Learning and Teaching Ethical Mistakes


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Learning and Teaching Ethical Mistakes: From Consultation Room to Class Room

This presentation was part of PPA's Ethics Educators Workshop

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Learning and Teaching Ethical Mistakes

  1. 1. Learning and Teaching Ethical Mistakes: From Consultation Room to Class Room John Gavazzi, PsyD, ABPP Richard Small, PhD, ABPP Michele Miele, MA
  2. 2. Learning Objectives <ul><li>Understand the importance of teaching ethical mistakes in the classroom </li></ul><ul><li>Highlight the Acculturation Model </li></ul><ul><li>List several ideas related to the Consultation Model </li></ul><ul><li>Describe the importance of modeling vulnerability and openness </li></ul>
  3. 3. O verarching goal is to teach errors in order to prevent unfortunate events or harmful behavior Work on avoiding the term “unethical”
  4. 4. Why discuss ethical errors? <ul><li>Patient safety issues </li></ul><ul><li>Appropriate education of students </li></ul><ul><li>Provide competent supervision for psychologists-in-training </li></ul>
  5. 5. Why discuss ethical errors? <ul><li>Understanding risk management </li></ul><ul><li>Assist practicing colleagues </li></ul><ul><li>Develop skills to enhance high quality services </li></ul>
  6. 6. Why discuss ethical errors? <ul><li>Highlight how licensing boards work to protect the public </li></ul><ul><li>Discuss pertinent issues, like offering an apology </li></ul>
  7. 7. Ethical decision-making is a complex process <ul><li>Knowledge base: APA code, Pennsylvania law, regulations </li></ul><ul><li>Emotional factors </li></ul><ul><li>Cognitive biases/situational factors </li></ul><ul><li>Outcomes are uncertain </li></ul>
  8. 8. Ethical decision-making strategies are typically taught in ethics books and classes The APA Ethical Principles and Code of Conduct do not include a model of ethical decision-making
  9. 9. Acculturation Model
  10. 10. Acculturation <ul><li>A process to change the cultural behavior of an individual through contact with another culture. The process of acculturation occurs when there is an adaptation into an organization or society. </li></ul>
  11. 11. Ethical Culture of Psychology <ul><li>Our system of common beliefs, shared meanings, norms and traditions that distinguish psychologists as professionals. </li></ul><ul><li>It is a learned set of skills, bases of knowledge and ethical beliefs, as described in our ethics code. </li></ul>
  12. 12. Acculturation as a Process <ul><li>Can be a complex process </li></ul><ul><li>Some parts of a psychologist’s practice and lifestyle may be easily acculturated while others not </li></ul><ul><li>Process that may continue throughout the education or career as a psychologist </li></ul>
  13. 13. Ethical Acculturation <ul><li>Identification with personal value system </li></ul><ul><li>(high vs. low) </li></ul><ul><li>Identification with value system of psychology </li></ul><ul><li>(high vs. low) </li></ul>
  14. 14. Acculturation Model of Ethical Decision-making High Professional Ethics Low Professional Ethics High Personal Ethics Low Personal Ethics Integration Separation Assimilation Marginalization
  15. 15. Marginalization <ul><li>Style: Lower focus on professional ethics </li></ul><ul><li> Lower focus on personal ethics </li></ul><ul><li>Risks: Greatest risk of harm </li></ul><ul><li> Lack appreciation for ethics </li></ul><ul><li> Motivated by self-interest </li></ul><ul><li> Less concern for patients </li></ul>
  16. 16. Separation <ul><li>Style: Lower focus on professional ethics </li></ul><ul><li> Higher focus on personal ethics </li></ul><ul><li>Risks: Compassion overrides good professional judgment </li></ul><ul><li> Fail to recognize the unique role of psychologists </li></ul>
  17. 17. Assimilation <ul><li>Style: Higher focus on professional ethics </li></ul><ul><li> Lower focus on personal ethics </li></ul><ul><li>Risks: Developing overly legalistic stance </li></ul><ul><li> Rigidly conforming to individual rules while missing broader issues </li></ul>
  18. 18. Integration <ul><li>Style: High focus on professional ethics </li></ul><ul><li> High focus on personal ethics </li></ul><ul><li>Reward: Implement values in context of professional roles </li></ul><ul><li> Reaching for the ethical ceiling </li></ul><ul><li> Aspirational ethics </li></ul>
  19. 19. Memes <ul><li>Meme : a cultural unit (an idea or value or pattern of behavior) that is passed from one person to another by non-genetic means (as by imitation); </li></ul><ul><li>&quot;memes are the cultural counterpart of genes&quot; </li></ul>
  20. 20. Remedial Ethics <ul><li>Mandatory “floor” </li></ul><ul><li>Minimum standards adopted by the profession </li></ul><ul><li>Focus on the law or standards to protect the public </li></ul>
  21. 21. Remedial Ethics <ul><li>Overemphasis on regulations and enforceable standards </li></ul><ul><li>Incomplete view of ethics </li></ul>
  22. 22. Positive Ethics <ul><li>Ethics as a movement away from the punishment and anxiety-producing components of ethics </li></ul><ul><li>Fulfill their highest ideals </li></ul><ul><li>A means to help interpret and apply ethics standards </li></ul>
  23. 23. Positive Ethics is NOT <ul><li>An avoidance of ethical codes, case law, regulations, and statutes </li></ul><ul><li>A rationalization to explain inappropriate behaviors or decisions </li></ul>
  24. 24. Benefits of Positive Ethics <ul><li>Broadens a psychologist’s understanding of ethics in a broader context </li></ul><ul><li>Sensitize psychologists to ethical implications of decisions on a daily basis </li></ul>
  25. 25. Benefits of Positive Ethics <ul><li>Assist psychologists in balancing competing ethical demands </li></ul>
  26. 26. Student Perspective
  27. 27. Ethics in the Classroom <ul><li>Understanding the Ethical Culture of Psychology </li></ul><ul><li>Developing Professionalism </li></ul><ul><ul><li>Dress code </li></ul></ul><ul><ul><li>Language </li></ul></ul><ul><ul><li>Self Awareness </li></ul></ul><ul><li>Level of Acculturation – Integration </li></ul><ul><ul><li>Learning policy and procedure – Ethics Code </li></ul></ul><ul><ul><li>Internalizing a strong ethical constitution both professionally and personally. </li></ul></ul>
  28. 28. Experiences in the field <ul><li>Clients pursuing personal/ friendship/ intimate relations with you. </li></ul><ul><ul><li>Rejection </li></ul></ul><ul><ul><li>Generalizations </li></ul></ul><ul><li>Using your cell phone for work </li></ul><ul><li>Gift receiving </li></ul><ul><li>Self -Disclosure </li></ul><ul><li>Dealing with suicidal patients and crises </li></ul><ul><li>The role of Supervision </li></ul>
  29. 29. Ethics in the Classroom <ul><li>Exercises on personal examination of ones level of acculturation  </li></ul><ul><li>Exercises on professionalism – appearance, attitude, language, and understanding that you are being watched even in your personal life.  </li></ul><ul><li>Dilemma setting – mock therapy sessions – role playing  </li></ul><ul><li>Video sessions of situations and then discussion to follow  </li></ul>
  30. 30. Ethics in the Classroom <ul><li>Debate format – ex. confidentiality versus the duty to warn </li></ul><ul><li>Teacher, being a good role model – as we are to our clients </li></ul><ul><ul><li>Let it be evident to our clients/students that we practice professional and personal ethics. </li></ul></ul><ul><li>Understanding the role of the supervisor during internships </li></ul><ul><li>Understanding their role as a professional </li></ul>
  31. 31. Teaching Ethical Errors Vignettes Case Consultation Model
  32. 32. Moving beyond ethical versus unethical Some dilemmas do not have a clear solution, especially when there are competing ethical principles in play.
  33. 33. Vignettes <ul><li>Insure that the instructor or supervisor can identify the competing ethical principles </li></ul><ul><li>Provide sufficient clinical detail </li></ul><ul><li>If actual case, need to disguise identifying information sufficiently </li></ul>
  34. 34. Vignettes <ul><li>Usually less threatening or revealing to the instructor or supervisor </li></ul><ul><li>Many ethics books have vignettes (along with some semblance of an answer) </li></ul><ul><li>PPA bulletin board has over 35 real life ethical vignettes </li></ul>
  35. 35. Case Consultation Model <ul><li>Prepare a clinical case as if you are seeking consultation from a peer </li></ul><ul><li>Document relevant clinical details and emotional dynamics </li></ul><ul><li>Highlight ethical issues or conflicts involved </li></ul>
  36. 36. Case Consultation Model <ul><li>Outline your possible solutions and decision-making strategy </li></ul><ul><li>Discuss what you did clinically </li></ul><ul><li>Address the outcome of the intervention and your emotional reactions </li></ul>
  37. 37. Important Highlights <ul><li>Increase awareness of ethical issues </li></ul><ul><ul><li>Know the code </li></ul></ul><ul><ul><li>Know the laws, regulations </li></ul></ul><ul><ul><li>Read The Pennsylvania Psychologist </li></ul></ul><ul><ul><li>Commonwealth requires 3 credits in ethics per renewal period, so attend CE workshops on ethics </li></ul></ul>
  38. 38. Important Highlights <ul><li>Acculturation process </li></ul><ul><ul><li>Becoming part of the community of psychologists – PPA, APA, Listserv </li></ul></ul><ul><ul><li>Awareness of ethical issues through ongoing continuing education </li></ul></ul><ul><ul><li>Develop a network of colleagues or join a peer consultation network – Ethics Committee </li></ul></ul>
  39. 39. Important Highlights <ul><li>When teaching ethical errors </li></ul><ul><ul><li>Teacher can use ethical decision-making as one means to highlight errors </li></ul></ul><ul><ul><li>Vignettes can be helpful to highlight pertinent issues and can be emotionally safe </li></ul></ul><ul><ul><li>Case consultation model can be used as a means to role model ethical struggles and acculturation process </li></ul></ul>