Unlearning Ethics“Received Wisdom” andPrinciple-Based EthicsBy Sam Knapp, EdD ABPP and John Gavazzi, PsyD, ABPPJune 2013 – Pennsylvania Psychological Association
www.papsyblog.orgMore on ethics educationGreat resource
Course Objectives• List common beliefs that are not based onoverarching ethical principles• Describe the methodology to be used to identifyfalse or unhelpful ethical or risk managementprinciples
General Outline• Acculturation Model• Three simple strategies• Principle-based ethics• Unhealthy or Unhelpful Strategies
General Outline• The Unlearning Experience**• Examples of “Received Wisdom”****This is the time for the most group interaction.However, we want to make this fun andinformative, so feel free to contribute at any timeduring the presentation.
Participant Safety• Creating a safe environment• Avoid the word “unethical”• We are all learning in this process• Demonstrate courtesy and respect for others
ExercisesHandout 1: The Dumb ExerciseHandout 2: Wisdom to contemplate
I. An Acculturation ModelOne way of remaining a life-longlearnerProvides another way to discuss ethicalbehaviors and decisions
AcculturationA process to change the cultural behavior of anindividual through contact with another culture.The process of acculturation occurs when there isan adaptation into an organization or society.
Ethics Acculturation Model• An outgrowth of positive ethics that integratespersonal ethics and professional obligations.• Psychology has a system of shared anddistinctive norms, beliefs, and traditions.• This set of beliefs is reflected in our ethics code.
Acculturation as a Process• Can be a complex process• Some parts of a psychologist’s practice andlifestyle may be easily acculturated whileothers not• Process that will likely continue throughoutthe education or career as a psychologist
Ethical AcculturationIdentification with personal value system(higher vs. lower)Identification with value system of psychology(higher vs. lower)
Acculturation Model of ethicaldevelopmentIntegration SeparationAssimilation MarginalizationHigher onProfessional EthicsHigher on PersonalEthicsLower on PersonalEthicsLower onProfessional Ethics
MarginalizedMatrix: Lower on professional ethicsLower on personal ethicsRisks: *Greatest risk of harm*Lack appreciation for ethics*Motivated by self-interest*Less concern for patients
AssimilationMatrix: Higher on professional ethicsLower on personal ethicsRisks: Developing an overly legalisticstanceRigidly conforming to certainrules while missing broaderissues
SeparationMatrix: Lower on professional ethicsHigher on personal ethicsRisks: Compassion overrides goodprofessional judgmentFail to recognize the uniquerole of psychologists
IntegratedMatrix: Higher on professional ethicsHigher on personal ethicsReward: Implement values in contextof professional rolesReaching for the ethicalceilingAspirational ethics
II. Three simple strategies1. Ask the patient first (if and when appropriate)2. Does the intervention or issue help the patientflourish?3. Honest self-reflection:Will this satisfy your needs/values or the patient’s?
Respect for Autonomy• Does not mean promoting autonomy(individuation or separation)• Means respecting the autonomous decisionmaking ability of the patient
Autonomy• It encompasses freedom of thought and action.• Individuals are at liberty to behave as theychose.- Determining goals in therapy- Making life decisions (e.g., marriage, divorce)- Scheduling appointments and terminating treatment
Autonomy & ConsentFoundational Standard 3.10“When psychologists conduct research or provideassessment, therapy, counseling or consultingservices in person or via electronic transmissionor other forms of communication, they obtain theinformed consent of the individual or individualsusing language that is reasonably understandableto that person ……”
Beneficence• The principle of benefiting others and acceptingthe responsibility to do good underlies theprofession.- Providing the best treatment possible- Competency- Referring when needed
BeneficenceBasis of foundational standard 2.01“Psychologists provide services, teach, andconduct research with populations and in areasonly within the boundaries of their competence.”
NonmaleficenceThe principle is doing no harm.- Demonstrating competence- Maintaining appropriate boundaries- Not using an experimental technique as thefirst line of treatment- Providing benefits, risks, and costs
NonmaleficenceFoundational Standard 3.04“Psychologists take reasonable steps to avoidharming their clients/patients, students,supervisees, research participants,organizational clients, and others with whomthey work, and to minimize harm when it isforeseeable and unavoidable.”
FidelityThis principle refers to being faithful tocommitments. Fidelity includes promisekeeping, trustworthiness, and loyalty.- Avoiding conflicts of interests that couldcompromise therapy- Keeping information confidential- Adhering to therapeutic contract (e.g.,session length, time, phone contacts, etc.)
FidelityFoundational Standard 4.01“Psychologists have a primary obligation and takereasonable precautions to protect confidentialinformation.”
JusticeJustice primarily refers to treating people fairlyand equally.In their work-related activities, psychologists do notengage in unfair discrimination based on age, gender,gender identity, race, ethnicity, culture, national origin,religion, sexual orientation, disability, socioeconomicstatus, or any basis proscribed by law. (3.01)
IV. Unhealthy or UnhelpfulStrategiesThese strategies can be readily tiedback into the Acculturation Modeland Principle-based Ethics
Unhealthy or Unhelpful Strategies• Overemphasis on rules or The Code• Interpreting rules without understandingoverarching ethical principles• Setting a low bar for professional behavior
Unhealthy or Unhelpful Strategies• Intrusive advocacy• Lack of understanding boundaries and the“therapeutic frame”• Allowing personal values to trump professionalboundaries (without self-reflection and/orconsultation)
V. The Unlearning Exercise10 examples of “ReceivedWisdom” that may not be so wise
VI. What about the followingexamples of “Received Wisdom”?More Group Discussion
Informed Consent• Informed consent only occurs at the beginningof treatment• Informed consent mainly involves the patient tosign forms for risk management purposes
Self-disclosure• Self-disclosure is never appropriate by thepsychologist during psychotherapy orassessment• Self-disclosure is clearly a boundary violationthat is always wrong
Psychotropic medication• Psychologists cannot talk with patients aboutmedication.• Technically, it is practicing medicine without alicense.
Suicidal & Homicidal Patients• When dealing with high risk patients, it is betterto not document a great deal of information.• If you do not document much detail, then youhave greater legal protection from an attorneyindicating that you did something wrong.Attorneys can twist words easily, so the less thebetter.
No suicide contract• This is an important risk management strategy• This is the standard of care• This strategy helps the patient from actuallyharming him or herself.
Always give 3 names when referring aperson for treatment• It is the standard of care.• Co-pay, insurance, ability to access the referral isimmaterial.• Relationship with the patient or referral is not ahigh priority
Never talk with patients about religion• Psychotherapy is like other polite conversations,so it is improper to talk about religion.• Psychologists are not sufficiently trained inreligious matters.• The best strategy is to refer patients to theirpriest, pastor, rabbi or spiritual guide
HIPAA applies in every situation• HIPAA applies to pre-employment evaluations• HIPAA applies to security evaluations.• HIPAA applies to fitness for duty evaluations.• What about forensic evaluations?
If you have not been investigated,then you are acting ethically.• Only people engaging in marginalized behaviorget caught. Therefore, if I am not beinginvestigated, my behavior must be appropriate.• I follow all the rules strictly, therefore, I must beacting ethically.
If you know of another psychologistengaging in marginalized behavior,then it is best to not do anything.• Someone else should bring it up• “I am not supervising the psychologist, so I cannotbring it up.”
Other pearls of wisdom thatseem sketchy?Other ethical dilemmas?
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