Ethical behaviour of physicians and psychologists: similarities and differences

Ferencz Kaddari M, Koslowsky M, Weingarten MA
Journal of Medical Ethics Published Online First: 18 August 2017.

Abstract

Objective 

To compare the coping patterns of physicians and clinical psychologists when confronted with clinical ethical dilemmas and to explore consistency across different dilemmas.

Population 88 clinical psychologists and 149 family physicians in Israel.

Method 

Six dilemmas representing different ethical domains were selected from the literature. Vignettes were composed for each dilemma, and seven possible behavioural responses for each were proposed, scaled from most to least ethical. The vignettes were presented to both family physicians and clinical psychologists.

Results 

Psychologists’ aggregated mean ethical intention score, as compared with the physicians, was found to be significantly higher (F(6, 232)=22.44, p<0.001, η2=0.37). Psychologists showed higher ethical intent for two dilemmas: issues of payment (they would continue treating a non-paying patient while physicians would not) and dual relationships (they would avoid treating the son of a colleague). In the other four vignettes, psychologists and physicians responded in much the same way. The highest ethical intent scores for both psychologists and physicians were for confidentiality and a colleague's inappropriate practice due to personal problems.

Conclusions 

Responses to the dilemmas by physicians and psychologists can be categorised into two groups: (1) similar behaviours on the part of both professions when confronting dilemmas concerning confidentiality, inappropriate practice due to personal problems, improper professional conduct and academic issues and (2) different behaviours when confronting either payment issues or dual relationships.

The research is here.

Trump's politicking raises ethics red flags

Julie Bykowicz
The Associated Press
Originally posted on June 27, 2017

Here is an excerpt:

The historically early campaigning comes with clear fundraising benefits, but it has raised red flags. Among them: Government employees have inappropriately crossed over into campaign activities, tax dollars may be subsidizing some aspects of campaign events, and as a constant candidate, the president risks alienating Americans who did not vote for him.

Larry Noble, former general counsel to the Federal Election Commission, said the early campaigning creates plenty of "potential tripwires," adding: "They're going to have to proceed very carefully to avoid violations."

The White House ensures that political entities pay for campaign events, and White House lawyers provide advice to employees to make sure they do not run afoul of rules preventing overtly political activities on government time, spokeswoman Lindsay Walter said Tuesday.

The Trump team has decided that any risks are worth it.

The article is here.

Harvard Tells Profs Not to Sleep With Undergrads

By John Lauerman

Bloomberg Business

Originally posted February 5, 2015

Harvard University banned professors from having “sexual or romantic relationships” with undergraduates, joining a list of campuses that have taken similar steps.

Many colleges discourage but don’t ban sex between professors and students. While a national professors’ group doesn’t favor such a prohibition, recent moves by Harvard, Yale University and the University of Connecticut suggest the tide may be turning.

The entire story is here.

Verification of Postdoctoral Experience: Pitfalls for Students

By Rachael Baturin, MPH, JD
The Pennsylvania Psychologist
June 2012

One of the requirements for students interested in becoming licensed in Pennsylvania is to complete one year of postdoctoral experience. It is very important for potential supervisees to review the postdoctoral experience requirements before they start this experience as there are a lot of nuances to the law, and the postdoctoral experience requirements vary from state to state. There have been cases where supervisees did not review the requirements before starting their experience, their experience did not qualify for the postdoctoral year, and they needed to repeat it.

This article will discuss some of the pitfalls that supervisees and supervisors have faced when trying to complete the verification of postdoctoral experience form, which must be sent to the State Board of Psychology upon completion of postdoctoral requirements. If readers would like to review all postdoctoral requirements in Pennsylvania, they can be found in the Pennsylvania State Board of Psychology’s regulations, Section 41.32 and Section 41.33, available on the State Board’s website: http://www.pacode.com/secure/data/049/chapter41/chap41toc.html.

Practical Issues

First, the supervisee should check to see whether the supervisor has been subject to any disciplinary actions by the State Board of Psychology. If they are currently being disciplined, they may not qualify as a supervisor. After December 1, 2015, postdoctoral supervisors must have completed either a course in supervision or 3 hours of continuing education in supervision.

Second, supervisees are required to have at least half of their training in diagnosis, assessment, therapy, other interventions, consultation, and individual supervision received as a supervisee, and the other half may be in teaching in association with either an organized psychology program preparing practicing psychologists and/or a postdoctoral training program, supervision provided as a supervisor, professional development, or research. For example, if a supervisee is doing 40 hours per week of research and 20 hours per week of direct services, the student should count 20 hours of research and 20 hours of direct services per week because at least half must be in direct services. There have been cases where the supervisee submitted a verification form on which it appeared as though 50% of the time was not in providing direct services because the supervisee was submitting too many research hours.

An hour of diagnosis, assessment, or therapy does not necessarily have to be an hour of direct patient contact. For example, a supervisee could spend an hour in therapy with a child and then spend another hour talking to the pediatrician and the school. Both of those hours should be counted toward fulfilling the 1,750-hour requirement for the postdoctoral year.

As another example, if the supervisee is just starting supervision and is seeing clients fewer than 15 hours per week, the supervisee could ask the supervisor for a research project to undertake in order to obtain additional hours, as long as they do not exceed 50% of the postdoctoral hours.

Next, supervisees are required to have 2 hours of face-to-face meetings with their supervisors per week. If you need to complete your experience in two different settings, you are still required to have 2 hours of face-to-face meetings with your supervisor at each site unless the sites are interrelated. For example, if one site is owned by ABC Corporation and the other is owned by XYZ Corporation, then the supervisee is required to get 2 hours of supervision at each site. However, if both sites were owned by ABC Corporation and one was the main office and the other a satellite office then the supervisee would be required to obtain only 2 hours of supervision for both sites. Also, supervisees must be present at each site for at least 6 consecutive months for the experience to count. There have been cases where students failed to meet this requirement and had to repeat the experience.

Last, the supervisor is required to maintain records or notes of the scheduled supervisory sessions, observe client/patient sessions of the supervisee or review verbatim recordings of these sessions on a regular basis and must prepare written evaluations or reports which are discussed with the supervisee. Once again, cases exist in which the supervisor failed to produce the written evaluations and the experience did not count.

Dual Relationships

The supervisor and supervisee must not be in a dual relationship. The supervisor cannot be related to the supervisee by blood or marriage, nor can the supervisor have a therapeutic relationship with the supervisee. In addition, supervisees are not allowed to pay supervisors for supervision (although supervision may be paid by a third party). The supervisor must be free from the supervisee’s control or influence and must be allowed to stop the supervisory relationship if necessary.

Vignette 12: A Request for Assistance

Dr. Lilith Crane, a psychologist from a small rural campus, calls you on the phone for a consultation.

Dr. Crane currently works with an undergraduate student, Dan, on issues related to self-esteem and depression.  An ongoing theme in therapy revolves around his sexual orientation.  Dan recently came out to his parents, who were accepting of his gay orientation and lifestyle.  From that positive experience, Dan wants to start a support organization for other GLBTQ students on campus. 

Dan explained to Dr. Crane that this group would be student-led and meet on campus.  He does not view it as a therapy group.  Dan’s vision is that the group would meet periodically to provide one another with support, to do problem solving, to share information and personal struggles, and perhaps to provide some psycho-educational work on campus.  Dan indicates that they may also want to engage in fundraising in order for GLBTQ students to attend state or national events.

Dan asked a number of faculty members to be the faculty advisor of this group.  While most were supportive, all declined the invitation (likely because the campus is small and in a conservative area of the state).

Out of options, Dan asked Dr. Crane to be the faculty advisor.  Dr. Crane applauded and appreciated the student’s energy and creativity, but indicated some concern about dual role with the student.  She told the student that she would think about the request prior to answering.

Dr. Crane is questioning the pros and cons of being the psychologist and the faculty advisor.  Dr. Crane feels ambivalent because of their therapeutic relationship, but also wants to help Dan because he appears to have limited options.

What are the possible downsides to entering the dual relationship?

What are the possible steps Dr. Crane can take to mitigate any potential difficulties?

What are other steps that the psychologist may want to take in this situation?

Dual-Relationship Dilemmas of Rural and Small-Community Psychologists

Dual Relationships in Rural and Small Community Psychologist

Jury Rules in Favor of Man Suing Therapist for Sparking Relationship with his Wife during Counseling

by TaMaryn Waters

Tallahassee Democrat

This is not a made-for-television-movie scenario, but it felt like one for Richard Webb. His 25-year marriage was crumbling so he sought counseling from Kevin Ragsdale from September 2007 to January 2008, court records show.

Within the four-month span of counseling, Webb's wife was brought in to joint counseling sessions.

But Webb didn't know Ragsdale conducted private sessions with his wife and later sparked a relationship.

Webb sued Ragsdale, who married Webb's wife in January 2010, for emotional damages and a Leon County jury has ruled the therapist violated several code of ethics...

<snip>

Dana Brooks, Webb's attorney, said the jury ruled Ragsdale was 65 percent responsible for negligence that caused a "legal cause of harm or loss" to Webb and 35 percent of the negligence was caused by Webb.

Brooks, however, said there was no evidence presented at trial related to Webb's role in negligence.

She plans to file a motion for a post trial hearing.

Brooks said a judge will make a judgment on what the final verdict should be for Webb, including damages, during the post trial, which could be sometime next month.

She said her client, the father of three children ages 14, 18 and 21 during the time of the counseling, said Webb continues to have "a great deal of difficulty on any kind of parenting issues" now that Ragsdale has married his ex-wife.

"My client feels like he is being completing supplanted and replaced," she said.

================

Thanks to Ken Pope for this story.

For some reason, the Tallahassee Democrat no longer has the full story on their web site.

Psychologist admits to romance with inmate

Paul Walsh for the Star Tribune

A psychologist had a summertime romance with an inmate she was counseling, the state Board of Psychology determined, prompting the panel to revoke her license for at least 10 years.

In findings released Thursday, the board found that Nicole Holman, 33, of St. Paul, admitted to state Department of Corrections investigators that she and the inmate began their sexual relationship in June 2010 while she was providing therapy to him as part of the chemical dependency program.

While the board's report didn't disclose where Holman worked, state records show that she was at the Lino Lakes prison at the time of the relationship. The name of the inmate also was not disclosed.

According to the board:

Holman and the inmate "engaged in sexually explicit dialogue" in telephone conversations last summer. One call refers to the inmate "spanking" Holman. Two other calls refer to when the inmate exposed himself to Holman, "presumably during a therapeutic session."

In a three-week period from late July to mid-August, the inmate called Holman's cell phone 106 times.

Holman can apply to have her license restored in 10 years.

Prior to working with the Department of Corrections, Holman was employed with Hennepin County as a child-protection social worker, according to county records.

A telephone message was left Thursday afternoon with Holman seeking a reaction to the board's ruling.