learning and teaching ethical mistakes

Learning and Teaching Ethical Mistakes:Learning and Teaching Ethical Mistakes:

From Consultation Room to Class RoomFrom Consultation Room to Class Room

John Gavazzi, PsyD, ABPPJohn Gavazzi, PsyD, ABPP

Richard Small, PhD, ABPPRichard Small, PhD, ABPP

Michele Miele, MAMichele Miele, MA

Learning ObjectivesLearning Objectives

Understand the importance of teaching Understand the importance of teaching ethical mistakes in the classroomethical mistakes in the classroom

Highlight the Acculturation ModelHighlight the Acculturation Model

List several ideas related to the Consultation List several ideas related to the Consultation ModelModel

Describe the importance of modeling Describe the importance of modeling vulnerability and opennessvulnerability and openness

OOverarching goal is to teach verarching goal is to teach errors in order to errors in order to preventprevent

unfortunate events or harmful unfortunate events or harmful behaviorbehavior

Work on avoiding the term Work on avoiding the term “unethical”“unethical”

Why discuss ethical errors?

Patient safety issuesPatient safety issues

Appropriate education of studentsAppropriate education of students

Provide competent supervision for Provide competent supervision for psychologists-in-trainingpsychologists-in-training


Understanding risk managementUnderstanding risk management

Assist practicing colleaguesAssist practicing colleagues

Develop skills to enhance high quality Develop skills to enhance high quality servicesservices


Highlight how licensing boards work to Highlight how licensing boards work to protect the publicprotect the public

Discuss pertinent issues, like offering an Discuss pertinent issues, like offering an apologyapology

Ethical decision-making is a Ethical decision-making is a complex processcomplex process

Knowledge base: APA code, Knowledge base: APA code, Pennsylvania law, regulationsPennsylvania law, regulations

Emotional factorsEmotional factors

Cognitive biases/situational factorsCognitive biases/situational factors

Outcomes are uncertainOutcomes are uncertain

Ethical decision-making strategies are typically Ethical decision-making strategies are typically taught in ethics books and classestaught in ethics books and classes

The APA Ethical Principles and Code of The APA Ethical Principles and Code of Conduct do not include a model ofConduct do not include a model of

ethical decision-makingethical decision-making

Acculturation ModelAcculturation Model

Acculturation Acculturation

A process to change the cultural behavior A process to change the cultural behavior of an individual through contact with of an individual through contact with another culture. The process of another culture. The process of acculturation occurs when there is an acculturation occurs when there is an adaptation into an organization or society.adaptation into an organization or society.

Ethical Culture of PsychologyEthical Culture of Psychology

Our system of common beliefs, shared Our system of common beliefs, shared meanings, norms and traditions that meanings, norms and traditions that distinguish psychologists as professionals.distinguish psychologists as professionals.

It is a learned set of skills, bases of It is a learned set of skills, bases of knowledge and ethical beliefs, as knowledge and ethical beliefs, as described in our ethics code. described in our ethics code.

Acculturation as a ProcessAcculturation as a Process

Can be a complex processCan be a complex process

Some parts of a psychologist’s practice Some parts of a psychologist’s practice and lifestyle may be easily acculturated and lifestyle may be easily acculturated while others notwhile others not

Process that may continue throughout the Process that may continue throughout the education or career as a psychologisteducation or career as a psychologist

Ethical AcculturationEthical Acculturation

Identification with personal value systemIdentification with personal value system

(high vs. low)(high vs. low)

Identification with value system of Identification with value system of psychologypsychology

(high vs. low)(high vs. low)

Acculturation Model of Ethical Acculturation Model of Ethical Decision-makingDecision-making

Integration Separation

Assimilation Marginalization

High Professional Ethics Low Professional Ethics

High Personal Ethics

Low Personal Ethics

MarginalizationMarginalization

Style: Style: Lower focus on professional ethicsLower focus on professional ethics

Lower focus on personal ethicsLower focus on personal ethics

Risks: Risks: Greatest risk of harmGreatest risk of harm

Lack appreciation for ethicsLack appreciation for ethics

Motivated by self-interestMotivated by self-interest

Less concern for patientsLess concern for patients

SeparationSeparation

Style: Style: Lower focus on professional ethicsLower focus on professional ethics

Higher focus on personal ethicsHigher focus on personal ethics

Risks: Risks: Compassion overrides good Compassion overrides good professional judgment professional judgment

Fail to recognize the unique role Fail to recognize the unique role of psychologists of psychologists

AssimilationAssimilation

Style:Style: Higher focus on professional ethics Higher focus on professional ethics

Lower focus on personal ethicsLower focus on personal ethics

Risks:Risks: Developing overly legalistic Developing overly legalistic stancestance

Rigidly conforming to individual Rigidly conforming to individual rules rules while missing broader while missing broader issuesissues

IntegrationIntegration

Style: Style: High focus on professional ethicsHigh focus on professional ethics

High focus on personal ethicsHigh focus on personal ethics

Reward: Reward: Implement values in context of Implement values in context of professional roles professional roles

Reaching for the ethical ceilingReaching for the ethical ceiling

Aspirational ethicsAspirational ethics

MemesMemes

MemeMeme: a cultural unit (an idea or value or : a cultural unit (an idea or value or pattern of behavior) that is passed from pattern of behavior) that is passed from one person to another by non-genetic one person to another by non-genetic means (as by imitation);means (as by imitation);

"memes are the cultural counterpart of "memes are the cultural counterpart of genes"genes"

Remedial EthicsRemedial Ethics

Mandatory “floor”Mandatory “floor”

Minimum standards adopted by the Minimum standards adopted by the professionprofession

Focus on the law or standards to Focus on the law or standards to protect the publicprotect the public

Remedial EthicsRemedial Ethics

Overemphasis on regulations and Overemphasis on regulations and enforceable standardsenforceable standards

Incomplete view of ethicsIncomplete view of ethics

Positive EthicsPositive Ethics

Ethics as a movement away from Ethics as a movement away from the punishment and anxiety-the punishment and anxiety-producing components of ethicsproducing components of ethics

Fulfill their highest idealsFulfill their highest ideals

A means to help interpret and apply A means to help interpret and apply ethics standardsethics standards

Positive Ethics is NOTPositive Ethics is NOT

An avoidance of ethical codes, case An avoidance of ethical codes, case law, regulations, and statuteslaw, regulations, and statutes

A rationalization to explain A rationalization to explain inappropriate behaviors or decisionsinappropriate behaviors or decisions

Benefits of Positive EthicsBenefits of Positive Ethics

Broadens a psychologist’s Broadens a psychologist’s understanding of ethics in a broader understanding of ethics in a broader contextcontext

Sensitize psychologists to ethical Sensitize psychologists to ethical implications of decisions on a daily implications of decisions on a daily basisbasis

Benefits of Positive EthicsBenefits of Positive Ethics

Assist psychologists in balancing Assist psychologists in balancing competing ethical demandscompeting ethical demands

Student PerspectiveStudent Perspective

Ethics in the ClassroomEthics in the Classroom Understanding the Ethical Culture of PsychologyUnderstanding the Ethical Culture of Psychology

Developing ProfessionalismDeveloping Professionalism Dress codeDress code LanguageLanguage Self AwarenessSelf Awareness

Level of Acculturation – IntegrationLevel of Acculturation – Integration Learning policy and procedure – Ethics CodeLearning policy and procedure – Ethics Code Internalizing a strong ethical constitution both Internalizing a strong ethical constitution both

professionally and personally.professionally and personally.

Experiences in the fieldExperiences in the field Clients pursuing personal/ friendship/ intimate Clients pursuing personal/ friendship/ intimate

relations with you.relations with you. RejectionRejection GeneralizationsGeneralizations

Using your cell phone for work Using your cell phone for work

Gift receiving Gift receiving

Self -Disclosure Self -Disclosure

Dealing with suicidal patients and crisesDealing with suicidal patients and crises

The role of SupervisionThe role of Supervision

Ethics in the ClassroomEthics in the Classroom Exercises on personal examination of ones level Exercises on personal examination of ones level

of acculturation of acculturation

Exercises on professionalism – appearance, Exercises on professionalism – appearance, attitude, language, and understanding that you attitude, language, and understanding that you are being watched even in your personal life. are being watched even in your personal life.

Dilemma setting – mock therapy sessions – role Dilemma setting – mock therapy sessions – role playing playing

Video sessions of situations and then discussion Video sessions of situations and then discussion to follow to follow

Ethics in the ClassroomEthics in the Classroom Debate format – ex. confidentiality versus the Debate format – ex. confidentiality versus the

duty to warnduty to warn

Teacher, being a good role model – as we are to Teacher, being a good role model – as we are to our clientsour clients Let it be evident to our clients/students that Let it be evident to our clients/students that

we practice professional and personal ethics.we practice professional and personal ethics.

Understanding the role of the supervisor during Understanding the role of the supervisor during internshipsinternships

Understanding their role as a professionalUnderstanding their role as a professional

Teaching Ethical ErrorsTeaching Ethical Errors

VignettesVignettes

Case Consultation ModelCase Consultation Model

Moving beyond ethical versus Moving beyond ethical versus unethicalunethical

Some dilemmas do not have a Some dilemmas do not have a clear solution, especially when clear solution, especially when

there are competing ethical there are competing ethical principles in play.principles in play.

VignettesVignettes

Insure that the instructor or supervisor can Insure that the instructor or supervisor can identify the competing ethical principlesidentify the competing ethical principles

Provide sufficient clinical detailProvide sufficient clinical detail

If actual case, need to disguise identifying If actual case, need to disguise identifying information sufficientlyinformation sufficiently

VignettesVignettes

Usually less threatening or revealing to the Usually less threatening or revealing to the instructor or supervisorinstructor or supervisor

Many ethics books have vignettes (along Many ethics books have vignettes (along with some semblance of an answer)with some semblance of an answer)

PPA bulletin board has over 35 real life PPA bulletin board has over 35 real life ethical vignettesethical vignettes


Prepare a clinical case as if you are Prepare a clinical case as if you are seeking consultation from a peerseeking consultation from a peer

Document relevant clinical details and Document relevant clinical details and emotional dynamicsemotional dynamics

Highlight ethical issues or conflicts Highlight ethical issues or conflicts involvedinvolved


Outline your possible solutions and Outline your possible solutions and decision-making strategydecision-making strategy

Discuss what you did clinicallyDiscuss what you did clinically

Address the outcome of the intervention Address the outcome of the intervention and your emotional reactionsand your emotional reactions

Important HighlightsImportant Highlights

Increase awareness of ethical issuesIncrease awareness of ethical issues

Know the codeKnow the code Know the laws, regulationsKnow the laws, regulations Read Read The Pennsylvania PsychologistThe Pennsylvania Psychologist Commonwealth requires 3 credits in ethics Commonwealth requires 3 credits in ethics

per renewal period, so attend CE workshops per renewal period, so attend CE workshops on ethicson ethics


Acculturation processAcculturation process

Becoming part of the community of Becoming part of the community of psychologists – PPA, APA, Listservpsychologists – PPA, APA, Listserv

Awareness of ethical issues through ongoing Awareness of ethical issues through ongoing continuing educationcontinuing education

Develop a network of colleagues or join a Develop a network of colleagues or join a peer consultation network – Ethics Committeepeer consultation network – Ethics Committee


When teaching ethical errors

Teacher can use ethical decision-making as Teacher can use ethical decision-making as one means to highlight errorsone means to highlight errors

Vignettes can be helpful to highlight pertinent Vignettes can be helpful to highlight pertinent issues and can be emotionally safeissues and can be emotionally safe

Case consultation model can be used as a Case consultation model can be used as a means to role model ethical struggles and means to role model ethical struggles and acculturation processacculturation process

learning and teaching ethical mistakes

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