In Episode 5, John continues to outline relevant factors related to ethical decision-making. The psychologist's fiduciary responsibility is emphasized. Additionally, John outlines one ethical decision-making model as well as cognitive biases and emotional factors involved with ethical decision-making. John will make suggestions on how to improve ethical decision-making.

1. By John Gavazzi, PsyD ABPP

2.  Describe one decision-making model
 Identify one cognitive bias and one emotional
factor that can adversely affect ethical
decision-making
 Outline three strategies to aid with ethical
decision-making

3.  We reviewed that ethical decision-making can
be complex

4. Rational Psychologist: Know the Code!!
Psychologist Patient
Learn the rules
Apply the rules
Outcomes will follow

5. PatientPsychologist
Learn the rules
Apply the rules
Outcomes will follow
Understand patient
dynamics
Understand the
relationship
Know the Code + Know your patient

6.  Distinguish ethical decision-making from
clinical decisions, risk management, and legal
questions (even though there is overlap)

7.  We reviewed the Acculturation Model both as
ways to acculturate to psychology as well as
how ethical decisions are made

8. Acculturation Model of
ethical development
Integration Separation
Assimilation Marginalization
Higher on
Professional Ethics
Higher on Personal
Ethics
Lower on Personal
Ethics
Lower on
Professional Ethics

9.  We reviewed the five foundational principles
on which the APA ethics code is founded
 We touched on the idea that the APA ethics
code does not have an ethical decision-
making strategy
 Ethical dilemmas are usually a function of two
competing foundational principles

10. Autonomy
Beneficence
Nonmaleficence
Fidelity
Justice

11.  Psychologist is the expert and has greater
power in the relationship
 Patient is vulnerable
 Psychologist is ultimately responsible for
what happens in treatment

12. Often ethical dilemmas involve apparent
conflicts between respect for patient
autonomy versus beneficence

13.  Identify the competing ethical principles
 Help to determine which principle has
precedence and why
 The importance of emotion in ethical
decision-making and moral judgments
 Cognitive biases are also important to
consider

15. The APA Ethical Principles and Code of
Conduct do not include a model of
ethical decision-making
Other resources may aid with decision-
making, but do not highlight how to work
through dilemmas

16. S Scrutinize
H Hypothesize
A Analyze
P Perform
E Evaluate

17. 1. Goal is to define the problem by identifying
the conflicting ethical principles
2. Generate a wide range of possible solutions
and identify pros and cons
3. Merge or knit the possible solutions
together in a way that maximizes the
benefits and limits the disadvantages
4. Implement
5. Look back or evaluate

18. “integrative framework”
steps two and three generate solutions that
maximize your personal values within the
context of your professional role

19. Avoid dichotomous thinking– either I have to
do x or y.
Duty to Warn example: either I have to warn
the potential victim of a threat or I have to
protect confidentiality.

20. 1. We have to train ourselves to think about
larger ethical principles first
2. We need to have the ability to slow
ourselves down prior to making good,
ethical decisions
Why?

21.  Malcolm Gladwell’s book “Blink”
 Jonathan Haidt’s book on Moral Intuition
 David Pizarro’s work on motivated moral
reasoning

22.  Top down approach
 Start with ethical principles
 Work from those principles to make good
decisions about our work

23.  Intuitive
 Automatic
 Emotional
 Rapid

24. Why do psychologists (still and continue to) have
sex with their patients?

25. Negative emotions related to
ethical and moral decision-making
Positive emotions related to our
good decision-making skills and
ethical knowledge
 Fear
 Anxiety
 Disgust
 Disrespect
 Passion
 Calmness/Centered
 Empathy
 Respect/Sympathy
 Elevation

26.  The Fundamental Attribution Error
 Actor Observer Bias
 Availability Heuristic
 Trait Negativity Bias
 Confirmation Bias
 Competence Bias

27.  This cognitive style places an undue
emphasis on the patient’s behavior in the
therapeutic relationship
 Overemphasis on the patient
 Psychologist may lack insight into what s/he
is doing to promote those responses

28.  This cognitive style places an undue
emphasis on external factors for the
psychologist’s behavior
 In an attempt to avoid responsibility, the
psychologist can overemphasize the patient’s
role in the ethical dilemma.

29.  This cognitive error leads one to use
information that readily comes to mind or
easiest to access
 Easiest to go with that which is most
representative of the patient or scenario

30.  When the psychologist more readily recalls
unpleasant characteristics of the patient as
compared with positive characteristics of the
patient
 It is common for psychologists to work with
individuals they do not like or enjoy

31.  The cognitive style in which psychologists
look for evidence to confirm their beliefs
about the patient or the situation.
 Motivated moral reasoning

32.  Dunning-Kruger Effect: a cognitive bias in
which unskilled individuals suffer from
illusory superiority, mistakenly rating their
ability as much higher than average.
 Poor performers fail to learn from their
mistakes.
 And, they fail to internalize direct feedback
from others.

33.  Length of time in treatment
 Patient complexity
 Emotional intensity/therapeutic relationship
 Current focus (or lack thereof) in treatment

34. A Brief Review

35.  Knowledge base: APA code, foundational
principles, state law, regulation, case law
 Become aware of emotional factors
 Remain aware of cognitive biases/situational
factors
 Patient/relationship factors
 Outcomes are uncertain – Ambiguity remains

36. Emotions
Decision-
making
Skills
Cognitive
Biases
External
Rules
Personal
Ethics
Psychologist
Complexity
Length of
time in
treatment
Current
focus in
treatment
Boundaries
Patient
Variables
Therapeutic Alliance

37. Why study ethics and ethical decision-
making as a part of clinical practice?

38.  Fiduciary Responsibility
 Providing the highest quality of care possible
 Reinforcing doing the best possible for your
patient
 Better treatment outcomes

39. Independent Actions Help from others
 Self Reflection
 Documentation
 Transparency
 Continuing Education
 Self-care
 Consultation
 Supervision
 Psychotherapy
 Continuing Education

40.  Good general basis to contemplate and
discuss ethical issues in psychological
practice
 Look at vignettes as training tools
 Remain aware of ethical issues in your
practice and work on skill building

41.  Future podcasts will look at ethical-decision
making, clinical issues, and risk management
with vignettes on the Ethics and Psychology
website
 I will have guests to help review clinical
vignette using the Acculturation Model, the
foundational principles, personal biases
(personal ethics and morality) and give
possible options to resolve the dilemma