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Making Ethical Choices: Self-Reflection and Beyond
This document discusses the importance of self-reflection in ethical decision-making for psychologists. It describes an acculturation model for ethics training using an ethics autobiography to help students integrate their personal values with their professional ethical responsibilities. The document outlines several strategies psychologists can use to thoughtfully consider how their own values, experiences, and emotions influence their ethical judgments and decisions when working with patients. It emphasizes developing self-awareness and practicing self-care so psychologists are able to make ethical choices from an integrated sense of identity and virtue, rather than just following rules.
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Making Ethical Choices: Self-Reflection and Beyond
- 1. Michele Miele, M.A.,M.S. Allison Bashe, Ph.D. John Gavazzi, Psy.D. ABPP Jay Mills, Ph.D., ABPP
- 2. Describe why self-reflection should be a consistent part of the ethical choice-making process Understand the purpose and usefulness of the ethics autobiography for use in ethics courses Identify basic components of ethical choice- making
- 3. Self-Reflection ◦ Introspection and the willingness to learn: Fundamental nature Purpose Essence Personal challenge of Self-reflection (Dr. X) Challenge: Reflect on your ‘self’ your person
- 4. The Advisory Committee on Colleague Assistance ACCA Self-awareness: Physical and psychological wellness Factors affecting professional functioning Self-care involves: Prevention Awareness Positive Ethics
- 5. Buddhist psychologist: ◦ Teach self-care to clients ◦ Model it by practicing self-care You cannot give something that you do not have yourself ◦ Eastern society – Caring for self – to give to others ◦ Western society - Caring for self - act of selfishness
- 6. Do wepractice what we recommend to our clients ? If not, why ? Do you over-identify with the ‘helper’ role ? Do you adopt a separated view of the “us and them”? Do we ourselves practice the most primary step in therapy that we ask of our clients ? Which is . . .
- 7. Leads to greater understanding of self ◦ Why do we do what we do ? ◦ Why do we say what we say ? ◦ Why do we feel what we feel ? Self-discovery ◦ How do you react and respond internally to our external world ? ◦ Our inner-self is a dynamic in every interaction ◦ Awareness of who and what affects us; why and how ?
- 8. Elements of a system interact: ◦ Activity ceases to be solely independent ◦ Behavior depends on inter-dynamics Humans of a social system interact: ◦ Activity ceases to be solely independent ◦ Behavior depends on inter-dynamics Perceptual channels: Intrinsic dispositions Extraneous information
- 9. Inter-dynamics of your environment ◦ Intrinsic and extrinsic = You Aristotle’s belief of self-awareness ◦ Self-awareness is identical to objects of awareness ◦ Knower = object of knowledge “Since the known is known, and the knower is the known . . . the knower is known.”
- 10. You are NOT an empty vessel ◦ Knowledge enters and interacts with ‘self’ ◦ Reaction: Inter-dynamic of our perception and knowledge In Aristotle's time ◦ People were powerless to ‘think’ ◦ Expected to submit to the authority of the law, religion ◦ Only the great philosophers knew how to ‘think’ Release the oppressive garment ◦ Liberty to ‘think’ ◦ Knowledge integrates with Self ◦ Outcome: Development of Self-identity
- 11. Objectivity vs. Subjectivity ◦ Respond to our external world vs. understanding our intrinsic nature Aristotle’s four states of character: ◦ Virtuous person acts properly, willingly with no effort liberated (Integrated) ◦ Strong willed person makes himself act properly strict boundaries (Assimilated) ◦ Weak willed person tries to act properly, and fails loose boundaries (Separated) ◦ Vicious willed person act improperly without regret rebellious (Marginalized)
- 12. Self-reflection autobiography - weak-willed – Choice The Nursing and Midwifery Council: ◦ ‘Your character must be sufficiently good for you to be capable of safe and effective practice without supervision’ Turning 18 ◦ “Today you do what is right because it is what is expected of you, tomorrow you do what is right because it is what you want to do” Human being as opposed to a Human doing
- 13. Professional Virtue: ◦ Integrating a sense of Ethical Identity Internal evaluation and reflection Awareness of your ‘self’ and your ‘ethics’ Merging personal and professional ethics Responses to your inter-dynamic world Becomes a part of your ‘being’ rather than your ‘doing’
- 14. Aristotle. 1984. TheComplete Works of Aristotle . Barnes, Jonathan, ed. Princeton: Princeton UP Barnett, J., & Cooper, N. (2009). Creating a culture of self-care. Clinical Psychology: Science & Practice, 16, 16-20. Bashe, A., Anderson, S. K., Handelsman, M. M., & Klevansky, R. (2007). An acculturation model for ethics training: The ethics autobiography and beyond. Professional Psychology: Research And Practice, 38(1), 60-67. Begley, A. (2011). The good, the bad and the 'not so bad': reflecting on moral appraisal in practice. Nursing Inquiry, 18(1), 21-28. Cummins, P., Massey, L., & Jones, A. (2007). Keeping ourselves well: strategies for promoting and maintaining counselor wellness. Journal of Humanistic Counseling, Education & Development, 46, 35-49. Handelsman, M., Gottlieb, M., & Knapp, S. (2005) Training Ethical Psychologists: An Acculturation Model. Professional Psychology: Research and Practice 36 , 59–65.
- 15. Knapp, S. (2006).Practical ethics for psychologists: A positive approach . Washington, DC: American Psychological Association. Michalon, M. (2001). "Selflessness" in the service of the ego: contributions, limitations and dangers of Buddhist psychology for western psychology. American Journal of Psychotherapy, 55(2), 202. Pope, K., Sonne, J., & Greene, B. (2006). What therapists don’t talk about and why: Understanding taboos that hurt us and our clients. Washington, DC: American Psychological Association. Stovall, P. (2011) Professional Virtue and Professional Self-Awareness: A Case Study in Engineering Ethics. Science of Engineering Ethics, 17,109–132. Tognoli, E., Lagarde, J., De Guzman, G.C., Kelso, J.A.S. (2007). From the cover: The phi- complex as a neuromarker of human social coordination. Proceedings of the National Academy of Sciences, 104, 8190-8195.
- 16.
- 19. Ethics becomes cornerstone of professional identity Respects individual backgrounds Learning becomes a process “going from inside out” Represents a more positive approach Provides a common language
- 23. Builds onthe process of ethical acculturation Demonstrates importance of self-reflection Helps with integration and emotional connection Helps to identify acculturation strategies Becomes a point of reference
- 24. Bashe, Anderson, Handelsman, & Klevansky, 2007 Berry, 1980, 2003 Handelsman, Gottlieb, & Knapp, 2005 Handelsman, Knapp, & Gottlieb, 2002 Shulman, 1999 Tjeltveit, 2006
- 25. What are your top three values? Where do they come from?
- 26. Discuss ways thatyour values are compatible with our profession Discuss ways that your values conflict with our profession
- 27. What are someoptions?
- 28. Rational Psychologist Learnthe rules Apply the rules Outcomes will follow
- 29. Learn the rules Understand patient Apply the rules dynamics Outcomes will follow Understand the relationship
- 30. Psychologist Patient Variables Therapeutic Alliance
- 31. Looking at how well a psychologist integrates his/her values and behaviors into the ethical culture of psychology Psychology has a set of normative principles and behaviors related to ethical behavior and appropriate conduct
- 32. APA’s Code of Conduct Commonwealth Psychology regulations found in the Psychology Law and Practice Act Federal Regulations, such as HIPAA Court decisions aka case law
- 33. The APA EthicalPrinciples and Code of Conduct do not include a model of ethical decision-making Other resources dictate behavior, but do not highlight how to work through dilemmas
- 35. The means to comply with a standard may not always be readily apparent Two seemingly competing standards may appear equally appropriate Application with of a single standard or set of standards appear consistent with one or more aspirational principle, but not another
- 36. Autonomy Beneficence Nonmaleficence Fidelity Justice
- 37. Often ethical dilemmasinvolve apparent conflicts between respect for patient autonomy versus beneficence or Respect for autonomy versus general or public beneficence
- 38. Identify the competing ethical principles Help to determine which principle has precedence and why The importance of emotion in ethical decision- making and moral judgments
- 39. S Scrutinize H Hypothesize A Analyze P Perform E Evaluate
- 40. 1. Goal isto define the problem by identifying the conflicting ethical principles 2. Generate a wide range of possible solutions and identify pros and cons 3. Merge or knit the possible solutions together in a way that maximizes the benefits and limits the disadvantages 4. Implement 5. Look back or evaluate
- 41. “integrative framework” stepstwo and three generate solutions that maximize your personal values within the context of your professional role
- 42. Avoid dichotomous thinking–either I have to do x or y. For example, either I have to warn the potential victim of a threat or I have to protect confidentiality.
- 43. Malcolm Gladwell’s book “Blink” Jonathan Haidt’s book on Moral Intuition Jay Mills article on emotions in ethical decision- making
- 44. Fear Passion Anxiety Calmness/Centered Empathy Disgust Respect/Sympathy Disrespect Positive emotions related to our good Negative emotions related to ethics decision-making skills and ethical and moral decision-making knowledge
- 45. Why do psychologists(still and continue to) have sex with their patients?
- 46. The Fundamental Attribution Error Availability Heuristic Trait Negativity Bias Confirmation Bias
- 47. Dunning-Kruger Effect: a cognitive bias in which unskilled individuals suffer from illusory superiority, mistakenly rating their ability as much higher than average. Poor performers fail to learn from their mistakes. And, they fail to internalize direct feedback from others.
- 49. Knowledge base: APA code, Pennsylvania law, regulations Become Aware of emotional factors Cognitive biases/situational factors Outcomes are uncertain
Editor's Notes
- #18 Berry 1980 Maintenance = Degree to which people hold onto the values and traditions of their culture of origin Notions based on: Family influences Religious and spiritual backgrounds Models of professional relationships we have experienced (teacher-student) Models of other relationships (friends) In terms of ethical acculturation, students will have preexisting notions of right and wrong professional behavior Contact and Participation = Degree to which people adopt the traditions and values of their new culture In terms of ethical acculturation, adopting the ethical culture of psychology means valuing the APA ethical standards
- #19 In this slide, the N/S axis represents Maintenance where north is high maintenance and south is low maintenance The W/E axis represents Contact/Participation where west is high contact and east is low contact Integration = high on both maintenance and contact = best choice = Most coherence between personal and professional identities Marginalization = low on both maintenance and contact = may be temporary strategy where students give up their own moral sense but don’t yet appreciate professional ethics Other two are a mismatch between personal morality and professional identity Separation = high in maintenance but low in contact = make decisions based more on personal morality and less on professional principles = could feel alienated from profession Assimilation = low in maintenance but high in contact = give up too much of personal morality and ove-ridentify with the profession = could lead to overly simplistic applications of professional principles
- #20 Several advantages over approaches that focus more heavily on rules and cases Cornerstone = important at all stages of our professional development Backgrounds = students are not empty vessels = family, other professional roles Inside out = Shulman, 1999 = helpful to id personal ethics first = thereafter can see explicitly how personal and professional ethics interact Positive = Handelsman, Knapp, and Gottlieb, 2002 = we are active in our morality and engaged in a process = Ethical Acculturation is a process of developing and maintaining a professional identity, not just adopting a list of rules Common language = Difficulty grasping ethics principles is an example of acculturation stress, thus statements/decisions are not “unethical” but rather reflect a particular strategy (e.g., separation)
- #21 We need to reflect actively and decide how much of our own personal morality can be adapted to our growing knowledge and appreciation of the ethical culture of psychology Acculturation is an ongoing developmental process We want to develop a strategy of integration
- #22 Provides an opportunity to id and clarify personal, cultural, and family of origin values Things that go into it include the ones here plus Culture, Traditions, Motivations, Ideals, Experience in other professions Opportunity to ask: What is your idea of right and wrong personal behavior and where does this conception come from? What did you learn from your family of origin about right and wrong?
- #23 How do personal ethics interact with or conflict with professional ethics? Opportunity to ask: What is your idea of right and wrong professional behavior, and where does this conception come from? What experiences have you had in the field and what ethical dilemmas have you already encountered? What professional ethics in the field are most compatible with your own personal values, and which professional ethics are least compatible?
- #24 Again emphasizes that students are not passive players in their learning Maintains the theme of acculturation Integration = Students prior experiences connected to your learning goals and concepts of your ethics course Emotional engagement that can facilitate learning and motivation Point of reference = throughout the course students (and you) can refer back to these
- #25 Presentation heavily based on my article with others Built on work by Berry on Acculturation Handelsman, Knapp and Gottlieb’s work on Positive Ethics and Ethical Acculturation as a framework for teaching ethics Shulman credit for inside out Tjeltveit (Chelt-Vait) for the quote I used in my talk
- #26 Tjeltveit (Chelt-Vait) = 2006 = “ Retrieval of one’s ethical heritage, the implicit and perhaps unconscious source of automatic ethical assumption, may be particularly important….This retrieval permits us to develop intellectually rich and nuanced ethical commitments, commitments that are at once consistent with who we have been and that– because carefully examined– become fully ours in the present.”
- #27 Be creative Particularly consider how values you would first think would be positive, could conflict with ethics principles in certain cases