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Ethics in Psychotherapy > Midterm - Foundations > Flashcards

Midterm - Foundations Flashcards

1
Q

Professional Ethics

A

The analysis and determination of how members of a group of professionals ought to act when judged against a system of values

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2
Q

Values

A

Beliefs and attitudes that provide direction to everyday living, can be of an individual or a group

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3
Q

Code of Ethics

A

Normative thinking about shared values that guide expectations for professional conduct

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4
Q

Morality

A

Our perspectives of right and proper conduct and involves evaluation of actions on the basis of some broader cultural context or religious standard.

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5
Q

Levels of Ethical Practice

A

Mandatory Ethics (standards) and Aspirational Ethics (codes)
*if in conflict, adhere to mandatory ethics

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6
Q

Mandatory Ethics

A

level of ethical function where therapists comply with minimum standards, acknowledging the basic “musts” and “must nots.” Can be written or unwritten. e.g. CRPO Standards of Practice

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7
Q

Aspirational Ethics

A

The highest professional standards of conduct to which therapists can aspire. e.g. Ethical Codes

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8
Q

Value of Power Differential

A
  • Confidence in their caregiver’s knowledge, training, and expertise
  • Security, safety, and protection
  • Role boundary clarification and maintenance
  • Assessments of progress
  • Sensitivity, respect, fairness, and care
  • Provision of direction, focus, treatment, guidance, and support
  • Overview and access to a bigger picture and wider view of persons and situations
  • Chain of accountability
  • Facilitated accomplishment of task and purpose
  • Final decision-making authority for therapeutic process rests in therapists
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9
Q

Forms of Power

A

-Legitimate Power
-Referent Power
-Expert Power

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10
Q

Legitimate Power

A

-comes when given RP title
-formal
-can enforce conformity
-position

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11
Q

Referent Power

A

-based on establishing and building the therapeutic alliance
-non-coercive
-grounded in trust and respect
-earned over time

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12
Q

Expert Power

A

-something we hold within us
-knowledge
-training
-skill
-experience
-cases for therapist credibility

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13
Q

Competency

A

skills, knowledge and judgement

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14
Q

entry-level proficiency of RP

A

uses competencies in an informed manner and does not normally require immediate supervision/direction; achieves outcomes consistent with generally accepted standards; and seeks supervision/refers when in unusual and difficult to resolve or complex situations

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15
Q

5 Categories of CRPO Competencies

A
  1. Foundations
  2. Collegial& Interprofessional Relationships
  3. Professional Responsibilities
  4. Therapeutic Process
  5. Professional Literature & Applied Research
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16
Q

Resources for Decision Making

A
  1. Internal (decision making skills and model, knowledge of ethics and laws (and how we interpret them), moral principles, intentionality/power, courage of your convictions (intuition and guilt), guidance of the Holy Spirit, experience)
  2. External (code of ethics, professional standards, laws, agency policies, insurance, client, supervision, consultation/peers, PD)
17
Q

4 features of a Code of Ethics

A
  1. Based on principles that are valued by the members of the proffesion and society.
  2. Principles have universality - apply to all individuals under similar circumstances
  3. Appropriate actions can be taken using reasoning.
  4. Actions lead to outcomes that are accepted by society

*all codes are to protect clients not the therapist

18
Q

Values/Principles of CRPO Code of Ethics

A

-Autonomy & Dignity of all persons
-excellence in professional practice
-integrity
-justice
-responsible citizenship
-responsible research
-support for colleagues

19
Q

Limitations of Codes of Ethics

A
  • can be too rigid
  • can be too aspirational
  • can be too black and white when life is messy
  • may not cover everything explicitly, still leaves room for personal judgment
20
Q

Law vs. Regulation

A

Law = the minimum standard society will tolerate. Enforced by the government.
Regulation = legal and ethical practice of regulated health professionals. Establishes the scope of practice and how laws will be enforced by provincial regulatory bodies (e.g. CRPO)

Law is the lowest bar/standard we must adhere to, regulation is the practicality of the law

21
Q

Laws pertaining to Psychotherapy in Ontario

A

-Regulated Health Professionals Act, 1991
-Psychotherapy Act, 2007
-Affirming Sexual Orientation and Gender Identity Act, 2015
-Child, Youth and Family Services Act, 2017
-Missing Persons Act
-Long Term Care Homes Act, 2007,
-Retirement Homes Act, 2010
-Health Care Consent Act (HCCA), 1996
-Personal Health Information Protection Act (PHIPA), 2004
-Substitute Decision Maker Act, 1992
-Criminal Codes

22
Q

Duties of Regulatory Bodies

A
  • Determine standards for admission into the profession
  • Screen applicants applying for registration (Ontario), certification or licensure
  • Regulate the practice of psychotherapy to protect the public
  • Quality assurance (e.g. CRPO quality assurance exam every 2 years)
  • Conduct disciplinary proceedings (following investigation of complaints)
23
Q

How CRPO protects public interest

A
  • maintaining a Public Register of members;
  • holding registrants accountable for their conduct by investigating and addressing all complaints;
  • providing funding for therapy and counselling in the event a client is sexually abused by an RP;
  • developing, establishing and maintaining requirements for registration and renewal;
  • developing Professional Practice Standards For Registered Psychotherapists and the Code of Ethics;
  • ensuring the ongoing competence of members through the Quality Assurance (QA) Program; and
  • taking action to prevent non-members from using restricted titles.
24
Q

3 Types of Ethics

A
  1. Principle Ethics (What should I do? - focus on what is right and wrong and actions)
  2. Virtue Ethics (Who do I want to be? relates to our own moral qualities and virtues, Am I okay doing this? Does it fit with who I want to be as a person/Christian?)
  3. Relational Ethics (How will my actions manifest consideration and care for others? looking at the situation systemically and considering who besides the client and therapist will be impacted)
25
Q

6 moral/ethical principles to guide decision-making

A
  1. nonmaleficence
  2. beneficence
  3. autonomy
  4. justice
  5. integrity/vereacity
  6. fidelity
26
Q

Nonmaleficence

A

Above all, do no harm.
(e.g. do not collude with clients, exploit or harass them, intentionally trigger them, encourage harmful behaviour, not provide service client paid for, avoid potentially harmful conflict of interests)

27
Q

Beneficence

A

Your actions do good.
(e.g. informed consent, encourage healthy behaviour, provide psychoeducation)

28
Q

Autonomy

A

A person has the right to make their own informed decisions and actions towards their personal wellbeing.
Treating the client with dignity and respect.

29
Q

Justice

A

Treating all clients fairly. Not always exactly the same, equity not equality.

30
Q

Integrity/Veracity

A

Being honest. “Speak the truth in love,” transparency, being consistent with clients

31
Q

Fidelity

A

Keeping promises and honouring commitments. Being trustworthy, reliable and responsible.

32
Q

Steps in Ethical Decision Making

A
  1. Identify and define the problem at the Intuitive Level (list the facts and internal tensions/conflicts/concerns/feelings; state the ordinary moral sense - compare to past similar experiences; reflect on therapist values, power/privilege, biases, assumptions, wounds, hot buttons; ask “have any of these influenced my perspective of the problem?)
  2. Re-define the problem.
  3. List alternative responses.
  4. For each response, identify the benefits/problems with the response (consider who will be affected by the decision and how, who is the client; what is the worst thing that could happen; what is the desired outcome; assess whether there is any missing any knowledge, skills, experience, or expertise)
  5. Assess through the Critical Evaluative Level (by considering ethical rules and standards [CRPO, AAMFT]; agency policy; provincial or federal laws and statues; ethical principles)
  6. Obtain consultation (at least 3 peers; documentation of consultation)
  7. List Clinical Actions that would make sense to take
  8. Ask: Can I do it? Can I live with myself?
    *Yes –
    *9. Plan
    *10. Act
    *11. Document
    *12. Evaluate
    ^no
    ^9: Ask, do I have good reasons to deviate from the norm?
    ^10. Consult
    ^11. Document
    ^12. Choose
    ^13. Act
    ^14. Document
    ^15. Evaluate
33
Q

Ethical Maturity

A

-Develops through reflective practice
-Fostering ethical sensitivity and watchfulness of own feelings and potential ethical issues
-Discerning ethical decisions (in alignment with our principles and values)
-Implementing ethical decisions (with courage despite possible consequences)
-Ability to articulate and justify the decision(s) to stakeholders
-Ethical peace and stability (making peace and finding closure regardless of outcome)
-Learning from what has happened and “testing” the decision through reflection
-may need to step outside of comfort zone

34
Q

Personal factors that influence ethical decision making

A
  • values, beliefs, and worldview
  • schemas, biases
  • past traumas/experiences
  • emotions (countertransference)
  • previous work experience
  • family of origin and attachment style
  • our past experiences in relationships
  • culture
  • level of empathy/how much relate to/identify with client
    *our level of intuition/ability to read others body language
  • mood/feelings of therapist that day/what else is happening in their life at the time
  • stage of life/Developmental stage
  • competence/level of experience
  • relationship with Christ, spiritual relationship and practice
  • moral identity - what you are willing to stand up for
  • degree of self-interest
  • personal boundaries
  • personal habits (e.g. around drinking, sex, etc.)
  • ego strength
  • access to resources
  • interest areas
  • imagination and creativity
  • self-criticism
35
Q

advantages and limitations of three types of ethics

A
  1. Principle: A: clear and straightforward, analytical. L: sometimes principles can contradict one another; can be gray areas in ethics and not everything is black and white as principle expects
  2. Virtue: A: considers personal values. L: everyone as different morals and values; can be too aspirational
  3. Relational: A: looks beyond client and the law. L: very complicated and messy, hard to find clear path forward
36
Q

Reasons therapists may act unethically

A
  • self interest/client exploitation/personal gain
  • lack of/distorted view of personal boundaries
  • insensitive and unaware of it
  • countertransference and unaware of it
  • personal bias unaware of
  • fear
  • ego of therapist at risk
  • emotional impairment/burnout
  • emotional connection to client
  • vengefulness
  • lack of knowledge/competence
  • misinformation/having the wrong information

Ethics in Psychotherapy (5 decks)

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