Dilemma 18: Co-authorship with a Former Patient

Dr. Jordan is a psychologist who typically works with a wide variety of patients.  At the end of the day, he listens to voicemail messages to learn that a former patient is reaching out to him for a request. 

Prior to returning the call, Dr. Jordan reviews the patient’s chart.  The patient had been in treatment for about 10 months on a weekly basis.  The treatment notes indicate that she dropped out of therapy about one year ago.  She stopped therapy because her insurance changed and Dr. Jordan was not an in-network provider.  The therapy focused on depression and anxiety related to work-related issues, interpersonal limitations, and relationship difficulties.  Some of the sessions focused on a sexually abusive relationship between a basketball coach and the patient when she was age 13 to 16.    

Dr. Jordan returns the phone call.  After the initial greetings, the former patient indicates that she has finally started to write down more thoughts, memories, and recollections about her abusive experiences.  She stated that Dr. Jordan recommended that she write down her memories.  She recalled that he agreed that it could make a good book.  She stated she wanted to include some education around sexual abuse and tell her story in a healthy, therapeutic manner.

When attempting to clarify the request, the former patient is not asking to return to therapy, but to have Dr. Jordan become the co-author or a consultant for the book.  Dr. Jordan thanked her for the compliment and indicated that he needed to think about the request.  He promised to call her back within a week.

Dr. Jordan calls you on the phone for an ethics consultation.

What are the ethical issues involved in this case?

What are some possible suggestions for Dr. Jordan?

If you were Dr. Jordan, how would you feel about this request?

Liberating Reason From the Passions: Overriding Intuitionist Moral Judgments Through Emotion Reappraisal

Matthew Feinberg, Robb Willer, Olga Antonenko and Oliver P. John
Psychological Science, 2012; 23 (7): 788 DOI: 10.1177/0956797611434747

Abstract

A classic problem in moral psychology concerns whether and when moral judgments are driven by intuition versus deliberate reasoning. In this investigation, we explored the role of reappraisal, an emotion-regulation strategy that involves construing an emotion-eliciting situation in a way that diminishes the intensity of the emotional experience. We hypothesized that although emotional reactions evoke initial moral intuitions, reappraisal weakens the influence of these intuitions, leading to more deliberative moral judgments. Three studies of moral judgments in emotionally evocative, disgust-eliciting moral dilemmas supported our hypothesis. A greater tendency to reappraise was related to fewer intuition-based judgments (Study 1). Content analysis of open-ended descriptions of moral-reasoning processes revealed that reappraisal was associated with longer time spent in deliberation and with fewer intuitionist moral judgments (Study 2). Finally, in comparison with participants who simply watched an emotion-inducing film, participants who had been instructed to reappraise their reactions while watching the film subsequently reported less intense emotional reactions to moral dilemmas, and these dampened reactions led, in turn, to fewer intuitionist moral judgments (Study 3).

'Conversion therapy' for gay patients unethical, says professional body

British Association for Counselling and Psychotherapy formalises policy change for 30,000-strong membership

Peter Walker
guardian.co.uk
Originally published Monday 1 October 2012


Britain's biggest professional body for psychotherapists has instructed members that it is unethical for them to attempt to "convert" gay people to being heterosexual, formalising a policy change long demanded by rights groups.

The British Association for Counselling and Psychotherapy has written to its near-30,000 members to inform them of the new guidelines. The letter says the BACP "opposes any psychological treatment such as 'reparative' or 'conversion' therapy which is based upon the assumption that homosexuality is a mental disorder, or based on the premise that the client/patient should change his/her sexuality". The body adds that it recognises World Health Organisation policy that says such therapies can cause severe harm to an individual's mental and physical health.

The statement, drawn up by the board of governors, ends: "BACP believes that socially inclusive, non-judgmental attitudes to people who identify across the diverse range of human sexualities will have positive consequences for those individuals, as well as for the wider society in which they live. There is no scientific, rational or ethical reason to treat people who identify within a range of human sexualities any differently from those who identify solely as heterosexual."

The entire story is here.

Christian group files suit to stop gay therapy ban

By The Associate Press
Originally published October 2, 2012


A Christian legal group has filed a lawsuit to overturn a first-of-its-kind California law that prohibits licensed mental health professionals from practicing therapies aimed at making gay and lesbian teenagers straight.

The California-based Pacific Justice Institute challenged the law signed Saturday by Gov. Jerry Brown. The lawsuit was filed late Monday in U.S. District Court in Sacramento.

The institute filed the suit on behalf of a psychiatrist and a marriage and family therapist who is also a church pastor in San Diego. It also names as a plaintiff Aaron Bitzer, a Culver City man who says he has benefited from the "reparative" therapy.

The lawsuit claims the law, which is scheduled to take effect Jan. 1, violates First Amendment and equal protection rights.

Meanwhile, gay rights advocates are making plans to get other states to join California in banning such therapies.

Brown called the therapies "quackery" that "have no basis in science or medicine."

The entire story is here.

Suicide Outbreak Prompts CDC Assessment

Community education and availability of mental health resources are called essential in efforts to limit suicidal behavior.

By Christopher White
Psychiatric News
Originally published September 21, 2012

In the first five months of this year, 11 young people completed suicide in Kent and Sussex counties in Delaware, an increase from the yearly average of four in those aged 12 to 21 from 2009 to 2011.

Reflecting the state’s concern about this troubling development, the Delaware Department of Health and Human Services asked the federal Centers for Disease Control and Prevention (CDC) to conduct an epidemiological study to determine the rates of fatal and nonfatal suicide behaviors in the area, analyze risk factors, and recommend strategies to prevent future suicides.

Of the 11 decedents, four were students at the same high school, two were students at other local high schools, one was a student at a middle school, one had dropped out of high school, two had graduated from area high schools and were still living in Sussex County, and one was an adult with unknown education history.


The entire story is here.

Suicide, Not Car Crashes, #1 Cause of Injury Death

By Jennifer Warner
WebMD Health News
Originally published September 20, 2012

Suicide has overtaken car crashes as the leading cause of injury-related deaths in the U.S.

(cut)

The top five leading causes of injury-related deaths were:

1. Suicide
2. Motor vehicle crashes
3. Poisoning
4. Falls
5. Homicide

Researchers say the findings demonstrate that suicide is now a global public health issue.

"Our finding that suicide now accounts for more deaths than do traffic crashes echoes similar findings for the European Union, Canada, and China," they write.

Researchers say deaths from unintentional poisoning rose, in part, because of a sharp rise in prescription drug overdoses.

The entire article is here.

Is A Competitive Health Care Model All It’s Cracked Up To Be?

By Julie Appleby and Marilyn Werber Serafini
Kaiser Health News, in conjunction with The Atlantic
Originally published on September 20, 2012

Republican vice presidential nominee Paul Ryan says his proposal to overhaul Medicare would use market competition to tame costs in the government health program relied on by almost 50 million people.

As models, he often cites the health program for federal employees – including members of Congress -- and Medicare’s prescription drug program. "It works with federal employees, it works with the prescription drug benefit, and more to the point, it saves Medicare," Ryan said on "Meet the Press" in April.

Both of those programs get high marks from beneficiaries for the choices they offer. But their track record on cost control is more complicated, raising questions about whether the competitive model is in fact the silver bullet that backers have suggested. 

The federal employee health insurance program is often touted as holding down the increase in premium prices more successfully than private workplace plans or government-run programs. But a data analysis done for Kaiser Health News (KHN) and interviews with experts shows it has not held down costs per enrollee as efficiently as Medicare during the past decade.

Average spending in the federal workers’ program grew at 7.1 percent annually per enrollee, higher than the 5.8 percent growth rate for traditional Medicare – excluding the drug program -- over the decade ending in 2010, according to data analyzed at KHN’s request.  The analysis, based on 10-year averages, was done by Walton Francis, a consultant and principal author for 30 years of the Consumers’ Checkbook Guide to Health Plans for Federal Employees.

The entire story is here.

California Is First State to Ban Gay ‘Cure’ for Minors

By ERIK ECKHOLM
The New York Times
Originally published September 30, 2012

California has become the first state to ban the use for minors of disputed therapies to “overcome” homosexuality, a step hailed by gay rights groups across the country that say the therapies have caused dangerous emotional harm to gay and lesbian teenagers.

“This bill bans nonscientific ‘therapies’ that have driven young people to depression and suicide,” Gov. Jerry Brown said in a statement on Saturday after he signed the bill into law. “These practices have no basis in science or medicine, and they will now be relegated to the dustbin of quackery.”

The law, which is to take effect on Jan. 1, states that no “mental health provider” shall provide minors with therapy intended to change their sexual orientation, including efforts to “change behaviors or gender expressions, or to eliminate or reduce sexual or romantic attractions or feelings toward individuals of the same sex.”

The entire story is here.

Spontaneous giving and calculated greed

D. G. Rand, J. D. Greene & M. A. Nowak

Nature 489, pp 427-430 – doi:10.1038/nature11467

Abstract

Cooperation is central to human social behaviour. However, choosing to cooperate requires individuals to incur a personal cost to benefit others. Here we explore the cognitive basis of cooperative decision-making in humans using a dual-process framework. We ask whether people are predisposed towards selfishness, behaving cooperatively only through active self-control; or whether they are intuitively cooperative, with reflection and prospective reasoning favouring ‘rational’ self-interest. To investigate this issue, we perform ten studies using economic games. We find that across a range of experimental designs, subjects who reach their decisions more quickly are more cooperative. Furthermore, forcing subjects to decide quickly increases contributions, whereas instructing them to reflect and forcing them to decide slowly decreases contributions. Finally, an induction that primes subjects to trust their intuitions increases contributions compared with an induction that promotes greater reflection. To explain these results, we propose that cooperation is intuitive because cooperative heuristics are developed in daily life where cooperation is typically advantageous. We then validate predictions generated by this proposed mechanism. Our results provide convergent evidence that intuition supports cooperation in social dilemmas, and that reflection can undermine these cooperative impulses.

The entire article is here.

Here is a portion of a review of this article:

The researchers wanted to know whether people's first impulse is cooperative or selfish. To find out, they started by looking at how quickly different people made their choices, and found that faster deciders were more likely to contribute to the common good. 

Next they forced people to go fast or to stop and think, and found the same thing: Faster deciders tended to be more cooperative, and the people who had to stop and think gave less.

Finally, the researchers tested their hypothesis by manipulating people's mindsets. They asked some people to think about the benefits of intuition before choosing how much to contribute. Others were asked to think about the virtues of careful reasoning. Once again, intuition promoted cooperation, and deliberation did the opposite.

While some might interpret the results as suggesting that cooperation is "innate" or "hard-wired," if anything they highlight the role of experience. People who had better opinions of those around them in everyday life showed more cooperative impulses in these experiments, and previous experience with these kinds of studies eroded those impulses. 

The entire review is here.