Ethical and Moral Foundations in Mental Health Treatment
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Transcript of Ethical and Moral Foundations in Mental Health Treatment
Ethical and Moral Foundations in Mental Health
John D. Gavazzi, PsyD ABPPPsychologist
Ethics Educator
TW Ponessa and AssociatesJuly 18, 2014
www.ethicalpsychology.com
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Course Objectives
At the end of the presentation, the participant will be able to:
1. List the five foundational principles
2. Apply two NBCC directives or ACA principles to clinical practice
3. Explain how one personal, moral value integrates with good clinical practice
Personal Moral Development
Principle-based ethics
Ethical Codes
Examples of Morality in Treatment
Vignette Analysis
General Outline
• Creating a safe environment
• Avoid the word “unethical”
• We are all learning in this process
• Demonstrate courtesy and respect for others
Participant Safety
Personal moral compass-Believe it to be right
Knowing the difference between right and wrong
Emotional responses to dilemmas and actions
Implicit/rapid/automatic/internal/affective
Research shows people judge themselves and others based on moral characteristics – evolutionary and social reasons to judge “character”
Morality
Rules of Conduct – Profession/society
More external – Community (of peers)
Easier means to judge others’ actions
Can constrain individual choices or create dilemmas
Explicit/cognitive/external/measured
Ethics
Don't get caught. (Prep is important)
Killing must serve a purpose. (Murder?)
Be sure. (Evidence must add up)
Blend in. (Hired as forensic spatter expert.)
Control urges, and channel them.
The Case of Dexter Morgan
1. Religion/Family of Origin
2. Education: College and CE
3. Personal Education: Reading and Experience
4. Honest self-reflection
Personal Moral Development
Care - Harm
Fairness – Cheating
Loyalty-Betrayal
Authority – Subversion
Sanctity (Purity) – Degradation
Liberty - Oppression
Moral Foundations - Haidt
How did it develop?
How often do you use it to reflect on professional life?
How often do you use it to reflect on personal life?
How do you integrate your morals into your ethical practice?
What is your Moral Code?
Do you use it “before the fact”?
Is it intuitive and unconscious?
Is it more cognitive?
Is it written down?
What is your moral code?
Is it acceptance of another person’s or institution’s code in full?
If yes, why?
If not, why?
What is your moral code?
Do you use it “after the fact”?
Fundamental Attribution Error
Actor-Observer Bias
Motivated Moral Reasoning
What is your Moral Code?
Moral Licensing (Karmic balance or Cognitive Distortion)
Emotional Reasoning (Disgust)
Moral Dumbfounding (Do I really know?)
Personal Identity Protection Bias
Concepts in Moral Reasoning
Acculturation Model of professional development
Integration Separation
Assimilation Marginalization
Higher on Professional Ethics
Higher on Personal Ethics
Lower on Personal Ethics
Lower on Professional Ethics
Marginalized
Matrix: Lower on professional ethicsLower on personal ethics
Risks: *Greatest risk of harm*Lack appreciation for ethics*Motivated by self-interest*Less concern for patients
Assimilation
Matrix: Higher on professional ethicsLower on personal ethics
Risks: Developing an overly legalistic stance
Rigidly conforming to certainrules while missing broader issues
Separation
Matrix: Lower on professional ethicsHigher on personal ethics
Risks: Compassion overrides goodprofessional judgment
Fail to recognize the unique role of treatment
Integrated
Matrix: Higher on professional ethicsHigher on personal ethics
Reward: Implement values in context of professional roles
Reaching for the ethical ceiling
Aspirational ethics
AutonomyBeneficence
NonmaleficenceFidelityJustice
Principle-Based Ethics
Does not mean promoting autonomy (individuation or separation)
Means respecting the autonomous decision making ability of the patient
Respect for Autonomy
It encompasses freedom of thought and action.
Individuals are at liberty to behave as they chose.
- Determining goals in therapy
- Making life decisions (e.g., marriage, divorce)
- Scheduling appointments and terminating treatment
Autonomy
The principle of benefiting others and accepting the responsibility to do good underlies the profession.
- Providing the best treatment possible
- Competency
- Referring when needed
Beneficence
The principle is doing no harm.
- Demonstrating competence
- Maintaining appropriate boundaries
- Not using an experimental technique as the first line of treatment
- Providing benefits, risks, and costs
Nonmaleficence
This principle refers to being faithful to commitments. Fidelity includes promise keeping, trustworthiness, and loyalty.
- Avoiding conflicts of interests that could compromise therapy
- Keeping information confidential
- Adhering to therapeutic contract (e.g., session length, time, phone contacts, etc.)
Fidelity
Justice primarily refers to treating people fairly and equally.
Become aware of our biases/judgments to avoid negative countertransference and inequality.
Concepts of justice may included “social justice” and advocacy outside of our offices. Example include legislative and advocacy work.
Justice
NBCC Directives
Part of the Code of Ethics
Do no harm
Competence
Promote Welfare of others
Communicate Truthfully
Integrity of the profession, avoid damaging public trust
Collaboration & positive working relationships
ACA Code of Conduct
The Counseling Relationship
Avoid harm
Multiple relationships
Informed Consent
Managing Boundaries
Documentation
Cultural Sensitivity
Careful with imposing your values on others
Advocacy work
ACA Code of Conduct
Confidentiality and Privacy
Respecting rights and privacy
Couples/Family Treatment
Informed Consent
Client access to records
Document/Records
Case Consultation
Storage and Disposal of Records
Community Beneficence -Danger
ACA Code of Conduct
Professional Responsibility
Competence
Specialization/CE
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Media Presentations
Professional Impairment
No Sexual Harassment
Nondiscrimination
ACA Code of Conduct
Evaluation, Assessment & Interpretation
Client Welfare
Competence
Informed Consent
Diagnosis
Cultural Sensitivity
Prejudice/Pathology
Appropriate instruments
Forensic Issues
ACA Code of Conduct
Supervision, Training and Teaching
Client Welfare
Competence
Informed Consent
Multicultural Competence
Conflict of Interest
Boundary Issues
Sexual Issues
Teaching Ethics
Studies show that individuals who teach ethics and philosophy are not any more ethical or moral than others
The most ineffective way to teach ethics is learning ethical codes. Thoughts on this?
Quick note on teaching
Ethical VignettesFrom real life ethical dilemmas in the
mental health field
Older patient dies in car accident. The patient was not suicidal.
Adult child goes through papers and wants to find out what was discussed in treatment.
What should you do?
Recent vignette
Vignette Warehouse on Ethics and Psychology site
www.ethicalpsychology.com
Other Vignettes
Questions and Answers
Complete course evaluations