Ethical Practice in Small Communities: Challenges and Rewards for Psychologists


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Book provides important contribution to field
(February 2007 Issue)

“Ethical Practice in Small Communities: Challenges and Rewards for Psychologists”
By Janet A. Schank and Thomas M. Skovholt American Psychological Association Washington, D.C., 2006

By Paul Efthim, Ph.D.

When "Ethical Practice in Small Communities" arrived on my desk, I immediately assumed it was some sort of guide for rural practitioners. It seemed like an ideal book to review for this publication, which reaches psychologists far outside the urban centers of New England.

Once I began reading, however, I was surprised how readily the geographic notion of "small community" can be expanded quite usefully to include many other possibilities, including military and law enforcement settings, gay, lesbian, bisexual and transgender communities, ethnic, linguistic and faith-based communities, the deaf community, small colleges and therapists who treat other therapists. The potential audience for a book on this topic is quite broad, as many of us practice and live within such close-knit groups.

If we live and work in a small community, how do we practice ethically while our personal lives overlap with those of our clients? This is the key dilemma for small-community practitioners, according to psychologist authors Janet Schank and Thomas Skovholt, both from Minnesota. Although there are a number of excellent guidebooks on ethical practice, they tend to give relatively brief attention to the unique challenges encountered in small communities. Schank and Skovholt have produced perhaps the first comprehensive consideration of the topic between two covers.

The opening two chapters review the broad context of professional ethics and the specifics of the 2002 revision of the APA Ethics Code. Next, the book lays out the ethical issues most relevant to psychologists in small communities: multiple/dual relationships ("sometimes unavoidable"), confidentiality, limits of competence, bartering, sexual relationships (two words: never appropriate) and informed consent to treatment. Later sections cover rural practice, other small communities and specific strategies to minimize risk. The book concludes with recommendations for both individual practitioners and for psychology in general.

As any practitioner in a small community can attest, a slew of problems can arise in such settings, particularly around multiple relationships and roles. For example: a spouse may have accepted a dinner invitation to another couple's home, not knowing that the psychologist partner is seeing one of the partners in therapy. A former patient walks in to a therapist's regular AA meeting. A psychologist risks personal isolation by not getting involved in community groups to avoid having contact with current and former patients.

Schank and Skovholt guide readers through such dicey terrain by outlining a decision-making process that involves systematic use of the relevant ethics codes and principles, consideration of patients' needs, acknowledgment of constraints on available options in small communities, use of consultation and so on. They show how to talk to patients about such dilemmas and how to anticipate many of the small-world problems that one cannot specifically predict but can generally anticipate: e.g., "How should we handle it if we see each other at a social gathering?" As indicated in the subtitle, the book also considers the rewarding aspects as well as the downsides of working and living in the same community.

Many of the book's sections sound like a literature review from a dissertation and in fact, the book did grow out of a qualitative dissertation by the first author. This fact helps explain some of the volume's strengths and weaknesses. Extensive excerpts from interviews with small-community psychologists breathe life into ethical concepts that can seem rather abstract. At the same time, the book's scholarly writing style and heavy reliance on academic citations makes for a choppy read. Several intriguing concepts (e.g., "boundaried generosity") are introduced but not explained.

Despite some of its stylistic shortcomings, this book is an important contribution to the field and is recommended to practitioners in small and contained communities.

Paul Efthim, Ph.D. is a licensed psychologist in full-time practice in Brookline, Mass. He holds a faculty appointment at the Massachusetts School of Professional Psychology.