Dark side of ethics podcast: False Risk management strategies

False Risk Management Strategies

Slide presentation for Podcast 8 that can be found here

The Dark Side of Ethics

By Sam Knapp, EdD ABPP and John Gavazzi, PsyD, ABPP

At the end of the workshop the participants will be able to:

1. Explain the concept of a false risk management strategy,

2. Identify two false risk management strategies,

3. Outline how a false risk management strategy hinders high quality psychological care.

Podcast Objectives

Having an ethics code or attending lectures on ethics codes are among the least effective ways to ensure ethical behavior.

Counterintuitive Fact

People should not act on principle(standing on principle can be an unprincipled stand)

Counterintuitive statement

Altruism and empathy can be unethical.

Counterintuitive statement

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.

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.

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

Ethical Acculturation

Identification with personal value system(higher vs. lower)

Identification with value system of psychology

(higher vs. lower)

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

MarginalizedMatrix: Lower on professional ethics

Lower on personal ethics

Risks: Greatest risk of harm/potentially exploitative

Lack appreciation for ethicsMotivated by self-interestLess concern for patients

AssimilationMatrix: Higher on professional ethics

Lower on personal ethics

Risks: Adopted professional standardsMay develop an overly legalistic stanceRigidly conforming to certain rules while

missing broader issuesThere may be a misinterpretation of the

rulesMay lack compassion

SeparationMatrix: Lower on professional ethics

Higher on personal ethics

Risks: Compassion overrides good professional judgment

Fail to recognize the unique role of psychologists

Motivated moral reasoning

IntegratedMatrix: Higher on professional ethics

Higher on personal ethics

Reward: Implement values in context of professional roles

Reaching for the ethical ceiling/aspirationalHighly effective psychologistEthics outside the office (advocacy, public education)

Assimilated Strategies

False Risk Management

A False Risk Management Strategy is an action or intervention on the part of psychologist that is meant to reduce liability or harm, but does not. Ironically, some of these actions or interventions likely hinder the psychologist’s ability to provide high quality of care.

What is a False Risk Management Strategy?

Memes are ways that information is passed through a culture.

Memes are to genes as social information is to genetic information.

False Ethical Memes

Listeners may want to self-reflect on how they learn information on ethics and clinical practice.

Unsure how exactly some of these memes are spread.

Self-reflection

• Informed consent only occurs at the beginning of treatment

• Informed consent mainly involves the patient to sign forms for risk management purposes

Informed Consent

• Self-disclosure is never appropriate by the psychologist during psychotherapy or assessment

• Self-disclosure is clearly a boundary violation that is always wrong

Self-disclosure

• Psychologists cannot talk with patients about medication.

• Technically, it is practicing medicine without a license.

Psychotropic medication

• 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.

Suicidal & Homicidal Patients

• This is an important risk management strategy

• This is the standard of care

• This strategy helps the patient from actually harming him or herself.

No suicide contract

• 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

Always give 3 names when referring a person for treatment

If you know any questions, please contact John at johngavazzi@aol.com

• Follow me on Twitter @johngavazzi

• Follow me on Tumblr at psychbuilder.tumblr.com