Ethical dilemmas experienced by school psychologists in South Africa

ABSTRACT

School psychologists often face complex ethical and legal issues in their work, which become more challenging as the needs of students and school systems evolve. When faced with ethical dilemmas, it can be difficult for school psychologists to determine the best course of action, particularly when there is no clear solution. This study explored the ethical dilemmas experienced by psychologists working in South African schools in the Western Cape. The aim was to understand the ethical landscape in which they operate. The research was conducted through semi-structured telephone interviews with 16 participants, who shared 58 ethical dilemmas they had experienced. The data were analyzed using thematic analysis, identifying six themes: confidentiality, role definition, assessments and reports, workload, consent, and scope of practice. Participants utilized various strategies to manage dilemmas, such as relying on professional codes, setting boundaries, seeking supervision, and prioritizing the child’s best interests. The study highlights the complex context in which school psychologists navigate ethical issues and their impact on the types of dilemmas they face. Finally, suggestions are provided for training and practical application.

KEYWORDS:

• Ethics
• ethical dilemmas
• school psychology
• educational psychology
• South Africa

Introduction

Psychologists perform many roles within the school system, but their primary responsibility is to protect the rights and welfare of the children they serve (Boccio, 2015). The profession’s ethical and legal mandates must be upheld when determining how best to meet clients’ needs. Ethical codes are informed by philosophical frameworks that guide appropriate professional behavior and decision-making in an ideal world. They apply broad ethical principles and specific rules to the problems that arise in professional practice in “doing the right thing.” Furthermore, ethical codes play a crucial role in the psychology profession. They not only lend credibility to the profession but also help psychologists understand their expected behaviors (McCleary & Dawes, 2023). By following these codes, psychologists can ensure that the parties involved, such as children, parents, schools, and psychologists, are protected and that their well-being is prioritized (Lasser et al., 2013). The codes thus act as a compass, guiding appropriate professional behavior, informing ethical decision-making, and safeguarding the clients.

However, professional codes are aspirational, and psychologists often use their judgment to apply these standards (Knapp et al., 2015). Psychologists often face situations where they must balance conflicting concerns and obligations or reconcile competing ethical principles. Sometimes, they must deal with challenging and distressing scenarios in which professional guidelines, laws, or ethics codes do not offer clear guidance. In such cases, they must find ways to navigate the situation while upholding the highest ethical standards.

Ethical dilemmas occur when ethical standards conflict, the best course of action is unclear, or when there is pressure to act unethically (Wassenaar, 2002). An ethical dilemma arises when two or more ethical principles conflict and fulfilling one principle offends the other (Beauchamp & Childress, 2009; Knapp et al., 2015). There is no definitive or correct solution to the given problem (Lindén & Rådeström, 2008). In schools, such dilemmas involve “competing ethical principles, conflicts between ethics and law, the conflicting interests of multiple parties, dilemmas inherent in the dual roles of employee and student advocate, poor educational practices resulting in potential harm to students, and because it is difficult to decide how broad ethics code statements apply to a particular situation” (Jacob et al., 2022, p. 23/24). And this is the dilemma, given that there are several ways to respond ethically.

Although ethics are widely acknowledged as essential, limited research is currently available on the ethical challenges that school psychologists encounter. The available research can be categorized into five main streams. Firstly, studies that investigate the types of dilemmas school psychologists face, such as those conducted by Jacob-Timm (1999) and Mendes et al. (2016). Secondly, research that focuses on the frequency of ethical dilemmas, typically using questionnaires (Dailor & Jacob, 2011; Huhtala et al., 2017). Thirdly, research that examines specific ethical dilemmas, such as administrative pressure (Boccio et al., 2016), technology (Carlson & Harvey, 2004), assessment (Bayi, 2010; Knauss, 2001), relationship with well-being/burnout (Boccio et al., 2016; Huhtala et al., 2017), and breaking confidentiality (Rae et al., 2009). Fourthly, research focusing on training, such as Babione’s study in 2010. Lastly, research examines how psychologists deal with ethical issues, such as those conducted by Bayi (2010), Helton and Ray (2009), and Osborn (2012).

Framing professional ethics theoretically

Ethics is not only limited to the realm of philosophy but is also crucial in practice. Philosophical theories of good conduct influence the way ethical behavior is practiced. There are three main theoretical frameworks for professional ethics: deontological, consequential, and virtue ethics.

Deontological ethics, also known as duty ethics, is a moral framework based on the idea that individuals have specific moral duties and obligations that they must fulfill, regardless of the consequences. In psychology, this approach involves adhering to ethical codes and guidelines, such as those established by the American Psychological Association, and prioritizing the rights and well-being of clients.

The deontological framework of ethics is based on three principles that form the ethical approach most professional codes of ethics and psychology boards adopt. These principles are duties, rights, and fairness (Allan, 2016). From a deontological perspective, doing good means fulfilling one’s duty to society without necessarily considering the consequences beforehand. This approach recognizes that certain actions will always be wrong, regardless of their outcomes (Zalta & Nodelman, 2020). In cases where ethical considerations conflict with the law, deontologists choose to follow the law (Zalta & Nodelman, 2020). This ethical approach, followed by psychological associations worldwide, emphasizes the importance of acting in accordance with duties such as non-maleficence and respect for human dignity.

Consequential ethics is a framework that centers on the outcomes and consequences of actions (Allan, 2016). In psychology, this approach involves assessing the possible advantages and drawbacks of different courses of action and selecting the course that will lead to the most significant benefit for the client.

Virtue ethics, on the other hand, emphasizes the character traits and values that guide ethical decision-making. In psychology, this approach involves cultivating virtues, such as honesty, compassion, and empathy, as a means of developing ethical judgment and behavior. Positive psychology often promotes ethics of virtue.

To make ethical decisions in the best interests of their clients, psychologists may need to use different frameworks. Each framework has strengths and weaknesses; thus, psychologists can navigate ethical dilemmas with integrity and professionalism by understanding and applying all three. In South Africa, the General Ethical Guidelines and Rules for Professional Practice for Health Professionals (HPCSA) outline principles that consider the consequences, duties, values, and rights of clients.

Psychology in South Africa

Psychology was recognized as a professional field in the Health Professions Act 56 of (1974), which outlines its scope (Wassenaar, 2002). The Health Professions Council of South Africa (HPCSA 2016) Professional Board for Psychology regulates the quality of psychologists’ work. They are responsible for accrediting graduate programs, creating a Professional Code of Conduct, and licensing (credentialling) after candidates have successfully completed the National Board exam, which strongly focuses on applying ethics and law. Psychologists must adhere to a complex set of legal and policy requirements stated in, for example, the Health Professions Act 56 of (1974), the Constitution of the Republic of South Africa Act 108 of (1996, 1996) with the Bill of Human Rights, Education Law and policies including inclusive education, Children’s Act 38 of (2005), Protection of Personal Information Act 4 of 2013 (POPIA), and Promotion of Access to Information Act 2 of 2000 (PAIA).

Registration (licensing) categories include clinical, counseling, industrial, educational, and research psychologists. Psychologists work in different contexts, including health, education, Non-Profit Organizations, and private practices. There is no distinct registration category for school psychology in South Africa. School psychologists could include educational, counseling, or clinical psychologists with a teaching qualification and experience. All psychologists are licensed to practice independently.

Registered psychologists in South Africa are bound by the Ethical rules of conduct for practitioners registered under the Health Professions Act of 1974 and its amendments (Government Gazette, 2006). In addition to the generic rules for healthcare practitioners, psychologists must adhere to The rules of conduct pertaining specifically to the profession of psychology (Government Gazette, 2006). They must maintain high levels of competence and adhere to best practice standards that do not exceed the scope of the profession and training. Additionally, psychologists must maintain professional relationships with their clients and obtain informed consent, especially when working with children in school settings. Psychologists need to respect human rights, promote the well-being, and best interests of the client, respect the client’s decision-making capabilities, and avoid causing harm, harassment, discrimination, and conflicting interests. In the school context, psychologists must avoid engaging in multiple relationships, as is clarifying their roles and responsibilities.

According to Wassenaar (2002), following laws and codes alone is insufficient to ensure adherence to ethical principles. Thus, following laws and codes simultaneously can also be challenging. Ethical decision-making is influenced by subtle contextual factors that cannot be addressed by laws and codes alone. Therefore, it is crucial to understand the role and context of psychologists to fully comprehend ethical dilemmas.

Authors such as Burke et al. (2007) and Allan (2016) raised concerns about the current ethical codes. Burke et al. (2007) criticized the South African ethical code for failing to guide professional practice because it does not reflect the complexity of the dilemmas faced by psychologists. The codes lack a theoretical foundation, are too prescriptive, focus mainly on individual clients, and prioritize the protection of psychologists instead of the people they serve, as noted by Allan (2016). Burke et al. (2007) describe this as “contextual myopia” (p. 110) because the codes seem to operate on the premise that psychologists work in isolation, where they are entirely autonomous and can dictate their course of action. However, in reality, psychologists must manage the demands of their employer (if not in private practice), the professional/therapeutic team, superiors/supervisors, the legal system, and the client, while also accounting for other constraints, such as lack of resources (Burke et al., 2007). Burke et al. (2007), therefore, highlighted the need for a South African ethical code that would be educational, informative, and help guide decision-making.

Psychologists working in schools

Working with children under the age of 18 in South Africa requires a high level of ethical behavior. This is emphasized in various international declarations and agreements, including the United Nations Universal Declaration of Human Rights (UN, 1948), the African Charter on the Rights and Welfare of the Child (OAU, 1990), and the UN Convention on the Rights of the Child (UN, 1989). Special care must be taken to protect children’s rights and welfare.

The Constitution of South Africa affirms that “A child’s best interests are of paramount importance in every matter concerning the child” (The Constitution of the Republic of South Africa, Act 108 1996, 1996, p. 12; see Children’s Act 38 of 2005). As a result, school psychologists are bound by legal and ethical standards and the unique cultures and expectations of the schools and districts in which they work. This can create challenging situations for psychologists who must navigate complex networks of relationships and contexts to avoid and manage ethical dilemmas. School psychologists often face several challenges that can make their job quite demanding. These challenges include juggling outdated procedures while providing direct and indirect services to diverse clients, including children, parents, administrative staff, principals, and school communities. They also must perform multiple roles in schools that are not clearly defined, including counselor, assessor, consultant, and in-service trainer (Moolla & Lazarus, 2014). In addition, managing heavy workloads, insufficient resources, uncooperative staff, teachers, and parents, managing expectations, and navigating between an ideal role and one feasible in practice can be overwhelming for school psychologists (Boccio et al., 2016).

Ethical dilemmas can potentially harm both clients and psychologists. According to Boccio et al. (2016), psychologists who face pressure from the administration to act unethically are more likely to experience burnout and lower job satisfaction and may consider leaving the field. Similarly, Huhtala et al. (2017) found that psychologists who frequently encounter ethical dilemmas or ruminate over them can experience increased stress levels. As ethical challenges can negatively affect the well-being of psychologists working in schools (Huhtala et al., 2017), it is important to understand these challenges and develop effective coping strategies.

Ethical dilemmas faced by psychologists in South Africa have been discussed in some publications (Nortje & Hoffmann, 2015; Nyawose, 2014; Wassenaar, 2002), but none have explored the ethical dilemmas experienced by psychologists working in schools. This study area is particularly relevant because the nature of the work, school context, and the role of psychologists in schools make it a challenging ethical arena. The research question that was central to the study and provided direction was: What kinds of ethical dilemmas do psychologists encounter while working in schools?

Method

Critical incident research

This study was qualitative, exploratory, and critical incident research. In the Critical Incident Technique (CIT), a critical incident is a significant event or occurrence of a particular activity (Hughes, 2007). The CIT aims to generate information about incidents and behaviors during these incidents to identify areas requiring attention and ultimately address practical problems (Butterfield et al., 2005; Twelker, 2003). The purpose of this investigation was to explore and describe the kinds of ethical dilemmas that psychologists face when working in schools. Therefore, the aim was not to evaluate the ethical behavior of psychologists or to focus on ethical decision-making processes, but rather to identify similarities, differences, and patterns using the CIT, which aligns with other social science studies (Hughes, 2007, p. 49).

CIT has proven to be a successful method for generating relevant data representing personal experiences (Gremler, 2004; Hughes, 2007; Jacob-Timm, 1999). In 1992, the American Psychological Association (APA) utilized critical incident research to develop its initial ethical code (Pope & Vetter, 1992). This technique gathers information most pertinent to the respondent’s experience in their own words (Gremler, 2004), which increases the probability of obtaining accurate and nuanced accounts of current practices related to psychologists (Jacob-Timm, 1999). CIT is a useful starting point for building a knowledge base and expanding future research (Hughes, 2007). Because of its inductive nature, the CIT is ideal for exploratory research (Gremler, 2004).

Data-collection and analysis

Using our designed interview schedule, the first author collected the data through semi-structured telephonic interviews. The schedule included closed questions that captured biographical information. Then, the participants were asked to describe an incident they faced in recent years that was ethically challenging or troubling without using any real names or identifying information. Participants had the option to describe numerous (or no) incidents. The open questions are like those used by previous researchers, such as Pope and Vetter (1992) and Lindén and Rådeström (2008).

With the consent of the participants, the interviews were recorded via the Cube ACR application and transcribed verbatim. The transcriptions were saved as “cases” in QDA Miner Lite, a free version of the qualitative data analysis software QDA Miner. The data obtained from the study were analyzed using thematic analysis with constant comparison, as described by Percy et al. (2015, p. 83). This approach uses a step-by-step process of coding and clustering the data into patterns or themes. The data were coded, and patterns developed as the analysis progressed. The analysis began with the first incident, and the subsequent responses were compared with previous codes and patterns. Themes were refined by constantly moving back and forth to ensure accuracy. The unit of analysis was the kind of ethical dilemmas experienced, referred to as critical incidents.

We obtained institutional clearance from the Stellenbosch University Research Ethics Committee: Social, Behavioral, and Education Research Project Number 14,692 to conduct the research. Participation in the study was voluntary, and all identities were kept confidential. The data were handled according to confidentiality requirements. After the interview, the voice files were immediately transferred to a password-protected OneDrive vault and then deleted from the phone. The transcriptions were anonymized and saved on a password-protected personal computer and OneDrive vault. The voice files were permanently deleted after the transcription process.

Participants

We conducted this research during the initial stages of the COVID-19 pandemic lockdown. Schools were closed, and potential participants either worked from home or only on certain days of the week. We used purposive sampling to identify registered psychologists working in schools who were willing to participate. Using snowball sampling, we recruited 16 participants who shared 58 ethical dilemmas. This is a common non-probability technique in qualitative research, where participants who responded to the initial call to participate in the study are asked to suggest other registered psychologists in their network who may be interested in participating (Merriam & Tisdell, 2016). This helped us during the lockdown period, as potential participants were hard to reach. The participants also felt more comfortable as they were referred by someone they knew and trusted. To protect their colleagues’ privacy, they shared the project information with their colleagues and obtained permission before sharing contact information with us.

The biographical information of the participants is presented in Table 1. Most psychologists worked in public schools (10), followed by private schools (3), and a few worked in both public and private schools (3). Some psychologists worked in the district office of the Western Cape Education Department (WCED) (3), as part of a circuit team (2), special schools (3), or international schools (2). Most of them worked across different phases (14), whereas others worked in the senior phase and Further Education and Training (FET) (2).

Table 1. Characteristics of the research participants.

Institution
Public	10	Private		3		Both	3
Type of Institution
WCED district team	3	WCED circuit team	2	Special school	2	International school	2
Phase of Education Worked With
Work across phases (Grades 1–12)			14	Work with senior and FET phases (Grades 7–12)			2
Age Distribution
30–39	8	40–49	3	50–59	4	60 +	1
Years of Experience
0–2	7	3–5	2	6–10	1	10 + more	6
Frequency of Ethical Dilemmas
Yearly	7	Monthly	3	Weekly	3	Daily	3

Participants were categorized by age as follows: 20–29 (0), 30–39 (8), 40–49 (3), 50–59 (4), and ≥60 years (1). They also had different levels of experience: 0–2 (7), 3–5 (2), 6–10 (1), and over ten years (6). These categories reflect the continuum outlined by Jacob et al. (2022), which includes novice practitioners, advanced beginners, competent practitioners, proficient practitioners, and experts.

Results

Frequency of dilemmas experienced

Psychologists reported encountering ethical dilemmas at different frequencies: never (0), yearly (7), monthly (3), weekly (3), and daily (3).

According to the study, three participants faced ethical dilemmas daily, three faced them weekly, three faced them monthly, and the remaining seven experienced them on a yearly basis. The study did not have enough participants to analyze the qualitative differences between the frequency of dilemmas reported, years of experience, or the type of institution. However, it is interesting to note that newly qualified and highly experienced psychologists reported daily and weekly ethical dilemmas. In contrast, psychologists with 3 to 10 years of experience reported experiencing dilemmas only yearly. This could be because newly qualified psychologists are still learning and may not feel as comfortable dealing with various situations. Alternatively, highly experienced psychologists may be better equipped to identify ethical dilemmas.

Types of dilemmas experienced

We were interested in the content and kinds of ethical dilemmas experienced by psychologists in schools. The themes identified are summarized in Table 2. Two-thirds of all dilemmas were related to confidentiality and role definitions.

Table 2. Summary of themes.

Theme	Category	Incidents
Privacy and Confidentiality		24
	Pressure from the schools to disclose information	6
	Disclosing confidential information	6
	Information disclosed by others	5
	Pressure from clients not to disclose	5
	Keeping records	2
Role definition		15
	Working with other role-players	7
	Multiple relationships	5
	Confusion about the role of the psychologist	3
Assessments and reports		5
	Pressure to make a diagnosis	3
	Pressure to omit a diagnosis	2
Workload		6
	Interns and newly qualified psychologists	4
	Psychologists working for the WCED	2
Consent		5
	School requests for service without appropriate consent	2
	Client refuses or stops therapy	3
Boundaries of competence		3

Privacy and confidentiality

Pressure from the school to disclose information

One of the most frequently experienced dilemmas the participants faced was pressure from principals, teachers, learning support teachers, and administrative staff to disclose confidential information. Two distinct scenarios are evident.

First, participants who displayed assertiveness or took time to establish a sense of camaraderie with their teachers were better equipped to handle ethical dilemmas. These psychologists demonstrated empathy toward their teachers and believed that the pressure showed their willingness to help the students.

It takes time, but I have built up a solid enough relationship with all the staff that they know that I’m gonna always say to them, “If there is anything you need to know, I will let you know.” (P14)

We will give them a broad idea but do not give them all the information. But then also just help the teacher to manage their behavior in class. Not give them all the detail but help them to help the child in the classroom. (P13)

Second, psychologists who did not feel prepared to deal with difficult situations or saw themselves as separate from the teachers found it more challenging to handle pressure from the staff. They described the staff as demanding and pressuring them for information. As a result, some psychologists physically withdrew or distanced themselves from the teachers, negatively impacting their work. One psychologist even considered quitting because of the stress caused by this situation.

I try to avoid the staff room because it is usually there. If I go into the staffroom in break to get coffee with myself and the other psychologist, we’ve got this joke that we just avoid the staffroom because it’s a dangerous place because we get pounced on and cornered. … . I just don’t go to the staff room./It would be nice to go down for coffee sometimes, but yeah, it’s really not a fun experience because we get cornered every time. (P6)

Teachers feel like they have a right to know exactly what’s going on in the child’s life. (P1)

I was constantly faced with a specific head of academics that wanted to know more information and you know it’s such a difficult space to be in because you’re employed by the school, and you have your ethical bounds as an educational psychologist. (P4)

Disclosing confidential information

This category describes situations in which psychologists face difficulties deciding whether to disclose information. Deciding to break confidentiality can be challenging. First, psychologists must weigh the risks to their clients or the school before reporting and determine whether breaching confidentiality is in the child’s best interest.

That was tricky to decide, okay … when are you breaching confidentiality by informing the principal, because of course there could be cases where the principal should know, for example, drug abuse or a teacher at the school who is perhaps doing something to students, understand, stuff like that, but there is a fine line. (P5)

Second, they must decide on how much to disclose.

You are confronted about again what does the teacher need to know to help and support this child or what do I need to keep to myself. (P4)

And you constantly have to juggle and jive. What am I allowed to say, what am I not allowed to say? (P15)

Third, they must assess whether the person they share information with is trustworthy.

Do you trust the principal with that information, because the principal has certain networks outside the school and is also involved and is friends with some of the parents? So yes, … I tried to not do that unless I really had to like if I thought it could cause trouble if the principal doesn’t know about this and if other students got pulled into it. (P5)

Fourth, being part of the school environment makes it challenging for psychologists to maintain confidentiality because of multiple relationships with all parties they see or work with daily.

It’s so much easier in a private practice to have that confidentiality because you’re removed of the kids you see in the hallway and all of that. In a school setting it’s a different ball game. (P4)

Psychologists possess confidential information that can help parents, teachers, and children to solve problems. However, the information has to be kept confidential.

And that is what we have to deal with, you have to stick to the code, you are not allowed to disclose, but you know what’s in front of you. (P15)

Although ethical codes and legislation provide clear guidelines for breaching confidentiality, real-life cases often present complex and nuanced situations that require careful consideration. As one psychologist said,

“it ranges, so it’s on a continuum.” (P14)

Information disclosed by others

Psychologists have faced multiple incidents in which they have kept information confidential, but a teacher or client has nonetheless shared sensitive information with others. This can lead to an awkward situation for psychologists when confronted by individuals who want to discuss information that should remain confidential.

It is not uncommon for clients to disclose their confidential information accidentally or purposely. For instance, in a case involving a group sexual offense, one of the clients revealed the identities of other parties to their parents, even though the client’s identity had to be protected. In another incident, a parent shared confidential information with the receptionist, who then disclosed it to other staff members. Additionally, some clients shared confidential information with their teachers, who then wished to verify or share it with a psychologist.

One psychologist suggested that teachers may not be aware of the importance of keeping information confidential because they are not trained in the ethical codes provided to them, unlike psychologists.

You can’t work without the teachers. I mean, that’s part of what we do here, and when it comes to our learners you have to involve the teacher. But people don’t understand the impact when you break ethical rules when you disclose information. That’s my biggest headache. (P15)

When a psychologist witnesses a teacher sharing a student’s personal information with others, it can be challenging to manage as the teacher is not the one transgressing. However, psychologists are responsible for ensuring that they protect the best interests of their clients. This includes appropriately safeguarding their clients’ welfare, privacy, and confidentiality.

Pressure from the client not to disclose

This category comprises two types of ethical dilemmas faced by psychologists. The first type is when a psychologist intends to disclose certain information but struggles to obtain the client’s consent. For instance, in cases where the psychologist has made a diagnosis, it would be beneficial for the client if the teacher knew about it to assist. However, the client opposes the disclosure of such information.

That was an ethical dilemma because we are sitting with a problem, we know what the barrier is, but he doesn’t want them to know how to help him scholastically, so he was gonna drown academically, and that was the dilemma. (P2)

Second, a psychologist may have a legal obligation to report certain situations, such as instances of abuse.

That is THE biggest ethical dilemma. Should I report it or not? … I’ve always tried, to the best of my abilities, to explain why we have to report it. … The problem is what happens from when he gets arrested to when he has to go to court? The problem is what happens in court? Will he be found guilty? Then what will happen? Will he get a reduced sentence or jail time? If his [finger]prints aren’t on record, they can’t do anything. Tomorrow he’s back, and he’s angry that you did these things to him. (P16)

Keeping records

One of the participants in the WCED expressed concern about the security of school reports because there were no facilities available to keep the files safe.

At the moment, all my files are at home. I won’t take them to school because the cupboard in my office; the maintenance team of the school has a spare key to get into that, and a lot of the maintenance workers’ children attend the school, and some of them are in therapy with me. (P6)

Role definition

Working with other role-players

A common challenge reported was working with other role players, including learning support staff, teachers, principals, and parents. Psychologists must decide how much to involve teachers in creating a holistic team without compromising confidentiality (P4). There may also be differences in expectations. For example, School management always works in the best interests of the school, and I work in the best interests of the individual (P14). School structures, such as a complicated referral framework, could create barriers.

So, there are many steps; there are many gatekeepers in the process, that is an ethical dilemma to me. There shouldn’t be that many steps or blockages for a kid and hoops that a kid has to jump through to get help at the end of the day. (P7)

A few of the dilemmas were centered on managing parents and their reactions.

When an adolescent goes to therapy in a private process the parent knows that something is going on right, so they’re taking them to see a psychologist. Whereas here, you know sometimes I have to call parents in and they had absolutely no idea that their kid was struggling. (P14)

Um, I do think that as a psychologist, you are very vulnerable to criticism. Yes, I had that with a few parents that you know were in denial and felt like, yeah, cause the client shares a lot of stuff with you that the family does, and then the family gets quite defensive. (P8)

Multiple relationships

Due to the interconnected nature of schools, it is nearly impossible for psychologists to avoid multiple relationships. They might see a client who is a friend of another client. This creates dilemmas when clients want to discuss things about each other. Psychologists may also be called for to mediate between children and teachers. Finally, schools are typically small communities where parents often interact with one another.

Confusion about the role of the psychologist

Some participants expressed that role players expect them to work miracles in therapy, or conversely, they limit the psychologist’s role to assessment and therapy.

The teacher decided to blame it on me for not fixing this child; they see this child as a cell phone, take it into the shop, and expect results. (P2)

Psycho-educational assessments and reports

Pressure to make a diagnosis

A few psychologists have described situations in which they were pressured by principals, teachers, and parents to make a particular diagnosis. The parents or teachers had their ideas about what would benefit the child and tried to influence the psychologist’s assessment for accommodations.

A psychologist at a private school shared that parents who pay for psychometric assessments expect a diagnosis to be made so their child can apply for accommodation. Psychologists who assess these clients feel pressured to deliver a diagnosis. If they fail to do so, parents express their disappointment and try to convince them to change their diagnoses.

Parents want you to write your report according to what they think the child must get, so you would; I would often have meetings with parents and meetings with the school-based support team, and they would say yes, you must just find this child needs a scribe and you must just find it in your stuff. (P4)

Pressure to omit a diagnosis

Parents sometimes request psychologists not to mention the diagnosis in the report or to keep it confidential from teachers. It is within the right of parents to withhold reports from schools. However, this ethical decision puts the psychologist in a difficult position where they may be unable to provide complete assistance to the client.

Workload

This theme revolves around the challenges and predicaments that arise from school psychologists’ excessive workload.

Newly qualified psychologists

A recently qualified psychologist expressed feeling defeated and unable to function professionally. They also faced an ethical dilemma regarding assisting students while practicing proper self-care.

Sometimes it does get too much, and then I’m not productive because I feel like I have to rush responses to emails. Yeah, it’s very difficult to give 100% if there’s too many./Before, I would say I’m gonna put the kids on a waiting list, but then I would just see them anyway because I feel bad, but now I’ve become quite strict with the waiting list. (P6)

A newly qualified psychologist working at a private school reported facing ethical dilemmas daily. They highlighted the pressure they faced from senior management at the school to disclose information about clients. Since the school is the employer, the psychologist felt it was a difficult space to navigate. In addition, the psychologist had difficulty determining what information should be shared with other teams, such as learning support, to best assist the client.

Psychologists working for the WCED

Two individuals who were part of a circuit team and district office highlighted the immense workload associated with their positions. They emphasized that this is a broader issue instead of an isolated incident. One person mentioned that there was a ratio of one psychologist to every 6,000 students for psychologists working at the district office. At the same time, the other cited a possible caseload of 26,000 in a circuit team. The WCED hires one psychologist per circuit team (Moolla & Lazarus, 2014). A circuit team is an interdisciplinary team of professionals whose main role is that of educational support. One circuit team can be responsible for as many as 40 schools (Moolla & Lazarus, 2014). In that case, one psychologist tends to the psychological service needs of up to 40 schools, albeit as part of a team of education support professionals. Both stated that this was an ongoing ethical dilemma.

The most basic ethical issue that anyone in our field working for the government experiences is the lack of service delivery, proper service delivery, as a result of sheer amount of numbers, the number of people there are, the number of problems there are./That is a daily issue for people employed by the government. There aren’t enough of us./If you don’t get to them, you don’t get to them. That is part of the ethical struggle because you know there are more, and you know there are more people who need to be seen. You have to prioritize. When the principal phones and says there is a potential suicide case, you have to pack up and go. Serious crises get first priority. (P16)

Finally, demonstrating the amount of work completed is easier for psychologists in some tasks than others. For instance, they can easily quantify the work done when conducting assessments, but it is not easy to demonstrate the same level of industriousness when conducting therapy sessions. This could potentially lead psychologists to focus more on one type of activity over another, as expressed by one psychologist who had concerns about this.

Consent

School requests for service without appropriate consent

A psychologist employed by the WCED reported instances in which schools referred students to therapy without parental consent. In one case, the principal demanded an assessment without obtaining consent from the student’s parents.

Client refuses or stops therapy

A potential ethical issue arises when a psychologist or school recommends therapy, but the client who is old enough to consent refuses.

She insisted she is fine, but the school wanted me to see her, but the learner didn’t want to come, so I just let it go. I just went with what the child wanted. (P2)

In another incident, the psychologist strongly recommended continued therapy, but the client opted to discontinue. It was difficult for the psychologist to not take the client’s termination of therapy as a personal rejection.

So, it was difficult because you, as a psychologist, also need to say to yourself that if this person does leave, I’m gonna be okay with it. So, ya that was for me, for myself, ethically, when she said she was going to leave to not try and convince her to stay. (P8)

Boundaries of competence

Psychologists have reported incidents of assisting clients outside of their competencies or cultural framework.

You’re having to deal with a lot of things, and you don’t necessarily have training in all of those different aspects./At a school, you get thrown pretty much everything and anything. (P1)

Ways of dealing with dilemmas

The psychologists in this study used various strategies to handle ethical dilemmas in the best possible manner. These included relying on the law, codes, and acts; establishing clear boundaries; seeking support from their team; demonstrating empathy; negotiating with the client; seeking supervision; and prioritizing the child’s best interests.

Relying on the law: ethical codes and acts

Many psychologists rely on codes and acts as their primary strategy. This was the most straightforward approach. In situations where they are required to disclose information, they can refer to the contract they have signed with the client or resist pressure from staff to disclose information by referring to the code.

You just learn to stick to your guides. You use the ethical rules and stuff to back you up because no one can go against what the HPCSA prescribes for us as Ed psychs. (P4)

A clear explanation was provided based on HPCSA guidelines and the SA constitution … [and the] Bill of Rights. (P12)

The Protection of Personal Information (POPI) Act of 2013 helps teachers understand the code of conduct that psychologists must follow.

The POPI Act is definitely helping the everyday person not to share information if they do not have informed consent. (P13)

Being firm and setting boundaries

Half of the psychologists stressed the need to assert themselves to avoid being coerced into unethical behavior by others. Psychologists use expressions such as cement myself, stand your ground, be firm, and firm boundaries. As some psychologists gain experience, they actively cultivate this skill.

Relying on their team

Psychologists have described how they can rely on the people in their networks to deal with dilemmas. They emphasized the importance of having a solid team to address such situations. Playing an active role in team building is crucial to deal with dilemmas better. Building a solid team has several benefits, including having someone to refer to, avoiding feelings of isolation, and making psychology more accessible.

It takes time, but I’ve built up a solid enough relationship with all the staff … I think the most important part of it has been taking, it’s making psychology and therapy less scary for everybody. (P14)

Showing empathy

While empathy cannot necessarily resolve ethical dilemmas, it can be an invaluable tool for psychologists dealing with the emotional burden that comes with facing ethical challenges. By considering the emotions and experiences of all parties involved, psychologists can gain a deeper understanding of the reasons for this dilemma. This understanding can help to remind psychologists that the person who puts them in a difficult situation is also human and imperfect and may not have intended any harm.

Teachers are very nice people, and they really just want to help./They will always try because they really care about their children in the class. (P13)

There is a background. Every child is a package. (P15)

Negotiating with the client

A common strategy used by psychologists, mainly when clients are reluctant to disclose information, is to negotiate with them.

I’ll say is it OK if I maybe not share your personal information with your teacher but maybe just give your teacher some tips on what they can do to support you in class without them actually knowing what the problem is and they are usually OK with that. (P6)

Establishing a transparent contract with clients at the beginning of the therapy is crucial. This includes ensuring that clients are aware of the limitations of confidentiality and situations in which confidentiality may be breached. The psychologists who participated in this study recognized this significance and worked with most clients to reach an agreement when confidentiality needed to be compromised.

Seeking supervision

When they felt uncertain about how to proceed, three psychologists suggested seeking guidance through supervision.

Focusing on the best interests of the child

Two psychologists suggested using the principle of the best interest of the child as a guide for ethical decision-making.

I try to stick to the best interest of the child principle as strongly as I can. (P6)

However, many issues remain unresolved, including ongoing incidents related to workloads and confidentiality.

Discussion: the ethical landscape of psychologists working in schools

This study aimed to investigate the ethical challenges faced by psychologists working in South African schools and the frequency and types of ethical dilemmas encountered while performing their jobs. Most of the participants experience dilemmas regularly. Many psychologists have reported experiencing significant events that they consider ethical dilemmas. Some grouped various incidents together as a continuous experience of the dilemma, including issues like workload and client data safety. It can be concluded that dealing with ethical dilemmas is an inevitable aspect of working as a psychologist in a school, based on the frequency and type of incidents described. The study identified six ethical dilemmas: confidentiality, role definition, assessments and reports, workload, consent, and boundaries of competence. These findings are consistent with those of previous studies conducted in other countries (Boccio et al., 2016; Jacob-Timm, 1999; Mendes et al., 2016; Osborn, 2012). The study also found that the types of dilemmas identified overlapped with those mentioned most frequently in Jacob-Timm’s (1999) study, namely, administrative pressure to act unethically, assessment, and confidentiality (see Jacob et al., 2022). Additionally, the findings are consistent with the three most common dilemmas found by Mendes et al. (2016): managing privacy and confidential information, pressure from schools to act unethically, and reporting abuse. Finally, the study’s results overlap with two of the three most common dilemmas identified by Osborn (2012), which were multiple relationships and confidentiality.

The present study raises concerns about the pressure placed on psychologists by role-players to behave unethically, which results in infringement on clients’ rights. Such administrative pressure to act unethically can lead to adverse outcomes such as burnout, conflict, lower job satisfaction, and a higher likelihood of leaving the field (Boccio et al., 2016). It is also worth noting that this study found many incidents involving ethical dilemmas that are constantly present and cannot be resolved easily or by psychologists alone. Therefore, participants who report frequent experiences of ethical dilemmas could be at risk of higher stress levels (Huhtala et al., 2017).

The ethical landscape in schools can be complex, especially for school psychologists. There are two main reasons for this finding. First, psychologists do not operate independently and must consider all role-players, as Lasser et al. (2013) and Mendes et al. (2016) emphasize. They need to build relationships with them, negotiate with them, and consider their level of knowledge, culture, and context (Prilleltensky et al., 1999). While they must adhere to professional codes and follow acts, they sometimes face heavy caseloads. School psychologists often have to navigate through a context in which their roles are not well-defined, which can cause misunderstandings (Moolla & Lazarus, 2014). Second, other entities work within schools besides psychologists. Consequently, psychologists do not always have control over the storage location of files, type of information shared, clients they interact with, or workload they must manage. Their ethics of duty may conflict with the frameworks of principals and systems administrators who must put the interest of the school or system, as opposed to an individual client, first. In addition, it is not uncommon for a psychologist to maintain confidentiality only to have information shared by students or teachers. Burke et al. (2007) argued that the current ethical code is ineffective in guiding psychologists as it does not reflect the complexities of their dilemmas and assumes that psychologists work alone. This is especially true for psychologists working with children and schools.

It is important to note that professional codes play a crucial role. For instance, the HPCSA’s Ethical Code of Conduct for Psychologists is a fundamental aspect that outlines the ethical duties and responsibilities that all registered psychologists must follow. It serves as a shield that protects psychologists from behaving in a manner detrimental to the people they serve. However, relying too much on codes can cause psychologists to focus more on avoiding risk than dealing with ethical responsibilities, which can be problematic. As Pope and Vasquez (2011) stated, “We cannot hide behind ethics codes as a refuge from an active, creative search for the most ethical response” (p. 16). To achieve the principles outlined in the Universal Declaration of Ethical Principles for Psychologists (2008), psychologists must strive to do better than just following the Code. They must aim to maximize benefits and minimize harm.

Psychologists often find themselves in a dilemma in which they must choose between putting themselves at risk by acting unethically and putting the child at risk by not helping or doing something that might harm the child. In some cases, a psychologist may have to choose between overworking or being unable to assist as many children as they would like. For example, a student might have to wait too long to see a WCED-appointed psychologist, which could lead a psychologist to consider a case they would typically refer to another professional. Managing such a large number of students is a complex issue, often referred to as a wicked problem.

If a psychologist chooses to follow the ethical code when they encounter dilemmas, they must be ready to accept the consequences of their decisions. For instance, if a psychologist reports abuse in a poor neighborhood, they fulfill their ethical and legal obligations. However, they must also be prepared to face the consequences of reporting the abuse. This could include the family losing its breadwinner, the child dropping out of school, and the perpetrator not being punished. Despite these negative implications, abuse may continue (Prilleltensky et al., 1999; Shriberg et al., 2020).

In the face of these ethical challenges, many participants were able to use the ethical code as a tool and their own and others’ strengths to resolve these dilemmas.

Implications for practice

Graduate psychology and internship education and training

We agree with researchers such as Jacob et al. (2022) that it is essential for graduate programs to cover both ethical and legal aspects of practice alongside ethical reasoning skills to effectively solve ethical and legal problems. We believe that this should be the national standard for program accreditation. In today’s world, ethics training should no longer be done by “osmosis” (Handelsman, 1986,, as cited in Jacob et al., 2022, p. 4), one-shot workshops, or simply focusing on ethical codes in a cookbook fashion. Professional ethics education should be carefully planned, structured, and explicitly taught at multiple levels.

Dailor and Jacob (2011) suggest that formal coursework in ethics and law should be provided, which includes an understanding of one’s personal, family, and cultural beliefs and values. This basic knowledge should be expanded to incorporate ethical and legal issues and problem-solving skills into professional practice and coursework components (Jacob et al., 2022; Whalen & Diamond, 2023). Supervisors and mentors should lead and model ethical-legal problem-solving skills, self-reflection, and discussions during practical training and internships. An often-neglected aspect of ethical behavior training is addressing self-care and stress management in professional practice.

The internship year allows students to develop professional competence under supervision. To help students feel more capable of dealing with various clients and situations when they begin their internships, including a broader range of case studies during their coursework years may be helpful. Recently, in South Africa, it has become mandatory for all interns to spend at least 10% of their internship programs on ethical and legislative issues. The number of hours is not supposed to be a matter of compliance; instead, learning to identify, analyze, and resolve ethical and legal issues systematically should be integrated into all activities and domains. Jacob et al. (2022) have provided valuable suggestions for professional training based on the National Association of School Psychologists (NASP) Professional Standards (2020). Diamond et al. (2021) and Whalen and Diamond (2023) proposed the DECIDE ethical problem-solving model as a tool for analyzing ethical and legal issues in school settings. This model can help interns and practitioners make informed and well-reasoned decisions to resolve problems, thereby building confidence in effectively and ethically handling such situations. However, there is still a lack of research on the most effective training methods for building competence and confidence.

Assertiveness workshops and continuous professional development (CPD) training

During the study, psychologists frequently reported ethical dilemmas related to the pressure from schools to disclose confidential information. Setting clear boundaries was an effective strategy for dealing with such dilemmas. To address this issue, attending assertiveness and conflict-resolution workshops could benefit psychologists, as it would help them develop the necessary skills to handle these situations and minimize ethical dilemmas.

Participants noted that familiarity with the code and legislation could act as a protective measure. This emphasizes the significance of attending CPD workshops annually to stay abreast of advancements in the field and legislation updates. The recent implementation of the new POPI Act is a prime example. Continuous learning equips psychologists with the knowledge and skills needed to address emerging ethical dilemmas in school settings.

Building strong teams and getting clinical supervision

Research conducted by psychologists has shown that working in strong and cohesive teams can facilitate the resolution of ethical dilemmas (Boccio, 2015). Moreover, psychologists can cultivate a positive work environment by fostering collaboration, promoting open communication, and encouraging mutual respect between colleagues and staff members.

Psychologists should establish positive relationships with principals, teachers, and other learning support staff members. They should also create a reliable referral network with other health professionals registered with the HPCSA, such as speech therapists, physiotherapists, and occupational therapists. If the school staff is not open to building relationships, psychologists may consider contacting a network or supervisor/senior psychologist outside the school for support. Fostering connections and networks is essential to providing students with the best possible care and support.

Seeking clinical supervision is always a reasonable option when feeling stuck. “Isolation is the enemy of careful deliberation; consultation is its friend” (Knapp et al., 2015, p. 11). Regular clinical supervision offers a structured setting for school psychologists to reflect on their practice, discuss complex cases, and receive feedback on ethical decision-making. This form of supervision aids psychologists in maintaining professional standards, improving their clinical abilities, and effectively navigating ethical dilemmas (see mendes et al., 2016). Supervision is mandatory for trainee psychologists but optional for registered psychologists in this context, often referred to as consultation.

Clarifying the role of the psychologist working in schools

It is not uncommon for ethical dilemmas to arise because of a lack of understanding of the psychologist’s role. To prevent this, principals, teachers, and other school professionals must clearly understand psychologists’ responsibilities. The psychologist or principal can take the initiative to briefly discuss the psychologist’s role during staff or team meetings. They should clarify what psychologists are and are not permitted to do within the boundaries of their ethical framework. As role clarification is an ongoing process in professional teams, it may be necessary to hold such discussions annually. Therefore, psychologists should advocate for their profession and educate schools and the public about their roles and responsibilities. In the absence of clear principles for psychologists working in South African schools, ethical codes such as the Principles for Professional Ethics by the National Association for School Psychology (NASP) (2020) and the International School Psychology Association (2021) can guide practitioners in matters specifically related to school, students, families, and teachers.

POPI act training for principals and teachers

The Protection of Personal Information Act (POPIA) (Act 4 of 2013) commenced on 1 July 2021. It is the most comprehensive data protection law in South Africa and sets the minimum standards for how personal information is collected, used, stored, shared, and destroyed. It impacts how schools manage the personal information of their students, staff, and parents. The participants perceive the POPI Act as a tool to protect privacy rights and prevent ethical dilemmas regarding consent, confidentiality, and personal data management. Some believe that principals and teachers who are knowledgeable about the act are less likely to divulge confidential information or pressure psychologists to do the same. Staff members should, therefore, be equipped and trained to comply with the POPI Act. Psychologists can play a significant role in conducting workshops and facilitating processes involving students’ personal information.

Reminding teachers of the educators act

Some psychologists say teachers may not fully comprehend the significance of working within an ethical code. However, it is worth noting that most teachers are registered with the South African Council for Educators (SACE), which has a Code of Professional Ethics included in the South African South African Council for Educator Act 31 of (2000). The Act clearly states that teachers should respect students’ privacy and confidentiality. Additionally, it emphasizes that teachers must not undermine their colleagues’ authority and should be mindful of their assigned responsibilities.

Teachers should be reminded about the ethical principles and legal obligations of handling confidential information. Continuous guidance, training, and collaboration among different role-players, including the SACE, school principals, and psychologists are important. Teachers can be better equipped to respect their students’ privacy and autonomy by working together while providing effective support and care. The school principals could provide continuous guidance, while the SACE could offer annual reminders in newsletters or CPD workshops. If teachers pressure psychologists to disclose confidential information, psychologists can explain ethical principles and relevant legislation or policies. Finally, psychologists can help train teachers through interactive workshops that focus on ethical principles, roles, and responsibilities.

Conclusion

As human beings, we have a responsibility to one another because we are all connected. The Universal Declaration of Ethical Principles for Psychologists (2008) emphasizes the importance of ethics in all fields, as ethical conduct leads to a healthy society where individuals can thrive. Ethics helps us recognize our responsibility to society and understand its impact. This study aimed to expand our knowledge of professional ethics in the context of psychologists working in schools. The study revealed that psychologists encounter numerous ethical dilemmas, such as those related to confidentiality, role clarification, assessments and reports, workload, informed consent, and the extent of their practice.

Our central argument in this paper is that while ethical codes and universal ethical principles based on the deontological framework are aspirational and inspirational and should guide psychologists’ behavior (Allan, 2013), they do not consider the complex circumstances in which school psychologists work. In addition, ethical codes are often not in sync with the laws that apply in our profession. By understanding the ethical dilemmas faced by school psychologists, we can revise the code of ethics, guidelines for professional practice, and training of psychologists so that they are better informed.

The present study has some limitations that should be considered. The primary limitations include how data were generated, response bias, and the nature of the research design. Critical incident research has a low response rate (Jacob-Timm, 1999), which raises concerns regarding non-response bias. In other words, there might be a difference between psychologists who chose to participate and those who did not. Another concern was the recollection bias. As the interview guide asked psychologists to report past events, they might have misremembered certain aspects of the incident. Participants may also have changed the nature of the dilemma by putting themselves in a more favorable light. This is called the social desirability bias, in which participants change their responses to conform to social norms (Neuman, 2014). However, it is important to note that exploratory research aims to obtain a general understanding of a phenomenon rather than produce conclusive answers (Neuman, 2014).

Further research should focus on the decision-making process and professional judgments in schools to describe ethical decisions. Participants selected to represent a range of experience levels would add depth to the findings by distinguishing between novice and experienced psychologists.

Acknowledgments

We thank all the psychologists who participated in this project.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Due to the nature of the research and ethical clearance requirements, supporting data is not available. Data supporting the findings of this study are available within the article.

Additional information

Notes on contributors

S. Wessels

Sonja Wessels, Sonja Wessels is a multidisciplinary professional with expertise in psychology, education, and business. She has completed a Bachelor of Arts in Humanities, a Bachelor of Arts Honours in Psychology, a post-graduate certificate in education, and a Master of Educational Psychology. During her tenure as an education manager, she has developed strong skills in mentoring, mediation, and leadership. With a keen interest in applying the principles of development, ethics, and transformation in a different field, she pursued her Master of Business Administration at Mannheim Business School in Germany while simultaneously working part-time in strategy and transformation. She joined a large insurance company as a full-time strategy manager in December 2023.

E. Swart

Estelle Swart is a Professor of Educational Psychology at Stellenbosch University in South Africa. Her research interests include the professional development of educational psychologists and teachers, support for inclusive education, childhood disability, and reflective professional practice. She has written numerous publications, presentations, and co-edited books. Some of her notable works include Addressing Barriers to Learning: A South African Perspective and Understanding Educational Psychology. Throughout her career, she has served on the South African Board for Psychology and also chaired the Division for Educational Psychology of the Psychological Society of South Africa.