Ethical Dilemmas and Diversity issues in

SupervisionSue C. Jacobs, Ph.D., N.D. Licensed Psychologist

Fellow, American Psychological AssociationLedbetter Lemon Diversity Professor in Counseling Psychology

Oklahoma State University College of Education

March 6, 2015: Laureate Psychiatric Clinic and HospitalNortheastern Oklahoma Psychology Internship Program

OVERVIEW

Review APA aspirational ethical principles and specific codes applicable to supervision and training

Professional ethics in the context of increasing cultural diversity and globalization

Cultural competency: How can supervisors respond to ‘‘elephants” of conflicting world views, cultural values and expectations that appear in the supervision room between supervisors, supervisees, and clients (and their families and communities and other professions)?

OVERVIEW

Examples of ethical challenges related to diversity in supervision

Example(s) of how ethical “rules” can become barriers in supervision (and practice) if separated from ethical ideals (aspirational principles)

An adapted “Acculturation Model” for ethical supervision and decision making

REVIEWEthical Ideals and Ethical Rules

APA Ethical principles of psychologists and code of conduct

General Principles, as opposed to Ethical Standards, are aspirational in nature. Their intent is to guide and inspire psychologists toward the very highest ethical ideals of the profession.

They do not represent obligations and should not form the basis for imposing sanctions.

Beneficence and Nonmaleficence

Fidelity and

Responsibility

Integrity

Justice

Respect for People's Rights and Dignity

Standards or “rules” specific to supervision

7.06 Assessing Student and Supervisee Performance (a) In academic and supervisory relationships, psychologists establish a timely and specific process for providing feedback to students and supervisees. Information regarding the process is provided to the student at the beginning of supervision.

(b) Psychologists evaluate students and supervisees on the basis of their actual performance on relevant and established program requirements.

7.07 Sexual Relationships with Students and Supervisees Psychologists do not engage in sexual relationships with students or supervisees who are in their department, agency, or training center or over whom psychologists have or are likely to have evaluative authority. (See also Standard 3.05, Multiple Relationships.)

And all the other standards related to education and training, clinical work, assessment, etc.

Professional ethics in the context of increasing cultural diversity and globalization: Some examples

Important trends: Cultures and Contexts are ever Changing

Increasingly diverse and aging population in U S

Increasing globalization and internationalization of our clients, trainees/supervisees, psychologists, and the communities in which we work, live, and play

Changing forms of communication: social media such as twitter, FB…

Key Developments impacting Ethical Supervision, Training, and

Practice

Universal Declaration of Ethical Principles for Psychologists (2008).

Focuses on ethical framework with a common set of ethical principals (ideals) and related values that could globally guide action

Primarily aspirational, leaving specific behavioral rules (codes) and ways of enforcement up to each region or county.

Advances in Ethical Training and Ethics of Supervision

Competencies movement and competency benchmarks identified for ethics education an training

Continues to include knowledge of rules, and laws, including case law

More emphasis on ethical ideals (principles)Increased attention to skills in ethical

decision making when conflicts among or between rules and ideals, including those related to cultural diversity and competence.

Growing Attention to Indigenous Psychology

United Nations (2008). United Nations Declaration on the rights of indigenous peoples.

Many of our methods have not been tested with people from non-Western cultural and philosophical traditions, may be unacceptable, and ineffective.

Indigenization of psychology means modifying Western guidelines (including ethical rules or codes) to be more culturally relevant and avoid harm.

Example: Society of Indian Psychologists recent Commentary on the American Psychology Association (APA) Ethical Principles of Psychologists and Code of Conduct

Perspective on cultural diversity and cultural competence has

broadened

Now focus on knowledge, skills, attitudes/awareness for multicultural competence

To develop a working alliance that will serve the needs of the client and the supervision process, we now explore cultural identity and development and intersecting identities and worldviews (including spirituality and religion)

Being a clinical supervisor requires lifelong learning

Many, if not most, supervisors were trained before recent developments in globalization and changes in views of cultural competence and focus on virtue ethics and principles rather than simply rules.

To be an ethical and culturally competent supervisor (and psychologist) today requires a lifelong attitude and openness to self evaluations, what Falendar et al. (2004) label “cultural humility.”

The “elephant” in the room

Because of the power difference between supervisee and supervisor, many supervisees do not disclose the elephant in the room, differences in values, beliefs, expectations.

Pettifor, et al. (2014) cite research that indicate that when diversity issues arise in supervision at all, supervisees perceive that they raised the issues, not the supervisor, though the supervisors believe they raised it.

Other research has found that supervisees raising diversity topics can create a strain or rupture in the supervisory relationship

Cultural competency in ethical clinical supervision

How can supervisors respond to ‘‘elephants” of conflicting world views, cultural values and expectations that appear in the supervision room between supervisors, supervisees, and clients (and their families and communities and other professions)?

Views of ethical and cultural competent supervision are in a continuum, are

fluid, and developing

Unilateral imposition of

expectations/rules

Seen as valid

for all

cultures

Considers “ideals”/ethical

principles responding to cultural difference

s

Examples of Ethical Challenges Related to Diversity and Globalization in Supervision

VIGNETTE 1 from Pettifor, et al. (2014)

A 25-YEAR OLD MALE GRADUATE STUDENT WHO IMMIGRATED TO U S WITH HIS FAMILY WHEN HE WAS 5 YEARS OLD IS IN A PLACEMENT IN A CHILDREN’S MENTAL HEALTH CENTER. HE MEETS WITH A 6-YEAR-OLD CHILD FOR THE FIRST TIME, ALONG WITH THE CHILD’S PARENTS. THE FAMILY MEMBERS RECENT IMMIGRANTS FROM A NON-WESTERN COUNTRY…

Supervisor attends to infraction of codes or “rules”, but appears to lose sight of the “ideals or aspirational principles from which the codes were drawn

VIGNETTE 2 from Pettifor, et al. (2014)

A FEMALE GRADUATE STUDENT, WHO IMMIGRATED TO THE U S FROM A NON-WESTERN COUNTRY AT THE AGE OF 9 WAS IN AN ADVANCED PRACTICUM PLACEMENT IN A GERONTOLOGY UNIT IN THE U S FOR INDIVIDUALS WHO HAD SUFFERED NEOROLOGICAL INJURY. HER MALE SUPERVISOR, WHO ALSO IMMIGRATED TO THE U S AS A YOUNG CHILD BUT FROM A DIFFERENT NON-WESTERN COUNTRY, WAS HAVING THE STUDENT “SHADOW” HIM DURING THE FIRST MONTH OF HER PLACEMENT. IN THE 2ND WEEK SHE OBSERVED THE SUPERVISOR ADMINISTOR AN INVENTORY FOR DISABILITY FOR AN 80-YEAR OLD WOMAN WHO HAD SUSTAINED A HEAD IMJURY WHEN HIT BY A MUNICIPAL TRUCK…

Example(s) of how ethical “rules” can become barriers in supervision (and practice) if separated from ethical ideals (aspirational principles)

VIGNETTE 3 from Pettifor, et al. (2014)

A CLIENT IS A UNIVERSITY STUDENT WHO IS MARIED TO AN INTERNATIONAL STUDENT FROM A NON-WESTERN COUNTRY THAT IS HER PARENTS’ COUNTRY OF ORIGIN. THE CLIENT AND HER SPOUSEHABE 3 CHILDREN UNDER THE AGE OF 3 WHO ARE CARED FOR BY HER MOTHER-IN-LAW, WHO RESIDES WITH THEM. THE PRESENTING PROBLEM IS THE CLIENT’S DEPRESSION. HER MOTHER-IN-LAWAND HER HUSBAND ARE DISAPPROVING OF HER DESIRE TO PURSIDE GRADUATE EDUCATION AND SHE FEELS THEY DO WHATEVER THEY CAN TO UNDERMINE HER. THE THERAPIST IS A GRADUATE STUDENT WHO STRONGLY BELIEVES IN INDIVIDUAL AUTONOMY AND THE “RIGHT” OF THE MOM…

Example of both supervisor and supervisee caught up in their own strong belief systems and, lacking respectful supervisory relationship, lose sight of the client and the client’s cultural context.

An adapted “Acculturation Model” for ethical supervision and decision making

From Handelsman, Gottlieb, and Knapp (2005) based on Berry’s model of acculturation applied to ethical identity

marginalization separation

Assimilation integration

PERSONAL ETHICS OF ORIGIN

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Suggested decision making model for ethical supervision

Move away from thinking of situations as Ethical vs Unethical: No faster way to disrupt a working supervisory relationship

Consider supervisor-supervisee relationship as collaborative and refer to acculturation model in discussing where supervisee and supervisor is on a particular issue. Consider the cultural context also of the client.

Supervisory decisions not only ethical. Adapted from Gavozzi webpage

Therapist’s decision making includes: decision making Clinical decision-making Risk management Legal Ethical decision-making

Professional ethics Personal ethics, values, or moralityConsideration of world-view, etc. of Client

Supervisor’s decision making includes: All of the above plus supervisee’s personal ethic and cultural

world view and level of clinical, ethical, and cultural development

Moving towards Culturally Competent Ethical Supervision

Practice with VignettesUse Acculturation decision making model to

look at supervisor and supervisee identity in context of case/ethical dilemma

Differentiate ethical decision from of decisionsMove towards the “Ideal” end of the continuum

remembering that “rules” are important also and must be considered/interpreted in terms of the aspirational principles and Cultural contexts of client and supervisee

Vignette A

You are a White, 42-year-old U.S. born open lesbian who is supervising a bi-racial (White and second generation South Asian) trans F-to-M advanced practicum student beginning his second rotation in a university counseling center His client is a 21 year old Latino who tells the intern he is sure he is a woman in a man’s body and wants to become a woman, but does not want to disappoint her family or have them reject her. The intern tells you he wants to tell the client that he is trans to help his relationship and trust with the client, that his research on counseling trans* suggests that is effective. What is the dilemma? What “rules” and “aspirations” are involved. Try to apply the adapted acculturation supervisor ethical and culturally competent decision making model.

Vignette B

You are a 60 year-old, White male Baptist psychologist in a Medical School outpatient setting with adult patients with diabetes. Your psychology intern is a brilliant 30-year old Lakota woman, whose doctoral training was in Utah, where she had some counseling practice with members of other tribes. Her client is a 50 year-old man from the Pawnee tribe who has been diagnosed with depression and complications from his diabetes. The client told her that he doesn’t trust the Western medicine and only comes to so his daughter doesn’t kick him out, that he doesn’t like the therapy. He likes the old healing ways. Your intern wants to stop using CBT and hear about his healing traditions, tell him the traditions from her tribe, and perhaps go with him to a healing sweat or other ceremony if his tradition allows men and women to seat together. Again, what is ethical dilemma, “rules”, “ideals. Discuss using the adapted acculturation ethical decision process.

If Time:

QuestionsConcernsDiscussion

REFERENCES and RESOURCES

REFERENCES

American Psychological Association (2010). Ethical principles of psychologists and code of conduct (2002, Amended June 1, 2010).Retrieved from http://www.apa.org/ethics/code/index.aspx

Falendar, C. A., Shafranske, E. P., & Falicov, C. P. (Eds.) (2014). Diversity and multiculturalism in clinical supervision: Foundation and praxis. Washington, DC: American Psychological Association.

Garvozzi web page: http://www.ethicalpsychology.com/p/ethics-and-psychology-podcasts.html

Gauthier, J., & Pettifor, J. L. (2012). The tale of two universal declarations: Ethics and human rights. In M. M. Leach, M. J. Stevens, G. Lindsay, A. Ferraro, & Y. Korkutr (Eds), The Oxford handbook of international psychological ethics (pp. 113-133) New York, NY: Oxford University. Doi 10.1093/oxfordhb/9780199739165.013.0009

REFERENCES & RESOURCES

Handelsman, M. M., Gottlieb, M. C., & Knapp, S. (2005). Training ethical psychologists: An acculturation model. Professional Psychology: Research and Practice, 36(1), 59-65. doi:10.1037/0735-7028.36.1.59

Pettifor, J., Sinclair, C., & Falender, C. A. (2014). Ethical supervision: Harmonizing rules and ideals in a globalizing world. Training and Education in Professional Psychology, 8 (4), 201-210. http://dx.doi.org/10.1037/tep0000046

Society of Indian Psychologists recent Commentary on the American Psychology Association (APA) Ethical Principles of Psychologists and Code of Conduct. Available for purchase at http://www.aiansip.org/

United Nations (2008). United Nations Declaration on the rights of indigenous peoples. New York, NY: United Nations. Retrieved from http://www.un.org/esa/socdev/unpfii/documents/DRIPS_en.pdf

Universal Declaration of Ethical Principles for Psychologists (2008). Retrieved from http://www.iupsys.org/ethics/univdec12008.html

Thank You!

MY CONTACT INFORMATION

Sue C. Jacobs, PhDProfessor, School of Applied Health and Educational Psychology

Myron Ledbetter and Bob  Lemon Counseling Psychology Diversity Professor

Director, OSU Preparing Future Faculty in Psychology ProgramCo-Director, Oklahoma Network for the Teaching of Psychology

Team Leader, OSU Difficult Dialogue ProgramAmerican Psychological Association Fellow, Division 17

425 Willard   Oklahoma State University   Stillwater, OK 74078-4024Phone: 405-744-9895   

Fax 405-744-6756   Email:  sue.c.jacobs@okstate.edu