Unit 3: Cultural and Ethnic Issues in Clinical Psychology - Seminar Unit 3: Cultural and Ethnic Issues in Clinical Psychology - Seminar Tonight we will discuss the major issues surrounding the following current controversies in the field of Psychology.

Here is a scenario for the Seminar Discussion: Michael is a 25-year-old graduate student at a large university. He is seeing Dr. Kelly, a clinical psychologist, for depression and anxiety. These symptoms emerged when Michael began graduate school about six months ago and have persisted. Michael's experience as a graduate student has included significant ongoing stressors, including financial insecurity, academic pressures, and turmoil in his romantic and family relationships. During one session, when Michael had suffered through a particularly stressful week and was feeling especially distraught, he spent the first 20 minutes of the session describing all the pressures he faced. At one point, Michael was quite agitated, and he said, "That school has wrecked my life. I hate that place. Maybe I ought to just blow the whole place up."

Seminar Discussion: 1. Dangerousness How does the Tarasoff court case apply to this clinical case? How does the Tarasoff court case apply to this clinical case? How can Dr. Kelly determine if Michael's comment constitutes a credible, legitimate threat? How can Dr. Kelly determine if Michael's comment constitutes a credible, legitimate threat? In your opinion, should Dr. Kelly break confidentiality based on Michael's comment? If so, with whom, specifically, should he communicate? How does this change if Michael is a high school student and 16 years old? In your opinion, should Dr. Kelly break confidentiality based on Michael's comment? If so, with whom, specifically, should he communicate? How does this change if Michael is a high school student and 16 years old? How is the issue of informed consent relevant to this case? How is the issue of informed consent relevant to this case?

Seminar Discussion: 2. Confidentiality Is it okay to talk to your friends about this if you don’t tell the client’s name? What is the � 6 degrees � concept? How does it apply to this situation? Is it okay to talk to your friends about this if you don’t tell the client’s name? What is the � 6 degrees � concept? How does it apply to this situation? How would this case be different if the client were an adolescent? How would this case be different if the client were an adolescent? How is confidentiality affected when the client is an adolescent? How is confidentiality affected when the client is an adolescent?

Cultural Competence “the counselor’s acquisition of awareness, knowledge, and skills needed to function effectively in a pluralistic democratic society… “ (Sue & Sue, p 21) “the counselor’s acquisition of awareness, knowledge, and skills needed to function effectively in a pluralistic democratic society… “ (Sue & Sue, p 21) 3 main components: awareness, knowledge, and skills 3 main components: awareness, knowledge, and skills Can Dr Kelly ethically claim a lack of knowledge concerning Michael's threat?

Cultural Competence: Self-Awareness Learning about one’s own culture Learning about one’s own culture –Values, assumptions, biases –By doing so, become less egocentric –Also, realize that differences are not deficiencies –Exploring one’s own prejudices in order to minimize them Would knowing one’s own culture help Dr. Kelly determine if Michael's comment constitutes a credible, legitimate threat?

What Constitutes a Culture? Narrow vs. broad definitions Narrow vs. broad definitions –Some argue that ethnicity and race are the defining characteristics of culture –Others argue that many other variables can define a culture, such as Socioeconomic status Socioeconomic status Religion Religion Gender Gender Age Age Geography/region Geography/region Sexual orientation Sexual orientation Political affiliation Political affiliation Subcultures (e.g., military, prison) Subcultures (e.g., military, prison) What determines a person’s culture to you?

Ethically Measuring the Outcome of Culture-Based Training Efforts Many questions remain Many questions remain –How can we measure a baseline of cultural competence? –How can we measure change after training? –Whose opinion should we seek? Psychologist, client, supervisor, others? –How can we infer cause?

Ethical Issues in Clinical Psychology APA Code of Ethics guides the behavior of clinical psychologists APA Code of Ethics guides the behavior of clinical psychologists Relevant issues include Relevant issues include –Confidentiality –Informed consent –Multiple relationships –Competence –Others

APA Code of Ethics First published in 1953 First published in 1953 Revised 9 times Revised 9 times Most recent edition was published in 2002 Most recent edition was published in 2002

APA Code of Ethics: Aspirational and Enforceable Aspirational Aspirational –General Principles section describes an ideal level of ethical functioning, or what to strive for Enforceable Enforceable –Ethical Standards section includes rules of conduct that can mandate minimal levels of behavior and can be specifically violated

APA Code of Ethics: Aspirational and Enforceable What are your thoughts on the aspirational and enforceable portions of the APA Code of Ethics? What are your thoughts on the aspirational and enforceable portions of the APA Code of Ethics? Should aspirational goals become hard-and-fast requirements of psychologists? Should aspirational goals become hard-and-fast requirements of psychologists?

APA Code of Ethics: Aspirational and Enforceable If so, how would you transform the current, more general aspirational goals into enforceable standards? Are the current enforceable standards too strict, too lenient, just right? How, if at all, would you modify these standards? If so, how would you transform the current, more general aspirational goals into enforceable standards? Are the current enforceable standards too strict, too lenient, just right? How, if at all, would you modify these standards? What aspirational goals or enforceable standards, if any, would you add to or remove from the code? What aspirational goals or enforceable standards, if any, would you add to or remove from the code?

Ethical Decision Making 8-step model 8-step model 1.Prior to any ethical dilemma arising, make a commitment to doing what is ethically appropriate. 2.Become familiar with the APA ethical code. 3.Consult any law or professional guidelines relevant to the situation at hand. 4.Try to understand the perspectives of various parties affected by the actions you may take. Consult with colleagues (always protecting confidentiality) for additional input and discussion.

Ethical Decision Making (cont.) 8 step model (cont.) 8 step model (cont.) 5.Generate and evaluate your alternatives. 6.Select and implement the course of action that seems most ethically appropriate. 7.Monitor and evaluate the effectiveness of your course of action. 8.Modify and continue to evaluate the ethical plan as necessary.

Psychologists’ Ethical Beliefs Some behaviors are viewed as absolutely unethical (e.g., sex with clients) Some behaviors are viewed as absolutely unethical (e.g., sex with clients) Some behaviors are views as absolutely ethical (e.g., addressing clients by first name) Some behaviors are views as absolutely ethical (e.g., addressing clients by first name) Many behaviors fall in “gray area” in between Many behaviors fall in “gray area” in between –Lots of difficult judgment calls

Confidentiality In general, psychologists are ethically obligated to maintain confidentiality In general, psychologists are ethically obligated to maintain confidentiality Some situations can arise in which breaking confidentiality is appropriate Some situations can arise in which breaking confidentiality is appropriate

Confidentiality: Tarasoff and the Duty to Warn Tarasoff is a court case regarding a college-student client who told his therapist he was going to kill his girlfriend (Tatiana Tarasoff) Tarasoff is a court case regarding a college-student client who told his therapist he was going to kill his girlfriend (Tatiana Tarasoff) Therapist contacted campus police who detained him, but after he was released, he killed her Therapist contacted campus police who detained him, but after he was released, he killed her

Confidentiality: Tarasoff and the Duty to Warn (cont.) Her family sued and won Her family sued and won The finding was that the therapist had the “duty to warn” the potential victim The finding was that the therapist had the “duty to warn” the potential victim This finding now sets a precedent for all therapists for breaking confidentiality This finding now sets a precedent for all therapists for breaking confidentiality

Confidentiality: Tarasoff and the Duty to Warn (cont.) How credible are clients’ threats? How credible are clients’ threats? What kinds of threats merit warnings? What kinds of threats merit warnings? –How should the unsafe behavior of clients with HIV/AIDS be understood in terms of threat? –Why or why not?

Confidentiality: When the Client is a Child Often, children will confide more if they can be assured that psychologists will not repeat everything to clients’ parents Often, children will confide more if they can be assured that psychologists will not repeat everything to clients’ parents Parents, of course, have a right to be informed Parents, of course, have a right to be informed Psychologists often make arrangements by discussing this with families up front Psychologists often make arrangements by discussing this with families up front Some issues, such as child abuse, require breaking of confidentiality to protect the child Some issues, such as child abuse, require breaking of confidentiality to protect the child

Informed Consent Required for research, assessment, therapy, and other professional activities Required for research, assessment, therapy, and other professional activities For therapy, informed consent is an ongoing process rather than a one- time event For therapy, informed consent is an ongoing process rather than a one- time event –As psychologist learns more about client, more information can be shared

Informed Consent (cont.) Informed consent for therapy must allow client the opportunity to ask questions and receive answers Informed consent for therapy must allow client the opportunity to ask questions and receive answers Informed consent process can be an early part of a strong therapeutic relationship Informed consent process can be an early part of a strong therapeutic relationship

Multiple Relationships Knowing someone professionally and in some other way Knowing someone professionally and in some other way –Romantic/sexual –Friendship –Business –Other ways Unethical when Unethical when –psychologist’s objectivity, competence, or judgment can be impaired –Exploitation or harm could result

Multiple Relationships What type of multiple relationships would you judge to be unethical? Provide several examples and your rationale for selecting these cases. What type of multiple relationships would you judge to be unethical? Provide several examples and your rationale for selecting these cases. Are there any multiple relationships that may not be unethical under the APA Code of Ethics? Provide several examples and your rationale for selecting these cases. Are there any multiple relationships that may not be unethical under the APA Code of Ethics? Provide several examples and your rationale for selecting these cases.

Ethics in Clinical Research Psychotherapy efficacy research Psychotherapy efficacy research –What should control group receive? No treatment (“Wait-list” control) No treatment (“Wait-list” control) Placebo treatment Placebo treatment Alternate treatment Alternate treatment –What ethical issues arise when any of these three options are used?

Questions?