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ETHICS IN PSYCHOLOGY Session 10 ETHICS IN THERAPY

ETHICS IN PSYCHOLOGY Session 10 ETHICS IN THERAPY. NİşantaşI UNIVERSITY. SESSION 10. LANDIS’ FACIAL EXPRESSION EXPERIMENT THERAPY Informed Consent to Therapy Therapy Involving Couples or Families Group Therapy Providing Therapy to Those Served by Others

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ETHICS IN PSYCHOLOGY Session 10 ETHICS IN THERAPY

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  1. ETHICS IN PSYCHOLOGYSession 10ETHICS IN THERAPY NİşantaşI UNIVERSITY

  2. SESSION 10 • LANDIS’ FACIAL EXPRESSION EXPERIMENT • THERAPY • Informed Consent to Therapy • Therapy Involving Couples or Families • Group Therapy • Providing Therapy to Those Served by Others • Sexual Intimacies with Current Therapy Clients/Patients • Sexual Intimacies with Relatives or Significant Others of Current Therapy Clients/Patients • Therapy with Former Sexual Partners • Sexual Intimacies with Former Therapy Clients/Patients • Interruption of Therapy • Terminating Therapy

  3. LANDIS’ FACIAL EXPRESSION EXPERIMENT • LANDIS’ FACIAL EXPRESSION EXPERIMENT • It was conducted by Dr. Landis, in 1924, at University of Minnesota. • The purpose of the experiment was to discover if all people have a common facial expression while feeling different emotions like fear, joy, disgust etc. • Each participant was brought into the lab and had black lines painted on their faces to examine the movement of their facial muscles. • The participants were then put through some tasks to encourage a strong reaction. • Each person photographed when the reacted.

  4. LANDIS’ FACIAL EXPRESSION EXPERIMENT • LANDIS’ FACIAL EXPRESSION EXPERIMENT

  5. LANDIS’ FACIAL EXPRESSION EXPERIMENT • The first tasks they were put through were to smell ammonia, watch pornography and put their hands in a bucket full of frogs. • In the final task, the participants were given a knife and a live rat and asked to cut the head off. • Even though all participants were disgusted by this, 1/3 of the participants went ahead and cut the rat’s head off. • For the participants who refused to cut, Landis took the knife and did it by himself. • It is found that people use a wide range of facial expressions to express the same emotion.

  6. LANDIS’ FACIAL EXPRESSION EXPERIMENT

  7. LANDIS’ FACIAL EXPRESSION EXPERIMENT

  8. LANDIS’ FACIAL EXPRESSION EXPERIMENT • But on the other hand, • The experiment showed the willingness of people to obey an authority figure or anything no matter how wrong it is. • In what perspectives the experiment was unethical?

  9. Therapy • Informed Consent to Therapy • APA (2017) Standard 10.01 and TPA(7.1), Ethics Code say: • When obtaining informed consent to therapy as required, Informed consent, psychologists inform clients/patients as early as feasible in the therapeutic relationship about the nature and anticipated course of therapy, fees, involvement of third parties, and limits of confidentiality and provide sufficient opportunity for the client/patient to ask questions and receive answers.

  10. Therapy • Informed Consent to Therapy • APA (2017) Standard 10.01 and TPA(7.1), Ethics Code say: • When obtaining informed consent to treatment for which generally recognized techniques and procedures have not been established, psychologists inform their clients/patients of the developing nature of the treatment, the potential risks involved, alternative treatments that may be available, and the voluntary nature of their participation.

  11. Therapy • Informed Consent to Therapy • APA (2017) Standard 10.01 and TPA(7.1), Ethics Code say: • When the therapist is a trainee and the legal responsibility for the treatment provided resides with the supervisor, the client/patient, as part of the informed consent procedure, is informed that the therapist is in training and is being supervised and is given the name of the supervisor.

  12. Therapy • Therapy Involving Couples or Families • APA (2017) Standard 10.02 and TPA(7.2), Ethics Code say: • When psychologists agree to provide services to several persons who have a relationship (such as spouses, significant others, or parents and children) they take reasonable steps to clarify at the outset (1)which of the individuals are clients/patients and (2)the relationship the psychologist will have with each person. This clarification includes the psychologist’s role and probable uses of the services provided or the information obtained.

  13. Therapy • Therapy Involving Couples or Families • APA (2017) Standard 10.02 and TPA(7.2), Ethics Code say: • If it becomes apparent that psychologists may be called on to perform potentially conflicting roles (such as family therapist and then witness for one party in the divorce proceedings) psychologists take reasonable steps to clarify and modify or withdraw from roles appropriately.

  14. Therapy Involving Couples or Families • 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!

  15. Therapy • Group Therapy • APA (2017) Standard 10.03 and TPA(7.3), Ethics Code say: • When psychologists provide services to several persons in a group setting, they describe at the outset the roles and responsibilities of all parties and the limits of confidentiality.

  16. Therapy • Group Therapy • 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.

  17. Therapy • Providing Therapy to Those Served by Others • APA (2017) Standard 10.04 and TPA(7.5), Ethics Code say: • In deciding whether to offer or provide services to those already receiving mental health services elsewhere, psychologists carefully consider the treatment issues and the potential client’s/patient’s welfare. Psychologists discuss these issues with the client/patient or another legally authorized person on behalf of the client/patient in order to minimize the risk of confusion and conflict, consult with the other service providers when appropriate, and proceed with caution and sensitivity to the therapeutic issues.

  18. Therapy • Providing Therapy to Those Served by Others • Sometimes psychologists may have potential clients who are already getting therapy from another psychologist. • This decision of the client may be because of: • Impulsivity • Poor judgment • Deception • Pathology on the part of the client. • If this is the case, then the potential psychologist should instruct the client to go back to his/her other therapist and resolve whatever the problem is, there, with the therapist.

  19. Therapy • Providing Therapy to Those Served by Others • Sometimes the client may have good reasons like: • If the client feels dissatisfied with the current psychologist and wants information about other treatment options. OR, • If the client wants more specialized services which his/her existing therapist is not qualified to provide. OR, • If the client is receiving treatment in one theoretical approach, • s/he may believe that another new approach will be better for him/her., etc.

  20. Therapy • Providing Therapy to Those Served by Others • Ethics code does not require therapists to refuse to accept clients already receiving therapy from someone else, without considering the circumstances. • Ethics code does not permit the therapist to accept the client without asking questions exploring the circumstances. • Psychologists should ask the reasons and consider the welfare of the client.

  21. Therapy • Sexual Intimacies with Current Therapy Clients/Patients • APA (2017) Standard 10.05 and TPA(7.5.1), Ethics Code say: • Psychologists do not engage in sexual intimacies with current therapy clients/patients.

  22. Therapy • Sexual Intimacies with Current Therapy Clients/Patients • This is one of the absolute statements in the APA Ethics Code.!!! • There is no recommendations to use clinical judgment to decide about engaging in sexual relationships with clients. • Sexual contact harms clients and sometimes the harm can be severe!

  23. Therapy • Sexual Intimacies with Current Therapy Clients/Patients • Several studies show that the frequency of lifetime sexual contact between psychologists and the clients to range between 0.02%-3% for female psychologists, 0.09%-12.1% for male psychologists. • Sexual contact with former clients is more frequent than • sexual contact with current clients. • The most common relationship is for an older male psychologist and a younger female client.

  24. Therapy • Sexual Intimacies with Current Therapy Clients/Patients • Sexual relationships with current clients does not only do harm to individual client but also harms the public image for therapists in general. • It also prevents people to seek help.

  25. MULTIPLE RELATIONSHIPS • APA (2017) Standard 3.05 and TPA (2.4), Ethics Code say: • a) .. • ‘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.’

  26. Therapy • Sexual Intimacies with Relatives or Significant Others of Current Therapy Clients/Patients • APA (2017) Standard 10.06 and TPA(7.5.1), Ethics Code say: • Psychologists do not engage in sexual intimacies with individuals they know to be close relatives, guardians, or significant others of current clients/patients. Psychologists do not terminate therapy to circumvent this standard.

  27. Therapy • Therapy with Former Sexual Partners • APA (2017) Standard 10.07 and TPA(7.5.2), Ethics Code say: • ‘Psychologists do not accept as therapy clients/patients persons with whom they have engaged in sexual intimacies.‘

  28. Therapy • Sexual Intimacies with Former Therapy Clients/Patients • APA (2017) Standard 10.02, Ethics Code say: • Psychologists do not engage in sexual intimacies with former clients/patients for at least two years after cessation of termination of therapy.

  29. Therapy • Sexual Intimacies with Former Therapy Clients/Patients • APA (2017) Standard 10.02, Ethics Code say: • b) Psychologists do not engage in sexual intimacies with former clients/patients even after 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 post termination sexual or romantic relationships with the clients/patients.

  30. Therapy • The APA Ethics Code prohibits sexual relationships with former cliens for 2 years. This does not mean 2 years and a green light! • It should mean 2 years and a flashing red light! • The American Counseling Association requires 5 years (ACA, 2005). • It is ‘almost never’ standard!! Because former clients are vulnerable to exploitation. Because, • A former psychologist still has influence and information to be used to keep the relationship going.

  31. Therapy • Interruption of Therapy • APA (2017) Standard 10.09 and TPA(7.6), Ethics Code say: • When entering into employment or contractual relationships, psychologists make reasonable efforts to provide for orderly and appropriate resolution of responsibility for client/patient care in the event that the employment or contractual relationship ends with paramount consideration given to the welfare of the client/patient.

  32. Therapy • Interruption of Therapy • Psychologists have the responsibility for coverage: • When they go on vacations • When they get ill • When they take extended leave from work etc. • In such cases, clients should be informed about the coverage arrangements of their therapists and therapists should prepare the client for the change.

  33. Therapy • Terminating Therapy • APA (2017) Standard 10.10 and TPA(7.7), Ethics Code say: • Psychologists terminate therapy when it becomes reasonably clear that the client/patient no longer needs the service, is not likely to benefit, or is being harmed by continued service. • Psychologists may terminate therapy when threatened or otherwise endangered by the client/patient or another person with whom with the client/patient has a relationship. • c) Except where precluded by the actions of clients/patients or third party payors, prior to termination, psychologists provide pretermination counseling and suggest alternative service providers as appropriate.

  34. Terminating Therapy • ‘ Psychologists may refuse to treat potential patients for any reason, including their perceived ability to pay for services. • ‘Once the treatment has started, however, they do not have an unqualified right to terminate unless the treatment is completed; the patient ends the relationship; or the psychologist recommends alternative services and provides termination counseling, unless precluded by the actions of the clients or third party payers (Knapp &VandeCreek, 2006, p.196).’

  35. Terminating Therapy • Psychologists can terminate treatment, even without the consent of the clients, if the • Client does not need treatment anymore, • Client is not benefiting from therapy, • Client is being harmed by the treatment, • Psychologist is threatened by the client. • Therapists are required to provide termination counseling to clients. • Usually, therapists who begin a treatment relationship with clients continue to provide that treatment until it is not needed anymore or the client decides to quit or discontinue.

  36. Abandonment: • Abandonment means termination of a client, • when the therapist knows or should have known that more treatment is needed for the client. • Abandonment can result in an ethical complaint or malpractice suit. • Malpractice suits have 4Ds: • Presence of a Duty • Deviation from the standards of the profession • Damage to the client • Direct connection between the deviation from duty and damage to the client.

  37. 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. • American Counseling Association. (2005). ACA Code of Ethics. Alexandria, VA: American Counseling Association. • http://www.apa.org/ethics/code/ethics-code-2017.pdf • https://www.psikolog.org.tr/turkey-code-tr.pdf

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