Use vignettes from www.papsyblog.org

1. John Gavazzi, PsyD ABPP
January 13, 2012

2.  Learning Objectives
 Online Information: Ethics blog and other
sites
 Structured information sharing
 Vignette analysis and case discussions

3. 1. List at least three ethical principles related to
APA’s code
2. Compare and contrast positive ethics and risk
management
3. Describe the Acculturation Model
4. Explain one ethical decision-making model
5. Analyze one ethical vignette by identifying
conflicting principles

4. www.papsyblog.org
Where Ethics is More Than a Code

5.  Ethics Blog
 Self-education
 Connecting with others: Blogs & other sites
 Becoming politically active

6.  Introduction and Applicability
 Preamble and General Principles
(Aspirational and based on principle-based
ethics)
 Ethical Standards (Enforceable and represent
minimum standards)

7.  The ethics code does not include federal
laws, such as HIPAA
 The ethics code does not include case law,
though influence is noted
 The ethics code is distinct and separate from
guidelines approved by the APA Council of
Representatives
 Quiz Question: How many are there?

8. Autonomy
Beneficence
Nonmaleficence
Fidelity
Justice

9.  Does not mean promoting autonomy
(individuation or separation)
 Means respecting the autonomous decision
making ability of the patient

10. 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

11.  The principle of benefiting others and
accepting the responsibility to do good
underlies the profession.
- Providing the best treatment possible
- Competency
- Referring when needed

12. Basis of foundational standard 2.01
“Psychologists provide services, teach, and
conduct research with populations and in
areas only within the boundaries of their
competence. . . “

13. 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

14. Foundational Standard 3.04
“Psychologists take reasonable steps to avoid
harming their clients/patients, students,
supervisees, research participants,
organizational clients, and others with whom
they work, and to minimize harm when it is
foreseeable and unavoidable.”

15. 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.)

16. Foundational Standard 4.01
“Psychologists have a primary obligation and
take reasonable precautions to protect
confidential information.”

17. Justice primarily refers to treating people fairly
and equally.
In their work-related activities, psychologists do not
engage in unfair discrimination based on age,
gender, gender identity, race, ethnicity, culture,
national origin, religion, sexual orientation,
disability, socioeconomic status, or any basis
proscribed by law. (3.01)

19. A process to change the cultural behavior of
an individual through contact with another
culture. The process of acculturation occurs
when there is an adaptation into an
organization or society.
The process involves developing relationships
with those within the culture to learn the
traditions, rules, roles, and behaviors to
become part of that group or community.

20.  Our system of common beliefs, shared
meanings, norms and traditions that
distinguish psychologists as professionals.
 It is a learned set of skills, bases of
knowledge and ethical beliefs, as described in
our ethics code.

21.  Our culture of ethics moves beyond ourselves
as individual psychologists.
 Expands into our ability to become connected
with the profession of psychology as well as
other professionals.
 Our ethical culture “happens” everyday when
we relate to our patients, peers, or general
population.

22.  Can be a complex process
 Some parts of a psychologist’s behaviors,
practice, and lifestyle may be easily
acculturated; while others will not
 Process that may continue throughout the
education or career as a psychologist

23.  Ethics Autobiography
 Exploring religious upbringing
 Exploring interpersonal relationships

24. Meme: a cultural unit (an idea or value or
pattern of behavior) that is passed from one
person to another by non-genetic means (as
by imitation);
"memes are the cultural counterpart of genes"

25. Identification with personal value system
(high vs. low)
Identification with value system of psychology
(high vs. low)
These are on a continuum more so than boxes.

26. Acculturation Model of
Ethical Decision-making
Higher on Professional EthicsLower on Professional Ethics
Integration Separation
Higher on Personal
Ethics
Assimilation Marginalization
Lower on Personal
Ethics

27. Style:Lower focus on professional ethics
Lower focus on personal ethics
Risks: Greatest risk of harm
Lack appreciation for ethics
Motivated by self-interest
Less concern for patients

28. Style:Lower focus on professional ethics
Higher focus on personal ethics
Risks:Compassion overrides good
professional judgment
Fail to recognize the unique role
of psychologists

29. Style: Higher focus on professional ethics
Lower focus on personal ethics
Risks: Developing overly legalistic stance
Rigidly conforming to individual rules
while missing broader issues

30. Style:High focus on professional ethics
High focus on personal ethics
Reward:Implement values in context of
professional roles
Reaching for the ethical ceiling
Aspirational ethics

31. Our level of acculturation and our style of
ethical decision-making

32.  Mandatory “floor”
 Minimum standards adopted by the
profession
 Focus on the law or standards to protect
the public

33.  A means to reduce risk in an uncertain
situation
 Decision-making strategies to avert problems
or liability of the psychologist
 False risk management strategies (memes,
such as the No Suicide Contract)

34.  No evidence to indicate that it helps reduce
suicidal behavior
 Cannot be used an part of an assessment
 Contract implies a legal tool to reduce risk
 May actually harm the therapeutic alliance,
not promote it

35.  Overemphasis on regulations and
enforceable standards
 Incomplete view of ethics
 Ethics is more than just a code

36.  Ethics as a movement away from the
punishment and anxiety-producing
components of ethics
 Fulfill their highest ideals
 A means to help interpret and apply
ethics standards

37.  An avoidance of ethical codes, case law,
regulations, and statutes
 A rationalization to explain inappropriate
behaviors or decisions

38.  Broadens a psychologist’s
understanding of ethics in a larger
context
 Sensitize psychologists to ethical
implications of decisions on a daily
basis

39.  Heighten awareness related to
ethics beyond our offices
 Assist psychologists in balancing
competing ethical demands

40. Remedial: Acquiring and maintaining
minimal formal qualifications
Positive: Striving for highest standards
Includes self-awareness and self-care
Emotional competence

41. Remedial: Avoiding boundary violations
Focus on sexual boundaries
Adhere to strict interpretation
Positive: Striving to enhance quality of
all professional relationships
Understand issues related to
multiple relationships

42. Remedial: Fulfilling legal responsibilities
to get consent forms or Privacy
Notices signed
Positive: Working to maximize client
participation with goals
and treatment processes

43. Remedial: Avoiding prohibited disclosure
Emphasis legal requirements
Positive: Striving to enhance trust
Understanding nuances when
working with families

44. What are some options?

45. The APA Ethical Principles and Code of
Conduct do not include a model of
ethical decision-making

47.  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

48. Often ethical dilemmas involve apparent
conflicts between respect for patient
autonomy versus beneficence
or
Respect for autonomy versus general or public
beneficence

49. S Scrutinize
H Hypothesize
A Analyze
P Proceed
E Evaluate

50. 1. Goal is to define the problem
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

51. “integrative framework”
steps two and three generate solutions that
maximize your personal values within the
context of your professional role

52. 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.

53.  Overemphasis on regulations and enforceable
standards
 “Thou shall not” oriented
 Minimum standards or the “ethical floor”
 Incomplete view of ethics

54.  Ethics as a movement away from the
punishment and anxiety-producing
components of ethics
 Fulfill their highest ideals
 A means to help interpret and apply ethics
standards

56.  Knowledge base: APA code, Pennsylvania law,
regulations
 Emotional factors
 Cognitive biases/situational factors
 Outcomes are uncertain

57.  Ethics occurs within the therapeutic
relationship
 Commitment to the relationship and high
quality of care
 Pulling together the code, your training, and
current professional role within the context of
the relationship with patient

58.  Ethics happens within the relationship
 Active approach to ethics, the relationship,
and decision-making
 Combines psychologist factors (which
includes emotions and biases) with clinical
features and the patient