Ethical dilemmas are ubiquitous in therapy (2) and represent the experience of an apparent conflict between alternatives, neither of which is completely acceptable. This article will take a closer look at what the therapist's ethical responsibilities entail and examine some common ethical problems faced by mental health professionals. What would you say or ask? The present study used a qualitative lens to explore the ethical dilemmas encountered by trainee clinical psychologists and the methods they used to resolve these dilemmas. The analysis of the responses regarding the resolution of the ethical dilemmas indicated that only 57% of the participants felt that they had resolved their dilemma successfully and effectively. However, it does not include information contained in some sections of the APA code, related to providing services in emergencies, delegation of work, fees, termination and processes for reporting ethical violations. 2014 [cited 2015 Jan 28]. This was compounded by the possibly negative impact on the therapeutic alliance or possible legal requirements. The early phase of professional development is the opportune time to inculcate sensitivity to ethical issues; an ethical watchfulness (36) that anticipates and addresses emergent dilemmas. Barnett JE. Ethics and code of conduct of clinical psychologists. The journey of the counselor and therapist: research findings and perspectives on professional development. 4. What would you say or ask? In recent years we have seen a development in which the term “ethical risk management” has been used to describe a way to be ethical and aware of legal issues at the same time. The participation rate was 52.2%. That client finally lands a job, at another nonprofit, but after the first week complains that the organization is unethical because he learned that it retains 40% of donations as "administrative expenses," so only 60% is spent on the cause. Fifty-seven per cent of the trainees reported that the dilemmas were resolved adequately, the prominent methods of resolution being supervision or consultation and guidance from professional ethical guidelines. De Sousa A. Self-awareness, monitoring and discussions with the supervisor could help trainees sort out the complex questions relating to culture and ethical practice. Pryor RG. Statement demanding justice for Dr Kafeel Khan, Public Statement: Gross violation of human rights due to the mandatory linking of Aadhar to health and allied social security schemes, Health Professionals’ Pledge Against Torture, Ethics of health research: developing the COHRED Fairness Index, MFC Statement on Escalating Challenges to Health in India, Medico Friend Circle condemns the arrest of Dr. Saibal Jana, MFC welcomes the stinging report on cleaning up medical education regulation, Appeal of Indian Doctors for Ethical Practice (IDEP), Public Debate EoLC @ TISS on July 16, 2016, MacKay E, O’Neill P. What creates the dilemma in ethical dilemmas? As you're reflecting on clients like this person, you're wondering if it's ethical to try to help them get jobs. The paper begins with a brief statement about the centrality of autonomy or self governance as a core ethical value in the interaction between health care worker and patient. By Saul McLeod, updated 2015. After the completion of the three-month period, the data were downloaded and the online survey was closed.. The trainee therapists experienced a range of difficult emotions when confronted with ethical dilemmas, and reported feeling pressured by a sense of responsibility, discomfort, anxiety, fear, panic, shock and irritation. In India, in particular, the absence of adequate regulation and licensing of the profession of clinical psychology makes the potential consequences of professional ethical violations uncertain. What would you say or ask? Michael C. Gottlieb, PhD, practices forensic and family psychology in Dallas, Texas, and is a clinical professor at the University of Texas Southwestern Medical Center, where he teaches professional ethics. Citation from SAGE. Supervision is an important crucible for trainee therapists in the process of learning professional skills and developing their professional identity. The survey schedule was developed on the basis of a review of the literature and was hosted online on the Survey Monkey platform. Fear of jeopardising the therapeutic relationship or potentially harming the client was mostly reported in the context of refusing a client’s gift or breaching confidentiality. Training programmes need to move beyond the “principle-ethics) approach’ (32), which emphasises the language of justice and universal maxims and is often seen as being embedded in western traditions. Psychologists are allowed to have personal values that may not be addressed within their code of et… I certainly did not wish to talk about it with my supervisor on the case for the fear that it would get my friend into trouble. Respondents in this study expressed concerns about the implementation of professional ethics guidelines and discussed the possible role of cultural variation in the interpretation of non-sexual boundary violations. Is a salesperson ethically obliged to reveal his product's core weakness? He wants your blessing. 8th National Bioethics Conference Of Forum for Medical Ethics Society THEME Crisis within a crisis: Scientific, ethical & humanitarian challenges of COVID-19, A Joint Statement on Technical, legal, ethical and implementation concerns regarding Aarogya Setu and other apps introduced during COVID-19 in India by Jan Swasthya Abhiyan (JSA), Internet Freedom Foundation (IFF), Forum for Medical Ethics Society (FMES), and All India People’s Science Network (AIPSN), http://www.apa.org/ethics/code/index.aspx, http://dx.doi.org/10.3329/bioethics.v3i2.11701. Indian research on the ethical issues faced by therapists in the training phase could not be found in the public domain. What would you say or ask? The current version of the ethics code, which introduced the distinction between … American Psychological Association. You've driven me to think about committing suicide." Lehavot K, Barnett JE, Powers D. Psychotherapy, professional relationships, and ethical considerations in the myspace generation. As such, discussion of ethical issues occurs at numerous points in this textbook. These dilemmas emerged when the therapist’s values or religious beliefs were opposed to those that guided the client’s decisions and actions. All her friends—and she has a lot of older friends in their 20s, so they’re legal. The findings of this study represent a preliminary exploration of the ethical dilemmas faced by emerging therapy practitioners. Indian J Psychiatry: IPS Clinical Practice Guidelines. If I had appropriately/ inappropriately disclosed myself and to what extent one should disclose self?”. Who Most Wants to Get Back Together With an Ex? Of course, they exist in all forms of counseling, from short-term advising to long-term therapy, from eating disorders counseling to career counseling. The mean age (and standard deviation) of the respondents was calculated. Examples from psychological practice. Professional boundaries and psychotherapy: a review. The sixth category included two different ethical conundrums that emerged during the therapeutic process. A brief survey schedule was developed for the study. 2007;53:30-31. Ethical dilemmas are important puzzles with no easy answers but are fun to contemplate. Boundary violations in the doctor–patient relationship in India. Was I supposed to avoid it? You sense he's not self-efficacious enough to do that well enough on his own but you don't want to unduly pressure him into paying you to work with him on the exploration. Leach M, Harbin JJ. Would it not be good for me to see her when I am already aware of some of her troubles/concerns? 16. Subjects: Psychology, Psychology WJEC, A2 psychology, Issues in research WJEC, non-human participants. In sum, most international and national codes are lacking in clear guidelines on the process of ethical decision-making to be followed when faced with tough choices. One trainee elaborated on the lack of specificity and clarity: “Professional ethical guidelines in India…are sketchy in form, lacking elucidation. A large proportion of respondents (34.3%) explained why they did not turn to professional ethical codes in the face of dilemmas during therapeutic interactions with clients. Tryon GS. ([email protected]), Associate Professor, Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bangalore 560 029 INDIA, Ananya Sinha At times, the ethical way may include a soothing touch, graciously accepting a gift and appropriately engaging in non-exploitative dual relationships. This emphasises principles and values such as respect for the dignity of people, caring for the well-being of people, integrity, and professional and scientific responsibilities to society. Kitchener KS. The purpose of an ethics code is “to reflect an explicit value system as well as clearly articulated decisional and behavioral rules” (Fisher, 2009) in which all members of the group following the code agree to adhere to. Edit. The APA first published their ethics code in 1953 and has been continuously evolving the code ever since. A subset of trainees (8.5%) highlighted dilemmas related to their level of competencein their role as therapists. The trainees’ comments on weighing the values of social justice and humanity against the obligation to follow “rational” principle-based ethics give rise to debates on the philosophical foundations of different ethical positions. The findings of this study confirmed the importance of guidance from an approachable supervisor when a trainee is confronted by ethical questions. What do you say or ask? Ten years later, the client calls and says he became very successful as a fundraiser and has risen to vice president of fundraising but is sick of it: the people management, the ever-increasing fundraising quotas, and he’s thinking about returning to a simpler job. Clinical Psychologists in India are required to register with the Rehabilitation Council of India (RCI) but the RCI ethics code is brief and not tailored specifically to the psychotherapist–client context. In the words of one trainee, “I think discussion with the supervisor helps. One study selectively focused on ethical issues emerging from online trainee–client interactions (17). Previous international research with practising therapists (15, 24) found that confidentiality and the negotiation of the boundaries of the relationship with clients were the most problematic domains. This method could be used to plan revisions of professional codes so that they cover the prominent dilemmas experienced by trainees and practitioners in India. You sell new Chevys. If psychologists learn of misuse or misrepresentation of their work, they take reasonable steps to correct or minimize . As for the reporting of ethical violations by a colleague, the revised code lacks specific directions and the mechanism of accountability is still not well defined in the Indian context. Again she’s calling me irresponsible even though I’ve worked my butt off to become a VP and afford the house, a nice car, furniture, vacations, everything.” What would you say or ask? He says, "I don't need to pay you for that. 5. The results indicate that there was no fixed pattern of emotional response to situations; the trainees responded differently to similar ethical dilemmas. The media is a very important part of our society and is best used in psychology as a constructive source that can provide a strong education about psychology to a large audience of different cultures, for free. What then are the appropriate professional distance and emotional boundaries? Ethical Issues; Psychology Research Ethics Psychology Research Ethics . A CASE FOR STANDARD. The client asks you to write his resume and cover letter. Examples Of Ethical Issues In Psychology, The SM case study brings up an ethical question, as SM cannot feel fear. A clinical psychologist is taught to maintain clear, responsible boundaries between herself and a client. Legal Issues and Professional Psychology. Another therapist spoke of the struggle arising from the ethical responsibility to respond to and report a colleague’s ethical transgressions: “The thought that I should report it to someone senior also crossed my mind but the colleague was also one of my closest friends who had helped me and been there for me through a lot of personal difficulties in my life. The trainees who provided written informed consent for the study were sent a secure link via e-mail to access the online survey, which was kept open for a period of three months. Plus, the website’s donor page makes no mention of this. She’d be a great salesman.” What would you say or ask? Ethical issues in counseling generally fall on the therapist. While Tyron (33) recommends that all trainees be given a copy of the professional ethical standards and sign to mark their commitment to ethical practice, this in itself would be incomplete. Avasthi A, Grover S. Ethical and legal issues in psychotherapy. Politis AN, Knowles A. Marty Nemko, Ph.D., is a career and personal coach based in Oakland, California, and the author of 10 books. Resolving Ethical Issues. It’s just edible after all…if I don’t accept, will they feel rejected? Even though legal issues are probably not what first come to mind when most people think about psychology there is more involved in the practice of professional psychology than theories and treatment options. You consider your writing a client’s resume and cover letter to be no more ethical than a parent writing their child’s college application essay. The client says, “Paula (his 18-year-old) isn’t a school person and when finishing high school, I’m trying to get her to be in the business with me. Informed consent. There is limited research on the ethical dilemmas encountered by trainee therapists in the global literature. Positive ethics, risk management, and defensive practice. The dilemmas were related to the disclosure of certain information about clients to their family members or the legal authorities and the uncertainty regarding the limits of confidentiality. that have arisen in the profession. The dimensions of the clinical and cultural context must be considered while evaluating the ethical aspects of a therapist’s behaviour. Available from: Indian Association of Clinical Psychologists (IACP) Secretariat [Internet]. Scientists Pinpoint Gut Bacteria Associated With Depression, 7 Basic Personality Ingredients of Difficult People. The trainee therapists (5.7%) also grappled with the question of whether to accept the client’s right to autonomyand self-determination while setting the goals of therapy and making life choices. ethical violation by a a colleague. How would she be able to pay her therapist outside campus when I know her being a student makes it financially difficult to survive? The results indicated that supervision/consultation with peers and professional colleagues (45.7%) and guidance from ethical codes (34.3%) were the most common strategies for resolution. He helped me get a fundraising job.” What would you say or ask? The client returns a few months later saying he wasn’t able to compete with other marijuana delivery services and wants you to help him find a job as a fundraiser for an environmental nonprofit. The implicit authority of the therapist in the “guru–chela” model of the therapist–client relationship in India (29) could influence the construction of the notion of the client’s autonomy and give rise to dilemmas. As you review your responses to these dilemmas, is there anything you want to keep in mind? The therapists were confronted with competing concerns, with confidentiality on one side and the client’s safety on the other. One trainee wondered about the limits of the professional role when a client phoned in distress late at night, and acknowledged that “they are also humans who need strength and support when alone.” Another therapist worried about the extended duration of sessions and growing closeness with a client. The client quits that job and decides to start a marijuana delivery service. An overview of the American Psychological Association (APA) Ethics Code is provided, including its history, revisions, and content. Psychologists have values and these values are infused throughout their professional work (Bergin, 1991; Meara, Schimdt, & Day, 1996; Prilleltensky, 1997; Remley & Herlihy, 2007; as cited in Shiles, 2009). The trainees’ responses can be used to develop case scenarios which reflect the primary real-world concerns and pedagogy that is centred around the learner. Psychology is a very sensitive field and ethical concerns are likely to arise when carrying out research and prescribing any method of treatment to an individual. Why are so many people drawn to conspiracy theories in times of crisis? Ethics have their conceptual roots in philosophy and as such are open to interpretation and influence from many sources (e.g., theoretical stance, cultural and personal factors, morals). About one-third of the respondents (34.3%) suggested that guidelines were informative and useful. University. The trainees mentioned concerns about the possible negative impact of a therapeutic technique or decision on their client’s welfare. That way, I needn’t provide a separate client background for each dilemma. Intrinsic to therapeutic interactions are the negotiation of the balance between the “person” of the therapist and his/her professional role, the fact that the therapist–client encounter takes place in a private space, and the inherent power imbalance between the therapist and client. Psychologists do not terminate therapy to circumvent this standard.” Case Analysis Professional and Ethical Issues in Forensic Psychology Samuelu Vaina Argosy University Dr. The paper presents an overview of ethical issues in clinical psychology. Millions of people do that and their kids don’t become addicted. The availability, accessibility and support of the supervisor were considered useful by the majority of the trainees who attempted to resolve their ethical quandary by this method. 4 Reasons Why You Should Express Gratitude Every Day. The choice of any one action inevitably results in some ethical principle being compromised. 77412 Chapter 5 - Ethical issues in clinical psychology. For example, one trainee viewed a female client’s infidelity as morally wrong, but was simultaneously aware of a client’s right to make her own life choices and determine her personal growth. It is important to remember that it breaks down not only to ‘consent’ (permission) but, more importantly, ‘informed’ (having/showing knowledge). The results may be considered signposts and could be used to identify the primary areas in which the strengthening of training in ethical paradigms and practice is required. A recent commentary (27) discussed how boundaries may be viewed differently in the Indian culture. The study aimed to explore trainee clinical psychologists’ perspectives on the ethical dilemmas faced in the practice of therapy. You tell them that before he selects a career, it would be wise to spend a session or two plus some homework to explore. Zhao JB, Ji JL, Tang F, Du QY, Yang XL, Yang ZZ. Health networks demand justice for Dr Payal Tadvi, condemn the caste based discrimination in medical education institutions, Announcement about Maiden Bioethics Essay Competition winners, Jana Swasthya Abhiyan Statement on Implications of Interim Union Budget 2019-20 for health. The frequencies and percentages of responses in each category were computed. All these contribute to the emergence of ethical dilemmas. Reasonable explanations could include the purpose of t… We bought a house and have a big mortgage and we’re still paying off our kids’ college loans. There have been diverse perspectives on the sanctity and interpretation of boundaries in the therapeutic relationship. The experience of ethical dilemmas in the arena of therapy and the methods of resolving these dilemmas were examined among 35 clinical psychologists in training, through an anonymous and confidential online survey. Request Maharashtra Government to file review petition in Supreme Court : matter regarding Dr Payal Tadv [with 600+ endorsements]’. Around 8.5% of the trainees reported dilemmas that centred around the basic principle of beneficence and non-maleficence –the ethical imperative to benefit clients and to do them no harm. Specifically, it addresses the broad philosophical ideas and views on mental illness on which ethical principles are based, including Greek philosophy and Christianity. Available from: Slack CM, Wassenaar DR. The client decides to discontinue working with you and a month later, phones you: “I saw another career counselor, who recognizes there’s nothing wrong with writing your resume and cover letter, and saying you’re Hispanic even it’s just 1/4 because there’s racism even against 1/4-Hispanic people. In the service of presenting as many dilemmas as possible within this space's confines, I’ll present each dilemma as pertaining to the same client. think about issues that arise when research involves human or animal subjects 1. These grey areas would be open to individual interpretation and trainee therapists would benefit from guided discussions and reading related professional literature (30, 31). The trainees also raised ethical questions regarding therapist competence, the beneficence and non-maleficence of therapeutic actions, and client autonomy. Access to the online survey was password-protected and available only to the investigators of the study. A small proportion of trainees (8.6%) brought the process of weighing the pros and cons of divergent responses to the dilemma directly into the therapeutic discourse. The feelings of doubt and uncertainty were experienced across a range of ethical dilemmas, but were most prominently associated with the issues of competence and the appropriateness of disclosing information about oneself. 7. key ethical issues. The second most common ethical dilemma reported by psychologists is conflicted relationships with a client. Indian J Med Ethics. Justice to Dr Payal Tadvi case | Seeking endorsements | Request Maharashtra Government to file review petition in Supreme Court, POSITION AVAILABLE (FULL TIME) EDITORIAL COORDINATOR FOR Indian Journal of Medical Ethics (IJME), Last Date for Application 07, November 2020, Submission to the National Human Rights Commission (NHRC) on behalf of Hub5 (HEaL Institute, APU, Seher-CHSJ, and IAPH) – COPASAH on human rights issues confronted by ASHAS and ANMs during the Covid-19 pandemic | Aug 7, 2020, Letter to MMC by FMES, PUCL-MH, FAOW, and MFC urging to restore its order suspending licenses of two doctors accused of abetting the suicide of Dr Payal Tadvi, Forthcoming Webinar – Being at the Frontline of Covid 19: Conversations with Grassroots Health Care Workers in India. Themes in therapist and counselor development. This lesson discusses ethical dilemmas as they relate to psychology and psychologists. The rights should definitely be protected, but there is the accompanying danger that therapists may focus on self-protection and engage in “defensive practice” (21). Ethics and the professional practice of psychologists: the role of virtues and principles. The process of disclosure was fraught with uncertainty. She says we need financial security, that we can't afford the risk of going into business." BS Psychology (BSP) Academic year. Because most of my counseling experience has been as a career counselor, the ethical dilemmas I present here are career-related but most have broader applicability. The potential sample included all 67 trainees enrolled in the MPhil or PhD programme in Clinical Psychology at a tertiary care government hospital for mental health and neurosciences in India. What would you say or ask? These are used to help unravel ethical issues relating to patient autonomy. The findings indicate the need to strengthen training and supervision methodologies and professional ethics codes for psychotherapists and counsellors in India. This encompassed clients’ revelations regarding sexual abuse, suicidal intent, past criminal acts or an adolescent client’s plan to run away from home without the parents’ knowledge. Issues such as accepting gifts and self-disclosure are not specifically addressed in most professional ethics codes for therapists and counsellors. DOI: https://doi.org/10.20529/IJME.2015.055. One of the other prominent concerns of the trainees wasconfidentiality(34.3%). The perspectives of the law, clinical practice and ethics intersect, and need to be negotiated, discussed and revisited in the process of therapy (26). Registered Australian psychologists’ responses to ethical dilemmas regarding medicare funding of their services. Pope KS, Vetter VA. A total of 35 trainees, with a mean age of 27 years (SD=3.91), participated in the study.
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