Class Summaries (dt. 23/02/'10, 26/02/'10 and 1/03/'10)

23rd Feb 2010

Ethical principles of psychologists and code of conduct, 2002

The code of conduct for clinical psychologists was framed in the year 1953. The code has undergone 9 revisions since conception. The following factors, in the opinion of the class, have led to major shifts in our understanding of ethics in general and specifically in the moral demands from the profession.

1) Research interest: as attested by more research on ethics in other fields too such as general activism, animal rights, laws in other fields, etc, contributing to more rigid ethics.
2) With the client becoming the consumer, (consumer protection act, 1986) there was a necessity to strengthen the code in order to protect the professionals against law suits.
3) Sudden popularity in the field as gauged by an increase in the number of professionals warranted a sound code of conduct to protect the integrity of the field. In 1990, there were about a hundred thousand clinical psychologists all over America and it was the 5th most popular subject opted in schools.

Relationship between law and ethics: Ethics binds a professional by principles and directs him/her to strive for the best possible service to the client but there is no legal mandate. Violation doesn’t lead to imprisonment. Whereas, laws don’t tolerate violation. The exceptions to this rule are “Violable laws” that are included in the code of conduct.
It is to be noted that ethics are aspirational whereas law is enforceable.

a) Aspirational laws don’t lay down a mandate that professionals have to follow it stringently 100% of the times but rather, should aspire to diligently follow them. No specific details of what to do and what not to do are laid down.

b) Mandatory ethics can be violated with the risk of putting one’s membership with the APA in jeopardy. APA’s ethical committee is the final jury on taking the decision to cancel the membership. Once the membership is cancelled, APA committee refers the guilty on to a local state council/ court, which takes the final decision as to continuation of the professional as a clinical psychologist.

An example was cited for a better understanding of the gray areas in adhering to certain guidelines of the code on the part of the professional.
A Bengali doctorate student was undergoing therapy from a Clinical psychologist where the patient confessed to having romantic feelings for a lady who didn’t reciprocate. In course of the therapy the patient also expressed his wish to hurt and eventually kill her. The Clinical psychologist, who was practicing in the same university as that of the patient, promptly informed the local police who interrogated the client. The police didn’t find enough evidence and the patient was given a restraint order against the lady. After a few months, the patient murdered her. Tara’s family complained that the clinical psychologist didn’t inform them.
Since then so many laws have been passed that recognize clients as consumers. Clients, who are disgruntled for any reason, file cases against clinical psychologists to the ethical committee. The general experience is that many times the cases are found to be false. Ironically, in spite of revisions and tightening of the code of conduct and more number of dos and don’ts, the number of ethical violations has been on the rise. Does it reflect the failure of the code of conduct? To better appreciate the complexities, it is opined by the class that it may become necessary to include ethics in a major way as part of a masters’ syllabus.

The 1980s and 1990s saw lots of research in this area. In 1987 about 460 practicing clinical psychologists in the USA responded to a survey where case vignettes were given and the participants were asked to say what they would do and not do. Only few participants could clearly answer the questions. Majority felt that response to any given situation will depend on contextual factors. This study clearly establishes that gray areas are involved in a clinical psychologist’s professional practice. One clear outcome of the study was that it came out very clearly that there was widespread consensus among the professionals that there can’t be a dual relationship with the client in the context of sexuality. Shaking hands with the client was not an ethical violation. Any confession of sexual abuse involving family members or otherwise would be immediately informed by the clinical psychologist.

Even if this research is replicated, it can be seen that a majority of cases fall in the gray areas. Ethical dilemmas have to be accepted as a part of professional practice. The rest of the session was about dealing with such ethical dilemmas.

There’s been a rise in ethical activism and rise in law suits, leading to a lot of loose ends being tied up by different associations. Hence to accommodate necessary behavioral principles, codes have been revised.
Any violation of the code may attract a Reprimand or cancellation of license depending on the severity of violation. The existing code of conduct probably has to go through an introspective deliberation as to the need to tighten it.

After discussion that continued in the same vein, case studies were distributed. Students were asked to note what constituted a violation and what did not. Went back to APA code of conduct to clarify and confirm.

To access the Ethical principles of psychologists and code of conduct, 2002, check this link out: http://www.apa.org/ethics/code/code.pdf

A few examples of the kind of case vignettes circulated around:

Case I: Dr.A recently became a licenced practitioner. He is a very competent professional. He sets up a private practice. Dr.A is very excited, wants a satisfactory and profitable career. Dr.A however nurtures ambitions of enhancing his financial status. His family situation also places high expectations of early success what with his wife being pregnant with their first child. A colleague refers a patient suffering from panic attacks to him. Dr.A has never treated panic attack before. The patient is wealthy which tempts Dr.A to counsel him several times a week when the right number of sittings would have been 3 times a week or less. But he sought out academic and scholarly material to improve his competence. What are the possible violations of ethics he has committed and what would you do if you were on the Ethical Committee? If you were Dr. A, what would you have done?

Students’ response: Violations: Asking him to come for more than 3 sessions is a violation as this doesn’t leave the client with enough time to do his homework. The sessions have to be paced according to the competencies of the client.
By APA’s guideline, this amounts to violation of mandatory ethics: 2.01, 2.06, 3.04, 3.10 (Pls refer link above for the specific principles.)

If we were put on this case, it is likely that it would have resulted in the following verdict:
1) A Warning to the practitioner
2) Should be made to take help and guidance of a supervisor or should have referred him on to someone if he was not sure of his competencies. Learning is not the primary goal. Helping is.

What should have been done: Dr.A should have informed the client of his inexperience but assured him of his knowledge of the client’s problem and give him an option of having an evaluative first session, following which, if he is satisfied, he can carry on with him while Dr.A takes guidance from his supervisor. Alternatively, Dr.A could also have referred the client on to some other professional.

Case 2: Dr B has been doing psychological testing for 5 yrs. He has a high level of competency. He used to enjoy his work once but then burned out. He gets into the habit of omitting tests and taking shortcuts. As this continued, on an occasion his diagnosis landed in error. A Child with LD was diagnosed as having MR. The child was put in special school. When the child was retested, it was found that his level of functioning was higher.

This amounts to violation of clause 2.06. The solution is to offer breaks to practitioners, inculcate the system of continuous professional education, and proper supervision.


26thFeb 2010

The Future of Clinical Psychology

This class saw a presentation by Subhasree who presented a paper that attempted to answer several questions about the future of clinical psychology, including the following:

1) Will clinical psychology be able to retain its identity or will it be dissolved into a number of sub-disciplines? This concern was brought up by her in the face of a widening boundary between research and practice within the field, and also the emergence of super-specialities within the scope of clinical psychology such as child clinical psychology, clinical health psychology, clinical neuropsychology and geropsychology.
2) However, if we were to think of clinical psychology of an undivided field, what do we stand to gain? In response to this question, the paper concluded that the developments in the different areas of the field (practice, research, diagnosis and therapy) seem to enrich and take leads from one another rather than establish any hard difference between the goals of one another, which is eventually, evidence based help to the clients in need.
3) The next concern is a never-ending question. What is our relationship with psychiatrists? The position this paper seems to take is that clinical psychologists will win the favour of the public if they collaborated with psychiatrists because of the public’s preference for a ‘quick cure’, that seemingly only medications and psychiatrists can offer.
4) The next premise addressed in this paper was the relationship with education. With clinical psychologists striving to place the field at a position of high regard, there has been great emphasis on rigorous research, competitive exams to admit the most competent students to master-level programs, sound ethics, etc.
5) The final question is a very interesting one. This paper tries to answer who is fit to treat whom? That is, what kind of therapist is most likely to succeed in treating what kind of clients? This question is answered by exploring the client-therapist variation strategy, which looks at the various client and therapist characteristics and what combinations of these characteristics are slated for success.

The demands that have been placed on this field were also discussed:

1) The number of clinical psychologists who are efficiently trained and who hold years of clinical experience are very few in the teaching forum. It is also felt that it is essential to offer students exposure to clinical materials which will only add to increase the competency of the training programs.
2)The division of labour between psychiatrists and psychologists when it comes to dealing with problems that are in the borderline between those of a purely psychiatric and psychological nature, as is feasible.
3) A need to construct further developments in the area of child psychology.
4) Including psychometrics in higher level courses.
5) Training of clinical psychologists in the biological sciences, such as anatomy, pathology, pharmacology, etc. so as to get an overall understanding of the client as a psychological and a biological organism.


1st march 2010

PANEL DISCUSSION

Opening question: What is the future of clinical psychological training and education? What would be our suggestions for improvements and modifications?

The panelists primarily felt that a gap exists between what’s happening in the field and what is being taught in class.
The question that was grappled with throughout the discussion was why not have a UG course with clinical specialization? The counter-argument to this proposition was that many don’t know if the clinical track is what they want to take up. Many universities don’t have a great UG course in order in the first place. Integration would make education worse.
Another counter argument posed was what happens to the inter disciplinarity of the field if we were to have an early specialization- Compromise on exploration.

A very pertinent suggestion that was made and agreed by all present was that maybe UG courses can have in depth papers that have been structured optimally to reduce the need to do such papers as systems of psychology and social psychology at the masters level, as this would permit the masters level courses to focus more on integration with the field of practice.

Another argument that rose was what role does the level of maturity of a student play in the process of decision making concerning opting for a specialized clinical psychology course and what are the implications that it has in taking the most from training? What then is the right age? To this, the class responded that a good number of people do not feel the calling even after completing a masters in clinical and this is not necessarily because of fading passion. Other considerations such as finances, personal dilemmas and others play a role. So age is not all. Even people who are a cent percent certain of things after UG may be thought to be going through a phase of rethinking because of the way masters course is structured.
Who gets disillusioned in such a case?!
Another position: It’s not only the course that decides why we want to do clinical psychology. It is also about seeing for yourself what the field is about and how much we get inspired by out- of- class exposures. A person who is interested will be interested no matter what course is inflicted on them.

The discussion then moved on to what the supposed “competencies” of a clinical psychologist are? How should it be developed?
The class thought such skills as observation, reflection, need to help, self- awareness (of one’s own motivations, competencies, etc), intrinsic motivation to remain committed, a well developed understanding of cause-and-effect, personal emotional stability, and the ability to use oneself in therapy to an optimal level.