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Ethics in Psychotherapy and Counseling


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Table of Contents

Acknowledgments xxiii Preface xxv Chapter 1 Strengthening Ethical Intelligence: What Do I Do Now? 1 Chapter 2 Ethics in Real Life: Grad School Didn't Prepare Us for This 7 Computer Coincidences 8 Life in Chaos 10 Evaluating Children 11 The Fatal Disease 12 The Mechanic 13 The Postdoctoral Experience 14 Staying Sober 15 Chapter 3 The Human Therapist and the (Sometimes) Inhuman Relationship: Being Absent in the Present 17 Chapter 4 Avoiding Pseudoscience, Fads, and Academic Urban Legends 22 Chapter 5 Ethical Judgment Under Uncertainty and Pressure: Critical Thinking About Heuristics, Authorities, and Groups 26 Cognitive Commitments 27 Authorities 29 Groups 30 WYSIATI 31 Imaginative Illusions 32 Chapter 6 26 Logical Fallacies in Ethical Reasoning 36 1. Ad Hoc Rationalization 36 2. Ad Hominem or Ad Feminam 37 3. Affirming the Consequent 37 4. Appeal to Ignorance (Ad Ignorantium) 38 5. Argument to Logic (Argumentum ad Logicam) 38 6. Begging the Question (Petitio Principii) 38 7. Composition Fallacy 39 8. Denying the Antecedent 39 9. Disjunctive Fallacy 40 10. Division Fallacy 40 11. Existential Fallacy 40 12. False Analogy 41 13. False Continuum 41 14. False Dilemma 41 15. False Equivalence 41 16. Genetic Fallacy 42 17. Golden Mean Fallacy 42 18. Ignoratio Elenchi 42 19. Mistaking Deductive Validity for Truth 43 20. Naturalistic Fallacy 43 21. Nominal Fallacy 44 22. Post Hoc, Ergo Propter Hoc (After This, Therefore on Account of This) 44 23. Red Herring 44 24. Slippery Slope (Also Known as the Camel's Nose Fallacy) 45 25. Straw Person 45 26. You Too! (Tu Quoque) 46 Chapter 7 Using and Misusing Words to Reveal and Conceal 47 Substitute the General for the Specific 49 Use a Conditional Frame for Consequences 49 Use Denied Motivation as Misdirection 50 Use the Abstract Language of Technicalities 50 Use the Passive Voice 50 Make Unimportant by Contrasting With What Did Not Occur 51 Replace Intentional Unethical Behavior With the Language of Accidents, Misfortune, and Mistakes 51 Smother the Events in the Language of Attack 52 Chapter 8 Ethics Placebos, Cons, and Creative Cheating: A User's Guide 54 Chapter 9 Trust, Power, and Caring 58 Trust 58 Power 60 Caring 63 Chapter 10 Moral Distress and Moral Courage 66 Chapter 11 The Ethics of Teletherapy, Internet Therapy, and Other Digital Work: Challenges of the New Technologies 82 Risks, Downsides, and Disasters 85 Five Special Pitfalls 88 Questions to Assess Uses of Digital Media 94 Chapter 12 Competence and the Human Therapist 102 Competence as an Ethical and Legal Responsibility 104 Competence and Conflict 105 Intellectual Competence: Knowing About and Knowing How 106 Emotional Competence for Therapy: Knowing Yourself 107 Chapter 13 Creating-and Using-Strategies for Self-Care 114 Paying Attention to the Self 114 What Happens When Self-Care Is Neglected 115 Making Sure the Strategies Fit 117 The Need for Change 122 Chapter 14 Creating a Professional Will 123 Who Takes Charge? 124 Who Serves as Backup? 124 Coordinated Planning 124 Your Office, Its Key, and Its Security 125 Your Schedule 125 Client Records and Contact Information 125 Avenues of Communication for Clients and Colleagues 126 New Messages for Your Answering Machine, E-mail Account, and So On 126 Informed Consent 126 Client Notification 126 Colleague Notification 127 Professional Liability Coverage 127 Attorney for Professional Issues 128 Billing Records, Procedures, and Instructions 128 Expenses 128 Your Personal Will 128 Legal Review 129 Copies of the Professional Will 129 Review and Update 129 Chapter 15 Codes and Complaints in Context: Historical, Empirical, and Actuarial Foundations 130 Mechanisms of Accountability 133 Ethics Committees, Codes, and Complaints 135 Patterns of Ethics Complaints for CPA and APA 143 The Hoffman Report 145 Licensing Boards 146 Civil Statutes and Case Law 150 Criminal Statutes 152 Conclusion 152 Chapter 16 Responding to Ethics, Licensing, or Malpractice Complaints 154 Don't Panic 155 Consult Your Attorney First-and Make Sure You Have a Good One! 155 Notify Your Professional Liability Carrier 156 Who Is Your Attorney's Client? 156 Is the Complaint Valid? 157 Did You Make a Formal Complaint More Likely? 157 Apologize and Accept Responsibility? 158 What Are You Willing to Have Done? 158 Recognize How the Complaint Is Affecting You 159 Get the Help and Support You Need 160 What Can the Ordeal Teach? 160 Chapter 17 Steps in Ethical Decision Making 161 Step 1: State the Question, Dilemma, or Concern as Clearly as Possible 161 Step 2: Anticipate Who Will Be Affected by the Decision 162 Step 3: Figure Out Who, If Anyone, Is the Client 162 Step 4: Assess Whether Our Areas of Competence-and of Missing Knowledge, Skills, Experience, or Expertise-Fit the Situation 162 Step 5: Review Relevant Formal Ethical Standards 163 Step 6: Review Relevant Legal Standards 163 Step 7: Review the Relevant Research and Theory 163 Step 8: Consider Whether Personal Feelings, Biases, or Self-Interest Might Shade Our Ethical Judgment 163 Step 9: Consider Whether Social, Cultural, Religious, or Similar Factors Affect the Situation and the Search for the Best Response 164 Step 10: Consider Consultation 164 Step 11: Develop Alternative Courses of Action 164 Step 12: Think Through the Alternative Courses of Action 164 Step 13: Try to Adopt the Perspective of Each Person Who Will Be Affected 165 Step 14: Decide What to Do, Review or Reconsider It, and Take Action 165 Step 15: Document the Process and Assess the Results 165 Step 16: Assume Personal Responsibility for the Consequences 166 Step 17: Consider Implications for Preparation, Planning, and Prevention 166 Chapter 18 Beginnings and Endings, Absence and Access 167 Accessibility for People With Disabilities 168 Clarification 168 Therapist Availability Between Sessions 171 Vacations and Other Anticipated Absences 172 Serious Illness and Other Unanticipated Absences 173 Steps for Making Help Available in a Crisis 173 Endings 177 Conclusion 179 Scenarios for Discussion 181 Chapter 19 Informed Consent and Informed Refusal 185 Process of Informed Consent 186 The Foundation of Informed Consent 188 Adequate Information 194 Considerations in Providing Informed Consent 195 Failing to Provide Informed Consent 195 Benefits of Informed Consent 196 Limits of Consent 197 Consent for Families and Other Multiple Clients 197 Unequal Opportunity for Informed Consent 198 Cognitive Processes 198 Problems With Forms 199 Additional Resources 200 Scenarios for Discussion 201 Chapter 20 Assessment, Testing, and Diagnosis 204 Awareness of Standards and Guidelines 205 Staying Within Areas of Competence 206 Making Sure That Our Tests and Assessment Methods Stay Within Their Areas of Competence 207 Understanding Measurement, Validation, and Research 207 Ensuring That Patients Understand and Consent to Testing 208 Clarifying Access to the Test Report and Raw Data 209 Following Standard Procedures for Administering Tests 210 Knowing the Literature on Recordings and Third-Party Observers 212 Awareness of Basic Assumptions 213 Awareness of Personal Factors Leading to Misusing Diagnosis 214 Awareness of Financial Factors Leading to Misusing Diagnosis 214 Acknowledging Low Base Rates 215 Acknowledging Dual High Base Rates 216 Avoiding Confusion Between Retrospective and Predictive Accuracy 217 Awareness of Forensic Issues 217 High-Stakes Testing 219 Attention to Potential Medical Causes 219 Critically Examining Prior Records and History 219 Clearly State All Reservations About Reliability and Validity 220 Providing Adequate Feedback 221 Scenarios for Discussion 222 Chapter 21 Sexual Attraction to Patients, Therapist Vulnerabilities, and Sexual Relationships With Patients 225 HowModern Ethics Codes Address Therapist-Client Sex 226 How Therapist-Client Sex Can Injure Clients 228 Gender and Other Patterns of Perpetrators and Victims 228 Common Scenarios of Therapist-Client Sex 232 Therapist Risk Factors 232 Why Do Therapists Refrain When They Are Tempted? 233 Confronting Daily Issues 233 Physical Contact With Clients 234 Sexual Attraction to Clients 236 When the Therapist Is Unsure What to Do 238 Working With Clients Who Have Been Sexually Involved With a Therapist 242 Ethical Aspects of Rehabilitation 242 Hiring, Screening, and Supervising 246 Scenarios for Discussion 247 Chapter 22 Nonsexual Multiple Relationships and Other Boundary Crossings: The Therapeutic, the Harmful, the Risky, and the Inevitable 252 How the Field Changed Its View of Boundary Issues 254 What Makes This Area So Hard for Us? 256 Research Leading to a Call for Changes in the Ethics Code 258 Multiple Relationships as Defined by the APA and CPA Ethics Codes 261 Three Interesting Examples ofMultiple Relationships 262 Research Review 264 Self-Disclosure 267 Bartering 267 Multiple Relationships and Boundary Issues in Small Communities 269 Seven Common Therapist Errors and Mending Fences 270 Sources of Guidance 271 Additional Resources 272 Scenarios for Discussion 273 Chapter 23 Culture, Context, and Individual Differences 276 Context, Competence, and Personal Responsibility 279 Bringing It All Back Home 281 Context of Oppression, Exclusion, Discrimination, and Inequity 283 Overcoming Barriers to Ethical Services 284 Scenarios for Discussion 294 Chapter 24 Confidentiality 298 Referral Sources 300 Public Consultation 301 Gossip 301 Case Notes and Patient Files 302 Phones, Faxes, and Messages 303 Home Office 303 Sharing With Loved Ones 303 Communications in Group or Family Therapy 304 Written Consent 304 Managed Care Organizations 305 Disclosing Confidential Information for Mandated Reports Only to the Extent Required by Law 308 Publishing Case Studies 309 Distraction 310 Focusing on Legal Responsibilities to the Exclusion of Ethical Responsibilities 310 Scenarios for Discussion 311 Chapter 25 Recognizing, Assessing, and Responding to Suicidal Risk 314 Special Considerations 319 Avoiding Pitfalls: Advice From Experts 323 Scenarios for Discussion 332 Chapter 26 Steps to Strengthen Ethics in Organizations: Research Findings, Ethics Placebos, and What Works 335 Keep Codes in Context 337 Respect the True Costs of Betraying Ethics 338 Encourage Speaking Up, Listening Carefully, and Acting With Fairness 340 Conclusion: Only If We Act 342 Chapter 27 Supervision 344 Clear Tasks, Roles, and Responsibilities 344 Competence 347 Assessment and Evaluation 350 Informed Consent 351 Sexual Issues 353 Supervisee Perceptions of Supervisor's Unethical Behavior 354 Beginnings and Endings, Absence and Availability 354 Scenarios for Discussion 355 Introduction to Appendices 360 Appendix A The Hoffman Report and the American Psychological Association: Meeting the Challenge of Change 361 What Does the Hoffman Report Have to Do With Each of Us as an Individual APA Leader, Member, or Outsider? 363 What Could Each of Us Have Done Differently? 364 What Do We Want Our Ethics and Our Ethics Enforcement to Be? 365 What Do We Do to Discover or Screen Out What Happens? 367 Where Do We Go From Here? 367 Appendix B The Hoffman Report: Resetting APA's Moral Compass 370 Lessons Learned 372 Conclusion 376 References 380 About the Authors 436 Author Index 443 Subject Index 459

About the Author

KENNETH S. POPE is in independent practice as a licensed psychologist. He has chaired the ethics committees of the American Psychological Association (APA) and the American Board of Professional Psychology (ABPP). He received the 2015 Canadian Psychological Association John C. Service Member of the Year Award. MELBA J. T. VASQUEZ is a psychologist in independent practice in Austin, Texas. She has served on various ethics committees and task forces and served as the 2011 President of the American Psychological Association.

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