Module 4: Confidentiality and Working with Diverse Populations Flashcards
What are the 3 basic guidelines for consent in the client/therapist relationship?
A. consent is informed, voluntary and discrete
B. consent is informed, private and discrete
C. Identify, describe and significant
D. consent is informed, voluntary and rational
Consent is informed - how long, fees, etc
Consent is voluntary - no coercion
Consent is rational - can client makes sound judgement
What is autonomy?
Free Will (Kant). The right to make ones own decisions
What are the guiding principles of autonomy?
A. justice, beneficence, integrity and self-care
B. justice, integrity, informed consent and shared decision making
C. obtain consent from clients and integrity
D. collect, record, disseminate and dispose of records
B. Justice, beneficence (doing good to others, includes moral obligations) integrity, self-care
What term did the group change from to, but then decided to keep?
Informed consent - shared decision making
What is honesty a component of?
a. informed consent
b. right to make ones own decisions
c. the integrity principal
d. the right to be left alone
The integrity principal
When must the psychologist obtain consent?
a. they do not require consent
b. when the client is impaired
c. from all clients
d. only when the client is not impaired
From all clients for all types of work they undertake. Even when the client is impaired. Sometimes even so-called mature adults.
Privacy is?
The right to be left alone and to their personal info
Confidentiality is?
Collect, record, disseminate and dispose of in a manner that protects the information of the client, even after death
Is it illegal to not disclose a possible threat from a client to others?
Not in Australia
Fidelity
trust and reliability
Is the promise of confidentiality ethical?
It is not ethical because the psychologist may not be able to deliver confidentiality
What are the 3 basic concepts in consent?
A. integrity, intrusion and justice
B. unjust intrusion, right to control and access
C. informed, voluntary and rational
D. A & B
Informed (fees, procedures, etc)
Voluntary (no coercion)
Rational (clients ability to understand the relevance
What are the 2 components of the right to privacy?
A. unjust intrusion in ones life and right to control records
B. collection of personal information and access to personal records
Unjust intrusion in one’s life and the right to control what happens to one’s records
What are the 5 parts of the Australian Privacy Principal?
- consideration, collection dealing with, the integrity, access and correction of personal information
- consideration, collection dealing with, the integrity, risk of harm, written summary of rights
- Risk of harm, written summary of rights, collection of personal info and rights and responsibilities
- written summary of rights and responsibilities
Consideration of personal information 1. Collection of personal information Dealing with personal information The integrity of personal information Access or correction of personal information
Who do you contact if you suspect child abuse? a. APAC code of ethics b. APS code of ethics c. APS ethical guidelines D APAC ethical guidelines
APS ethical guidelines
Legally obligated exposure (confidentiality)?
The client, legally, risk of harm and between colleagues without naming
What is allowable disclosure?
Supervisors inspections as well as APS guidelines for working with clients when there is a risk of harm and suicide i.e maybe a legal authority by a school
Who assesses for suicide risk over 25 years?
PSY team - Physical social team
CAT team - crisis assessment team
CAT team - crisis assessment team
What are three myths related to violence?
- That only violent or psychotic people commit murders
- That only violent people, and mainly psychotic people murder and that it can be predicted
- Only violent, abused and psychotic people murder
That only violent people commit murders
That people who kill are mainly psychotic
That violence is not something that can be predicted
What are 5 items on the checklist that works 10% of the time?
Active symptoms or a serious mental illness (particularly hallucinations)
Impulsivity
Lack of insight or disconnection from reality
Lack of empathy or remorse
Poor response to treatments like anxiolytics (anti-anxiety drugs)
What has been found to not be a risk of harm to others?
Paranoia
What is a tool to assess the risk of harming others?
Historical-Clinical Risk Management - 20 (HRC020-C)
What does a risk assessment clinician do?
He judges by experience and produces an estimate
Structural professional judgement?
A judgement can be made on 1 risk factor but 2 factors being present is the best
What is the COVE classification also known as?
The violence risk assessment guide
Factor analysis found instruments tap what four overlapping dimensions?
- violence, substance abuse, risk, symptoms
- criminal history, psychopathy, irresponsible lifestyle, criminal attitudes and all substance abuse-related problems
- criminal history, psychopathy, irresponsible lifestyle, criminal attitudes and all substance abuse-related problems
Actural?
Measures risk
How can group data powerfully inform?
Only by being part of a group may it be possible to tell whether something will happen. An example is the revolver choice. Would I pick the gun with 4 empty cartridges and 1 full or the other way around
One crucial point of a mixed treatment and assessment approach is?
Not enough to say a variable is a risk factor but also to show that a variable reduces the risk. i.e. someone is a risk, so steer them towards suitable employment
Novel assessment methods?
Use implicit measures (suggested though not directly expressed) or heuristics (mental shortcuts)
What are the 5 approaches to risk assessment by Skeem and Monaton
Unstructured clinical judgement
The standard list of risk factors
HCR20
COVR & LSI-R and VRG
Having read Skeen and Monatans review of the 5 methods, what is the optimal method for predicting the risk of violence?
They state that the unstructured clinical judgement method has the least empirical support, potentially leading to inaccurate prediction of violence. However, studies provide little evidence that one validated instrument predicts violence significantly better than another, essentially being interchangeable with estimates of accuracy falling within a narrow band. Instead, they argue for group-based assessments and the differentiation between risk assessment and risk reduction as a goal.
What is the optimal method for predicting violence?
Margins of errors surrounding risk assessments of violence are so wide as to make predictions “virtually meaningless” or group data can powerfully inform individual assessment of risk.
What are some controversies surrounding the empirical assessment of risk?
Error margins, the lack of differentiation, between instruments which suggest they all measure common factors and these factors may not necessarily be valid or reliable indicators of risk of violence, the potential for empirical measures to assess psychopathy and antisocial personality traits rather than the risk of violence, the dichotomous nature of risk prediction (e.g. violent/non-violent) when a continuous measure may be more appropriate; the differences between individual and group prediction, and the apparent confusion between the goals of risk assessment and risk reduction.
Empirical?
Verified by observation or experience rather than theory or logic
In suicide what must a psychologist be aware of?
Counter transference reactions, such as pity, fear, anger, panic, moral offence or need to save the client
What are Gerards 3 categories?
- The chronically ill, in pain or disabled, with a common factor of helplessness.
- Those who have experienced severe trauma and are now chronically depressed.
- Those who use suicide as a last resort to show their pain.
Suicide levels?
High risk - face to face assessment within 24 hours
Medium risk - face to face assessment within 1 week
Low risk - currently unwell or distressed - within 1 week
no current problems - within 1 month or 7 days of leaving acute inpatient unit.
What are 3 common reactions that psychologist experience to their patient’s suicide
shock
as a burden
a personal crisis, including guilt, doubt and fear
Fidicury relationship involves?
Trust
Communication technology can lead to?
Increased cognitive effort, decreased understanding and poorer interaction quality than if it was face to face
Psychologists feel more comfortable with the:
law
code
code
What percentage of psychologists felt it was their legal duty to disclose if there is imminent danger, even though it is not illegal in Australia
64%
What is the life expectancy of indigenous Australians?
19 years lower than non-indigenous
What are the 3 skills required to develop culturally proficient psychologists?
Attitudes: know your personal beliefs regarding cultures and monitor personal biases
Knowledge: Own and others world views. Socio-political influences such as discrimination and stereotyping, know historical practices, norms
Skills: to interact with diverse clients, skills are not culture-bound. Adaptable can work with interpreters
Ethnocentrism?
Not having preconceptions as per own culture
How many diverse groups in Australia?
Over 200 countries represented and languages other than English
What is difficult for interpreters and psychologists
Explaining tricky concepts that do not translate easily, i.e hallucinations or medications
What should be taken into account when employing an interpreter?
Learn, allow 10-15 mins prior to the session to brief the interpreter, respect confidentiality, match for gender, age or religion. Avoid relatives and children. Allow 10-15 minutes to debrief the interpreter. Caution when using interpreted tests.
What are some of the issues of using an interpreter?
Interpreters may not have had training and may be adversely affected or traumatised
With a slow pace (interpreting) could lose concentration
Transference and countertransference can interfere
It May take too long
Therapeutic Triad when using an interpreter
A triangle or interpreter behind the client
What are the 4 modes of interpreting?
linguistic mode (word for word and interpreter stays in a neutral and distanced position) Psychotherapeutic of constructionist mode (this is where the meaning or feeling of the words is more important) Advocate or community interpreter (advocate or represents the interests of the client) Cultural broker/bicultural worker (the spoken word plus cultural and contextual variables) -Contextual meaning relates to the circumstance, setting, idea, etc
If the interpreter is slow what might happen?
The psychologist may lose their thread of what is being said. To counter this it is best to have open communication, and trust to create a natural rhythm that makes everyone comfortable.
What is back translation?
This is where one translator translates from a language to another and another translator translates it back. Important for legal cases.
What are some problems with Psychometric tests?
Not adapted for the particular culture. Reliability, validity and norming. If not done correctly then it is compromised, i.e in African cultures distress may be interpreted differently or have a different meaning.
Culturally inclusive practice
7 million people worldwide are refugees, asylum seekers, internally displaced or stateless. Australia hosted only 0.3% (30,000) of the 80% of the world refugees, particularly Pakistan and Iran.
Conventions relating to the status of refugees
Under these, it is legal to seek asylum regardless of how one arrives in the country
Some effects of trauma and torture?
Identity confusion, lack of trust, grief and loss, mistrust and fear of authority, chronic pain, cognitive impairment
What are some of the problems for psychologists working with homeless and poor people?
They may ask for money for food and cigarettes
May be living in a car with a toddler
These are stereotypes of gay people, these are the realities
`1.sexual orientation and paedophilia are not the same
- children raised by GBTQ do very well
- cross-dressing as a fetish and transgender are different
- Same-sex is not something to be cured of
- Bisexuality can be lifelong or part of coming out
- LGBT have similar relationships (i.e lifelong) to any population
- LGBT should have the same rights as everyone
Your career: 2 outcomes of learning and applying psychology
- Reflect and learn from one’s experiences to be able to express feeling as in the psychology principals
- Apply the principles to promote ones own development through self-regulation to attain goods, etc
Socrates said:
An unexamined life is one not worth living
What is practice or praxis
Doing something based on theory and reflection
Wisdom (phronesis)
Praxis, phronesis
Informed by a moral disposition to act rightly understanding other people in context
Canonical (Schon)
accepted in law
Schon advocates two domains
Reflection in action (at the moment, because these are standard solutions) i.e a client brings up something which the psych refers to their toolbox to answer and
Reflection in action (happens afterwards in hindsight) i.e psych goes over and evaluates what happened
Reflection
reflection helps you learn and requires concentration, evaluation of which skills are required. It can be quite uncomfortable. Requires honesty and from different perspectives.
Autoethnographic ethic
Diary of self-reflection often used to train health professionals
Bakers 4 steps model for reflective writing
- identify - select experience
- describe - what are your thoughts, feelings
- significance - what have you personally got out of this experience
- what are the implications or how did it impact you
What are the 3 basic guidelines for consent in the client/therapist relationship
Consent is informed - how long, fees, 3rd parties, confidentiality, etc
Consent is voluntary - no coercion
Consent is rational - can client make a sound judgement
