Ethics is More than a Code:
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Transcript of Ethics is More than a Code:
Ethics is More than a Code:Ethics is More than a Code:
Ethical Foundations, Positive Ethical Foundations, Positive Ethics, and Ethical Decision-Ethics, and Ethical Decision-
MakingMaking
John Gavazzi, Psy.D., ABPPJohn Gavazzi, Psy.D., ABPP
Learning ObjectivesLearning Objectives
Describe positive ethicsDescribe positive ethics
Differentiate between remedial Differentiate between remedial ethics and positive ethicsethics and positive ethics
Identify ways that positive ethics Identify ways that positive ethics can maximize professional can maximize professional effectivenesseffectiveness
Learning ObjectivesLearning Objectives
Illustrate how a positive ethics approach Illustrate how a positive ethics approach can enrich your careercan enrich your career
Explain one ethical decision-making Explain one ethical decision-making modelmodel
Analyze one ethical dilemma and reflect Analyze one ethical dilemma and reflect on the personal and professional ethical on the personal and professional ethical values that led to the decision.values that led to the decision.
What is the “take What is the “take home?”home?”
Reflect on personal ethical valuesReflect on personal ethical values
Discern practical applicationsDiscern practical applications
Resources for future considerationResources for future consideration
Remedial EthicsRemedial Ethics
compared to compared to
Positive EthicsPositive Ethics
Remedial EthicsRemedial Ethics
Mandatory “floor” or minimum Mandatory “floor” or minimum standards of the professionstandards of the profession
Focus on the law or standards to Focus on the law or standards to protect the publicprotect the public
Can lead to an overemphasis on Can lead to an overemphasis on legal rules and an incomplete legal rules and an incomplete view of ethicsview of ethics
Remedial EthicsRemedial Ethics
Why do we sometimes overemphasize Why do we sometimes overemphasize remedial ethics?remedial ethics?
““Bad is stronger than good,” but, we Bad is stronger than good,” but, we have an internal moral grammar.have an internal moral grammar.
Are we so afraid of doing something Are we so afraid of doing something wrong that we lose opportunities to wrong that we lose opportunities to do good?do good?
Positive EthicsPositive Ethics
Ethics moves away from the Ethics moves away from the punishing and anxiety-punishing and anxiety-producing components of ethicsproducing components of ethics
Fulfill their highest idealsFulfill their highest ideals
A means to help interpret and A means to help interpret and apply ethics standardsapply ethics standards
Positive EthicsPositive Ethics
Positive ethics influenced by positive Positive ethics influenced by positive psychology or the effort to focus on psychology or the effort to focus on
uplifting and fulfilling aspects of uplifting and fulfilling aspects of human existence.human existence.
Precursors of Positive Precursors of Positive EthicsEthics
Lee VandeCreekLee VandeCreek
Patricia BricklinPatricia Bricklin
Sam KnappSam Knapp
Richard SmallRichard Small
Alan TjeltveitAlan Tjeltveit
CompetenceCompetence
Remedial:Remedial: Acquiring and maintaining Acquiring and maintaining minimal minimal formal qualificationsformal qualifications
Positive:Positive: Striving for highest Striving for highest standardsstandards
Includes self-awareness andIncludes self-awareness and
self-careself-care
Emotional competenceEmotional competence
RelationshipsRelationships
Remedial:Remedial: Avoiding boundary Avoiding boundary violations violations Focus on Focus on sexual boundariessexual boundaries
Adhere to strict interpretationAdhere to strict interpretation
Positive:Positive: Striving to enhance quality Striving to enhance quality of of all professional relationshipsall professional relationships
Understand issues related to Understand issues related to multiple relationshipsmultiple relationships
Patient EmpowermentPatient Empowerment
Remedial:Remedial: Fulfilling legal Fulfilling legal responsibilitiesresponsibilities
to get consent forms or to get consent forms or Privacy Privacy Notices signedNotices signed
Positive:Positive: Working to maximize client Working to maximize client participation with participation with
goalsgoals and treatment and treatment processesprocesses
TrustTrust
Remedial:Remedial: Avoiding prohibited Avoiding prohibited disclosuredisclosure
Emphasis legal requirementsEmphasis legal requirements
Positive:Positive: Striving to enhance trustStriving to enhance trust Understanding nuances Understanding nuances
when when
working with familiesworking with families
Positive Ethics is NOTPositive Ethics is NOT
An avoidance of ethical codes, case An avoidance of ethical codes, case law, regulations, and statuteslaw, regulations, and statutes
A rationalization to explain A rationalization to explain inappropriate behaviors or decisionsinappropriate behaviors or decisions
Benefits of Benefits of Positive EthicsPositive Ethics
Benefits of Positive Benefits of Positive EthicsEthics
Sensitizes psychologists to:Sensitizes psychologists to:
Ethical implications of their “habits of Ethical implications of their “habits of practice”practice”
Opportunities for creative decision Opportunities for creative decision makingmaking
Abilities to help difficult patientsAbilities to help difficult patients
Benefits of Positive Benefits of Positive EthicsEthics
Appreciate the moral values on Appreciate the moral values on which the APA code is basedwhich the APA code is based
Assist psychologists in balancing Assist psychologists in balancing competing ethical demandscompeting ethical demands
Help psychologists to address Help psychologists to address systemic social problemssystemic social problems
Ethics autobiographyEthics autobiography
Ethics genograms or chartsEthics genograms or charts
Self-Reflection on ValuesSelf-Reflection on Values
Self-Reflection on ValuesSelf-Reflection on Values
Are you a classical radical?Are you a classical radical?
Radical means “root”Radical means “root”
Do you fully consider the root or basic Do you fully consider the root or basic assumptions by which you live?assumptions by which you live?
Classical RadicalsClassical Radicals
Have a moral foundation or visionHave a moral foundation or vision
Are committed to the communityAre committed to the community
Have a goal for a more positive Have a goal for a more positive futurefuture
ML King was a classical ML King was a classical radicalradical
Moral foundation on Christianity Moral foundation on Christianity and influenced by other religious and influenced by other religious traditionstraditions
Commitment to entire American Commitment to entire American communitycommunity
Positive vision of “somebodyness” Positive vision of “somebodyness” in a “beloved community”in a “beloved community”
Are you a classical Are you a classical radical?radical?
Do you look at your habits of Do you look at your habits of practice and consider ways that practice and consider ways that
you can make them more you can make them more consistent with your values?consistent with your values?
Meet some Classical Meet some Classical RadicalsRadicals
Rebecca– “Love your neighbor as Rebecca– “Love your neighbor as yourself”yourself”
Jewish upbringing and communityJewish upbringing and community
Goal– more attention to helping pts with Goal– more attention to helping pts with life style issues– diet, exercise, etc.life style issues– diet, exercise, etc.
Challenge– “I can be too rigid at times, I Challenge– “I can be too rigid at times, I need to loosen up.”need to loosen up.”
Meet Some Classical Meet Some Classical RadicalsRadicals
Robert- “On earth as in heaven;” Robert- “On earth as in heaven;” Christian upbringing and communityChristian upbringing and community
Goal- integrate spirituality in therapy Goal- integrate spirituality in therapy for persons of different faith for persons of different faith backgrounds.backgrounds.
Challenge. “I tend to form opinions too Challenge. “I tend to form opinions too quickly. I need to listen more.”quickly. I need to listen more.”
Meet Some Classical Meet Some Classical RadicalsRadicals
Jennifer- “All religions are true.” Agnostic Jennifer- “All religions are true.” Agnostic background, but studying Eastern religionsbackground, but studying Eastern religions
Goal– help high conflict families as Goal– help high conflict families as consultant in collaborative divorce project.consultant in collaborative divorce project.
Challenge– “I tend to get overloaded. I need Challenge– “I tend to get overloaded. I need to make more time for family and self.”to make more time for family and self.”
Reflections on Values Reflections on Values
Ethical traditions, such as Ethical traditions, such as foundational religious writings?foundational religious writings?
Your ethical community?Your ethical community?
Your personal insights or Your personal insights or inspirations?inspirations?
Reflections on ValuesReflections on Values
Traditions– The Holy Bible, other Traditions– The Holy Bible, other religious writings; “science of religious writings; “science of morality”; Existential Phenomenology; morality”; Existential Phenomenology; philosophy; ethicsphilosophy; ethics
Community- family, “ethics buddies”, Community- family, “ethics buddies”, Psychology in PAPsychology in PA
PersonalPersonal
An Acculturation An Acculturation ModelModel
One Application of Positive One Application of Positive EthicsEthics
Acculturation Acculturation
A A processprocess to change the cultural to change the cultural behavior of an individual through behavior of an individual through contact with another culture. The contact with another culture. The process of acculturation occurs process of acculturation occurs when there is an adaptation into an when there is an adaptation into an organization or society.organization or society.
Ethics Acculturation Ethics Acculturation ModelModel
This model is a natural This model is a natural outgrowth of positive ethics in outgrowth of positive ethics in that it shows how to integrate that it shows how to integrate personal ethics into context of personal ethics into context of
professional obligations. professional obligations.
Ethical Culture of Ethical Culture of PsychologyPsychology
Our system of common beliefs, shared Our system of common beliefs, shared meanings, norms and traditions that meanings, norms and traditions that distinguish psychologists as distinguish psychologists as professionals.professionals.
It is a learned set of skills, bases of It is a learned set of skills, bases of knowledge and ethical beliefs, as knowledge and ethical beliefs, as described in our ethics code. described in our ethics code.
Ethical Culture of Ethical Culture of PsychologyPsychology
You cannot understand the laws of a You cannot understand the laws of a society without understanding the society without understanding the society.society.
You cannot understand the ethics of You cannot understand the ethics of psychology without understanding psychology without understanding the profession of psychologythe profession of psychology
Ethical Culture of Ethical Culture of PsychologyPsychology
Some rules may appear to be counter Some rules may appear to be counter intuitive:intuitive:
Do you loan money to patients?Do you loan money to patients?
Do you engage in routine mutual self-Do you engage in routine mutual self-disclosure?disclosure?
Do you place your welfare on an equal Do you place your welfare on an equal basis as your patients?basis as your patients?
Acculturation as a Acculturation as a ProcessProcess
Can be a complex processCan be a complex process
Some parts of a psychologist’s Some parts of a psychologist’s practice and lifestyle may be easily practice and lifestyle may be easily acculturated while others notacculturated while others not
Process that may continue Process that may continue throughout the education or career throughout the education or career as a psychologistas a psychologist
Ethical AcculturationEthical Acculturation
Identification with personal value Identification with personal value systemsystem
(high vs. low)(high vs. low)
Identification with value system of Identification with value system of psychologypsychology
(high vs. low)(high vs. low)
Acculturation Model of ethical training
IntegrationIntegration SeparationSeparation
AssimilationAssimilation MarginalizatMarginalizationion
Hi Professional Ethics Low Professional Ethics
Hi Personal Ethics
Low Personal Ethics
MarginalizedMarginalized
Matrix:Matrix: Low on professional ethicsLow on professional ethics
Low on personal ethicsLow on personal ethics
Risks:Risks:Greatest risk of harmGreatest risk of harm
Lack appreciation for Lack appreciation for ethicsethics
Motivated by self-interestMotivated by self-interest
Less concern for patientsLess concern for patients
AssimilationAssimilation
Matrix:Matrix: High on professional ethicsHigh on professional ethicsLow on personal ethicsLow on personal ethics
Risks:Risks: Developing an overly Developing an overly legalistic legalistic stancestance
Rigidly conforming to Rigidly conforming to individual individual rules while rules while missing broader missing broader issuesissues
SeparationSeparation
Matrix:Matrix: Low on professional Low on professional ethicsethics
High on personal ethicsHigh on personal ethics
Risks:Risks:Compassion overrides goodCompassion overrides good
professional judgmentprofessional judgment
Fail to recognize the Fail to recognize the unique unique role of psychologistsrole of psychologists
IntegratedIntegrated
Matrix:Matrix: High on professional ethicsHigh on professional ethics
High on personal ethicsHigh on personal ethics
Reward:Reward: Implement values in context Implement values in context of professional rolesof professional roles
Reaching for the ethical Reaching for the ethical ceilingceiling
Aspirational ethicsAspirational ethics
Integration- ExampleIntegration- Example
Separation: Treating a patient like a friend
Assimilation: Maintain rigid boundaries at times, to the point of being cold and distant
Integration: Cordial and friendly within the boundaries of a professional relationship
IntegrationIntegration
The integration strategy is used by The integration strategy is used by “classical radicals” in that they “classical radicals” in that they look to ways to adhere to their look to ways to adhere to their
foundational ethical beliefs in the foundational ethical beliefs in the context of their professional lives. context of their professional lives.
Understanding the Ethical Understanding the Ethical Foundation of the APA CodeFoundation of the APA Code
The Ethics Code does not The Ethics Code does not equal ethics.equal ethics.
Ethics = ethics ?Ethics = ethics ?
APA Ethics CodeAPA Ethics Code
Introduction and ApplicabilityIntroduction and Applicability
Preamble and General PrinciplesPreamble and General Principles
(Aspirational and based on (Aspirational and based on principle-based ethics)principle-based ethics)
Ethical Standards (Enforceable Ethical Standards (Enforceable and represent minimum and represent minimum standards)standards)
APA Ethics CodeAPA Ethics Code
The ethics code does not include The ethics code does not include federal laws, such as HIPAAfederal laws, such as HIPAA
The ethics code does not include The ethics code does not include case law, though influence is notedcase law, though influence is noted
The ethics code is distinct and The ethics code is distinct and separate from guidelines approved separate from guidelines approved by the APA Council of by the APA Council of Representatives (e.g., Child Custody Representatives (e.g., Child Custody Evaluation Guidelines)Evaluation Guidelines)
The enforceable portion of the APA The enforceable portion of the APA Code is based on principle-based Code is based on principle-based
ethicsethics
Respect for AutonomyRespect for Autonomy
BeneficenceBeneficence
NonmaleficenceNonmaleficence
FidelityFidelity
JusticeJustice
Respect for AutonomyRespect for Autonomy
Does not mean promoting autonomy Does not mean promoting autonomy (individuation or separation)(individuation or separation)
Means respecting the autonomous Means respecting the autonomous decision making ability of the patientdecision making ability of the patient
AutonomyAutonomy
It encompasses freedom of thought It encompasses freedom of thought and action. Individuals are at liberty and action. Individuals are at liberty to behave as they chose. to behave as they chose.
- Determining goals in therapy- Determining goals in therapy
- Making life decisions (e.g., marriage, - Making life decisions (e.g., marriage, divorce)divorce)
- Scheduling appointments and - Scheduling appointments and terminating treatmentterminating treatment
BeneficenceBeneficence
The principle of benefiting others and The principle of benefiting others and accepting the responsibility to do accepting the responsibility to do good underlies the profession. good underlies the profession.
- Providing the best treatment - Providing the best treatment possiblepossible
- Competency- Competency
- Referring when needed- Referring when needed
BeneficenceBeneficence
Basis of foundational standard 2.01Basis of foundational standard 2.01
““Psychologists provide services, teach, Psychologists provide services, teach, and conduct research with and conduct research with populations and in areas only within populations and in areas only within the boundaries of their the boundaries of their competence.”competence.”
NonmaleficenceNonmaleficence
The principle is doing no harm.The principle is doing no harm.
- Demonstrating competence- Demonstrating competence
- Maintaining appropriate boundaries- Maintaining appropriate boundaries
- Not using an experimental technique - Not using an experimental technique as the as the first line of treatmentfirst line of treatment
- Providing benefits, risks, and costs- Providing benefits, risks, and costs
NonmaleficenceNonmaleficence
Foundational Standard 3.04Foundational Standard 3.04
““Psychologists take reasonable steps to Psychologists take reasonable steps to avoid harming their clients/patients, avoid harming their clients/patients, students, supervisees, research students, supervisees, research participants, organizational clients, participants, organizational clients, and others with whom they work, and and others with whom they work, and to minimize harm when it is to minimize harm when it is foreseeable and unavoidable.”foreseeable and unavoidable.”
FidelityFidelity
This principle refers to being faithful to This principle refers to being faithful to commitments. Fidelity includes promise commitments. Fidelity includes promise keeping, trustworthiness, and loyalty. keeping, trustworthiness, and loyalty.
- Avoiding conflicts of interests that could - Avoiding conflicts of interests that could compromise compromise therapytherapy
- Keeping information confidential- Keeping information confidential
- Adhering to therapeutic contract (e.g., - Adhering to therapeutic contract (e.g., session length, session length, time, phone contacts, time, phone contacts, etc.)etc.)
FidelityFidelity
Foundational Standard 4.01Foundational Standard 4.01
““Psychologists have a primary Psychologists have a primary obligation and take reasonable obligation and take reasonable
precautions to protect confidential precautions to protect confidential information.”information.”
JusticeJustice
Justice primarily refers to treating people Justice primarily refers to treating people fairly and equally.fairly and equally.
In their work-related activities, In their work-related activities, psychologists do not engage in unfair psychologists do not engage in unfair discrimination based on age, gender, discrimination based on age, gender,
gender identity, race, ethnicity, culture, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, national origin, religion, sexual orientation,
disability, socioeconomic status, or any disability, socioeconomic status, or any basis proscribed by law.basis proscribed by law. (3.01) (3.01)
Principles and APA Principles and APA Ethics CodeEthics Code
The standards in the APA Ethics Code The standards in the APA Ethics Code
state the principle (“foundational state the principle (“foundational standards”);standards”);
amplify or apply the principle; or amplify or apply the principle; or
balance it with competing moral balance it with competing moral obligations.obligations.
Principles and APA Principles and APA Ethics CodeEthics Code
Beneficence—Beneficence—
Foundation– Standard 2.01Foundation– Standard 2.01
Amplification example– Standard 2.03 Amplification example– Standard 2.03
““Psychologists undertake ongoing Psychologists undertake ongoing efforts to develop and maintain their efforts to develop and maintain their competence.”competence.”
Principles and APA Principles and APA Ethics CodeEthics Code
Beneficence-Beneficence-
Balancing example- Standard 2.02Balancing example- Standard 2.02
Psychologists provide services in Psychologists provide services in emergencies even in areas where emergencies even in areas where they are not ordinarily competentthey are not ordinarily competent
APA Aspirational VirtuesAPA Aspirational Virtues
CompetenceCompetence
IntegrityIntegrity
ResponsibilityResponsibility
RespectRespect
WelfareWelfare
Social ResponsibilitySocial Responsibility
Ethics Across CulturesEthics Across Cultures
Relativism– the practices and beliefs of all cultures Relativism– the practices and beliefs of all cultures are equally ethicalare equally ethical
Universalism– the practices and beliefs of all Universalism– the practices and beliefs of all cultures must be evaluated according to universal cultures must be evaluated according to universal principles principles
Soft universalism- although the practices and beliefs Soft universalism- although the practices and beliefs of all cultures must be evaluated according to of all cultures must be evaluated according to universal principles, cultures may differ in the universal principles, cultures may differ in the interpretation and manifestation of these universal interpretation and manifestation of these universal principlesprinciples
Supererogatory QuestionSupererogatory Question
What must I do to fulfill my ethical What must I do to fulfill my ethical ideals?ideals?
As compared to:As compared to:
What must I do to fulfill the minimum What must I do to fulfill the minimum requirements of the ethics code?requirements of the ethics code?
Supererogatory QuestionSupererogatory Question
Supererogatory obligations are those Supererogatory obligations are those that we voluntary choose for that we voluntary choose for ourselves. Once they are chosen, ourselves. Once they are chosen, certain expectations follow.certain expectations follow.
Example– no one makes you become a Example– no one makes you become a parent, but if you are a parent there parent, but if you are a parent there are certain minimal expectations of are certain minimal expectations of you.you.
Some Supererogatory Some Supererogatory ActivitiesActivities
Engage in political advocacy for Engage in political advocacy for better access to mental health carebetter access to mental health care
Serve on a prison committee Serve on a prison committee addressing needs of mental health addressing needs of mental health populationpopulation
Putting effort into being the best Putting effort into being the best clinician that you can beclinician that you can be
Some Supererogatory Some Supererogatory ActivitiesActivities
Becoming proficient in a new area of Becoming proficient in a new area of practice in psychologypractice in psychology
Applying psychological knowledge to a Applying psychological knowledge to a growing area of public concern growing area of public concern (such as helping impaired drivers)(such as helping impaired drivers)
Some Supererogatory Some Supererogatory ActivitiesActivities
Give a public presentation on the Give a public presentation on the signs and symptoms of adolescent signs and symptoms of adolescent depression and suicidedepression and suicide
Write an op-ed article for a local Write an op-ed article for a local paper on the problems with mental paper on the problems with mental health carehealth care
Join a political action committee that Join a political action committee that advances the causes of psychologyadvances the causes of psychology
Some Supererogatory Some Supererogatory ActivitiesActivities
Provide information to business Provide information to business leaders about psychologically healthy leaders about psychologically healthy workplace principlesworkplace principles
Volunteer with local, state, national Volunteer with local, state, national psychological associationspsychological associations
Provide volunteer presentations to Provide volunteer presentations to other psychologists on positive ethicsother psychologists on positive ethics
Some Supererogatory Some Supererogatory AdviceAdvice
Supererogatory obligations Supererogatory obligations require prudence and balancerequire prudence and balance
If you adopt too many obligations, If you adopt too many obligations, you may fail or fall short of your you may fail or fall short of your primary obligationsprimary obligations
Supererogatory obligations may Supererogatory obligations may be combined with personal be combined with personal obligations (e.g., involve the family obligations (e.g., involve the family with Humane League)with Humane League)
Patient Focused Patient Focused Risk Risk
ManagementManagementPatient-FocusedPatient-Focused
Risk Management StrategiesRisk Management Strategies
Adapted from Bennet et al.Adapted from Bennet et al.
Positive Ethics and Positive Ethics and Difficult PatientsDifficult Patients
What patients are most difficult?What patients are most difficult?
Chronic dysphoriaChronic dysphoria
Interpersonal hostilityInterpersonal hostility
Threaten selves or othersThreaten selves or others
Unresponsive to treatmentUnresponsive to treatment
Difficult PatientsDifficult Patients
Often useful to look at ethical principles Often useful to look at ethical principles to guide our relationships with these to guide our relationships with these patients.patients.
““BANJO:” Beneficence, autonomy, BANJO:” Beneficence, autonomy, nonmaleficence, justice, and othersnonmaleficence, justice, and others
Often require us to engage in creative Often require us to engage in creative decision makingdecision making
Managing the RisksManaging the Risks
No psychologist can eliminate all risksNo psychologist can eliminate all risks
Risk management principles are designed Risk management principles are designed to minimize legal risks by identifying to minimize legal risks by identifying ways in which patients have been injuredways in which patients have been injured
There is no fixed or predetermined risk There is no fixed or predetermined risk management strategies for every management strategies for every situationsituation
Patient Focused Risk Patient Focused Risk Management StrategiesManagement Strategies
Informed ConsentInformed Consent
ConsultationConsultation
Increased documentationIncreased documentation
Redundant systems of Redundant systems of protectionprotection
Patient Focused Risk Management Patient Focused Risk Management StrategiesStrategies
Relationship to moral principlesRelationship to moral principles
Informed consent related to respect Informed consent related to respect for autonomyfor autonomy
Consultation, documentation, Consultation, documentation, redundant protections related to redundant protections related to beneficence and nonmaleficencebeneficence and nonmaleficence
Patient Focused Risk Management Patient Focused Risk Management StrategiesStrategies
Should be done to maximize Should be done to maximize transparencytransparency
Generally be open with patient about Generally be open with patient about goals and proceduresgoals and procedures
Be candid with consultantsBe candid with consultants
Document decision making accuratelyDocument decision making accurately
A Suicidal PatientA Suicidal Patient
The strategies should increase when The strategies should increase when the risk of harm increasesthe risk of harm increases
Utilizing these “integrated” Utilizing these “integrated” strategies fulfill both the legal strategies fulfill both the legal obligations as well as aspire to your obligations as well as aspire to your highest ethical standardshighest ethical standards
A Suicidal PatientA Suicidal Patient
Informed Consent– do you maximize Informed Consent– do you maximize their involvement in treatment plan?their involvement in treatment plan?
Documentation– Documentation– Do you use 8Do you use 8thth grade algebra teacher grade algebra teacher
method of documentation? method of documentation? Do you address all factors that Do you address all factors that
influence your decision making?influence your decision making?
A Suicidal PatientA Suicidal Patient
Consultation– do you routinely seek Consultation– do you routinely seek consultation with highly suicidal consultation with highly suicidal patients?patients?
Redundant Protections– do you seek Redundant Protections– do you seek second or third sources of second or third sources of information if possible and helpful?information if possible and helpful?
False Risk ManagementFalse Risk ManagementStrategiesStrategies
Avoid any risk management strategy Avoid any risk management strategy that appears to harm patientsthat appears to harm patients
Avoid any risk management strategy Avoid any risk management strategy that violates deeply held moral that violates deeply held moral principlesprinciples
False Risk ManagementFalse Risk Management
Always have suicidal patients sign “no Always have suicidal patients sign “no suicide” contractssuicide” contracts
Never take detailed notes when Never take detailed notes when treating a client who threatens to harm treating a client who threatens to harm othersothers
Never touch a patientNever touch a patient
Informed consent only consists of Informed consent only consists of having patients sign the paperhaving patients sign the paper
False Risk ManagementFalse Risk Management
Psychologists may believe that they are Psychologists may believe that they are following the laws or protecting following the laws or protecting themselvesthemselves
Actually, the psychologist may be Actually, the psychologist may be distorting laws and standards at the distorting laws and standards at the expense of generally accepted moral expense of generally accepted moral values or patient welfarevalues or patient welfare
Psychologist may risk alienating the clientPsychologist may risk alienating the client
Good risk management strategies Good risk management strategies involve a “culture of safety” involve a “culture of safety”
which attempt to:which attempt to:
Minimize mistakesMinimize mistakes
Provide high quality of serviceProvide high quality of service
Maximize ethical idealsMaximize ethical ideals
Developing a Culture of Developing a Culture of SafetySafety
Remaining alert to subtle clues Remaining alert to subtle clues with patient and office with patient and office
dynamicsdynamics
Proactively taking steps to Proactively taking steps to address issuesaddress issues
Psychologist to monitor his/her Psychologist to monitor his/her own behaviorown behavior
Origins of the Safety Origins of the Safety CultureCulture
Retrospective look at commercial Retrospective look at commercial disasters (Titanic, airplane crashes, disasters (Titanic, airplane crashes,
etc.)etc.)
Medical errors researchMedical errors research
Positive Ethics and Positive Ethics and Professional Professional DevelopmentDevelopment
Emotional Competence, Self-Emotional Competence, Self-care,care,
and Social Responsibilityand Social Responsibility
Emotional CompetenceEmotional Competence
The ability to reflect critically The ability to reflect critically upon one’s own behavior and to upon one’s own behavior and to withstand the many stresses that withstand the many stresses that occur when working with occur when working with adolescents in the mental health adolescents in the mental health system system
Importance of Self CareImportance of Self Care Well-being is associated with high levels Well-being is associated with high levels
of self-awareness, self-awareness, of self-awareness, self-awareness, strong social relationships, and a strong social relationships, and a balanced lifebalanced life
Resilient psychologists turn toward Resilient psychologists turn toward social support in order to cope social support in order to cope effectivelyeffectively
High functioning psychologists take time High functioning psychologists take time for personal and family activitiesfor personal and family activities
Importance of Self-CareImportance of Self-Care
Self-care is both an instrumental and Self-care is both an instrumental and intrinsic goalsintrinsic goals
Performance improves when we care for Performance improves when we care for ourselvesourselves
Our own well-being is intrinsically Our own well-being is intrinsically importantimportant
Challenges to Self-CareChallenges to Self-Care
PersonalPersonalProfessionalProfessional
Stressors chronic illness difficult Stressors chronic illness difficult patientpatient
EventsEvents serious accident patient serious accident patient suicidesuicide
Challenges to Self-careChallenges to Self-care
Work with challenging patientsWork with challenging patients
Our own unique psychological Our own unique psychological limitations and vulnerabilitieslimitations and vulnerabilities
Patients that threaten, attempt, or Patients that threaten, attempt, or commit suicidecommit suicide
Being threatened, assaulted, or Being threatened, assaulted, or stalked by patientsstalked by patients
Taking on too much at workTaking on too much at work
Challenges to Self-careChallenges to Self-care Family tensions, separation, and Family tensions, separation, and
divorcedivorce
Illness or death of a loved oneIllness or death of a loved one
Financial difficultiesFinancial difficulties
Societal traumas (e.g., 9/11 and VT)Societal traumas (e.g., 9/11 and VT)
Major life transitionsMajor life transitions
Reducing the Negative Reducing the Negative ImpactImpact
Familiarity with ethics codes, Familiarity with ethics codes, laws, and regulations (“before the laws, and regulations (“before the fact” controls)fact” controls)
Self-monitoring for stress, Self-monitoring for stress, distress, and impairmentdistress, and impairment
Join a professional peer support or Join a professional peer support or peer consultation grouppeer consultation group
Reducing the Negative Reducing the Negative ImpactImpact
Develop a healthy social Develop a healthy social network as a source of network as a source of supportsupport
Work with a mentor or Work with a mentor or supervisor to monitor your supervisor to monitor your workwork
PsychotherapyPsychotherapy
Increasing Positive Increasing Positive ExperiencesExperiences
Continuing education and Continuing education and ongoing professional ongoing professional developmentdevelopment
Joining and being active in a Joining and being active in a professional organizationprofessional organization
Pursuing healthy non-work Pursuing healthy non-work interestsinterests
Increasing Positive Increasing Positive ExperiencesExperiences
Making time for friends and Making time for friends and familyfamily
Religious or spiritual practiceReligious or spiritual practice
PsychotherapyPsychotherapy
Broad and Build TheoryBroad and Build Theory
Positive emotions help to broaden our Positive emotions help to broaden our behavioral repertoire and make us behavioral repertoire and make us more effective in our work.more effective in our work.
Positive emotions build emotional Positive emotions build emotional resources and increase resilience to resources and increase resilience to difficult times or traumas.difficult times or traumas.
Civic VirtueCivic Virtue
Social Responsibility
(versus Social Loafing)
Social ResponsibilitySocial Responsibility
There is no group outside of There is no group outside of psychology that advocates for our psychology that advocates for our
patients or our professionpatients or our profession
General beneficenceGeneral beneficence is to strengthen is to strengthen the mental health system so that our the mental health system so that our
society as a whole is healthiersociety as a whole is healthier
Social ResponsibilitySocial Responsibility
Using knowledge to benefit societyUsing knowledge to benefit society
Volunteer for non profit organization Volunteer for non profit organization or for community projector for community project
Political AdvocacyPolitical Advocacy
The legislative process governs many The legislative process governs many aspects of our lives – what we eat aspects of our lives – what we eat
and breatheand breathe
The legislative process is how we The legislative process is how we change the practice of psychology change the practice of psychology
for the betterfor the better
State Political AdvocacyState Political Advocacy
Recognition for psychologists’ role Recognition for psychologists’ role in hospital settings (Act 28)in hospital settings (Act 28)
Limited immunity for custody Limited immunity for custody evaluatorsevaluators
Mandated reporting requirements Mandated reporting requirements
Curbing outpatient authorization Curbing outpatient authorization for routine mental health carefor routine mental health care
Federal LevelFederal Level
Restoring the Medicare Restoring the Medicare reimbursement rates for reimbursement rates for psychological servicespsychological services
Mental Health parityMental Health parity
ReviewReview
Are you a classical radical?Are you a classical radical?
Do you use integrative strategies?Do you use integrative strategies?
Do you rely on your ethical Do you rely on your ethical foundations when engaging in foundations when engaging in creative decision making?creative decision making?
Do you think of the acronym “BANJO” Do you think of the acronym “BANJO” when faced with difficult patients?when faced with difficult patients?
ReviewReview
Do you rely on patient focused risk Do you rely on patient focused risk management strategies?management strategies?
Do you see the value of self-care in Do you see the value of self-care in helping you to fulfill your professional helping you to fulfill your professional obligations?obligations?
Do you identify your supererogatory Do you identify your supererogatory obligations and how to fulfill them?obligations and how to fulfill them?
Lunch BreakLunch Break
Positive Ethics and Positive Ethics and Ethical Decision-Ethical Decision-
makingmaking
Ethical Decision-Ethical Decision-MakingMaking
Some initial lectureSome initial lecture
Some group exercisesSome group exercises
The APA Ethical The APA Ethical Principles and Code Principles and Code of Conduct do not of Conduct do not include a model ofinclude a model ofethical decision-ethical decision-
makingmaking
Why is this a problem?Why is this a problem?
The means to comply with a standard The means to comply with a standard may not always be readily apparentmay not always be readily apparent
Two seemingly competing standards Two seemingly competing standards may appear equally appropriatemay appear equally appropriate
Application with of a single standard Application with of a single standard or set of standards appear consistent or set of standards appear consistent with one or more aspirational with one or more aspirational principle, but not anotherprinciple, but not another
In certain situations, In certain situations, we need to we need to constructconstruct or or createcreate a solution a solution
instead of looking up instead of looking up the enforceable the enforceable
standards in the APA standards in the APA Ethics Code.Ethics Code.
Common DilemmasCommon Dilemmas
Often ethical dilemmas involve Often ethical dilemmas involve apparent conflicts between respect for apparent conflicts between respect for patient autonomy versus beneficencepatient autonomy versus beneficence
OrOr
Respect for autonomy versus general or Respect for autonomy versus general or public beneficencepublic beneficence
5 Step Decision Making 5 Step Decision Making ModelModel
SS ScrutinizeScrutinize
HHHypothesizeHypothesize
AA AnalyzeAnalyze
PP ProceedProceed
EE EvaluateEvaluate
Decision Making FactorsDecision Making Factors
What are the moral principles / What are the moral principles / personal valuespersonal values
Clinical / Cultural valuesClinical / Cultural values
What are the relevant ethical codes / What are the relevant ethical codes / standardsstandards
Statutes / regulationsStatutes / regulations
What are the agency policiesWhat are the agency policies
What is the applicable case lawWhat is the applicable case law
Some Limiting Cognitive Some Limiting Cognitive FactorsFactors
Trait Negativity BiasTrait Negativity Bias: The tendency for : The tendency for negative traits to weigh more heavily negative traits to weigh more heavily than positive traits when forming than positive traits when forming impressionsimpressions
Fundamental Attribution ErrorFundamental Attribution Error: The : The tendency to see others’ behavior as tendency to see others’ behavior as reflective of internal traits and reflective of internal traits and dispositions, while overlooking or dispositions, while overlooking or minimizing the influence of external or minimizing the influence of external or situations factorssituations factors
Some Limiting Cognitive Some Limiting Cognitive FactorsFactors
Availability HeuristicAvailability Heuristic: The tendency : The tendency to base probability judgments on to base probability judgments on how easily examples come to mindhow easily examples come to mind
Representative HeuristicRepresentative Heuristic: The : The tendency to make a decision based tendency to make a decision based on the extent of the perceived on the extent of the perceived similarity with prototypical cases similarity with prototypical cases from a certain categoryfrom a certain category
Counteracting Errors in Counteracting Errors in ThinkingThinking
Afford time for self-reflectionAfford time for self-reflection
Examine the role of Examine the role of internal/dispositional issues as well as internal/dispositional issues as well as external/situational factorsexternal/situational factors
Generate a number of alternatives to Generate a number of alternatives to the dilemma (overconfidence can be the dilemma (overconfidence can be reduced)reduced)
Ask why could this decision be wrongAsk why could this decision be wrong
Some Limiting Emotional Some Limiting Emotional FactorsFactors
High AnxietyHigh Anxiety: Making a decision, any : Making a decision, any decision, will usually help reduce decision, will usually help reduce anxiety. However, the quickest solution anxiety. However, the quickest solution is not always the bestis not always the best
““Just Good Enough” solutions: Taking the Just Good Enough” solutions: Taking the first halfway decent idea as a means to first halfway decent idea as a means to move to the next taskmove to the next task
Too much or too little emotion hampers Too much or too little emotion hampers effective decision-making skillseffective decision-making skills
Strategies for Emotional Strategies for Emotional IssuesIssues
Create the time needed to calm Create the time needed to calm down and/or focus on the dilemmadown and/or focus on the dilemma
Reflect on how this dilemma Reflect on how this dilemma affects your practice and sense of affects your practice and sense of selfself
Seek consultationSeek consultation
Positive Ethics Positive Ethics encourages…encourages…
Increase awareness of ethical issuesIncrease awareness of ethical issues Know the codeKnow the code Know the laws, regulationsKnow the laws, regulations Participate on the listservParticipate on the listserv
Self-reflect on ethical decisionsSelf-reflect on ethical decisions
Develop insight into your emotional Develop insight into your emotional and cognitive styles when under and cognitive styles when under pressure and making difficult pressure and making difficult decisionsdecisions
Positive Ethics Positive Ethics encourages…encourages…
Acculturation processAcculturation process Becoming part of the community of Becoming part of the community of
psychologistspsychologists Awareness of ethical issues through Awareness of ethical issues through
ongoing continuing educationongoing continuing education
Judicious use of consultationsJudicious use of consultations
Benefits of ConsultationsBenefits of Consultations
Provide new informationProvide new information
Reduce emotional reactanceReduce emotional reactance
Provide feedback on decision making Provide feedback on decision making abilityability
Group ExerciseGroup Exercise
EvaluationsEvaluations