Dr. Steven Bucky has been published in the January/February 2014 issue of The National Psychologist on the topic of Ethical Issues in Assessing Treating Elite Athletes.

By Steven F. Bucky, Ph.D., ABPP

There has been a significant increase in interest among psychologists in providing clinical and sport psychology services to college, Olympic and professional athletes. The purpose of this article is to discuss some of the major ethical concerns most relevant to a psychologist's assessment and treatment of such athletes.

In my view, the most relevant ethical principles and standards to the assessment and treatment of elite athletes are: (1) determining and being clear with the athlete as to who is the client (2) informed consent (3) confidentiality (4) avoiding multiple relationships and (5) sensitivity to issues of diversity

Who is the client?

For the past 20-plus years, I have worked with professional football and baseball players, Olympic athletes and student athletes at San Diego State University (SDSU). When discussing my professional roles with relevant sports organization administrators, my position has always been that my primary professional responsibility/commitment/loyalty was going to be with the athlete. That is, the athlete was going to take priority over organization/league/university issues.

When conflicts arise between what is best for the athlete and what is best for the organization (APA 1.03), my recommendations to the athlete is to sign a release so that I could discuss clinical/personal issues with the coach or general manager/athletic director of the organization or; better yet, encourage the athlete to discuss the issues with the appropriate individual within the organization. (I generally offer to be present when such a discussion is scheduled).

It is important to be clear about the psychologist's commitment to the athlete in order to develop a trusting, productive and ethically sound professional relationship.

Informed Consent

The APA Ethical Principles of Psychologists and Code of Conduct (2002) defines informed consent as providing appropriate and clear understandable information to clients. In these cases, the importance of informed consent is that the professional role between the psychologist and athlete is clear and must be discussed early in the development of the athlete-psychologist professional relationship.

In addition, it is recommended that there are signed informed consent forms, which are routinely signed in the NFL, with Olympic athletes and on college campuses, It is less frequently available in major league baseball (MLB) due to the less formal relationship between the athlete and the psychologist.

In the NFL, on college campuses and with Olympic athletes, the vas majority of professional contacts take place in the psychologist's office so that there is an opportunity for a formal intake process, informed consent discussions and an opportunity for the athlete to sign appropriate forms. In MLB, the relationship tends to be much less formal, may take place in the locker room, physician examining room, on the field or in the dugout; professional contacts frequently do not resemble anything close to the traditional 45-60 minute psychotherapy session.

Confidentiality

It is extremely important for psychologists to be sensitive to the player's right to privacy and make confidentiality a high priority. It is worth noting that athletes frequently appear minimally concerned about confidentiality with their teammates and often openly talk to psychologists in the presence of their athlete colleagues.

When I was offered the drug/alcohol consultation positions at SDSU and with the San Diego Chargers, I recommended that I would be "invisible." not wanting my relationship with an athlete to potentially suggest that the athlete may have a drug/alcohol problem.

In 1993, when the head coach of the San Diego Chargers asked that I "hang out" in the locker room and field during practice so that players would voluntarily seek psychological consultations as opposed to only being "required" by the league or team, player privacy had to be managed differently (information only shared on a need-to-know basis with the permission of the athlete).

For example, I told my player/patients that I would nor greet them any differently than any other player in the locker room or on the field and that the purpose was to protect their privacy and not a statement of my lack of interest or unfriendliness. After that explanation, if one of the athlete/patients approached me to talk about personal issues, scheduling etc., I would stop to talk to other players (non-patients) so that my communication with the player/patient could not be distinguished from player/non-patients contacts; again the priority is protecting the privacy of athletes.

Multiple relationships

In order to develop and maintain a trusting productive relationship, psychologists working with athletes must develop positive constructive relationships (at times, described by athletes as the best adult relationship ever). Therefore, psychologists must do everything possible to avoid unethical multiple relationships.

In my view, that includes avoiding asking for tickets and autographs, avoiding social activities whenever possible and always avoiding financial/business relationships.

Diversity

It is important to note that athletes come from highly diverse backgrounds. Psychologists must respect and support diversity within the team, respecting the rights and dignity of each athlete and respecting player autonomy.

Two examples of racial sensitivity that I have experienced include:

• An African-American player just having signed a $32 million contract and during a brief conversation described himself as a "high-priced slave;" and
• Another African-American player having signed a $40 million-plus contract in the executive office on the second floor of the training facility after a brief interaction with an African-American staff member saying that "I now have to go down to the basement where I belong."

It is important for psychologists to be 1) sensitive to such concerns and help resolve such issues promptly, consistently, constructively and effectively; 2) knowledgeable about individual and cultural diversity issues; 3) sensitive and responsive to cultural diversity issues, and 4) aware of the interaction between the psychologist's own diversity and that of the athlete(s).

In closing, I would like to add that working with professional, Olympic and college athletes has been a particularly enjoyable set of experiences within my professional career and I encourage readers of this article to pursue such professional activities if interested and that integrating ethical assessments, clinical and sport psychology professional responsibilities with elite athletes may require modifications of our usual ethical professional psychology practices.