Transcript Ethical Dilemmas and Diversity issues in Supervision

Ethical Dilemmas and
Diversity issues in
Supervision
Sue C. Jacobs, Ph.D., N.D. Licensed Psychologist
Fellow, American Psychological Association
Ledbetter Lemon Diversity Professor in Counseling Psychology
Oklahoma State University College of Education
March 6, 2015: Laureate Psychiatric Clinic and Hospital
Northeastern Oklahoma Psychology Internship Program
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Review APA aspirational ethical principles and
specific codes applicable to supervision and
training
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Professional ethics in the context of increasing
cultural diversity and globalization
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Cultural competency: How can supervisors
respond to ‘‘elephants” of conflicting world views,
cultural values and expectations that appear in
the supervision room between supervisors,
supervisees, and clients (and their families and
communities and other professions)?
OVERVIEW

Examples of ethical challenges related to
diversity in supervision

Example(s) of how ethical “rules” can
become barriers in supervision (and practice)
if separated from ethical ideals (aspirational
principles)

An adapted “Acculturation Model” for ethical
supervision and decision making
OVERVIEW
REVIEW
Ethical Ideals and Ethical Rules
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Beneficence and
Nonmaleficence
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Fidelity and
Responsibility
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Integrity
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Justice
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Respect for People's
Rights and Dignity
APA Ethical
principles of
psychologists and
code of conduct
General Principles, as opposed
to Ethical Standards, are
aspirational in nature. Their
intent is to guide and inspire
psychologists toward the very
highest ethical ideals of the
profession.
They do not represent
obligations and should not form
the basis for imposing
sanctions.
7.06 Assessing Student and Supervisee Performance
(a) In academic and supervisory relationships, psychologists
establish a timely and specific process for providing feedback to
students and supervisees. Information regarding the process is
provided to the student at the beginning of supervision.
 (b) Psychologists evaluate students and supervisees on the basis
of their actual performance on relevant and established program
requirements.
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7.07 Sexual Relationships with Students and Supervisees
Psychologists do not engage in sexual relationships with students
or supervisees who are in their department, agency, or training
center or over whom psychologists have or are likely to have
evaluative authority. (See also Standard 3.05, Multiple
Relationships.)

And all the other standards related to education and
training, clinical work, assessment, etc.
Standards or “rules” specific to
supervision
Professional ethics in the context
of increasing cultural diversity and
globalization: Some examples
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Increasingly diverse and aging population
in U S
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Increasing globalization and
internationalization of our clients,
trainees/supervisees, psychologists, and
the communities in which we work, live,
and play
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Changing forms of communication: social
media such as twitter, FB…
Important trends: Cultures and
Contexts are ever Changing
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Universal Declaration of Ethical Principles for
Psychologists (2008).
Focuses on ethical framework with a common
set of ethical principals (ideals) and related
values that could globally guide action
Primarily aspirational, leaving specific
behavioral rules (codes) and ways of
enforcement up to each region or county.
Key Developments impacting
Ethical Supervision, Training, and
Practice
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Competencies movement and competency
benchmarks identified for ethics education
an training
Continues to include knowledge of rules, and
laws, including case law
More emphasis on ethical ideals (principles)
Increased attention to skills in ethical
decision making when conflicts among or
between rules and ideals, including those
related to cultural diversity and competence.
Advances in Ethical Training
and Ethics of Supervision
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United Nations (2008). United Nations Declaration
on the rights of indigenous peoples.
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Many of our methods have not been tested with
people from non-Western cultural and philosophical
traditions, may be unacceptable, and ineffective.
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Indigenization of psychology means modifying
Western guidelines (including ethical rules or codes)
to be more culturally relevant and avoid harm.
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Example: Society of Indian Psychologists recent
Commentary on the American Psychology
Association (APA) Ethical Principles of Psychologists
and Code of Conduct
Growing Attention to Indigenous
Psychology
Now focus on knowledge, skills,
attitudes/awareness for multicultural
competence
 To develop a working alliance that will
serve the needs of the client and the
supervision process, we now explore
cultural identity and development and
intersecting identities and worldviews
(including spirituality and religion)
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Perspective on cultural diversity
and cultural competence has
broadened
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Many, if not most, supervisors were trained
before recent developments in globalization
and changes in views of cultural competence
and focus on virtue ethics and principles
rather than simply rules.
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To be an ethical and culturally competent
supervisor (and psychologist) today requires
a lifelong attitude and openness to self
evaluations, what Falendar et al. (2004) label
“cultural humility.”
Being a clinical supervisor
requires lifelong learning
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Because of the power difference between
supervisee and supervisor, many supervisees
do not disclose the elephant in the room,
differences in values, beliefs, expectations.
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Pettifor, et al. (2014) cite research that
indicate that when diversity issues arise in
supervision at all, supervisees perceive that
they raised the issues, not the supervisor,
though the supervisors believe they raised it.
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Other research has found that supervisees
raising diversity topics can create a strain or
rupture in the supervisory relationship
The “elephant” in the room

How can supervisors respond to
‘‘elephants” of conflicting world views,
cultural values and expectations that
appear in the supervision room between
supervisors, supervisees, and clients (and
their families and communities and other
professions)?
Cultural competency in ethical
clinical supervision
Unilateral
imposition of
expectations/rules
Seen as valid for
all cultures
Considers
“ideals”/ethical
principles responding
to cultural
differences
Views of ethical and cultural competent
supervision are in a continuum, are
fluid, and developing
Examples of Ethical Challenges
Related to Diversity and Globalization
in Supervision
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A 25-YEAR OLD MALE GRADUATE STUDENT WHO
IMMIGRATED TO U S WITH HIS FAMILY WHEN HE
WAS 5 YEARS OLD IS IN A PLACEMENT IN A
CHILDREN’S MENTAL HEALTH CENTER. HE MEETS
WITH A 6-YEAR-OLD CHILD FOR THE FIRST TIME,
ALONG WITH THE CHILD’S PARENTS. THE FAMILY
MEMBERS RECENT IMMIGRANTS FROM A NONWESTERN COUNTRY…
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Supervisor attends to infraction of codes or “rules”,
but appears to lose sight of the “ideals or aspirational
principles from which the codes were drawn
VIGNETTE 1
from Pettifor, et al. (2014)
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A FEMALE GRADUATE STUDENT, WHO IMMIGRATED TO THE
U S FROM A NON-WESTERN COUNTRY AT THE AGE OF 9 WAS
IN AN ADVANCED PRACTICUM PLACEMENT IN A
GERONTOLOGY UNIT IN THE U S FOR INDIVIDUALS WHO
HAD SUFFERED NEOROLOGICAL INJURY. HER MALE
SUPERVISOR, WHO ALSO IMMIGRATED TO THE U S AS A
YOUNG CHILD BUT FROM A DIFFERENT NON-WESTERN
COUNTRY, WAS HAVING THE STUDENT “SHADOW” HIM
DURING THE FIRST MONTH OF HER PLACEMENT. IN THE 2ND
WEEK SHE OBSERVED THE SUPERVISOR ADMINISTOR AN
INVENTORY FOR DISABILITY FOR AN 80-YEAR OLD WOMAN
WHO HAD SUSTAINED A HEAD IMJURY WHEN HIT BY A
MUNICIPAL TRUCK…
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Example(s) of how ethical “rules” can become barriers in
supervision (and practice) if separated from ethical ideals
(aspirational principles)
VIGNETTE 2
from Pettifor, et al. (2014)
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A CLIENT IS A UNIVERSITY STUDENT WHO IS MARIED TO
AN INTERNATIONAL STUDENT FROM A NON-WESTERN
COUNTRY THAT IS HER PARENTS’ COUNTRY OF ORIGIN. THE
CLIENT AND HER SPOUSEHABE 3 CHILDREN UNDER THE AGE
OF 3 WHO ARE CARED FOR BY HER MOTHER-IN-LAW, WHO
RESIDES WITH THEM. THE PRESENTING PROBLEM IS THE
CLIENT’S DEPRESSION. HER MOTHER-IN-LAWAND HER
HUSBAND ARE DISAPPROVING OF HER DESIRE TO PURSIDE
GRADUATE EDUCATION AND SHE FEELS THEY DO WHATEVER
THEY CAN TO UNDERMINE HER. THE THERAPIST IS A
GRADUATE STUDENT WHO STRONGLY BELIEVES IN
INDIVIDUAL AUTONOMY AND THE “RIGHT” OF THE MOM…
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Example of both supervisor and supervisee caught up in
their own strong belief systems and, lacking respectful
supervisory relationship, lose sight of the client and the
client’s cultural context.
VIGNETTE 3
from Pettifor, et al. (2014)
An adapted “Acculturation Model” for
ethical supervision and decision
making
IDENTIFICATION WITH PSYCHOLOGY ETHICS
PERSONAL ETHICS OF ORIGIN
marginalization
separation
Assimilation
integration
From Handelsman, Gottlieb, and Knapp (2005)
based on Berry’s model of acculturation applied to
ethical identity
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Move away from thinking of situations as
Ethical vs Unethical: No faster way to
disrupt a working supervisory relationship
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Consider supervisor-supervisee
relationship as collaborative and refer to
acculturation model in discussing where
supervisee and supervisor is on a
particular issue. Consider the cultural
context also of the client.
Suggested decision making model
for ethical supervision
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Therapist’s decision making includes:
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decision making
Clinical decision-making
Risk management
Legal
Ethical decision-making
 Professional ethics
 Personal ethics, values, or morality
 Consideration of world-view, etc. of Client
 Supervisor’s decision making includes:
All of the above plus supervisee’s personal ethic and
cultural world view and level of clinical, ethical, and
cultural development
Supervisory decisions not only ethical.
Adapted from Gavozzi webpage
Practice with Vignettes
 Use Acculturation decision making model to look
at supervisor and supervisee identity in context
of case/ethical dilemma
 Differentiate ethical decision from of decisions
 Move towards the “Ideal” end of the continuum
remembering that “rules” are important also and
must be considered/interpreted in terms of the
aspirational principles and Cultural contexts of
client and supervisee
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Moving towards Culturally
Competent Ethical Supervision
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You are a White, 42-year-old U.S. born open lesbian who
is supervising a bi-racial (White and second generation
South Asian) trans F-to-M advanced practicum student
beginning his second rotation in a university counseling
center His client is a 21 year old Latino who tells the intern
he is sure he is a woman in a man’s body and wants to
become a woman, but does not want to disappoint her
family or have them reject her. The intern tells you he
wants to tell the client that he is trans to help his
relationship and trust with the client, that his research on
counseling trans* suggests that is effective. What is the
dilemma? What “rules” and “aspirations” are involved. Try
to apply the adapted acculturation supervisor ethical and
culturally competent decision making model.
Vignette A
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You are a 60 year-old, White male Baptist psychologist in a
Medical School outpatient setting with adult patients with
diabetes. Your psychology intern is a brilliant 30-year old
Lakota woman, whose doctoral training was in Utah,
where she had some counseling practice with members of
other tribes. Her client is a 50 year-old man from the
Pawnee tribe who has been diagnosed with depression and
complications from his diabetes. The client told her that he
doesn’t trust the Western medicine and only comes to so
his daughter doesn’t kick him out, that he doesn’t like the
therapy. He likes the old healing ways. Your intern wants to
stop using CBT and hear about his healing traditions, tell
him the traditions from her tribe, and perhaps go with him
to a healing sweat or other ceremony if his tradition allows
men and women to seat together. Again, what is ethical
dilemma, “rules”, “ideals. Discuss using the adapted
acculturation ethical decision process.
Vignette B
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If Time:
Questions
 Concerns
 Discussion
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REFERENCES and RESOURCES
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American Psychological Association (2010). Ethical principles of
psychologists and code of conduct (2002, Amended June 1,
2010).Retrieved from http://www.apa.org/ethics/code/index.aspx
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Falendar, C. A., Shafranske, E. P., & Falicov, C. P. (Eds.) (2014).
Diversity and multiculturalism in clinical supervision: Foundation and
praxis. Washington, DC: American Psychological Association.
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Garvozzi web page: http://www.ethicalpsychology.com/p/ethics-andpsychology-podcasts.html
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Gauthier, J., & Pettifor, J. L. (2012). The tale of two universal
declarations: Ethics and human rights. In M. M. Leach, M. J. Stevens,
G. Lindsay, A. Ferraro, & Y. Korkutr (Eds), The Oxford handbook of
international psychological ethics (pp. 113-133) New York, NY: Oxford
University. Doi 10.1093/oxfordhb/9780199739165.013.0009
REFERENCES
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Handelsman, M. M., Gottlieb, M. C., & Knapp, S. (2005).
Training ethical psychologists: An acculturation model.
Professional Psychology: Research and Practice, 36(1),
59-65. doi:10.1037/0735-7028.36.1.59
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Pettifor, J., Sinclair, C., & Falender, C. A. (2014). Ethical supervision:
Harmonizing rules and ideals in a globalizing world. Training and
Education in Professional Psychology, 8 (4), 201-210.
http://dx.doi.org/10.1037/tep0000046
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Society of Indian Psychologists recent Commentary on the American
Psychology Association (APA) Ethical Principles of Psychologists and Code
of Conduct. Available for purchase at http://www.aiansip.org/
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United Nations (2008). United Nations Declaration on the rights of
indigenous peoples. New York, NY: United Nations. Retrieved from
http://www.un.org/esa/socdev/unpfii/documents/DRIPS_en.pdf
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Universal Declaration of Ethical Principles for Psychologists (2008).
Retrieved from http://www.iupsys.org/ethics/univdec12008.html
REFERENCES & RESOURCES
Thank You!
Sue C. Jacobs, PhD
Professor, School of Applied Health and Educational Psychology
Myron Ledbetter and Bob Lemon Counseling Psychology
Diversity Professor
Director, OSU Preparing Future Faculty in Psychology Program
Co-Director, Oklahoma Network for the Teaching of Psychology
Team Leader, OSU Difficult Dialogue Program
American Psychological Association Fellow, Division 17
425 Willard Oklahoma State University
Stillwater, OK 74078-4024
Phone: 405-744-9895
Fax 405-744-6756 Email: [email protected]
MY CONTACT INFORMATION