1. John Gavazzi, PsyD ABPP
November 1, 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 and
Positive Ethics is more than a Slogan

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)

18.  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

19.  Broadensa psychologist’s
understanding of ethics in a larger
context
 Sensitizepsychologists to ethical
implications of decisions on a daily
basis

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

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

22. 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

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

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

26. 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.

27.  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.

28.  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.

29.  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

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

31. 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"

32. 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.

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

34. 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

35. 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

36. 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

37. 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

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

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

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

41.  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)

42.  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

43. What are some options?

44. Rational Psychologist
Learn the rules
Apply the rules
Outcomes will follow

45. Learn the rules Understand patient
Apply the rules dynamics
Outcomes will follow Understand the
relationship

46. Psychologist Patient
Variables
Therapeutic Alliance

47.  Looking at how well a psychologist integrates
his/her values and behaviors into the ethical
culture of psychology
 Psychology has a set of normative principles and
behaviors related to ethical behavior and
appropriate conduct

48.  APA’s Code of Conduct
 Commonwealth Psychology regulations found in
the Psychology Law and Practice Act
 Federal Regulations, such as HIPAA
 Court decisions aka case law

49. The APA Ethical Principles and Code of
Conduct do not include a model of
ethical decision-making
Other resources dictate behavior, but do not
highlight how to work through dilemmas

51.  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

52.  Autonomy
 Beneficence
 Nonmaleficence
 Fidelity
 Justice

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

54.  Identify the competing ethical principles
 Help to determine which principle has precedence
and why
 The importance of emotion in ethical decision-
making and moral judgments

55. S Scrutinize
H Hypothesize
A Analyze
P Perform
E Evaluate

56. 1. Goal is to define the problem by identifying the
conflicting ethical principles
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

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

58. 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.

59.  Malcolm Gladwell’s book “Blink”
 Jonathan Haidt’s book on Moral Intuition
 Jay Mills article on emotions in ethical decision-
making

60.  Fear  Passion
 Anxiety
 Calmness/Centered
 Empathy
 Disgust
 Respect/Sympathy
 Disrespect
Positive emotions related to our good
Negative emotions related to ethics decision-making skills and ethical
and moral decision-making knowledge

61. Why do psychologists (still and continue to) have sex
with their patients?

62.  The Fundamental Attribution Error
 Availability Heuristic
 Trait Negativity Bias
 Confirmation Bias

63.  Dunning-Kruger Effect: a cognitive bias in which
unskilled individuals suffer from illusory
superiority, mistakenly rating their ability as much
higher than average.
 Poor performers fail to learn from their mistakes.
 And, they fail to internalize direct feedback from
others.

65.  Knowledge base: APA code, Pennsylvania law,
regulations
 Become Aware of emotional factors
 Cognitive biases/situational factors
 Outcomes are uncertain