Ethical and Moral Foundations in Mental Health Treatment


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This workshop was dedicated to understanding ethical and moral foundations of exceptional mental health treatment.

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Ethical and Moral Foundations in Mental Health Treatment

  1. 1. John D. Gavazzi, PsyD ABPP Psychologist Ethics Educator TW Ponessa and Associates July 18, 2014
  2. 2. Easy to sign up Easy to follow and FREE More ethics education Daily stories on the nexus of healthcare, psychology, morality, philosophy, and public policy. Daily email, tweet, Tumblr on ethics Podcasts Ethics Vignettes Audio/video files Articles
  3. 3. At the end of the presentation, the participant will be able to: 1. List the five foundational principles 2. Apply two NBCC directives or ACA principles to clinical practice 3. Explain how one personal, moral value integrates with good clinical practice
  4. 4. Personal Moral Development Principle-based ethics Ethical Codes Examples of Morality in Treatment Vignette Analysis
  5. 5. • Creating a safe environment • Avoid the word “unethical” • We are all learning in this process • Demonstrate courtesy and respect for others
  6. 6. Personal moral compass-Believe it to be right Knowing the difference between right and wrong Emotional responses to dilemmas and actions Implicit/rapid/automatic/internal/affective Research shows people judge themselves and others based on moral characteristics – evolutionary and social reasons to judge “character”
  7. 7. Rules of Conduct – Profession/society More external – Community (of peers) Easier means to judge others’ actions Can constrain individual choices or create dilemmas Explicit/cognitive/external/measured
  8. 8. Don't get caught. (Prep is important) Killing must serve a purpose. (Murder?) Be sure. (Evidence must add up) Blend in. (Hired as forensic spatter expert.) Control urges, and channel them.
  9. 9. 1. Religion/Family of Origin 2. Education: College and CE 3. Personal Education: Reading and Experience 4. Honest self-reflection
  10. 10. Care - Harm Fairness – Cheating Loyalty-Betrayal Authority – Subversion Sanctity (Purity) – Degradation Liberty - Oppression
  11. 11. How did it develop? How often do you use it to reflect on professional life? How often do you use it to reflect on personal life? How do you integrate your morals into your ethical practice?
  12. 12. Do you use it “before the fact”? Is it intuitive and unconscious? Is it more cognitive? Is it written down?
  13. 13. Is it acceptance of another person’s or institution’s code in full? If yes, why? If not, why?
  14. 14. Do you use it “after the fact”? Fundamental Attribution Error Actor-Observer Bias Motivated Moral Reasoning
  15. 15. Moral Licensing (Karmic balance or Cognitive Distortion) Emotional Reasoning (Disgust) Moral Dumbfounding (Do I really know?) Personal Identity Protection Bias
  16. 16. Acculturation Model of professional development Integration Separation Assimilation Marginalization Higher on Professional Ethics Higher on Personal Ethics Lower on Personal Ethics Lower on Professional Ethics
  17. 17. Matrix: Lower on professional ethics Lower on personal ethics Risks: *Greatest risk of harm *Lack appreciation for ethics *Motivated by self-interest *Less concern for patients
  18. 18. Matrix: Higher on professional ethics Lower on personal ethics Risks: Developing an overly legalistic stance Rigidly conforming to certain rules while missing broader issues
  19. 19. Matrix: Lower on professional ethics Higher on personal ethics Risks: Compassion overrides good professional judgment Fail to recognize the unique role of treatment
  20. 20. Matrix: Higher on professional ethics Higher on personal ethics Reward: Implement values in context of professional roles Reaching for the ethical ceiling Aspirational ethics
  21. 21. Autonomy Beneficence Nonmaleficence Fidelity Justice
  22. 22. Does not mean promoting autonomy (individuation or separation) Means respecting the autonomous decision making ability of the patient
  23. 23. It encompasses freedom of thought and action. Individuals are at liberty to behave as they chose. - Determining goals in therapy - Making life decisions (e.g., marriage, divorce) - Scheduling appointments and terminating treatment
  24. 24. The principle of benefiting others and accepting the responsibility to do good underlies the profession. - Providing the best treatment possible - Competency - Referring when needed
  25. 25. The principle is doing no harm. - Demonstrating competence - Maintaining appropriate boundaries - Not using an experimental technique as the first line of treatment - Providing benefits, risks, and costs
  26. 26. This principle refers to being faithful to commitments. Fidelity includes promise keeping, trustworthiness, and loyalty. - Avoiding conflicts of interests that could compromise therapy - Keeping information confidential - Adhering to therapeutic contract (e.g., session length, time, phone contacts, etc.)
  27. 27. Justice primarily refers to treating people fairly and equally. Become aware of our biases/judgments to avoid negative countertransference and inequality. Concepts of justice may included “social justice” and advocacy outside of our offices. Example include legislative and advocacy work.
  28. 28. Part of the Code of Ethics Do no harm Competence Promote Welfare of others Communicate Truthfully Integrity of the profession, avoid damaging public trust Collaboration & positive working relationships
  29. 29. The Counseling Relationship Avoid harm Multiple relationships Informed Consent Managing Boundaries Documentation Cultural Sensitivity Careful with imposing your values on others Advocacy work
  30. 30. Confidentiality and Privacy Respecting rights and privacy Couples/Family Treatment Informed Consent Client access to records Document/Records Case Consultation Storage and Disposal of Records Community Beneficence -Danger
  31. 31. Professional Responsibility Competence Specialization/CE Advertisement to public Media Presentations Professional Impairment No Sexual Harassment Nondiscrimination
  32. 32. Evaluation, Assessment & Interpretation Client Welfare Competence Informed Consent Diagnosis Cultural Sensitivity Prejudice/Pathology Appropriate instruments Forensic Issues
  33. 33. Supervision, Training and Teaching Client Welfare Competence Informed Consent Multicultural Competence Conflict of Interest Boundary Issues Sexual Issues Teaching Ethics
  34. 34. Studies show that individuals who teach ethics and philosophy are not any more ethical or moral than others The most ineffective way to teach ethics is learning ethical codes. Thoughts on this?
  35. 35. From real life ethical dilemmas in the mental health field
  36. 36. Older patient dies in car accident. The patient was not suicidal. Adult child goes through papers and wants to find out what was discussed in treatment. What should you do?
  37. 37. Vignette Warehouse on Ethics and Psychology site
  38. 38. Complete course evaluations