Ethical Issues in 

Military
Psychology 8
W. Brad Johnson and Kristin L. Landsinger

The profession of psychology and the profession of There are elements of the practice of psychol-
arms have been integrally intertwined for more ogy in military settings that create unique and
than a century. Both clinical and research psychol- sometimes intense ethical tensions and conflicts
ogists share a long and distinguished history of ser- for psychologists. These are often particularly
vice to the nation in support of military personnel acute for psychologists in uniform. In this brief
and military leaders (Budd & Kennedy, 2006; chapter, we describe the aspects of military psy-
Driskell & Olmstead, 1989; Johnson, 2016). Today, chology practice that heighten ethical tensions
hundreds of active-duty psychologists—primarily and quandaries for psychologists. We then sum-
clinical/counseling specialists—serve military ser- marize seven specific ethical quandaries that
vice members and their families around the globe. occur with the greatest frequency or create the
Hundreds more serve the Department of Defense most acute conflicts for military psychologists.
(DoD) in civilian roles, providing clinical, consult- Illustrative vignettes are employed to bring these
ing, and research services. Military psychologists issues to life. We conclude this chapter with a set
provide a wide range of services including the of recommendations designed to help psycholo-
screening, evaluation, and clinical treatment of gists ameliorate and manage common ethical
military recruits, active-duty service personnel, tensions.
spouses, children, and other dependents. Because
uniformed military psychologists often find them-
selves quickly deployed to combat theaters, embed-  ow Military Contexts Can
H
ded with active military units, or stationed as Heighten Ethical Tensions
mental healthcare providers in solo (single-pro-
vider) locations, they must be particularly confi- Military psychologists must occasionally strug-
dent and competent as well-rounded generalists. gle with the simultaneous—and sometimes com-
peting—identities of professional psychologist
and commissioned military officer (Jeffery,
W.B. Johnson (*) Rankin, & Jeffery, 1992; Johnson, 2008). After
United States Naval Academy, 21 St. Ives Drive,
Severna Park, Annapolis, MD, USA
taking the oath of office, all military officers are
e-mail: [email protected] obligated to promote the combat readiness and
K.L. Landsinger
fighting power of the military and to support the
Department of Leadership, Ethics, & Law, United immediate military mission. There may be
States Naval Academy, 73 Gentry Ct, Annapolis, moments in the work of the uniformed psycholo-
MD, USA gist in which the dual identity of clinical provider
e-mail: [email protected]

© Springer International Publishing AG 2017 105

S.V. Bowles, P.T. Bartone (eds.), Handbook of Military Psychology,
DOI 10.1007/978-3-319-66192-6_8
106 W.B. Johnson and K.L. Landsinger

or researcher and commissioned officer create whom the psychologist owes specific ethical
difficulties identifying the primary client, balanc- obligations is an important consideration.
ing client best interests, deciphering the most • Conflicts between ethics and organizational
pressing ethical obligations, and avoiding poten- demands: Unlike their civilian counterparts,
tially harmful multiple relationships (Johnson, military psychologists are obligated to defend
Ralph, & Johnson, 2005; Zur & Gonzalez, 2002). the Constitution and place the immediate mili-
These concurrent identities often create tary mission first and foremost (Howe, 2003;
mixed-agency ethical dilemmas for psycholo- Jeffery et al., 1992; Johnson, 2008). Moreover,
gists. Mixed-agency dilemmas occur when there anything not directly relevant to achieving the
are conflicts between loyalties or obligations to military mission is superfluous in many ways.
clients and a broader organization; or, more sim- Most importantly, this means that the military
ply, simultaneous commitment to two or more objective must sometimes trump individual
entities (Howe, 2003; Kennedy & Johnson, interests. Nowhere is this conflict more salient
2009). Role stress can affect a military psycholo- than when a psychologist must clear a service
gist when he or she faces multiple obligations to member—particularly one who has already
an individual client or client group, a command- suffered traumatic experiences—for return to
ing officer, the DoD, or perhaps even society writ combat (Johnson, 2013b). The American
large. For instance, in an intense wartime envi- Psychological Association’s (APA) Ethics
ronment, the assessment of a recently trauma- Code enjoins psychologists to safeguard the
tized service member for fitness to return to best interests of those with whom they work,
combat may have implications for the service and to do no harm (APA, 2010). But in the
member, his or her military unit, a major military military, individual best interests must be bal-
mission, and the tide of a battle, particularly if anced against those of the larger unit, and the
that service member has a specialized skill set. nation.
Although mixed-agency dilemmas may occur in • Conflicts between ethics and statutes or regu-
other settings (e.g., managed care, schools, cor- lations: Military psychologists will occasion-
rections), the military psychologist’s dual identi- ally discover subtle incongruity or even
ties often exacerbate these dilemmas. Here are glaring discord between ethical standards
several additional elements of the military milieu (APA, 2010) and DoD statutes or regulations
that can heighten ethical tensions for military (Johnson, 2013b; Johnson, Grasso, &
psychologists. Maslowski, 2010). Notable conflicts may
occur in the areas of confidentiality, multiple
• Difficulty identifying the client: Although relationships, informed consent, third-party
civilian psychologists might take for granted requests for services, and promoting the indi-
the ability to quickly identify the primary vidual client’s best interests. Most alarming,
recipient of their services, this is not always psychologists have been sanctioned ethically
the case in the military (Johnson, 2008, for adhering to federal law and legally for
2013a). Because individual service members adhering to the Ethics Code (Jeffery et al.,
are often referred by their own chain of com- 1992).
mand, there may be multiple stakeholders • Inability to choose to enter or exit clinical/
invested in the outcome of a psychological consulting relationships: Particularly, when
assessment. For instance, when evaluating a assigned to small communities (e.g., isolated
soldier in advance of a sensitive mission, it bases, aircraft carriers, forward-deployed mil-
may be challenging to discern whether the pri- itary units), military psychologists do not have
mary client is the soldier, the mission leader, the luxury of vetting, refusing, or referring cli-
or the commanding officer. Clearly defining ents in order to prevent multiple roles, con-
all the parties involved in evaluation and to flicts of interest, or sudden and potentially
8  Ethical Issues in Military Psychology 107

harmful role shifts. Military psychologists in or those of colleagues. Selection of these ethical
solo billets must accept every service member issues was based upon our own experience as
in need of psychological services as a client, uniformed psychologists, consultations with mil-
no matter their preexisting relationship. itary practitioners, and the literature bearing on
Psychologists in these settings must increase the topic (Howe, 2003; Johnson, 2008; Kennedy
their tolerance for unavoidable boundary & Johnson, 2009; Kennedy & McNeil, 2006;
crossings. Moore & Barnett, 2013; Moore & Reger, 2006).
• Significant career repercussions for clients:
As a commissioned officer, the military psy-
chologist wields profound power over all Boundaries of Competence
aspects of a client’s life. Diagnostic, treat-
ment, and fitness-for-duty assessments may A recent graduate of a military clinical psychology
internship and a newly commissioned Air Force
significantly impact a client’s living and work- officer, Captain Estevez was soon deployed to a
ing conditions, potential job assignments, and forward surgical hospital as the only psychologist.
eligibility to remain on active duty (Johnson In that setting, she quickly discovered that a sub-
et al., 2005). Moreover, the referring com- stantial portion of her clinical triage responsibili-
ties involved brief neuropsychological assessments.
manding officer will often defer to the psy- Although she’d received only a cursory introduc-
chologist’s expertise and judgment. This may tion to neuropsychology generally and assessment
create tension for the psychologist who wishes specifically, she sought to consult online resources
to act with beneficence toward the individual and email periodically with a neuropsychology
colleague back home. Self-aware that she was far
client but also recognizes his or her obligation from competent in this specialty area, she did her
to military writ large. best to conduct rudimentary neuropsychology
• The military context is sometimes high risk: In screenings and draw general diagnostic conclu-
comparison to their civilian counterparts, mil- sions in her patient’s charts. She cringed wonder-
ing what real neuropsychologists back in the states
itary psychologists must conduct research, would make of her practicing in this area.
provide consultations, and practice health care
in combat theaters, aboard ships at sea, and as Psychologists are obligated by their Ethics
embedded members of deployed units. In Code to provide services only within the bound-
addition to the stress of serving in combat-­ aries of their demonstrated competence, based
proximal settings, psychologists in these set- upon education, training, supervised experi-
tings are sometimes exposed—directly and ence, consultation, and professional experience
indirectly—to traumatic events and disturbing (APA, 2010). But, because military psycholo-
images, physical risk, and emotional exhaus- gists often function as solo mental health pro-
tion (Johnson, 2013a). viders, even very early in their careers, far from
direct supervision or consultation, they are fre-
quently obligated by the exigencies of the con-
 op Ethical Quandaries in Military
T text to provide services outside the comfort zone
Psychology of their established competence (Johnson, 2016;
Moore & Reger, 2006). There is even a sense of
Having reviewed the ingredients of military cul- pride among military practitioners about “doing
ture and the realities of a psychologist’s commis- what one can for anyone who walks through the
sioned status that sometime exacerbate ethical door” of the clinic or emergency room. It is not
tensions, we now briefly summarize—in no par- unusual for uniformed psychologist to feel some
ticular order—seven of the primary ethical quan- tension, even distress, about whether their solo
daries routinely experienced by psychologists in or isolated context is justification enough for
the military. Each begins with a short vignette functioning well beyond their competence areas
based on amalgamations of our own experiences at times.
108 W.B. Johnson and K.L. Landsinger

Confidentiality informed consent, and sometimes minimalist and

creative documentation in client records, con-
An Air Force airman seeks treatment services for cerns about confidentiality continue to create
anxiety, sleep problems, and episodes of low
mood. He suggests vaguely to his psychologist that
routine conundrums.
he may have been sexually assaulted in the bar-
racks but refuses to acknowledge this directly. He
is very anxious about keeping this recent traumatic Sudden Role Shifts
experience, and even his consultation with mental
health, confidential. He appears fearful of the per-
An Army specialist is currently facing a Uniformed
petrator and also ashamed. Shortly after treatment
Code of Military Justice (UCMJ) charge for hav-
begins, and before the client will allow any report-
ing an unauthorized weapon on Post. While work-
ing of the assault, his Commanding Officer (CO)
ing with her lawyer to prepare her defense, the
refers this airman for a Command Directed
soldier reveals she was previously seen by an
Evaluation on the basis of the airman’s recent poor
Army psychologist for depression. The lawyer
performance. The CO requests any mental health
decides to pursue this angle and a Sanity Board
records, diagnosis, and fitness for duty
evaluation is ordered by the judge. Because the sol-
assessment.
dier’s psychologist is the only licensed mental
health provider on the Post, the lawyer, the Court,
One of the most persistent and pressing ethical and the psychologist’s own commanding officer
inform her that she must conduct the formal mental
quandaries for military psychologists is that of health evaluation and will likely be called as a wit-
confidentiality (McCauley, Hughes, & Liebling-­ ness at the Courts-martial proceedings.
Kalifani, 2008). Information about a client or
research participant that would never be dis- Although the APA Ethics Code cautions psy-
closed or reported without consent in the civilian chologists to avoid shifting roles with clients
world may not be protected from disclosure in without appropriate informed consent prior to
the military (Kennedy & Johnson, 2009). DoD the commencement of service delivery, military
directives specify that a legitimate military psychologists often find themselves suddenly
authority—often a commanding officer, military assuming administrative, supervisory, or foren-
court, or security clearance evaluator—may have sic roles with current, former, and future clients
access to client records on a “need to know” with little warning or capacity to anticipate this
basis. Military psychologists have often strug- new mandated role (APA, 2010; Johnson, 2008,
gled significantly with mixed-agency conflicts 2016). Particularly, when the psychologist is a
surrounding confidentiality. On one hand, confi- solo provider in an isolated duty station, the
dentiality is considered sacrosanct by nearly all opportunity to refer a client or refuse a com-
psychologists and it can be difficult for the new mand-directed evaluation or other forensic/
military psychologist to come to terms with fed- administrative assessment may be nonexistent.
erally mandated limits on confidentiality and the Of course, such sudden role shifts may be dis-
concomitant challenges those limits impose on tressing to clients and may diminish the value of
the task of engaging service members in caring, the preexisting treatment relationship when the
professional relationships. Some of the condi- assessment result has adverse consequences for
tions that may trigger disclosure of information the client. It is equally likely that a current or
about a service member without consent—condi- former client may feel uncomfortable when a
tions never encountered in the civilian sector— uniformed psychologist is assigned to a supervi-
may include serious risk of harm to a specific sory/military role with the client. Ethical con-
operational mission, when clients are “special” flicts are most acute when these role shifts are
personnel (e.g., those with special clearance or sudden, unanticipated, and beyond the control of
Special Forces designations, or when access to the psychologist. Military psychologists often go
weapons is contraindicated). Although psycholo- to great lengths to warn clients about the poten-
gists attempt to address this tension with rigorous tial for shifting roles in advance, and to work
8  Ethical Issues in Military Psychology 109

collaboratively with clients to ameliorate nega- Although multiple relationships do heighten

tive consequences when an evaluative or super- the risk for negative—often uncomfortable—
visory role is ­ suddenly added to a clinical/ healthcare and consultation outcomes, the reality
consultation relationship. is that embedded or solo psychologists are often
the only source of mental health care available to
service members. Therefore, military psycholo-
Multiple Relationships gists must increase their tolerance for boundary
crossings—daily occurrences—while assidu-
A Navy psychologist is called to his CO’s office to ously avoiding boundary violations (Gutheil &
discuss a new suicide prevention initiative for the
command. When the psychologist arrives, he sees
Gabbard, 1993). On the upside, when members
the Command Master Chief (CMC: the senior of an embedded unit see their psychologist as
enlisted leader of the command) is also in the competent, caring, and helpful, they are more
office. The psychologist has been seeing the CMC likely to seek services when necessary and more
in therapy for five months addressing a recurring
major depression with occasional suicidal
willing to trust the psychologist to manage
thoughts. The CO asks if the psychologist has for- unavoidable multiple roles professionally. And
mally met the CMC and the psychologist acknowl- there are times when a preexisting friendship
edges they have met. With no preamble, the CO with a “client” can actually enhance trust, empa-
then directs the psychologist and the CMC to work
together to create and deliver a new suicide preven-
thy, and caring that carry over in positive ways to
tion program for the command, aimed specifically a service–delivery relationship.
at sailors. The CO notes there are no better two
people for the project. With no time for further dis-
cussion, the CO thanks and then dismisses them.
 resenting Accurate Research
P
Findings and Clinical Diagnoses
Owing to the increasing frequency of military
psychologists becoming embedded with large A uniformed research psychologist conducts a
DoD-directed study on moral commitment—
combat units (e.g., Army brigades, aircraft carri- including willingness to report abuse of enemy
ers, deployed air wings)—simultaneously a combatants if this is witnessed—among Army sol-
member of the unit or force and a healthcare pro- diers. The results are not encouraging and reveal
fessional—it is nearly impossible for the embed- that despite a top General’s public claims, a sub-
stantial proportion of soldiers would not report
ded psychologist to avoid providing services to such abuse. When the findings are conveyed to his
colleagues, friends, senior officers in the chain-­ director—who happens to write the psychologist’s
of-­command, and direct subordinates (Johnson fitness report—the psychologist receives consider-
et al., 2005; Kennedy & McNeil, 2006; Staal & able pressure to “re-think” the findings before sub-
mitting them formally.
Stephenson, 2006). Although the Ethics Code
implores psychologists to exercise maximum An Army psychologist, newly stationed at a small
caution about participating simultaneously in forward deployed surgical unit in Afghanistan, is
more than one kind of relationship with any cli- alarmed when she discovers that soldiers and
ent (APA, 2010), multiple relationships in mili- marines who have experienced traumatic events
(e.g., death of close friends in combat, exposure to
tary psychology are ubiquitous and utterly remains after IED explosions) are screened for
unavoidable. Multiple relationships are most PTSD only with a short paper and pencil screening
risky when there are substantial differences or tool. The tool has high face validity, leading her to
conflicts between two or more roles filled by the believe that many impaired soldiers are denying
symptoms in order to “stay in the fight.” When the
psychologist, when the multiple roles cause sig- psychologist objects, noting that many of the com-
nificant distress or discomfort, when an extra-­ batants she interviews personally are quite symp-
treatment role diminishes the value of the tomatic for PTSD, and that a brief screener is not
treatment relationship, or when a multiple rela- an adequate method for conducting psychological
evaluations, the surgical unit CO says, “we don’t
tionship increases the risk for exploitation need to be over-diagnosing here. If they score low
(Kitchener, 2000).
110 W.B. Johnson and K.L. Landsinger

on the screener, get ‘em back out in the field. How  onsultation to Detainees or
C
would it look if we started diagnosing PTSD all the
time?”
Intelligence-Gathering Operations

As in any organization, psychologists A detainee who is living on the psychiatric cell

block for self-injurious behaviors agrees to meet
employed by the military may at times feel pres- with interrogators. When he comes back, he
sure to suppress or misrepresent research find- appears to be in good spirits, which is documented
ings that are unpopular with senior military or in his mental health record. A few hours later, the
governmental leaders. In the first vignette above, interrogator comes back to the unit and requests
copies of all the detainee’s mental health records.
the psychologist is placed in an ethical quandary He cites “national security” as a rationale and
when implicitly pressured by a superior officer to notes that “you wear the uniform; you should
shelve or somehow tamper with the results of a understand how this works.” When the psycholo-
study that clearly contradict the military’s public gist declines to give him the records, he immedi-
ately approaches the prison commander who
statements about soldier willingness to report subsequently orders the psychologist to release the
ethical transgressions against enemy combatants. records to the interrogator.
The ethical obligation to be transparent and hon-
est in reporting results is created by Standards Few issues in recent memory have created
2.04 and 9.01 of the Ethics Code (APA, 2010), more heated debate and divisive polarization
which creates a mandate for psychologists to among psychologists than the issue of psycholo-
base all opinions contained in their recommenda- gist participation in national security intelligence
tions, reports, and diagnostic evaluation state- gathering, specifically, interrogation work.
ments on information and techniques sufficient to Although there has been strident opposition to
substantiate their findings. Military psychologists participation in national security intelligence
must be vigilant regarding pressure, even coer- work on the part of psychologists, the words
cion, to deliver research or clinical outcomes that “interrogation” and “torture” are too often con-
are preferred or directly requested by an author- flated by opponents of psychologist consultation
ity but which are not based entirely on the best to interrogations, making reasoned dialogue
evidence available. nearly impossible. In fact, there is clear and con-
In the second vignette, the psychologist expe- sistent empirical evidence that interviewers and
riences pressure to ignore a scientifically and interrogators using rapport-based techniques do
professionally questionable approach to evaluat- gather valuable and actionable intelligence from
ing service members following traumatic events, detainees without causing harm (Johnson, 2013a;
as well as to downplay her own clinical evidence Meissner, Redlich, Bhatt, & Brandon, 2012).
gathered from interviews with some of these Moreover, the APA’s policy development over
combatants. Military psychologists must be cau- the past decade has unequivocally: (a) prohibited
tious about becoming coopted by commanding torture, cruel, inhuman, and degrading treatment;
officers in achieving expeditious administrative (b) prohibited harsh (“enhanced”) interrogation
outcomes (Howe, 2003; Jeffery et al., 1992; techniques; (c) prohibited psychologists from
Johnson, 2016). Clinical psychologists in uni- mixing roles with detainees or disclosing clinical
form are sometimes pressured to diagnose par- healthcare records to intelligence entities
ticularly troublesome service members with (Johnson, 2013a; Kennedy & Johnson, 2009).
personality disorders (leading to expeditious In the case above, the psychologist is clearly
administrative separations) or to minimize or out- correct in refusing to release client information to
right suppress evidence of psychopathology (e.g., an interrogator. Ethical standards bearing on mis-
PTSD, substance abuse, depression), in order to use of a psychologist’s work, multiple roles, con-
keep a high-value service member “in the fight” fidentiality, and conflicts between ethics and both
or to protect the military from negative public the law and organizational demands are all rele-
relations or expensive mental health care vant in supporting his decision. Although correct
services. in his ethical assessment and decision, it is clear
8  Ethical Issues in Military Psychology 111

that this military psychologist’s efforts to abide Embedded psychologists are sometimes
by the Ethics Code and APA policy are not well exposed directly or vicariously to traumatic
supported by his command. Should he continue events and disturbing images. Deployment-­
to experience pressure to behave unethically or in related stressors for psychologists include
any manner that violates human rights, it is also extended absences from family, exposure to
important that he solicit legal consultation. direct threat, and exposure to traumatic client
Most recently, the APA has passed a new pol- material (Johnson, Bertschinger, Snell, & Wilson,
icy effectively prohibiting any psychologist from 2014; Kraft, 2007). It is, of course, inevitable that
providing services to detainees at Guantanamo some of these psychologists will become
Bay (GITMO: APA, 2015). Although not part of “wounded healers” (Daneault, 2008), or psychol-
the ethics code, and therefore not enforceable by ogists who have become distressed and some-
the Ethics Committee at this time, a psychologist times impaired as a result of their work.
might be expelled from the APA should he or she Although psychologists are ethically required
provide any mental healthcare for detainees at to limit or suspend their professional work when
GITMO. This policy is the first that we know of too distressed or impaired to practice compe-
prohibiting psychologists from working in a spe- tently (APA, 2010), severely distressed clinicians
cific context or setting. In our view, it creates an are often the last ones capable of making such
unfortunate precedent; it implies that even appro- competence assessments effectively (Davis et al.,
priately trained military psychologists cannot 2006). In the case above, the psychologist is very
reasonably practice ethically with national secu- likely to be suffering from compassion fatigue,
rity detainees. As a consequence of the new pol- secondary traumatic stress, and possibly burnout
icy, DoD has begun withdrawal of all uniformed more generally that serve to suppress her compe-
psychologists from GITMO, leaving detainees tence and place her clients of risk of incompetent
without high-quality mental health care. At the care (Johnson, Bertschinger, Foster, & Jeter,
writing of this chapter, we note there appears to 2014). Although it is incumbent on this psychol-
be no concern within APA about the ethical ogist to own some awareness of her slipping
implications of leaving detainees without psy- competence and to seek consultation or somehow
chological care. limit her practice until her coping improves
(APA, 2010), it is equally incumbent on her
broader healthcare professional community to
 he Psychologist’s Own Psychological
T engage her in assessing competence and support-
Fitness ing her in regaining personal stasis. In combat
environments, isolated duty assignments, and
Several months into a combat theater deployment, when working with traumatized client popula-
a Navy psychologist finds that she is having great
difficulty attending to her clients. She has heard so
tions, it may truly “take a village” to monitor and
many grisly and traumatic stories of death and preserve professional competence.
injury from the combatants she treats, she has
begun to have nightmares and difficulty sleeping.
She also misses her daughter back home terribly.
On off days, she has begun to ride the base bus
Conclusion and Recommendations
around for hours at a time, drinking up to a fifth of
vodka in a day. She cringes to herself the next day Military psychologists often work and provide
when she realizes she is still somewhat intoxicated services in a milieu that creates or exacerbates
doing triage clinical work. Although she has some
awareness that she is struggling emotionally and
ethical tensions and conflicts. Uniformed mili-
that her coping strategies are risky, she is the only tary psychologists often struggle with their dual
psychologist at the base and reluctant to admit—to identities as military officer and licensed health-
herself or anyone else—that she can’t “hack it” care professional, and they occasionally encoun-
like the brave men and women she sees every day
in her clinic.
ter mixed-agency dilemmas in which ethical
obligations to individual clients may not easily be
112 W.B. Johnson and K.L. Landsinger

reconciled with obligations to a larger institution • Know ethical standards and federal statutes
or the exigencies of a specific military mission. and abide by an ethical decision-making pro-
Among other common ethical quandaries, mili- cess: Having facility with your professional
tary psychologists often report concern about ethics code as well as those government regu-
boundaries of competence, confidentiality, mul- lations and federal laws most relevant to your
tiple relationships, sudden—and unanticipated— specific work is critical to thinking wisely
role shifts, ensuring accuracy in research findings about your various obligations. Moreover, it is
and clinical diagnoses, preserving their own psy- always wise to abide by a consistent and prag-
chological fitness, and in rare cases, consulting to matic ethical decision-making process when
detainee mental health care. confronted with a dilemmas or conflict (e.g.,
We conclude this chapter with several brief Barnett & Johnson, 2008; Kitchener, 2000).
recommendations for military psychologists • Appreciate the distinction between mixed-­
designed to reduce or mitigate ethical tensions so agency tensions and conflicts: Although ten-
that they do not escalate into ethical conflicts sions between distinct ethical obligations,
(Johnson, 2008, 2014, 2016; Johnson et al., between ethics and laws, and between ethical
2005). obligations owed to various entities will occur
with some frequency, remember that most of
• Establish strong consultative relationships these tensions can be resolved effectively with
with senior members of the military organiza- thoughtful dialog and consultation. Most ten-
tions that solicit your services. Quite often, sions need not escalate to the point of an ethi-
collaborative and proactive working relation- cal conflict (e.g., when abiding by a law will
ships with commanding officers and others violate an ethical standard or vice versa).
will prevent conflicts related to intrusions on • Assume that every member of the military
client confidentiality; leaders will be more organization is a potential client: Owing to
inclined to defer to your judgment regarding a isolated duty stations, deployments with the
service member’s disposition if they know and units you serve, and the close quarters and
trust you. daily boundary crossings ubiquitous to mili-
• Remember that your commissioned military tary psychology, assume that any member of
status does not override your obligations to the unit may very well become a client at
the Ethics Code: As you reason through ethi- some point. Balance friendly collegiality with
cal quandaries and conflicts, remain attuned to good personal boundaries in anticipation of
your unequivocal obligation to abide by the possibly shifting to a service-delivery role
Ethics Code (APA, 2010). Although balancing with colleagues, subordinates, and superiors.
ethical obligations with federal statutes and • Increase your own tolerance for routine
the exigencies of a military mission is criti- boundary crossings: Because everyday inter-
cally important, your identity as a military actions with clients external to the consulta-
officer will not necessarily buffer you from the tion room are unavoidable and inevitable in
professional consequences of transgressing an military settings, work diligently to increase
ethical standard. your comfort with such interactions while
• Provide rigorous and ongoing informed con- doing your best to preserve privacy, confiden-
sent to all clients: Appreciating that delivery tiality, and the client’s best interests. Be sure
of psychological services in military settings to have conversations with clients about how
comes with persistent risks to confidential- they would prefer to handle such interactions
ity, multiple roles, and unanticipated role during the informed consent process.
shifts, be particularly attentive to securing • Establish and maintain ongoing external con-
detailed and ongoing informed consent for sulting relationships: In order to maintain
services from clients (both individual and ­reasonable boundaries with members of the
organizational). military community—particularly when
8  Ethical Issues in Military Psychology 113

embedded with a unit on deployment— Daneault, S. (2008). The wounded healer. Canadian
Family Physician, 54, 1218–1219.
arrange and nurture at least one solid collegial
Davis, D. A., Mazmanian, P. E., Fordis, M., Harrison,
consulting relationship external to your mili- R. V., Thorpe, K. E., & Perrier, L. (2006). Accuracy
tary community. Such relationships can be of physician self-assessment compared with observed
important both for ethics consultations and for measures of competence: A systematic review.
Journal of the American Medical Association, 296,
collegial friendship and your own mental
1094–1102.
health. Driskell, J. E., & Olmstead, B. (1989). Psychology in the
• Remain attuned and responsive to your own military: Research applications and trends. American
levels of distress and competence: Especially Psychologist, 44, 43–54.
Gutheil, T. G., & Gabbard, G. O. (1993). The concept
when deployed to a combat theater, embedded
of boundaries in clinical practice: Theoretical and
with a military unit for extended periods, or risk-management dimensions. American Journal of
when providing services to traumatized ser- Psychiatry, 150, 188–196.
vice members, be sure to vigorously pursue Howe, E. G. (2003). Mixed agency in military medi-
cine: Ethical roles in conflict. In D. E. Lounsbury &
self-care, actively engage with colleagues (via
R. F. Bellamy (Eds.), Military medical ethics: Volume
distance consultation if necessary), be self-­ I (pp. 331–365). Falls Church, VA: Office of the
compassionate, and seek honest assessments Surgeon General, U. S. Department of the Army.
of your current psychological and professional Jeffery, T. B., Rankin, R. J., & Jeffery, L. K. (1992). In ser-
vice of two masters: The ethical-legal dilemma faced
competence.
by military psychologists. Professional Psychology:
• Always ask yourself: In this situation, what is Research and Practice, 23, 91–95.
in my client’s best interest? When ethical or Johnson, W. B. (2008). Top ethical challenges for mili-
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