John Gavazzi and Sam Knapp present on ethics

1. Unlearning Ethics
“Received Wisdom” and
Principle-Based Ethics
By Sam Knapp, EdD ABPP and John Gavazzi, PsyD, ABPP
June 2013 – Pennsylvania Psychological Association

2. www.papsyblog.org
More on ethics education
Great resource

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
• Acculturation Model
• Three simple strategies
• Principle-based ethics
• 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

8. I. An Acculturation Model
One way of remaining a life-long
learner
Provides another way to discuss ethical
behaviors and decisions

9. 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.

10. 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.

11. 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

12. Ethical Acculturation
Identification with personal value system
(higher vs. lower)
Identification with value system of psychology
(higher vs. lower)

13. 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

14. 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

15. 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

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

17. 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

18. II. Three simple strategies
1. Ask the patient first (if and when appropriate)
2. Does the intervention or issue help the patient
flourish?
3. Honest self-reflection:
Will this satisfy your needs/values or the patient’s?

19. Autonomy
Beneficence
Nonmaleficence
Fidelity
Justice
III. Principle-Based Ethics

20. Respect for Autonomy
• Does not mean promoting autonomy
(individuation or separation)
• Means respecting the autonomous decision
making ability of the patient

21. 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

22. 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 ……”

23. 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

24. 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.”

25. 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

26. 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.”

27. 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.)

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

29. 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)

30. IV. Unhealthy or Unhelpful
Strategies
These strategies can be readily tied
back into the Acculturation Model
and Principle-based Ethics

31. Unhealthy or Unhelpful Strategies
• Overemphasis on rules or The Code
• Interpreting rules without understanding
overarching ethical principles
• Setting a low bar for professional behavior

32. 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)

33. V. The Unlearning Exercise
10 examples of “Received
Wisdom” that may not be so wise

34. VI. What about the following
examples of “Received Wisdom”?
More Group Discussion

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

36. 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

37. Psychotropic medication
• Psychologists cannot talk with patients about
medication.
• Technically, it is practicing medicine without a
license.

38. 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.

39. 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.

40. 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

41. 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

42. 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?

43. 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.

44. 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.”

45. Other pearls of wisdom that
seem sketchy?
Other ethical dilemmas?

46. Questions and Answers
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