The road to hell is paved with good intentions - Virgil
In Hell there will be nothing but law and due process will be meticulously observed. ~ Grant Gilmore
Hell
Samuel K. Knapp, Ed.D., ABPP PsychologistJohn D. Gavazzi, PsyD, ABPP Psychologist
Annual Convention of the Pennsylvania Psychological AssociationJune, 2015
Ethics education in general
Dual Systems/Ethics Code
Foundational Principles & Acculturation Model
Rings of Hell
Experiential Exercises
Overview
1. Describe fear or avoidance based theories of ethics
2. Identify ways to incorporate overarching ethical values in to their practices; and,
3. Apply positive approaches to real life clinical situations.
Learning Objectives
Negative Expectations
Moral emotions like guilt, fear, & shame
Can ethics education pave the way to ethics hell?
Midway in our life’s journey, I went astrayFrom the straight road and woke to find myself
Alone in a dark wood. How shall I say
What wood that was! I never saw so drearSo rank, so arduous a wilderness!
Its very memory gives shape to fear.
Death could scarce be more bitter than that place!
Canto 1: lines 1-7
Inscription at the entrance to Hell
“Abandon all hope ye who enter here.”
Dante’s Divine Comedy
Proscriptive: Those beliefs, behaviors, or actions that avoid harm
Prescriptive: Those beliefs, behaviors, or actions that seek beneficial outcomes
Dual Systems & Ethics
Aspirational Ethics: Reaching for the ethical ceiling by promoting patient well-being
Enforcement Ethics: Standing on the ethical floor as to avoid doing harm
Dual Systems & Ethics Code
Research shows that bad has a much stronger punch than good
Loss aversion
Defensive practice
Bad is stronger than good
Autonomy
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
Beneficence
The principle of benefiting others and accepting the responsibility to do good underlies the profession.
- Providing the best treatment possible
- Competency
- Referring when needed
Nonmaleficence
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
Fidelity
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.)
Justice
Justice primarily refers to treating people fairly and equally.
-Treating patients equally regardless of insurance
-Providing high quality of service regardless of gender, ethnicity, orientation, etc.
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
The Acculturation Model
Acculturation
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.
Acculturation Model
Provides a model to track our descent into hell
A different vantage point to address ethical behaviors and decisions
Acculturation as a Process
Can be a complex process
Some parts of a psychologist’s practice and lifestyle may be easily acculturated while others not
Ethics Acculturation Model
Psychology has a system of shared and distinctive norms, beliefs, and traditions.
This set of beliefs is reflected in our ethics code.
Ethical Acculturation
Identification with personal value system
(higher vs. lower)
Identification with value system of psychology
(higher vs. lower)
Acculturation Model of ethical
development
Integration Separation
Assimilation Marginalization
Higher on
Professional Ethics
Higher on Personal
Ethics
Lower on Personal
Ethics
Lower on
Professional Ethics
Assimilation – First Ring of Hell
Matrix: Higher on professional ethics
Lower on personal ethics
Risks: Developing an overly legalistic stance
Rigidly conforming to certain rules while missing broader issues
Assimilated Strategies
Assimilated strategies are often “fear based” –where motive to avoid harming another or incurring punishment for oneself, causes the psychologist to adopt legalistic stances.
Assimilated strategy attempts to be prevention focused
Fail to give adequate attention or weight to the overarching ethical principles that guide or should guide professional behavior
A psychologist receives a phone message from a former patient. The former patient is asking for the psychologist to be a “character witness” as he has an upcoming hearing for a minor criminal offense. His attorney believes that some good, written character references will really help out with the case.
The psychologist pulls the former patient’s chart. The psychologist has not worked with the patient for about two years. Additionally, none of the treatment issues had to do with impulse control or antisocial tendencies. Therapy lasted about a year and focused on depression and relationship issues. The psychologist recalls that the patient had always been good-natured, attended appointments regularly, and worked well in therapy. The psychologist remembers the former patient as a likeable person.
Vignette 9: Psychologist as Character Witness
Second Ring of Hell - Separation
Matrix: Lower on professional ethics
Higher on personal ethics
Risks: Compassion overrides good
professional judgment
Fails to recognize the unique role of psychologists
Separated strategies are often “benefits-based” –where the motive for promoting the well-being of the patient causes the psychologist to be blind to ways that well-meaning people can cause harm
Separated strategy attempts to be promotion focused
Fails to give adequate attention or weight to the overarching ethical principles that guide or should guide professional behavior
Separation
A psychologist receives a phone message from a former patient. The former patient is asking for the psychologist to be a “character witness” as he has an upcoming hearing for a minor criminal offense. His attorney believes that some good, written character references will really help out with the case.
The psychologist pulls the former patient’s chart. The psychologist has not worked with the patient for about two years. Additionally, none of the treatment issues had to do with impulse control or antisocial tendencies. Therapy lasted about a year and focused on depression and relationship issues. The psychologist recalls that the patient had always been good-natured, attended appointments regularly, and worked well in therapy. The psychologist remembers the former patient as a likeable person.
Vignette 9: Psychologist as Character Witness
Type I Reasoning Type 2 Reasoning
Rule-based
Deliberate
Analytic
Slower
Intuitive
Automatic
Emotional
Rapid
Third Ring: Emotional Reasoning
Cognitive Biases Unhealthy Emotional Responses
Fear or Anxiety
Sexual Attraction
Guilt
Disgust
Anger
Availability Heuristic
Confirmatory Hypothesis Testing
Fundamental Attribution Error
Actor Observer Bias
Type 1 Reasoning can lead to errors
Professional isolation is correlated with:
• Lower quality work
• Job dissatisfaction
• Burnout
• Interpersonal defensiveness
Professional isolation can happen in group practices.
Fourth Ring: Isolation
Denial of Emotions
Lack of self-compassion or adequate self-care
Failure to achieve work-life balance
Working harder than your patients are
Fifth Ring: Emotional Pain/Burnout
Sixth Ring: Marginalization
Matrix: Lower on professional ethics
Lower on personal ethics
Risks: *Greatest risk of harm
*Lack appreciation for ethics
*Motivated by self-interest
*Less concern for patients
Upon seeing Satan:
“[Virgil] made me stop, and stepping aside he said. . . This is the placeWhere you must arm your soul against all dread!”
“Do not ask, Reader, how my blood ran coldAnd my voice choked up with fear. I cannot write it.This is the terror that cannot be told.
I did not die, and yet I lost life’s breath,Imagine for yourself what I became, Deprived at once of both my life and death.
Canto XXXIV, lines 19-27.
Sinners are ironically positioned to demonstrate their sin
Satan is frozen in waist-deep ice, trying to fly away from God. The beating of the wings keeps the water frozen, preventing his escape.
Marginalization is the antithesis of the psychology’s values and ethics – a professional who is upside down
In Dante’s Hell
Independent Actions Help from others
Self Reflection
Documentation
Transparency
Continuing Education
Self-care
Consultation
Supervision
Psychotherapy
Continuing Education
Matrix: Higher on professional ethics
Higher on personal ethics
Reward: Implement values in context of professional roles
Reaching for the ethical ceiling
Aspirational ethics
Overemphasis on rules or The Code
Interpreting rules without understanding overarching ethical principles
Setting a low bar for professional behavior
Intrusive advocacy
Lack of understanding boundaries and the “therapeutic frame”
Allowing personal values to trump professional boundaries (without self-reflection and/or consultation)
In the study of religious persons, a body of research has identified positive and negative religious coping.
Positive religious coping could include relying interpreting the events as a way to improve oneself (or one’s understanding of the world), seeking out support from the religious community, viewing relationship with God as a source of strength, and a willingness to show compassion and forgiveness towards oneself.
Negative religious coping would include interpreting the events as punishment from God, being isolated from the religious community, feeling shame to the point that it is paralyzing, or not forgiving oneself.
We can see a parallel process in coping with stressful professional events. Do we use positive coping strategies— seeking assistance from others, being self-reflective (yet forgiving of ourselves if we made mistakes) or negative (self-condemning, paralyzed with fear, preoccupied with guilt, catastrophizing the consequences of our mistakes).
The Ethics Acculturation model can be used as a positive coping device if we use it to understand how we did (or might have) responded to specific situations.
You can sign up for a one-credit take home CE credit.
It consists of a short article about ethics acculturation, a short quiz, and a diary for self-reflection
Flipped classroom concept