Frustrations in the Gym
Frustrations in the Gym
The purpose of this assignment is to examine ethical issues for professionals working in exercise psychology, rehabilitation, and in other professions related to physical activity as a means for maintaining individual health and well-being. Ethical principles and guidelines, previously discussed, will be applied to these various environments for critical analysis and discussion. Despite the differences in environments, the ethical situations exercise psychology professionals face, often, fall within the same parameters as those of other helping professions.
For this assignment, first, read the following article from the Argosy University online library resources:
Pauline, J., Pauline, G., Johnson, S., & Gamble, K. (2006). Ethical issues in exercise psychology. Ethics & Behavior, 16(1), 61–76.
Now, answer the following questions:
- Are issues of competency and training more complex for exercise psychology professionals than for applied sport psychology professionals?
- What ethical dilemmas are unique to the relationship between a client and an exercise psychology professional? Are there distinct differences in this relationship compared to a relationship between a client and a sport psychology professional?
Answer each question in 200–300 words. Your response should be in Microsoft Word document format. Name the file SP6300_M4_A1_LastName_FirstInitial.doc and submit it to the appropriate Discussion Area by the due date assigned.
Through the end of the module, comment on the posts of two of your peers. In your reviews, check whether the answers given to the second question support their answers to the first one. Discuss any inconsistencies or similarities in your classmates’ answers. All written assignments and responses should follow APA rules for attributing sources.
Assignment 1 Grading CriteriaMaximum PointsIdentified and described the differences in competency and training issues for exercise psychology professionals as compared to applied sport psychology professionals.8Analyzed and described the ethical dilemmas unique to exercise psychology professionals.8Compared the relationship between a client and an exercise psychology professional with that of the relationship between a client and a sport psychology professional.8Reviewed the posts of at least two peers and pointed out any inconsistencies and similarities.8Wrote in a clear, concise, and organized manner; demonstrated ethical scholarship in accurate representation and attribution of sources, displayed accurate spelling, grammar, and punctuation.4Total:36
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 counseling
psychology, health promotion, and themovement sciences. This emerging field involves
diverse mental health issues, theories, and general information related to physical
activity and exercise. Numerous research investigations across the past 20 years
have shown both physical and psychological benefits from physical activity and exercise.
Exercise psychology offersmany opportunities for growth while positively influencing
the mental and physical health of individuals, communities, and society.However,
the exercise psychology literature has not addressed ethical issues or dilemmas
faced by mental health professionals providing exercise psychology services. This initial
discussion of ethical issues in exercise psychology is an important step in continuing
tomove the fieldforward. Specifically, this article will address theemergenceof exercise
psychology and current health behaviors and offer an overview of ethics and
ethical issues, education/training and professional competency, cultural and ethnic diversity,
multiple-role relationships and conflicts of interest, dependency issues, confidentiality
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. Exercise
psychology encompasses approaches from the fields of psychiatry, clinical
and counseling psychology, health promotion, and the movement sciences (Buckworth
& 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 enhanced
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 physical
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 uncharted
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 services
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 enhance
physical activity patterns. Therefore, the need and opportunity for practitioners
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 practitioners
implementing exercise as a component of therapy must be examined.
Thus, the remainder of this article will focus on selected ethical issues and potential
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 psychology
and current health behaviors, an overviewof ethics and professional resources,
education/training and professional competency, cultural and ethnic diversity,
multiple-role relationships and conflicts of interest, dependency issues, confidentiality
and recording keeping, and advertisement and self-promotion. In conclusion,
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 behavioral
choices. In America today, choosing desirable health behaviors such as regu-
62 PAULINE, PAULINE, JOHNSON, GAMBLE
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 physical
activity, many are unable to maintain the adapted behavior. The physical activity
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 strategies
to assist individuals with the adoption and maintenance of more active lifestyles
(Buckworth & Dishman, 2002b). Currently, there is an abundance of literature
indicating that the adoption of a more active lifestyle will enhance mental
well-being (reduce depression and anxiety and enhance self-esteem) while decreasing
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 individual
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 exercise
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 documented
physical and psychological benefits of exercise, psychologists and counselors
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 exercise
as part of a treatment plan despite the literature supporting its use.
ETHICAL ISSUES IN EXERCISE PSYCHOLOGY 63
For most people physical activity poses minimal risks. However, it is important
that all clients, regardless of ethnic or cultural background, obtain physician approval
to begin an exercise regimen. In addition to the physician approval, conservative
therapists desiring to add exercise to treatment should also have their clients
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 profession’s
members in working settings. An ethics code provides integrity to a profession,
professional values and standards, and fosters public trust through the establishment
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 society
as related to a profession. These values and beliefs, as well as common professional
practices, can and do change with the passing of time due to numerous factors,
making it necessary for ethical codes and standards to also change.
The American Psychological Association (APA; 2002) ethics code is a well developed
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 derived
from the APA’s (1992) ethics code and has not been updated since its inception.
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 consultations.
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 practitioners
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 focus
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-
64 PAULINE, PAULINE, JOHNSON, GAMBLE
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 voluntarily
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 different
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 clients/
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 complex
issue concerning training. Training for exercise practitioners is complex due
to licensure. Clearly, to refer to oneself as a “psychologist,” an individual must satisfy
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 psychology
but will likely not be able to meet the requirements for psychology licensure.
Thus, practitioners can not ethically refer to themselves as “exercise psychologists”
because they will not be licensed as psychologists within their state of em-
ETHICAL ISSUES IN EXERCISE PSYCHOLOGY 65
ployment. Likewise, licensed psychologists with limited or no training in the
movement sciences should not ethically refer to themselves as “exercise psychologists”
because of a lack of proper training in exercise science.
Education and training from both exercise or movement science and psychology
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 sciences,
and sport and exercise psychology. In 1991, AAASP established certification
criteria for becoming a certified consultant of AAASP. The interdisciplinary
requirements of AAASP certification require coursework and practicum guidelines
for students who desire or specialize in applied sport or exercise psychology
(Sacks, Burke, & Schrader, 2001). The requirements appear adequate and are necessary
but reflect only minimal foundational training. AAASP certification requirements
should not be viewed as sufficient training to become an effective exercise
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 competent
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 interdisciplinary
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 assessment;
cognitive–affective bases of behavior; professional ethics and standards;
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
66 PAULINE, PAULINE, JOHNSON, GAMBLE
health practitioner, or certified consultant of AAASP) within the field of exercise
psychology. The aforementioned curriculum and practical training seems to provide
the necessary education for mental health professionals regarding the physical
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 ensure
that teaching, research, and practice have an ongoing positive impact on those
desiring services (Bickham, 1998). Both APA and AAASP provide a variety of opportunities
and methods for scholars and practitioners to maintain professional
competency. Some of these methods include independent study, continuing education
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) believed
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 ethnicity
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 importance
of understanding the culture and background of a variety of populations is vitally
important in both exercise and therapeutic settings.
Research indicates high rates of obesity and inactivity among women and minority
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 racial/
ethnic minorities, especially minority women, is generally higher than in
Whites in the United States (Flegal, Carroll, Ogden, & Johnson, 2002). More specifically,
among women, non-Hispanic White women have the lowest occurrence
ETHICAL ISSUES IN EXERCISE PSYCHOLOGY 67
(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 indirectly
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 exercise
and rehabilitation facilities.
A first step in maintaining appropriate boundaries is to establish a common protocol
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.
68 PAULINE, PAULINE, JOHNSON, GAMBLE
Maintaining this distance becomes even more difficult when exercising with
clients. Exercising together can be a great vehicle for building rapport and developing
communication between practitioner and client. Conversely, exercising with
clients may cloud the boundaries and thus cause some confusion or ambiguity regarding
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 inappropriate
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 importance.
It is the practitioner’s ethical responsibility to have a candid discussion with
the client that clearly defines a therapeutic relationship and the limitations concerning
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 therapeutic
boundaries. The practitioner should have a clear rationale for prescribing
exercise in a client’s treatment plan. In addition, the rationale for exercising together
(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 determining
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 adherence,
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 activity
they enjoy. Enjoyment of the activity has been positively correlated to adhering
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 numerous
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 necessary
for therapeutic consultations. Last, walking can be performed inside or outside
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 alternative
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 cardiovascular
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
ETHICAL ISSUES IN EXERCISE PSYCHOLOGY 69
strength training activities require specialized equipment and facilities and present
increased potential for risk of injury. In addition, a couple of potential ethical dilemmas
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, exercise
physiologist, or personal trainer in terms of providing or modifying an exercise
prescription. Furthermore, practitioners should be cognizant of their primary
role, which is to assist with exercise adherence and consultation. Exercise psychology
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 inappropriate
attempts at amorous and other nonprofessional relationships. Sexualizing
the relationship with a client is clearly unethical as well as very unsound professional
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 appropriate.
However, contact that is intended to express emotional support, reassurance,
or an initial greeting can be misinterpreted as an invitation for advances. The
social environment, revealing clothes, and close proximity that surround the exercise
setting can lead to inappropriate advances by clients or practitioners. Recognition
of signs, both in clients and in therapists, and dealing with these feelings immediately
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, thetwoindividuals are not ethically “free” to pursue amoresocial or intimate
relationship. It is strongly suggested to have a cooling off period (several
monthsto years) inwhichboth parties agree towait prior to pursuing a relationship at
a different level.Amore conservative approach suggested by Bernstein and Hartsell
(2004) is to followthe belief ofoncea client, always a client.With the adoption of 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 relationships
is a client’s level of dependency on a therapist’s services and influence.With-
70 PAULINE, PAULINE, JOHNSON, GAMBLE
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 dependence
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., human
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 successfully
gain the necessities to survive independently. Similarly, clients attend counseling
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 individuals
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, including
stressful periods (Sperling & Berman, 1994). Interestingly, a therapeutic
relationship has the potential for activating an adult client’s attachment expectations
and behaviors (Bowlby, 1988; Woodhouse, Schlosser, Crook, Ligiero, &
Gelso, 2003).
As previously stated, it is important to realize that individuals who seek therapeutic
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 desired
outcomes (e.g., losing weight, increasing their levels of physical activity,
mood alteration). During these counseling sessions, clients may complete physical
activities (e.g., walking, jogging, strength training) with their therapist. Some
therapists believe conducting therapy while exercising with their clients is beneficial
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 activities,
a therapist gains an immediate perception of how the client is progressing
ETHICAL ISSUES IN EXERCISE PSYCHOLOGY 71
with the assigned tasks. Therefore, alterations to the treatment plan can be introduced
while exercising.
As clients accomplish their goals (e.g., losing the desired amount of weight, increasing
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). Numerous
research investigations indicate that an increase in the level of physical activity
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, clients
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 example,
certain individuals are unwilling to work out alone or require motivation, social
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 supervision
of a fitness trainer. Despite the lack of research, a similar level of dependence
for a client may develop during a therapeutic relationship with an exercise
therapist. To date, no research investigations have examined the level of clients’dependence
on their exercise therapist. However, “exercising with clients during
therapy could promote dependency” (Hays, 1999, p. 61). Therefore, exercise practitioners
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 traditional
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 relationship”
(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
72 PAULINE, PAULINE, JOHNSON, GAMBLE
essential to learn the specifics in your own area. Presented in the following paragraphs
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, dieticians).
Collaboration with colleagues is an important means of ensuring and maintaining
the competence of one’swork 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 extent
necessary to achieve the purposes of the consultation. Maintaining confidentiality
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 practitioner’s
responsibility to become knowledgeable about employing appropriate methods
for protecting the confidentiality of records concerning clients (Fisher, 2003).
The Internet and other electronic media are vulnerable to breaches in confidentiality
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 selfpromotion.
However, these skills become important when trying to increase one’s
exposure and attracting potential clients.Without development or training in ethical
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 certifications
is the first step in understanding the process of advertising and public statements.
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 influential
individuals due to their position, title, or status. For example, Dr. White prescribes
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 speaking
engagements about the nature and benefits of exercise psychology and adherence
counseling will be professionally beneficial by creating the opportunity for
practitioners to integrate and synthesize theories and research findings into practice
for their specific audience. Another vehicle to enhance exposure is through
public interviews with local radio, television, and newspapers. The establishment
of aWeb site is another possible source of exposure. Speaking engagements, interviews,
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. However,
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 developing
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 rewarding
career.Within the challenges lie numerous ethical considerations and behaviors
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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