Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Consultation. Show all posts
Showing posts with label Consultation. Show all posts

Monday, February 6, 2023

How Far Is Too Far? Crossing Boundaries in Therapeutic Relationships

Gloria Umali
American Professional Agency
Risk Management Report
January 2023

While there appears to be a clear understanding of what constitutes a boundary violation, defining the boundary remains challenging as the line can be ambiguous with often no right or wrong answer. The APA Ethical Principles and Code of Conduct (2017) (“Ethics Code”) provides guidance on boundary and relationship questions to guide Psychologists toward an ethical course of action. The Ethics Code states that relationships which give rise to the potential for exploitation or harm to the client, or those that impair objectivity in judgment, must be avoided.

Boundary crossing, if allowed to progress, may hurt both the therapist and the client.  The good news is that a consensus exists among professionals in the mental health community that there are boundary crossings which are unquestionably considered helpful and therapeutic to clients. However, with no straightforward formula to delineate between helpful boundaries and harmful or unhealthy boundaries, the resulting ‘grey area’ creates challenges for most psychologists. Examining the general public’s perception and understanding of what an unhealthy boundary crossing looks like may provide additional insight on the right ethical course of action, including the impact of boundary crossing on relationships on a case-by-case basis. 

(cut)

Conclusion

Attaining and maintaining healthy boundaries is a goal that all psychologists should work toward while providing supportive therapy services to clients. Strong and consistent boundaries build trust and make therapy safe for both the client and the therapist. Building healthy boundaries not only promotes compliance with the Ethics Code, but also lets clients know you have their best interest in mind. In summation, while concerns for a client’s wellbeing can cloud judgement, the use of both the risk considerations above and the APA Ethical Principles of Psychologists and Code of Conduct, can assist in clarifying the boundary line and help provide a safe and therapeutic environment for all parties involved. 


A good risk management reminder for psychologists.

Tuesday, April 7, 2020

Four pieces of ethical advice for practitioners during COVID-19

Four pieces of ethical advice for practitioners during COVID-19Rebecca 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.

Monday, December 10, 2018

What makes a ‘good’ clinical ethicist?

Trevor Bibler
Baylor College of Medicine Blog
Originally posted October 12, 2018

Here is an excerpt:

Some hold that the complexity of clinical ethics consultations couldn’t be reduced to multiple-choice questions based on a few sources, arguing that creating multiple-choice questions that reflect the challenges of doing clinical ethics is nearly impossible. Most of the time, the HEC-C Program is careful to emphasize that they are testing knowledge of issues in clinical ethics, not the ethicist’s ability to apply this knowledge to the practice of clinical ethics.

This is a nuanced distinction that may be lost on those outside the field. For example, an administrator might view the HEC-C Program as separating a good ethicist from an inadequate ethicist simply because they have 400 hours of experience and can pass a multiple-choice exam.

Others disagree with the source material (called “core references”) that serves as the basis for exam questions. I believe the core references, if repetitious, are important works in the field. My concern is that these works do not pay sufficient attention to some of the most pressing and challenging issues in clinical ethics today: income inequality, care for non-citizens, drug abuse, race, religion, sex and gender, to name a few areas.

Also, it’s feasible that inadequate ethicists will become certified. I can imagine an ethicist might meet the requirements, but fall short of being a good ethicist because in practice they are poor communicators, lack empathy, are authoritarian when analyzing ethics issues, or have an off-putting presence.

On the other hand, I know some ethicists I would consider experts in the field who are not going to undergo the certification process because they disagree with it. Both of these scenarios show that HEC certification should not be the single requirement that separates a good ethicist from an inadequate ethicist.

The info is here.

Sunday, November 11, 2018

Nine risk management lessons for practitioners.

Taube, Daniel O.,Scroppo, Joe,Zelechoski, Amanda D.
Practice Innovations, Oct 04 , 2018

Abstract

Risk management is an essential skill for professionals and is important throughout the course of their careers. Effective risk management blends a utilitarian focus on the potential costs and benefits of particular courses of action, with a solid foundation in ethical principles. Awareness of particularly risk-laden circumstances and practical strategies can promote safer and more effective practice. This article reviews nine situations and their associated lessons, illustrated by case examples. These situations emerged from our experience as risk management consultants who have listened to and assisted many practitioners in addressing the challenges they face on a day-to-day basis. The lessons include a focus on obtaining consent, setting boundaries, flexibility, attention to clinician affect, differentiating the clinician’s own values and needs from those of the client, awareness of the limits of competence, maintaining adequate legal knowledge, keeping good records, and routine consultation. We highlight issues and approaches to consider in these types of cases that minimize risks of adverse outcomes and enhance good practice.

The info is here.

Here is a portion of the article:

Being aware of basic legal parameters can help clinicians to avoid making errors in this complex arena. Yet clinicians are not usually lawyers and tend to have only limited legal knowledge. This gives rise to a risk of assuming more mastery than one may have.

Indeed, research suggests that a range of professionals, including psychotherapists, overestimate their capabilities and competencies, even in areas in which they have received substantial training (Creed, Wolk, Feinberg, Evans, & Beck, 2016; Lipsett, Harris, & Downing, 2011; Mathieson, Barnfield, & Beaumont, 2009; Walfish, McAlister, O’Donnell, & Lambert, 2012).

Tuesday, April 24, 2018

When therapists face discrimination

Zara Abrams
The Monitor on Psychology - April 2018

Here is an excerpt:

Be aware of your own internalized biases. 

Reflecting on their own social, cultural and political perspectives means practitioners are less likely to be caught off guard by something a client says. “It’s important for psychologists to be aware of what a client’s biases and prejudices are bringing up for them internally, so as not to project that onto the client—it’s important to really understand what’s happening,” says Kathleen Brown, PhD, a licensed clinical psychologist and APA fellow.

For Kelly, the Atlanta-based clinical psychologist, this means she’s careful not to assume that resistant clients are treating her disrespectfully because she’s African American. Sometimes her clients, who are referred for pre-surgical evaluation and treatment, are difficult or even hostile
because their psychological intervention was mandated.

Foster an open dialogue about diversity and identity issues.

“The benefit of having that conversation, even though it can be scary or uncomfortable to bring it up in the room, is that it prevents it from festering or interfering with your ability to provide high-quality care to the client,” says Illinois-based clinical psychologist Robyn Gobin, PhD, who has experienced ageism from patients. She responds to ageist remarks by exploring what specific concerns the client has regarding her age (like Turner, she looks young). If she’s met with criticism, she tries to remain receptive, understanding that the client is vulnerable and any hostility the client expresses reflects concern for his or her own well-being. By being open and frank from the start, she shows her clients the appropriate way to confront their biases in therapy.

Of course, practitioners approach these conversations differently. If a client makes a prejudiced remark about another group, Buckman says labeling the comment as “offensive” shifts the attention from the client onto her. “It doesn’t get to the core of what’s going on with them. In the long run, exploring a way to shift how the client interacts with the ‘other’ is probably more valuable than standing up for a group in the moment.”

The information is here.

Thursday, August 31, 2017

Stress Leads to Bad Decisions. Here’s How to Avoid Them

Ron Carucci
Harvard Business Review
Originally posted August 29, 2017

Here is an excerpt:

Facing high-risk decisions. 

For routine decisions, most leaders fall into one of two camps: The “trust your gut” leader makes highly intuitive decisions, and the “analyze everything” leader wants lots of data to back up their choice. Usually, a leader’s preference for one of these approaches poses minimal threat to the decision’s quality. But the stress caused by a high-stakes decision can provoke them to the extremes of their natural inclination. The highly intuitive leader becomes impulsive, missing critical facts. The highly analytical leader gets paralyzed in data, often failing to make any decision. The right blend of data and intuition applied to carefully constructing a choice builds the organization’s confidence for executing the decision once made. Clearly identify the risks inherent in the precedents underlying the decision and communicate that you understand them. Examine available data sets, identify any conflicting facts, and vet them with appropriate stakeholders (especially superiors) to make sure your interpretations align. Ask for input from others who’ve faced similar decisions. Then make the call.

Solving an intractable problem. 

To a stressed-out leader facing a chronic challenge, it often feels like their only options are to either (1) vehemently argue for their proposed solution with unyielding certainty, or (2) offer ideas very indirectly to avoid seeming domineering and to encourage the team to take ownership of the challenge. The problem, again, is that neither extreme works. If people feel the leader is being dogmatic, they will disengage regardless of the merits of the idea. If they feel the leader lacks confidence in the idea, they will struggle to muster conviction to try it, concluding, “Well, if the boss isn’t all that convinced it will work, I’m not going to stick my neck out.”

The article is here.

Wednesday, May 3, 2017

Ethics office says it wasn’t consulted about Ivanka Trump job

CNN Wire
Originally published May 2, 2017

The White House brought Ivanka Trump on as an adviser without consulting the Office of Government Ethics, the ethics office says.

The New York Times and Politico reported March 20 that the president’s older daughter was working out of a West Wing office. A White House official told CNN that she would get a security clearance but would not be considered a government employee.

The next day, White House Press Secretary Sean Spicer assured reporters that Ivanka Trump would follow the ethics restrictions that apply to federal employees. He said she was acting “in consultation with the Office of Government Ethics.”

But the ethics office, in a letter made public Monday, said it was not consulted. Director Walter Shaub said he reached out to the White House and to Ivanka Trump’s lawyer on March 24 to tell them that Ivanka Trump should be considered a federal employee, subject to those rules.

Monday, April 10, 2017

Citigroup Has an On-call Ethicist to Help It Solve Moral Issues

Alana Abramson
Fortune Magazine
Originally posted March 17, 2017

It turns out that Citigroup has an on-call ethicist to handle issues around the intersection of banking, finance, and morality.

The bank has worked with Princeton University Professor David Miller for the past three years, according to the Wall Street Journal. His role includes providing advice to top executives and reviewing topics and projects they have concerns about.

Miller was brought on, according to the Journal, by Citigroup CEO Michael Corbat, who felt the role was necessary after learning about employees' hesitations to voice concerns about wrongdoings, and public perceptions of banks.

The article is here.

Wednesday, October 28, 2015

Exploring Accountability of Clinical Ethics Consultants: Practice and Training Implications

Kathryn L. Weise & Barbara J. Daly
The American Journal of Bioethics
Volume 14, Issue 6, 2014

Abstract

Clinical ethics consultants represent a multidisciplinary group of scholars and practitioners with varied training backgrounds, who are integrated into a medical environment to assist in the provision of ethically supportable care. Little has been written about the degree to which such consultants are accountable for the patient care outcome of the advice given. We propose a model for examining degrees of internally motivated accountability that range from restricted to unbounded accountability, and support balanced accountability as a goal for practice. Finally, we explore implications of this model for training of clinical ethics consultants from diverse academic backgrounds, including those disciplines that do not have a formal code of ethics relating to clinical practice.

The entire article is here.

Sunday, October 25, 2015

Doctors' use of smartphones 'could threaten patient confidentiality'

By Denis Campbell
The Guardian
Originally published October 7, 2015

Details of patients’ illnesses and treatment could be leaked because so many doctors use smartphones to send details of their cases to each other, including x-ray results and photographs of wounds, warns research.

Patients are at risk of having their confidentiality breached because up to two-thirds of doctors are using SMS texts and picture messages to share information, including photographs of wounds, in the search for a second opinion.

The findings prompted concern that sensitive details of patients’ conditions could become public if doctors’ phones were lost or stolen or they inadvertently sent a message to a wrong number.

Research among 287 doctors and 564 nurses working at the five hospitals in the Imperial College healthcare NHS trust in London found that 65% of the doctors had used SMS messages to communicate with colleagues about a patient.

The entire article is here.

Tuesday, November 11, 2014

Human-subjects research: The ethics squad

By Elie Golgin
Nature
Originally published October 21, 2014

Here is an excerpt:

Ethical dilemmas in research are nothing new; what is new is that scientists can go to formal ethics consultancies such as Silber's to get advice. Unlike the standard way that scientists receive ethical guidance, through institutional review boards (IRBs), these services offer non-binding counsel. And because they do not form part of the regulatory process, they can weigh in on a wider range of issues — from mundane matters of informed consent and study protocol to controversial topics such as the use of experimental Ebola treatments — and offer more creative solutions.

The consulting services are “a really new area”, says Joshua Crites, a research ethicist at the Pennsylvania State College of Medicine in Hershey. “Even some of the most basic questions get complicated really quickly, and it's better to have a group of ethicists working together to sort this out.”

The entire article is here.

Thursday, September 18, 2014

Use and Misuse of Mental Health Professionals in Custody Cases

By Stephen Gassman and David A. Martindale
New York Law Journal
Originally published August 29, 2014

Here is an excerpt:

As is evident from the decision, the trial court found the mother misused numerous mental health professionals in pursuit of her goal of cutting the father out of the child's life. While accepting the evaluator's findings and most of his conclusions concerning the mother's ongoing alienation, the court did not adopt the evaluator's specific recommendation on the ultimate issue of what custodial arrangement would serve the child's best interests.

The court carefully delineated its reasons for so doing, articulating those facts of which the evaluator had been unaware. Particularly noteworthy is the court's statement that one of the "salient facts revealed during the course of the Hearing" and, therefore, unknown to the evaluator, was that the mother had "received extensive—over 50 hours—of preparation for her forensic interview…from…Dr. Jonathan Gould," a well-known forensic consultant from North Carolina. Justice Colangelo stated that this intensive preparation was "to the detriment of [the mother's] position…." in terms of assessing credibility.

The entire article is here.

Tuesday, September 2, 2014

Episode 14: Ethics and Quality Enhancement Strategies

In Episode 14, John welcomes Dr. Sam Knapp back to the podcast.  Sam was fresh off his Lifetime Achievement Award in Ethics Education from the American Psychological Association.  After John's first attempt at listener mail, the topic moves toward ethics education and ways to contemplate positive ethics.  Rather than looking at remedial ethics or the ethical floor, John and Sam give examples about striving for the ethical ceiling.  The focus on quality enhancement strategies grew out of risk management strategies.  From a quality enhancement perspective, Sam and John give several examples of what may trigger the need for quality enhancement strategies.  They also review four quality enhancement strategies: 1) consultation, 2) empowered collaboration, 3) documentation, and 4) redundant protections.  Sam and John also talk about psychologists' emotional reactions to patients.

At the end of this podcast, the listener will be able to:

1. Outline three quality enhancement strategies,
2. Describe how to prepare for a helpful consultation, and,
3. List the reasons why redundant protections are helpful in clinical practice.

Click here to earn one APA-approved CE credit


Or listen directly below




Resources for this podcast


Sam Knapp and John Gavazzi

John Gavazzi, PsyD ABPP


Ken Pope and Barbara G. Tabachnick

Wednesday, October 23, 2013

Quality Attestation for Clinical Ethics Consultants: A Two-Step Model from the American Society for Bioethics and Humanities

By Eric Kodish, Joseph J. Fins, and others
The Hastings Center Report
Originally published October 1, 2013

Abstract

Clinical ethics consultation is largely outside the scope of regulation and oversight, despite its importance. For decades, the bioethics community has been unable to reach a consensus on whether there should be accountability in this work, as there is for other clinical activities that influence the care of patients. The American Society for Bioethics and Humanities, the primary society of bioethicists and scholars in the medical humanities and the organizational home for individuals who perform CEC in the United States, has initiated a two-step quality attestation process as a means to assess clinical ethics consultants and help identify individuals who are qualified to perform this role. This article describes the process.

The entire story is here.

Monday, June 24, 2013

Five Ethical Mistakes To Avoid with Clients on the Internet

This is a brief overview of common mistakes to avoid with online psychotherapy.  If nothing else, this short video should help a psychologist contemplating providing online psychotherapy services.





From the Australian Counseling Association.

Wednesday, November 14, 2012

HCEC Pearls and Pitfalls: Suggested Do’s and Don’t’s for Healthcare Ethics Consultants


Joseph A. Carrese and the Members of the
American Society for Bioethics and Humanities
Clinical Ethics Consultation Affairs Standing Committee


1. Don't assume that the question you are asked to address is a matter of ethics, or that it is the primary issue or the only issue. Do take the time to clarify for yourself (and your team) the following: What are the relevant concerns, and are they a matter of ethics?

Those requesting an ethics consultation recognize that a problem exists. However, they may not be able to accurately determine whether the problem is truly a matter of ethics or not, and even if they can, they may not be able to correctly articulate the precise nature of the ethical concerns (that is, the values about which there is uncertainty or conflict). Further, requesters may not appreciate that, in addition to the question(s) they have raised, other important ethical concerns may be involved. One important task for HCECs, then, is to determine if the request is appropriate for ethics consultation and, if so, to clarify the ethical concern(s). 1 If the request does not involve an ethics question (that is, what should be done in the face of uncertainty or conflict about values), it should be referred to other resources in the healthcare system that are better equipped to handle such requests. For example, if the requester is seeking a legal opinion, he or she should be referred to legal counsel. Similar to making a diagnosis in clinical medicine, where precision in diagnosis leads to appropriate intervention, clearly and accurately identifying and describing the ethical concerns in an ethics consultation will more likely lead to a correct and helpful analysis and appropriate recommendations. Another parallel to clinical medicine is that, as the case unfolds over time, new issues may emerge. An initial set of questions, even when addressed and resolved, may lead to awareness of new ethical issues as the case evolves. The consultant should be attentive and open to this possibility and revisit the ethics question(s) in the consultation, as needed.

The other 11 suggestions are here.

Thanks to Ken Pope for this article.