Clinical Psychology PDF

# Clinical Psychology ## Week 1: Introduction to Clinical Psychology * Clinical psychology was first used in print by Lightner Witmer in 1907. * Witmer was also the first to operate a psychological clinic. * Witmer envisioned clinical psychology as a discipline with similarities to a variety of ot...

# Clinical Psychology ## Week 1: Introduction to Clinical Psychology * Clinical psychology was first used in print by Lightner Witmer in 1907. * Witmer was also the first to operate a psychological clinic. * Witmer envisioned clinical psychology as a discipline with similarities to a variety of other fields, specifically medicine, education, and sociology. * A clinical psychologist, therefore, was a person whose work with others involved aspects of treatment, education, and interpersonal issues. * At his clinic, the first clients were children with behavioral or educational problems. * However, even in his earliest writings, Witmer (1907) foresaw clinical psychology as applicable to people of all ages and with a variety of presenting problems. ### Definitions of Clinical Psychology * According to various introductory psychology textbooks and dictionaries of psychology: Clinical psychology is essentially the branch of psychology that studies, assesses, and treats people with psychological problems or disorders. * The American Psychological Association (APA) defines clinical psychology as follows: The field of Clinical Psychology integrates science, theory, and practice to understand, predict, and alleviate maladjustment, disability, and discomfort as well as to promote human adaptation, adjustment, and personal development. * Clinical psychology involves rigorous study and applied practice directed toward understanding and improving the psychological facets of the human experience, including but not limited to issues or problems of behavior, emotions, or intellect. ### Education and Training in Clinical Psychology * The aspiring clinical psychologist must obtain a doctoral degree in clinical psychology. * Most students enter a doctoral program with only a bachelor's degree, but some enter with a master's degree. * Some graduates of such master's programs go on to earn doctoral degrees, while others enter the work force in some capacity. * For those entering with a bachelor's degree, training typically consists of at least 4 years of intensive, full-time coursework, followed by a 1-year, full-time predoctoral internship. * Required coursework includes courses on psychotherapy, assessment, statistics, research design and methodology, biological bases of behavior, cognitive-affective bases of behavior, social bases of behavior, individual differences, and other subjects. * A master's thesis and doctoral dissertation are also commonly required, as is a practicum in which students start to accumulate supervised experience doing clinical work. * When the on-campus course responsibilities are complete, students move on to the predoctoral internship, in which they take on greater clinical responsibilities and obtain supervised experience on a full-time basis. * Most APA-accredited doctoral programs in clinical psychology offer (but may not require) training within a specialty track. The most common specialty areas are clinical child, clinical health, forensic, family, and clinical neuropsychology. ## The Discipline of Psychology * Psychology: The study of behavior and mental processes, involves the application of scientific methods to inquire into the biological, cognitive, affective, developmental, personality, social, cultural, and individual difference dimensions of human behavior. * It is an extremely broad discipline with wide reach and great impact to society and humanity. * Psychologists study the intersection of two critical relationships: * brain function and behavior * environment and behavior * As scientists, psychologists follow rigorous scientific methods, using standardized tools and procedures for observation. * They apply scientific findings in ethically responsible and creative ways. ## The Practice of Psychology * The state recognizes the multifarious specializations and functions of psychologists along with the crucial significance of the psychological services they provide to a multi-diverse population. * The regulation of the profession is important to protect the various publics who avail of their services. * The Republic Act 10029 was enacted into law to regulate the practice of Psychology in the Philippines. * Under the law, Practice of Psychology is defined as the delivery of psychological services that involve the application of psychological principles and procedures for the purpose of describing, understanding, predicting and influencing the behavior of individuals or groups. * The goal of this work is to assist in the attainment of optimal human growth and functioning. ### The delivery of psychological services includes, but is not limited to: * **Psychological Interventions:** * Psychological counseling * Psychotherapy * Psychosocial support * Life coaching * Psychological debriefing * Group processes; * Other psychological interventions * **Psychological Assessment:** gathering and integration of psychology-related data for the purpose of making a psychological evaluation accomplished through a variety of tools including: * Individual tests * Projective tests * Clinical interviews * **Assessing diverse psychological functions including:** * Cognitive abilities * Aptitudes * Personality characteristics * Attitudes * Values * Interests * Emotions * Motivations * This work is done in support of psychological counseling, psychotherapy and other psychological interventions. * **Psychological Programs:** * Development * Planning * Implementation * Monitoring * Evaluation of psychological treatment programs * Other psychological intervention programs for individuals and/or groups. * **The term "other psychological interventions" shall be deemed to include:** * Preventive and therapeutic measures: * Play and expressive arts therapy * Music therapy and trauma healing * Correctional, rehabilitative and behavioral modification measures * **Consultation:** providing extensive knowledge, specialized technical assistance and expertise in an advisory capacity to consultees in regard to: * Mental and behavioral concerns * Emotional distress * Personality disorders * Other neuropsychological dysfunctions * Psychological evaluation * Diagnostic interpretations * Reports * Recommendations, as part of a case study, or in support of diagnostic screening; * Placement * Management/administrative decisions * Psychiatric evaluation * Legal action * Psychological counseling * Psychotherapy * Change intervention * **Assessing diverse psychological functions shall include the:** * Development * Standardization * Publication of psychological tests which measure adjustment and psychopathology * And/or the creation of assessment tools primarily for psycho-diagnostic purposes. * **The term "other psychological intervention programs" shall include:** * Addiction rehabilitation and treatment programs; * Behavioral management and intervention programs in correctional facilities; * Psychological training programs which involve inner processing; and mental health programs in disaster and emergency situations, either for individuals and/or communities. ### Clinical supervision: * The direction, guidance, mentoring, and cliniquing of psychology practitioners and intern; psychometricians and other trainees for psychology-related work to meet the standards of quality and excellence in professional practice. ### The practice of psychology in the Philippines covers such areas: * Clinical psychology * Counseling psychology * Assessment psychology * Social psychology * Developmental psychology * Cognitive psychology * Industrial/organizational psychology. ### The practice of psychology in the Philippines * There is no distinction made in the legislation or in the regulation between Psychologists across these specialties at this point. * Within these areas, a Psychologist may work with a variety of individual client populations such as children, adolescents, or adults, or may focus their attention on families, couples or organizations. * **Licensure is on two levels:** * For those with at least a Master's Degree in Psychology who can be called a Psychologist; * For those with at least a Bachelor's degree in Psychology who can work under the supervision of a psychologist, called a psychometrician. ## Psychologist * A psychologist is a natural person who is duly registered and holds a valid Certificate of Registration and a valid Professional Identification Card as Professional Psychologist, issued by the Professional Regulatory Board of Psychology (PRBP) and the Professional Regulation Commission (PRC) pursuant to Section 3(c), Article III, of R.A. No. 10029, for the purpose of delivering the different psychological services defined under the IRR. ### Psychologists work in a range of settings including: * Schools * Hospitals * Industry * Social service agencies * Rehabilitation facilities and correctional facilities * Private practice. * Regardless, they must be competent in formulating and communicating a psychological diagnosis. ## Psychometrician * Is a natural person who has been registered and issued a valid Certificate of Registration and a valid Professional Identification Card as psychometrician by the PRBP and the PRC in accordance with Sec. 3 (d), Article III of R.A. No. 10029. * Provided, that these activities shall at all times be conducted under the supervision of a licensed professional psychologist: * Administering and scoring objective personality tests, structured personality tests, excluding projective tests * Other higher level forms of psychological tests; interpreting the results of these tests * Preparing a written report on these results Conducting preparatory intake interviews of clients for psychological intervention sessions. * All the assessment reports prepared and done by the psychometrician, shall always bear the signature of the supervising psychologist who shall take full responsibility for the integrity of the report. ### Clientele can include those with: * Psychological and emotional difficulties * Academic and behavioral difficulties * Victims of abuse and calamities; * Psychological evaluation for work purposes, * Marital nullification * Child custody * Those in organizations that need to improve human relations and behavior among personnel; * and many others. ### Professional activities and employment settings ## Where do Clinical Psychologists Work? * Private practice * Academician * Government agencies, public schools, substance abuse centers, corporation, and university counseling center; * Other settings: psychiatric hospitals, general hospitals, community mental health centers. * Medical schools, Veterans affairs medical centers ## What do Clinical Psychologists Do? * Psychotherapy * Diagnosis/Assessment * Teaching * Supervision * Research/Writing * Consultation * Administration ## Closely Related Mental Health Professionals ### Clinical Psychologists * Are likely to work with seriously disturbed individuals; * Work more often in hospitals and inpatient psychiatric units; * Tend to endorse behaviorism strongly; * Tend to be more interested in applications of psychology to medical settings. * They are trained to appreciate the biological aspects of their client's problems; * They view client's problems as behavioral, cognitive, emotional but amenable to change via nonpharmacological methods. ### Counseling Psychologists * Likely to work with less pathological clients; * Work more often in university counseling centers; * Tend to endorse humanistic/client-centered approaches more strongly; * Tend to be intereted in vocational testing and career counseling. ### Psychiatrists * Go to medical school and are licensed physicians; * They emphasize biology to such an extent that disorders are viewed as physiological abnormalities of the brain; * They prescribe medication. ### Social workers * They focus their work on the interaction between an individual and the components of society that may contribute to or alleviate the individual's problems; * They see many problems as products of many social; * They conduct fieldwork; * They focus on issues such as arranging for the client's transition to the community and make sure that the needs are in place' * They help clients by connecting them with social services; * They typically earn master's degree rather than a doctorate. ### School psychologists * They usually work in schools, but some may work in day-care centers or correctional facilities; * Their function is to enhance the intellectual, emotional social and developmental lives of students. * They conduct psychological testing used to determine diagnoses such as learning disabilities and emotional needs of students; * They consult with adults involved in student's lives. ### Professional Couselors * They earn a master's degree and often complete training within 2 years. * They attend graduate programs in counseling or professional counseling. * Their work generally involves counseling, with little emphasis on psychological testing or research. * They specialize in career, school, addiction, couple/family, or college counseling. ## Week 2: Current Controversies in Clinical Psychology * Prescription Privileges * Evidenced-based treatments/Manualized treatments * Payment Methods * The Influence of Technology ### Prescription Privileges * Movements who pursue this privilege has its roots in the 1980s or before, but in the 1990s and 2000s, it rose to the level of a high-profile, high-stakes debate. * New Mexico and Louisiana were granted prescription privileges to appropriately trained psychologists in 2002 and 2004, respectively. ### Why Clinical Psychologists should Prescribe? * **Shortage of psychiatrists:** In some rural areas, there is low ratio of professionals with the training and ability to prescribe medication. * **Clinical psychologists are more expert than primary care physicians:** Clinical psychologists are experts in mental health problems, hence they could be better able to diagnose problems correctly and select effective medications. * **Other non-physician professionals already have prescription privileges:** Sets a precedent for specially trained clinical psychologists to do the same. * **Convenience for clients:** Treatment is streamlined, saving both time and money. Risk of the problems due to miscommunication is eliminated. * **Professional autonomy:** Clinical psychologists can feel capable of independently providing a wider range of services to their clients. * **Professional identification:** Ability to prescribe sets psychologists apart from nonprescribing therepists, counselors, social workers, etc. * **Evolution of the profession:** Embracing prescription privileges is seen as the next logical step in the progression (De Leon, 2002). * **Revenue for the profession:** Increased income may offset some of the salary decreases reported by psychologists, including those occurring as a result of the impact of managed care. ### Why Clinical Psychologists should NOT Prescribe? * **Training issues:** Comprehensive understanding of everything is involved in a prescription decision, hence something close to full-pledge medical training is essential; extended semesters, lack of faculty with expertise to teach. * **Threats to psychotherapy:** Shift from an appreciation of biological, cognitive or emotional processes to symptom reduction via pharmacology. * **Identity confusion:** Until all active psychologists prescribe, identity crisis could emerge within the profession. * **Potential influence of the pharmaceutical industry:** If psychologists prescribe, they will inevitably find themselves targeted by pharmaceutical industry. ### Evidenced-Based Treatments/Manualized Therapy * The movement in favor of this has intensified in the 1990s and 2000s; * Researchers sought to answer questions about the benefits of psychotherapy; * Hans Eysenck's statement sparked much research on the topic, and early wave of research proved Eysenck wrong; * Target question: "Does therapy work? "Which forms of therapy work best for which disorders?" * The practice of clinical psychology based on empirical research evidence in combination with clinical expertise and client characteristics, culture and preferences. ### Manualized Therapy * These are forms of psychotherapy that follow a therapy manual, which provides detailed instructions for all phases of the treatment of a specific disorder, typically used in outcome studies supporting evidenced-based treatments. ### Advantages of Evidenced-Based Treatments/Manualized Therapy * **Scientific legitimacy:** Inconsistency hardly seems appropriate for a discipline that calls itself a science; Empirical approach = beneficial and uniformly practiced treatment. * **Establishing minimal levels of competence:** Psychologists will be obligated to follow and the public will receive a more consistent, proven brand of treatment. * **Training improvements:** List of manualized, evidenced-based therapy can be incorporated into graduate programs. * **Decreased reliance on clinical judgment:** Clinical judgment can be susceptible to bias, thus, outcome is compromised; with evidenced-based techniques, outcome may be enhanced. ### Disadvantages of Evidenced-Based Treatments/Manualized Therapy * **Threats to psychotherapy relationship:** Therapy manuals do not emphasize client-therapist relationship; they tend to emphasize technique. * **Diagnostic complications:** Therapy for clients with "clean" disorders may not work on clients with more "messy" diagnostic features. * **Restrictions on practice:** The movement suggested that the only therapies worth practicing are those with empirical support. * **Debatable criteria for empirical evidence:** The criteria are biased in favor of more empirically-oriented therapies (behavioral and cognitive), and shut down therapies that produce less easily quantifiable results (psychodynamic or humanistic). ### Overexpansion of Mental Disorders * The size and scope of the DSM has vastly increased since its inception in the 1950s. * The climb in mental disorder rates goes by many names: Overdiagnosis Diagnostic expansion Diagnostic inflation Diagnostic creep Medicalization of everyday problems False positives False epidemics. ### Criticism about Overdiagnosis of DSM-5 * There has been no real epidemic of mental illness... the diagnostic labels have changed and are too elastic; Problems that used to be an expected and tolerated part of life are now diagnosed and treated as mental disorder." * "The danger of DMS-5 ideology is that it extends the scope of mental disorder to a point where almost anyone can be diagnosed with one." * "The more that psychiatric diagnoses appear to encroach on the boundaries of normal behavior, the more psychiatry opens itself to criticisms that there is no validity to the concept of mental disorders." ### Consequences of Overdiagnosis * People can get treatment they don't need; * It can affect a person's self image via stigma; * It can affect the person's self-efficacy and overall wellness; * It can influence how health insurance companies consider the person as a potential enrollee; * It can affect how a court of law views the person in terms of a guilt regarding crime or suitability for child custody. ### New Disorders and New Definitions of Old Disorders * Practicing clinicians make diagnoses without detailed consideration of the precise definition of mental disorders and offer treatments whether or not a diagnosis has been made at all; * Mental health professionals rely more on professional experience, intuition and "gut feelings" than symptoms checklist to guide diagnostic decisions. ### The Influence of the Pharmaceutical Industry * The more disorders there are, the more potential customers these companies have to target their advertising toward; * Pharmaceutical companies are pleased if those who write the DSM were on their payroll; * The pharmaceutical industry is trying to "colonize" psychiatry; ### Payment Method * **Effect on therapy:** Psychologists can control firsthand the confidentiality of their own private files but not the clinical information that they have been required to share with the insurance company; self-pay is unaffordable option. * **Effects on diagnosis:** Most health insurance and managed care companies require a DSM diagnosis for treatment. ### The Influence of Technology * Technological tools are now used in the direct delivery of psychological services; * **Applications:** * Interview through videoconferencing * Email/chat * Interactive internet site (for the public) * Online psychotherapy programs * Virtual reality techniques * Computer-based self-instructional programs * Handheld electronic communication devices ### How Well do Cybertherapy and other Applications of Technology Work? * Because cybertherapy and other applications of technology are recent developments, the amount of data on their benefits to clients is quite small; * Cybertherapy appears to work as well as more traditional, in-person forms of psychotherapy for a variety of disorders; e.g. CBT of anxiety disorders was equally effective whether the treatment was delivered in person or via computer (Reger and Gahm, 2009) ### Emerging Professional Issues * As clinical psychologists embrace new technologies and incorporate them into their practices, professional issues continue to arise; * In response, the profession is making efforts to ensure that the services provided are safe, effective and ethical; * The APA ethical code includes several updates designed to address the increasing use of technological tools. ### Suggestions for those who uses technology-based practice * Obtain informed consent from clients; * Know and follow any applicable laws on teleheath and telemedicine; * Know and follow the most recent version of APA ethical code; * Ensure the client's confidentiality by using encryption or similar methods; * Appreciate how issues of culture may be involved; * Do not practice outside the scope of your expertise; * Be knowledgeable about emergency resources in any community from which your clients may seek services; * Stay abreast of changes to the laws, ethical codes, or technology relevant to your practice. ## Week 3: Cultural Issues in Clinical Psychology * The Rise of Multiculturalism in Psychology * Cultural Competence * Training Psychologists in Cultural Issues ## How important is the issue of cultural awareness to clinical psychologists? ### Multiculturalism as the Fourth Force * A defining issue of the current era of psychology; represents the fourth force, but it does not aim to dethrone any of the first three forces; * It enhances and strengthens existing models by infusing them with sensitivity and awareness of how they can be best applied to individuals of various cultural backgrounds. ### Culture a powerful force in the clinical and counseling fields * It shapes the way the client understands the very problem for which he or she is seeking help. ### Recent Professional Efforts to Emphasize Issues of Culture * Journals and books; * Emergence of APA / PAP divisions; * APA/PAP Ethical code; * APA accreditation standards * DSM Efforts Toward Multiculturalism * Revisions of prominent assessment methods. ### Cultural Competence * **Multicultural counseling competence:** The counselor's acquisition of awareness, knowledge and skills needed to function effectively in a pluralistic democratic society. * **On an organizational/societal level:** Advocating effectively to develop new theories, practices, policies and organizational structures that are more responsive to all groups. ### Components of Multicultural Competence * **Cultural Self-Awareness:** Come to understand that his or her viewpoint is (like everyone's) unique and idiosyncratic; * **Knowledge of Diverse Cultures:** Knowledge not only of the current lifestyle of the members of the culture but also the group's history especially regarding major social and political issues; * **Culturally Appropriate Clinical Skills:** Develop appropriate strategies for assessment and treatment; The approaches and techniques that a psychologist uses to improve a client's life should be consistent with the values and life experience of that client. ### Are We All Alike or Different? * Which cultural group do you belong and within this group what do you consider as your exception in their cultural tendency? #### ETIC vs. EMIC perspective * **ETIC:** Emphasizes the similarities between all people; assumes universality among all people; * **EMIC:** Recognizes and emphasizes culture-specific norms; considers a client's behaviors, thoughts, and feelings within the context of the client's own culture rather than imposing norms of another culture onto the client. ### Tripartite Model of Personal Identity * **Individual level:** The premise is "all individuals are like no other individuals." * **Group level:** The premise is "all individuals are like some other individuals." * **Universal level:** The premise is "all individuals are like all other individuals." ### What Constitutes a Culture? #### Narrow vs. Broad definition * **Narrow:** Ethnicity and race as the defining characteristics * **Broad:** Any and all potentially salient ethnographic, demographic, status, or affiliation identities. (Pederson, 1999) * **Ethnographic:** culture demographic: race, sex and age. * **Affiliation identities:** Family, interpersonal identity... ### What Constitutes a Culture? * **Interacting Cultural Variables:** Cultural variables may interact in unique ways to shape the life experience of the client; Race and culture may be important to other clients, but other variables might play significant roles as well. ### What do you think is the best way to increase cultural self-awareness among current members of the profession? ## Training Psychologists in Cultural Issues ### Educational Alternatives: * Graduate programs include courses to address culture; * Incorporate issues of culture in courses of psychotherapy, assessment and research; * Emphasize real-world experience with individuals of diverse cultures. ### Critical Elements of Multiculturally Infused Psychology Curriculum * Explicitly state a commitment to diversity; * Actively make an effort to recruit graduate students from diverse population; * Actively make an effort to recruit and retain a diverse faculty; * Make efforts to make the admission process fair and equitable; * Ensure that students gain awareness of their on cultural values and biases, knowledge of other groups, and skills to work wit diverse populations; * Examine all courses for an infusion of a culture-centered approach throughout the curriculum; * Evaluate students on their cultural competence on a regular basis. ## Measuring the Outcome of Culture-Based Training Efforts * At the moment, measuring outcome-based efforts is at a very early stage or empirical investigation as researchers grapple with the issue. * There may be a gap between psychologists "practice" and what they "preach" regarding multicultural competence. * Efforts promoting multiculturalism are clearly resulting in some needed improvements related to clinical and research activities of clinical psychologists. ## Week 4: Ethical Issues in Clinical Psychology * PAP Code of Ethics * Confidentiality * Informed Consent * Boundaries and Multiple Relationships * Competence * Ethics in Clinical Assessment * Ethics in Clinical Research * Contemporary Ethical Issues ## Brief History ### American Psychological Association Code of Ethics * 1953: APA published the first code of ethics; its appearance corresponded with the rise of professional psychology around that time period. * Since then, 9 revised editions of the ethical code have been published. ### Psychological Association of the Philippines Code of Ethics * 1980s: PAP adopted a Code of Ethics for Psychologists; * 2007: The Board of Directors of the PAP resolved to constitute a committee to revise the code of ethics, with the goal of updating the code and making it more inclusive and applicable to all psychologists. * April 18, 2009: First draft of the Code was presented to the PAP Board of Directors; * July 24, 2009: The revised PAP Code of Ethics was finally ratified by the PAP Board of Directors. * Mindful of the fact that the Code can never complete address all the possible emergent ethical concerns, the PAP encourages all its members to study the Code and make suggestions for its continuous improvement. * Members who have suggestions for new provisions or improvements and/or amendments to the old provisions should submit these in writing, with supporting arguments and explanations, to the PAP Board. * In the last quarter of 2020, a committee was tasked to revise the Code of Ethics, in view of recent technological developments as well as the implications of the Covid-19 pandemic on the practice of psychology. * The final version was approved by the Board of Trustees on their regular meeting on August 26, 2022. ### Ethical Code Features #### General Principles * They are aspirational. * They describe an ideal level of ethical functioning or how psychologists should strive to conduct themselves. * They offer more broad descriptions of the exemplary ethical behavior. #### Ethical Standards * They include enforceable rules of conduct. * If the psychologist is found guilty of an ethical violation, it is a standard (not a principle) that is violated. * They are more specific than general principles. | Code | Ethical PRINCIPLES | Code | Ethical PRINCIPLES | | :--- | :--- | :--- | :--- | | APA | A. Beneficence and Nonmaleficence | APA | II. Competent Caring for the Well-Being of Persons andoples | | APA | B. Fidelity and Responsibility | APA | IV. Professional and Scientific Responsibilities to Society | | APA | C. Integrity | APA | III. Integrity | | APA | D. Justice | APA | E. Respect for People's Rights and Dignity | | PAP | Integrated in Principle 1 Respect for the Dignity of Persons andoples | PAP | Integrated in Principle 1 Respect for the Dignity of Persons and Peoples | | PAP | I. Respect for the Dignity of Persons and Peoples | PAP | I. Respect for the Dignity of Persons and Peoples | | PAP | 1. Resolving Ethical Issues | PAP | 1. Resolving Ethical Issues | | PAP | 2. Competencies | PAP | 2. Competencies | | PAP | 3. Human Relations | PAP | 3. Human Relations | | PAP | 4. Privacy and Confidentiality | PAP | 5. Advertisements and Public Statements | | PAP | 5. Advertisements and Public Statements | PAP | 6. Record Keeping and Fees | | PAP | 6. Record Keeping and Fees | PAP | 7. Assessment | | PAP | 7. Education and Training | PAP | 8. Therapy | | PAP | 8. Research and Publication| PAP | 9. Education and Training | | PAP | 9. Assessment | PAP | 10. Research | | PAP | 10. Therapy | | | #### Ethical Decision Making * When any ethical issue arises, a clinical psychologist should be equipped with a process by which to make the most ethical decision possible. * The APA's ethical code does not offer any such decision-making models per se, but such models have been recommended by a number of experts in the field. #### Celia Fisher * Served as the chair of APA's Ethical Code Task Force; in her book Decoding the Ethics Code, she proposes an eight-step model for ethical decision-making. ### Ethical Decision Making * Prior to the ethical dilemma arising, make a commitment to doing what is ethically appropriate. * Become familiar with APA/PAP ethical code. * Consult any law or professional guidelines relevant to the situation at hand. * Try to understand the perspectives of various parties affected by the actions you may take. * Consult with colleagues. * Generate and evaluate your alternatives. * Select and implement the course of action that seems most ethically appropriate. * Monitor and evaluate the effectiveness of your course of action. * Modify and continue to evaluate the ethical plan as necessary. ### Ethical Decision Making * Psychologists best prepare themselves to deal with ethical dilemmas by becoming generally ethical people with sound values. * Functioning as an ethical psychologists should not be a rote exercise. * The model for decision-making work best when utilized by a person who has already examined his or her own values and aligned them with the ethics of the profession. #### Psychologist's Ethical Beliefs * What do psychologists actually believe about the ethicality of behaviors they might perform? * What ethical beliefs do they hold? * These questions were addressed in a large-scale survey of the APA members. * More than 450 members of Division 29 (Psychotherapy) of the APA rated the ethicality of 83 separate behaviors that a psychologist might perform toward, with, or in response to a client. * Few behaviors (sex with clients or former clients, socializing with current clients, disclosing confidential information without cause or permission) are viewed as BLATANTLY UNETHICAL. * Few other behaviors (shaking hands with clients, addressing clients by first name, breaking confidentiality if clients are suicidal or homicidal) are viewed as UNQUESTIONABLY ETHICAL. * Most of the 83 behaviors fell in the gray area between ethical and unethical, illustrating both the challenges that psychologists face in making wise judgments regarding ethical issues and the importance of a sound model of ethical decision making. ### Confidentiality * The profession is entrusted by the public to provide professional services without sharing the private, personal details offered in the process; however, confidentiality is not ABSOLUTE; * **ISSUES:** * Tarasoff Case: set the legal precedent for the understanding of clinical psychologists on the limits of confidentiality agreements with clients; * CP have a duty to warn people toward whom their clients make credible, serious threats. * **When the client is a child/adolescent:** therapists working with these clients often negotiate arrangement with clients and parents whereby the parents will not expect to be informed of what the client discloses in therapy except under specified condition. * **ISSUES:** Child abuse: mental health professionals break confidentiality to report known or suspected child abuse * Some situations demand that the clinical psychologist's primary responsibility shift to the immediate prevention of harm; * Child abuse situations often require the CP to make difficult judgment calls. ### Informed consent * Is an essential process in any professional activity conducted by psychologists; * **Assessment and therapy:** Assures the person to become knowledgeable about the activities in which they may participate; * **Research:** Instructs psychologists to inform prospective participants about numerous aspects of the study; ### Multiple relationships * Multiple relationship occurs when a psychologist is in a professional role with person and at the same time. * Is in another role with the same person; * Is in a relationship with a person closely associated with people whom the psychologist has the professional relationship; * Promises to enter into another relationship in the future with the person or a person closely associated with or related to the person. ### What makes it UNETHICAL? * **Two Criteria:** * Impairment in the psychologist - if the role with the client makes it difficult for the psychologist to remain objective, competent, or effective, then it should be avoided; * Exploitation or harm to the client - therapist-client relationship is characterized by unequal power; therapist is the authority. ### Competence * Competent clinical psychologist are those who are sufficiently capable, skilled, experienced, and expert to adequately complete the professional tasks they undertake; * Psychologists not only need to become competent; they must also remain competent. * **Continuing education regulations** - enable the psychologists to renew their licenses by attending lecture, participating in workshops, etc. * **Cultural competence** - one of the aspects of competence that clinical psychologists must develop; * **ISSUE:** Own personal problem of psychologists can lessen their competence; * **Measures:** Obtaining professional consultation, determining whether they should limit, suspend, or terminate their work-related duties. ### Ethics in Clinical Assessment * **Test Selection:** Entail a number of factors, including the psychologist's competence; the client's culture, language, and age; and the test's reliability and validity; * Psychologists must not select tests that have become obsolete or have been replaced by revised editions that are better suited to the assessment questions being addressed. * **Test Security:** Psychologists should make efforts to protect the security and integrity of the test materials they use. * Psychologists should prevent the questions, items, and other stimuli included in psychological tests from entering the public domain. #### Ethics in Clinical Assessment * **Test Data:** Refer to the raw data that the client provided during testing - responses and other notes that the psychologist made; * The current edition instructs the psychologists to release test data unless there is reason to believe that the data will be misused or will harm client; * This revision reflects the more global shift toward patient autonomy. ### Ethics in Clinical Research #### Psychotherapy efficacy * The participants in therapy efficacy studies who don't receive the treatment being studied are placed in one of these conditions: * No treatment (wait-list control) * Placebo treatment * (personal interaction with professional but the therapeutic techniques was deliberately omitted) * Alternate treatment ### Contemporary Ethical Issues * Manage care and ethics - confidentiality; diagnosis; * Technology and ethics - test security; * Ethics in small community - multiple relationships. ==End of OCR for page 21==