Ethics and Rx

Question 1

What are the 5 general principles of APA ethics?

Answer 1

APA, 2010; Beauchamp & Childress, 20011. Beneficence, and Nonmalificence (help, and do not harm)2. Fidelity and responsibility (be faithful to the profession and personally responsible)3. Integrity (accurate, honest, truthful)4. Justice (fair and just, free from biased behavior)5. Respect for People’s Rights and Dignity

Question 2

What is Gottlieb’s ethical decision-making model?

Answer 2

(Gottlieb, 1993)Model examines three dimensions–power, duration of relationship, and clarity of termination-recognizes that high power, long duration, and unclear terminations are especially dangerous

Question 3

What is Kitchener’s (1984) model for ethical decision making?

Answer 3

Rules (codes), ethical principles, and ethical theory guide decision-making process

Question 4

Should multiple relationships be entered to meet a psychologist’s own needs?

Answer 4

Nope (Barnett et al., 2007)

Question 5

What are questions you can ask before entering into a multiple relationship?

Answer 5

(Younggren & Gottlieb, 2004)1 Is entering into a relationship in addition to the professional one necessary, or should I avoid it?2 Can the dual relationship potentially cause harm to the patient?3If harm seems unlikely or avoidable, would the additional relationship prove beneficial?4 Is there a risk that the dual relationship could disrupt the therapeutic relationship?5 Can I evaluate this matter objectively?

Question 6

Accepting the principles __________ does not relieve psychologists from the burden of decision-making in ethical dilemmas

Answer 6

prima facie (Kitchener, 1984)

Question 7

What’s the difference between privacy, confidentiality, and privilege?

Answer 7

äó¢Privacy: right to decide how much is disclosed and how much personal data is shared with othersäó¢Confidentiality: general standard that obliges professionals not to discuss info about clientsäó¢Privilege: legal term describing certain specific types of relationships that enjoy protection from disclosure in legal proceedings; granted by law and belongs to the client in the relationship

Question 8

What are the 10 ethical standards (APA, 2010)?

Answer 8

1)Resolving Ethical Issues: 2)Competence: 3)Human Relations: Donäó»t discriminate ; donäó»t harass or cause harm; avoid multiple relationships (3.05); refrain from conflicts of interest4)Privacy and Confidentiality: 5)Advertising and other public statements: Avoid false, deceptive, or fraudulent statements6)Record keeping and fees: 7)Education and training: 8)Research and publication: 9)Assessment10)Therapy: Informed consent must be obtained; sexual intimacies prohibited; termination issues

Question 9

What is Koocher & Keith-Spiegel’s (1998) ethical decision-making model?

Answer 9

äó¢Determine whether the situation is an ethical oneäó¢Consult APA ethical guidelinesäó¢Consult knowledgeable peers and ethics hotlineäó¢Explore your own possible motivationsäó¢Evaluate the rights and vulnerabilities of all involved partiesäó¢Come up with alternativesäó¢Consider the outcomes of the alternativesäó¢Make a decisionäó¢Implement the decisionäó¢Document everything

Question 10

If law and ethics are in a fight, who wins?

Answer 10

Law (Koocher & Keith-Spiegel, 1998)

Question 11

Tarasoff vs Board of Regents of the University of California (1976) led to the duty to _______ and _______.

Answer 11

Warn and protect

Question 12

Do therapists need to warn people if somebody with HIV is having unprotected sex?

Answer 12

Difficult ethical dillema (Lamb et al., 1989)–a function of assessment of dangerousness and whether there is an identifiable victim (if the victim is “society” that is too broad)As of 1990 no courts had applied Tarasoff to HIV infection (Knapp & VandeCreek, 1990)

Question 13

Child abuse refers to what 5 areas?

Answer 13

(APA, 1995)physical abuse, emotional abuse, sexual abuse, physical neglect, and emotional neglect

Question 14

Do states grant you immunity if you report child abuse?

Answer 14

Yes, but only if you follow the states’ procedures (Small et al., 2002)

Question 15

What are problems associated with blending roles with clients/supervisees?

Answer 15

oLoss of objectivity; confusion; feelings of rejection and abandonmentoRisky therapistsoRisky career periods: inexperienced; internship; midcareer; end of career cycleoRisky work settings: individual practices who are often isolatedoRisky clients: victim of violent attacks or abuse; low self-esteem; early deprivations; use positive limit setting

Question 16

Are there any arguments for having multiple relationships?

Answer 16

Lazarus (1994) argues that overly rigid boundaries fail to really help some clients–and it is possible to help or exploit regardless of boundary-issues

Question 17

Internet treatment, pros

Answer 17

-quick, easy, cheap, serves rural areas, convenience (Naglieri et al., 2004)

Question 18

What are 6 myths about internet research?

Answer 18

1.Internet samples are not sufficiently diverse2.Internet samples are unusually maladjusted - 3.Internet findings do not generalize across presentation formats4.Internet participants are not sufficiently motivated5.The Anonymity provided by web questionnaires compromises the integrity of the data6.Internet findings are not consistent with the findings from traditional methods

Question 19

Internet treatment cons

Answer 19

-don’t know if client (or someone else) is taking test-can’t judge clients’ mental state when giving feedback-high-stakes situations are problematic (child custody, etc)-testing is possible, but not assessment (integrating multiple pieces of info from mul

Question 20

What are general arguments in favor of allowing psychologists to prescribe medication?

Answer 20

(Bush, 2001)a. Psychotropic medications are a helpful intervention for clients b. logical extension of practice to address biological factorsc. with appropriate training, psychologists can join psychiatrists in providing the full spectrum of efficacious treatments, fills the gap between psychiatrists and psychologists, d. may be a matter of economic survival in competitive managed care contexte. Koocher & Keith-Spiegel (2008) summarize:i. the majority of psychiatric drug prescribing already originates with non-psychiatrist providers such as primary care physicians ii. psychologists practice in many communities lacking psychiatrists iii. improved care of elderly overmedicated patients in nursing homes would become possibleiv. psychologists already have much of the knowledge and skills necessary to access behavioral and cognitive changes in a scientific manner v. some other categories of non-physician providers already have privileges vi. psychologists typically have better training in human psychopathology and therapy at initial licensing than do most psychiatry residents

Question 21

Arguments against prescription privileges?

Answer 21

Arguments Against (Lichtenberg et al 2008)a. safe and effective use of medication requires extensive training of brain and body; not what we have currently b. adding rx will dilute the existing scope of psychological practice (assessment and therapy) where psychologists make unique contributions. Foundations could be eroded and become indistinguishable from psychiatryc. adding coursework on prescriptions may erode focus on basic psychological science, research methods (Bush, 2001; Heiby, 2002)d. There appears to be a split in the field about what the field thinks/wants i. APA is pursing agenda with appropriate training ii. Div 17 has not taking a position iii. Divi 12 is advocating against RxP iv. Most surveyed who supported privileges did not want to pursue (1 in 20; Walters, 2001) v. only 1/3 surveyed strongly supported APAäó»s policy and only 10% wanted to pursue (Heiby et al, 2004)

Question 22

Is there any support for empirically supported online treatments?

Answer 22

Sure (Ritterband et al., 2003)

Question 23

What are best practices for handling social networking (SNS) online?

Answer 23

(Lannin & Scott, 2013) t search for clients online (generally) but exceptions (Clinton et al., 2010)2.Develop tech competence (McMinn et al., 2011), know what personal info of yours is online,set privacy controls, consult with colleagues3. Reduce liability risk online-consult HIPAA, HITECH, and state law (Wheeler, 2011), avoid dangerous speech–libel, breeches of confidentiality, denigration of psychology, etc.

Question 24

What should we do with the whole prescription drug privileges debate?

Answer 24

a. Buelow & Chafetz (1996) propose more elaborate ethical practice guidelines:i. specially trained psychopharmacologistsii. assessment as precursor to prescriptioniii. drug intervention alone is insufficient for most patientsiv. benefit to risk ratiov. avoid polypharmacyvi. special attention to the unique needs of medically illvii. Avoid medical model where every physician prescribes drugsb. Heiby et al (2004)i. pause push on legislation to investigate possible impact of laws and trainingii. come to some consensus

Question 25

Other pros of prescribing medications?

Answer 25

f. Bersoff (2008) adds based on a debate at the 2002 APA convention i. it is our societal responsibility to provide high-quality primary care ii. a psychologist first and then add psychopharmocology as an additional clinical skill iii. if psychology doesnäó»t invest in the future then undergraduates will no longer seek out the fieldh. Walters (2001) meta-analysis of arguments adds: i. greater community care and increased service delivery to underserved populations ii. physicians with no mental health training currently write 83% of prescriptions iii. would enhance income and status of those with privileges

Question 26

Other cons of prescription privileges?

Answer 26

e. Koocher & Keith-Spiegel add: i. would medicalize the discipline at the expense of more traditional therapies that target the causes of mental disorders ii. adding coursework would require dramatic changes in training model (not feasible?) iii. added time and training costs iv. psychologists who prescribe may experience atrophy of psychotherapy skills f. Walters (2001) meta-analysis: i. evidence is that the lay person doesnäó»t understand differences in careers, thus no more prestige ii. psychiatry use to be expert in both; but too time consuming and moved to biological; could also happen to psychology