ETHICS IN PSYCHOLOGY-5

Psychologists need to use ethical-decision-making skills when (a) an applicable ethical or legal standard requires them to use their professional judgment, (b) the APA Ethics Code or laws are silent, (c) the Ethics Code conflicts with the law or organizational policies, and (d) they need to decide what supererogatory obligations to assume

Professional judgment APA Ethics Code uses modifiers such as reasonably, appropriately, or potentially. – Standard Informed Consent to Therapy, states that "psychologists inform clients/patients as early as is feasible in the therapeutic relationship about the nature and anticipated course of therapy, fees, involvement of third parties, and limits of confidentiality." Consequently, psychologists have to determine when it is feasible to reach that agreement.

APA Ethics Code or Legal Standards are Silent 1992 Ethics Code (APA, 1992) - no reference to the transmission of information through or conducting health care services through electronic means APA Ethics Code - no explicit mention of "e- therapy,“ although it does address – the necessity of informing clients about the limits of confidentiality of electronic communications, – the need for accuracy in public statements made through electronic means – the importance of security when records are transferred in electronic formats

Conflicts With Laws or Organizational Standards If the Ethics Code conflicts with a particular law, however, then psychologists "make known their commitment to the Ethics Code and take steps to resolve the conflict" (Standard 1.02, Conflicts Between Ethics and Law, Regulations, or Other Governing Legal Authority). If the Ethics Code conflicts with an organizational policy, then psychologists "make known their commitment to the Ethics Code, and to the extent feasible, resolve the conflict in a way that permits adherence to the Ethics Code“ (Standard 1.03, Conflicts Between Ethics and Organizational Demands). Solution- try to fulfill both

Supererogatory Obligations Relying on a personal ethics code that compels them to do more than just avoid being disciplined – Ex- go beyond this basic standard and become very skilled at what they do, instead of being minimally competent

THE FIVE-STEP MODEL (a) to identify or scrutinize the problem, (b) to develop alternatives or hypotheses, (c) to evaluate or analyze options, (d) to act or perform the best option, and (e) to look back or evaluate the results.

“Good decision” (a) it is consistent with the values or moral principles of the psychologist in that there is sufficient reason to justify acting on behalf of one moral principle or norm rather than another; (b) the action has a realistic chance of success; (c) no morally preferable alternative is available; (d) the infringement of the offended norm is the least possible, consistent with the primary aims; (e) the psychologist seeks to minimize any negative effects of infringing on the offended norm or moral principle; (f) the decision must be made impartially without regard for extraneous information (Beauchamp & Childress, 2001).

A Problem Intern A supervising psychologist heard a credible report that a predoctoral intern had alcohol on his breath while at work. Other evidence pointed to an alcoholic intern. The intern's patient evaluations were not good; the intern was sometimes late for work, especially on Monday mornings; and once, while on call, he could not be reached until the next day.

Identify or Scrutinize the Problem Know the APA Ethics Code “gut” reactions – a strain in interpersonal relationships or a feeling of emotional uneasiness The supervising psychologist has moral obligations to the patient (i.e., to protect the welfare of the supervisee's patients), the supervisee (i.e., to enhance the professional development of the supervisee), the employer, the student's training program, and society in general (i.e., not to promote the career of an individual who is incompetent, and therefore, to report accurately any substantial problems with the supervisee on forms to the licensing board)

Factors That Decrease Solution- Generating Abilities Cognitive factors – cognitive rigidity the tendency to fixate on one possible solution dichotomous thinking Emotional factors – High anxiety select the first or one of the first solutions that come to mind

availability heuristic – People use the availability heuristic when they estimate frequency based on how easily a target comes to mind, but more memorable events are not necessarily more frequent (Kahneman, 2003). a clinician may easily recall several times in which a certain intervention was associated with a remarkable improvement in a patient’s symptoms, but may not recall that, on many other occasions, the technique was ineffective and even counterproductive representative heuristic – occurs when one assesses the correspondence between a sample and a population or, more generally, between a specific out- 20 ethical dilemmas in psychotherapy come and one’s preconceptions of it if a psychologist’s model of a person with histrionic personality disorder is a female, then the psychologist may not consider that diagnosis for a new male patient,

Confirmation bias – preexisting notions influence subsequent reasoning and can affect information gathering, analysis, and retrieval in the face of an ethical dilemma. trusting that a colleague is an ethical practitioner may unduly influence one to dismiss his or her troublesome behavior. “believing is seeing”

Stress – stress can cause people to focus excessively on their potential losses An Impulsive Supervisee When a supervisor asked about how the treatment of his student’s patient was progressing, the student said that he had terminated her. Because the student and patient had only met a few times, the supervisor asked why. The student said that the patient had expressed a sexual interest in him and that he terminated the professional relationship, unilaterally, to avoid any possibility that continued contact would lead to an inappropriate relationship on his part.

Affect heuristic – forming opinions or actions too quickly using only their emotions. “The affect heuristic is an instance of substitution, in which the answer to an easy question (How do I feel about it?) serves as an answer to a much harder question (What do I think about it? Or, What should I do about it?)” (Kahneman, 2011, p. 139)

Factors That Increase Solution- Generating Abilities Cognitive factors – look for alternatives "within" the problem (such as looking at the situation as a "problem within a problem") – look for alternatives outside of ("without") the problem (i.e., viewing the problem as a subset of a larger or more general problem). Emotional factors – Sensitivity to emotional discomfort – A sense of uneasiness Self care Self regulation Self reflection

Benefits of Consultation – improves the quality of decisions – identify sources of knowledge, types of interventions, or resources that could be useful to the psychologist – help reduce strong emotional affect and allow psychologists to process the information more clearly – help psychologists to clarify and think through the dilemma themselves – challenge psychologists to explore their perceptions, intuitions, assumptions, and logic

Evaluate or Analyze Options identify the advantages and disadvantages of each potential solution. select a solution that combines the best elements of the different solutions proposed through a process akin to theory knitting.

Act or perform many psychology graduate students who reached the "right" solution to an ethical dilemma did not intend to act on that solution. – lack of moral courage – May not be the right solution – May not reflect personal values Finally look back and evaluate

EMERGENCY OR CRISIS DECISION MAKING Require immediate decisions – Need to be distinguished from crises in which psychologists have a high degree of emotional arousal and feel a need to resolve the situation quickly to reduce their emotional discomfort. Psychologists can increase the likelihood of making reasonable decisions in emergencies or crises if they know the APA Ethics Code and other disciplinary codes. awareness of their own emotional states

COMPETENCE

Technical knowledge Social skills Emotional well-being Emotional competence refers to psychologists' ability to withstand the emotional difficulties associated with professional practice. more likely to make prudent decisions- carefully thinking through complex situations by attending to factual information, social cues, and personal feelings.

"Psychologists provide services, teach, and conduct research with populations and in areas only within the boundaries of their competence, based on their education, training, supervised experience, consultation, study, or professional experience" (Standard Z.Ola, Boundaries of Competence).

Maintaining competence- an ever-expanding knowledge base of psychology Consultation – peer consultation or mutual consultation The supervisory relationship

Competence With Cultural and Linguistic Minorities Mixed findings- Outcome data alone suggest that these demographic variables are not always crucial in treatment outcomes, anecdotal evidence continues to suggest that they are, at least for some persons. ensure a high level of skill when working with diverse populations distributive justice applies as well in that, all things being equal

Determining Cultural Competence A doctoral intern at the counseling center was from a Chinese American background, but her family had lived in the United States since the 1850s. Because of her appearance and Chinese name, the supervisor assumed that she was especially competent to work with the Asian students who came to the counseling center. This assumption was not always warranted as she had little in common with Asian students whose families had only recently immigrated to the United States.

Background preparation Assessment – Inaccurate diagnosis amok (i.e., a murderous frenzy occurring mainly in Malaysia – Appropriate assesment instruments – Assimilation The interaction of gender and culture – Bicultural identities – Intervention Language the patient's family structure, worldviews, and values and how they may affect the relationship and treatment document culturally relevant variables acculturation stress

Competence With Sexual Minorities Childhood trauma legal and social stigmatization higher risk than heterosexuals to develop depression, personality disorders, or other mental illnesses Suicidal risk is especially high among adolescents

Minimum requirement- avoid prejudice and discrimination against persons of other sexual orientations being gay affirmative means – having special knowledge of the population and the unique stressors they face, – knowledge of LGBT issues, – understanding of how to handle emotional reactions to patients who are LGBT, and – comfort dealing with explicit sexual issues – understanding the importance of LGBT relationships and the ways in which family is defined

What is the presenting problem? confusion about sexual orientation is a presenting problem for the patient, only if it is said so…

Competence With Religious Minorities Religious beliefs sometimes have a profound influence on the thoughts, feelings, and behaviors of believers – how they think about the roles of husband and wife (e.g., hierarchical rather than egalitarian), – child-rearing practices (e.g., emphasis on corporal punishment rather than positive reinforcement and modeling), or – same-sex orientation (e.g., homosexuality is a sin rather than homosexuality is a lifestyle choice). religious-based form of psychotherapy

MOVING INTO NEW AREAS OF COMPETENCE proficiency credential Psychologists have to make sure – if they are current with the scientific basis in the relevant domain, – have mastered the needed clinical skills, understand the treatment milieu, – appreciate any ethical or legal issues involved – apprentice themselves to an experienced psychologist

Emerging or Experimental Treatments Does empirical evidence support the use of these techniques? – for what populations and under what conditions can they be of benefit? – Do other treatments have a greater likelihood of success? – Could the treatment be iatrogenic? Has the psychologist consulted with peers about the use or application of this technique? Are patients informed about the innovative nature of the treatment? Will the psychologist monitor the progress and welfare of patients throughout the course of treatment? Is the psychologist sufficiently trained in the technique? Will the patient be discouraged from trying more conventional approaches if the experimental one fails?

Alternative or Complementary Treatments Alternative treatments refer to those treatments that are not taught regularly in professional programs. – Relaxation exercises for personality disorders Complementary treatments are the same as alternative treatments except that they are used in conjunction with instead of in place of traditional treatments – Herbal supplements and massage therapy

Therapy by Telephone or Other Electronic Means Concerns – Adequate assessment and intervention without the benefit of visual cues? – Can confidentiality be maintained? – Is the individual who is sending the communication indeed the person he or she claims to be? the data do not support the use of online therapy as a preferred mode of treatment

Exceptions to competence – Emergency – Unavailability of the services

EMOTIONAL COMPETENCE Standard 2.06, Personal Problems and Conflicts, requires psychologists to "refrain from initiating an activity when they know or should know that there is a substantial likelihood that their personal problems will prevent them from performing their work-related activities in a competent manner.“ Well-being of the psychologist Improved self-knowledge may help psychologists become more effective in identifying their own emotional reaction and sensitivity to patient information

"Psychologists strive to be aware of the possible effect of their own physical and mental health on their ability to help those with whom they work" (Principle A, Beneficence and Nonmaleficence). Personal stressors Professional stressors

Personal stressors – dysfunctional families of origin – mental illnesses or addictions to alcohol or other drugs – Distress and impairment – Stressful life events

Stress management – Take regular vacations, – separate professional from private life, – exercise, – eat properly, – get medical attention – develop social relationships and interests outside of the professional work The ideal model is not a psychologist who is free of stress or negative life events but a psychologist who knows how to handle them

Professional stressors – compassion fatigue Individuals who tend to be overly idealistic or dedicated are at risk of burning out Strong personal ethics but weak professional ethics – vicarious traumatization trauma therapists risk compromises to their well-being as a result of continual contact with trauma survivors Burnout more common among psychologists who were – young, – had a low income, – experienced lack of control in their therapeutic setting, – felt overcommitted to patients, – engaged in little personal psychotherapy.

Prevention of impairment – Seeking periodic vacations, – scheduling breaks in the day, – using stress management techniques – keeping caseloads at manageable levels, – refusing to accept certain types of patients, – limiting work hours

Professional Stressful Life Events – one in four psychologists is likely to have a patient commit suicide – Assaults against health professionals 40% of psychologists reported being attacked by a patient at least once in their careers about 23% of the attacks resulted in physical injury to the psychologist The protective measures – refusing to treat certain patients, – refusing to disclose personal data to patients, – Prohibiting patients to appear at the psychologist's home, – locating the office in a "safe" building, – specifying intolerable patient behaviors, – having an unlisted phone number.

Professional Stressful Life Events – Sexual harassment – 10% of psychologists reported being stalked – older psychologists experience greater satisfaction – "Make your environment work for you, not against you"

Above all, do no harm…