Four pieces of ethical advice for practitioners during COVID-19

Rebecca Schwartz-Mette
APAservices.org
Originally posted 2 April 20

Are you transitioning to full-time telepsychology? Launching a virtual classroom? Want to expand your competence in the use of technology in practice? You can look to APA’s Ethics Committee for support in transforming your practice. Even in times of crisis, the Ethical Principles of Psychologists and Code of Conduct (hereafter “Ethics Code” or “Code;” 2002, Amended June 1, 2010 and Jan. 1, 2017) continues to guide psychologists’ actions based on our shared values. Here are four ways to practice in good faith while meeting the imminent needs of your community:

Lean in

Across the nation, rather than closing their practices and referring out, psychologists are accepting the challenge to diligently obtain training and expand their competence in telepsychology. Standard 2.02, “Providing Services in Emergencies,” allows psychologists to provide services for individuals for whom other services aren’t available through the duration of such emergencies, even if they have not obtained the necessary training. The Ethics Committee supports those psychologists working in good faith to meet the needs of patients, clients, supervisees and students.

Get training and support

Take advantage of the APA’s new (and often free) resources to develop and expand your competence, in line with Standard 2.03, “Maintaining Competence.” Expand your network by connecting with colleagues who can provide peer consultation and supervision to support your efforts.

Consider referrals

The decision to transition to telepsychology may not be for everyone. Competency concerns, lack of access to technology, and specific needs of particular clients may reflect good reasons to refer to practitioners who can provide telepsychology. Psychologists should assess each client’s needs in light of their own professional capacities and refer to others who can provide needed services in line with Standard 10.10(c), “Terminating Therapy.”

Take care of yourself

Psychologists are human and can feel lost in the ambiguity of this unprecedented time. It is your ethical mandate to also care for yourself. Practicing accurate self-assessment, leaning on colleagues when needed, and taking time to unplug from the news and practice to recharge helps to prevent burnout and is entirely consistent with 2.06, “Personal Problems and Conflicts.” Make self-care a verb and connect with your community of psychologists today.

The Ethical Practice of Psychotherapy: Clearly Within Our Reach

Jeff Barnett
Psychotherapy, 56(4), 431-440
http://dx.doi.org/10.1037/pst0000272

Abstract

This introductory article to the special section on ethics in psychotherapy highlights the challenges and ethical dilemmas psychotherapists regularly face throughout their careers, and the limits of the American Psychological Association Ethics Code in offering clear guidance for how specifically to respond to each of these situations. Reasons for the Ethics Code’s naturally occurring limitations are shared. The role of ethical decision-making, the use of multiple sources of guidance, and the role of consultation with colleagues to augment and support the psychotherapist’s professional judgment are illustrated. Representative ethics challenges in a range of areas of practice are described, with particular attention given to tele-mental health and social media, interprofessional practice and collaboration with medical professionals, and self-care and the promotion of wellness. Key recommendations are shared to promote ethical conduct and to resolve commonly occurring ethical dilemmas in each of these areas of psychotherapy practice. Each of the six articles that follow in this special section on ethics in psychotherapy are introduced, and their main points are summarized.

Here is an excerpt:

Yet, the ethical practice of psychotherapy is complex and multifaceted. This is true as well for psychotherapy research, the supervision of psychotherapy by trainees, and all other professional roles in which psychotherapists may serve. Psychotherapists engage in complex and challenging work in a wide range of practice settings, with a diverse range of clients/patients with highly individualized treatment needs, histories, and circumstances, using a plethora of possible treatment techniques and strategies. Each possible combination of these factors can yield a range of complexities, often presenting psychotherapists with challenges and situations that may not have been anticipated and that tax the psychotherapist’s ability to choose the correct or most appropriate course of action. In such circumstances, ethical dilemmas (situations in which no right or correct course of action is readily apparent and where multiple factors may influence or impact one’s decision on how to proceed) are common. Knowing how to respond to these challenges and dilemmas is of paramount importance for psychotherapists so that we may fulfill our overarching obligations to our clients and all others we serve in our professional roles.

Beyond the Boundaries: Ethical Issues in the Practice of Indirect Personality Assessment in Non-Health-Service Psychology

Marvin W. Acklin
Journal of Personality Assessment
https://doi.org/10.1080/00223891.2018.1522639

Abstract

This article focuses on ethical quandaries in the practice of indirect personality assessment in non-health-service psychology. Indirect personality assessment methods do not involve face-to-face interaction. Personality assessment at a distance is a methodological development of personality and social psychology, psychobiography, and psychohistory. Indirect personality methods are used in clinical, forensic, law enforcement, public safety, and national security settings. Psychology practice in non-health-service settings creates tensions between principles of beneficence and duty to society. This article defines methods of indirect personality assessment and some ethical ramifications. Their application in non-health-service settings occurs in the context of intense controversy over the ethics of psychologists’ participation in work settings where there are third-party loyalties, absence of voluntary informed consent, presence of nonstipulated harms, and absence of legal and ethical accountability. A hypothetical case example illustrates typical quandaries encountered in a national security assessment. This article provides a framework for critically examining ethical quandaries, a contemporary conceptual and process model for integrative moral cognition, and parameters for ethical reasoning by the individual practitioner under the exigencies of real-world practice.

Business ethics: am I boring you?

Katherine Bradshaw
The Guardian
Originally published November 8, 2012

Here is an excerpt:

We need to bridge the gap between ethics programmes and daily worklife – and stories can help us do that.

No matter how sophisticated we are as a society, stories continue to be our preferred way of communicating and sharing our experiences of life. From a book at bedtime to the latest cliffhanger of our favourite soap, stories help us connect and communicate our emotions and values with each other.

Business ethics training at its worst can include material which seems distant to staff and how they do their day-to-day job. A set of compliance dictats communicated with slides animated with clip art, or an eLearning programme with easy multiple choice questions conducted in isolation, is unlikely to engage anyone with what really matters.

Ethical values need to be embedded into company culture so that they are reflected in the way that business is actually done. This requires an ethics programme with objectives beyond just imparting knowledge and raising awareness of expected standards – the challenge is to communicate their relevance and importance at all levels and locations in a way that impacts on understanding, decisions and behaviours.

The article is here.

Fiction: Simulation of Social Worlds

By Keith Oatley
Trends in Cognitive Science
(2016) Volume 20, Issue 8, p 618–628

Here is an excerpt:

What is the basis for effects of improved empathy and theory-of-mind with engagement in fiction? Two kinds of account are possible, process and content, and they complement each other.

One kind of process is inference: engagement in fiction may involve understanding characters by inferences of the sort we make in conversation about what people mean and what kinds of people they are. In an experiment to test this hypothesis, participants were asked to read Alice Munro's The Office, a first-person short story about a woman who rents an office in which to write. In one condition, the story starts in Munro's words, which include ‘But here comes the disclosure which is not easy for me. I am a writer. That does not sound right. Too presumptuous, phony, or at least unconvincing’. In a comparison version, the story starts with readers being told directly what the narrator feels: ‘I’m embarrassed telling people that I am a writer …’ , p. 270). People who read the version in Munro's own words had to make inferences about what kind of person the narrator was and how she felt. They attained a deeper identification and understanding of the protagonist than did those who were told directly how she felt. Engagement in fiction can be thought of as practice in inference making of this kind.

A second kind of process is transportation: the extent to which people become emotionally involved, immersed, or carried away imaginatively in a story. The more transportation that occurred in reading a story, the greater the story-consistent emotional experience has been found to be. Emotion in fiction is important because, as in life, it can signal what is significant in the relation between events and our concerns [42]. In an experiment on empathetic effects, the more readers were transported into a fictional story, the greater were found to be both their empathy and their likelihood of responding on a behavioral measure: helping someone who had dropped some pencils on the floor. The vividness of imagery during reading has been found to improve transportation and to increase empathy. To investigate such imagery, participants in a functional magnetic resonance imaging (fMRI) machine were asked to imagine a scene when given between three and six spoken phrases, for instance, ‘a dark blue carpet’ … ‘a carved chest of drawers’ … ‘an orange striped pencil’. Three phrases were enough to activate the hippocampus to its largest extent and for participants to imagine a scene with maximum vividness. In another study, one group of participants listened to a story and rated the intensity of their emotions while reading. In a second group of participants, parts of the story that raters had found most emotional produced the largest changes in heart rate and greatest fMRI-based activations.

The article is here.

Our research was key to the 10,000-hour rule, but here’s what got oversimplified

Anders Ericsson and Robert Pool
Salon.com
Originally posted April 16, 2016

Here is an excerpt:

Research has shown this to be true in field after field. It generally takes about ten years of intense study to become a chess grandmaster. Authors and poets have usually been writing for more than a decade before they produce their best work, and it is generally a decade or more between a scientist’s first publication and his or her most important publication — and this is in addition to the years of study before that first published research. A study of musical composers by the psychologist John R. Hayes found that it takes an average of twenty years from the time a person starts studying music until he or she composes a truly excellent piece of music, and it is generally never less than ten years. Gladwell’s ten-thousand-hour rule captures this fundamental truth — that in many areas of human endeavor it takes many, many years of practice to become one of the best in the world — in a forceful, memorable way, and that’s a good thing.

On the other hand, emphasizing what it takes to become one of the best in the world in such competitive fields as music, chess, or academic research leads us to overlook what we believe to be the more important lesson from the study of the violin students. When someone says that it takes ten thousand — or however many — hours to become really good at something, it puts the focus on the daunting nature of the task. While some may take this as a challenge — as if to say, “All I have to do is spend ten thousand hours working on this, and I’ll be one of the best in the world!”—many will see it as a stop sign: “Why should I even try if it’s going to take me ten thousand hours to get really good?” As Dogbert observed in one “Dilbert” comic strip, “I would think a willingness to practice the same thing for ten thousand hours is a mental disorder.”

The article is here.

The Ethics of Physicians’ Web Searches for Patients’ Information

Nicholas Genes and Jacob Appel
The Journal of Clinical Ethics
Volume 26, Number 1, Spring 2015

When physicians search the web for personal information about their patients, others have argued that this undermines  patients’ trust, and the physician-patient relationship in general. We add that this practice also places other relationships at risk, and could jeopardize a physician’s career.

Yet there are also reports of web searches that have unambiguously helped in the care of patients, suggesting circumstances in which a routine search of the web could be beneficial. We advance the notion that, just as nonverbal cues and unsolicited information can be useful in clinical decision making, so too can online information from patients. As electronic records grow more voluminous and span more types of data, searching these resources will become a clinical skill, to be used judiciously and with care—just as evaluating the literature is, today.

But to proscribe web searches of patients’ information altogether is as nonsensical as disregarding findings from physical exams—instead, what’s needed are guidelines for when to look and how to evaluate what’s uncovered, online.

The entire article is here.

Why Doctors need Stories

By Peter D. Kramer
The New York Times
Originally published October 18, 2014

Here is an excerpt:

I have long felt isolated in this position, embracing stories, which is why I warm to the possibility that the vignette is making a comeback. This summer, Oxford University Press began publishing a journal devoted to case reports. And this month, in an unusual move, the New England Journal of Medicine, the field’s bellwether, opened an issue with a case history involving a troubled mother, daughter and grandson. The contributors write: “Data are important, of course, but numbers sometimes imply an order to what is happening that can be misleading. Stories are better at capturing a different type of ‘big picture.’ ”

Stories capture small pictures, too. I’m thinking of the anxious older man given Zoloft. That narrative has power.

The entire article is here.

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