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Ethical Dilemmas and Diversity issues in Supervision Sue C. Jacobs, Ph.D., N.D. Licensed Psychologist Fellow, American Psychological Association Ledbetter.

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Presentation on theme: "Ethical Dilemmas and Diversity issues in Supervision Sue C. Jacobs, Ph.D., N.D. Licensed Psychologist Fellow, American Psychological Association Ledbetter."— Presentation transcript:

1 Ethical Dilemmas and Diversity issues in Supervision Sue C. Jacobs, Ph.D., N.D. Licensed Psychologist Fellow, American Psychological Association Ledbetter Lemon Diversity Professor in Counseling Psychology Oklahoma State University College of Education March 6, 2015: Laureate Psychiatric Clinic and Hospital Northeastern Oklahoma Psychology Internship Program

2 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)?

3 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

4 REVIEW Ethical Ideals and Ethical Rules

5 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

6 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 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.)3.05, Multiple Relationships And all the other standards related to education and training, clinical work, assessment, etc.

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

8 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…

9 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.

10 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.

11 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

12 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)

13 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.”

14 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

15 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)?

16 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 differences

17 Examples of Ethical Challenges Related to Diversity and Globalization in Supervision

18 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

19 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 2 ND 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)

20 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.

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

22 From Handelsman, Gottlieb, and Knapp (2005) based on Berry’s model of acculturation applied to ethical identity marginalizationseparationAssimilationintegration PERSONAL ETHICS OF ORIGIN IDENTIFICATION WITH PSYCHOLOGY ETHICS

23 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.

24 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 morality  Consideration 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

25 Moving towards Culturally Competent Ethical Supervision Practice with Vignettes Use Acculturation decision making model to look at supervisor and supervisee identity in context of case/ethical dilemma Differentiate ethical decision from of decisions Move 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

26 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.

27 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.

28 If Time: Questions Concerns Discussion

29 REFERENCES and RESOURCES

30 REFERENCES  American Psychological Association (2010). Ethical principles of psychologists and code of conduct (2002, Amended June 1, 2010).Retrieved from 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: psychology-podcasts.htmlhttp://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 ) New York, NY: Oxford University. Doi /oxfordhb/

31 REFERENCES & RESOURCES Handelsman, M. M., Gottlieb, M. C., & Knapp, S. (2005). Training ethical psychologists: An acculturation model. Professional Psychology: Research and Practice, 36(1), doi: /  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),  Society of Indian Psychologists recent Commentary on the American Psychology Association (APA) Ethical Principles of Psychologists and Code of Conduct. Available for purchase at United Nations (2008). United Nations Declaration on the rights of indigenous peoples. New York, NY: United Nations. Retrieved from Universal Declaration of Ethical Principles for Psychologists (2008). Retrieved from

32 Thank You!

33 MY CONTACT INFORMATION Sue C. Jacobs, PhD Professor, School of Applied Health and Educational Psychology Myron Ledbetter and Bob Lemon Counseling Psychology Diversity Professor Director, OSU Preparing Future Faculty in Psychology Program Co-Director, Oklahoma Network for the Teaching of Psychology Team Leader, OSU Difficult Dialogue Program American Psychological Association Fellow, Division Willard Oklahoma State University Stillwater, OK Phone: Fax


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