Positive Ethics: Enhancing Awareness & Making Excellent Choices Colorado Psychological Association April 29, 2016 Mitch Handelsman, Ph.D University of Colorado Denver mitchell.handelsman@ucdenver.edu I II Opening Exercise: The Culture of Mental Health: In your time in psychology, what is the most counterintuitive, shocking, or surprising professional activity or issue that you have encountered so far? What didn’t you expect about being or becoming a psychologist? What feelings have you experienced, positively and negatively, about your profession or discipline? Ethics Acculturation A Definition of ACCULTURATION: Berry’s definition of psychological acculturation: “A set of internal psychological outcomes including a clear sense of personal and cultural identity, good mental health, and the achievement of personal satisfaction in the new cultural context” (Berry & Sam, 1997, p 299, emphases added) B ETHICS ACCULTURATION: A set of internal psychological outcomes including a clear sense of personal and ethical identity, good mental health, and the achievement of personal satisfaction in the new ethical context C Two variables Maintenance – of culture of origin Contact & Participation – with new culture D Four strategies Strategies of Ethics Acculturation Low Integration Separation Assimilation Marginalization High High Low Maintenance: Personal “Ethics of Origin” Contact & Participation: Professional Ethics Strategies of Ethics Acculturation Integration a b c d e Look for overlapping values Changing expressions of values Modifying existing values Creating new values Re-order priority of values Assimilation a Sometimes hard to differentiate from integration by an observer b Following rules, but at risk of alienation Separation a Varieties i Inadequately trained, uninformed about differences in cultures: “socialization failures” ii Openly hostile to constraints iii Those from other professional cultures b How to think of “stupid” rules: i Are they implementations of higher values that you and the culture have in common? ii They might be opportunities to articulate your own values, and the values of the profession—to facilitate integration iii They might be key to future fulfillment! Opportunity to positive ethics Marginalization a Sometimes temporary b Personal convenience c Disturbed or impaired professionals II Exercise A Which strategy will you lean toward in a crisis? What’s your second-choice behind integration? III Acculturation Stresses A Culture-of-origin factors, training, social support, lack of role models B Cultural Distance – difference between the two cultures C Cultural Shedding – unlearning of previous culture D Situational pressures (e.g., financial issues, external pressures, “difficult” patients, personal needs) III Attributional Issues A Fundamental attribution error B Attributing success to self IV Nonrational Factors (from Rogerson et al., 2011) A Intuition and Reasoning Minimizing anticipated regret How choices are presented (80% vs 20%) People feel loss more than gain Increase risk taking in face of perceived loss B Heuristics and Biases More accessible characteristics or questions substituted for more effortful ones Availability heuristic (judging frequency) Representativeness heuristic (matching prototype) Anchoring (frames) Confirmation bias Self-serving bias Bias Blind Spot C Affect and Conflict V Affect heuristic – automatic evaluations Avoidance of ambivalence – or deciding Overconfidence Implementing the Ethics Acculturation Model A “Helpful Prompts” (adapted from Knapp, Gottlieb, & Handelsman, 2015, pp 83-84) What would I if the person were not my patient, but my sister-in-law, a stranger off the street, a car salesperson, my hair stylist, and so on? What values [the term values in these questions can include virtues, principles, and other guides] am I operating from when I speculate on the judgments in my personal life? What would I want to if there would be no personal or professional repercussions (e.g., if nobody ever found out what I did)? What would I according to the strictest interpretation of my professional ethics code and other guides, such as my agency policies, state and provincial laws, and so on? What would I if there were no laws that restricted my options? What are my motivations—those that I would share with others and those that I have but wouldn’t want to admit to others? What would I want to have my friends or colleagues say about me regarding this issue? What values of my profession overlap with which values I hold from my family, my religion, my previous professions, and other aspects of my personal life? If there is an apparent conflict between my personal impulses and my professional obligations, In general, am I more likely to act in accordance with my personal values or professional values? 10 In this situation, am I being pulled in the direction of the personal (separation) or professional (assimilation)? 11 Why may I be experiencing this conflict? 12 Is there a value of mine that I haven’t thought of that would justify my actions from both a personal and professional point of view? 13 Is there a personal value I hold (e.g., respect) that I could value more than the one I’m using (e.g., loyalty to friends)? 14 Can I incorporate the professional value I’m struggling with (e.g., informed consent, informing patients about risks) into an existing personal value or virtue (e.g., compassion)? 15 Can I change the implementation of my personal values to make my actions more compatible with my professional obligations? VI Useful Questions for Discussion, Deliberation of Cases, Policies, Etc A What would you “pre-therapist”? That is, what would you as a friend, or relative? Why? B What are your values as a human being? What are your gut-level motivations? (Good and bad) C What does your professional culture say? What values is the culture operating under? (Good and bad) D Acculturation stresses? E What are your potential strategies? Pure separation Pure assimilation Integration, including a) New implementation of your existing values b) Modifying existing values c) New values d) Reorganization of your hierarchy of values e) Actualization of virtues (e.g., prudence, humility, respectfulness) F What factors may be influencing your decision making? Situational factors Attributional pitfalls Nonrational factors References and Useful Readings American Psychological Association (2010) Ethical principles of psychologists and code of conduct (including 2010 amendments) Washington, DC: Author Retrieved from http://www.apa.org/ethics/code/index.aspx Anderson, S K., & Handelsman, M M (2010) Ethics for psychotherapists and counselors: A proactive approach Malden, MA: Wiley-Blackwell Bashe, A., Anderson, S K., Handelsman, M M., & Klevansky, R (2007) An acculturation model for ethics training: The ethics autobiography and beyond Professional Psychology: Research and Practice, 38, 60-67 Bazerman, M H., & Tenbrunsel, A E (2011) Blind spots Princeton, NJ: Princeton University Press Beauchamp, T., & Childress, J (2001) Principles of biomedical ethics (5th ed.) New York: Oxford University Press Berry, J W., & Sam, D L (1997) Acculturation and adaptation In J W Berry, M H Segall, & C Kagitỗibasi (Eds.) Handbook of Cross-Cultural Psychology (pp 291-326) Needham Heights, MA: Allyn and Bacon Betan, E J., & Stanton, A L (1999) Fostering ethical willingness: Integrating emotional and contextual awareness with rational analysis Professional Psychology: Research and Practice, 30, 295-301 Deutsch, C J (1984) Self-reported sources of stress among psychotherapists Professional Psychology: Research and Practice, 15, 835-845 Epstein, R S., & Simon, R I (1990) The Exploitation Index: an early warning indicator of boundary violations in psychotherapy Bulletin of the Menninger Clinic, 54, 450-465 [The entire exploitation index is reprinted at http://www.oregon.gov/OBCE/publications/EMEBC_appendix_F.pdf] Gottlieb, M C., Handelsman, M M., & Knapp, S (2008) Some principles for ethics education: Implementing the acculturation model Training and Education in Professional Psychology, 2, 123-128 Gottlieb, M C., Handelsman, M M., & Knapp, S (2013) A model for integrated ethics consultation Professional Psychology: Research and Practice, 44, 307-313 Guthiel, T., & Gabbard, G (1993) The concept of boundaries in clinical practice: Theoretical and risk management dimensions American Journal of Psychiatry, 150, 188-196 Handelsman, M M (2001) Learning to become ethical In S Walfish & A K Hess (Eds.), Succeeding in graduate school: The career guide for psychology students (pp 189-202) Mahwah, NJ: Lawrence Erlbaum Handelsman, M M., Gottlieb, M C., & Knapp, S (2005) Training ethical psychologists: An acculturation model Professional Psychology: Research and Practice, 36, 59-65 Handelsman, M M., Knapp, S., & Gottlieb, M C (2009) Positive ethics: Themes and variations In C R Snyder & S J Lopez (Eds.) Oxford Handbook of positive psychology (2nd ed., pp 105-113) New York: Oxford University Press Kahneman, D (2011) Thinking, fast and slow New York: Farrar, Straus and Giroux Kitchener, K.S (1984) Intuition, critical evaluation and ethical principles: The foundation for ethical decisions in counseling psychology The Counseling Psychologist, 12, 43-55 Knapp, S J., Gottlieb, M C., & Handelsman, M M (2015) Ethical dilemmas in psychotherapy: Positive approaches to decision making Washington, DC: American Psychological Association Knapp, S., Handelsman, M M., Gottlieb, M C., & VandeCreek, L D (2013) The dark side of professional ethics Professional Psychology: Research and Practice, 44, 371-377 Knapp, S., VandeCreek, L D., Handelsman, M M., & Gottlieb, M C (2013) Professional behaviors and decisions on the ethical rim Professional Psychology: Research and Practice, 44, 378-383 Knapp, S J., & VandeCreek, L D (2012) Practical ethics for psychologists: A positive approach (2nd ed.) Washington, DC: American Psychological Association Meara, N M., Schmidt, L D., & Day, J D (1996) Principles and virtues: A foundation for ethical decisions, policies, and character The Counseling Psychologist, 24, 4-77 Rogerson, M D., Gottlieb, M C., Handelsman, M M., Knapp, S., & Younggren, J (2011) Nonrational processes in ethical decision making American Psychologist, 66, 614-623 Thomas, J T (2005) Licensing board complaints: Minimizing the impact on the psychologist’s defense and clinical practice Professional Psychology: Research and Practice, 36, 426-433 Tjeltveit, A C To what ends? Psychotherapy goals and outcomes, the good life, and the principle of beneficence Psychotherapy: Theory, Research, Practice, Training, 43, 186-200 ... Knapp, S J., & VandeCreek, L D (2012) Practical ethics for psychologists: A positive approach (2nd ed.) Washington, DC: American Psychological Association Meara, N M., Schmidt, L D., & Day, J D... Knapp, S J., Gottlieb, M C., & Handelsman, M M (2015) Ethical dilemmas in psychotherapy: Positive approaches to decision making Washington, DC: American Psychological Association Knapp, S., Handelsman,... 36, 59-65 Handelsman, M M., Knapp, S., & Gottlieb, M C (2009) Positive ethics: Themes and variations In C R Snyder & S J Lopez (Eds.) Oxford Handbook of positive psychology (2nd ed., pp 105-113)