What are the ethical issues involved in providing psychotherapy for pain populations?
Patients who are referred for pain psychology evaluation and treatment by their health care practitioner may not appreciate that the referring party will confer with the mental health professional about their psychological condition. The way in which information is communicated needs to be discussed and understood by the patient. In addition, in cases where the patient has ongoing litigation, they should be made aware that they may have waived the privilege of confidentiality due to the legal case, and that therefore all of their psychological records may be subject to discovery and open to subpoena. The potential for harm in these circumstances requires a thoughtful informed consent, patient education, consultation with the patient’s attorney if permission is granted, and an understanding of the implications of the release of sensitive personal information. Another area of ethical concern is that patients and providers may request professional opinions that are outside the psychotherapist’s scope of expertise, such as providing legal or medical recommendations. Psychotherapists, especially psychologists, are often asked to conduct psychological evaluations for pain populations. An important ethical consideration with these evaluations is the selection of tests and measures appropriate for pain populations, and the use of standardized normative data based on these populations for the interpretation of test data (i.e., not only relying on psychological tests standardized on psychiatric patient populations but including those standardized on medical patient populations to avoid inflation of scales due to incorrect norms).