Psychological Ethics Notes PDF

Psychological ethics notes History of research ethics Тема/поим Резиме Before WWII The scientific method is widespread, but no general consensus in research ethics - Good intentions(?), bad practice...

Psychological ethics notes History of research ethics Тема/поим Резиме Before WWII The scientific method is widespread, but no general consensus in research ethics - Good intentions(?), bad practice - 1920 Little Albert, J. Watson – Fear conditioning - 1939, "monster study" - orphan children - Tuskegee syphilis experiment 1932-1972 Eugenics: - Francis Galton - Practices that aim to improve genetic quality of the population (selectively mating people with "better" genes) - "good" and "bad" genes - Nazi eugenics- Mein Kampf During WWII Nazi Germany: - Hypothermia - Mustard gas - Burns - Poison - Seawater Japan – Unit 731: - Vivisection - Radiation - Weapon tests Response: Nurenberg trials 1945-49 Tokyo trials 1946-1948 Nuremberg code Voluntary consent Fruitful results Based on animal experimentation Avoid unnecessary suffering No a priori knowledge of possible injury or death (only if you are the subject) Risk should not exceed importance Proper preparations Only qualified personnel Participants should have the liberty to stop experiment  Prepare to terminate if necessary Psychological topics after Issues raised by nazism come to the forefront: WWII - obedience - authority - peer pressure - aggression Milgram experiment 1961 – Stanley Milgram Researching the effect of authority on obedience Stanford prison experiment 1971 – Phillip Zimbardo Guards and prisoners 24 male subjects Belmont report (1978) Ethical principles and guidelines for the protection of human subjects in research. A response to the Tuskegee-experiment: - Respect for persons - Beneficence - Justice Declaration of Helsinki World Medical Association (WMA) - Of medical research on human subjects Main goals: - Risks, benefits - Vulnerable groups and individuals - Scientific requirements - Ethics committees, Institutional Research Boards (IRB) - Privacy - Informed consent - Placebo use - Aftercare 5 main tenets of research ethics Discuss intellectual property frankly Be conscious of multiple roles Follow informed-consent rules Respect confidentiality and privacy Tap into ethics resources Ethics committees Most countries' laws require ethics committees to operate in institutions (Institutional Review Boards, IRB). In the last decade Review Board rules got stricter in all institutions The role of research committees Scientific quality Is it realistic?  Who are the participants? Exclusion criteria? What are the risks? Benefits? Is it publishable? Ethical research and questionable research practices Тема/поим Резиме Empirical research - Collects evidence in favor or against a hypothesis - Quantitatively, or sometimes qualitatively Confirmatory Exploratory Confirmatory: - Null Hypothesis - Alternative hypothesis Structure Introduction “Literature shown here brings evidence in favor of A, and other studies shown here show evidence in favor of B. I deducted that if A and B is true, then X should be also true, but I need to check it out. This study is about looking for X” Methods “In this study I took the following steps to …” Collect data Collect data in a way that the variable describing X is measured Collect data in a way that the variable measured describes only X Results “On the data collected I fitted a statistical model that is identical to my theoretical model” The model shows a significant difference in the measured variable between groups, though we have found evidence in favor of X Discussion “We have found evidence in favor of X, but it is not a surprise, because A, B, and also C points in a direction where X is true” “Although, we should stay humble, D shows contradicting evidence, so we should research more” P-value The p value is the probability to find a sample in the population that is as extreme, or more extreme than the collected data, if we assume that the null hypothesis is correct. Significant < 0.05 < Not significant Publication bias Questionable research practices Practices that allow to distort, or confuse results in order to change the (QRP) relevance of the results - Intentional - Non-transparent Fishing expedition: - Presenting exploratory research as confirmatory (hypothesis-confirming) research - Using multiple dependent variables without hypotheses, or correction - HARKing (hypothesizing after the results are known), post-hoc analysis Conditional stopping: - Hypothesis testing while collecting data, or continuing data collection until the significance level is reached P-hacking: - Data transformations, exclusions, using analytical techniques in an arbitrary way in order to reach significance level, or increase effect size - Researchers degrees of freedom Misguiding visualisation: - Visualizing data in a way that the effect size or relevance is enlarged Full on fraud (dishonest research): - Diederik A. Stapel Problem of competence Communicate evidence only Emphasize uncertainty Stick to your field Research Practice  Be aware about authority How to fix practices Preregistration Registered reports Open data practices Publicly shared research data Publicly shared analysis data Publicly shared experimental procedure Data blinding - a security and privacy measure used to limit access to sensitive information by masking or hiding certain parts of the data. Competence Тема/поим Резиме Competence - the ability to do something well professionally - Legal authority to do something Boundaries of competence Psychologists provide services, teach, and conduct research with populations and in areas only within the boundaries of their competence, based on their education, training, supervised experience, consultation, study, or professional experience. Where scientific or professional knowledge in the discipline of psychology establishes that an understanding of factors associated with age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, or socioeconomic status is essential for effective implementation of their services or research, psychologists have or obtain the training, experience, consultation, or supervision necessary to ensure the competence of their services, or they make appropriate referrals, except as provided in Standard 2.02, Providing Services in Emergencies. Psychologists planning to provide services, teach, or conduct research involving populations, areas, techniques, or technologies new to them undertake relevant education, training, supervised experience, consultation, or study. When psychologists are asked to provide services to individuals for whom appropriate mental health services are not available and for which psychologists have not obtained the competence necessary, psychologists with closely related prior training or experience may provide such services in order  to ensure that services are not denied if they make a reasonable effort to obtain the competence required by using relevant research, training, consultation, or study. Competence of a psychologist Intellectual competence: - Technical knowledge, knowledge of the method - Communication skills - Social sensitivity Emotional competence - Empathy - Emotional balance - Resilience Technical knowledge Professional knowledge - In what group is it validated? - Boundaries of the method? Where are my boundaries in knowledge? Communication skills Appearance: - Clothes - Posture - Facial expressions Speech: - Wording - Mannerism - Speech impediments Social sensitivity Knowledge and acceptance of different social/political groups: - Nationality - Gender - Sexual orientation - Political orientation - Accent - Class Empathy Empathy =/= Sympathy - ability to see the word as your client - Judgement free attitude - Understanding the client's feelings Can be practiced: - Understanding - Judgement free - Advice free Emotional balance Physical and mental health:  - Meaningful relationships - Balanced diet - sleep - Free time - Sport Self-knowledge Therapy / Supervision Resilience = the capacity to withstand or to recover quickly from difficulties; toughness. - Self-defense - Endurance - Recovery RISK: Burnout Supervision - A key part of professional growth - Minimum requirement of high quality work Roles: - Advice in specific cases - Processing difficult cases - effects - Help in finding boundaries of competence Professional partners Such as... - Other psychological methods - Law - Medicine - Clergy – people of faith - Professions or methods outside of psychology To do: - Study the basics - Assess order of importance Common pitfalls Not being aware of boundaries of competence Deterioration of competence over time Too many specializations Isolated work Good practices Looking at the level of your competence time-by-time Read relevant scientific works Continuous supervision Communicate with colleagues Feel free to be incompetent and handle problems accordingly Confidentiality and privacy Тема/поим Резиме Confidentiality - The confidential handling and retention of information shared in a trusted relationship. - It is based on the informed consent process, where the client is informed of their rights regarding confidential information. - The statement must address data management and confidentiality issues. - Respecting and protecting privacy in all its aspects. Legal background Data management laws in specific countries GDPR Psychologist = Data manager Psychotherapy Defined by local laws, in Hungary it is regulated by the Health act Can be conducted by a doctor, or clinical psychologist (in hungary) Medical privacy Most developed countries have enacted laws protecting people's medical health privacy. - Medical staff is obliged to protect the privacy of patients - Patients have the right for their health and personal data (medical secrets) to be shared only with authorized individuals. Patients can decide who is informed about their illness and its expected outcomes, and who is excluded from knowing their health data. Disclosure without the patient’s consent is allowed if: - Required by law, or - Necessary to protect the life, health, or physical integrity of others. Confidential information Includes: - The fact that therapy or counseling is taking place - Everything said during the session - Test results and provided materials - Information from/about the client - Photos, videos, recordings, drawings, writings, emails, and messages Informed consent The client must be informed about: - The data collected - How the data is managed  - How the data is stored - The communication mediums - Recordings - Data destruction Psychologist’s confidentiality It must be respected in all areas of life. The identity of clients and the content of sessions must not be shared, - not even with family - or colleagues - unless the client has given explicit consent. (e.g. supervision, focus groups) The client also needs to keep the confidentiality of the therapy Issues arising from breaching Workplace disadvantages confidentiality Conflicts in family or community Privacy violations of high-status or famous individuals Indirect participants (e.g., family members) may have their rights violated. Confidential information: - The fact that the client uses the service - What kind of service is being used Confidentiality waivers Confidentiality must be broken if: - The client is a danger to themselves or others - There is a risk of abuse It can also be waived: - In supervision or consultation - If the client authorizes the psychologist The Tarasoff case A famous 1969 case in California where a therapist learned of a client's plan to commit murder during a session. The client eventually murdered Tatiana Tarasoff despite prior police intervention. This case set a precedent that professionals must notify the police or take steps to protect potential victims. Balancing danger prevention and Often these principles are in conflict and require careful confidentiality consideration. How can the danger be reduced without breaching confidentiality? Technology and confidentiality What tools are used for communication? How are session details recorded? Where are the tests, recordings, and notes stored? What technology is present during the session? What platforms are used for contact? Therapist-client relationship Тема/поим Резиме APA Code: 3.01 Unfair In their work-related activities, psychologists do not engage in unfair Discrimination discrimination based on age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, socioeconomic status, or any basis proscribed by law. Negative discrimination Psychologists must avoid any form of discrimination in their practice. Age Gender Gender identity Race Ethnicity Culture Religion Sexual orientation Body type Disability Socioeconomic status How to handle discrimination Recognize the impact of different social situations on behavior and mental health. Refer clients if necessary, consult with a supervisor, or develop further skills. Understand that we may not be able to help every person who comes through the door. Survey findings (Hansen et al.) One survey of 149 psychologists regarding their practices and beliefs reported that for 86% of the individual items explored, participants did not practice what they preached. - 42% of the respondents rarely or never implemented a professional development plan to improve their multicultural competence, - 39% rarely or never sought culture-specific case consultation, - 27% rarely or never referred a client to a more culturally qualified provider. How to address bias and Reflect on yourself – recognize unconscious stereotypes, stereotypes biases, and prejudices.  Reflect on others – be aware of and speak up when you observe discrimination or bias. APA Code - Therapist client APA Code: 3.05 Multiple Relationships relationship Psychologists avoid dual relationships if they could impair objectivity, competence, or effectiveness in their professional role or risk harm to the client. APA Code: 6.04 Fees and Financial Arrangements Psychologists and clients should reach an agreement about compensation and billing as early as possible in the professional relationship. Fees must comply with the law and not exploit the client. Sexual attraction in therapy It is very rare for a therapist to never feel any attraction toward a client in their career (Pope, Keith-Spiegel & Tabachnick, 1986). - A self-reported survey revealed that 95% of male therapists and 76% of female therapists experienced attraction toward a client. APA Code: 10.05 Sexual Intimacies with Current Therapy Clients/Patients Psychologists do not engage in sexual intimacies with current therapy clients/patients. Causes of attraction Psychologists: Physical attractiveness Positive mental or cognitive traits Sexualized characteristics Vulnerability Personality traits Clients: appeared to fulfill the psychologist's needs and desires. seemed to be attracted to the psychologist. Reminded the psychologist of someone In rare cases, had some form of personality disorder Psychologists who feel attracted to clients: - Become more engaged - Pay more attention - Are more easily distracted from the topic - Are less objective Only half of the respondents discussed their attraction in supervision. Supervision Supervision provides an ideal opportunity for psychologists to reflect on their emotions and seek advice.  It is especially important to address sexual attraction in therapy before it affects the therapeutic relationship. If the issue cannot be resolved, termination of the therapeutic relationship and referral to another therapist may be necessary. Managing attraction Usually attraction stays at a low level, and disappears over time, thus focusing on the management of these feelings can be sufficient until they last Feelings might also escalate quickly, though it is important not to downplay or trivialize them Red flags of attraction The problem becomes serious when: - We often daydream about the client - taking more care with grooming on the client’s appointment day - wanting to touch the client - eliciting irrelevant personal information - having trouble focusing during the sessions Therapists attracted to clients Should one discuss such feelings with the client? Most therapists do not recommend it (Fisher, 2004; Gelso, Pérez Rojas, & Marmarosh, 2014, in Koocher, Keith_Spiegel, 2016). - the client may not be able to deal with it (easily becomes confused, uncomfortable etc.) - injects the therapist’s own issues into the client’s life. - the client might perceive it as harassing or even repulsive. - the client may interpret it as an invitation to follow the therapist’s lead outside the office (which may not (and should not) be the therapist’s intent) Discuss it with another therapist, an experienced and trusted colleague, or an approachable supervisor. Therapists attraction to clients Forms: - Solicitation - Physical advancing - Verbal / nonverbal conduct - Humor (!) Single / multiple / persistent With: - Employees - Supervisees - Students - colleagues Clients attracted to therapists Psychotherapy: has an intimate nature - Powerful feelings can be experienced as love, (but are based more on the therapeutic context than on the therapist as a specific person) Survey of female psychologists: - almost half reported sexualized behavior emanating from their male and, less often, female clients. - The younger the therapist, the more likely the perceived sexualized behavior directed toward them (deMayo, 1997). 3 aspects to consider when a client 1. How does the therapist interpret the meaning of the expresses attraction in an client’s behavior? Was it intentional? Was it perhaps an inappropriate way attempt to control, seduce, or dominate? If it seemed to be unintentional, was the client trying to affiliate or bond? 2. How does the therapist view his or her part in bringing this on? What role did he or she play that may have elicited this behavior? Might a joke or offhanded comment have prompted inappropriate behavior? 3. What was the therapist’s own internal emotional response? Did it feel flattering, bewildering, annoying, or disgusting? Other contextual variables also need to be considered before making the appropriate response: eg. the personal styles of both client and therapist and the duration and purpose of therapy. Important to know Important: to preserve professional boundaries and protect the client’s self-esteem. When a client discloses erotic feelings, it does not necessarily mean that the client expects them to be acted on - What the therapist interprets as seductive behavior could be signs of dependency - The better course of action is: further exploration of the client’s feelings and putting the focus back on why the client is in therapy. When the therapist also has Goodyear and Shumate (1996): feelings - simulated therapy sessions portraying a client disclosing a sexual interest in a therapist; - the sessions were rated by groups of therapists. Behaviors of therapists who disclosed reciprocal attraction (followed by an indication that it would not be acted on) was seen as less therapeutic for the client and less skillful than was a condition in which the therapist remained noncommittal. Aggressive seduction from client In the rare case when a client becomes aggressively seductive, it is better to tell the client that therapy is a “talking relationship” and  discussing why the behavior is inappropriate. “There are many people who are available to sleep with you, I’m trying to make a different contribution to your life. I’d like to be your therapist and what you’re asking is not what a therapist does,” or, “This room is meant to be a safe space for you to learn what it’s like to have a caring relationship without sex, so that you can confront the problems for which you came to get help” (Gutheil and Brodsky, 2008, p. 187 in Koocher and Keith-Spiegel, 2016). Referring the client to another therapist Physically touching clients Complicated issue An intensely intimate, complex mode of communication Whereas boundaries violated in the extreme are unanimously viewed as unethical, far more variability of opinion pertains to the use of touch in psychotherapy Touch can come across in many ways. It is an intensely intimate, complex mode of communication to convey support, consolation, empathy, caring, and sincere concern. Touch can also signal sexuality or elicit anxiety, aggression, and fear. The relationship between the “toucher” and the “touchee” and how and where each party is being touched can create complicated ethical dilemmas for everyone, including therapists. Whereas boundaries violated in the extreme are unanimously viewed as unethical, far more variability of opinion pertains to the use of touch in psychotherapy. Non-erotic touching Touch in psychotherapy is the most controversial of all boundary crossings (touch is associated with sex). When therapists do touch clients, the circumstances most frequently considered appropriate include expressions of emotional support and reassurance or during initial greeting or closing of sessions. Children and the distressed or depressed may benefit from appropriate touch. Very brief nonerotic touching on the hand, back, and shoulders involves the safest areas of touch and can still convey a compassionate, supportive message. Erotic touching When therapists intentionally touch clients with erotic intent, a boundary violation has occurred. Behavior primarily intended to arouse or satisfy sexual desires is the general definition of erotic contact offered by Holroyd and Brodsky (1977, 1980). - Such touching (excluding intercourse) was anonymously self-reported by 9% of male and 1% of female therapists sampled in their 1977 survey.  Accused therapists can always deny their intent, which may or may not be truthful… Sexually intimate behaviour with The American Psychological Association (APA) did not adopt a clients prohibition against sexual intimacies with clients until 1977. - Yet, even prior to the late 1970s, sex with clients was generally viewed as poor professional practice, a dual-role relationship, and likely to be exploitative. - Today, all major mental health professional codes have clear prohibitions against engaging in sexual behavior with current clients APA Code 10.05 Sexual Intimacies Psychologists do not engage in sexual intimacies with current with Current Therapy therapy clients/patients. Clients/Patients Incidence - Anonymous self-report surveys revealed that far more therapists engage in sexual behavior than is ever reported to ethics committees and state licensing boards (e.g., Parsons & Wincze, 1995). - Early survey data indicated that as many as 26% of male and 3% of female therapists acknowledged engaging in sexual intimacies with their clients (Schoener, Milgrom, & Goniorek, 1984). - Another survey revealed no significant differences across psychiatry, social work, and psychology in the rates of self-reported sexual relationships (Borys & Pope, 1989). Who is responsible? ALWAYS THE THERAPIST! In interviews by Somer and Saadon (1999), almost one fourth of clients who claimed to have had sexual relations with their therapists admitted that they initiated the first embrace. - BUT: shifting blame or responsibility to the client— even one who is adeptly manipulative or seductive—is never an excuse for incompetent, unprofessional behavior. - The obligation to uphold ethical, legal, and professional standards is not a duty to be excused, or assigned to clients. Harms to clients Pope (1989, 1994) described a cluster of symptoms seen in some clients who endured sexual relationships with their therapists. These included: - ambivalence about the therapist similar to that of incest victims who hold both love and negative feelings toward the offending family member; - feelings of guilt, as if the client were to blame for what  happened; - feelings of isolation and emptiness; - cognitive dysfunction; - identity and boundary disturbances; - difficulties in trusting others as well as themselves; - confusion about their sexuality; - lability of mood and feeling out of control; - suppressed rage; - increased risk for suicide or other self-destructive reactions. Common offender characteristics Offending therapists: - also tend to have strong denial or rationalization defenses in place, - are more likely to engage in rescue fantasies, - have a family history of sanctioned boundary transgressions, - are intolerant of negative transference - more likely to work alone - often deny to themselves that their behavior has any adverse impact on clients - are deficient in their ability to empathize Sexual relationships with former Taken together, available findings suggest that between 3% and 10% clients of survey respondents had sex with former clients. - Fewer than half of the psychologists in a survey (Akamatsu, 1988) judged sex with ex- clients as a serious ethical problem. - And, sexual relationships with current clients was viewed as more unethical than sex with former clients In 1992, the APA ethics code revision team proposed a lifetime ban on sex with previous therapy clients based on the risks to clients, practitioners, and the profession - After lengthy debates, the APA arrived at a clumsy compromise: a 2-year posttermination moratorium clause placed clear limitations in the short run but opened the opportunity for sexual relations without professional repercussion after 2 years. - Thus, psychologists who entered into sexual relationships with former clients bore the burden of demonstrating that no exploitation was at issue should former clients press a complaint. APA Code 10.08 Sexual Intimacies with Former Therapy Clients/Patients (a) Psychologists do not engage in sexual intimacies with former  clients/patients for at least two years after cessation or termination of therapy. 10.08 (b) Psychologists do not engage in sexual intimacies with former clients/patients even after a two-year interval except in the most unusual circumstances. Psychologists who engage in such activity after the two years following cessation or termination of therapy and of having no sexual contact with the former client/patient bear the burden of demonstrating that there has been no exploitation, in light of all relevant factors, including (1) the amount of time that has passed since therapy terminated; (2) the nature, duration, and intensity of the therapy; (3) the circumstances of termination; (4) the client’s/patient’s personal history; (5) the client’s/patient’s current mental status; (6) the likelihood of adverse impact on the client/patient; and (7) any statements or actions made by the therapist during the course of therapy suggesting or inviting the possibility of a post termination sexual or romantic relationship with the client/patient. Concerns about sexual Given the available evidence, along with transference and relationships with clients trust issues, there are serious concerns about engaging in post termination sexual relationships, even with the stated qualifiers. Data suggest well over half of the post termination sexual liaisons between therapists and their clients began quickly, within the first 6 months (Gartrell et al., 1986). Multiple relationships Тема/поим Резиме APA 3.05 Multiple Relationships A multiple relationship occurs when a psychologist is in a professional role with a person and (1) at the same time is in another role with the same person, (2) at the same time is in a relationship with a person closely associated with or related to the person with whom the psychologist has the professional relationship, or (3) promises to enter into another relationship in the future with the person or a person closely associated with or related to the person. A psychologist refrains from entering into a multiple relationship if the multiple relationship could reasonably be expected to impair the psychologist’s objectivity, competence, or effectiveness in performing his or her functions as a psychologist, or otherwise risks  exploitation or harm to the person with whom the professional relationship exists. Multiple relationships that would not reasonably be expected to cause impairment or risk exploitation or harm are not unethical. ) If a psychologist finds that, due to unforeseen factors, a potentially harmful multiple relationship has arisen, the psychologist takes reasonable steps to resolve it with due regard for the best interests of the affected person and maximal compliance with the Ethics Code. (c) When psychologists are required by law, institutional policy, or extraordinary circumstances to serve in more than one role in judicial or administrative proceedings, at the outset they clarify role expectations and the extent of confidentiality and thereafter as changes occur. Types of multiple relationships Work Financial Emotional / sexual Other Multiple relationship In a professional role with another person AND at the same time… - is in another role with the same person - is in a relationship with a third person who is closely related to the person who the psychologist is in a professional relationship with - promises to enter into another relationship in the future with either the person or another person closely related Are all multiple relationships Boundary crossings can be an integral part of well formulated unethical? treatment plans or evidence-based treatment plans. - Examples are, flying in an airplane with a patient who suffers from a fear of flying, having lunch with an anorexic patient, making a home visit to a bed ridden elderly patient, going for a vigorous walk with a depressed patient, or accompanying a patient to a dreaded but medically essential doctor's appointment to which he or she would not go on their own. Why not? Impaired objectivity Poor judgment Diminished competence Declined efficacy relationships are unlikely to be truly mutual Dilemmas and conflicts Less training and experience – difficulty with keeping boundaries  Careful consideration of boundary crosses: are they really necessary? Assess the client’s boundaries: personality disorders, history of exploitation Crossing boundary violation Potentially helpful boundary crossings also include going on a hike, giving a non-sexual hug, sending cards, exchanging appropriate (not too expensive) gifts, lending a book, attending a wedding, confirmation, Bar Mitzvah or funeral, or going to see a client performing in a show. Boundary crossings are not unethical. Ethics code of all major psychotherapy professional associations (e.g., APA, ApA, NASW, ACA, NBCC) do not prohibit boundary crossings, only boundary violations. BUT: Debates do continue regarding the point at which a boundary crossing becomes a boundary violation. Elements of contract for Goal setting (in a language accessible to the client): psychotherapy/counselling - Who is the client (individual, family, group) - What is the aim - How will we work together, what technique(s) will be used - Risks of the intervention, alternative treatment - Frequency, duration, and number of sessions - Keeping contact between sessions - Legal aspects (e.g. underage client, obligation for treatment) - Confidentiality: to family members, colleagues, friends… - Limits of confidentiality: potential life threatening, supervision - Aim and ways of documentation: who can have access - Financial issues: fee, method, frequency and timing of payment, what to do if payment is hindered Functions of the contract: - Information - Setting the frames: protection for both the client and the psychologist - Sets a basis for safety - Facilitates cooperation - Makes clear distinction between the professional relationship and other relationships - Helps recognizing if boundaries are crossed Risky therapists example: Heated topic of interest: Self-disclosing therapists - Some hold the position that therapists should share only professionally related information. But, most mental health  professionals apparently do knowingly self-disclose, at least on occasion - The question, then, is: how, when, why, and what. Self-disclosures can be benign and helpful (many studies examined the role played by self-disclosure in the process of therapy): can increase the connection with the client and affords marginalized clients more power in the relationship - BUT: greater risk for problematic relationships with clients. well-considered illustrations may help make a point or signal empathy, - BUT: absorbing therapy time with extended renditions of one’s own personal history and family issues is not typically justifiable. EMDR – Eye movement Desensitisation and Reprocessing In PTSD Phase 1: The client’s history is discussed and a treatment plan is developed with attention to the pacing of therapy and the selection of traumatic events that will be part of treatment. In addition, the client’s internal and external resources are assessed. Phase 2: In the preparation phase, the therapist explains the EMDR therapy process, terms, and sets expectations. The therapist and client collaborate to prepare specific techniques to cope with any emotional disturbance that might come up. Some clients need quite a bit of time in phases 1 and 2 in order to feel ready to move on to the following phases. Phase 3: In assessment, the event to reprocess (also known as the target event) is identified, along with images, beliefs, feelings, and sensations about the event. Initial baseline measures are set. Phase 4: In the fourth phase, desensitization, the side to side eye movements, sounds, or taps are begun while focusing on the traumatic event, and continue until the client’s SUD reduces to zero (or 1 if appropriate). During this time, new thoughts, sensations, images, and feelings may emerge. Phase 5: When desensitization is complete, installation begins. In this phase, the client associates and strengthens a positive belief with the target event until it feels completely true. Phase 6: During the body scan, the client is asked to hold in mind the target event and the positive belief while scanning the body from head to toe. Any lingering disturbance from the body is reprocessed. Phase 7: Every session of reprocessing ends with the seventh phase, closure, in which the client is assisted to return to a state of calm in the present moment whether the reprocessing is complete or not. Reprocessing of an event is complete when the client feels neutral about it the positive belief feels completely true and the body is completely clear of disturbance. Phase 8: Reevaluation, is how each new session begins after reprocessing. The client and therapist discuss recently processed memories to ensure that distress is still low and that the positive cognition is still strong. Future targets and directions for continued treatment are determined. Ethics of efficiency Тема/поим Резиме Effectiveness and efficiency Effectiveness: - Does the therapy have any effect on the symptoms? Efficiency: - How fast does it work? - How much does it take to work? - Is it faster or better than other therapies? How do ethics come into the picture? Measures of efficiency Randomized control trials - Randomly assigned groups - Symptoms as concreate outcome measures - Appropriate control and experimental groups Meta-analysis - Analyzing multiple results at the same time - Effect sizes - Appropriate selection Client satisfaction Control groups Non-directive supportive therapy (NDST): - Carl Rogers - Counselor-client relationship - Unconditional positive alignment - Person-centered - Self knowledge EMDR evidence Study 1 – individual TF CBT and EMDR are equally effective in treating PTSD. Study 2 – EMDR and brief eclectic psychotherapy are both effective for PTSD, but EMDR leads to a faster reduction in symptoms. Study 3 – EMDR therapy showed greater improvements compared to non-trauma-focused CBT in treating oncological patients. Study 4 – EMDR is no more effective than other exposure techniques, and the eye movements are unnecessary. Purple hat therapy “Hypothetically, a doctor could ask clients with driving phobias to wear a large purple hat while applying relaxation and cognitive coping skills to in vivo practice.” Rosen & Davidson, 2003 Purple hat therapy refers to any medical practice in which an established form of therapy is mixed with an unlikely new addition (such as wearing a purple hat) and then is claimed to be effective because of the new addition, when in fact the effectiveness is due to  the established component. Pitfalls of choosing a method Anecdotal evidence Peer-pressure Confirmation bias Publication bias Legal regulation of psychological practice in the EU Тема/поим Резиме Legal regulation of a profession Example: Medical professions, e.g.: Paramedics Clear regulation of practices Boundary between professional competencies Legal boundaries on training and education Country, or region level differences in regulation Psychotherapy or counseling “Counseling” is a brief treatment that targets a specific symptom or situation, while “psychotherapy” is a longer-term treatment that attempts to gain more insight into someone's problems. Strasbourg declaration In accordance with the aims of the World Health Organisation (WHO), the non-discrimination accord valid within the framework of the European Union (EU) and intended for the European Economic Area (EEA), and the principle of freedom of movement of persons and services, the undersigned agree on the following points: 1. Psychotherapy is an independent scientific discipline, the practice of which represents an independent and free profession. 2. Training in psychotherapy takes place at an advanced, qualified and scientific level. 3. The multiplicity of psychotherapeutic methods is assured and guaranteed. 4. A full psychotherapeutic training covers theory, self-experience, and practice under supervision. Adequate knowledge of various psychotherapeutic processes is acquired. 5. Access to training is through various preliminary qualifications, in particular human and social sciences. The EAP’s Definition of 1. The practice of psychotherapy is the comprehensive, conscious Psychotherapy and planned treatment of psychosocial, psychosomatic and behavioural disturbances or states of suffering with scientific  psychotherapeutic methods, through an interaction between one or more persons being treated, and one or more psychotherapists, with the aim of relieving disturbing attitudes to change, and to promote the maturation, development and health of the treated person. It requires both a general and a specific training/education. 2. The independent practice of psychotherapy consists of autonomous, responsible enactment of the capacities described in paragraph 1; independent of whether the activity is in free practice or institutional work Two routes to becoming a therapist 1. spread over a minimum of seven years, with the first three years being the equivalent of a relevant University degree, and then four years which must be a training specific to Psychotherapy and at Masters EQF7 standard. The specialist training specific to Psychotherapy must contain all of the elements outlined by EAP which are required to become a Psychotherapist and should comprise a minimum of 1400 hours. 2. conducted as a five year full-time academic education and training in Psychotherapy organised by a University. This must be at Masters EQF7 level and contain specialist training specific to Psychotherapy. The training must include all the elements outlined by EAP which are required to become a Psychotherapist. Core competencies (according to 13 domains: EAP) Professional, Autonomous & accountable practice Psychotherapeutic Relationship Exploration Contracting Various Techniques Management of Change, Crisis & Trauma work Completion & Evaluation Collaboration with other professionals Supervision Ethics & cultural sensitivities Management & administration Prevention & education https://www.europsyche.org/app/uploads/2019/05/Final-Core-Co mpetencies-v-3-3_July2013.pdf Country differences Fully regulated systems: Austria (1990 Psychotherapy Act), Germany (Psychotherapists' Law), Malta, or Hungary  Countries with limited or no regulation, e.g., Bulgaria, Greece, and Estonia, Kosovo. - Different training requirements, different title protection EuroPsy European Certificate in Psychology - A way of identifying the professional training and qualifications of a European psychotherapist. - Goal is to integrate psychotherapeutic certificates across nations.