Psychological Assessment Reports

Ethical Considerations in Writing Psychological Assessment Reports

Mark H. Michaels Private Practice

In this article, the author addresses the ethical questions and decision evaluators associated with the writing of psychological assessment reports. Issues related to confidentiality, clinical judgment, harm, labeling, release of test data, and computer usage are addressed. Specific suggestions on how to deal with ethical concerns when writing reports are discussed, as well as areas in need of further research. © 2005 Wiley Periodicals, Inc. J Clin Psychol 62: 47–58, 2006.

Keywords: ethics; report writing; assessment

As the final product, and often the only communication about an evaluation, the psycho- logical report is a powerful tool for influencing change or making decisions about the individual being evaluated. The impact of such an evaluation can be life changing, such as employment decisions, or simply informative, such as what psychiatric symptoms are most prominent. Because the psychological report is often given immense weight, care must be taken to ensure any written work is completed with due respect to the ethical obligations involved. Some ethical issues, such as requests by employers for confidential information regarding an employee’s evaluation, are fairly straightforward. Ethical deci- sions in report writing, however, are less distinct and more subtle. Decisions are made all throughout the process about matters such as the wording of reports or what data to include.

Some guidance in making these ethical decisions can be found in the Ethical Prin- ciples of Psychologists and Code of Conduct (EPPCC; American Psychological Associ- ation [APA], 2002). However, ethical standards delineated by diverse sources do not always coincide. For example, the Standards for Educational and Psychological Testing (SEPT; American Education Research Association [AERA], APA, National Council on Measurement in Education, 1999) state:

Correspondence concerning this article should be addressed to: Mark H. Michaels, 211 E. Ocean Blvd. #258, Long Beach, CA 90802; e-mail: drsmnj@earthlink.net

JOURNAL OF CLINICAL PSYCHOLOGY, Vol. 62(1), 47–58 (2006) © 2006 Wiley Periodicals, Inc. Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/jclp.20199

When test scores are used to make decisions about a test taker or to make recommendations to a test taker or a third party, the test taker or the legal representative is entitled to obtain a copy of any report of scores or test interpretation, unless the right has been waived or is prohibited by law or court order.

This is not completely consistent with the EPPCC standard 9.04, which states that “ . . . Psychologists may refrain from releasing test data to protect a client/patient or others from substantial harm or misuse or misrepresentation of the data or the test . . .” (p. 14). Updates of ethical codes, such as the 2002 EPPCC revision, typically superseded previous versions. However, when various codes are not consistently comparable, or when guidelines are offered by separate groups, newer codes may conflict with, rather than supersede, previous practices. When addressing ethical questions, especially when faced with disparate ethical guidelines, clinicians should make decisions with due delib- eration of several general considerations.

This article will address ethical questions that fall within three general areas: the balance between (a) providing information and protecting client welfare, (b) providing information and protecting client confidentiality, and (c) utilizing information that may be of assistance and ensuring information is reliable and valid.

Beneficence and Autonomy

Bricklin (2001) raises a critical issue of autonomy and beneficence. She underscores the dilemma inherent in decisions about what and how to share information. Providing infor- mation respects a client’s right to know (autonomy), while not providing information that would be potentially harmful or disturbing protects that individual’s welfare (benefi- cence). Though there is no one approach that will universally balance these disparate aspirations, there are several considerations that help inform the evaluator’s approach to writing a report.

Harm

One especially significant consideration when writing a report is how conclusions or included data may harm the individual. Directly, a report can cause harm if it leads to negative consequences for the individual. A few immediate consequences that can result from the information added to a report include being denied employment, required to stand trial, or denied health care services. Conversely, harm to others may be prevented even if the client does not obtain a desired outcome. For example, an unqualified indi- vidual being denied a public safety position may ultimately benefit others in the commu- nity. In general, harm to a client may manifest in two primary ways—through a direct impact on the individual’s emotional state or indirectly by modifying how others behave toward that individual.

Smith (1978) discusses two problems that can arise when a client reads a report about himself or herself: misuse of the knowledge obtained and impaired trust in the clinician. Trusting the evaluator, provided that the clinician’s sole role is as tester, is unlikely to be a problem in most cases. Harm from the information included in the report, however, continues to be relevant long after any contact with the evaluator is concluded. Although there is little direct information about harm caused by obtaining knowledge from psychological reports specifically, information regarding psychiatric records may enlighten this issue.

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One way in which harm may be manifest is through the impact of report content on others’ perceptions of the individual, including health care providers, school personnel, or others. Markham (2003) found nursing staff rated their experience with patients receiv- ing certain diagnoses more negatively. Socall and Holtgraves (1992) found that greater rejection was evident toward people labeled as mentally ill, even when exhibiting similar behavior as non-ill individuals. Similar findings regarding differential perceptions of students have been found in school settings (Schwartz & Wilkinson, 1987).

A second aspect of harm is how emotional distress may be created for the client when presented with information about them. Though there is little direct research on how seeing report information impacts clients, there are some research findings that bear on this issue. Kosky and Burns (1995) found that, for the most part, patients’ access to their own records created no problems, though this was not true for all individuals. Roth, Wolford, and Meisel (1980) note how limited access to records can be beneficial. Spe- cifically, when patients were allowed to view their records, though not keep copies, reactions were generally positive. Others have also found that access to records can facilitate rapport and client cooperation (Doel & Lawson, 1986; Golodetz, Ruess, & Milhous, 1976). Bernadt, Gunning, and Quenstedt (1991) found that 28% of patients were upset after seeing a clinical summary. They also found differing reactions depend- ing on diagnosis. Kantrowitz (2004) found that patients had varied, though generally positive, reactions when reading about themselves.

Interestingly, Kantrowitz (2004) also noted that some of the writers acknowledged that knowing patients were going to be reading what was written modified what was included. Although she was investigating written work about treatment, it is easy to imagine how knowing that a client will read an assessment report would affect the con- tent as well. Specific investigation of this area would be illuminating.

A concern specifically raised by Smith (1978) is that report information may be misused. For example, misunderstanding or inaccurate application of IQ scores, diagno- ses, or personality descriptions may be utilized to limit access to services or funding. Smith (1978) specifically argues that misuses may also involve prematurely gained self- knowledge, perhaps leading to treatment resistance. In addition, misinterpretation of tech- nical terms can lead to erroneous conclusions about the individual. Consistent understanding of technical terms has been found to be absent even among clinicians (Rucker, 1967). Given this, it is easy to imagine how technical information could be inaccurately applied by those not already well versed in psychological principles and jargon.

Labeling

Diagnoses of mental retardation, psychiatric illness, or other personal challenges can be stigmatizing (Hayne, 2003). For example, psychiatric, as compared to medical, patients have been found to be viewed more unfavorably (Fryer & Cohen, 1988). Standard 8.8 of the Standards of Educational and Psychological Testing (AERA et al., 1999) specifies that if labels are employed, the least stigmatizing label be used. This presents a dilemma when omitting a label such as a diagnosis might deny the individual resources. In such a situation, beneficence can be assigned to both providing and not providing a label. For example, providing a diagnosis may benefit the client by ensuring external resources, but not providing a diagnosis may be of benefit by avoiding emotional distress. This high- lights the complicated considerations involved in weighing beneficence and autonomy.

In addition to diagnoses, labeling can occur in subtle ways as well. Comments on cognitive weaknesses or “poor coping skills” can be construed as congenital flaws rather

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than as stylistic differences or as areas needing additional training. The report writer must carefully consider how evaluation results are presented, as well as the intended and poten- tial audiences, when offering any information that may be construed negatively.

An ancillary point is where a diagnosis may fall on the continuum of severity. Pro- viding a more severe diagnosis may allow an individual to receive or afford services needed while a more benign diagnosis might rescue the person from potentially prejudi- cial labeling. Provided the decision follows the EPPCC section 6.06, regarding accuracy of information given to payers for services, this decision should be made taking the best interest of the individual in mind. This choice does require some judgment and may present a struggle for many clinicians.

Caution about labeling is particularly relevant for evaluations of minors; such results may be viewed by numerous individuals on a treatment team and by parents (Howe & Miramontes, 1992). Moreover, evaluation comments can become incorporated into other documents (e.g., Individual Education Plans) without the context of the original report, and then transferred along with the child’s records from year to year.

Intelligence Quotient Scores

Like diagnosis, IQ represents technical information that may be misconstrued by untrained individuals. Providing intelligence test scores has long been a point of debate (Kaufman & Lichtenberger, 2002; Lezak 1988). This debate bears directly on EPPCC standard 9.04. Inclusion of scores allows for easy comparison, either normatively or to past eval- uation findings. In contrast, IQ scores can easily become the focus, with subsequent discussion of cognitive strengths and weaknesses being lost. For example, providing a full-scale IQ may result in a child’s exclusion from an accelerated academic program, even if the report subsequently explains the limited accuracy of the single score given verbal and nonverbal differences or subtest scatter. The evaluator’s decision must weigh the relative benefit of having a score included against the potential drawbacks.

Given the well-documented increase in IQ over time (Flynn, 1998), reporting IQ scores from older tests (e.g., more than 10 years old) are likely to be inaccurate. For example, in a few years, scores on the Wechsler Adult Scales of Intelligence (third edi- tion) is anticipated to be 3 points higher than when the test was first published in 1997. Accuracy of IQ test scores takes on new magnitude when decisions are being made about life and death consequences, such as forensic evaluation in death penalty cases (Cici, Scullin, & Kanaya, 2003). Using a range of error helps to ameliorate this problem, but providing a numeric score could be considered inaccurate enough to raise ethical ques- tions. The problem of increasing IQ scores may fall in a gray area when considering what would constitute outdated test results (EPPCC section 9.08: Obsolete Tests). Not taking the age of normative data into account may result in improper use of test results.

Bricklin (2001) states when considering autonomy and beneficence, autonomy usu- ally takes precedence. Utilizing this guiding idea must be tempered, however, when a choice may advance both principles to some extent. In the example of providing a diag- nosis, including a label in the report both respects the individual’s right to know and their welfare, at least in part, by facilitating provision of resources. Including intelligence test scores, in particular, may span multiple ethical questions, being relevant to both potential harm and to client confidentiality.

Beneficence and Confidentiality

Psychological evaluations contain some of the most intimate and influential information one can obtain about another person, and care should be taken to ensure the report is only

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shared with appropriate consent or as required by law. Confidentiality is a concern when developing the content of the report as well. Section 4.04 of the EPPCC states, “Psy- chologists include in written and oral reports and consultations, only information ger- mane to the purpose for which the communication was made” (p. 7). For example, if notable information emerges during an evaluation, that was not part of the original refer- ral question, should that information be included in the report? On one hand, such infor- mation could be very helpful to the referral source, and ultimately to the individual. On the other hand, providing information that was not requested may violate the individual’s right to confidentiality (EPPCC section 4.04: Privacy). Consent to release information would solve this dilemma in most cases; however, there may be instances when including information would not be desired by the client, such as in some personnel or forensic evaluations. This ethical problem may be best addressed by clarifying in advance, how such potential findings will be handled. If permitted by law, psychologists may release information without consent to provide needed professional services (EPPCC section 4.05: Disclosures). It is questionable if this would apply to inclusion of information in a report; however, despite the potential utility of that information. In the absence of advance clarification and consent, evaluators should be cautious and keep information in reports germane to the referral question.

Release of Test Data

Inclusion of raw data within a report has given rise to a significant debate (Matarazzo, 1995; Naugle & McSweeny, 1995). The Standards for Educational and Psychological Testing generally encourages omission of test data (AERA et al., 1999). Although it has been argued that raw data should be routinely appended to neuropsychological reports, Naugle and McSweeny (1995) point out potential ethical violations, particularly of Stan- dard 2.02 of the Ethical Principles of Psychologists (APA, 1992) regarding misuse of test information and section 5.03 regarding privacy. Though renumbered with the 2002 ethics code revision (APA, 2002), the sections noted by Naugle and McSweeny (1995) remain. Moreover, a new section addressing the inclusion of test data clarifies that, in the absence of a release from the client, data should be provided only as required by law or court order. Notably, reference to the qualifications of those receiving information was deleted.

In the Statement on the Disclosure of Test Data (SDTD) by the American Psycho- logical Association Committee on Psychological Tests and Assessment (1996), several considerations on the disclosure of raw test data are identified. These include consent to release information, disclosure to unqualified individuals, test security and copyright obligations, and conformity with legal statutes, regulatory mandates, and organizational rules. Some of these considerations do not directly parallel those in the EPPCC. For example, the SDTD discourages release of information to “unqualified” individuals, though the EPPCC has no such admonition. Evaluators should reflect on all positions carefully before deciding how much, if any, information is disclosed.

Although differences may occur across jurisdictions, in general, legal and ethical release of test information cannot be done without the client’s consent (APA, 2002). Obtaining consent to release the report would effectively allow release of all relevant data regardless of form. In some instances, however, such as when the client is an orga- nization rather than an individual, release of any test scores to the individual tested might not be authorized.

Perhaps the most compelling concern with regard to raw data is the intended reader (Pieniadz & Kelland, 2001), especially for clinicians who are working in the legal arena.

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It is not uncommon that raw data be requested in psycho-legal evaluations. Moreover, the test items or questions that form the basis for an individual’s responses are also some- times called into question. Although the limitations on who is qualified to have access to raw data has changed with the 2002 revision of the EPPCC, the evaluator should still be aware of who is requesting the release of data. Though qualifications are no longer addressed in the EPPCC, test data may still be withheld (a) if data may be misused or misrepre- sented, and (b) to protect the client or others from substantial harm (EPPCC section 9.04). Hence, release of data to unqualified individuals still may present an ethical trans- gression (APA, 1996).

Even prior to the revision of the APA ethics code, some argued that release of data did not represent an ethical problem (Matarazzo, 1995). Recent revision of the ethics code and introduction of the Health Information Portability and Accountability Act of 1996 (HIPAA; 1996) requirements may have actually lessened concerns about release of data. For example, Erard (2004) notes that release of test data present even less of a dilemma, especially because the EPPCC no longer requires data be released only to qualified individuals. However, he also notes that the changes do not fully clarify this question, and suggests that clinicians continue to follow the Specialty Guidelines for Forensic Psychologists (Committee on Ethical Guidelines for Forensic Psychologists, 1991) in taking reasonable steps to ensure data be interpreted by qualified professionals. Presently, clinician’s may be wise to choose the more cautious approach.

Release of Test Procedures and Materials

It is standard practice for test publishers to require clinicians’ agreement not to release any information about a test or test materials to unqualified persons. This agreement is typically a prerequisite for a test publisher to allow use of that instrument. Moreover, psychologists are generally discouraged from releasing information on ethical grounds and are required to respect copyright laws (APA, 1996). However, psychologists are frequently asked to provide information about the contents of a test. This may be for comparison to more current evaluation results, to clarify the basis of the evaluator’s conclusions, or for opposing parties in legal action to challenge the results or the test itself. Whatever the purpose, maintaining the copyright or proprietary rights to the test material may conflict with legal and clinical needs. The APA SDTD (1996) states:

It is prudent for psychologists to be familiar with the terms of their test purchase or lease agreements with test publishers as well as reasonably informed about relevant provisions of the federal copyright laws. Psychologists may wish to consult with test publishers and/or knowledgeable experts to resolve possible conflicts before releasing specific test materials to ensure that the copyright and proprietary interests of the test publisher are not compromised.

The Statement also suggested that individuals consider the audience that might receive the test materials, and obtain permission of test publishers before reprinting or copying any test material. Additionally, the EPPCC specifically distinguishes between test data and test materials, and encourages psychologists to make reasonable efforts to “maintain the integrity and security of test materials and other assessment techniques” (p. 14).

Knapp and VandeCreek (2001) note that in forensic reports it is particularly impor- tant to substantiate findings. A clinician may feel it is important to include relevant examples of responses or specific data to substantiate conclusions. For example, listing Minnesota Multiphasic Personality Inventory-2 (MMPI-2) critical items the individual endorsed is a powerful way of communicating about that person’s functioning. In these instances, release of test material is not supplemental to the report, but directly included

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in the report content. However, maintaining test security is an ethical requirement (EPPCC section 9.11: Test Security). It is reasonable for evaluators to exert the same caution applicable to release of appended test data when deciding whether to include such mate- rial within the report narrative. Of course, the evaluator can choose not to include any specific information about an instrument within the report itself. This approach circum- vents having to address this question unless a separate direct request is made for test materials.

In her discussion of the decision making process, Bricklin (2001) states that one consideration in resolving ethical dilemmas is whether there are “compelling reasons to deviate from the standard.” This process is made more challenging when disparate stan- dards are, themselves, at variance. Any deviation from confidentiality standards can be even more problematic as many jurisdictions require confidentiality by law. Again, choices that enhance all competing interests may serve the client best. In the absence of this possibility, striving to achieve the first objective set forth in the EPPCC (General Prin- ciple A) should be the foremost guiding principle. That is, do no harm.

Validity and Utility

One specific aspect of providing information ethically involves the use of data that may be of limited reliability or validity. Section 9.02 of the EPPCC states, “Psychologists use assessment instruments whose validity and reliability have been established for use with members of the population tested. When such validity or reliability has not been estab- lished, psychologists describe the strengths and limitations of test results and interpretation” (p. 13).

Further, client statements and behavior during an evaluation are considered to be test data (EPPCC section 9.04: Release of Test Data). Many reports include client statements, information from collateral sources, or data from less reliable instruments. This may occur as background data or within the evaluation results. Providing information about client’s statements or behavior may stretch the limits of section 9.02, but may also have great utility in helping the reader understand the individual. Hence, the psychologist must be cautious to ensure, or at least explain the limitations of, the validity of statements in all sections of the report. These decisions are crucial as the referral source may not distin- guish which information is more reliable or valid once it has been combined into a report.

Clarifying the limitations of an evaluator’s observations may be a delicate venture. For example, “clarifying” the limited reliability of a client’s statement that she never drinks alcohol may suggest the individual is lying. The evaluator needs to weigh the benefit of incorporating less-reliable information against the drawback of violating EPPCC section 9.02. Judging how critical questionably valid information is in clarifying assess- ment findings may be the yardstick for determining if a compelling reason for violating the standard is present.

Computer-Aided Assessment and Ethics

One area that has become increasingly relevant to report writing is computer-based test interpretation (CBTI). Many programs incorporate, along with computer scoring, inter- pretive statements organized in a format similar to portions of a written report. Though test publishers usually include a disclaimer that these statements are not to be considered a final report, even aggregate incorporation of the statements may risk a breech of ethics. Neither the individual’s unique characteristics (Butcher, Perry, & Hahn, 2004), nor com-

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binations of information from different sources are incorporated in generating these statements. The algorithmic basis for statement generation may also not be available to the evaluator. Nevertheless, evaluators are still ethically bound to ensure the information utilized is accurate (EPPCC section 9.09: Interpretation Services). The level of detail necessary to make this determination has yet to be determined, representing an important area of future research.

Ensuring the accuracy of information is also challenging because the basis for inter- pretive statements may not be clear (Lichtenberger, this issue, 2006, pp. 19–32). Mat- arazzo (1986) notes that many computer interpretation programs follow from an expert’s judgment, and disparate opinions are rarely included. Providing only one analysis does not mean that interpretations are inaccurate, but does make the evaluator’s job discerning interpretive precision more challenging. Butcher, Perry, and Atlis (2000) review several studies that address the accuracy of CBTI interpretations. They conclude that most stud- ies supported the accuracy of interpretation, though as much as 50% of interpretative statements will not apply to a specific client. These findings are not universal though (Feldstein et al., 1999).

Questions about validity of interpretive statements and computer algorithms are not easily addressed within the narrative of a written report. However, deciding how much weight to put on specific results can ultimately affect the written document contents.

Taking CBTI statements at face value, such as wholesale pasting of statements into a report, would likely be considered unethical. Attempting to explain the limitations of such data may result in the evaluator writing more about the interpretive process than about the client. In the end, incorporation of CBTIs may be best addressed by integrating computer-generated information as merely one source of data, analogous to all other data generated from the evaluation. Any interpretation written in the report would thus reflect an amalgam of information that converges on a particular conclusion. In this way, any limitations of computer-generated statements’ reliability or validity are at least tempered. Including CBTI interpretations only after confirming with other sources, such as refer- ence texts or even clinical experience, would also be helpful.

How to Address Ethical Questions in the Written Report

Provided written reports are kept to a readable length (Harvey, this issue, 2006, pp. 5– 18), evaluators have limited space in which to offer information or suggestions. Some decisions about what to include or leave out are required, including choices about back- ground information, previous test results, interpretive statements, diagnoses, recommen- dations, and raw data. Perhaps the most significant of these are choices regarding interpretation of a person’s cognitive and personality functioning. For example, incorpo- rating statements about a person’s weaknesses or problematic behavior could lead to negative perceptions by others, or emotional distress for the individual. Decisions about including any interpretive statements should be governed by the guiding principles of autonomy, beneficence, confidentiality, and above nonmaleficence. Moreover, inclusion of any information should minimize intrusion on privacy (EPPCC section 4.04).

Decisions about what to incorporate can follow several steps. The first consideration is whether information included will harm the client. If so, it is better to leave that infor- mation out or reword the explanation such that it is less likely to cause distress or lead to labeling. Second, information should not be included if it will clearly or very likely breech confidentiality. Clinicians should take reasonable care to avoid including data that go beyond the agreed upon scope of the evaluation, even if that information may be of help to the client. Perhaps the wisest approach is to ensure the individual is informed and

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provides consent to all findings being discussed, even if those findings end up being adverse or disagreeable. Finally, information should be included if it will be of benefit to the individual, provided doing so does not compromise the prior considerations.

Language

As significant as whether information is provided is how it is provided. Specifically, how interpretations and opinions are worded can have a significant impact on the conclusions a reader may draw. For example, stating that an individual has a “weakness in simulta- neous processing” has a more negative, and hence potentially deleterious, connotation than stating that the individual “learns more effectively in a step-by-step manner.” The content and style of any statements can moderate, or exacerbate, the impact a report may have on perceptions of the client by the referral source or even by the client.

Writing clearly and precisely has been advocated by many authors (Harvey, this issue, 2006, pp. 5–18; Lichtenberger, Mather, Kaufman, & Kaufman, 2004; Ownby, 1997). Additionally, it is preferable that information be provided in a positive way, focusing on the individual’s strengths (Snyder, Ritschel, Rand, & Berg, this issue, 2006, pp. 33– 46). Utilizing precise and thoughtful language helps address the issues of harm, labeling, and confidentiality. Moreover, emotional distress is likely to be minimized if the information presented is focused on capabilities rather than liabilities.

Presenting the Report

Allen et al. (1986) note that a report may generate an in-person discussion of test find- ings. Providing verbal feedback along with written information has been demonstrated to enhance therapeutic rapport and client self-perception (Allen, Montgomery, Tubman, Frazier, & Escovar, 2003); it also allows for questions to be answered thoroughly. Although not a mandate that psychologists present information in-person, section 9.10 of the EPPCC encourages psychologists to take “reasonable steps to ensure that explanations of results are given to the individual” (p. 14). Providing verbal feedback along with the written report, rather than merely a copy of the report, seems preferable given the potential shortcomings of the latter approach (Kantrowitz, 2004).

The need to provide feedback to a client raises a final ethical question: Should a copy of the report be given to a client? The position of refraining from releasing information (section 9.04) and providing information (section 9.10) may present an ethical challenge when the request is for a copy of the report rather than merely an explanation of results. Although it has been argued that access to one’s own record enhances treatment in some ways (Doel & Lawson, 1986), the full effect of such releases has yet to be established with regard to psychological reports specifically. Clarifying this question will help inform clinician’s decisions about balancing the competing interests of autonomy and beneficence.

Future Needs

The present discussion is not meant to be comprehensive. There will inevitably be vari- ations or elaborations of the ideas discussed in this review when working with specific populations or questions. Custody, organizational, and worker’s compensation evalua- tions each present unique report writing challenges (Ackerman, this issue, 2006, pp. 59– 72). Still, many of the concepts currently identified are fundamental to all reports. Some questions raised in this discussion require more information before a comprehensive list of options for ethical resolution can be generated. These include:

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1. What impact does the release of reports or interpretive information have on cli- ents? This includes the release to others as well as to the client directly.

2. Does knowledge that a client will read a report change the content included?

3. How do clinicians take confidentiality into account when deciding to incorporate specific conclusions or use specific wording in reports?

4. How do clinicians address and evaluate the accuracy of computer programs inter- pretive algorithms?

5. What impact does the Internet have on computer-aided interpretation and narra- tive generation, as well as confidentiality of report documents and test stimuli? This reflects a broader question about confidentiality of reports in electronic media.

6. One final, if only tangentially related, emerging question is how much the prolif- eration of readily available professionally developed tests that yield narrative reports (e.g., e-harmony.com-style evaluations) change the way consumers view psychological reports in general?

Answering these questions will go a long way toward improving the basis for mak- ing sound ethical decisions when writing psychological reports.

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