Ethically Speaking

For APA Board Member Barry Anton, PhD, the long flights between his home base in Tacoma, Wash., and APA headquarters represent precious time to get work done. That's why he sometimes flies undercover: If his seatmates ask what he does, he tells them he's a funeral home director.

"They're usually not too eager to talk about coffins and urns," says Anton, who took more than 100 flights last year. "Most people don't want to talk about death on an airplane."

More often, Anton simply avoids eye contact, puts on his noise-canceling headphones and pulls out a stack of work. Doing so not only allows him to use his time productively. It also means he can avoid getting sucked in to fellow passengers' requests for advice on their mental health problems. And that means he can also avoid getting caught up in the sticky ethical dilemmas that can result.

Enforced intimacy

There's something about being in close quarters with strangers for hours that does something to people, says APA President Melba J.T. Vasquez, PhD.

When seatmates hear you're a psychologist, she says, they typically have one of two reactions. "Some people get a little paranoid, and say, 'I'm going to quit talking now that I know you're a psychologist because you must be analyzing me,'" she says. "Others don't shut down; instead, they want to share more."

It's the ones who want to tell you all about their problems that you have to watch out for, warns Lindsay Childress-Beatty, JD, PhD, of APA's Ethics Office. That's true whether the person is a seatmate, a fellow party-goer or anyone else a psychologist might encounter in a social setting.

There's not much in APA's Ethics Code that applies specifically to such situations, says Childress-Beatty. The code does require psychologists to have an adequate basis for diagnosing or offering recommendations, and it requires psychologists to stay within the boundaries of their own professional competence. "People hear you're a psychologist and assume you know everything about everything having to do with psychology," says Childress-Beatty.

But these and other standards apply to psychologists' professional relationships, not their private lives. When the person in the aisle seat starts asking for advice, Childress-Beatty emphasizes, a psychologist's No. 1 goal should be to avoid giving even the appearance that he or she is establishing a professional relationship with that person. That means sticking to generalities and not letting the other person pull you into the details. Of course, says Childress-Beatty, "that is exactly what they're often going to want to do."

Letting them do so could potentially open up liability issues, says psychologist Jeffrey N. Younggren, PhD, a risk management consultant for APA's Insurance Trust.

"Giving specific advice to someone you haven't evaluated is not only clinically unwise, it's also legally unwise," says Younggren.

By engaging in psychological talk, you also open yourself up to getting tangled up in duty-to-report troubles. "What if someone next to you tells you about child abuse?" says Younggren. While you haven't established a professional relationship with that person, he says, you may still have a duty to report—even though you may not even know who your seatmate is. "Violation of duty is something you can get sued for," he warns.

Small talk over pretzels

Potential liability probably isn't something you want to worry about at 30,000 feet, or even in your neighbor's backyard. How can you avoid such concerns?

One common strategy is simply to refuse to engage. Younggren, for example, puts his headphones on immediately and doesn't talk to anyone. "I can be pretty isolated on an airplane," he says.

When Vasquez is on a plane, she is willing to chat over meals, but if someone does ask a psychological question, she usually says "I'm off-duty right now," or "I'm a psychologist, but I'm not your psychologist."

Psychologists should always be kind, however. "It's important to be compassionate to someone, as a human being," says Vasquez. If a seatmate reveals a problem, such as a grandchild's autism diagnosis, Vasquez will explain that that's not her area of expertise, make it clear she's not acting in a professional role and then say something along the lines of "It's my understanding that what's helpful to people in that situation is …" She'll then go on to share general educational information, but also suggest other resources. Psychologists can steer seatmates to APA's Help Center (www.apa.org/helpcenter), for example, which offers articles on anxiety, depression and dozens of other topics.

Anton uses similar tactics. "I always try to be respectful of people," he says. Outside the "therapeutic environment" of his own office, where informed consent and confidentiality rule, he limits himself to giving general advice and handing out business cards with an invitation to contact him for referrals to psychologists in the person's home town.

If the person next to him is afraid of flying, for instance, Anton might explain that flying is much safer than driving to the airport. "A lot of times, educating a person about unrealistic fears is in fact a therapeutic intervention," he says. "A layperson could do it."

Occasionally, there will be an airborne crisis, whether it's a fearful flyer having a panic attack or someone having some other kind of psychological emergency. If the person next to you seems to be in distress or announces that he's suicidal, says Childress-Beatty, a psychologist could encourage the person to alert a flight attendant or do so him or herself. "There's no psychologist/patient relationship, so the conversation is not confidential," she says.

Sometimes a flight attendant will approach a psychologist for help. After all, says Anton, the flight manifest typically indicates who's a doctor. He has had two occasions when the crew has turned to him for assistance, both times for a nervous flyer with shortness of breath that turned out to be a panic attack.

"You can help in those kinds of emergency situations," says Younggren, explaining that you may be protected under Good Samaritan laws. "Regardless of immunity, your conduct would still be covered by your malpractice insurance and is an exception that is understood in the Ethics Code."

Sometimes, adds Anton, it can be difficult to resist the urge to offer advice even when it's not an emergency.

"Children act out on planes, and I'm a child and family psychologist," he says. "You want to go over to parents and say, 'Here's a good way to manage that behavior.' But I resist: I don't want to impose myself on someone."


Rebecca A. Clay is a writer in Washington, D.C.

Want continuing education on ethical issues? Visit our "Ethics Rounds" series by Dr. Stephen Behnke, director of APA's Ethics Office. To complete each program, read the learning objects and the articles, then purchase and complete the online exam. Go to CE Resources and search for "ethics rounds."