Competence as our Cornerstone: Ethics in Psychology Training Association of Psychology Postdoctoral and Internship Centers APPIC 2014 Conference Austin, Texas Saturday, May 3, 2014 Stephen Behnke, JD, PhD, MDiv APA Ethics Office

The 2015 APA Student Ethics Writing Prize! Roundtrip to APA Convention, with three nights stay Student presents winning paper at Convention Paper is published in Ethics and Behavior $ Ethics Educator Award! Presented at Convention A very nice plaque with your name Photograph suitable for framing

Competence The Cornerstone of Ethics: A View from the APA Ethics Office

What Does It Mean to be an Ethical Gatekeeper? Gatekeeping involves: 1) A passage between 2) Two or more places with the 3) Authority to allow passage, or not, and the 4) Responsibility for that decision.

Gatekeeping involves considering and balancing multiple ethical responsibilities : To the public To the trainee To the profession To your program To the other trainees in the cohort Would you refer a close friend or family member to this individual?

Principle A Beneficence and Nonmaleficence Psychologists strive to benefit those with whom they work and take care to do no harm. A competent psychologist will have the capacity to do good and to avoid harm.

Comments that come to the APA Ethics Office from trainees

1.My program treated me unethically. 2.My private information was shared with others in the program. 3.My supervisor makes me feel uncomfortable. 4.One of the other interns is impaired. 5.What I’m being asked to do violates my religious beliefs.

What can viewing these five comments through the lens of competence tell us about how to approach ethical dilemmas in psychology training?

An Historical Note about the Law of Competence: Move from generalized/global competence to competencies

The move from generalized/global competence to competencies Profound implications for psychology training

Competency Initiatives in Professional Psychology Education Directorate APA Website Competence as the cornerstone of ethics

APA Commission on Accreditation Guidelines and Principles for Accreditation of Programs in Professional Psychology Domain B: Program Philosophy, Objectives, and Curriculum Plan Revised Competency Benchmarks for Professional Psychology Knowledge of ethical/legal/professional standards and guidelines Awareness and application of ethical decision making Ethical conduct across a developmental spectrum

Competence across Five Domains 1.Clinical/training 2.Legal 3.Ethical 4.Institutional policy 5.Risk management

Issue 1: My program treated me unethically.

APA Ethical Standard 2.01 Boundaries of Competence (a) Psychologists provide services, teach and conduct research with populations and in areas only within the boundaries of their competence...

Consider responding to difficult trainee situations as a unique competence Who in your training program has this competence?

APA Ethics Code Preamble The development of a dynamic set of ethical standards for psychologists' work-related conduct requires a personal commitment and lifelong effort to act ethically…and to consult with others concerning ethical problems. (emphasis added)

Strong convergence between principles in law, ethics, and psychology training A good working relationship with your program’s attorney should help prevent situations from becoming adversarial Orientation of APA General Counsel: How can we help you achieve your goals? Attorney as Consultant

Notice and Process Central to both law and ethics Combining proactive/prophylactic and reactive approaches in a competent, comprehensive manner

APA Ethical Standard 7.02 Descriptions of Education and Training Programs Psychologists responsible for education and training programs take reasonable steps to ensure that there is a current and accurate description of the program content…

APA Commission on Accreditation Guidelines and Principles for Accreditation of Programs in Professional Psychology (2013 ) Domain E: Student-Faculty Relations 4. At the time of admission, the program provides the students with written policies and procedures regarding program and institution requirements and expectations regarding students’ performance...

A Practical Guidebook for the Competency Benchmarks Orienting trainees to benchmarks and methods of evaluation. Trainees should be oriented to the program’s competencies, means of evaluation, and competency expectations at the start of their training, and at relevant transitions (e.g., before starting practicum)...

APA Ethical Standard 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...

Make clear to trainees in writing what is expected Make clear to trainees what policies apply if they fall short of what is expected of them You be clear what policies apply if trainees fall short of what is expected of them

The Law of No Surprises What is expected of trainees? What happens if a trainee falls short of expectations? Whether a particular trainee is meeting program expectations The status of a particular trainee in the program vis-à-vis a remediation plan

Be thoroughly familiar with the process your program has set forth Follow your process carefully Document that you have followed your process Program faculty speak with one, not multiple, voices

Critical Role of Assessment (What psychologists are good at doing!) McCutcheon, S.R. (2008). Addressing problems of insufficient competence during the internship year. Training and Education in Professional Psychology, 2,

Assess at individual and system levels Forrest, L., Elman, N., & Miller, D. (2008). Psychology trainees with competence problems: From individual to ecological conceptualizations. Training and Education in Professional Psychology, 2,

Gilfoyle, N. (2008). The legal exosystem: Risk management in addressing student competence problems in professional psychology training. Training and Education in Professional Psychology, 2,

Tie the remediation plan to your assessment of the problem A trainee’s remediation plan follows from an assessment of the trainee’s deficits that follows from the program’s identification of competencies required for successful completion

Tie the remediation plan to your assessment of the problem A Question: Which aspect of your trainee’s problem or challenge will this aspect of your remediation plan address?

Tie the remediation plan to your assessment of the problem Focus on behaviors that need to change rather than diagnoses Remediation Plan Template

Beware of the Promoveatur ut Amoveatur Principle

2. My private information was shared with others in the program.

What is the nature of the information being shared? Privacy vs. Confidentiality vs. Privilege An especially complex relationship in training programs

APA Ethical Standard 7.04: Student Disclosure of Personal Information Psychologists do not require students or supervisees to disclose personal information in course- or program-related activities, either orally or in writing, regarding sexual history, history of abuse and neglect, psychological treatment, and relationships with parents, peers, and spouses or significant others except if (1) the program or training facility has clearly identified this requirement in its admissions and program materials or (2) the information is necessary to evaluate or obtain assistance for students whose personal problems could reasonably be judged to be preventing them from performing their training- or professionally related activities in a competent manner or posing a threat to the students or others.

APA Ethical Standard 4.07: Use of Confidential Information for Didactic or Other Purposes

Privacy vs. Confidentiality vs. Privilege What is the rule, guideline, or principle governing this particular communication?

3. My supervisor makes me feel uncomfortable.

Supervisory Competence: A fairly recent development in psychology training

A Question: How “malleable” are the boundaries in psychology graduate training programs between faculty/supervisors and trainees?

A Question of Competence: When can the malleability of boundaries be used to the benefit of trainees? When does this malleability work to the detriment of trainees?

44 Standard 3.05a: Multiple Relationships Paragraph 2 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.

APA Ethical Standard 3.05: Multiple Relationships Multiple multiple relationships exist within training programs, rendering an appropriate response complicated

Conflict of Interest model to understand multiple relationships

Self-Other Differentiation Central to good ethical thinking Cui bono?

Issue 4 One of the other interns is impaired.

49 APA Ethical Standard 2.06 Personal Problems and Conflicts (b) When psychologists become aware of personal problems that may interfere with their performing work-related duties adequately, they take appropriate measures, such as obtaining professional consultation or assistance and determine whether they should limit, suspend or terminate their work-related duties.

APA Ethical Standard 1.04 Informal Resolution of Ethical Violations When psychologists believe that there may have been an ethical violation by another psychologist, they attempt to resolve the issue by bringing it to the attention of that individual...

Responding to Problematic Faculty Members and Supervisors “To the extent we become better teachers, students will become better professionals” McCutcheon, 2008

Responding/Intervening as a competence Where do psychologists learn this competence? Do psychology training programs teach this competence? Do psychology training programs model this competence?

Issue 5. What I’m being asked to do violates my religious beliefs.

What if a trainee does not wish to acquire a competence that the training program believes is essential to becoming a psychologist?

Julea Ward Ward v. Wilbanks (2010) Ward v. Polite (2012)

Overarching Principles 1.Substance vs. process 2.Deference to educators

Julea Ward Two options No-referral policy

The American Counseling Association Code of Ethics (2005) A.4.b. Personal Values Counselors are aware of their own values, attitudes, beliefs, and behaviors and avoid imposing values that are inconsistent with counseling goals. Counselors respect the diversity of clients, trainees, and research participants.

The American Counseling Association Code of Ethics (2005) C.5. Nondiscrimination Counselors do not condone or engage in discrimination based on age, culture, disability, ethnicity, race, religion/ spirituality, gender, gender identity, sexual orientation, marital status/partnership, language preference, socioeconomic status, or any basis proscribed by law. Counselors do not discriminate against clients, students, employees, supervisees, or research participants in a manner that has a negative impact on these persons.

The United States Constitution Amendment I Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.

How the Courts Analyzed the Facts A.The District Court B.The Appeals Court

The District Court The program’s policy was “neutral” and “generally applicable” The policy did not single out Julea Ward’s religious beliefs. e.g., Veterinary school

The District Court “The dismissal was entirely due to plaintiff’s refusal to change her behavior, not her beliefs.”

The Appeals Court Is the policy being applied in a selective manner?

The Appeals Court School did not have any written no-referral policy (an “after-the-fact invention”?) School and the ACA Ethics Code allow referrals The ACA Ethics Code allows explicitly value- based referrals School had a “yes-referral” policy

The American Counseling Association Code of Ethics (2005) A.9.b. Counselor Competence, Choice, and Referral Recognizing the personal, moral, and competence issues related to end-of-life decisions, counselors may choose to work or not work with terminally ill clients who wish to explore their end-of-life options. Counselors provide appropriate referral information to ensure that clients receive the necessary help.

The Appeals Court At some point, an exception-ridden policy takes on the appearance and reality of a system of individualized exemptions, the antithesis of a neutral and generally applicable policy and just the kind of state action that must run the gauntlet of strict scrutiny.

The Appeals Court A reasonable jury could find that the policy was “Pretextual” The Formal Review: A “Theological bout”

Briefly: The take-home points A program may establish a policy requiring students to abide by a professional code of ethics. How the policy is applied is what caused the problem in the Ward case. Schools may prohibit students from imposing their values on students. Legally relevant question: When do the exceptions swallow up the rule?

Training and Education in Professional Psychology 2012, Vol. 6, No. 4, Constitutional Claims in the Context of Mental Health Training: Religion, Sexual Orientation, and Tensions Between the First Amendment and Professional Ethics

“Conscience Clause” A Misnomer?

What Does It Take to be an Ethical Gatekeeper? Working knowledge of laws and institution’s policies Good clinical skills Self-knowledge Wisdom Courage A Close Colleague whom you Trust (if you don’t have one, begin looking at this meeting).

Thank you, APPIC! from the APA Ethics Office