have to disclose information about an individual that implies a violation of Army standards or lack of mission readiness. The commander is obligated to report the information up the chain of command regardless of how it was discovered. Unlike civilian psychologists, military psychologists have little autonomy in navigating or avoiding these multiple relationships.

Confidentiality, the cornerstone of a psychologist’s profession, does not exist in the military. They are frequently in situations where they must decide which agency’s best interest to adhere to. A major example of this conflict evolves when psychologists are asked to breach confidentiality in service of mission readiness or the commander’s need to know. This “need to know” about a service member’s fitness for duty takes precedence over the individual’s mental health and privacy needs, essentially granting commanders unrestricted access to health records. War crimes, which a psychologist must also disclose, initiate a breach of confidentiality. 

Mixed agency refers to the obligation a military psychologist has to various agencies and their applicable ethics, laws, policies, and/or regulations. Unlike civilian psychologists who are discouraged from providing forensic evaluations for their long-term clients, military psychologists may be required to perform a behavioral evaluation of patients and to make fitness-for-duty recommendations to the commander, further confounding the patient-therapist relationship. Hence, this mixed agency and uncertainty can discourage service members from full disclosure during therapy. As mentioned previously, the needs of the mission can conflict with the therapeutic needs of the individual and best ethical practices. 

Military psychologists must be aware of the tenuous situation they enter into when they take the oath for military service. They should operate under the assumption that every service member is a potential client while increasing comfortability and comfort and flexibility with managing boundary crossings. They must know the ACA Ethics Code and hold fast to these standards as best as possible while being prepared to balance the needs of individuals with the needs of the greater organization and its mission. 

Ethical practice in a military environment requires balancing at the individual and agency levels. Prohibiting military psychologists from engaging in multiple relationships is unrealistic and would lead to isolation. There is a need for awareness of the conflict stemming from these relationships. Furthermore, the psychologist should also educate and prepare new patients for these transitions and the expectations associated with each role. Understanding the extensive exceptions to confidentiality is important, so psychologists can better inform service members of possible breaches of confidentiality and align themselves with ACA Ethical Standards.

 

What is necessary is a best interest approach that includes working through an ethical dilemma model to determine the potential risks and consequences to the individual and the unit. Decision-making models that will lead to the successful navigation of these concerns are needed. Psychologists should also maintain a relationship with a military lawyer and stay up-to-date on the ACA Ethics Code, military regulations, and laws. Addressing these ethical challenges requires a commitment to ongoing training, staying informed about relevant ethical guidelines, and a dedication to balancing the needs of the military with the ethical obligations to individual service members.

References

1. Frey, R. A. M. (2016). Ethical Challenges for Military Psychologists: When Worlds Collide. Ethics & Behavior, 27(4), 283–296. doi:10.1080/10508422.2016.1193811 

2. Johnson, W. & Landsinger, Kristin. (2017). Ethical Issues in Military Psychology. 10.1007/978-3-319-66192-6_8. 

3. McCauley, M., Hughes, J. H., & Liebling-Kalifani, H. (2008). Ethical Considerations for Military Clinical Psychologists: A Review of Selected Literature. Military Psychology, 20(1), 7–20. doi:10.1080/08995600701753128 

4. Staal, M., King, R. (2000). Managing a Multiple Relationship Environment: The Ethics of Military Psychology. Professional Psychology: Research and Practice 2000. Vol. 31, No. 6. 698-705. DOI: 10.I037//0735-7028.31.6.698  

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About The Author

Sehej Kaur

Member, PsyCreative Column, Psychology Committee NMIMS

Sehej Kaur is a first year student, currently pursuing B.Sc. Applied Psychology from NMIMS, Mumbai. All that is needed to impress her is to have a similar spectrum of music taste as hers and a collection of serene sky and moon pictures. She has a passionate eye for beauty in the little things of life and loves capturing the subtleness of everyday moments. She likes to pen down her thoughts as it helps her gain mental clarity. She is really meticulous in her work. For her, self-development is not a destination, but a journey.