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Making Ethical Choices: Self-Reflection and Beyond

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Making Ethical Choices: Self-Reflection and Beyond

  1. 1. Michele Miele, M.A., M.S. Allison Bashe, Ph.D.John Gavazzi, Psy.D. ABPP Jay Mills, Ph.D., ABPP
  2. 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. 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. 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. 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. 6.  Do we practice 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. 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. 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. 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. 10.  You are NOT an empty vessel ◦ Knowledge enters and interacts with ‘self’ ◦ Reaction: Inter-dynamic of our perception and knowledge In Aristotles 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. 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. 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. 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. 14. Aristotle. 1984. The Complete Works of Aristotle . Barnes, Jonathan, ed. Princeton: Princeton UPBarnett, 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. 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. 16. Allison Bashe, PhD
  17. 17.  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
  18. 18.  Builds on the 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
  19. 19.  Bashe, Anderson, Handelsman, & Klevansky, 2007 Berry, 1980, 2003 Handelsman, Gottlieb, & Knapp, 2005 Handelsman, Knapp, & Gottlieb, 2002 Shulman, 1999 Tjeltveit, 2006
  20. 20. What are your top three values?Where do they come from?
  21. 21. Discuss ways that your values are compatible with our professionDiscuss ways that your values conflict with our profession
  22. 22. What are some options?
  23. 23. Rational Psychologist Learn the rules Apply the rules Outcomes will follow
  24. 24. Learn the rules Understand patientApply the rules dynamicsOutcomes will follow Understand the relationship
  25. 25. Psychologist Patient Variables Therapeutic Alliance
  26. 26.  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
  27. 27.  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
  28. 28. The APA Ethical Principles and Code of Conduct do not include a model of ethical decision-makingOther resources dictate behavior, but do not highlight how to work through dilemmas
  29. 29.  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
  30. 30.  Autonomy Beneficence Nonmaleficence Fidelity Justice
  31. 31. Often ethical dilemmas involve apparent conflicts between respect for patient autonomy versus beneficence or Respect for autonomy versus general or public beneficence
  32. 32.  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
  33. 33. S ScrutinizeH HypothesizeA AnalyzeP PerformE Evaluate
  34. 34. 1. Goal is to define the problem by identifying the conflicting ethical principles2. Generate a wide range of possible solutions and identify pros and cons3. Merge or knit the possible solutions together in a way that maximizes the benefits and limits the disadvantages4. Implement5. Look back or evaluate
  35. 35. “integrative framework” steps two and three generate solutions thatmaximize your personal values within the context of your professional role
  36. 36. 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.
  37. 37.  Malcolm Gladwell’s book “Blink” Jonathan Haidt’s book on Moral Intuition Jay Mills article on emotions in ethical decision- making
  38. 38.  Fear  Passion Anxiety  Calmness/Centered  Empathy Disgust  Respect/Sympathy Disrespect Positive emotions related to our goodNegative emotions related to ethics decision-making skills and ethicaland moral decision-making knowledge
  39. 39. Why do psychologists (still and continue to) have sex with their patients?
  40. 40.  The Fundamental Attribution Error Availability Heuristic Trait Negativity Bias Confirmation Bias
  41. 41.  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.
  42. 42.  Knowledge base: APA code, Pennsylvania law, regulations Become Aware of emotional factors Cognitive biases/situational factors Outcomes are uncertain

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