Unit 3: Cultural and Ethnic Issues in Clinical Psychology - Seminar Unit 3: Cultural and Ethnic Issues in Clinical Psychology - Seminar Tonight we will.

Unit 3:  Cultural and Unit 3:  Cultural and Ethnic Issues in Clinical Ethnic Issues in Clinical Psychology - Seminar   Psychology - Seminar   

Tonight we will discuss the major Tonight we will discuss the major issues surrounding the following issues surrounding the following current controversies in the field current controversies in the field of Psychology.of Psychology.

Here is a scenario for Here is a scenario for the Seminar the Seminar Discussion:Discussion:

Michael is a 25-year-old graduate student at a large Michael is a 25-year-old graduate student at a large university. He is seeing Dr. Kelly, a clinical psychologist, for university. He is seeing Dr. Kelly, a clinical psychologist, for depression and anxiety. These symptoms emerged when depression and anxiety. These symptoms emerged when Michael began graduate school about six months ago and Michael began graduate school about six months ago and have persisted. Michael's experience as a graduate student have persisted. Michael's experience as a graduate student has included significant ongoing stressors, including has included significant ongoing stressors, including financial insecurity, academic pressures, and turmoil in his financial insecurity, academic pressures, and turmoil in his romantic and family relationships. During one session, romantic and family relationships. During one session, when Michael had suffered through a particularly stressful when Michael had suffered through a particularly stressful week and was feeling especially distraught, he spent the week and was feeling especially distraught, he spent the first 20 minutes of the session describing all the pressures first 20 minutes of the session describing all the pressures he faced. At one point, Michael was quite agitated, and he he faced. At one point, Michael was quite agitated, and he said, "That school has wrecked my life. I hate that place. said, "That school has wrecked my life. I hate that place. Maybe I ought to just blow the whole place up."Maybe I ought to just blow the whole place up."

Seminar Discussion:Seminar Discussion:

1.    Dangerousness1.    Dangerousness How does the How does the TarasoffTarasoff court case apply to this clinical court case apply to this clinical

case?case? How can Dr. Kelly determine if Michael's comment How can Dr. Kelly determine if Michael's comment

constitutes a credible, legitimate threat?constitutes a credible, legitimate threat? In your opinion, should Dr. Kelly break confidentiality In your opinion, should Dr. Kelly break confidentiality

based on Michael's comment? If so, with whom, based on Michael's comment? If so, with whom, specifically, should he communicate?  How does this specifically, should he communicate?  How does this change if Michael is a high school student and 16 change if Michael is a high school student and 16 years old?years old?

How is the issue of informed consent relevant to this How is the issue of informed consent relevant to this case?case?

Seminar Discussion:Seminar Discussion:

2.    Confidentiality2.    Confidentiality Is it okay to talk to your friends about this if you don’t Is it okay to talk to your friends about this if you don’t

tell the client’s name?  What is the �6 degrees� tell the client’s name?  What is the �6 degrees� concept?  How does it apply to this situation?concept?  How does it apply to this situation?

How would this case be different if the client were an How would this case be different if the client were an adolescent?  adolescent? 

How is confidentiality affected when the client is an How is confidentiality affected when the client is an adolescent?adolescent?

Cultural CompetenceCultural Competence

““the counselor’s acquisition of the counselor’s acquisition of awareness, knowledge, and skills needed awareness, knowledge, and skills needed to function effectively in a pluralistic to function effectively in a pluralistic democratic society… “ (Sue & Sue, p 21)democratic society… “ (Sue & Sue, p 21)

3 main components: awareness, 3 main components: awareness, knowledge, and skillsknowledge, and skills

Can Dr Kelly ethically claim a lack of Can Dr Kelly ethically claim a lack of knowledge concerning Michael's knowledge concerning Michael's threat?threat?

Cultural Competence: Cultural Competence: Self-AwarenessSelf-Awareness Learning about one’s own cultureLearning about one’s own culture

– Values, assumptions, biasesValues, assumptions, biases– By doing so, become less egocentricBy doing so, become less egocentric– Also, realize that differences are not deficienciesAlso, realize that differences are not deficiencies– Exploring one’s own prejudices in order to Exploring one’s own prejudices in order to

minimize themminimize them

Would knowing one’s own Would knowing one’s own culture help Dr. Kelly culture help Dr. Kelly determine if Michael's determine if Michael's comment constitutes a comment constitutes a credible, legitimate threat?credible, legitimate threat?

What Constitutes a What Constitutes a Culture?Culture? Narrow vs. broad definitionsNarrow vs. broad definitions

– Some argue that ethnicity and race are the defining Some argue that ethnicity and race are the defining characteristics of culturecharacteristics of culture

– Others argue that many other variables can define a culture, Others argue that many other variables can define a culture, such assuch as

Socioeconomic statusSocioeconomic status ReligionReligion GenderGender AgeAge Geography/regionGeography/region Sexual orientationSexual orientation Political affiliationPolitical affiliation Subcultures (e.g., military, prison)Subcultures (e.g., military, prison)

What determines a person’s What determines a person’s culture to you?culture to you?

Ethically Measuring the Ethically Measuring the Outcome of Culture-Outcome of Culture-Based Training EffortsBased Training Efforts Many questions remainMany questions remain

– How can we measure a baseline of How can we measure a baseline of cultural competence?cultural competence?

– How can we measure change after How can we measure change after training?training?

– Whose opinion should we seek? Whose opinion should we seek? Psychologist, client, supervisor, Psychologist, client, supervisor, others?others?

– How can we infer cause?How can we infer cause?

Ethical Issues in Ethical Issues in Clinical PsychologyClinical Psychology APA Code of Ethics guides the APA Code of Ethics guides the

behavior of clinical psychologistsbehavior of clinical psychologists Relevant issues includeRelevant issues include

– ConfidentialityConfidentiality– Informed consentInformed consent– Multiple relationshipsMultiple relationships– CompetenceCompetence– Others Others

APA Code of EthicsAPA Code of Ethics

First published in 1953First published in 1953 Revised 9 timesRevised 9 times Most recent edition was published Most recent edition was published

in 2002in 2002

APA Code of Ethics: APA Code of Ethics: Aspirational and Aspirational and EnforceableEnforceable AspirationalAspirational

– General Principles section describes General Principles section describes an ideal level of ethical functioning, an ideal level of ethical functioning, or what to strive foror what to strive for

EnforceableEnforceable– Ethical Standards section includes Ethical Standards section includes

rules of conduct that can mandate rules of conduct that can mandate minimal levels of behavior and can minimal levels of behavior and can be specifically violatedbe specifically violated

APA Code of Ethics: APA Code of Ethics: Aspirational and Aspirational and EnforceableEnforceable What are your thoughts on the What are your thoughts on the

aspirational and enforceable aspirational and enforceable portions of the APA Code of portions of the APA Code of Ethics? Ethics?

Should aspirational goals become Should aspirational goals become hard-and-fast requirements of hard-and-fast requirements of psychologists? psychologists?

APA Code of Ethics: APA Code of Ethics: Aspirational and Aspirational and EnforceableEnforceable If so, how would you transform the If so, how would you transform the

current, more general aspirational current, more general aspirational goals into enforceable standards? Are goals into enforceable standards? Are the current enforceable standards too the current enforceable standards too strict, too lenient, just right? How, if at strict, too lenient, just right? How, if at all, would you modify these standards? all, would you modify these standards?

What aspirational goals or enforceable What aspirational goals or enforceable standards, if any, would you add to or standards, if any, would you add to or remove from the code?remove from the code?

Ethical Decision Ethical Decision MakingMaking 8-step model8-step model

1.1. Prior to any ethical dilemma arising, make a Prior to any ethical dilemma arising, make a commitment to doing what is ethically commitment to doing what is ethically appropriate.appropriate.

2.2. Become familiar with the APA ethical code.Become familiar with the APA ethical code.3.3. Consult any law or professional guidelines Consult any law or professional guidelines

relevant to the situation at hand.relevant to the situation at hand.4.4. Try to understand the perspectives of Try to understand the perspectives of

various parties affected by the actions you various parties affected by the actions you may take. Consult with colleagues (always may take. Consult with colleagues (always protecting confidentiality) for additional protecting confidentiality) for additional input and discussion.input and discussion.

Ethical Decision Ethical Decision Making (cont.)Making (cont.) 8 step model (cont.)8 step model (cont.)

5.5. Generate and evaluate your alternatives.Generate and evaluate your alternatives.

6.6. Select and implement the course of Select and implement the course of action that seems most ethically action that seems most ethically appropriate.appropriate.

7.7. Monitor and evaluate the effectiveness of Monitor and evaluate the effectiveness of your course of action.your course of action.

8.8. Modify and continue to evaluate the Modify and continue to evaluate the ethical plan as necessary.ethical plan as necessary.

Psychologists’ Ethical Psychologists’ Ethical BeliefsBeliefs Some behaviors are viewed as Some behaviors are viewed as

absolutely unethical (e.g., sex with absolutely unethical (e.g., sex with clients)clients)

Some behaviors are views as Some behaviors are views as absolutely ethical (e.g., addressing absolutely ethical (e.g., addressing clients by first name)clients by first name)

Many behaviors fall in “gray area” in Many behaviors fall in “gray area” in betweenbetween– Lots of difficult judgment calls Lots of difficult judgment calls

ConfidentialityConfidentiality

In general, psychologists are In general, psychologists are ethically obligated to maintain ethically obligated to maintain confidentialityconfidentiality

Some situations can arise in Some situations can arise in which breaking confidentiality is which breaking confidentiality is appropriateappropriate

Confidentiality:Confidentiality: TarasoffTarasoff and the Duty and the Duty to Warnto Warn TarasoffTarasoff is a court case regarding is a court case regarding

a college-student client who told a college-student client who told his therapist he was going to kill his therapist he was going to kill his girlfriend (Tatiana Tarasoff)his girlfriend (Tatiana Tarasoff)

Therapist contacted campus Therapist contacted campus police who detained him, but police who detained him, but after he was released, he killed after he was released, he killed herher

Confidentiality:Confidentiality: Tarasoff Tarasoff and the Duty to Warn and the Duty to Warn (cont.)(cont.) Her family sued and wonHer family sued and won The finding was that the therapist The finding was that the therapist

had the “duty to warn” the had the “duty to warn” the potential victimpotential victim

This finding now sets a precedent This finding now sets a precedent for all therapists for breaking for all therapists for breaking confidentialityconfidentiality

Confidentiality:Confidentiality: Tarasoff Tarasoff and the Duty to Warn and the Duty to Warn (cont.)(cont.) How credible are clients’ threats?How credible are clients’ threats? What kinds of threats merit What kinds of threats merit

warnings?warnings?– How should the unsafe behavior How should the unsafe behavior

of clients with HIV/AIDS be of clients with HIV/AIDS be understood in terms of threat? understood in terms of threat?

– Why or why not?Why or why not?

Confidentiality: When Confidentiality: When the Client is a Childthe Client is a Child Often, children will confide more if they Often, children will confide more if they

can be assured that psychologists will can be assured that psychologists will not repeat everything to clients’ not repeat everything to clients’ parentsparents

Parents, of course, have a right to be Parents, of course, have a right to be informedinformed

Psychologists often make arrangements Psychologists often make arrangements by discussing this with families up frontby discussing this with families up front

Some issues, such as child abuse, Some issues, such as child abuse, require breaking of confidentiality to require breaking of confidentiality to protect the childprotect the child

Informed ConsentInformed Consent

Required for research, assessment, Required for research, assessment, therapy, and other professional therapy, and other professional activitiesactivities

For therapy, informed consent is an For therapy, informed consent is an ongoing process rather than a one-ongoing process rather than a one-time eventtime event– As psychologist learns more about As psychologist learns more about

client, more information can be sharedclient, more information can be shared

Informed Consent Informed Consent (cont.)(cont.) Informed consent for therapy Informed consent for therapy

must allow client the opportunity must allow client the opportunity to ask questions and receive to ask questions and receive answersanswers

Informed consent process can be Informed consent process can be an early part of a strong an early part of a strong therapeutic relationshiptherapeutic relationship

Multiple RelationshipsMultiple Relationships

Knowing someone professionally and Knowing someone professionally and in some other way in some other way – Romantic/sexualRomantic/sexual– FriendshipFriendship– BusinessBusiness– Other waysOther ways

Unethical when Unethical when – psychologist’s objectivity, competence, or psychologist’s objectivity, competence, or

judgment can be impairedjudgment can be impaired– Exploitation or harm could resultExploitation or harm could result

Multiple RelationshipsMultiple Relationships

What type of multiple relationships What type of multiple relationships would you judge to be unethical? would you judge to be unethical? Provide several examples and your Provide several examples and your rationale for selecting these cases. rationale for selecting these cases.

Are there any multiple relationships Are there any multiple relationships that may not be unethical under the that may not be unethical under the APA Code of Ethics? Provide APA Code of Ethics? Provide several examples and your several examples and your rationale for selecting these cases.rationale for selecting these cases.

Ethics in Clinical Ethics in Clinical ResearchResearch Psychotherapy efficacy researchPsychotherapy efficacy research

– What should control group receive?What should control group receive? No treatment (“Wait-list” control)No treatment (“Wait-list” control) Placebo treatmentPlacebo treatment Alternate treatmentAlternate treatment

– What ethical issues arise when What ethical issues arise when any of these three options are any of these three options are used?used?

Questions?Questions?