(a) Psychologists refrain from initiating an activity when they know or should know that there is a substantial likelihood that their personal problems will prevent them from performing their work-related activities in a competent manner.
There is a growing body of research indicating that emotional, social, health-related, and other personal problems can interfere with psychologists’ ability to use their skills effectively. Substance abuse problems, acute depression or other mental disorders, chronic or life-threatening diseases, and other stressful life events such as divorce or the death of a loved one are situations that sometimes prevent psychologists from performing their work in a competent manner (W. B. Johnson & Barnett, 2011; O’Connor, 2001; Sherman & Thelen, 1998). Work-related stressors, such as social isolation in private practice, burnout, and vicarious traumatization encountered by some psychologists working with survivors of trauma, can lead to boundary violations and otherwise compromise effective job performance (Pearlman & Saakvitne, 1995; Skorupa & Agresti, 1993). Clients/patients, students, employers, and employees suffer when personal problems prevent psychologists from competently implementing their work, and the misconduct that is often a product of these circumstances harms public perceptions of psychology.
Standard 2.06a requires psychologists to refrain from beginning an activity when there is a substantial likelihood their personal problems may impair their ability to perform their work competently. The phrases “refrain from beginning” and “substantial likelihood” indicate that the intent of this standard is preemptive: It prohibits psychologists from taking on a professional or scientific role when their personal problems have the potential to impair their work. As signified by the phrase “or should know,” psychologists suffering from problems that would reasonably be expected by members of the profession to cause work-related impairment will not avoid a finding of violation of this standard by claiming they did not know that their problems could interfere with their work. Pope and Brown (1996) note that competence in the conduct of psychotherapy requires knowledge of self-monitoring techniques to identify one’s own emotional strengths and weaknesses, needs and resources, and abilities and limits. Signs may include intense emotional reactions during therapy.
A psychologist had just returned to independent practice following chemotherapy for a cancer that was now in remission. The psychologist believed that she had recovered from the fatigue and mental stress of the chemotherapy but recognized that such symptoms may persist. She set up a weekly consultation meeting with a colleague to help monitor her work until she was confident that the symptoms had fully abated.
An industrial–organizational psychologist responsible for preemployment screening for an organization had begun to drink heavily and found that he needed to have several beers before seeing candidates in the morning and several more drinks periodically throughout the workday. In response to a complaint to the APA Ethics Committee filed by an applicant who was appalled by the psychologist’s slurring of words during a screening, the psychologist claimed that his alcoholism prevented him from acknowledging he had a problem.
Strategies for Preventing Work-Related Stress Involving High-Risk Clients/Patients
Kristen Webb (2011) addressed the ethical dilemma of providing consistent and reliable care to a patient with suicidal urges, self-harming behaviors, and significant abandonment issues with the need to ensure competent provision of services in formal sessions and telephone contact. She scheduled brief (8-minute) regular telephone check-ins between sessions to assure the patient of her availability to assist with life-threatening urges, but she limited these phone calls to skills coaching. She adhered to firm boundaries for beginning and ending sessions. Webb carefully used self-disclosure to provide the patient with examples of how she had weathered storms in her life, consistently monitoring the effect of the disclosures on her patient and the therapeutic (vs. countertransferential) motivation for the disclosures, and sought regular peer consultation. She was alert to feelings of professional discouragement, physical exhaustion, and stress related to fears of a poor outcome for her patient. She monitored her sleep and eating, created transitional activities between work and home, and made time to set aside her worries and counter the self-isolation that therapists can experience through self-nourishing exercise and socializing. Readers may also wish to refer to the Hot Topic in Chapter 3 on the ethics of self-care.
(b) When psychologists become aware of personal problems that may interfere with their performing work-related duties adequately, they take appropriate measures, such as obtaining professional consultation or assistance, and determine whether they should limit, suspend, or terminate their work-related duties. (See also Standard 10.10, Terminating Therapy.)
Standard 2.06b applies to situations in which psychologists who are already providing services, teaching, or conducting research become aware that their personal problems are interfering with their work. The standard calls for psychologists to take appropriate steps to remedy the problem and to determine whether such remedies are sufficient for them to continue work-related activities.
A teaching psychologist who was undergoing outpatient treatment for a life-threatening medical disorder found it increasingly difficult to prepare lectures, grade papers, and mentor students effectively. The psychologist consulted with the chair of the department, who agreed to assign an experienced graduate teaching assistant for the lectures. The psychologist also asked a colleague to serve as a consultant on the two dissertations he was currently mentoring.
Distinguishing between personal and professional impairment is not always easy, nor is there consensus among members of the profession on how to identify work-related impairment (P. L. Smith & Burton Moss, 2009; Williams, Pomerantz, Segrist, & Pettibone, 2010). Fear of losing highly valued abilities in the face of serious, chronic, or life-threatening diseases or being judged by colleagues as incompetent can create denial and professional blind spots (Barnett, 2008). Health problems and personal distress become professional deficits when they make services ineffective or compromise functioning in ways that harm students, research participants, organizational clients, and patients (Munsey, 2006). Signs of impairment may include intense emotional reactions (e.g., anger or uncontrolled sexual attraction), disrespectful comments to clients/patients or students, lack of energy or interest in work, or using work to block out negative personal feelings to the detriment of those with whom one works (Pope & Vasquez, 2007; P. L. Smith & Burton Moss, 2009).
To comply with this standard, psychologists can turn to the increasing number of state licensing boards and state psychological associations that provide colleague assistance programs to help psychologists deal proactively with and remediate impairment (APA Committee on Colleague Assistance, 2006; Barnett & Hillard, 2001). If such steps are not adequate to ensure competence, Standard 2.06a requires that psychologists appropriately limit, suspend, or terminate work-related duties.
A counseling psychologist returned to her position at a college counseling center after sick leave for physical injuries incurred during a car accident. Within a week at the counseling center, the psychologist realized the pain medication she was frequently taking during the day was interfering with her ability to focus on clients’ problems. She contacted a psychologist assistance program in her state that helped her taper off the medications, provided ongoing supervision to help her self-monitor her ability to perform her tasks, and provided support for the psychologist to approach the director of the counseling center to cut back on her hours.
A psychologist working in a correctional facility was violently attacked by a new prisoner during a psychological assessment interview. The psychologist did not seek psychological counseling for his reaction to the assault. A month later, the psychologist was conducting an intake of a prisoner who reminded him of his attacker. Although the psychological assessment did not provide evidence of extreme dangerousness, the psychologist’s report indicated the prisoner was highly dangerous and should be assigned to the most restrictive environment (adapted from Weinberger & Sreenivasan, 2003).
Need to Know: Education and Training Stressors
Graduate students are also vulnerable to stressful life experiences, physical or mental illness, and substance use problems. In addition, graduate schools and postdoctoral internships or research can create distress related to financial concerns, relocation, lack of social support, and academic and related time pressures (APA, Committee on Colleague Assistance, 2006; Tamura, 2012). Education and training programs can increase the competent conduct of practice and research by providing (a) materials on how personal problems can diminish professional competence; (b) strategies for assessing and monitoring when these problems may compromise effectiveness and harm those with whom they work; (c) opportunities to openly discuss these issues with faculty and supervisors; and (d) fair and effective approaches to remediation and, if necessary, termination, when a student exhibits signs of impairment (N. J. Kaslow, et al., 2007; Tamura, 2012; see also Hot Topic “The Ethical Component of Self-Care” in Chapter 3).
Multicultural Ethical Competence
Ethical decision making for psychological research and practice in diverse cultural venues must be sensitive to cultural attitudes toward individual autonomy and communal responsibility, historical and contemporary discrimination within society and psychology as a discipline, sociopolitical factors influencing definitions of race and ethnicity, and variations in immigration history, acculturation, cultural/ethnic identity, language, and mixed race/ethnic heritage (Arrendo & Toporek, 2004; Fisher et al., 2002; Fisher et al., 2012; Fisher, in press; Lyon & Cotler, 2007; Ponterotto, Casas, Suzuki, & Alexander, 2001; D. W. Sue & Sue, 2003; Trimble & Fisher, 2006). Multicultural responsibility requires “a fusion of personal and professional commitments to consider culture during ethical encounters” (Ridley et al., 2001, p. 176). This Hot Topic section applies the ethical decision-making model introduced in Chapter 3 to help psychologists identify key questions to consider as a means of acquiring the attitudes and knowledge essential to multicultural ethical competence.
Multicultural Ethical Commitment
Multicultural ethical commitment requires a strong desire to understand how culture is relevant to the identification and resolution of ethical problems. It demands a moral disposition and emotional responsiveness that moves psychologists to explore cultural differences and creatively apply the APA Ethics Code to each cultural context. Cultivation of these competencies thus includes motivation to consider the influence of culture in psychologists’ work conscientiously, prudently, and with caring discernment.
The desire to ensure that cultural sensitivity is integrated into ethical decision making requires a willingness to reflect on how one’s own cultural values and cultural identity influence the way ethics is conceived in one’s activities as a psychologist (Arredondo, 1999; Helms, 1993; Trimble, Trickett, Fisher, & Goodyear, 2012). Furthermore, multicultural ethical competence entails recognition of harms that psychology can exert on culturally diverse groups by invalidating their life experiences, defining their cultural values or differences as deviant, and imposing the values of dominant culture upon them (Fisher, 1999; Fisher et al., 2002; Fowers & Davidov, 2006; Prilleltensky, 1997; Trimble & Fisher, 2006; Vasquez, 2012).
In psychological research and practice, multicultural ethical commitment involves motivation to do the following:
· Critically examine moral premises in the discipline that may largely reflect Eurocentric conceptions of the good
· Question “deficit” and “ethnic group comparative” approaches to understanding cultural differences
· Address the reality and impact of racial discrimination in the lives of cultural minorities
· Recognize that socially constructed racial/ethnic labels can strip participants of their personal identity by responding to them only in terms of racial or ethnic categorizations
· Avoid conceptually grouping members of ethnic minority groups into categories that may not reflect how individuals see themselves
· Engage in self-examination of how institutional racism may have influenced each psychologist’s own role, status, and motivation to develop professional identities free from these influences
· Develop the flexibility required to respond to rapid cultural diversification and fluid definitions of culture, ethnicity, and race
Multicultural Ethical Awareness
Multicultural ethical commitment is just the first step toward multicultural ethical competence. Good intentions are insufficient if psychologists fail to acquire relevant knowledge about cultural differences and how they may affect the expression of and solutions for ethical problems. To ethically work with diverse populations, psychologists must remain up-to-date on advances in multicultural research, theory, and practice guidelines relevant to their work (Salter & Salter, 2012). This may include an understanding of the following:
· The history of ethical abuses of cultural minorities in the United States, and how this may exacerbate disparities in mental health care, employment, criminal justice, and involvement in psychological research
· The impact on mental health of historical and contemporary discrimination in employment, education, housing, and other areas
· Cultural and contextual factors that may facilitate or interfere with psychological well-being or responsiveness to treatment
· Scientific, social, and political factors influencing the definitions of race, ethnicity, and culture, and how these may serve as barriers to conducting psychological activities that protect individuals’ rights and welfare
· Within-group as well as between-group differences that may be obscured by cultural stereotypes in society and within the discipline of psychology
· Knowledge and skills in constructing and implementing culturally valid and language-appropriate assessments, treatments, research procedures, teaching strategies, and consulting and organizational evaluation techniques
· Knowledge of relevant ethical standards in the APA Ethics Code and organizational guidelines relevant to multicultural ethical competence in research and practice
· Knowledge of antidiscrimination federal and state laws relevant to the contexts in which psychologists work
Goodness-of-Fit Ethics and Multicultural Ethical Decision Making
Multicultural ethical commitment and ethical awareness are essential but not sufficient to ensure ethical resolution of multicultural challenges. Given the dynamic nature of individual, institutional, and sociopolitical concepts of race, culture, and ethnicity, ethical decision making across different cultural contexts can be informed but may not be resolved by previous approaches to ethical problems. Many multicultural ethical challenges are unique to the culture, the salience of the culture for a particular individual in a particular context, other within-culture individual differences, the environment in which the psychological activity occurs, and the goals of that activity (Nicolaidis et al., 2010). In applying the steps for ethical decision making described in Chapter 3, multicultural ethical competence includes (a) creating a goodness of fit between the cultural context and the psychologist’s work setting and goals and (b) engaging in a process of co-learning that ensures this fit (Fisher, 1999, 2002a, in press; Fisher & Goodman, 2009; Fisher & Masty, 2006; Fisher & Ragsdale, 2006; Fisher et al., 2012; Trimble, Trickett, Fisher, & Goodyear, 2012).
Applying goodness-of-fit ethics to multicultural contexts requires reflection on the following questions:
· What are the cultural circumstances that might render individuals more susceptible to the benefits or risks of the intended psychological assessment, treatment, or research?
· Are cultural factors under- or overestimated in the assessment, treatment, organizational evaluation, or research plan?
· Do psychologists and members of cultural groups with whom they work have different conceptions of practice goals or research benefits?
· Are traditional approaches to informed consent and confidentiality protections compatible with the values of spirit, collectivity, and harmony characteristic of different ethnocultural populations?
· Are there aspects of the psychological work setting that are “misfitted” to the competencies, values, fears, and hopes of recipients of psychological services, examinees, employees, or research participants?
· How can the setting (including the aims and procedures to accomplish these aims) be modified to fit the requirements of culturally sensitive and responsibly conducted psychology?
· How can psychologists engage organizations and employees, clients/patients and practitioners, students and school personnel, research participants, and investigators in discussions that will help illuminate the cultural lens through which each views the psychologist’s work?
Culture is a dynamic construct influenced by an ever-changing sociopolitical landscape. Ethical decision making that includes multicultural commitment and awareness can help psychologists correct cultural misimpressions and biases in their work. An openness to learning from and collaborating with stakeholders can help psychologists implement and monitor the cultural adequacy of ethical decisions and make appropriate adjustments when necessary. Multicultural ethical competence requires a process of lifelong learning that enables psychologists to make ethical decisions that reflect and respect the values of the discipline of psychology and the values of cultural communities.