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


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


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?


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 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.


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


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


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


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.”


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


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.


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.”


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


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)


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


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


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?


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)


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


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

Business

Ethics is More than a Code: