Infusing Ethical and Multicultural Competencies Into Internship Training: A Participatory Workshop...

Infusing Ethical and Multicultural Infusing Ethical and Multicultural Competencies Into Internship Training:Competencies Into Internship Training:

A Participatory WorkshopA Participatory Workshop

APPIC ConferenceAPPIC ConferencePortland, OregonPortland, Oregon

April 17, 2009April 17, 2009

Erica H. Wise, Ph.D.Erica H. Wise, Ph.D.Department of PsychologyDepartment of Psychology

UNC Chapel HillUNC Chapel Hill

APPIC 2009APPIC 2009 22

OverviewOverview

1.1. Being an ethical role model for our Being an ethical role model for our traineestrainees

2.2. Ethical and multicultural Ethical and multicultural considerations in supervision and considerations in supervision and trainingtraining

3.3. Effective strategies for developing Effective strategies for developing ethical and multicultural ethical and multicultural competencies at the internship competencies at the internship levellevel


Serving as an EthicalServing as an EthicalRole ModelRole Model

o Be familiar with ethical and legal Be familiar with ethical and legal standardsstandards

o Attend ethics and multicultural Attend ethics and multicultural workshopsworkshops

o Be familiar with practice guidelines Be familiar with practice guidelines (e.g. Ethics Code, LGBTQ, Multicultural)(e.g. Ethics Code, LGBTQ, Multicultural)

o Regularly consult with colleagues Regularly consult with colleagues o Promote ethical and multicultural Promote ethical and multicultural

discourse in your agencydiscourse in your agency


General Ethical Considerations in General Ethical Considerations in Supervision and TrainingSupervision and Training

o Be familiar with guidelines and Be familiar with guidelines and standards related to supervision and standards related to supervision and trainingtraining

o Incorporate these principles into the Incorporate these principles into the your training programyour training program

o Create an atmosphere that fosters Create an atmosphere that fosters discourse about ethics, multicultural discourse about ethics, multicultural considerations and practiceconsiderations and practice

Professional Professional Self-RegulationSelf-Regulation

Risk managementRisk managementAspirational EthicsAspirational Ethics

55


Philosophical UnderpinningsPhilosophical Underpinnings

There are two philosophical world views that There are two philosophical world views that are commonly drawn from in the study of are commonly drawn from in the study of moral and ethical reasoning:moral and ethical reasoning:

o DeontologicalDeontologicalo The Moral ImperativeThe Moral Imperativeo Choices and behavior are inherently right or Choices and behavior are inherently right or

wrong wrongo TeleologicalTeleological

o Utilitarianism or PragmatismUtilitarianism or Pragmatismo Choices and behaviors are judged by outcomeChoices and behaviors are judged by outcome


Sources of Guidance Sources of Guidance for the Practice of Psychologyfor the Practice of Psychology

o APA Ethics CodeAPA Ethics Codeo HIPAA and other federal regulationsHIPAA and other federal regulationso Psychology Practice Act in your statePsychology Practice Act in your stateo Your agency or institutionYour agency or institutiono Guidelines and best practices Guidelines and best practices

documentsdocuments


Ethical Issues in SupervisionEthical Issues in Supervision

Major Ethical Issues:Major Ethical Issues:oCompetence and Client WelfareCompetence and Client Welfareo Informed Consent Informed Consent oConfidentialityConfidentialityoSupervisee RightsSupervisee RightsoThe Relationship Between The Relationship Between

Supervisor and SuperviseeSupervisor and Supervisee


Competence and Competence and

Client WelfareClient Welfare


2.05 Delegation of Work to 2.05 Delegation of Work to Others (excerpt)Others (excerpt)

Psychologists who Psychologists who delegate work to…delegate work to…supervisees…takesupervisees…take reasonable steps reasonable steps to…authorize only those responsibilities to…authorize only those responsibilities that that such persons can be expected to such persons can be expected to perform competentlyperform competently on the basis of on the basis of their education, training and their education, training and experience…with the level of experience…with the level of supervision being provided.supervision being provided.


Informed ConsentInformed Consent


10.01 Informed Consent to 10.01 Informed Consent to TherapyTherapy

o Psychologists inform clients/patients as early as is Psychologists inform clients/patients as early as is feasible in the therapeutic relationship about the feasible in the therapeutic relationship about the nature and anticipated course of therapy, fees, nature and anticipated course of therapy, fees, involvement of third parties, and involvement of third parties, and limits of limits of confidentialityconfidentiality and provide sufficient opportunity and provide sufficient opportunity for the client/patient to ask questions and receive for the client/patient to ask questions and receive answers. answers.

o When the therapist is a trainee and the legal When the therapist is a trainee and the legal responsibility for the treatment provided resides responsibility for the treatment provided resides with the supervisorwith the supervisor, the client/patient, as part of , the client/patient, as part of the informed consent procedure, is informed that the informed consent procedure, is informed that the therapist is in training and is being supervised the therapist is in training and is being supervised and is given the name of the supervisor.and is given the name of the supervisor.

10.02 Therapy Involving 10.02 Therapy Involving Couples or FamiliesCouples or Families

(a)(a) When psychologists agree to provide When psychologists agree to provide services to several persons who have a services to several persons who have a relationship (1) which of the individuals relationship (1) which of the individuals are clients/patients and (2) the are clients/patients and (2) the relationship the psychologist will have relationship the psychologist will have with each person. This clarification with each person. This clarification includes the psychologist’s role and the includes the psychologist’s role and the probable uses of the services provided or probable uses of the services provided or the information obtained. the information obtained.

1313APPIC 2009APPIC 2009

What do psychologists say?What do psychologists say?

““Informed consent is a shared decision Informed consent is a shared decision making process in which the making process in which the professional communicates sufficient professional communicates sufficient information to the other individual so information to the other individual so that s/he may make an informed that s/he may make an informed decision about participation in the decision about participation in the professional relationship.”professional relationship.”

Barnett, PPRP, 2007Barnett, PPRP, 20071414APPIC 2009APPIC 2009

Readability of NPP Forms?Readability of NPP Forms?The Numbers Game, Washington Post, 2005The Numbers Game, Washington Post, 2005

0% of patient privacy forms were as easy 0% of patient privacy forms were as easy to read as comicsto read as comics

1% were as easy to read as J.K. Rowling’s 1% were as easy to read as J.K. Rowling’s “Harry Potter and the Sorcerer’s Stone.”“Harry Potter and the Sorcerer’s Stone.”

8% were as easy to read as H.G. Wells’s 8% were as easy to read as H.G. Wells’s “The War of the Worlds”“The War of the Worlds”

91% were as easy to read as professional 91% were as easy to read as professional medical literature or legal contractsmedical literature or legal contracts


Etymology of Etymology of InformInform

From the Latin From the Latin InformarInformare; e;

inin= causative preposition + = causative preposition +

formareformare= to make or to form; to form = to make or to form; to form an idea an idea

““To cause someone to form an idea”To cause someone to form an idea”


Etymology of Etymology of ConsentConsent

From the Latin From the Latin comsentirecomsentire

comcom= with + = with +

sentiresentire=to feel or to sense =to feel or to sense

““To feel together; to feel with; to be of To feel together; to feel with; to be of one mind”one mind”


Final Thoughts on Final Thoughts on Informed ConsentInformed Consent

““To cause someone to form an ideaTo cause someone to form an idea

To feel together; to feel with; to be of To feel together; to feel with; to be of one mind”one mind”

How can the Informed Consent process How can the Informed Consent process truly serve more than a risk truly serve more than a risk management function?management function?

Wise, PPRP, 2007Wise, PPRP, 20071818APPIC 2009APPIC 2009


ConfidentialityConfidentiality

CONFIDENTIALITYCONFIDENTIALITY

Done or communicated in confidence; told in Done or communicated in confidence; told in secretsecret

In the context of an intimate or trusting In the context of an intimate or trusting relationshiprelationship

Latin: Latin: con = with; fidere = trustcon = with; fidere = trust

General PrincipleGeneral Principle Balance between: Balance between: public welfare public welfare and and individual rights individual rights

2020


General RuleGeneral RuleMandated ExceptionsMandated ExceptionsPermitted ExceptionsPermitted Exceptions

2121


Definition of TermsDefinition of Terms

o PrivacyPrivacyo ConfidentialityConfidentialityo PrivilegePrivilege



General RuleGeneral Ruleo Mandated ExceptionsMandated Exceptionso Permitted ExceptionsPermitted Exceptions


General RuleGeneral Rule

4.01 Maintaining Confidentiality4.01 Maintaining Confidentiality

Psychologists have a primary obligation and Psychologists have a primary obligation and take reasonable precautions to protect take reasonable precautions to protect confidential information obtained through confidential information obtained through or stored in any medium, recognizing that or stored in any medium, recognizing that the extent and limits of confidentiality may the extent and limits of confidentiality may be regulated by law or established by be regulated by law or established by institutional rules or professional or institutional rules or professional or scientific relationship. scientific relationship.


Limits of ConfidentialityLimits of Confidentiality

4.02 Discussing the Limits of Confidentiality4.02 Discussing the Limits of Confidentiality

(a) Psychologists discuss with persons (a) Psychologists discuss with persons (including, to the extent feasible, persons who (including, to the extent feasible, persons who are legally incapable of giving informed are legally incapable of giving informed consent and their legal representatives) and consent and their legal representatives) and organizations with whom they establish a organizations with whom they establish a scientific or professional relationship (1) the scientific or professional relationship (1) the relevant limits of confidentiality and (2) the relevant limits of confidentiality and (2) the foreseeable uses of the information generated foreseeable uses of the information generated through their psychological activities. (See through their psychological activities. (See also Standard 3.10, Informed Consent.)also Standard 3.10, Informed Consent.)

(excerpt)(excerpt)


Disclosure With Consent Disclosure With Consent

4.05 Disclosures4.05 Disclosures(a) Psychologists may disclose (a) Psychologists may disclose

confidential information with the confidential information with the appropriate consent of the appropriate consent of the organizational client, the individual organizational client, the individual client/patient, or another legally client/patient, or another legally authorized person on behalf of the authorized person on behalf of the client/patient unless prohibited by client/patient unless prohibited by law.law.


Disclosures Without ConsentDisclosures Without Consent

4.05 (b) Psychologists disclose confidential 4.05 (b) Psychologists disclose confidential information without the consent of the individual information without the consent of the individual only as mandated by law, or where permitted by only as mandated by law, or where permitted by law for a valid purpose such as to (1) provide law for a valid purpose such as to (1) provide needed professional services; (2) obtain needed professional services; (2) obtain appropriate professional consultations; (3) protect appropriate professional consultations; (3) protect the client/patient, psychologist, or others from the client/patient, psychologist, or others from harm; or (4) obtain payment for services from a harm; or (4) obtain payment for services from a client/patient, in which instance disclosure is client/patient, in which instance disclosure is limited to the minimum that is necessary to limited to the minimum that is necessary to achieve the purpose. (See also Standard 6.04e, achieve the purpose. (See also Standard 6.04e, Fees and Financial Arrangements.)Fees and Financial Arrangements.)


Supervisee RightsSupervisee Rights


7.02 Descriptions of Education and 7.02 Descriptions of Education and Training ProgramsTraining Programs

Psychologists responsible for education and training Psychologists responsible for education and training programs take reasonable steps to ensure that programs take reasonable steps to ensure that there is a current and accurate description of the there is a current and accurate description of the program content (including participation in program content (including participation in required course- or program-related counseling, required course- or program-related counseling, psychotherapy, experiential groups, consulting psychotherapy, experiential groups, consulting projects, or community service), training goals projects, or community service), training goals and objectives, stipends and benefits, and and objectives, stipends and benefits, and requirements that must be met for satisfactory requirements that must be met for satisfactory completion of the program. This information must completion of the program. This information must be made readily available to all interested be made readily available to all interested parties.parties.


7.04 Student Disclosure of 7.04 Student Disclosure of Personal InformationPersonal Information

Psychologists Psychologists do not require students do not require students or supervisees to disclose personal or supervisees to disclose personal informationinformation in course- or program- in course- or program-related activities, either orally or in related activities, either orally or in writing, regarding sexual history, writing, regarding sexual history, history of abuse and neglect, history of abuse and neglect, psychological treatment, and psychological treatment, and relationships with parents, peers, relationships with parents, peers, and spouses or significant others and spouses or significant others except if…except if…


7.04 Student Disclosure of 7.04 Student Disclosure of Personal InformationPersonal Information

o The program or training facility has The program or training facility has clearly identified this requirement in its clearly identified this requirement in its admissions and program materials oradmissions and program materials or

o The The information is necessary to evaluate information is necessary to evaluate or obtain assistance for studentsor obtain assistance for students whose whose personal problems could reasonably be personal problems could reasonably be judged to be preventing them from judged to be preventing them from performing their training- or performing their training- or professionally related activities in a professionally related activities in a competent manner or posing a threat to competent manner or posing a threat to the students or others.the students or others.


7.06 Assessing Student and 7.06 Assessing Student and Supervisee PerformanceSupervisee Performance

o In academic and In academic and supervisory relationshipssupervisory relationships, , psychologists establish a timely and psychologists establish a timely and specific process for providing feedback to specific process for providing feedback to students and supervisees. Information students and supervisees. Information regarding the process is provided to the regarding the process is provided to the student at the beginning of supervision.student at the beginning of supervision.

o Psychologists evaluate students and Psychologists evaluate students and supervisees on the basis of their supervisees on the basis of their actual actual performanceperformance on relevant and established on relevant and established program requirements.program requirements.


The Relationship Between The Relationship Between Supervisor and SuperviseeSupervisor and Supervisee


3.05 Multiple Relationships3.05 Multiple RelationshipsA multiple relationship occurs when a A multiple relationship occurs when a

psychologist is in a professional role with a psychologist is in a professional role with a person and:person and:o At the same time is in a relationship with a At the same time is in a relationship with a

person closely associated with or related to the person closely associated with or related to the person with whom the psychologist has the person with whom the psychologist has the professional relationship, or professional relationship, or

o Promises to enter into another relationship in Promises to enter into another relationship in the future with the person or a person closely the future with the person or a person closely associated with or related to the person.associated with or related to the person.

o At the same time is in another role with the At the same time is in another role with the same person, same person,


3.05 Multiple Relationships3.05 Multiple Relationships(excerpt)(excerpt)

o A psychologist refrains from entering into a A psychologist refrains from entering into a multiple relationship if the multiple relationship multiple relationship if the multiple relationship could reasonably be expected to could reasonably be expected to impair the impair the psychologist’s objectivity, competence, or psychologist’s objectivity, competence, or effectivenesseffectiveness in performing his or her functions as in performing his or her functions as a psychologist, or otherwise a psychologist, or otherwise risks exploitationrisks exploitation or or harm to the person with whom the professional harm to the person with whom the professional relationship exists.relationship exists.

o Multiple relationships that would not reasonably Multiple relationships that would not reasonably be expected to cause impairment or risk be expected to cause impairment or risk exploitation or harm are not unethical.exploitation or harm are not unethical.


3.08 Exploitative Relationships3.08 Exploitative Relationships

Psychologists Psychologists do not exploitdo not exploit persons persons over whom they have over whom they have supervisory, supervisory, evaluativeevaluative, or other authority such as , or other authority such as clients/patients, students, clients/patients, students, superviseessupervisees, research participants, , research participants, and employees. and employees.


7.07 Sexual Relationships With 7.07 Sexual Relationships With Students and SuperviseesStudents and Supervisees

Psychologists Psychologists do not engage in sexual do not engage in sexual relationshipsrelationships with students orwith students or superviseessupervisees who are in their who are in their department, agency, or training department, agency, or training center or over whom psychologists center or over whom psychologists have or are likely to have have or are likely to have evaluative evaluative authorityauthority..


Psychologists in TrainingPsychologists in Training 90-270.4 Exemptions90-270.4 Exemptions

Example from NC Psychology Practice ActExample from NC Psychology Practice Act(d) Nothing in this article shall be construed as (d) Nothing in this article shall be construed as

limiting the activities, services, and use of title limiting the activities, services, and use of title designating training status of a student, intern, designating training status of a student, intern, fellow, or other trainee…preparing for the fellow, or other trainee…preparing for the practice of psychology under the supervision and practice of psychology under the supervision and responsibility of a qualified psychologists…responsibility of a qualified psychologists…provided that such activities and services provided that such activities and services constitute a part of his or her course of study as a constitute a part of his or her course of study as a matriculated graduate student in psychology.matriculated graduate student in psychology.


Developing Ethical Competencies Developing Ethical Competencies in our Trainees…in our Trainees…

What are we trying to do?What are we trying to do?


ADPTC Competency Outline ADPTC Competency Outline #7 Ethical Competencies#7 Ethical Competencies

During the practicum, the student will build During the practicum, the student will build on coursework in ethical practice, on coursework in ethical practice, developing individual, practical knowledge developing individual, practical knowledge of ethical practice, including linkage of the of ethical practice, including linkage of the APA ethics code (APA, 2002) to behavior APA ethics code (APA, 2002) to behavior and decision making in actual clinical and decision making in actual clinical settings. In addition, students should settings. In addition, students should increase and apply their understanding of increase and apply their understanding of legal standards (state and federal, e.g., legal standards (state and federal, e.g., HIPAA) and APA practice guidelines. HIPAA) and APA practice guidelines.


ADPTC CO Ethical CompetenciesADPTC CO Ethical Competencies

More specifically, during practicum training the student will More specifically, during practicum training the student will work to develop the following ethical competencies:work to develop the following ethical competencies:

KnowledgeKnowledge of ethical/professional codes, standards and of ethical/professional codes, standards and guidelines; knowledge of statutes, rules, regulations and guidelines; knowledge of statutes, rules, regulations and case law relevant to the practice of psychology.case law relevant to the practice of psychology.

Recognize and analyze ethical and legal issues Recognize and analyze ethical and legal issues across the across the range of professional activities in the practicum setting.range of professional activities in the practicum setting.

Recognize and understand the ethical Recognize and understand the ethical dimensions/features of dimensions/features of his/her own attitudes and practice his/her own attitudes and practice in the clinical setting.in the clinical setting.

Seek appropriate information and consultation Seek appropriate information and consultation when when faced with ethical issues.faced with ethical issues.

Practice appropriate professional assertiveness Practice appropriate professional assertiveness related to related to ethical issues (e.g., by raising issues when they become ethical issues (e.g., by raising issues when they become apparent to the student). Evidence commitment to apparent to the student). Evidence commitment to ethical practice. ethical practice.

Competency BenchmarksCompetency BenchmarksReadiness for InternshipReadiness for Internship

Essential ComponentEssential Component: :

Intermediate level knowledge and understanding of the Intermediate level knowledge and understanding of the APA Ethical Principles and Code of Conduct and other APA Ethical Principles and Code of Conduct and other relevant ethical/ professional codes, standards and relevant ethical/ professional codes, standards and guidelines; laws, statutes, rules, regulations guidelines; laws, statutes, rules, regulations

Behavioral AnchorBehavioral Anchor: : o Identifies ethical dilemmas effectively Identifies ethical dilemmas effectively o Actively consults with supervisor to act upon ethical and legal Actively consults with supervisor to act upon ethical and legal

aspects of practiceaspects of practiceo Addresses ethical and legal aspects within the case Addresses ethical and legal aspects within the case

conceptualizationconceptualizationo Discusses ethical implications of professional workDiscusses ethical implications of professional worko Recognizes and discusses limits of own ethical and legal Recognizes and discusses limits of own ethical and legal

knowledgeknowledgeAPPIC 2009APPIC 2009 4242

Competency BenchmarksCompetency BenchmarksReadiness for Entry to PracticeReadiness for Entry to Practice

Essential ComponentEssential Component::

Routine command and application of the APA Ethical Routine command and application of the APA Ethical Principles and Code of Conduct and other relevant Principles and Code of Conduct and other relevant and other ethical, legal and professional standards and other ethical, legal and professional standards and guidelines of the profession and guidelines of the profession

Behavioral AnchorBehavioral Anchor: : o Spontaneously and reliably identifies complex ethical & legal Spontaneously and reliably identifies complex ethical & legal

issues, analyzes them accurately and proactively addresses issues, analyzes them accurately and proactively addresses themthem

o Aware of potential conflicts in complex ethical and legal issues Aware of potential conflicts in complex ethical and legal issues and seeks to prevent problems and unprofessional conductand seeks to prevent problems and unprofessional conduct

o Aware of the obligation to confront peers and or organizations Aware of the obligation to confront peers and or organizations regarding ethical problems or issues and to deal proactively regarding ethical problems or issues and to deal proactively with conflict when addressing professional behavior with others with conflict when addressing professional behavior with others



Strategies Strategies

o Didactics and formal seminarsDidactics and formal seminarso Integrate ethical and Integrate ethical and

multicultural considerations into multicultural considerations into all agency activitiesall agency activities

o SupervisionSupervisiono Experiential learningExperiential learningo Socratic questioningSocratic questioning


Supervision ConsiderationsSupervision Considerations


Supervision DefinedSupervision Defined

““An intervention provided by a more An intervention provided by a more senior member of a profession to a senior member of a profession to a more junior member or members of more junior member or members of that same profession”that same profession”

(Bernard & Goodyear, (Bernard & Goodyear, 2004)2004)


Supervision…Supervision…o Is evaluative and extends over timeIs evaluative and extends over time

o Enhances professional functioning of the Enhances professional functioning of the junior personjunior person

o Monitors quality of professional services to Monitors quality of professional services to the clientthe client

o Serves as a gatekeeper for the professionServes as a gatekeeper for the profession

(Bernard & Goodyear, (Bernard & Goodyear, 2004)2004)


Supervision as a Triadic SystemSupervision as a Triadic System

Client Supervisee Supervisor


The Supervisory DyadThe Supervisory Dyad

Supervisee Supervisor


A stronger supervisory relationship A stronger supervisory relationship will facilitate increased trainee will facilitate increased trainee disclosure and enhanced disclosure and enhanced examination of multicultural and examination of multicultural and ethical considerationsethical considerations


Empirical Evidence Suggests Empirical Evidence Suggests That With Improved AllianceThat With Improved Alliance

Supervisees will:Supervisees will:oDisclose more in supervisionDisclose more in supervisionoAdhere to treatment betterAdhere to treatment betteroConnect better to their clientConnect better to their client

(Bernard & Goodyear, 2004)(Bernard & Goodyear, 2004)


How Supervisors Help Foster a How Supervisors Help Foster a Strong AllianceStrong Alliance

Create shared goals with superviseeCreate shared goals with supervisee

Consider the process of evaluationConsider the process of evaluationo Criteria for evaluation (based on what?)Criteria for evaluation (based on what?)o Formative versus Summative (when?)Formative versus Summative (when?)o Evaluation feedback and instruments (how?)Evaluation feedback and instruments (how?)

Cultivate a safe, supportive atmosphereCultivate a safe, supportive atmosphereo Discuss multicultural issues Discuss multicultural issues o Address negative experiences/interactionsAddress negative experiences/interactions


Strategies for developing ethical Strategies for developing ethical competencies in our traineescompetencies in our trainees

Early in training (practicum):Early in training (practicum):o Supervisor initiative to focus on Supervisor initiative to focus on

ethicsethicso Incorporate ethics in a structured Incorporate ethics in a structured

manner into supervision processmanner into supervision processo Intervene actively in ethical decision-Intervene actively in ethical decision-

makingmakingo Recognize individual differences in Recognize individual differences in

critical thinking in superviseescritical thinking in supervisees


Strategies for developing ethical Strategies for developing ethical competencies in our traineescompetencies in our trainees

Later in training (internship/postdoc):Later in training (internship/postdoc):o Can recognize ethical dilemmas and to Can recognize ethical dilemmas and to

function more autonomously in ethical function more autonomously in ethical decision makingdecision making

o May still need assistance with complex May still need assistance with complex ethical dilemmasethical dilemmas

o Inculcate value of life long learning related Inculcate value of life long learning related to ethical competencyto ethical competency

o Can identify context specific ethics in Can identify context specific ethics in order to develop templatesorder to develop templates


Experiential LearningExperiential Learning

A model of ethical decision A model of ethical decision making using clinical making using clinical supervision vignettessupervision vignettes


Ethical Decision MakingEthical Decision Makingo Recognize a situation in which there is an ethical Recognize a situation in which there is an ethical

dilemma or in which there is potential for harmdilemma or in which there is potential for harmo Identify the underlying moral or ethical principle or Identify the underlying moral or ethical principle or

dilemmadilemmao Consult available sources of guidanceConsult available sources of guidanceo Consult a knowledgeable colleague or expertConsult a knowledgeable colleague or experto Consider sources of influence (internal/external) Consider sources of influence (internal/external)

that might impact your judgmentthat might impact your judgmento Identify potential options and likely consequencesIdentify potential options and likely consequenceso Decide on a course of actionDecide on a course of actiono Take it one step at a time*Take it one step at a time*

Adapted from Koocher, G.P. and Keith-Spiegel, P., Adapted from Koocher, G.P. and Keith-Spiegel, P., Ethics in PsychologyEthics in Psychology, 1998, 1998


Multicultural Ethical VignettesMulticultural Ethical Vignettes

An 18yo male comes in to your clinic to discuss the “self-hate” An 18yo male comes in to your clinic to discuss the “self-hate” that he experiences because of his attraction to other males. He that he experiences because of his attraction to other males. He tells you that he is a fundamentalist Christian and has read on the tells you that he is a fundamentalist Christian and has read on the internet about “reparative therapies” that are designed to “make internet about “reparative therapies” that are designed to “make me normal”. He requests this treatment and volunteers that he me normal”. He requests this treatment and volunteers that he has no interest in “learning to accept the unacceptable”.has no interest in “learning to accept the unacceptable”.

A 23yo Latina female comes in to your clinic because she is feeling A 23yo Latina female comes in to your clinic because she is feeling extreme conflict between her desire to continue in her Ph.D. extreme conflict between her desire to continue in her Ph.D. program in biochemistry and her wish to be close to her extended program in biochemistry and her wish to be close to her extended family in California. They want her to come home and get to know family in California. They want her to come home and get to know a local male whose family is from the same small town in Mexico. a local male whose family is from the same small town in Mexico. She is lonely and struggles with intense guilt.She is lonely and struggles with intense guilt.

A 24yo male Asian graduate student from Taiwan comes in to your A 24yo male Asian graduate student from Taiwan comes in to your clinic because he feels increasingly unhappy with his major in clinic because he feels increasingly unhappy with his major in computer science. He tells you that his family expects him to be a computer science. He tells you that his family expects him to be a computer science engineer; in fact, they would not have funded computer science engineer; in fact, they would not have funded travel, living and tuition expenses for him to study anthropology travel, living and tuition expenses for him to study anthropology about which he has an intellectual passion.about which he has an intellectual passion.

FB and the Concerned InternFB and the Concerned Intern

An intern comes to you and confides their concern about An intern comes to you and confides their concern about a fellow intern who has a Facebook site that includes a fellow intern who has a Facebook site that includes detailed personal information. Your agency has no detailed personal information. Your agency has no explicit policy related to this issue.explicit policy related to this issue.

What if the intern’s FB site includes drinking photos from a recent spring What if the intern’s FB site includes drinking photos from a recent spring break trip to Key West?break trip to Key West?

What if the intern’s FB site includes links to a site that features racist What if the intern’s FB site includes links to a site that features racist and/or LGBTQ targeted humor? and/or LGBTQ targeted humor?

What if you work with high risk patients in your setting? What if you work with high risk patients in your setting? What if the concerned intern indicates that they don’t want anyone to What if the concerned intern indicates that they don’t want anyone to

know that they raised the issue with you?know that they raised the issue with you? Do you have an ethical or legal obligation to act in this situation?Do you have an ethical or legal obligation to act in this situation? If you do decide to take action, what are the pros and cons of handling this If you do decide to take action, what are the pros and cons of handling this

situation privately versus publicly?situation privately versus publicly? What would you do?What would you do?


Supervisor ConcernSupervisor Concern

You are an internship TD. An intern confides in you that one of You are an internship TD. An intern confides in you that one of her supervisors has been spending supervision time her supervisors has been spending supervision time discussing his personal health problems. This supervisor discussing his personal health problems. This supervisor has made deprecating remarks about the mostly lower SES has made deprecating remarks about the mostly lower SES clients who seek treatment in your setting. The intern tells clients who seek treatment in your setting. The intern tells you that she does not want you to “stir things up” by you that she does not want you to “stir things up” by talking to the supervisor about her complaint and adds that talking to the supervisor about her complaint and adds that she is “the vulnerable party” in this situation. she is “the vulnerable party” in this situation. How would you react to this disclosure from the intern?How would you react to this disclosure from the intern?

How would you respond to the intern?How would you respond to the intern? What are the ethical and legal issues considerations in this What are the ethical and legal issues considerations in this

situation?situation? What are your obligations (if any)?What are your obligations (if any)? What would you do?What would you do?



Distressed InternDistressed InternYou have noticed that your supervisee Pat has seemed quieter You have noticed that your supervisee Pat has seemed quieter

than usual in supervision and in the training seminar. When than usual in supervision and in the training seminar. When you casually ask at the end of a supervision session how Pat is you casually ask at the end of a supervision session how Pat is doing, Pat confides in you that Pat’s former partner has just doing, Pat confides in you that Pat’s former partner has just ended a 6 year relationship that began when they were in ended a 6 year relationship that began when they were in college. Pat begins to sob with great intensity when describing college. Pat begins to sob with great intensity when describing the situation to you. Pat has been distraught and has even had the situation to you. Pat has been distraught and has even had thoughts of not wanting to live. Pat begs you not to tell the thoughts of not wanting to live. Pat begs you not to tell the training committee because “the humiliation would make training committee because “the humiliation would make things worse”. In addition to being on call that day, you are things worse”. In addition to being on call that day, you are already running late for a meeting, have several phone calls to already running late for a meeting, have several phone calls to return and a client waiting to be seen.return and a client waiting to be seen.

What might you be feeling?What might you be feeling? What are your various obligations?What are your various obligations? What if you are aware that at least one of Pat’s clients is What if you are aware that at least one of Pat’s clients is

dealing with the painful ending of a romantic relationship?dealing with the painful ending of a romantic relationship? What are the relevant ethical or legal obligations?What are the relevant ethical or legal obligations? What are some possible courses of action?What are some possible courses of action?


Staff Halloween PartyStaff Halloween Party

The counseling center staff is planning theirThe counseling center staff is planning theirannual Halloween party. This is traditionallyannual Halloween party. This is traditionallya time during which staff “let loose”; dress a time during which staff “let loose”; dress up in costumes and share good food andup in costumes and share good food anddrinks. Some of the staff wants to invite thedrinks. Some of the staff wants to invite theInterns so that they will feel more included inInterns so that they will feel more included inthe staff and get to know every better. Some staff the staff and get to know every better. Some staff feel uncomfortable drinking and partying with feel uncomfortable drinking and partying with students present.students present. What are the relevant ethics considerations?What are the relevant ethics considerations? What are the potential benefits and risks?What are the potential benefits and risks? What would you advise the staff?What would you advise the staff?

Supervisor Competence

You are supervising Joan who is an intern at your center. She took an advanced DBT case formulation seminar, completed an intensive DBT practicum and was a RA in a DBT lab in her doctoral program. She is very excited about applying this approach to a client who has presented to the outpatient clinic with a history of self injurious behavior. You have worked with such clients, but your only exposure to DBT was a weekend workshop that you participated in several hears ago.

What would your thoughts and feelings be? Are you competent to supervise this treatment case? What are the legal and ethical issues? What are your options? What would you do?



Relationship ConcernRelationship Concern

Earl is a recently separated staff member who is supervising Earl is a recently separated staff member who is supervising Edith. Edith approaches Earl towards the end of the day Edith. Edith approaches Earl towards the end of the day with a request to discuss a client she is concerned about. with a request to discuss a client she is concerned about. Earl explains that he is busy the next hour, and he has an Earl explains that he is busy the next hour, and he has an appointment later that evening and needs to leave on time appointment later that evening and needs to leave on time in order to get dinner before his appointment. However, in order to get dinner before his appointment. However, Edith is welcome to join him and discuss her concerns over Edith is welcome to join him and discuss her concerns over dinner. Edith really wants to discuss her case but feels dinner. Edith really wants to discuss her case but feels uncomfortable discussing the case over dinner. She is also uncomfortable discussing the case over dinner. She is also concerned that her supervisor will think less of her if she concerned that her supervisor will think less of her if she isn’t willing to do this. You are a staff member that works isn’t willing to do this. You are a staff member that works with Edith and she mentions the situation to you before with Edith and she mentions the situation to you before responding to Earl’s invitation.responding to Earl’s invitation.

What would your reaction be?What would your reaction be? Would you feel differently if the genders were reversed?Would you feel differently if the genders were reversed? What would be relevant ethical issues in this situation?What would be relevant ethical issues in this situation? What would your do?What would your do?

Infusing Ethical and Multicultural Competencies Into Internship Training: A Participatory Workshop...

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