Recent presentation on moral development, moral reflection, acculturation to the community of psychology, principle-based ethics of psychology, and false ethical memes for psychologists

1. UNLEARNING ETHICS
ETHICAL MEMES & MORAL DEVELOPMENT
By Sam Knapp, EdD ABPP and John Gavazzi, PsyD, ABPP
October 31, 2013 – Pennsylvania Psychological
Association

2. WWW.PAPSYBLOG.ORG
MORE ON ETHICS EDUCATION

3. COURSE OBJECTIVES
• List common beliefs that are not based on
overarching ethical principles
• Describe the methodology to be used to identify
false or unhelpful ethical or risk management
principles

4. GENERAL OUTLINE
• Personal Moral Development
• Acculturation Model
• Principle-based ethics
• Memes in Professional Life
• Unhealthy or Unhelpful Strategies

5. GENERAL OUTLINE
• The Unlearning Experience**
• Examples of “Received Wisdom”**
**This is the time for the most group interaction.
However, we want to make this fun and
informative, so feel free to contribute at any time
during the presentation.

6. PARTICIPANT SAFETY
• Creating a safe environment
• Avoid the word “unethical”
• We are all learning in this process
• Demonstrate courtesy and respect for others

7. EXERCISES
• Handout 1: The Dumb Exercise
• Handout 2: Wisdom to contemplate
• Handout 3: Bloom’s Educational Taxonomy

8. I. PERSONAL MORAL DEVELOPMENT
1. Religion/Family of Origin
2. Education: College and CE
3. Personal Education: Reading and Experience
4. Honest self-reflection

9. MORAL FOUNDATIONS
Care - Harm
Fairness – Cheating
Loyalty-Betrayal
Authority – Subversion
Sanctity (Purity) – Degradation
Liberty - Oppression

10. WHAT IS YOUR MORAL CODE?
• How did it develop?
• How often do you use it to reflect on professional
life?
• How often do you use it to reflect on personal life?
• How do you integrate morals into ethics?

11. WHAT IS YOUR MORAL CODE?
• Do you use it “before the fact”?
• Is it intuitive and unconscious?
• Is it more cognitive?
• Is it written down?

12. WHAT IS YOUR MORAL CODE?
• Is it acceptance of another person’s code in full?
• If yes, why?
• If not, why?

13. WHAT IS YOUR MORAL CODE?
• Do you use it “after the fact”?
• Fundamental Attribution Error
• Actor-Observer Bias
• Motivated Moral Reasoning

14. II. AN ACCULTURATION
MODEL
One way of remaining a life-long learner
Provides another way to discuss ethical
behaviors and decisions

15. 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.

16. ETHICS ACCULTURATION MODEL
• An outgrowth of positive ethics that integrates
personal ethics and professional obligations.
• Psychology has a system of shared and distinctive
norms, beliefs, and traditions.
• This set of beliefs is reflected in our ethics code.

17. 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
• Process that will likely continue throughout the
education or career as a psychologist

18. ETHICAL ACCULTURATION
Identification with personal value system
(higher vs. lower)
Identification with value system of psychology
(higher vs. lower)

19. Acculturation Model of
ethical development
Higher on
Professional Ethics
Lower on
Professional Ethics
Integration
Separation
Assimilation
Marginalization
Higher on Personal
Ethics
Lower on Personal
Ethics

20. MARGINALIZED
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

21. ASSIMILATION
Matrix:
Higher on professional ethics
Lower on personal ethics
Risks:
Developing an overly legalistic
stance
Rigidly conforming to certain rules while
missing broader issues

22. SEPARATION
Matrix:
Lower on professional ethics
Higher on personal ethics
Risks:
Compassion overrides good
professional judgment
Fail to recognize the unique
role of psychologists

23. INTEGRATED
Matrix:
Higher on professional ethics
Higher on personal ethics
Reward:
Implement values in context
of professional roles
Reaching for the ethical ceiling
Aspirational ethics

24. III. PRINCIPLE-BASED ETHICS
Autonomy
Beneficence
Nonmaleficence
Fidelity
Justice

25. RESPECT FOR AUTONOMY
• Does not mean promoting autonomy (individuation
or separation)
• Means respecting the autonomous decision making
ability of the patient

26. 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

27. AUTONOMY & CONSENT
Foundational Standard 3.10
“When psychologists conduct research or provide
assessment, therapy, counseling or consulting
services in person or via electronic transmission or
other forms of communication, they obtain the
informed consent of the individual or individuals using
language that is reasonably understandable to that
person ……”

28. 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

29. BENEFICENCE
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.”

30. NONMALEFICENCE
The principle is doing no harm.
- Demonstrating competence
- Maintaining appropriate boundaries
- Not using an experimental technique as the
line of treatment
- Providing benefits, risks, and costs
first

31. NONMALEFICENCE
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.”

32. 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.)

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

34. JUSTICE
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)

35. IV. UNHEALTHY OR
UNHELPFUL STRATEGIES
THESE STRATEGIES CAN BE READILY TIED BACK INTO THE
ACCULTURATION MODEL AND PRINCIPLE-BASED ETHICS

36. UNHEALTHY OR UNHELPFUL
STRATEGIES
• Overemphasis on rules or The Code
• Interpreting rules without understanding
overarching ethical principles
• Setting a low bar for professional behavior

37. UNHEALTHY OR UNHELPFUL
STRATEGIES
• Intrusive advocacy
• Lack of understanding boundaries and the
“therapeutic frame”
• Allowing personal values to trump professional
boundaries (without self-reflection and/or
consultation)

38. V. MEME THEORY
REMEMBER, IT’S ONLY A THEORY

39. MEMES
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"

40. THE POWER OF MEMES
• Evolutionary Psychology and Heuristics
• Bottom-up approach to moral reasoning (although
we think the opposite is true)
• The “Bad” outweighs the “Good” in moral
reasoning

41. VI. THE UNLEARNING
EXERCISE
10 EXAMPLES OF “RECEIVED WISDOM” THAT MAY
NOT BE SO WISE

42. WHAT ABOUT THE FOLLOWING
EXAMPLES OF “RECEIVED WISDOM”?
More Group Discussion
On Memes (of sorts)

43. INFORMED CONSENT
• Informed consent only occurs at the beginning of
treatment
• Informed consent mainly involves the patient to sign
forms for risk management purposes

44. SELF-DISCLOSURE
• Self-disclosure is never appropriate by the
psychologist during psychotherapy or assessment
• Self-disclosure is clearly a boundary violation that is
always wrong

45. PSYCHOTROPIC MEDICATION
• Psychologists cannot talk with patients about
medication.
• Technically, it is practicing medicine without a
license.

46. SUICIDAL & HOMICIDAL PATIENTS
• When dealing with high risk patients, it is better to
not document a great deal of information.
• If you do not document much detail, then you have
greater legal protection from an attorney indicating
that you did something wrong. Attorneys can twist
words easily, so the less the better.

47. NO SUICIDE CONTRACT
• This is an important risk management strategy
• This is the standard of care
• This strategy helps the patient from actually harming
him or herself.

48. ALWAYS GIVE 3 NAMES WHEN
REFERRING A PERSON FOR TREATMENT
• It is the standard of care.
• Co-pay, insurance, ability to access the referral is
immaterial.
• Relationship with the patient or referral is not a high
priority

49. NEVER TALK WITH PATIENTS ABOUT
RELIGION
• Psychotherapy is like other polite conversations, so it
is improper to talk about religion.
• Psychologists are not sufficiently trained in religious
matters.
• The best strategy is to refer patients to their
priest, pastor, rabbi or spiritual guide

50. HIPAA APPLIES IN EVERY SITUATION
• HIPAA applies to pre-employment evaluations
• HIPAA applies to security evaluations.
• HIPAA applies to fitness for duty evaluations.
• What about forensic evaluations?

51. IF YOU HAVE NOT BEEN
INVESTIGATED, THEN YOU ARE ACTING
ETHICALLY.
• Only people engaging in marginalized behavior get
caught. Therefore, if I am not being
investigated, my behavior must be appropriate.
• I follow all the rules strictly, therefore, I must be
acting ethically.

52. IF YOU KNOW OF ANOTHER
PSYCHOLOGIST ENGAGING IN
MARGINALIZED BEHAVIOR, THEN IT IS
BEST TO NOT DO ANYTHING.
• Someone else should bring it up
• “I am not supervising the psychologist, so I cannot
bring it up.”

53. OTHER PEARLS OF WISDOM
THAT SEEM SKETCHY?
OTHER ETHICAL DILEMMAS?

54. QUESTIONS AND
ANSWERS
COMPLETE COURSE EVALUATIONS