| 0. Preface
| xvii
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| PART 1: FOUNDATIONS
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| 1. Helping Without Hurting
| 3
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| 1. Psychological ethics: responsibility to help more and hurt less
| 3
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| 2. WHAT DO I DO NOW? "The psyche" highly sensitive "subject."
| 6
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| 3. Eight basic assumptions about ethical awareness
| 7
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| 2. Ethics in Real Life
| 12
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| 1. Records
| 13
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| 2. Lunch
| 14
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| 3. The mechanic
| 15
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| 4. Evaluating children
| 15
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| 5. Staying sober
| 16
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| 6. The internship
| 17
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| 7. The fatal disease
| 17
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| 8. Life in chaos
| 18
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| 9. Language: the interpreter
| 19
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| 10. Computer coincidences
|
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| 3. Ethics Theories and Codes
| 22
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| 1. Theories of ethics
| 23
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| 1. Utilitarianism
| 23
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| 2. Kantian ethics
| 24
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| 3. Feminist ethics
| 24
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| 4. American Indian ethics
| 25
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| 2. Codes, accountability and conflicts
| 27
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| 3. American Psychological Association approach to ethics code
| 29
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| 1. The first APA code
| 30
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| 2. The empirical approach to a code half a century later
| 31
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| 3. Confidentiality
| 31
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| 4. Blurred, dual or conflictual relationships
| 31
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| 5. Payment sources, plans, settings and methods
| 33
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| 6. Academic settings, teaching dilemmas
and concerns about training
| 33
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| 7. Forensic psychology
| 34
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| 8. Research
| 34
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| 9. Conduct of colleagues
| 34
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| 10. Sexual issues
| 35
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| 11. The current APA ethics code
| 35
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| 4. Canadian Psychological Association's approach to an ethics code
| 36
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| 5. Adjudication of ethics complaints for CPA and APA
| 37
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| 4. Dignity and Respect
| 40
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| 1. Treating each person with dignity and respect
| 40
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| 2. Diagnostic Categories
| 45
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| 3. Financial Concerns
| 46
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| 4. Fatigue
| 46
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| 5. Personal predispositions, biases and prejudices
| 46
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| 5. Trust, Power, Caring, and Healing
| 48
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| 1. Trust
| 48
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| 2. Power
| 51
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| 1. Power conferred by the state
| 52
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| 2. Power to name and define
| 53
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| 3. Power of testimony
| 54
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| 4. Power of knowledge
| 54
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| 5. Power of expectation
| 55
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| 6. Therapist-created power
| 55
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| 7. Inherent power-differential
| 56
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| 3. Caring and Healing
| 56
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| 6. Competence, Humility, and the Human Therapist
| 59
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| 1. Competence as an ethical and legal responsibility
| 62
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| 2. Competence and conflict
| 62
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| 3. Intellectual competence: know about and knowing how
| 65
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| 4. Emotional competence for therapy: knowing yourself
| 73
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| 7. Culture, Context, and Ethics in Psychotherapy and Counseling
| 73
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| 1. Culture has always been a part of healing
| 74
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| 2. Cultural competence
| 75
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| 1. The impact of cultural competence on treatment
| 77
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| 3. Cultural competence and professional guidelines
| 79
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| 4. Building cultural competence
| 80
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| 1. Looking inward
| 81
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| 2. Looking outward
| 83
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| 5. Scenarios for discussion
| 84
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| 8. 17 Steps in Ethical Decision-Making
| 88
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| 1. State the question, dilemma or concern as clearly as possible
| 89
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| 2. Anticipate who will be affect by the decision
| 89
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| 3. Figure out who, if anyone, is the client
| 89
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| 4. Assess whether our areas of competence—and of missing knowledge,
skills, experience or expertise—fit the situation
| 90
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| 5. Review relevant formal ethics codes and standards
| 90
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| 6. Review relevant legal standards
| 90
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| 7. Review the relevant research and theory
| 91
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| 8. Consider whether personal feelings, biases or self-interest
might shade our ethical judgment
| 91
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| 9. Consider whether social, cultural, religious, or similar factors affect
the situation and the search for the best response
| 91
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| 10. Consider consultation
| 92
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| 11. Develop alternative courses of action
| 92
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| 12. Think through the alternative courses of action
| 92
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| 13. Try to adopt the perspective of each person who will be affected
| 93
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| 14. Decide what to do, review or reconsider it, and take action
| 93
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| 15. Document the process and assess the results
| 93
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| 16. Assume personal responsibility for the consequences
| 94
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| 17. Consider implications for preparation, planning and prevention
| 94
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| 9. Moral Distress and Moral Courage
| 95
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| 1. The psychologist as whistle blower: A case study
| 100
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| 2. Background
| 101
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| 3. Bureaucratic-professional conflict
| 104
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| 4. The transfer
| 105
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| 5. Legal maneuvers
| 109
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| 6. The profession's response
| 110
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| 7. The loneliness of whistle blowing
| 111
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| PART 2: COMMON SOURCES OF PROBLEMS
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| 10. Ethics, Science, and Pseudoscience
| 115
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| 11.Ethical Fallacies
| 121
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| 1. Ad hoc rationalization
| 121
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| 2. Ad hominem or ad feminam (bullshit. ad hominem.)
| 122
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| 3. Affirming the consequent
| 122
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| 4. Appeal to ignorance (ad ignorantium)
| 123
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| 5. Argument to logic (argumentum ad logicam
| 123
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| 6. Begging the question (petitio principii)
| 123
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| 7. Composition fallacy
| 124
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| 8. Denying the antecedent
| 124
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| 9. Disjunctive fallacy
| 125
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| 10. Division fallacy or decomposition fallacy
| 125
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| 11. Existential fallacy
| 125
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| 12. False analogy
| 126
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| 13. False continuum
| 126
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| 14. False dilemma
| 126
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| 15. False equivalence
| 127
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| 16. Genetic fallacy
| 127
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| 17. Golden mean fallacy
| 127
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| 18. Ignoratio elenchi
| 128
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| 19. Mistaking deductive validity for truth
| 128
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| 20. Naturalistic fallacy
| 128
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| 21. Nominal fallacy
| 129
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| 22. Post hoc, ergo propter hoc (after this, therefore on account of this)
| 129
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| 23. Red herring
| 130
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| 24. Slippery slope (the camel's nose fallacy)
| 130
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| 25. Straw person —bullshit. Straw man
| 131
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| 26. You too! (tu quoque)
| 131
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| 12. Pitfalls in Ethical Judgment
| 132
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| 1. Substitute the general for the specific
| 144
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| 2. Use a conditional frame for consequences
| 145
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| 3. Use denied motivation as misdirection
| 145
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| 4. Use the abstract language of technicalities
| 145
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| 5. Use the passive voice
| 145
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| 6. Make unimportant by describing what did not occur
| 146
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| 7. Replace intentional unethical behavior with the language of
accidents, misfortune, and mistakes
| 147
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| 8. Smother the events in the language of attack
| 147
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| 9. Using language to generate empathy
| 148
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| 13. Language and Ethics
| 142
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| 14. Ethics Placebos, Rationalizations, and Excuses
| 149
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| PART 3: SPECIAL TOPICS
|
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| 15. Beginnings and Endings, Absence and Access
| 157
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| 1. Accessibility for people with disabilities
| 158
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| 2. Clarification
| 159
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| 3. Therapist availability between sessions
| 161
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| 4. Vacations and other anticipated absences
| 163
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| 5. Serious illness and other unanticipated absences
| 163
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| 6. Steps for making help available in a crisis
| 164
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| 7. Endings
| 167
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| 8. Conclusion
| 170
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| 9. Scenarios for discussion
| 172
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| 16. Informed Consent and Informed Refusal
| 175
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| 1. Frightening forms, empty formalities, and needless burdens
|
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| 2. Process of informed consent
|
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| 3. The foundation of informed consent
|
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| 4. Adequate information
|
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| 5. Considerations in providing informed consent
|
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| 1. Failing to Provide Informed Consent
| 186
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| 2. Benefits of Informed Consent
| 188
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| 3. Limits of Consent
| 188
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| 4. Consent for Families and Other Multiple Clients
| 188
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| 5. Unequal Opportunity for Informed Consent
| 189
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| 6. Cognitive Processes
| 190
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| 7. Problems with Forms
| 190
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| 6. Scenarios for discussion
|
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| 17. Creating and Using Strategies for Self-Care
| 196
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| 1. Paying attention to the self
| 196
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| 2. What happens when self-care is neglected
| 197
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| 1. Disrespecting clients
| 197
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| 2. Disrespecting work
| 198
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| 3. Making More Mistakes
| 198
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| 4. Lacking energy
| 198
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| 5. Becoming anxious and afraid
| 198
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| 6. Using work to block out unhappiness, pain, and discontent
| 198
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| 7. Losing interest
| 199
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| 3. Making sure the strategies fit
| 199
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| 1. Isolation vs. connection
| 199
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| 2. Monotony vs. variety
| 200
|
| 3. Fatigue vs. limits, rest, and renewal
| 200
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| 4. The sedentary life vs. physical activity and exercise
| 200
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| 5. The dispirited life vs. nurturing the spirit
| 201
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| 6. The unsupported life vs. support networks
| 201
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| 4. The need for change
| 205
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| 18. Creating a Professional Will
| 206
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| 1. Who takes charge?
| 207
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| 2. Who serves as backup?
| 207
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| 3. Coordinated planning
| 207
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| 4. Your office, its key, and its security
| 208
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| 5. Your schedule
| 208
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| 6. Client records and contact information
| 209
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| 7. Avenues of communication for clients and colleagues
| 209
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| 8. New messages for your answering machine, email account, etc
| 209
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| 9. Informed consent
| 210
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| 10. Client notification
| 210
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| 11. Colleague notification
| 211
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| 12. Professional liability coverage
| 211
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| 13. Attorney for professional issues
| 211
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| 14. Billing records, procedures, and instructions
| 211
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| 15. Expenses
| 212
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| 16. Your personal will
| 212
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| 17. Legal review
| 212
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| 18. Copies of the professional will
| 213
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| 19. Review and update
| 213
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| 19. Responding to Ethics, Licensing, or Malpractice Complaints
| 214
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| 1. Don't panic
| 215
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| 2. Consult your attorney first-and make sure you have a good one!
| 215
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| 3. Notify your professional liability carrier
| 216
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| 4. Who is your attorney's client?
| 217
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| 5. Is the complaint valid?
| 217
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| 6. Did you make a formal complaint more likely?
| 217
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| 7. Apologize and accept responsibility?
| 218
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| 8. What are you willing to have done?
| 219
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| 9. Recognize how the complaint is affecting you
| 220
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| 10. Get the help and support you need
| 220
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| 11. What can the ordeal teach?
| 221
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| 20. Assessment, Testing, and Diagnosis
| 222
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| 1. Awareness of standards and guidelines
| 223
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| 2. Staying within areas of competence
| 224
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| 3. Ensuring that our tests and assessment methods
stay within their areas of competence
| 225
|
| 4. Understanding measurement, validation, and research
| 226
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| 5. Ensuring that patients understand and consent to testing
| 226
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| 6. Clarifying access to the test report and raw data
| 227
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| 7. Following standard procedures for administering tests
| 228
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| 8. Knowing the literature on recordings and third-party observers
| 230
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| 9. Awareness of basic assumptions
| 231
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| 10. Awareness of personal factors leading to misusing diagnosis
| 232
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| 11. Awareness of financial factors leading to misusing diagnosis
| 233
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| 12. Acknowledging low base rates
| 234
|
| 13. Acknowledging dual high base rates
| 235
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| 14. Avoiding confusion between retrospective and predictive accuracy
| 235
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| 15. Awareness of forensic issues
| 236
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| 16. High stakes testing
| 236
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| 17. Attention to potential medical causes
| 238
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| 18. Critically examining prior records and history
| 238
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| 19. Clearly state all reservations about reliability and validity
| 239
|
| 20. Avoiding the cultural equivalency fallacy in assessment
| 240
|
| 21. Providing adequate feedback
| 240
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| 22. Scenarios for discussion
| 243
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| 21. Confidentiality
| 246
|
| 1. Note to readers
| 248
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| 2. Referral sources
| 249
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| 3. Public consultation
| 249
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| 4. Gossip
| 250
|
| 5. Case notes and patient files
| 250
|
| 6. Phones, faxes, and messages
| 251
|
| 7. Home office
| 251
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| 8. Sharing with loved ones
| 252
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| 9. Post-death confidentiality
| 252
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| 10. Communications in group or family therapy
| 252
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| 11. Written consent
| 253
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| 12. Managed care and other organizations
| 254
|
| 13. Disclosing confidential information for mandated reports only
to the extent required by law distraction
| 256
|
| 14. Publishing case studies
| 257
|
| 15. Distraction
| 258
|
| 16. Focusing on legal responsibilities to
the exclusion of ethical responsibilities
| 259
|
| 17. Scenarios for discussion
| 259
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| 22. Recognizing, Assessing, and Responding to Suicidal Risk
| 263
|
| 1. Assessing suicidal risk
| 266
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| 1. Direct verbal warning
| 266
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| 2. Plan
| 267
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| 3. Past attempts
| 267
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| 4. Indirect statements and behavioral signs
| 267
|
| 5. Depression
| 267
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| 6. Hopelessness
| 267
|
| 7. Alcohol use and abuse.
| 267
|
| 8. Marital separation or divorce
| 267
|
| 9. Clinical syndromes
| 267
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| 10. Sex
| 268
|
| 11. Age
| 268
|
| 12. Race and ethnicity
| 268
|
| 13. Religion
| 268
|
| 14. Living alone
| 268
|
| 15. Bereavement
| 268
|
| 16. Unemployment
| 268
|
| 17. Health status
| 268
|
| 18. Impulsivity
| 268
|
| 19. Rigid thinking
| 268
|
| 20. Stressful events
| 269
|
| 21. Release from hospitalization
| 269
|
| 22. Isolation, lack of a sense of belonging, or loneliness
| 269
|
| 2. Special considerations
| 269
|
| 3. Avoiding pitfalls: advice from experts
| 272
|
| 4. Scenarios for discussion
| 283
|
| 23. Supporting Human Rights and Addressing Oppression in Psychotherapy
| 288
|
| 1. Universal Declaration of Ethical Principles for Psychologists
and Actionable Exemplars.
| 290
|
| 2. Addressing oppression in psychotherapy
| 292
|
| 3. The socialization and oppression in psychotherapy framework
| 293
|
| 1. Historical Context and Socialization
| 293
|
| 2. Overlapping Forms of Oppression
| 296
|
| 3. The Therapeutic Context
| 296
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| 4. Navigating Oppressive Encounters in Therapy
| 298
|
| 1. Pause and Pay Attention to Your Emotional Reactions
| 298
|
| 2. Contextualize the Exchange
| 298
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| 3. Decide How Best to Proceed
| 299
|
| 4. Take Care of Your Wellness
| 299
|
| 5. Consider Consultation
| 300
|
| 5. Therapists Can Also Perpetrate Oppression
| 300
|
| 4. Engaging in social justice actions
| 300
|
| 5. Scenarios for discussion
| 302
|
| 24. Therapists in a Virtual World
| 306
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| Teletherapy, Electronic Records, and Social Media
|
| 1. Empirical support and varied validity
| 306
|
| 2. Benefits of digital clinical work
| 307
|
| 3. Risks, downsides, and disasters
| 309
|
| 4. Social media challenges
| 312
|
| 5. Social media attacks
| 313
|
| 6. Test security in the digital world
| 315
|
| 7. Five special pitfalls
| 316
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| 1. Computers and other technology can fail
| 316
|
| 2. Internet legalese implications are often impossible to understand
| 317
|
| 3. The client may make fun of the sessions in cyberspace
| 318
|
| 4. Therapists underestimate how much
personal media affects reputation
| 319
|
| 5. In distance work it is easy to insufficiently
research foreign laws and regulations
| 320
|
| 8. Questions to assess uses of digital media
| 321
|
| 1. Where is the computer?
| 321
|
| 2. Is the computer protected from hackers?
| 321
|
| 3. Is the computer protected from malicious code that
can access confidential information?
| 322
|
| 4. Is your computer protected from viruses and other malware?
| 322
|
| 5. Is the computer protected using a strong password?
| 323
|
| 6. Is confidential information encrypted?
| 323
|
| 7. How Are Confidential Files Deleted?
| 324
|
| 8. How Are Computer Disks Discarded?
| 324
|
| 9. How do you guard against human error in handling confidential information?
| 324
|
| 10. How do you make sure that only the intended recipient
receives your confidential information?
| 324
|
| 11. Do your clients understand how they can and can't communicate
with you on the internet?
| 325
|
| 12. Is your website or your institution’s website accessible
to people with disabilities?
| 325
|
| 13. Are forms for clients to sign onto your website adequately secure?
| 326
|
| 14. Are there social media links between you and client (and family)
and how do such links affect your relationship?
| 326
|
| 15. Do you know the laws and rules governing digital clinical services?
| 326
|
| 15. Do you know the new research on clinical services
through digital media?
| 326
|
| 25. Sexual Attraction to Patients
Therapist Vulnerabilities and Sexual Relationships with Patients
| 327
|
| 1. How modern ethics codes address therapist-client sex
| 328
|
| 2. How therapist-client sex can injure clients
| 330
|
| 3. Gender and other patterns of perpetrators and victims
| 330
|
| 4. Common scenarios of therapist-client sex
| 333
|
| 5. Characteristics of 958 Patients Who Had Been Sexually
Involved with a Therapist
| 334
|
| 6. Therapist risk factors
| 335
|
| 7. Why do therapists refrain when they are tempted?
| 335
|
| 9. Confronting daily issues
| 335
|
| 8. Reasons Therapists Offer for Refraining from
Sexual Involvement with Clients.
| 336
|
| 10. Physical contact with clients
| 337
|
| 11. Sexual attraction to clients
| 338
|
| 12. Table 25.3. Characteristics of Clients to Whom
Therapists Are Attracted.
| 339
|
| 13. When the therapist is unsure of what to do
| 341
|
| 1. Fundamental prohibition
| 342
|
| 2. Slippery slope
| 342
|
| 3. Consistency of communication
| 342
|
| 4. Clarification
| 342
|
| 5. Client's welfare
| 343
|
| 6. Consent
| 343
|
| 7. Adopting the client's view
| 343
|
| 8. Competence
| 344
|
| 9. Uncharacteristic behaviors
| 344
|
| 10. Consultation
| 344
|
| 14. Working with clients who have been sexually involved with a therapist
| 345
|
| 15. Ethical aspects of rehabilitation
| 345
|
| 1. Competence
|
|
| 2. Ten common therapists' reactions to victims of
therapist-patient sexual involvement.
| 349
|
| 3. Informed consent
|
|
| 4. Assessment
|
|
| 5. Power and trust
|
|
| 16. Hiring, screening, and supervising
| 349
|
| 17. Scenarios for discussion
| 351
|
| 26. Nonsexual Multiple Relationships and Other Boundary Crossings:
The Therapeutic, the Harmful, the Risky, and the Inevitable
| 357
|
| 1. How the field changed its view of boundary issues
| 359
|
| 2. What makes this area so hard for us?
| 361
|
| 1. Being caught unprepared
| 361
|
| 2. Self-interest vs the client's needs
| 362
|
| 3. The allure of rigidity
| 362
|
| 4. Emotions and risk management
| 362
|
| 3. Research leading to a call for a change in the ethics code
| 363
|
| 4. Blurred, dual, or conflictual relationships
| 364
|
| 5. Multiple relationships as defined by the apa and cpa ethics codes
| 366
|
| 6. Three interesting examples of multiple relationships
| 367
|
| 1. Opportunity
| 367
|
| 2. Employee benefits
| 368
|
| 3. Helping as a friend
| 368
|
| 7. Research review
| 369
|
| 8. Self-disclosure
| 372
|
| 9. Bartering
| 372
|
| 10. Multiple relationships and boundary issues in small communities
| 374
|
| 11. Seven common therapist errors and mending fences
| 375
|
| 12. Sources of guidance
| 376
|
| 13. Scenarios for discussion
| 377
|
| 27. Steps to Strengthen Ethics in Organizations:
Research Findings, Ethics Placebos, and What Works
| 380
|
| 1. Keep codes in context
| 383
|
| 2. Respect the true costs of betraying ethics
| 384
|
| 3. Encourage speaking up, listening carefully, and
acting with fairness
| 386
|
| 4. Conclusion: only if we act
| 388
|
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