When good psychologists go bad

PowerPoint Presentation

When Good Psychologists Go Bad:Ethics and IssuesDecember 9, 2016Georgia Psychological AssociationMary Gresham, Ph.D.Atlanta Financial Psychology

ethicsMary Gresham, Ph.D.Atlanta Financial Psychology

Turn to freely associate, whatever comes in your mind to the word ethics. Notice what comes up for you. Then turn to the person next to you and describe your associations to the word ethics.

Mary Gresham, Ph.D.Atlanta Financial PsychologyTake a moment to reflect on a situation in your work as a psychologist about which you felt uneasy or unsure and are willing to share with others.Write it down.

Uncertainty

It may or may not be related to an ethical issue you have faced.

Ethics programs can be intimidating..Mary Gresham, Ph.D.Atlanta Financial Psychology

My primary goal today is for you to leave with a positive experienceas I have asked colleagues what they felt in past ethics workshops they have said it increased their anxiety and fear and/or was not relevant or boring. Today I am not going to use hypothetical cases or dramatic and unusual cases and hopefully you will leave this program with lowered anxiety and increased positive affect.

Mary Gresham, Ph.D.Atlanta Financial Psychology2.03 Maintaining CompetencePsychologists undertake ongoing efforts to develop and maintain their competence.APA Code

In general, we meet this by attending workshops, reading and studying and talking issues through with colleagues. The profession helps us with this by requiring that we attend approved workshops and trainings. You are now meeting this code. In general research shows that the longer we are out of training, the more difficult it is to keep up with the changes in the field, especially to keep up with the research in the field of psychology. The digital age in which we live creates an overload of information and figuring out what to pay attention to is difficult. The factor that seems most highly correlated with receiving a complaint is professional isolation and not belonging to or participating in professional groups. The next slide will guarantee that you will feel better.

Mary Gresham, Ph.D.Atlanta Financial Psychology

ASPPB

In 2015, data collected from 64 boards..in the us and Canada showed that the primary violation that led to a board order was the failure to keep up with the CE requirements and be able to document. In Georgia you are required to keep your documentation for 4 years. So right now you are avoiding the primary complaint made about licensed psychologists.

Mary Gresham, Ph.D.Atlanta Financial PsychologyASPPBProposed competency assessmentDevelopment of EPPP2Timeline: Jan 2019?5 areas to measure based on Survey of practicing psychologists

As a note, the survey showed that the highest area deemed as critical by practicing psychologists was ethics.

Mary Gresham, Ph.D.Atlanta Financial PsychologyASPPBCredentials BankPLUS Online ApplicationsE PassportInterjurisdictional Practice IPCCPQ

Credentials bank is where you can store your licensing information; PLUS allows online applications for licensure to 14 states; E. Passport for telepsychology is not yet active, need 7 states to sign on to become active; the IPC will allow psychologists to work for 30 work days in one of these 7 states, includes Georgia; CPQ for psychologists who have been licensed 5 years with no disc actions to apply to participating states for licensure, 34 states and Canada


Where does your question belong?

The first step in answering the question you had about your work is to ask yourself where the question belongs. It is highly likely that your question may belong in more than one category as those are the kinds of questions that cause us the most difficulty.


Is this a legal issue?

It is easy to try to define our ethics by what is legal. When the law and ethics collide we are allowed to clarify the nature of the conflict and attempt to resolve it. The majority of questions that come to ethics committees have to do with clarifying the law and our ethics. Often psychologists are confused about the difference between a subpoena and a court order and the role of a fact witness vs an expert witness and what to do when asked to participate I legal proceedings involving a client.


Is this a risk management issue?

Risk management refers to the principles of practice that can help us avoid a lawsuit or defend us if we are the subject of a complaint.. The primary teachers of risk management are sponsored by professional malpractice insurers and reflect the best practices that will protect us in a lawsuit. The primary topics that fall under this category are ongoing informed consent,proper documentation and record keeping concerns and consultation.


Is this a clinical issue?

Many of us are engaged in providing services in health care..that is now the majority of the membership of APA..by and large we tend to be in independent practice. Understanding when an issue may have negative consequence clinically but might fit a risk management strategy is sometimes needed. Many therapists will feel a need to write a letter of termination when a client drops out and quits therapy. However, this is not generally necessary and can be clinically contraindicated. Many also believe that they need to avoid all boundary crossings when working with a client. However, it may be very appropriate and clinically positive to cross a boundaryexploitive and inappropriate boundary crossings differ from attending a public event where you know a client will be present and can talk about it.


Is this a business issue?

Should you be self-employed? Should you accept insurance? Which types of clients and services are the most profitable in your work? How will you prepare for a cash flow reduction? Should you add a new service? How do you market and advertise your services? How will you set your fee and what is the market rate for your services?


Is this a technology issue?

There are many issues now related to the increase the use of technology in our practices. Whether and how we encrypt email, the use of payment processing systems, our cell phones, the use of technology and social media has changed the world of professional practice. Staying up to date and upgrading software and systems is essential. Using apps in practice is becoming more and more prevalent but many of us lack knowledge of the best evidence based apps. Understanding technology also means being proficient enough in computer issues to avoid accidentally sending social media invitations to our clients with whom we have emailed about appointment times. Backing up or storing information on the cloud so that it is retrievable is also important.

Mary Gresham, Ph.D.Atlanta Financial PsychologyDoing good, doing no harmTrust, ResponsibilityIntegrity, honestyFairness, JusticeRespect, dignity of othersIs this an ethical issue?

Ethics call on us to be our best selves in our work. It is inevitable that we will make mistakes and will have times when we are not able to hold our ethical high ground.

Mary Gresham, Ph.D.Atlanta Financial PsychologyEncourages meeting the minimum standardsThe problem with code based ethics

What is the problem with using codes of behavior? Research done on environmental standards and sanctions showed that when a group who had no knowledge of the standards and sanctions was given choices about what standard to impose, they chose a higher standard than the minimum. They also chose higher sanctions for breaking the standard. When another group was told the legal standard and legal sanction, they chose the lowest level that met the standard and imposed the minimum standard. When we have codes, we orient to the code instead of using our own standards of behavior. 16

Mary Gresham, Ph.D.Atlanta Financial PsychologyEncourages meeting the minimum standardsNarrows attention to the rulesThe problem with code based ethics

Our attention is narrowed to the rules.17

Mary Gresham, Ph.D.Atlanta Financial PsychologyEncourages meeting the minimum standardsNarrows attention to the rulesDoesnt help with the gray areas or conflicting priorities where most ethical dilemmas occurThe problem with code based ethics

Often the rules dont really help us because our biggest ethical dilemmas occur in gray areas where the rules may be in conflict with each other or unclear. I would like to refer you to a reference for an ethical reasoning process that can be more helpful than a code. Ethics education in many professions is now using ethical processes and practice with working through ethical dilemmas using the reasoning process instead of relying on a code. The Center for Applied Ethics at Santa Clara University in California has developed a 5 step process to apply to ethical issues as well as a framework to help us think ethically and understand the basic principles of ethics. You have a copy of this ethical reasoning process in your handout. Take a minute to review it. It also describes differing types of ethical systems.18

Mary Gresham, Ph.D.Atlanta Financial PsychologyFive step process in your handoutIncludes identifying the ethical issues, research, taking time to consider, consultation with colleagues, identifying each stakeholder, generating alternatives, looking at the consequences, making a decision and minimizing harm.

Steps in Ethical Reasoning

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Mary Gresham, Ph.D.Atlanta Financial PsychologyCommon cognitive and decisional strategies that we use and can lead to ethical problems.Behavioral ethics

Behavioral ethics has come out of the work on decision making that originally formed the field of behavioral finance. Behavioral ethics tries to help us see how our common methods of processing can lead us into trouble. The work is based on understanding that we have 2 systems for processing..the fast intuitive emotional system known as System 1 and the slower more laborious and reflective system that causes our brain to work harder known as System 2.


Take out a piece of paper and about 6 inches from each other, place a dot on the left and a cross on the right. When you are ready, cover your left eye and with your right eye, look at the dot. Move the paper towards or away from you until you find the place where the cross disappears. This is your blind spot. We all have a blind spot. This is the place where we truly cannot see. In our world of ethics we have numerous blind spots. 2 recent studies had trained actors call therapists, asking for appointments. name. In one study the she left a message from Allison and in the other she left the name of Lakisha. Callback rates were similar, Allison was significantly more likely to be offered an appointment or a longer conversation and Lakisha was more likely to be told that the therapist had a full case load. In general we are more comfortable relating to others when we perceive that they are like us. You may want to go to the Implicit Association Test website and take one of the tests that looks at our response times to paired associations based on personal variables. There of course is some controversy about what the IAT is measuring but it is fun to take anyway. I felt pretty sure that I would show a preference for older adults, but ended up with no preference. You can take this fun test based on fo variables and I recommend that you consider doing it.

Atlanta Financial PsychologyAtlanta Financial PsychologyMary Gresham, Ph.D.

Take a moment to write down a number between 1 and 10 that reflects how ethical you believe yourself to be. The majority of you will rate yourselves as well above average. A Survey done by Seven Walfish et al in 2012 showed that 25% of therapists in practice rated themselves to perform at the 90% level in terms of clinical competence. In addition to our tendency to evaluate our competence levels in our chosen field, we can erroneously rate our ability to provide other services. If you decide to cross over into offering other services it is essential that you also receive supervision before you provide that service.One of the primary areas of difficulty for psychologists that leads to ethical and professional problems is to take on a role either in forensic work or industrial organizational consulting without having had the proper training and supervision.and feeling overconfident of our abilities to do that. In general we tend to over rate our own contributions to an endeavor; when team members quantify their own contributions, they tend to add up to about140% of the task. Overconfidence in ourselves is one common cognitive mistake that can lead to an ethical misstep and Dr. Daniel Kahneman after his many years of research in this area rates overconfidence as the primary cognitive mistake most made. In addition when we see other making ethical missteps we tend to attribute it to heir character failings but when we make one, we describe the context as being the primary consideration. 22


How is it framed?

How we frame an issue is essential in how we respond to something. Again, refer back to the frames we have discussedwhen we frame something as purely a legal issue or purely a business issue or purely a risk management issue. we are more likely to ignore the ethical implications of an action. It is really easy to frame things in our field as legal issues.


University of Oregon psychologist

Dr Shelly Kerr is very good psychologist who framed an issue about client records as legal and technological.. found to have committed an ethical violation when she sent a clients therapy records to the University of Oregons general counsel . She heard the request and relied on the universitys attorney to state that she was required to do so. By framing it as legal and technology issue, she neglected the ethical issue involved. The counseling center client had just completed a failed mediation with the university over rape allegations involving members of the basketball team. The client had not signed a release and had also received a complete copy of her own records and so the tech backup and legal reasoning used by the universitys counsel was confused and incorrect. By not clarifying that what the university attorney wanted her to do w in conflict ethical records release she was found to be in violation of our ethics code

The series of experiments in social psychology that have been done in the lab are called money priming experiments and Subtle hints of money are introduced, for example using a screensaver with dollars floating vs a screensaver with fish floating. People are largely unaware of the impact of money hints on their behavior. Researcher Kathleen Vohs found that people respond to money primes by preferring to work alone, not asking for help, offering less help to others, working harder at impossible tasks, feeling less physical discomfort and feeling less social discomfort when excluded. The conclusion from numerous studies is that without realizing it, money increases a feeling of self-sufficiency and reduces engagement with others. There are many other studies that show that we are often influenced by factors beyond our awareness. Thus, when we are motivated by financial interests we are more likely to make a private or independent decision and not consider the effect on others. In Minnesota, the psychology board suspended the licenses of several psychologists were found to be in non payment of either their state taxes or child support. Conflicts with other entities about finances can spill over into your professional life even though in your mind those things may not be related and see them as very separate. Fee issues with clients are also a source of difficulty because they can be framed as business, ethical and clinical issues and are difficult to talk about.25


Self-interest

Research done by Dan Ariely shows that the majority of us are likely to cheat a little bit on tests when we know we wont be caught..we cheat just enough to meet our self interest but not enough to make us feel bad about it or to get caught. These studies have been replicated many times. However, when we start to move to self-interest in small steps and then keep adding to it, we can end up beyond what is perceived as fair by others. One example of this is doctors charging a surcharge to clients who pay via credit card. In 10 states this is illegal but we can fail to take this into account. Surcharges cannot be applied to debit cards or HSA cards and must be approved by Mastercard and Visa. In addition if you take American Express, you cannot do this. However, this is a behavior that is easy to rationalize and one in which it is difficult to be caught. Other types of self interest are asking for client testimonials and reviews.

Mary Gresham, Ph.D.Atlanta Financial Psychology Self interest or Confusion?Use of PhD (C) title

Employees vs Contractors

Use of online quiz on your website

Trainess are often unaware that the consumer has no idea what the PhD candidate title means and that it is important to let consumers know if you or are not fully licensed. Employers often mix up the rules about employees and contractors in their hiring. Consumers also have no idea that a survey or quiz that is designed for a website is not the same as a reliable or valid instrument used in assessment. If you do make one up, it is supposed to be clearly labelled as a survey designed for educational and entertainment purposes.


Loss Aversion

We feel financial losses at about twice the intensity that we experience financial gains. This makes it hard for us to write off our losses when we have a setback. Unwittingly, we can decide to use a collection process against bad debts instead of realizing that the wiser course of action is to learn from the experience and take it as tuition in the school of business. When a New Jersey lawyer named Philip received legal papers last year informing him that his former psychologists practice was suing him over an unpaid bill, he was initially upset they could not work out a payment arrangement outside of court.It was only later, Philip said in an interview, that he scanned the papers again and realized something else: that the psychologist to whom he had confided his innermost feelings had included hismental healthdiagnosis and treatments he received in publicly filed court documents. Philip is now countersuing Dr. Helfmann and his partners, the psychology group and the practices debt collection lawyers for invasion of privacy, breach of the psychologist-patient privilege, fraud and misrepresentation, and other claims. He is seeking the courts permission to represent other patients as part of a class action. Dr Helfmann is the past president of the NJPA, a director of professional affairs there and the psychologist of the year.


Reciprocity effect

The reciprocity effect is strong social instinct in which we feel more obligation towards someone who gives us extra time, extra services, or small tokens. Without realizing it, we can create a social debt if we give a client a free first session or consistently break our own time boundaries for our services. Because many psychologists think of themselves as altruistic and generous, we are unaware of the obligations we can unwittingly create. Using a free first session as an incentive to call a certain psychologist is very different than not charging for a first session because the client is a poor fit for your services or approach.. A psychologist in Colorado offers free first sessions for every therapist in her practice. She also offers the opportunity to purchase a gift certificate for a loved one who may need therapy sending an email to the prospective client with a gift note from you and offering a refund if your gift is not accepted. Consider the pressure that a social debts incurs.

In one study, people were asked if they would buy a daffodil to benefit the American Cancer Society in 5 weeks. 83% said they would buy the flower but only 43% actually did so. The subjects in this study were also asked how much of the $5 payment for being in the study they would donate. To charity. They predicted they would donate $2.50 but only gave $1.50. So our ability to predict our future behavior is very limited because we have failed to take into account the context in which we will be operating in the futureTexas is a state in which the licensing board actions are clearly transparent and published in one place on their website..in the comprehensive list of board actions, about 10% are simply failure to release a requested record to a patient in a timely manner. When time is short and we have an administrative task that does not feel urgent we are more likely to spend our time doing what seems more urgent and forget the records request...In general, we tend to see ethical missteps of others as a function of their character or their personality but we view our own as a function of the context in which they occur.

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The role of empathy in unethical actions is often overlooked. When we like and feel for someone who has a serious difficulty, we want to help them and often feel good that we can help them. Sometimes we dont ask when helping is really hurting others, ourselves or society.. A Wisconsin psychologist was recently found going beyond his role as a psychologist by their licensing board when he was treating an elderly couple estranged from their daughter. He was moved to help them by developing a questionnaire that listed their flaws as parents and what they wish they had done differently. Since the daughter would not accept mail from her parents, the psychologist mailed her the questionnaires and a letter from his stationary. He wrote to the daughter that her parents really wanted to know how she was doing and offering to help with a reunification process. Psychologists can also be unwittingly unethical when they mix roles in assessment and therapy. In this scenario which is frequently found, a client will ask for a letter, often affirming that they are a good parent when facing a divorce. Other assessment roles which are frequently requested are a letter stating that they need a FMLA leave of absence for mental health reasons. Or letter of reference for a job, grad school. It is important to recall that only the minimum amount of information can be released and that mixing roles, even when you want to be helpful can be troublesome.

The Robin Hood effect refers to the tendency of people to be unethical in their attempt to equalize the resources between an entity that they perceive as wealthy to an entity that they perceive as deservingeither for themselves or someone they have empathy for. In this way, the higher human emotion of empathy can lead to unethical behaviors.Psychologists have found that car emissions inspectors are more likely to help drivers of modest and old cars with a false pass than drivers of luxury cars. The inspectors do not consider the long term ethical dilemma of air pollution and are willing to help cheat a large impersonal bureaucratic agency for the person in front of them.And sometimes psychologists who want to equalize resources do so by waving the copay for insurance clients, or giving the client an upcoded diagnosis, a down coded diagnosis or changing the treatment code to falsely reflect individual therapy instead of couples therapy. They collude with their clients against the large wealthy impersonal bureaucracy of an insurance company or an institution where they work.32

What is the role of being a whistleblower. think of a time when you observed a questionable action and did not deal with it....then think of a time when you saw someone doing something and did address it. What was the difference for you? Social science research can shed some light on this.. When asked to write about a time when they witnessed misbehavior and dealt with it.., the subjects wrote about fairness. When they were asked about witnessing misbehavior and not reporting it, they emphasized loyalty emphasize fairness and justice and downplay the loyalty aspect . An example of a psychologist who prioritized loyalty over fairness is Dr Raymond Fowlerwho notified Dr Elizabeth Loftus that APA had received an ethics complaint about her false memory work so that she could resign quickly from APA and not have to undergo the ethics complaint process.

Oftentimes psychologists hear about possible ethical violations of others via confidential information from clients. 33

When we have committed to a course of action, it is hard to change course when we have committed time, energy and money to it. We have invested and cant quit. Think of a time when you put too much into a losing situation and had trouble stopping yourself. Pause. For instance in this photo the ship captain was determined to land the marlin who is now in the process of sinking the boat. It is hard to admit failure and know when to cut your losses. This is called the sunken cost fallacy we may have invested a significant amount of our resources into something and not be able to change course when it is not working out. A good example of this is a psychologist who became angry with a postdoctoral supervisee who left her clinic during the middle of the first year with 2 weeks notice. The psychologist felt that she had been mistreated and withheld money due under the 50/50 fee split agreement that had been arranged. She called the new postdoc site and angrily stated that the new site had been unethical in recruiting the supervisee and that the supervisee had issues. When psychologists feel that they have invested a lot in a supervisee, an employee or a contractor, conflicts can emerge. There are a number of cases involving supervision of a longstanding employee who may be doing substandard work but because the practitioner has a lot invested in the relationship, they have difficulty letting go. There are also a number of cases where the psychologists treatment mode is not working well but they persist in using the same approach.34


Status Quo Bias

A North Carolina psychological assistant was found to be using the HTP and the Jesness-R in an outdated manner for child evaluations. His defense was that this is how he has always done it and no one ever complained before. The North Carolina board has noted that psychologists are increasingly using tests with outdated versions and norms. The have stipulated that psychologists have one year in which to get and begin using new versions and norms for psychological testing. Research shows that after about 20 years in practice, professionals have a more difficult time updating their skills. Many of these are good psychologists who are unaware of the decline of their skills.

. An acquaintance of mine is a regional sales manager for a large Fortune 500 company. Once per quarter, the sales agents are encouraged to have an intensive cold-calling sales day and are additionally rewarded for the sales that come from that day..what happens is that the sales agents do not want to cold call because it no longer worksand instead of cold calling, they have a regular day but date their sales agreements so it appears that the sale came from that dayupper management continues to believe that this program works because they have the evidence that sales increase on that day..If you work in an organization that sets your goals for you, you will be more likely to use cheating to meet the goal than if you have set it for yourself. A psychologist in Wisconsin was found to be below the standard of practice by shortening sessions to 15 minutes but recording them as 45 minute sessions to make a quota set by his employer. Another psychologist gave a testing questionnaire to a client in detention to complete on his own as he did not have time to wait for the client to complete it. When psychologists are trying to meet imposed goals such as treatment or productivity goals, there is pressure to meet the goal that can lead to unethical behavior.

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We are often influenced by the behavior of the group. When asked to help Toby, all agreed to cheat on his behalf. We are social creatures and look around to see what others are doing. Then we determine what to do. In experiments done by Dan Ariely, he notes that when one subject in a group openly cheats, others are likely to do so as well, especially if the one who cheats is liked by the group. Research also shows that when people perceive a leader as unethical, they commit more unethical acts as well. If you think for a minute, you can easily recall a time when either a group or a leader wanted you to do something that you did not feel right about and you did it anyway. There are numerous examples in social psychology that show the power of the group to influence behavior.37


APA Ethics controversy

Dr. Stephen Behnke was the ethics head at APA. He is by all accounts a good psychologist, bright and well trained and versed in ethical issues. In a review of the Hoffman report, there are numerous descriptions of his collaborations with the DOD to craft messaging and review policy that would support the use of psychologists as behavioral consultants for interrogations in role that is clearly differentiated from a role of treating professional. Many emails exist in which he asked for guidance as to how to frame ethics policy to protect the use of psychologists in security interrogations, with his stance being that psychologists would need to be consultants to make sure that these interrogations were conducted in an ethical manner. He is described as withholding information, including the information that he was also hired and paid as a training contractor by the DOD to train in how interrogations could be conducted ethically without disclosing that publicly. He was asked and agreed to write a casebook on the specific techniques that would not be allowed but did not write the requested casebook that was agreed to after the PENS report was found to be an inadequate response. Only in 2011 did he write some case material that was put on the web. After Obama was elected and the political climate changed, he is described as no longer vigorously opposing the ethics code changing as it no longer conflicted with the interrogations policies of the DOD.

Mary Gresham, Ph.D.Atlanta Financial PsychologyIt is clear in retrospect that I should have been much more skeptical of the staff. However, this is not a simple matter due to the nature of our roles in governance as volunteers who usually have full-time responsibilities elsewhere, either in jobs or practice, and most do not live in Washington, DC. APA is a complex company which combines a membership organization, a large scholarly publishing operation, and real estate holdings, and there is no way that volunteers could become as knowledgeable as staff about matters under their purview. Ron LevantAPA Ethics controversy

Although many also find serious problems with the Hoffman report, their perceptions generally depend on group membership. Group membership seems to be divided between staff, the governing volunteers and their roles, members of military psychology, members of peace psychology, practitioners in health care and organizational consultants. This is great example of how group membership determines what is seen as ethical and unethical behavior and how subjective the determination is. This is also a good example of how we explain our behavior by saying I could not have known then what I know now . In-group bias is always a factor and making ourselves aware of it is important. Take a moment and list as many group memberships as you can call up.


Taboo Topics

What are some topics that are taboo and difficult to discuss?Some of the topics that are hardest to discuss are physical illness, emotional problems, social loneliness, financial stressors and professional failures.. Taboo topics are more likely to cause us to withhold information from colleagues because they are threatening.

Mary Gresham, Ph.D.Atlanta Financial PsychologyUse of herbal supplementsProbioticsVitamin therapyPrescription Omega 3Gene sight/DNA testing

Alternative approaches

There is an increasing public interest in the use of alternative and complementary approaches. Many psychologists are interested in these approaches as well. In general it is important to note that you need to encourage your clients to speak with their physician if they are using alternative treatments that can interfere with other medications. Other approaches that are of interest to clients are acupuncture, reiki, biofeedback, neurofeedback, massage therapy, chiropractic, mindfulness meditation and yoga.

Mary Gresham, Ph.D.Atlanta Financial PsychologyOnline therapy

This is the wild west of services at the moment. Ethical cases have just begun to be opened for this area and it is ever changing. A number of states have begun to crack down on providing services across state lines. Be sure if you decide to do online work that you have developed a good informed consent, and are practicing according to APA guidelines. BE sure to use a good platform like Vsee or Zoom.

Mary Gresham, Ph.D.Atlanta Financial PsychologyConcierge Therapy

Derived from the field of concierge medicine, using flat fees or service packages to provide whatever service is needed in a variety of locations is emerging as another trend in psychology.


ESA

Mary Gresham, Ph.D.Atlanta Financial PsychologyHigher risk areas of work High risk behaviorsHigh risk clientsTechnology changesLicensing/credential issuesProfessional willsEthical Trends

We can continue to identify the high risk areas of work: forensic, especially child custody; supervision where you are legally responsible for others work; High risk behaviors continue to be boundary violations with clients that are exploitive either romantically or financially; also taking on both assessment and therapy roles;High risk clients continue to be clients who are suicidal, dysregulated, in crisis, and exhibit therapy interference behaviors. Technology issues continue with constant change; texting; video therapy; electronic records;Licensing and credentialing issues are high priority, especially working across state lines ; The field now has a large contingent of older practitioners and Oregon is now requiring psychologists to designate who will be responsible for clients; this may increase.

What actually works in promoting ethical behaviors??

Preparation: Prepare yourself for an ethical dilemma by trying to imagine it with vivid detail. Plan how you will act in the situation. Then prepare yourself for the actual situation by understanding that emotional factors will come into play at the time of action. As you imagine how you will act at the time, predict the existence of your emotional and less rational self. Give yourself a number of options in how you will respond. Giving yourself more options increases the chances that you apply higher level reasoning to this situation.

Reward your ethical behavior..means taking the time to reflect and feel good about a decision you made that reflected your positive ethical behavior. Turn to one person and taking turns, tell about a time when you made a good ethical decision and felt good about the outcome. We often take our positive actions for granted and fail to appreciate and reward ourselves for the time when we did the right thing.46

Mary Gresham, Ph.D.Atlanta Financial PsychologyNot always accessiblePeer consultation

Mary Gresham, Ph.D.Atlanta Financial PsychologyNot always accessibleIdentified as primary way to stay ethical in our workPeer consultation

Mary Gresham, Ph.D.Atlanta Financial PsychologyNot always accessibleIdentified as primary way to stay ethical in our workTake this as opportunity to form a temporary peer group and discuss the situation you wrote down or another that has come to mind.Peer consultation

Get into groups of four. Take time to decide how your group is going to process the issue. You will have a 20 minute peer group. You can decide to allocate the time equally, process only one example thoroughly.

Mary Gresham, Ph.D.Atlanta Financial PsychologyOur Work Lives

Still looks like a much needed profession according to the Bureau of Labor Statistics

The world changes


As our world changes, we no longer have all the information we need in terms of case examples or evidence for innovative approaches.

The world changesIncreased competition from other professions, including coachingAtlanta Financial PsychologyAtlanta Financial PsychologyMary Gresham, Ph.D.


The world changesIncreased competition from other professions, including coachingUncertainty about healthcare laws/increase in political polarization



The world changesIncreased competition from other professions, including coachingUncertainty about healthcare laws/increase in political polarizationDemands of consumers increasing



The world changesIncreased competition from other professions, including coachingUncertainty about healthcare laws/increase in political polarizationDemands of consumers increasingThe internet



The world changesIncreased competition from other professions, including coachingUncertainty about healthcare laws/increase in political polarizationDemands of consumers increasingThe internetMobile and smartphone use



The world changesIncreased competition from other professions, including coachingUncertainty about healthcare laws/increase in political polarizationDemands of consumers increasingThe internetMobile and smartphone useCultural competence demandsAtlanta Financial PsychologyAtlanta Financial PsychologyMary Gresham, Ph.D.


Mary Gresham, Ph.D.Atlanta Financial PsychologyThe material often seems obviousEthics of Self-Care

Mary Gresham, Ph.D.Atlanta Financial PsychologyThe material often seems obviousThe difficulty is in implementation, not in lack of knowledgeEthics of Self-Care

Mary Gresham, Ph.D.Atlanta Financial PsychologyThe material often seems obviousThe difficulty is in implementation, not in lack of knowledgeSystems and organizations also need to changeEthics of Self-Care

Mary Gresham, Ph.D.Atlanta Financial Psychology2.06 Personal Problems and Conflicts(a) Psychologists refrain from initiating an activity when they know or should know that there is a substantial likelihood that their personal problems will prevent them from performing their work-related activities in a competent manner.APA Standards

This code is one that is difficult to apply as we often do not know what we should know about ourselves. In general are encouraged to self assess and sustain ourselves and to figure this out on our own.

Mary Gresham, Ph.D.Atlanta Financial Psychology2010 survey of 658 practitionersPracticing an average of 23 yearsColleague Assistance Surveys

Mary Gresham, Ph.D.Atlanta Financial Psychology2010 survey of 658 practitionersPracticing an average of 23 yearsWork an average of 40 hours/weekColleague Assistance Surveys

Mary Gresham, Ph.D.Atlanta Financial Psychology2010 survey of 658 practitionersPracticing an average of 23 yearsWork an average of 40 hours/weekIdentify stressors/coping responsesColleague Assistance Surveys

Mary Gresham, Ph.D.Atlanta Financial PsychologyWork/life balancePsychologists Stressors

Mary Gresham, Ph.D.Atlanta Financial PsychologyWork/life balanceFinancial stressPsychologists Stressors

Mary Gresham, Ph.D.Atlanta Financial PsychologyWork/life balanceFinancial stressPhysical health/fatiguePsychologists Stressors

Mary Gresham, Ph.D.Atlanta Financial PsychologyWork/life balanceFinancial stressPhysical health/fatigueWorries about clients

Psychologists Stressors

Mary Gresham, Ph.D.Atlanta Financial PsychologyWork/life balanceFinancial stressPhysical health/fatigueWorries about clientsFamily problemsPsychologists Stressors

Mary Gresham, Ph.D.Atlanta Financial PsychologyTime

Barriers to self care

Mary Gresham, Ph.D.Atlanta Financial PsychologyTimeMinimization of distressBarriers to self care

Mary Gresham, Ph.D.Atlanta Financial PsychologyTimeMinimization of distressPrivacy/confidentiality concernsBarriers to self care

Mary Gresham, Ph.D.Atlanta Financial PsychologyTimeMinimization of distressPrivacy/confidentiality concernUnmotivatedBarriers to self care

Mary Gresham, Ph.D.Atlanta Financial PsychologyTimeMinimization of distressPrivacy/confidentiality concernUnmotivatedFinancial concernsBarriers to self care

Mary Gresham, Ph.D.Atlanta Financial PsychologyTimeMinimization of distressPrivacy/confidentiality concernUnmotivatedFinancial concernsDifficulty identifying resourcesBarriers to self care

The low utilization of colleague assistance programs has led to their being discontinued in many states.


Research on Scarcity

Research by Mullainathan, S. & Shafir, is really interesting on the effects of resource scarcity in a number of settings. Their work looks at the effects of scarcity in money, time and social connections. IN general they find that scarcity has a self perpetuating cycle; and that it narrows our attention to keep overfocusing on the missing resources; and that in general the lack of cognitive capacity when we feel scarcity seems to lower our IQs about 14 points.

Mary Gresham, Ph.D.Atlanta Financial PsychologyChoose a partner for this exerciseDescribe to your partner what a difficult or negative day at work is like for you.Describe

Mary Gresham, Ph.D.Atlanta Financial PsychologyNow describe to your partner what a really positive and good day at work is like for you.Describe

You will each have 6 minutes to talk about this. Did you find that describing the hard day was easier or harder for you? Did either description feel more vivid to you? Recall that research shows that we generally pay more attention and feel more about the negative than the positive..this is normal human processing.

Mary Gresham, Ph.D.Atlanta Financial PsychologyLife satisfaction : income, health, work

Subjective Well-Being

Ed Dieners work has found evidence over 3 decades has found factors that are clear in defining what subjective well being is. There are 3 primary and distinct factors that compose the measurement of this concept. SWB has been found to correlate highly with ratings by informants and other measures of behavior.

Mary Gresham, Ph.D.Atlanta Financial PsychologyLife satisfaction : income, health, workPositive affect: social relationships

Subjective Well-Being

Mary Gresham, Ph.D.Atlanta Financial PsychologyLife satisfaction : income, health, workPositive affect: social relationshipsNegative affect: perception of problems, internal and interpersonal conflict.Subjective Well-Being

Mary Gresham, Ph.D.Atlanta Financial PsychologyCultural influences are significantCollectivist vs. individualist culturesExample: Contentment vs. ExcitementWhat we know

In individualist countries like the US experiencing more positive than negative emotions is associated with life satisfaction. In collectivist nations such as Japan, pacific Rim relationship harmony is more important. In the US job characteristics of autonomy and achievement are more important in determining work satisfaction.

Mary Gresham, Ph.D.Atlanta Financial PsychologyFactors that increase effectiveness: Motivation, engagement, belief, age , from Western culture.Longer term, task varietyInterventions to increase

There are certain interventions that we know will increase the ratings on these 3 factors. How well the interventions work depend on the following.

Mary Gresham, Ph.D.Atlanta Financial PsychologyPositive PsychologyThree good things dailyUse of character strengths in new wayGratitude letter

Mary Gresham, Ph.D.Atlanta Financial PsychologyWork of Pennebaker and others

Correlated with improved health

Easily adaptedExpressive Writing

Pennebaker has used an expressive writing intervention in numerous research studies; he has found that writing over 4 occasions with instructions to really let yourself go and feel emotions as you write results in an initial increase in feeling down but over time leads to less utilization of health services.

Mary Gresham, Ph.D.Atlanta Financial PsychologyAffect Regulation Systems


Compassion vs. Empathy

As neuroscientists have studied the brain scans they have found that the states of empathy and compassion are quite different but we often confuse them. Empathy refers to our activation in which we attune and often share the emotional experience of another person. In research studies done with videos of people in distress, empathic attunement by a helper was found to lead to exhaustion and an increase in negative affect. When helper s were trained to experience compassion instead of empathy , they were taught to have a feeling warmth and benevolence towards the orphans, of loving kindness and wishes for their well being. They no longer felt distress and fatigue.

Mary Gresham, Ph.D.Atlanta Financial PsychologyFor someone to develop genuine compassion towards others, first he or she must have a basis upon which to cultivate compassion, and that basis is the ability to connect to ones own feelings and to care for ones own welfare... Caring for others requires caring for oneself. Tenzin Gyatso, the 14th Dalai Lama

Compassion


Self-compassion

There are a number of compassion training programs. An 8 week training program developed by Dr. Kristen Neff has been developed and researched. There is a high correlation between improved self compassion and a reduction in anxiety and depression. There is also a reduction in rumination, and cortisol measures. Psychotherapy that was focused on reducing self criticism also showed an improvement in self compassion.

Mary Gresham, Ph.D.Atlanta Financial PsychologySelf-compassion

Mary Gresham, Ph.D.Atlanta Financial PsychologyBurnout

Vicarious traumatization

Compassion fatigueNegative caregiver states

Much of the work on self care is oriented to trying to recover from a negative state that has become chronic over time. The new emphasis on self care is oriented to prevention of negative states and ethical responsibilities to avoid them when possible. Burnout refers to feelings of exhaustion , physical, mental and emotional; having more control over your workvicarious traumatization refers to intrusive imagery and a changed world view from working with trauma victims; specialized training in trauma treatment and rebalancing a case load have been found to make a big difference. compassion fatigue is better described as empathy fatigue: Feeling too much for those in distress


Taking Inventory

As you reflect on the topic of self care, you will design a self care plan for yourself. Your plan is designed to act as a preventative effort for ethical mis steps. The basics of a good plan are to help you thrive, not just survive. Your plan reflects the intentionality you will carry forward and how you will integrate it into your life as opposed to it becoming one more thing to add on. Identify for yourself the needs that you currently feel. What will it take to really thrive? If you need ideas, look at the handout developed from a workshop called Self care. It throws out broad categories, not specific techniques; which ones grab your attention? Develop your own specifics, looking at the categories. Intention is the beginning, followed by monitoring, and integration.

Mary Gresham, Ph.D.Atlanta Financial PsychologyThe End






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Health & Medicine

When good psychologists go bad