1. Question: Can a person who works in a setting such as a college counseling center or a state hospital call himself or herself a "psychologist" if he/she is not yet licensed?

Answer: Prior to 1998, the answer to this question would have been "yes." At that time, the law allowed the salaried employees of "corporations, partnerships and associations" to call themselves "psychologists" while providing psychological services under the supervision of a licensed psychologist. But that law (M.G.L. Chapter 112, section 123) was amended in 1998, making the practice of psychology or the use of the title "psychologist" by any unlicensed individual punishable by a fine of not more than $500 and/or imprisonment of up to 3 months. Additionally, M.G.L. Chapter 112, section 65(c) allows the Board to levy administrative penalties up to $1000 for the first offense and $2500 for each subsequent offense for the unlicensed practice of psychology.

We have encountered some situations in which an organization's website uses the term "psychologist" for an unlicensed person, but the individual never refers to himself or herself in that way. Although the organization may not have consulted the unlicensed person beforehand or even informed him/her about the content of the website, the unlicensed person bears responsibility for the way in which the organization presents his/her credentials to the public. Any unlicensed individual working for an organization is responsible for informing himself/herself about the way that organization represents his/her credentials and correcting any misrepresentations.

2. Question: A Psychologist receives a valid authorization form from a former patient giving permission to release all his records to an attorney. In the patient's records are two reports that the Psychologist received from a hospital and a school. Is the Psychologist obligated to withhold these reports and not release them to anyone else or must he release everything in the record?

Answer: There is nothing in Massachusetts law or in HIPAA that confers special status on health information in the client record received from a third party. The question of whether to release third party reports and/or other medical records should be based on one issue: patient authorization.

In the question above, it is stipulated that the former patient provided a valid authorization for release of his records. It should be noted here that information about substance abuse is protected by federal law and a general record release authorization is not sufficient. Release of substance abuse information requires a specific authorization.

MGL chapter 112, section 12CC allows that if "the psychotherapist believes providing the entire record would adversely affect the patient's well-being," then he/she could provide a summary of the record to the patient. But if the patient still insists on release of the entire record, "the psychotherapist shall make the entire record available to either the patient's attorney, with the patient's consent" or to another psychotherapist designated by the patient. Note that there is no mention of third-party reports in the statute.

If there is any question about whether it is in the best interest of the patient to release a report, the Psychologist should certainly contact the patient (or the parent/guardian) and discuss the pertinent issues. If the patient decides to exclude the report from the authorization, then the Psychologist is, of course, not obligated to release it. But the critical issue here is the former patient's consent, not the origin of the document.

It is not uncommon to receive reports that are stamped with a statement that the report is not to be re-released. Stamping a report does not create legal or ethical obligations. Simply put, if it is in the patient's file, and the patient authorizes its release, the Psychologist is obligated to release it, even if it was obtained from another source.

3. Question: A Psychologist completes a testing battery on an adolescent, provides feedback to the patient and her parents, and provides them with a report. Six months later, the Psychologist receives a valid authorization form signed by the parents requesting that the test data be released to them. Is it a violation of the Ethical Principles of Psychologists for the Psychologist to release test data (e.g., patient responses to test questions, raw scores) to non-psychologists who have no training in the scoring and interpretation of the tests involved?

Answer: The Psychologist is obligated to provide the test data, but not the questions which are part of a copyrighted document. MGL Chapter 112, section 12cc provides a possible exception: "If in the reasonable exercise of his professional judgment, the psychotherapist believes providing the entire record would adversely affect the patient's well-being, in such instances, the psychotherapist shall make a summary of the record available to the patient." However, if the patient or parent/guardian insists on having the entire record despite the potential impact on his or his child's well-being, the Psychologist must make the entire record available (including test data) to either the patient's attorney or to another psychotherapist designated by the patient.

[see also Ethical Principles of Psychologists and Code of Conduct (2002), 9.04 "Release of Test Data"]

4. Question: In a graduate course in family therapy, the professor requires each student to present to the class a genogram of her own family and to discuss family issues that might affect her therapeutic work with families. Is it ethical to require the sharing of personal family information in a graduate course?

Answer: This is permissible if the program or training facility has clearly identified this requirement in its admissions and program materials.

[see Ethical Principles of Psychologists and Code of Conduct (2002), 7.04]