Psychology Ethics

Some thoughts on yesterday's class

I thoroughly enjoyed and appreciated last night's class. It was heartwarming to hear people speaking freely, with thoughtfulness. People shared their thoughts, listened, and learned from one another. And this is what a doctoral program should be like. It has been good to experience this as my last class.

As a fifth year student, I have seen a lot of changes over these years, with myself, the faculty, the students, and the program overall. we all know that the transition was hard, and recently I have heard from both Dr. Riley and Dr. Gardner that they appreciated the difficulty of the transition and the toll it took on some of us. Recnelty, it was explained in greater detail and although i appreciated the information in retrospect, all I ever really wanted as a student is a reasonable explanation of the whats and whys of any changes. This encourages thoughtfulness and always implies respect. I don't bode well with the "just do what i say" routine- even my parents didn't do that- i was always encouraged to ask questions. Although now i have a better understanding of why things were the way they are, again all i think anyone ever wanted (with the exception of one or two students who truly wanted things to stay exactly the same way) was a reasonable explanation and basic respect. This approach demands that the deliverer of the ordinance is prepared to defend his or her position. Perhaps the newness of the program made that approach difficult- I really don't know.

What is bittersweet is to hear the reaction of my fellow classmates who came in during the year of the transition. i remember feeling how a divide and conquer tactic was being used to pull these students in with rhetoric and feelings of specialness. I couldn't blame anyone, in their first year of a demanding program, to seek any form of shelter. But i grew concerned that they were like automatons, blindly following what they were told.

Over the years I have grown to appreciate the personalities and subtleties of all my classmates. What i saw last night was an element of thoughtfulness that unfortunately has not been encouraged during the lean formative years of this program's transition. Being able to actually "think" about something requires a certain level of independence- to be able to defend emerging perspectives and ideas with SUPPORT from the faculty- not with the unfair playing field of having to refute the opinions of a seasoned professional. This is as ridiculous as the high school drama teacher who gets on stage to perform a part because he/she does so much better. What is going on here, perhaps a failed acting career?????

So I could appreciate my classmates thoughts around not getting positive support in our fledgling ideas. I hope that changes as things relax a little bit around here and there is a settling in process. This is bound to happen. As Mary noted, it was positive just to have a place to talk, and refreshing to realize how we all share some similar feelings, but were able to bend and contribute, change our minds- this is how a professional is molded, not blind obedience (obedience is for a technician)- and we all know this intrinsically.

Two brief points- Kate- you made a very important contribution and brought up something that everyone was thinking about, but forgot somewhere along the line of pecking for position, and developing the skeptical frown lines of the average psychologist. Moran, you made a remarkable observation that psychologists play out nasty little turf wars to hide the embarrassing fact that we have no power after all- that was great! and it really emphasize why divisiveness (oh yes that old divide and conquer) truly does work to disseminate power. I will think of this the next time I draw a line too sharply in the sand.

Tuesday April 13, 2004

Website

The Pilavin and Pilavin study set out to further study a particularly important type of human behavior- that of how a sense of personal harm determines the extent to which someone helps another in need. The bleeding victim was considered to be more of a “risk” (although I am not sure why- whether this was due to a fear of a transmittable disease, or concern that the person could be significantly more harmed and the aid rendered would not be sufficient.

Although this is an important area of study, there are a number of problems with this type of research. For one, people can’t just be involved in research without an informed consent. It is not know if and how these people’s identities were revealed or concealed- were they videotaped? Also, was there any debriefing after the incident? If so, how did the coerced participants feel about not helping- or helping for that matter? How did they feel about being involved unwittingly in a research study? Also there were safety issues, such as being in a relatively uncontrolled environment such as a subway, in which some people tried to pull the emergency brake. Furthermore, we do not know the psychological history of these participants. What if someone is experiencing PTSD? Is it even more important to consider these in the wake of 911? Even one or two of these questions is enough to pull the plug on this research. I doubt it would pass a review board today.

I have read of studies where people’s behavior were studied when their own mortality was made “salient.” This series of studies was testing the “terror management” theory, based on existential issues originally developed by Ernest Becker. In these elegantly designed studies, people were not exposed to a fake “dead” person, or told they had a fatal illness! Instead, research participants (with full informed consent) were told they were taking a series of tests. Interspersed within the “dummy” tests were the real instruments that tested the theory (ie. One task was to write about their own death and then certain dependent variables were studied). Replicated results were found in multiple studies in which minor conditions were modified. The difference between this study and the Pilavin and Pilavin study was that the subjects were informed they would be subjects. They were tested in a controlled condition, and debriefing occurred. As I write this, I don’t see why the Pilavin study couldn’t be similarly tested in a lab, under controlled conditions, and with informed consent. Some of this could be measured in questionnaire forms, in which various scenarios could be proposed, followed by different actions. Although people may try to look good and results may not bear out in-vivo, there should be enough material gathered to answer their research question. Another possibility is to have a confederate scenario while in the lab, again under controlled conditions, with debriefing, confidentiality, and informed consent.


Study two- Depression study

In some ways this study did not test the hypothesis as well as it could. They wanted to know if medication was as good as psychotherapy. If so, why not just pick one type of therapy? I think it makes things more complicated, unnecessarily, to include more than one type of psychotherapy. Also, were the subjects given informed consent and was it explained to them that there was a treatment (imipramine) that was found to be effective for depression. If they were informed of this option and decided to go for non-medication treatment, then this might be ok, but I wonder if there would then be a skew with certain types of subjects choosing a certain type of medication


MMPII-2 Feedback

answers- 1) A 2) A 3) D 4)C 5)D

I found some initial first reactions to the two articles handed out. One is remembering how there was a time when test feedback was considered possibly harmful to the client. This harkens back to the earlier days of psychology, when the therapist had to adopt sagelike and unapproachable qualities. It is a welcome change that we are expected to provide feedback, but i wonder how often these old lessons come into play? Another reaction to the research paper was that up until this study (1992) there were no controlled studies demonstrating that clients benefit from test feedback. Finn and Tonsager set about to test this theory. they found subjects who received test feedback on MMPI II showed a more significant decrease in symptoms than the controls. Furthermore, clients in the feedback group reported positive reactions to recieiving feedback. this supports the currently held assumption that feedback is important and is consistent with the ethical standards on this issue.

In reading this i was reminded of my own reluctance to provide feedback, especially when it is negative results, and how i sometimes do give my feedback rather inelegantly. Why is this so? Well for one, I don't know if i can answer all the questions posed, because the client usually wants straight answers and i find myself retreating into jargon, especially during the provision of negative feedback. Given this, i should take the time prior to feedback to prepare my thouhgts as to how to present the feedback. I have to make sure i am appealing to the level of the client ( i.e.; a child, adult, one with learning disability). I should try to be focused on a few salient points instead of jumping all over the place. i think the greatest skill is delivering information in its simplest form, so i can only imaging that giving more focus to this task would be very helpful for me to improve upon.

I found this list on a website by Kenneth Pope (http://kspope.com/ethics/ethical.php)
and thought i would share with the class:


Rationalizing Unethical Behavior
However well-developed our individual professional ethics, there may be times when the temptation is just too great and we need to justify behaving unethically. The following rationalizations--adapted from those originally suggested by Pope and Vasquez--can make even hurtful and reprehensible behaviors seem ethical, or at least insignificant. All of us, at one time or another, probably have endorsed at least some of them. If some excuses seem absurd and humorous to us, it is likely that we have not yet had to resort to using those particular rationalizations. At some future moment of great stress or exceptional temptation, those absurdities may gain considerable plausibility if not a comforting certitude.


It's not unethical as long as the topic of ethics never comes up. If no one says anything about ethics, all can breathe a sigh of relief and concentrate on the important matters. As long as the only language of ethics is silence, no choices or acts can be identified as unethical.


It's not unethical if there's no ethics code, legislation, case law, or professional standard specifically prohibiting it that you didn't already know about. Two basic rules are at work here: specific ignorance and specific literalization. "Specific ignorance" means that if you don't know about, for example, a prohibition against making a custody recommendation without actually meeting with the people involved, then the prohibition doesn't really exist in a way that applies to you. As long as you weren't aware of certain ethical standards in advance, then you cannot be considered ethically accountable for your actions. The rule of "specific literalization" allows you declare any act that is not specifically mentioned in the formal standards to be ethical. Interestingly, this rule can be called into play even when the psychologist knows in advance about a specific prohibition, if the psychologist also invokes the rule known as "insufficient qualification." Consider, for example, a psychologist who knows that there is an ethical standard prohibiting sexual involvement with a therapy client. The psychologist can call attention to the fact that the sex occurred outside of the consulting room and that the standards made no mention of sex occurring outside the consulting room, or that the psychologist's theoretical orientation is cognitive-behavioral, psychoanalytic, or humanistic, and that the standards do not explicitly mention and therefore presumably are not relevant for his or her specific theoretical orientation.


It's not unethical if you know at least 3 other psychologists who have done the same thing. After all, if there were anything wrong with it, do you really think others would be doing it so openly that you would have heard about it?


It's not unethical if none of your students, research participants, supervisees, or therapy clients has ever complained about it. If one or more did complain about it, it is crucial to determine whether they constitute a large representative sample of those you encounter in your work, or are only a few atypical, statistically insignificant outliers.


It's not unethical if a student, research participant, supervisee, or therapy client wanted you to do it.


It's not unethical as long as the student's/research participant's/supervisee's/therapy client's condition made them so awful to be around that their behavior evoked (that is to say: caused) whatever it was you did, and they must own responsibility for it. Which is not, of course, an admission that you actually did something.


It's not unethical if you have a disorder or condition (psychological, medical, or just being tired and cranky), and that disorder or condition is willing to assume responsibility for your choices and behavior.


It's not unethical if you are pretty sure that legal, ethical, and professional standards were created by those who cause harm to countless thousands because of their closed-minded, simplistic approaches; or by those who are not involved in teaching, supervision, research, therapy, or other aspects of what psychologists do and so don't comprehend the hard realities that those doing the real work of psychology confront; or by those who do the real work of psychology and have as a consequence become so entrenched in their own ways of doing things that they want to require everyone else to live by their idiosyncratic rules.


It's not unethical if you've heard that the people involved in enforcing standards (e.g., licensing boards, administrative law judges) are dishonest, stupid, extremist, unlike you in some significant way, or--however well-meaning they may be--are conspiring against you.


It's not unethical if you're basically a good person and have upheld most of the other ethical standards. This "majority rule" gives you time off (from ethics) for good behavior. This means that all of us can safely ignore a few of the ethical standards as long as we scrupulously observe the other, far more important ones. In tight circumstances, we need observe only a majority of the standards. In a genuine crisis, we need only have observed one of the standards at some time in our lives. Or at least given it serious consideration.


It's not unethical if you don't mean to hurt anybody. If anyone happens to get hurt it was clearly an accident because you didn't intend it, and no one should be held responsible for something that is a chance, accidental happenstance.


It's not unethical if there is no set of peer-reviewed, adequately replicated, universally-accepted set of scientific research findings demonstrating, without qualification or doubt, that exactly what you did was the sole cause of harm to the student, supervisee, research participant, or therapy client. Few have articulated this principle with more compelling eloquence than a member of the Texas pesticide regulatory board charged with protecting Texas citizens against undue risks from pesticides. Discussing Chlordane, a chemical used to kill termites, he said, "Sure, it's going to kill a lot of people, but they may be dying of something else anyway."


It's not unethical if it's a one-time-only exception to your customary approach. Really. This is it. Never again. Don't even ask.


It's not unethical if you're an important figure in the field. Many psychologists have defined importance using such criteria as well-known, extensively published, popular with students, popular with granting agencies, holding some appointive or elective office, being rich, having a large practice, having what you think of as a "following" of like-minded people, etc. But many of us find such ill-considered criteria to be far to vulnerable to Type II error. In deciding whether we are an important figure in the field, who, after all, knows us better than ourselves?


It's not unethical if you're really pressed for time. In light of your unbelievable schedule and responsibilities, who after all could really expect you to attend to every little ethical detail?

April 01, 2004

IN GOD WE TRUST ALL ELSE BRING DATA

Dawes, RM Prediction and Diagnosis

One of my first reactions to this rather dense examination of the issues surrounding clinical judgment is how important it is to study research and consider the data wehn applying psychological principles. Although we've often been exposed to this, obviously in a university which would want to support a scientific approach, it seems the exposure was tinged with a perhaps unnecessarily high level of emotional arousal, so that it sometimes stopped students from thinking. For myself, and likely other students as well, i am much more amenable to accomodating new information when it is presented in a well-designed and dispassionate manner. Clearly, this chapter, in its very nonjudgmental way (in my opinion) did more for me to convince me of the importance of actuarial considerations than the last few years of having it shoved down my throat. I really want to thank Dr Combs for his article selection.

As i have been a therapist for a number of years, i can see how i could become rather smug in my ability to target specific clinical behaviors that would point me to make particular predictions. I do think clinicians develop highly attuned skills in observing human behavior, and each practiced clinician essentially develops his own 'database' of knowledge. It is true that clinicians might be more likely to see one type of presentation, and will tend to generalize (e.g. the whole if i am a hammer everything looks like a nail). it is much more efficient for the CNS to assimilate information into preexisting 'sets' than it is to accomodate information, thereby developing a distinct mind set.

When taken from an ethical perspective, it goes back to "knowing thyself" and "knowing thy research" and finding a way to incorporate the two. If we acknowledge that we have a likely bias, then we can utilize objective material to help maintain better control of our bias. Likewise, in the face of data (and lots of it, according to this article) we may be able to make room in our brains for more discriminating mind sets when examining a patient. Or better yet, keep the DSM in your back pocket for a little external hard drive.

I examined the clinical efficacy of Paxil using a PDR 2000. The studies involved three different dosages, 20, 40 and 60 and with populations of ocd, depression and anxiety


Depression

Efficacy established in six placebo-controlled studies

Shown to be significantly more effective than placebo on at least two measures:

Hamilton Depression Rating Scale
Hamilton Depressed mood item
Clinical global impression- also showed an improvement with sleep disturbance factor and anxiety factor

Taken over a one year period of either paxil or placebo, those on paxil showed a lower relapse rate (15%0 than compared with placebo- this was true for both males and females

OCD

Efficacy demonstrated in two 12 week studies with placebos. There was a variation in the dosage level, 20 mg 40 mg and 60 mg

Placebo 20 mg worse- 14% No change 44% minimal improvement 24% much improved 11% very much improved 7%

Vs. for exampled 40 mg Paxil the following results were obtained:

Worse 7% no change 22% minimally improved 29% much improved 22% very much improved 20%


Although at the ends of the spectrum (i.e. no change or worse vs. very much improved) show a sizable difference between the two conditions, it is noteworthy that in the middle area of mammal improvement there was only a 5% difference.



What interested me the most was that the efficacy of this medication was only based on what seemed to me to be a minimal amount of research- usually only three were cited, and the effect size wasn't all that big in some situations. i thought about psychology's adoption of efficacy studies and thought that three RCT studies wasn't all that much, expecting medicine to be more. then i thought about how medicine treats people with all sorts of different co-morbidities as well, yet i am sure in lab studies, most comorbidities were considered exclusion factors. given this, i think of all the overmedicated people, especially senior citizens, out there who might be having all sorts of interactions, therefore reducing the generalizabilty of these studies.

March 09,2004

Moon, BLakey, Gorsuch, and Fantuzzo article

answers- 1 B 2 D 3 A 4 A 5 C

i can't say i was all that surprised by the findings in the study that examined accuracy of WAIS administration. What i was glad about was that it seems as LaSalle students we are relatively well-prepared compared to some other individuals. I think overall we have received good training on test administration and interpretation. It makes me wonder, however, that after school has ended and i want to try a new test, should i be under an ethical obligation to take a course in this test? I suppose it depends on the test. For example, if i don't get a chance to do any Rorschachs at my internship, and find i need to do a rorscahc, i would defintiely obtain additional training at an Exner workshop. On the other hand, there may be a computereized cognitive test that i will not need much training on and therefore should be able to read throug the manual.

Over and over again, as i move further into this class and the educational material, i am again struck with how much responsibility i will hold in the future, and how respectful i need to be of that privilege. It has made a difference in the way i view my job and also in the way i see myself in relation to others. As an example, when i was out in california last month for a seminar, i met a very nice person who had attended the neurofeedback seminar because he had started a business where he would manage a neurofeedback office, and planned on hiring trained professionals. it turned out that he was a survivor of a traumatic brain injury and had undergone neurofeedback therapy with outstanding results. as we got to talk more, he revealed a very disturbing relationship with a former therapist (a licensed professional counselor) who had made some very serious ethical violations, including
6.01 documentation of profesional and scientific work and maintenance of records
6.04 fees and financial arragmeents
6.06 accuracy in reports to payors and funding sources
3.05 multiple relationahips
3.08 exploitative relationships
3.02 sexual harrassment

and the most important principle A of Beneficience and nonmalficence. I was very glad that i had started in this class, and had watched how denise had worked thorough her difficulty with the therapist who was shaving sex with her client. i felt like i could take a knowledgeable leadership role. i am currently invovled in making a report to the state of colorade on these significant charges.

i know that we are told that the transition between being in the classroom and being in the internship will move us into the role of a professional, but it seems to be happening to me in this class. it seems i am able to take a position and ethical standpoint and yet am not moving into some sort of finger-pointing judgmental stance. this is what i was afraid this class would be like- very rigid. but it is not. instead it requires a sensitive reasoning process that carries with it a significant amount of responsibility. It seems that we are being well trained to wear this mantle.

my intial reaction on chapter five was recognizing how psychology has moved into a specialty area. there are many different aresas of focus and concommitant expertise, such as research, neuropsycholgy, and knoweldge of special groups, such as vision and hearing impaired or specific multicultural groups. in some ways, i find this a relief becasue i think so many helpers are always trying to go overboard in helping others (one of the reasons many of us get into this field i'm sure) and it feels good to set limits by acknowdedging that you only have limited experience and feel the need to refer to someonoe else. to me that provides me with some modicum of relief, so that i am not expected to be omnipotent. for me, i look forward to developinng a specialty in cognitive assessment and neuropsychology, and it helps provide me with a direction and a commitment to an area of interest. I do not have much experience with children, so it helps me recognize an area where i need to get more training ( i think psychologists neec to be generalists first, and therefore i should have some basic competentce in working with the entire age range) but it also makes me feel more comfortable in referring someone out, which is actually what i did today at my counseling practice. in the past i thought iw as just expected to know 'everything' and i appreciate a recognition of limitations in this field.

022304

answers to pope spiegael and tabachnick:
1)d 2)b 3)d 4)a 5)b 6)b 7)a 8)b 9)a 10)c

Some thoughts on this article- Wow we are really getting into some interesting stuff. I must say i am very grateful for this class as it is covering so many important areas for us as students. I would say the most important piece i took from the article is the importance of education while a student is in graduate school. i would offer that the curriculum should incorporate this education in the human sexuality course, or at least in the ethics course. Being able to explore the issue of therapist's sexuality and feelings towards the client would be an important part of an overall education. Also, considering the disturbing statistics on professors/supervisors and female students and their increased likelihood for later sexual contact with their own clients (which in my understanding is higher than actual sexual contact with therapists and their clients), some intervention at the graduate level would be helpful in helping these students find their voice and stop this pattern of behavior.

Kudos to the psychoanalytic world for at least addressing this issue. Depsite the mudslinging that often occurs in these parts about their relative "uselessness" as a therapeutic approach, at least their theoretical orientation attempts to address this very real problem. I wonder how it has been dealt with in other more modern theoretical approaches, or have the acknowledgement of sexual drive and libido been thrown out with other "dinosaurs" such as the therapeutic relationship and process issues? I'd be interested in knowing.

It was reassuring to hear that therapists are able to recognize that they can have these feelings but would not act on them due to ethical concerns. Also there were a large number that sought out supervision for these concerns. I think that clients might be more aware of it than they would like to believe. I wonder how often these sorts of things are addressed in the context of therapy. ok more later i have a client