ETHICS IN PSYCHOLOGY Session 5 CONFIDENTIALITY

1. ETHICS IN PSYCHOLOGYSession 5CONFIDENTIALITY NİşantaşI UNIVERSITY

2. SESSION 5 • MONSTER STUDY • CONFIDENTIALITY

3. MONSTER STUDY • https://www.youtube.com/watch?v=b2qHhl5-FEo (1.40sn) • Dr. Wendell Johnson and his graduate student Mary Tudor conducted this experiment. • It is called Monster Study by his colleagues, because he used innocent orphan children as subjects. • He involved 22 orphan children from Iowa, in 1930s. • He divided these children into 2 groups for speech therapy. • One group received positive therapy (labeled as normal speakers), • the other group received negative feedback and therapy (labeled as stutterers) for 6 months. • The group labeled as stutterers did actually show signs of stuttering. • There were 6 normal children in the stutterers group, 5 of them developed speech problems.

4. MONSTER STUDY cont. • 3 of 5 stuttering children in the stutterers group became progressively worse. • He did not informed the children about the purpose of the experiment. • Children were thinking that they were receiving speech therapy. • Dr. Johnson tried to induce stuttering into healthy children. • Labeling children made them worse. • Some healthy children started stuttering. • He could not undo the damage. • He kept the study hidden, it is found only in Mary Tudor’s thesis. • Children suffered lifelong psychological effects.

5. MONSTER STUDY cont.

6. MONSTER STUDY cont. • Why unethical? • Had no good intentions. • HARMED the children. • NO informed consent. • NO debriefing after the study. • Kept the study hidden. • Publicity: You ask yourself if you would be willing to have your action to be known by others.

7. PRIVACY AND CONFIDENTIALITY • Maintaining Confidentiality • Discussing the Limits of Confidentiality • Recording • Minimizing Intrusions on Privacy • Disclosures • Consultations • Use of Confidential Information for Didactic or Other Purposes

8. WHAT IS CONFIDENTIALITY? • ‘Obligations of psychologists to protect the privacy of patient information (Knapp& VandeCreek, 2006, p111). • Confidentiality rules are based on the moral principles of beneficence (promote client welfare), nonmaleficence (avoid actions that could harm clients), integrity (keep promises), respect for client autonomy (clients have control over the release of the info gathered from client services). • Clients would be more open in their communications, if they have the assurance of confidentiality from the psychologist. • Confidentiality is to ensure that clients feel safe enough and trust to share their information.

9. CONFIDENTIALITY CONT. • At the beginning of the therapy, psychologists should inform their clients about the exceptions to confidentiality. • According to TPA, Ethics Code underlines: • ‘When the client’s condition poses a danger to him/herself and others.’ • ‘In cases of child or adolescent abuse or neglect and in cases of harm to vulnerable adults.’ • Family therapy, group therapy, treatment of adolescents/children, treatment of adults with mental health illness have different and unique aspects.

10. CONFIDENTIALITY IN FAMILY THERAPY • Psychologists should explain the rules of confidentiality in the beginning of the therapy, and should inform clients how they are going to handle the information learned through private conversation with individual members of the family. • Psychologists should decide whether or not the information obtained from private conversation is about the individual or the family members. • Clients may share information privately because they fear anger, or embarrassment, or they want to develop an alliance with the psychologist. • Some psychologists use this information in the therapy, some psychologists do not use this information from private conversations. • Clarify your policy in the beginning of the therapy!

11. CONFIDENTIALITY IN GROUP PSYCHOTHERAPY • It is harder to protect client privacy in group psychotherapy because large number of persons involve and have the information shared during the sessions. • Psychologists should: • Address and discuss confidentiality with the group members, • Inform members in the beginning of the therapy, • May ask clients to sign statements promising to respect privacy of others in the group.

12. CONFIDENTIALITY WITH CHILDREN/ADOLESCENTS • Psychologists should discuss the confidentiality openly with everyone involved at the start of the therapy. • ‘Most psychologists make an exception to confidentiality when the life or safety of the adolescent or a third party is imminently endangered and disclosure is necessary to protect a life (Knapp& VandeCreek, 2006, p118)’. • The determination of what threatens life or safety requires to assess many things: • Nature and frequency, • Intensity and duration of the behavior, • The chance that therapy can be successful in changing that behavior, • The harm to the relationship if are told without the consent of the child.

13. CONFIDENTIALITY WITH ADULTS WITH MENTAL ILLNESSES • Usually requires contact with a treating doctor and caretaker family members. • Rules of confidentiality apply to them like other clients. • Psychologists are advised to get permission from the client before talking to the family members.

14. Confidentiality with suicIDAL CLIENTS • The five step model can be used to evaluate the responsibilities of psychologists in situations in which clients threaten to harm themselves: • 1)Identify the problem (determination of dangerousness is an ongoing process, not a one time event, psychologists estimate the risks, previous attempts, the presence of a plan(SLAP*), availability of means to do so, etc.) • 2)Develop alternatives (decisions on the treatment plan should focus on long term treatment of the mental illness and the short-term safety of the patient.) • Safety agreements: a psychologist asks suicidal clients to sign a no-suicide agreement. The patient promises that s/he will not commit suicide and they will contact the psychologist or take other precautions if s/he feels the urge to commit suicide.)

15. Confidentiality with suicIDAL CLIENTS cont. • 3) Evaluate the options(adopt the interventions that have most advantages and exclude the ones that have most disadvantages) • 4) Act or Perform • 5) Look back or evaluate (assess the degree of suicidality and the effectiveness of the intervention.) • *SLAP: • Specificity (Seriousness) • Lethality • Availability • Proximity

16. MAINTAINING CONFIDENTIALITY • APA (2017) Standard 4.01 and TPA, Ethics Code say: • ‘Psychologists have a primary obligation and take reasonable precautions to protect confidential information obtained through or stored in any medium, recognizing that the extent and limits of confidentiality may be regulated by law or established by institutional rules or professional or scientific relationship.’

17. DISCUSSING THE LIMITS OF CONFIDENTIALITY • APA (2017) Standard 4.02 and TPA, Ethics Code say: • ‘a) Psychologists discuss with persons (including to the extent feasible, persons who are legally incapable of giving informed consent and their legal representatives) and organizations with whom they establish a scientific or professional relationship (1)the relevant limits of confidentiality and (2) the foreseeable uses of the information generated through their psychological activities.’ • ‘b) Unless it is not feasible or is contraindicated, the discussion of confidentiality occurs at the outset of the relationship and thereafter as new circumstances may warrant.’

18. RECORDING • APA (2017) Standard 4.03 and TPA, Ethics Code say: • ‘Before recording the voices or images of individuals to whom they provide services, psychologists obtain permission from all such persons or their legal representatives.’

19. MINIMIZING INTRUSIONS ON PRIVACY • APA (2017) Standard 4.04 and TPA, Ethics Code say: • ‘a)Psychologists include in written and oral reports and consultations , only information germane to the purpose for which the communication is made.’ • ‘b)Psychologists discuss confidential information obtained in their work, only for appropriate scientific or professional purposes and only with persons clearly concerned with such matters.’

20. DISCLOSURES • APA (2017) Standard 4.05 and TPA, Ethics Code say: • ‘a) Psychologists may disclose confidential information with the appropriate consent of the organizational client, the individual client, or another legally authorized person on behalf of the client,.’

21. CONSULTATIONS • APA (2017) Standard 4.06 and TPA, Ethics Code say: • ‘When consulting with colleagues, (1)psychologists do not disclose confidential information that reasonably could lead to the identification of a client/patient, research participant or other person or organization with whom they have a confidential relationship, unless they have obtained the prior consent of the person or organization or the disclosure can not be avoided and (2)they disclose information only to the extent necessary to achieve the purposes of the consultation.’

22. USE OF CONFIDENTIAL INFORMATION FOR DIDACTIC OR OTHER PURPOSES • APA (2017) Standard 4.07 and TPA, Ethics Code say: • ‘Psychologists do not disclose in their writings, lectures, or other public media, confidential, personally identifiable information concerning their clients/patients, students, research participants, organizational clients or other recipients of their services that they obtain during the course of their work, unless (1)they take reasonable steps to disguise the person or organization, (2)the person or organization had consented in writing or (3)there is legal authorization for doing so.’

23. REFERENCE • Knapp, S.J., and VandeCreek, L.D. (2006). Practical ethics for psychologists. A positive approach. Washington, D.C.: American Psychological Association. • American Psychological Association. (2017). Ethical principles of psychologists and code of conduct. Washington, D.C.: APA. • http://www.apa.org/ethics/code/ethics-code-2017.pdf • https://www.psikolog.org.tr/turkey-code-tr.pdf • https://www.youtube.com/watch?v=b2qHhl5-FEo