This chapter governs the professional conduct of licensed psychologists, registered psychology associates, and applicants for both. In this chapter, the following terms have the meanings indicated. Terms Defined. “Board” means the Maryland Board of Examiners of Psychologists. “Client” means the individual, couple, family, group, business, agency, school, organization, or association that the psychologist or psychology associate provides, or has provided, with professional services. “Multiple relationship” means a relationship in which an individual is concurrently participating in two or more roles with another. “Psychologist” means an individual who is licensed by the Board to practice psychology. “Psychology associate” means an individual who is registered by the Board to practice psychology under the supervision of a psychologist. “Public statement” means any oral, printed, or electronic communication or announcement made by or on behalf of a psychologist, psychology associate, or applicant, and directed to another individual or group. “Sexual intimacies” means acts engaged in with or without clothing involving: Genital contact; Nongenital contact with the hips, loin, thigh, buttocks, or breasts; Exposure or observation of genitals or nude portions of a body involving breasts, buttocks, or genitals; or Other behaviors engaged in for the purpose of sexual arousal or sexual gratification. In General. A psychologist shall be fully responsible for the psychologist’s professional decisions and professional actions; A psychologist and psychology associate shall be jointly responsible for the psychology associate’s professional decisions and professional actions. A psychologist or psychology associate shall: Notify the Board in writing within 60 days if a license, certificate, permit, or registration granted by another authority for the practice of psychology has been limited, restricted, suspended, revoked, or subjected to other disciplinary action by the particular licensing or granting authority; Provide psychological services only in the context of clear professional and scientific relationships and roles accepted by the standard of practice of the discipline of psychology; Make known the psychologist’s or psychology associate’s commitment to the Code of Ethics and Professional Conduct and resolve potential conflicts with the Code of Ethics and Professional Conduct in a responsible manner; Treat all individuals in a fair and objective manner without discrimination based on age, gender, race, ethnicity, culture, national origin, disability, socioeconomic status, or another basis proscribed by law; Interact with individuals in the workplace in a respectful manner without engaging in behavior that is harassing or demeaning; and Comply with a Board order. A psychologist or psychology associate may not: Knowingly or willfully destroy, damage, alter, obliterate, or otherwise obscure a medical record or billing record or other information about a patient in an effort to conceal the information from use as evidence in an administrative, civil, or criminal proceeding; Intimidate or influence an individual to withhold or change testimony in hearings or proceedings before the Board or those otherwise delegated to the Office of Administrative Hearings; Hinder, prevent, or otherwise delay an individual from making information available to the Board in furtherance of an investigation of the Board; or Take credit for work the psychologist or psychology associate has not actually performed or supervised. Supervision. A psychologist shall: Be responsible for the actions of those the psychologist supervises; and Ensure that those the psychologist employs act in accordance with the Maryland Psychologists Act and the provisions of this chapter. Research. A psychologist or psychology associate shall: Respect the dignity and protect the welfare of research subjects, and comply with all relevant statutes, regulations, and institutional and administrative rules concerning treatment of research subjects; Take responsibility for the ethical treatment of research participants by collaborators, supervisees, and employees; Acquire, care for, use and dispose of animals in compliance with laws, regulations, and applicable professional standards; Ensure appropriate consideration of the comfort, health and humane treatment of animals used in research; Make clear, either as a researcher or a writer, the nature of the participation, as well as the costs and the psychologist's obligations to be accepted by research participants; Obtain required approval from host institutions before conducting research; and Report research findings accurately, presenting only the psychologist’s or psychology associate’s work or making appropriate citations when needed. Teaching. A psychologist or psychology associate shall ensure that statements in course catalogs, seminar brochures, and course outlines are accurate and not misleading, particularly in terms of the: Subject matter to be covered; Nature of course experiences; and Basis for evaluating performance. Professional Competence. A psychologist or psychology associate shall: Limit practice to the areas of competence by which proficiency has been gained through education, training, and experience; Acquire the special education and training needed to address the cultural differences of special populations; Avoid unfair discrimination based on age, gender, race, ethnicity, culture, national origin, disability, socioeconomic status, or other basis proscribed by law; Use interventions and assessment techniques only when the psychologist or psychology associate knows that the circumstances are appropriate applications of those interventions and techniques, supported by reliability, validation, standardization, and outcome studies; Maintain competence by meeting the requirements of continuing education as set forth in COMAR 10.36.02; Engage in ongoing consultation with other psychologists, psychology associates, or relevant professionals and seek appropriate education, training, and experience, when developing competence in a new service or technique; and Document and maintain appropriate records of professional and scientific work. Impaired Competence. A psychologist or psychology associate shall: Represent accurately and objectively the psychologist’s or psychology associate’s professional qualifications; and Seek competent professional assistance to determine whether to suspend, terminate, or limit the scope of professional or scientific activities when the psychologist or psychology associate becomes or is made aware that the psychologist’s or psychology associate’s competence is impaired. A psychologist or psychology associate may not: Undertake or continue a professional relationship with a client when the competence or objectivity of the psychologist or psychology associate is or could reasonably be expected to be impaired due to: Mental, emotional, physiological, pharmacological, substance abuse, or personal problems; or The psychologist’s or psychology associate’s present or previous familial, social, sexual, emotional, financial, supervisory, political, administrative, or legal relationship with the client or a person associated with or related to the client; or Engage in other relationships that could limit the psychologist’s or psychology associate’s objectivity or create a conflict of interest or the appearance of a conflict of interest. Public Statements and Advertising. A psychologist or psychology associate shall: Represent accurately and objectively the psychologist’s or psychology associate’s professional qualifications, education, experience, and areas of competence; Correct others who misrepresent the psychologist’s or psychology associate’s professional qualifications or affiliations; and Identify a paid advertisement as a paid advertisement. A psychologist or psychology associate may not: Misrepresent, directly or by implication, the affiliations or the purposes or characteristics of institutions and organizations with which the psychologist or psychology associate is affiliated; Claim organizational membership in a manner that suggests specialized competence or qualifications that the psychologist or psychology associate does not have; Make public statements that contain: False, fraudulent, misleading, or deceptive statements; Partial disclosures of relevant facts that misrepresent, mislead, or deceive; or Statements that create false or unjustified expectations of favorable results; or Solicit, either in person or through others, business or testimonial endorsements from clients who are vulnerable to undue influence. Informed Consent. When conducting research or providing assessment, psychotherapy, counseling, or consulting with an individual or organization in person or by electronic transmission or other forms of communication, a psychologist or psychology associate shall: In general: Obtain informed consent using appropriate language understandable to the client; Vary appropriate informed consent forms and procedures to ensure that the client: Has the capacity to consent; Has been provided with information concerning participation in the activity that reasonably might affect the willingness to participate, including limits of confidentiality and monetary costs or reimbursements; Is aware of the voluntary nature of participation and has freely and without undue influence expressed consent; and Is given the opportunity to ask questions and receive answers regarding the activity; In research, make clear to the client: The nature of the participation as well as the costs and other obligations to be accepted by research participants; The purpose and nature of any evaluations, treatment, or educational or training procedure; All aspects of research including any risks and consequences of the research that will reasonably be expected to influence willingness to participate; The right to withdraw from treatment or research at any time; and The notification that permission shall be given by the client, student, or research participant before the use of observation or electronic taping, recording, or filming procedures; and In therapeutic relationships, explain to the client: The clarification of reasonable expectations; The nature and purpose of testing, reports, and consultations; The limits of confidentiality; Specific information concerning fees, billing, and electronic services available in the payment of fees; Psychotherapeutic schedules; and The process and conditions of termination of therapy. Financial Arrangements and Fees. A psychologist or psychology associate shall: Make advance financial arrangements that are clearly understood by the client; Inform the client about the possibility of initiating a collection procedure before using that procedure; Comply with the provisions regarding patient referrals contained in Health Occupations Article, §§1-301 — 1-306, Annotated Code of Maryland; Make full disclosure in advance to the client of any remuneration given or received for making or accepting referrals; and Refrain from signing statements for insurance purposes as though the psychologist or psychology associate provided a service that was actually provided by someone else. A psychologist or psychology associate shall: Perform evaluations and diagnostic services in a professional relationship when assessment data is indicated by the professional context; Administer psychological tests in keeping with accepted standards of practice and avoid use of obsolete measurement techniques; Use appropriate or specialized assessment instruments when working with individuals from special populations; Use appropriate scoring devices, norms, and standards in evaluating test protocols; Select scoring and interpretive programs and services on the basis of evidence of the validity of the programs and procedures; Report the results of assessment procedures by: Using adequate interpretative aids or explanations; Including any deficiencies of the assessment norms for the individual assessed, and any relevant reservations or qualifications which affect the validity, reliability, or other interpretation of results; and Avoiding misuse of automated interpretative reports; Base recommendations or decisions on test results that are reasonably current and not obsolete; Supply a manual or other printed material which fully describes the development of the assessment procedure or service, the rationale, evidence of validity and reliability, and characteristics of the normative population when offering an assessment procedure or automated interpretation service to other professionals; and Release test results only to patients and clients as appropriate. A psychologist or psychology associate may not: Release test protocols or raw data to persons who are not qualified to interpret and use the information appropriately, except as required by law; Encourage or promote the use of psychological assessment techniques or computerized assessment and interpretation by unqualified persons; or Reproduce test materials or describe psychological tests or other assessment devices in popular publications, lectures, or public presentation in ways that might compromise their validity. A psychologist or psychology associate shall: Take appropriate steps to disclose to all involved parties conflicts of interest that arise, with respect to a psychologist’s or psychology associate’s clients, in a manner that is consistent with applicable confidentiality requirements; and Make arrangements for another appropriate professional to deal with emergency needs of the psychologist’s or psychology associate’s clients as appropriate, during periods of anticipated absences from professional availability. Exploitation. A psychologist or psychology associate may not: Exploit or harm clients, colleagues, students, research participants, or others; Take actions that violate or diminish the legal and civil rights of clients or of others who may be affected by the action; Exploit the trust and dependency of clients, students, and subordinates; Allow personal, social, religious, organizational, financial, or political situations and pressures to lead to a misuse of their influence; or Enter into a new nonpsychological, nonprofessional relationship with a former client that is considered exploitative dependent on, but not limited to: The nature, duration, and intensity of professional services rendered to the client; The length of the professional relationship; The length of time between the termination of the professional relationship and the initiation of the nonprofessional relationship; The mental stability of the psychologist or psychology associate and former client; The circumstances of termination, including, but not limited to, statements or actions of the psychologist or psychology associate suggesting or inviting the possibility of a post-termination relationship; and The likelihood of adverse impact on the client. Sexual Misconduct. A psychologist or psychology associate may not: Engage in sexual intimacies with a current client; Engage in sexual intimacies with a former client: For at least 2 years after the cessation or termination of professional services; or After the 2 years following the cessation or termination of professional services if the sexual relationship is exploitative in light of the following factors: The nature, duration, and intensity of professional services rendered to the client; The length of the professional relationship; The length of time between the termination of the professional relationship and the initiation of the nonprofessional relationship; The mental stability of the psychologist or psychology associate and former client; The circumstances of termination including, but not limited to, statements, or actions of the psychologist or psychology associate suggesting or inviting the possibility of a post-termination sexual or romantic relationship; and The likelihood of adverse impact on the former client; Engage in sexual intimacies with individuals known to be the parents, guardians, spouses, domestic partners, sexual partners, children, or siblings of the client or for at least 2 years after cessation or termination of professional services; Terminate a professional relationship with a client for the purpose of engaging in sexual intimacies with one of the individuals set forth in §C(3) of this regulation; Engage in sexual behavior with a client in the context of a professional evaluation, treatment, procedure, or service to the client, regardless of the setting in which the professional service is rendered; or Engage in sexual behavior with a client under the pretext of diagnostic or therapeutic intent or benefit. Harassment. A psychologist or psychology associate may not: Engage in sexual solicitation, physical advances, or verbal or nonverbal conduct that is sexual in nature, which behavior occurs in connection with the psychologist’s or psychology associate’s professional role; Engage in sexual harassment of the psychologist’s or psychology associate’s past or present clients, supervisees, research participants, or employees, with deliberate or repeated comments, gestures, or physical contacts of a sexual nature; or Create a hostile workplace or educational environment by unwelcome and offensive behaviors that are sufficiently severe or intense to be abusive of a reasonable individual in that environment whether it consists of a single act or of multiple persistent or pervasive acts. A psychologist or psychology associate shall: Provide psychological services for minor children or for adults who have legal guardians only with appropriate authorization; and Take special care to protect the interests of minors or clients who are unable to give voluntary, informed consent. Termination of Services. A psychologist or psychology associate shall: Make or recommend referral to other professional, technical, or administrative resources if the referral is clearly in the best interest of the client; and Unless precluded by the actions of the client, terminate the professional relationship in an appropriate manner, notify the client in writing of this termination, and assist the client in obtaining services from another professional, if: It is reasonably clear the client is not benefiting from the relationship; A multiple relationship develops or is discovered after the professional relationship has been initiated; Impaired competency or objectivity develops or is discovered after a professional relationship has been initiated; or The psychologist or psychology associate has been threatened or otherwise endangered by the client or another person with whom the client has a relationship. A psychologist or psychology associate shall: Maintain confidentiality regarding information obtained from a client in the course of the psychologist’s or psychology associate’s work; Discuss the requirements and limitations of confidentiality at the beginning of the professional relationship or at the intake interview; Safeguard information obtained in clinical or consulting relationships or evaluative data concerning children, students, employees, and others obtained in the course of practice, teaching, research, or other professional services; Release mental health records or other confidential information only as permitted or required by law; Obtain written permission for the electronic recording of interviews; Avoid undue invasion of privacy by ensuring that written and oral reports contain only data relevant to the purpose of the evaluation; Treat any assessment result or interpretation regarding an individual as confidential information; and Obtain informed written consent before presenting in writing, lecture, or other public forums identifying information obtained during the course of professional work, and disguise this information when case reports or other confidential information are used as a basis for teaching or research. Legal and Ethical Limits. A psychologist or psychology associate shall inform: Clients of the legal and ethical limits of confidentiality; Clients below the age of minority, or who have legal guardians, of the limits the law imposes on the right of confidentiality with respect to communications with the psychologist or psychology associate, to the extent that the client can understand, at the beginning of the professional relationship; Research participants of any limits to confidentiality as part of the informed consent; and Clients of the duty imposed by law to inform authorities of abuse and neglect of children and vulnerable adults. Record Keeping. A psychologist or psychology associate shall: Keep records of a patient's condition and assessment results; Maintain clinical records of informed consent, presenting problems, diagnosis, fee arrangements, dates and substance of each billed service, original test data with results and other evaluative material, and the results of any formal consultations with other professionals; Make provisions for maintaining confidentiality in the storage and disposal of written and electronic records; Ensure that professional records are maintained for a period consistent with State and federal laws; Limit access to client records and ensure that a person working under the psychologist’s or psychology associate’s authority including, but not limited to office personnel, comply with the requirements for confidentiality of client material; and Provide evaluations or treatment reports within a reasonable time consistent with State and federal laws on proper and lawful requests by a client, insurance carrier, court, institution, or other authorized health provider. Health Occupations Article, §§1-212, 18-311, and 18-313(7), Annotated Code of Maryland Effective date: October 26, 1992 (19:21 Md. R. 1891) Regulation .05B amended effective June 26, 2000 (27:12 Md. R. 1140) Regulations .01 — .08 repealed and new Regulations .01 — .08 adopted effective November 10, 2003 (30:22 Md. R. 1582) Regulation .01 amended effective June 7, 2004 (31:11 Md. R. 857); May 25, 2015 (42:10 Md. R. 684) Regulation .02B amended effective May 25, 2015 (42:10 Md. R. 684) Regulation .03 amended effective May 25, 2015 (42:10 Md. R. 684) Regulation .04 amended effective May 25, 2015 (42:10 Md. R. 684) Regulation .05 amended effective May 25, 2015 (42:10 Md. R. 684) Regulation .06 amended effective May 25, 2015 (42:10 Md. R. 684) Regulation .07 amended effective May 25, 2015 (42:10 Md. R. 684) Regulation .08 amended effective May 25, 2015 (42:10 Md. R. 684)