Ethical and Moral Foundations in Mental Health

John D. Gavazzi, PsyD ABPPPsychologist

Ethics Educator

TW Ponessa and AssociatesJuly 18, 2014

www.ethicalpsychology.com

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Course Objectives

At the end of the presentation, the participant will be able to:

1. List the five foundational principles

2. Apply two NBCC directives or ACA principles to clinical practice

3. Explain how one personal, moral value integrates with good clinical practice

Personal Moral Development

Principle-based ethics

Ethical Codes

Examples of Morality in Treatment

Vignette Analysis

General Outline

• Creating a safe environment

• Avoid the word “unethical”

• We are all learning in this process

• Demonstrate courtesy and respect for others

Participant Safety

Personal moral compass-Believe it to be right

Knowing the difference between right and wrong

Emotional responses to dilemmas and actions

Implicit/rapid/automatic/internal/affective

Research shows people judge themselves and others based on moral characteristics – evolutionary and social reasons to judge “character”

Morality

Rules of Conduct – Profession/society

More external – Community (of peers)

Easier means to judge others’ actions

Can constrain individual choices or create dilemmas

Explicit/cognitive/external/measured

Ethics

Don't get caught. (Prep is important)

Killing must serve a purpose. (Murder?)

Be sure. (Evidence must add up)

Blend in. (Hired as forensic spatter expert.)

Control urges, and channel them.

The Case of Dexter Morgan

1. Religion/Family of Origin

2. Education: College and CE

3. Personal Education: Reading and Experience

4. Honest self-reflection

Personal Moral Development

Care - Harm

Fairness – Cheating

Loyalty-Betrayal

Authority – Subversion

Sanctity (Purity) – Degradation

Liberty - Oppression

Moral Foundations - Haidt

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 your morals into your ethical practice?

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?

What is your moral code?

Is it acceptance of another person’s or institution’s code in full?

If yes, why?

If not, why?

What is your moral code?

Do you use it “after the fact”?

Fundamental Attribution Error

Actor-Observer Bias

Motivated Moral Reasoning

What is your Moral Code?

Moral Licensing (Karmic balance or Cognitive Distortion)

Emotional Reasoning (Disgust)

Moral Dumbfounding (Do I really know?)

Personal Identity Protection Bias

Concepts in Moral Reasoning

Acculturation Model of professional development

Integration Separation

Assimilation Marginalization

Higher on Professional Ethics

Higher on Personal Ethics

Lower on Personal Ethics

Lower on Professional Ethics

Marginalized

Matrix: Lower on professional ethicsLower on personal ethics

Risks: *Greatest risk of harm*Lack appreciation for ethics*Motivated by self-interest*Less concern for patients

Assimilation

Matrix: Higher on professional ethicsLower on personal ethics

Risks: Developing an overly legalistic stance

Rigidly conforming to certainrules while missing broader issues

Separation

Matrix: Lower on professional ethicsHigher on personal ethics

Risks: Compassion overrides goodprofessional judgment

Fail to recognize the unique role of treatment

Integrated

Matrix: Higher on professional ethicsHigher on personal ethics

Reward: Implement values in context of professional roles

Reaching for the ethical ceiling

Aspirational ethics

AutonomyBeneficence

NonmaleficenceFidelityJustice

Principle-Based Ethics

Does not mean promoting autonomy (individuation or separation)

Means respecting the autonomous decision making ability of the patient

Respect for 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

Autonomy

The principle of benefiting others and accepting the responsibility to do good underlies the profession.

- Providing the best treatment possible

- Competency

- Referring when needed

Beneficence

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

Nonmaleficence

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.)

Fidelity

Justice primarily refers to treating people fairly and equally.

Become aware of our biases/judgments to avoid negative countertransference and inequality.

Concepts of justice may included “social justice” and advocacy outside of our offices. Example include legislative and advocacy work.

Justice

NBCC Directives

Part of the Code of Ethics

Do no harm

Competence

Promote Welfare of others

Communicate Truthfully

Integrity of the profession, avoid damaging public trust

Collaboration & positive working relationships

ACA Code of Conduct

The Counseling Relationship

Avoid harm

Multiple relationships

Informed Consent

Managing Boundaries

Documentation

Cultural Sensitivity

Careful with imposing your values on others

Advocacy work

ACA Code of Conduct

Confidentiality and Privacy

Respecting rights and privacy

Couples/Family Treatment

Informed Consent

Client access to records

Document/Records

Case Consultation

Storage and Disposal of Records

Community Beneficence -Danger

ACA Code of Conduct

Professional Responsibility

Competence

Specialization/CE

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Media Presentations

Professional Impairment

No Sexual Harassment

Nondiscrimination

ACA Code of Conduct

Evaluation, Assessment & Interpretation

Client Welfare

Competence

Informed Consent

Diagnosis

Cultural Sensitivity

Prejudice/Pathology

Appropriate instruments

Forensic Issues

ACA Code of Conduct

Supervision, Training and Teaching

Client Welfare

Competence

Informed Consent

Multicultural Competence

Conflict of Interest

Boundary Issues

Sexual Issues

Teaching Ethics

Studies show that individuals who teach ethics and philosophy are not any more ethical or moral than others

The most ineffective way to teach ethics is learning ethical codes. Thoughts on this?

Quick note on teaching

Ethical VignettesFrom real life ethical dilemmas in the

mental health field

Older patient dies in car accident. The patient was not suicidal.

Adult child goes through papers and wants to find out what was discussed in treatment.

What should you do?

Recent vignette

Vignette Warehouse on Ethics and Psychology site

www.ethicalpsychology.com

Other Vignettes

Questions and Answers

Complete course evaluations