Ethics: Distance is the Best Armor

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  • 1. Distance is the Best Armor Ethical Decision-making in Clinical Practice John D. Gavazzi, Psy.D., ABPP Donald Jennings, Ed.D
  • 2. Objectives
    • Learn the most frequently asked questions of APA’s Ethics Committee.
    • Understand one model of ethical decision-making.
    • Heighten awareness regarding multiple relationships.
    • Identify forensic issues related to the practice of psychology.
    • Recognize confidentiality issues in a variety of settings
  • 3. Ethics
        • Personal ethics
        • Higher moral principles
        • Ethical codes/principles
        • Ethics as law
  • 4. Goals of the Ethical Codes
    • To educate and guide ethical decision-making
    • To provide a clear statement about what contributes to unethical behavior
  • 5. Difficulties with ethics codes
    • There are approximately 100 enforceable standards
    • Codes do keep current (e.g., online psychotherapy)
    • Codes are not always clear and may contain conflicting information
  • 6. Autonomy
    • It encompasses freedom of thought and action. Individuals are at liberty to behave as they chose.
    • - Determining goals in therapy
    • - Making decisions (e.g., marriage)
    • - Terminating treatment
  • 7. Versus
    • Authoritarianism
    • Laissez-Faire
  • 8. Beneficence
    • The principle of benefiting others and accepting the responsibility to do good underlies the profession.
    • - Providing the best treatment possible
    • - Refer when needed
  • 9. Nonmaleficence
    • The principle is doing no harm.
    • - Not using an experimental technique as the first line of treatment
    • - Providing benefits, risks, and costs
  • 10. Versus
    • Non-productive therapy
    • Iatrogenic effects of therapy
  • 11. Fidelity
    • This principle refers to being faithful to commitments. Fidelity includes promise keeping, trustworthiness, and loyalty.
    • - Avoid conflicts of interests that could compromise therapy
    • - Therapeutic contract (e.g., session length, time, attention)
  • 12. Versus
    • Divided Loyalties
    • Lack of informed consent
  • 13. Risks
    • Ethics Committees
    • Licensing Board
    • Civil Litigation
    • Criminal Court
  • 14. APA Ethics Office – FAQs
    • Release of records (subpoenas & raw test data to attorneys)
    • Multiple/sexual relationships between client- therapist
    • Multiple relationship/sexual boundaries with supervision
    • Abrupt termination (clinic restructuring, managed care)
    • Forensic/custody matters
    • Test security
    • Confidentiality (breaches and issues between and within institutions)
  • 15. APA Ethics Cases
    • Felony Conviction
    • Loss of license
    • Sexual misconduct/Multiple relationships
    • Child Custody
    • Practicing outside area of competence
  • 16. Malpractice Carriers
    • Sexual misconduct/Multiple relationships
    • Custody Evaluations
    • Practicing outside area of competence
  • 17. State/Provincial Boards of Psychology
    • Unlicensed practice of psychology
    • Multiple relationships
    • Custody Evaluations
    • Practice outside area of competence
    • False representations (misleading advertising)
  • 18. Ethical Decision-Making: A Problem-Solving Approach
    • 1. Describe the parameters of the situation& define potential issues
    • 2. Consult the guidelines (APA Ethics Code, State Licensing Law)
    • 3. Generate the alternative decisions possible for each issue.
    • 4. Enumerate the consequences of making each decision.
    • 5. Consult with a colleague
    • 6. Make the decision.
    • 7. Document your decision-making process and any consultations that you obtained
  • 19. Boundaries Definitions, External Boundary Issues, & Internal Boundary Issues
  • 20. Principles Related to Boundaries
    • Not all boundary crossings are problematic.
    • Some boundary crossings are always wrong and/or prohibited.
    • It is impossible to avoid all boundary crossings.
    • Evaluation of boundary crossings can be helped by the principles that underlie our ethics code.
  • 21. External Boundary Issues
    • Working within limited or small social networks
    • Working in certain settings
    • Forensic versus Clinical Roles
    • Supervisors
  • 22. Internal Boundary Issues
    • Non-therapeutic self-disclosure
    • Psychological voyeurism
    • Intrusive advocacy
    • Allowing patients certain advantages
    • Selling products to patients
    • Touching and hugging
  • 23. Helpful Tips
    • Psychologists should avoid dual-role and conflict-of-interest relationships.
    • Sexually intimate behavior with patients is a serious boundary violation with possible legal and ethical consequences.
    • Psychologists need to carefully monitor rationalizations when faced with multiple roles and seek assistance before blending roles.
    • Psychologists need to recognize their own feelings toward each patient and how these feelings may interfere with psychotherapy. Seek supervision or consultation if you are engaging in these behaviors.
  • 24. Group Exercise Boundaries
  • 25. Forensic Issues Responding to Subpoenas, Releasing Raw Data, Custody Evaluations, & Forensic and Clinical Roles
  • 26. Responding to Subpoenas
    • Subpoenas are a legal demand for information; authorized by a court and served by attorney.
    • Subpoenas can be issued without the knowledge of the patient.
    • Subpoenas should not be ignored
  • 27. Responding to Subpoenas
    • Advise the patient and the patient’s attorney.
    • Obtain a written release of information.
    • If patient refuses, communicate the refusal in writing to the party requesting information.
  • 28. Releasing Raw Data
    • Test scores, stimuli, and patient responses; not raw handwritten notes
    • Possible misuse of data (e.g., erroneous conclusions, responses taken out of context)
    • Raw data (stimuli, test questions) may become part of the public domain.
    • Raw data can be released to a qualified psychologist who is working with a non-psychologist professional (with appropriate release of information).
  • 29. Custody Evaluations
    • Highly specialized and complex process
    • Refer to APA’s Guidelines for Child Custody Evaluations in Divorce Proceedings
    • PPA’s Child Custody Project Group
    • Need a high level of training, skills, and supervision to perform competently
  • 30. Clinical vs. Forensic Roles
    • See Chart on last page of handout
    • Blending clinical and forensic roles must be avoided.
    • Be clear at the outset of the relationship what your role is and what your responsibilities are.
  • 31. Group Exercise Forensic Issues
  • 32. Confidentiality Privacy, Privilege, and Confidentiality
  • 33. Privacy
    • A basic right granted by the 4th ammendment of the Constitution to decide how much of a person’s thoughts, feelings, or personal data should be shared with others.
  • 34. Privilege
    • A legal term that prevents disclosing information in court or other legal proceedings because that information was gathered in a special relationship.
    • The patient has the privilege and can waive it.
  • 35. Confidentiality
    • A professional standard of conduct that obliges the psychologist from discussing information with anyone.
    • Confidentiality is a cornerstone of psychotherapy.
  • 36. Breaches of Confidence
    • Duty to Warn
    • Patient Welfare/Safety
    • Mandated child abuse
  • 37. Helpful Tips
    • Psychologist knowledge of general principles and issues is crucial
    • Informed consent at the beginning of treatment is essential.
    • Prior to releasing any records or general information, a written release of information is usually necessary.
  • 38. Helpful Tips
    • There is a “need to know” basis when releasing records. Record keeping becomes an issue.
    • Special considerations need to be made for rights of minors and legally incompetent individuals.
  • 39. Group Exercise Confidentiality
  • 40. Wrap Up Question & Answer Evaluation Forms