Ethics in Sport Counseling

Assignment 3: Ethics in Sport Counseling It is vital to have a sound ethical foundation during all aspects of practice. As a sport psychologist, when providing counseling to student athletes, be sure to adhere to the code of ethics.For this assignment, search the Internet for the code of ethics of the American Counseling Association (ACA). Use the following keyword for your Internet search:ACAYou may also refer to the Web link in the American Counseling Association of this course.Read the following articles found in Doc Sharing:Ethical Issues in Exercise PsychologyEthics in Sport and Exercise PsychologySummarize the ACA code of ethics. Add bullet points with the ways the code may need to be different or interpreted differently for sports psychology clients. Add a conclusion that explains whether any dynamics and considerations of athletes as clients make the ethical code for sport psychologists unique. Submit your response in Microsoft Word and submit this to the Submissions Area by the due date assigned. Name your file SP6104_M1_A3_lastname_firstinitial.doc. All written assignments and responses should follow APA rules for attributing sources.Grading CriteriaMaximum Pointsxplained clearly the dynamics that attribute to the uniqueness of the sport psychologists’ ethical code.14Accurately and logically supported response through examples.14Wrote in a clear, concise, and organized manner; demonstrated ethical scholarship in accurate representation and attribution of sources, displayed accurate spelling, grammar, and punctuation.4Total:32

Ethical Issues in Exercise Psychology

Jeffrey S. Pauline, Gina A. Pauline, Scott R. Johnson, and Kelly M. Gamble

School of Physical Education, Sport, and Exercise Science Ball State University

Exercise psychology encompasses the disciplines of psychiatry, clinical and counsel- ing psychology, health promotion, and the movement sciences. This emerging field in- volves diverse mental health issues, theories, and general information related to physi- cal activity and exercise. Numerous research investigations across the past 20 years have shown both physical and psychological benefits from physical activity and exer- cise. Exercise psychology offers many opportunities for growth while positively influ- encing the mental and physical health of individuals, communities, and society. How- ever, the exercise psychology literature has not addressed ethical issues or dilemmas faced by mental health professionals providing exercise psychology services. This ini- tial discussion of ethical issues in exercise psychology is an important step in continu- ing tomovethefield forward.Specifically, thisarticlewilladdress theemergenceofex- ercise psychology and current health behaviors and offer an overview of ethics and ethical issues, education/training and professional competency, cultural and ethnic di- versity, multiple-role relationships and conflicts of interest, dependency issues, confi- dentiality and recording keeping, and advertisement and self-promotion.

Keywords: ethics, exercise psychology, sport psychology

The emerging field of exercise psychology consists of diverse mental health issues, theories, and general information related to physical activity and exercise. Exer- cise psychology encompasses approaches from the fields of psychiatry, clinical and counseling psychology, health promotion, and the movement sciences (Buck- worth & Dishman, 2002a). The establishment of optimal mental health with nonclinical, clinical, and population based settings is often the primary focal point of exercise psychology practitioners. Physical activity is viewed as a treatment

ETHICS & BEHAVIOR, 16(1), 61–76 Copyright © 2006, Lawrence Erlbaum Associates, Inc.

Correspondence should be addressed to Jeffrey S. Pauline, School of Physical Education, Sport, and Exercise Science, Ball State University, Muncie, IN 47306-0270. E-mail: jpauline@bsu.edu

modality for mood alteration, management of psychopathology and stress, and en- hanced self-worth. Exercise psychology practitioners also focus on factors related to exercise program characteristics that influence exercise adoption and adherence for individuals, groups, and communities (Berger, Pargman, & Weinberg, 2002).

The field of exercise psychology and consulting has many opportunities for growth. Potential employment opportunities can be found in the areas of colleges and universities, management of corporate fitness programs, counseling in physi- cal rehabilitation clinics, and individual consultation with a diverse clientele. The effectiveness of exercise practitioners or consultants is often dependent on their ability to develop a collaborative relationship with their clients and other professionals.

When consulting with exercisers and/or incorporating exercise into a traditional treatment plan, mental health practitioners may feel as if they are treading in un- charted waters due to some of the unique consultation circumstances and settings in the exercise environment. Until now, the literature has not directly addressed ethical issues or dilemmas related to providing exercise adherence counseling ser- vices or including exercise as a component of a traditional treatment plan. The heightened media attention and rising mental health care costs have increased the allocation of funding by federal agencies (i.e., National Institutes of Health) to en- hance physical activity patterns. Therefore, the need and opportunity for practitio- ners to assist with exercise adoption and maintenance is only going to increase over the next decade as we continue to search for alternative treatment options to fight physical health problems (e.g., obesity) and mental health issues. With this increased opportunity and demand, the need to provide proper guidance to practi- tioners implementing exercise as a component of therapy must be examined.

Thus, the remainder of this article will focus on selected ethical issues and po- tential ethical dilemmas facing mental health professionals who provide exercise adherence consultations and/or include exercise as a component of counseling or therapy. Specifically, this article will address the emergence of exercise psychol- ogy and current health behaviors, an overview of ethics and professional resources, education/training and professional competency, cultural and ethnic diversity, multiple-role relationships and conflicts of interest, dependency issues, confiden- tiality and recording keeping, and advertisement and self-promotion. In conclu- sion, future issues and opportunities related to the field of exercise psychology will be presented.

EMERGENCE OF EXERCISE PSYCHOLOGY AND CURRENT HEALTH BEHAVIORS

The emergence of exercise psychology is due to the decline in lifestyle and behav- ioral choices. In America today, choosing desirable health behaviors such as regu-

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lar physical activity and a healthy diet are not typically practiced to the degree they should be. According to the U.S. Department of Health and Human Services (USDHHS; 2000) Healthy People 2010 report, only 22% of adults in the United States engage in moderate physical activity for 30 min five or more times a week, whereas nearly 25% of the population is completely sedentary. Furthermore, when people do attempt to modify a lifestyle behavior by, for example, increasing physi- cal activity, many are unable to maintain the adapted behavior. The physical activ- ity adherence research reports dropout rates up to 50% within the first 6 months of the start of an exercise regimen (Dishman, 1988).

The cause for weight gain in Americans has been clearly identified. Simply put, we are eating more and exercising less than ever before. Americans are eating approximately 15% more calories than in previous years (Putnam, Kantor, & Allshouse, 2000). Combine the increased caloric consumption with the previously mentioned physical activity patterns and you have a formula for weight gain for a large segment of our society.

Based on the aforementioned statistics and data regarding obesity, diet, and physical inactivity, the outlook may appear bleak. However, there is hope due to the development of effective behavioral and cognitively based intervention strate- gies to assist individuals with the adoption and maintenance of more active life- styles (Buckworth & Dishman, 2002b). Currently, there is an abundance of litera- ture indicating that the adoption of a more active lifestyle will enhance mental well-being (reduce depression and anxiety and enhance self-esteem) while de- creasing the likelihood of developing obesity and other risk factors (i.e., high blood pressure and cholesterol) for chronic diseases such as cardiovascular disease and cancer (USDHHS, 1996). Furthermore, the literature clearly indicates that an indi- vidual does not have to be an athlete or exercise vigorously to engage in beneficial exercise (Public Health Service, 2001). The American College of Sports Medicine (ACSM; 2000) training guidelines for physical fitness and exercise performance recommends for aerobic activities 3 to 5 days per week of moderate-intensity exer- cise for 20 to 60 min (in at least 10-min sessions) and weight training that includes one or more sets of 8 to 12 repetitions of 8 to 10 exercises at least 2 days a week.

Interestingly, many practitioners are utilizing exercise as a therapeutic modality to improve traditional psychological services. Hays (1999) indicated that exercise can be utilized to cope with clinical issues (e.g., depression, anxiety, and weight management), issues of daily living, and improving self-care. Exercise psychology research supports the use of exercise as a treatment modality for both clinical and nonclinical clients (Buckworth & Dishman, 2002a). Based on the well docu- mented physical and psychological benefits of exercise, psychologists and coun- selors need to be aware of the benefits that can be gained by adding exercise to a traditional treatment plan. However, due to issues pertaining to ethical dilemmas and/or competency, some practitioners may believe it is unethical to include exer- cise as part of a treatment plan despite the literature supporting its use.

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For most people physical activity poses minimal risks. However, it is important that all clients, regardless of ethnic or cultural background, obtain physician ap- proval to begin an exercise regimen. In addition to the physician approval, con- servative therapists desiring to add exercise to treatment should also have their cli- ents complete the Physical Activity Readiness Questionnaire (PAR-Q; British Columbia Ministry of Health, 1978). The PAR-Q is designed to identify adults who may not be suited to participate in physical activity due to various physical ailments.

ETHICS OVERVIEW AND PROFESSIONAL RESOURCES

The purpose of an ethics code is to provide guidance and governance for a profes- sion’s members in working settings. An ethics code provides integrity to a profes- sion, professional values and standards, and fosters public trust through the estab- lishment of high standards (Fisher, 2003). It should be noted that no code of conduct or set of ethical guidelines can account for all possible situations or ethical dilemmas. Ethical codes are developed from the current values and beliefs in soci- ety as related to a profession. These values and beliefs, as well as common profes- sional practices, can and do change with the passing of time due to numerous fac- tors, making it necessary for ethical codes and standards to also change.

The American Psychological Association (APA; 2002) ethics code is a well de- veloped and ever-evolving document that provides ethical principles and codes of conduct to govern and guide its membership. In contrast, the Association for the Advancement of Applied Sport Psychology’s (AAASP; 1994) ethical code is de- rived from the APA’s (1992) ethics code and has not been updated since its incep- tion. It is designed to address issues specific to sport and exercise psychology work. There are differences between APA and AAASP ethical principles and codes. Those differences will be discussed later as they relate to exercise consulta- tions. Whelan, Meyer, and Elkin (2002) provided a detailed discussion of the AAASP principles and ethical standards and serve as a good reference for a sport and exercise psychology practitioner preparing to be or currently involved with sport psychology consulting or exercise adherence counseling. Fisher (2003) and Bernstein and Hartsell (2004) also serve as good sources for both general practitio- ners and exercise consultants.

The ACSM is recognized by health professionals throughout the world as the leading organization and authority on health and fitness. The ACSM’s primary fo- cus is to advance health through science, medicine, and education. Furthermore, the ACSM (2003) has established a code of ethics with the principal purpose of “generation and dissemination of knowledge concerning all aspects of persons en-

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gaged in exercise with the full respect for the dignity of people” (¶ 1). To achieve its principal purpose, the ACSM (2003) established the following four sections:

1. Members should strive continuously to improve knowledge and skill and make available to their colleagues and the public the benefits of their professional expertise.

2. Members should maintain high professional and scientific standards and should not volun- tarily collaborate professionally with anyone who violates this principle.

3. The College, and its members, should safeguard the public and itself against members who are deficient in ethical conduct.

4. The ideals of the College imply that the responsibilities of each Fellow or member extend not only to the individual, but also to society with the purpose of improving both the health and well-being of the individual and the community. (¶ 1)

Therefore, the ACSM is an excellent resource for mental health professionals to consult for guidance concerning issues related to exercise, health, and fitness.

EDUCATION/TRAINING AND PROFESSIONAL COMPETENCY MAINTENANCE

The field of exercise psychology is a merger between psychology and exercise or movement science. Individuals specializing in either of these areas will have dif- ferent competencies and thus the ability to practice with different populations. Most professionals recognize the value of having individuals in the field from both backgrounds due to the uniqueness of their training. The APA (2002) ethics code specifies that in emerging areas such as exercise psychology practitioners should “take reasonable steps to ensure the competence of their work and to protect cli- ents/patients, students, supervisees, research participants, organizational clients, and others from harm” (p. 5).

The ideal training for exercise therapists or consultants is an ongoing debate. The two primary sources of training for exercise practitioners are (a) psychology (i.e., counseling or clinical psychology) and (b) the movement sciences (i.e., kinesiology or exercise physiology). As previously mentioned, psychology and movement sciences have been meshed together to form the discipline of exercise psychology. However, these two disciplines are indeed separate and pose a com- plex issue concerning training. Training for exercise practitioners is complex due to licensure. Clearly, to refer to oneself as a “psychologist,” an individual must sat- isfy the state requirements for licensure within the state in which he or she works. Most people trained in the movement sciences can specialize in exercise psychol- ogy but will likely not be able to meet the requirements for psychology licensure. Thus, practitioners can not ethically refer to themselves as “exercise psycholo- gists” because they will not be licensed as psychologists within their state of em-

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ployment. Likewise, licensed psychologists with limited or no training in the movement sciences should not ethically refer to themselves as “exercise psycholo- gists” because of a lack of proper training in exercise science.

Education and training from both exercise or movement science and psychol- ogy is a necessity for scholar–practitioners in the field of exercise psychology. Due to the interdisciplinary nature of exercise psychology, students will most likely need to create an individualized plan of study suited to meet their future goals and career objectives by combining courses from traditional psychology, sport sci- ences, and sport and exercise psychology. In 1991, AAASP established certifica- tion criteria for becoming a certified consultant of AAASP. The interdisciplinary requirements of AAASP certification require coursework and practicum guide- lines for students who desire or specialize in applied sport or exercise psychology (Sacks, Burke, & Schrader, 2001). The requirements appear adequate and are nec- essary but reflect only minimal foundational training. AAASP certification re- quirements should not be viewed as sufficient training to become an effective exer- cise consultant. Furthermore, the attainment of AAASP certification requirements does not permit an individual to ethically use the title “exercise psychologist.”

The following is a recommendation of minimal interdisciplinary coursework based on most state licensure requirements and AAASP certification, to be compe- tent to do specialized consultation in exercise psychology. This recommendation is not a comprehensive list intended to address every possible career aspiration within exercise psychology, but it can provide some initial guidance. The interdis- ciplinary coursework should focus on the areas of psychology, sport science, and sport psychology. The exercise psychology curriculum should include

1. Traditional psychology courses such as human growth and development; biological, social, and cultural bases of behavior; counseling skills; psychopathology; individual and group behavior; psychological assess- ment; cognitive–affective bases of behavior; professional ethics and stan- dards; statistics; and research design.

2. Sport science courses should incorporate biomechanical and physiological bases of sport, motor development, motor learning, fitness assessment, fundamentals of strength and conditioning, aerobic and weight training, and sport nutrition.

3. Last, sport psychology, performance enhancement, exercise psychology, health psychology, and social aspects of sport and physical activity should be included.

In addition to formal coursework, practical experience (i.e., internships and/or practicum) focused on the application of psychological principles, theories, and practices in the exercise setting is also a necessity. The practical experience must be supervised by a qualified specialist (e.g., licensed psychologist, licensed mental

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health practitioner, or certified consultant of AAASP) within the field of exercise psychology. The aforementioned curriculum and practical training seems to pro- vide the necessary education for mental health professionals regarding the physi- cal and psychological benefits of exercise.

Nevertheless, this initial, formal coursework and applied experience is not in and of itself enough to allow one to practice ethically throughout his or her career. Maintaining professional competence through continuing professional education is extremely important in any field, including exercise psychology. The scientific and professional knowledge base of psychology and exercise/movement science is continually evolving, bringing with it new research methodologies, assessment procedures, and forms of service delivery. Life-long learning is fundamental to en- sure that teaching, research, and practice have an ongoing positive impact on those desiring services (Bickham, 1998). Both APA and AAASP provide a variety of op- portunities and methods for scholars and practitioners to maintain professional competency. Some of these methods include independent study, continuing educa- tion courses or workshops, supervision, and formal postdegree coursework.

Maintaining professional competency is also an important ethical requirement that is valued highly by the APA, the AAASP, and the ACSM. Over 96% of AAASP professionals recently surveyed by Etzel, Watson, and Zizzi (2004) be- lieved that it is important to maintain professional competency through continuing education training. This very high percentage is a clear indication of the value AAASP members place on maintaining professional competency. Maintaining professional competence through continuing professional education ensures that the scholars and practitioners in the field of exercise psychology are providing the most current services to their clients.

CULTURAL AND ETHNIC DIVERSITY

The ethical standards of the APA (2002) and the AAASP (1994) clearly indicate the importance of recognizing that human differences such as age, gender, and eth- nicity do exist and can significantly impact a practitioner’s work. The standards emphasize the responsibility to develop the skills required to be competent to work with a specific population or to be able to make an appropriate referral. The impor- tance of understanding the culture and background of a variety of populations is vi- tally important in both exercise and therapeutic settings.

Research indicates high rates of obesity and inactivity among women and mi- nority groups. About 33.4% of all women are obese, compared to 27.5% of men (Goldsmith, 2004). The age-adjusted prevalence of overweight and obesity in ra- cial/ethnic minorities, especially minority women, is generally higher than in Whites in the United States (Flegal, Carroll, Ogden, & Johnson, 2002). More spe- cifically, among women, non-Hispanic White women have the lowest occurrence

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(30.7%) of obesity, non-Hispanic Black women have the highest (49.0%), and Mexican American women are in the middle (38.4%; Hedley et al., 2004).

The importance of cultural sensitivity and awareness is clearly underscored by the aforementioned data. Barriers to exercise adherence are often directly or indi- rectly related to personal and cultural factors. Therefore, when working in the area of exercise consulting, a practitioner needs to consider the impact, positive and negative, of factors associated with gender, ethnicity, socioeconomic status, and other potentially relevant culturally based factors.

In traditional counseling and clinical settings, the impact of factors associated with gender, ethnicity, and culture is also highly relevant for successful outcomes. In 1972, the Association of Multicultural Counseling and Development (AMCD), was established to assist with recognizing the assets of culture and ethnicity, and other social identities and to address concerns about ethical practice (Arredondo & Toporek, 2004, p. 45). These factors are also pertinent for practitioners who desire to include exercise as a component of treatment. A series of essential questions to address prior to prescribing exercise as a therapeutic modality include: Is exercise valued in the culture and/or by the client? What is the prior exercise history of the client? What types of social support are available to assist the client with exercise adherence? Does the client’s culture create any additional barriers for adherence for exercise and traditional treatment?

MULTIPLE-ROLE RELATIONSHIPS AND CONFLICTS OF INTEREST

Multiple-role relationships are often viewed as occurring when the therapeutic connection has moved toward a friendship relationship (Bernstein & Hartsell, 2004). Multiple-role conflicts in therapy and consultations for exercise adherence may be encountered when clear boundaries have not been established. When the relationship boundary between the professional and client becomes clouded, the likelihood of multiple-role conflicts greatly increases. Every practitioner needs to maintain ethically proper professional boundaries. Establishing and maintaining such boundaries can be difficult due to the casual atmosphere that surrounds the exercise environment. The casual environment is created by the type of clothing worn during exercise, music being played, and the social atmosphere of many ex- ercise and rehabilitation facilities.

A first step in maintaining appropriate boundaries is to establish a common pro- tocol when communicating with all new clients. Instead of using first names, which seems to be a more common custom, it might be helpful to be consistent with the practice of referring to clients by last name and title (Miss, Ms., Mrs., and Mr. Brown). This practice encourages clients to maintain a distance from the therapist.

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Maintaining this distance becomes even more difficult when exercising with clients. Exercising together can be a great vehicle for building rapport and devel- oping communication between practitioner and client. Conversely, exercising with clients may cloud the boundaries and thus cause some confusion or ambiguity re- garding the nature of the relationship between client and practitioner. There are no current guidelines and/or laws relative to this specific situation. However, both the APA (2002) and AAASP (1994) ethic codes indicate that multiple roles can be in- appropriate and unethical if handled in the wrong way and need to be maintained with great caution. Clarifying the nature of the relationship during the intake and informed consent process, prior to exercising with the client, is of primary impor- tance. It is the practitioner’s ethical responsibility to have a candid discussion with the client that clearly defines a therapeutic relationship and the limitations con- cerning nontherapeutic personal contact. For example, personal contacts such as engaging in recreational or competitive athletic teams, attending sporting events, and other general social functions together are in violation of maintaining thera- peutic boundaries. The practitioner should have a clear rationale for prescribing exercise in a client’s treatment plan. In addition, the rationale for exercising to- gether (i.e., to develop rapport) should be clearly communicated and understood between practitioner and client.

When exercising with clients, a common dilemma the practitioner faces is de- termining what type of physical activity should be implemented. As previously mentioned, research has found a variety of activities (aerobic and anaerobic) that provide physical and psychological benefits (USDHHS, 1996). In regard to adher- ence, it is vital to have clients’ input concerning activity selection. When clients have input into the selection process, they will likely select/choose a physical ac- tivity they enjoy. Enjoyment of the activity has been positively correlated to adher- ing and maintaining an exercise regimen (Wankel, 1993).

Walking is one of the most commonly reported types of physical activity (USDHHS, 1996). Walking is an excellent choice of physical activity for numer- ous reasons. First and foremost, many people are able to walk. Furthermore, the risks associated with walking are minimal due to the low to moderate intensity level. Also, most people are able to walk and talk simultaneously, which is neces- sary for therapeutic consultations. Last, walking can be performed inside or out- side and requires minimal equipment or modification of clothing. For clients who are able to and desire a more intensive level of activity, jogging is a viable alterna- tive to walking. When selecting jogging, a major requirement is for the therapist and client to have a high level of cardiovascular fitness. A high level of cardiovas- cular fitness allows them to talk with each other while exercising.

Anaerobic activities such as strength training provide clients and therapists with another viable option for activity selection. During strength training, there is ample time for communication and discussion between practitioner and client. However, there are a few limiting factors when choosing strength training. Most

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strength training activities require specialized equipment and facilities and present increased potential for risk of injury. In addition, a couple of potential ethical di- lemmas when including strength training are competency and confidentiality. The therapist may not have the knowledge base and/or experience to supervise a strength training program that would accomplish desirable health and therapeutic objectives. It may also be difficult to maintain confidentiality due to other people exercising in very close proximity.

The mental health practitioner should not assume the role of a physician, exer- cise physiologist, or personal trainer in terms of providing or modifying an exer- cise prescription. Furthermore, practitioners should be cognizant of their primary role, which is to assist with exercise adherence and consultation. Exercise psychol- ogy practitioners ethically need to be aware of their professional limitations and competence boundaries vis-à-vis their education and training.

Maintaining an appropriate distance is sometimes useful in diverting inappro- priate attempts at amorous and other nonprofessional relationships. Sexualizing the relationship with a client is clearly unethical as well as very unsound profes- sional practice that harms both the client and practitioner (APA, 2002; AAASP, 1994). Practitioners often hold an advantage of power over the people with whom they work. Furthermore, practitioners occupy a position of trust and are expected to advocate the welfare of those who depend on them.

Physical contact within the counseling and exercise setting is often ethically ap- propriate. However, contact that is intended to express emotional support, reassur- ance, or an initial greeting can be misinterpreted as an invitation for advances. The social environment, revealing clothes, and close proximity that surround the exer- cise setting can lead to inappropriate advances by clients or practitioners. Recogni- tion of signs, both in clients and in therapists, and dealing with these feelings imme- diately and objectively is the best approach. The practitioner should discuss these feelings with an experienced, respected, and trusted colleague. If the practitioner is unable to control his or her feelings, termination and referral are recommended as a method of protecting both the client and practitioner. However, on termination of the relationship, the two individualsarenotethically“free” topursueamoresocialor in- timate relationship. It is strongly suggested to have a cooling off period (several months toyears) inwhichbothpartiesagree towaitprior topursuinga relationshipat a different level. A more conservative approach suggested by Bernstein and Hartsell (2004) is to followthebeliefofonceaclient, alwaysaclient.With theadoptionof this approach, once a professional relationship is initiated it must always be maintained, thus reducing the notion or intention of modifying any professional relationship.

DEPENDENCY ON THE THERAPIST

Another issue that must be discussed in collaboration with multiple-role relation- ships is a client’s level of dependency on a therapist’s services and influence. With-

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out question, as human beings we live in a world where dependency on others is crucial to an individual’s survival. Memmi (1984) explained that the level of de- pendence on others should be presented from three perspectives: “1) according to the identity of the dependent (e.g., child, adult), 2) to that of the provider (e.g., hu- man being, animal, or object), and 3) to the object provided (e.g., winning a medal versus establishing a friendship)” (p. 18). For example, children (dependent) rely on their caregivers (provider) for acquiring and supplying food, water, and shelter (objects provided) to survive within our society. Therefore, as children develop into adults, they must acquire the knowledge and skills from a caregiver to success- fully gain the necessities to survive independently. Similarly, clients attend coun- seling sessions in hopes of gaining the appropriate knowledge and skills so they can effectively cope with issues that currently disrupt their quality of life.

Another view of examining the level of a client’s dependence on a therapist is intertwined within attachment theory. “John Bowlby’s attachment theory is based on an attachment behavioral system—a homeostatic process that regulates infant proximity-seeking and contact-maintaining behaviors with one or few specific in- dividuals who provide physical or psychological safety or security” (Sperling & Berman, 1994, p. 5). Bowlby (1980) indicated that the level of continuity, which is a key component of attachment theory, is the way children construct attachment behaviors into a strategy for relating with others and how these behaviors greatly influence succeeding behaviors across the life span. An individual’s attachment behavioral system can become activated through various activities and events, in- cluding stressful periods (Sperling & Berman, 1994). Interestingly, a therapeutic relationship has the potential for activating an adult client’s attachment expecta- tions and behaviors (Bowlby, 1988; Woodhouse, Schlosser, Crook, Ligiero, & Gelso, 2003).

As previously stated, it is important to realize that individuals who seek thera- peutic services are usually attempting to alter their behaviors and/or emotions to manage problems interfering with their daily lives. In other words, clients may seek the services of mental health professionals because they believe therapists have the ability and knowledge to provide care, comfort, and guidance to relieve their debilitating issues (Bowlby, 1988; Farber, Lippert, & Nevas, 1995; Riggs, Jacobvitz, & Hazen, 2002; Slade, 1999).

Specifically, within the realm of exercise psychology, individuals may solicit a therapist for psychological services to assist in the quest of achieving their de- sired outcomes (e.g., losing weight, increasing their levels of physical activity, mood alteration). During these counseling sessions, clients may complete physi- cal activities (e.g., walking, jogging, strength training) with their therapist. Some therapists believe conducting therapy while exercising with their clients is bene- ficial to the overall treatment plan and objectives (Hays, 1999). For example, mental health practitioners can monitor clients’ behavioral and emotional states while completing the physical activities together. During these physical activi- ties, a therapist gains an immediate perception of how the client is progressing

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with the assigned tasks. Therefore, alterations to the treatment plan can be intro- duced while exercising.

As clients accomplish their goals (e.g., losing the desired amount of weight, in- creasing the level of physical activity, mood alteration), it is probable that they will develop a new identity and/or level of self-worth (e.g., confidence, esteem). Nu- merous research investigations indicate that an increase in the level of physical ac- tivity will improve individuals’ mental well-being and decrease numerous health risks (e.g., cardiovascular disease, cancer; USDHHS, 1996).

Unfortunately, the realization of clients’ desired outcomes (e.g., loss of weight, positive self-image, mood alteration) potentially could produce an increased level of dependence (i.e., attachment) on the therapist and services provided. That is, cli- ents may develop the notion that the therapeutic relationship with their exercise practitioner must continue to achieve and maintain the desired outcomes. Dishman (1988) explained adherence to exercise (i.e., physical activity) can be difficult, as up to 50% of exercisers drop out within the first 6 months of initiating an exercise program. This may be a reason why some individuals who maintain an exercise regimen become dependent on the services provided by fitness trainers. For exam- ple, certain individuals are unwilling to work out alone or require motivation, so- cial support, and guidance from a fitness trainer to complete physical activities and pursue their physical fitness goals. Thus, a level of dependence is established, and possibly strengthened, as the individual continues an exercise routine under the su- pervision of a fitness trainer. Despite the lack of research, a similar level of depend- ence for a client may develop during a therapeutic relationship with an exercise therapist. To date, no research investigations have examined the level of clients’de- pendence on their exercise therapist. However, “exercising with clients during therapy could promote dependency” (Hays, 1999, p. 61). Therefore, exercise prac- titioners should be aware that clients’ level of dependency may become an issue even if the sessions produce the desired healthy outcomes.

CONFIDENTIALITY AND RECORD KEEPING

Confidentiality is another central ethical issue that often arises in a variety of tradi- tional and exercise counseling settings. Confidentiality is directly addressed in both the APA (2002) and AAASP (1994) ethics codes of conduct. Standard 4.01 of the APA (2002) ethics code states that practitioners “have a primary obligation and take reasonable precautions to protect confidential information obtained through or stored in any medium, recognizing that the extent and limits of confidentiality may be regulated by law or established by institutional rules or scientific rela- tionship” (p. 7). Clients value privacy, and it is not uncommon for a client to begin an initial interview by asking about confidentiality (Zaro, Barach, Nedelman, & Dreiblatt, 1994). Because the limits of confidentiality differ from state to state, it is

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essential to learn the specifics in your own area. Presented in the following para- graphs are some general recommendations for maintaining confidentiality across a variety of activities as they relate to exercise consultations.

Within the dynamic of exercise consultations it is common to collaborate with a variety of professionals (e.g., physicians, trainers, exercise physiologists, dieti- cians). Collaboration with colleagues is an important means of ensuring and main- taining the competence of one’s work and the ethical conduct of psychology. When consulting with colleagues, one should not disclose confidential information that reasonably could lead to the identification of a client. Even when prior consent has been granted by the client, the disclosure of information should be only to the ex- tent necessary to achieve the purposes of the consultation. Maintaining confidenti- ality and respect for the client’s privacy should be upheld at all times and is vital in maintaining a collaborative and trusting relationship with clients.

When using the Internet or other sources of electronic media, it is the practitio- ner’s responsibility to become knowledgeable about employing appropriate meth- ods for protecting the confidentiality of records concerning clients (Fisher, 2003). The Internet and other electronic media are vulnerable to breaches in confidential- ity that may be beyond an individual’s control. For example, when personal files or therapy notes are stored on a common server or university system server, security measures such as the use of password protection and firewall techniques should be in place. Conducting assessments, exercise adherence, or traditional counseling via e-mail, secure chat rooms, cell phone, or providing services on a Web site are all mediums in which confidentiality can be violated. Clients should be informed of the risks to privacy and limitations of protection when utilizing an electronic medium to deliver exercise consultation services. Similarly, safeguards should also be used for handwritten therapy notes, treatment plans, or client records. These types of records and documents should be stored in locked file cabinets.

ADVERTISEMENT AND SELF-PROMOTION

Most individuals do not become involved in the field of psychology—whether it is general, clinical, sport, or exercise psychology—due to their abilities for self- promotion. However, these skills become important when trying to increase one’s exposure and attracting potential clients. Without development or training in ethi- cal marketing or self-promotion, it is quite common for the issues pertaining to self-promotion and marketing to be discomforting (Heil, Sagal, & Nideffer, 1997).

The APA (2002) ethics code (Ethical Standard 5) addresses advertising and other public statements more thoroughly than does the AAASP (1994) ethics code (i.e., General Ethical Standard 16). Clearly identifying one’s credentials or certifi- cations is the first step in understanding the process of advertising and public state- ments. It is the professionals’ responsibility to appropriately identify their creden-

ETHICAL ISSUES IN EXERCISE PSYCHOLOGY 73

tials and take the initiative to correct misrepresentations when mistakes are made. In addition, it is unethical to solicit testimonials from current clients or other influ- ential individuals due to their position, title, or status. For example, Dr. White pre- scribes exercise as a component of counseling for a famous actress. She attains her desired therapeutic goals through proper exercise adherence and counseling. Based on this scenario, it is unethical for Dr. White to solicit a testimonial from the actress promoting the benefits of his counseling.

There are ethical and appropriate methods of enhancing one’s visibility. These methods include, but are not limited to, speaking at various rehabilitation clinics, exercise facilities, and civic organizations. Providing information through speak- ing engagements about the nature and benefits of exercise psychology and adher- ence counseling will be professionally beneficial by creating the opportunity for practitioners to integrate and synthesize theories and research findings into prac- tice for their specific audience. Another vehicle to enhance exposure is through public interviews with local radio, television, and newspapers. The establishment of a Web site is another possible source of exposure. Speaking engagements, inter- views, and the development of a Web site are excellent methods of “getting your name out there,” but there is no guarantee that these methods will lead to clients and referrals.

The development of a client and referral base is an ongoing challenge. How- ever, the practitioner who is able to interact with colleagues from various settings (e.g., physicians, athletic trainers, physical therapists, personal trainers, exercise physiologists, and other mental health professionals) will have an advantage in de- veloping a wide range of referral sources. Furthermore, there is no substitute for word-of-mouth referrals. This means those practitioners who develop an effective working relationship and provide effective strategies to assist their clientele in reaching their desired goals will be able to maintain and expand their client list.

FUTURE ISSUES AND OPPORTUNITIES

Issues related to the most desirable qualifications for the exercise psychologist or consultant will continue to be debated. However, it appears that interdisciplinary training is vital and will positively contribute to the development of collaborative and effective professionals within the field of exercise psychology. A movement toward accreditation of programs also adds to the establishment of quality training for future professionals.

Employment in the field of exercise psychology and consulting, which bridges the areas of psychology and movement sciences, can provide a challenging and re- warding career. Within the challenges lie numerous ethical considerations and be- haviors that should be clearly conceptualized prior to and while involved in this emerging field. The previous discussion of potential ethical issues and dilemmas is

74 PAULINE, PAULINE, JOHNSON, GAMBLE

by no means a complete guide. This article is just a starting point for future dialog regarding ethical issues related to exercise psychology and consulting.

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American Psychological Association. (1992). Ethical principles of psychologists and code of conduct. American Psychologist, 47, 1597–1611.

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Arredondo, P., & Toporek, R. (2004). Multicultural counseling competencies = ethical practice. Jour- nal of Mental Health Counseling, 26, 44–55.

Association for the Advancement of Applied Sport Psychology. (1994). Ethical principles and stan- dards. Retrieved February 21, 2005, from http://www.aaasponline.org/ethics.html

Berger, B., Pargman, D., & Weinberg, R. (2002). Foundations of exercise psychology. Morgantown, WV: Fitness Information Technology.

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76 PAULINE, PAULINE, JOHNSON, GAMBLE

INTRODUCTION TO THE SPECIAL ISSUE

Ethics in Sport and Exercise Psychology

Edward F. Etzel and Jack C. Watson II Department of Sport and Exercise Psychology

West Virginia University

And yet, as Aristotle developed, and young men crowded about him to be taught and formed, more and more his mind turned from the details of science to the larger and vaguer problems of conduct and character. (Durant, 1973, p. 75)

The age old “problems of conduct and character” of everyday life and professional psychology represent both longstanding vagaries and daily challenges. Since the inception of this journal, numerous contributors from nearly all corners of the pro- fession have shared their thinking about ethics and other issues of conduct and character. This special issue of Ethics & Behavior is devoted to a rapidly emerging corner of professional psychology that some readers may be familiar with, whereas likely a majority are not—namely, sport and exercise psychology.

Although the field of sport psychology has been around for quite a long time (ap- proximately 100 years), it is a relative newcomer to psychology in this country. In fact, it was only in 1986 that the American Psychological Association (APA) ap- proved the creation of the Division of Exercise and Sport Psychology (Division 47) from a rather small special interest group of professionals (APA, 2005a). Recently, the APA’s Council of Representatives gave its approval to the establishment of a pro- fessional proficiency in sport psychology (APA, 2005b). Currently, Division 47 has approximately 1,100 members. Sister organizations such as the Association for the Advancement of Applied Sport Psychology (AAASP) and the International Society of Sport Psychology have hundreds of members, some of whom belong to Division 47. The stated mission of Division 47 is linked to advancing “the scientific, educa- tional, and clinical foundations of exercise and sport psychology” (APA, 2005b). From these recent (i.e., past 25 years) developments, it is possible for us to say that

ETHICS & BEHAVIOR, 16(1), 1–3 Copyright © 2006, Lawrence Erlbaum Associates, Inc.

Correspondence should be addressed to Edward F. Etzel, School of Physical Education, West Vir- ginia University, Morgantown, WV 26506-6116. E-mail: eetzel@wvu.edu

sport and exercise psychology as a profession is growing and becoming much more popular among students, professionals, athletes, and coaches.

Sport and exercise psychology professionals’ backgrounds and practice do- mains are quite wide ranging. Many have roots in the so-called movement sciences such as physical education, motor learning, and kinesiology. Others are trained in the more traditional service delivery areas of psychology such as counseling coun- seling psychology, and clinical psychology. Currently, there is no established model for training nor is there licensure available specifically for sport and exer- cise psychology. Those professionals who provide services to the public can apply to become a Certified Consultant with AAASP. However, this title indicates only that the individual has completed specified requirements in terms of coursework and applied practice and does not require an assessment of knowledge.

What may be gleaned from the previous overview is that there is not a typical sport psychologist. Many professionals working in this field can be found em- ployed in a variety of academic positions in higher education, university counsel- ing centers, sports medicine clinics, and in private practices, which may or may not be solely focused on sport and exercise psychology service provision. Further- more, sport psychology professionals’ clientele may range from individual ama- teur and high-profile professional athletes, exercisers, coaches, amateur and pro- fessional sport teams, sports medicine patients (e.g., injured persons), youth sport parents, and performing artists (e.g., dancers).

As the reader might imagine, given the range of clientele noted in the previous paragraph, service provision does not always follow a traditional format nor is it often provided during the 50 min hour in an office. Clients may talk to their sport and exercise psychology professional at the pool deck, along the sidelines, on play- ing fields, in hotel lobbies, gyms, athletic training rooms, and elsewhere. Clients may also feel the need to talk with a service provider while they are training or competing out of state or country. Such interesting persons, meeting places, and times often lead to ethical quandaries that in many cases have been evaluated from a different perspective than those in traditional psychology.

This special issue of Ethics & Behavior focuses particular attention on these professional issues that are often challenges unique to those working in the field of sport and exercise psychology. These articles authored by experienced profession- als in sport and exercise psychology cover information related to multiple-role is- sues, the training in ethics of graduate students, the provision of exercise psychol- ogy services, the development a professional practice, and work and travel with elite Olympic-level sport teams. We understand that the perspectives raised in this journal issue may be at times contrary to normally held beliefs of practicing psy- chologists. However, we encourage you to consider the many issues presented with an open mind and hope that it will lead you, the reader, to a better understand- ing of the ethical nuances of sport and exercise psychology practice. We trust that you will enjoy this special issue of Ethics & Behavior!

2 ETZEL AND WATSON

REFERENCES

American Psychological Association, (2005a). Purposes and goals. Retrieved from http://www.psyc. unt.edu/apadiv47/about_purposesandgoals.html

American Psychological Association, (2005b). Division projects. Retrieved from http://www.psyc. unt.edu/apadiv47/about_divprojects.html#past

Durant, W. (1973). The story of philosophy. New York: Simon & Schuster.

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