Competence as our Cornerstone:
Ethics in Psychology Training
Association of Psychology Postdoctoral and Internship
Centers
APPIC 2014 Conference
Austin, Texas
Saturday, May 3, 2014
Stephen Behnke, JD, PhD, MDiv
APA Ethics Office
The 2015 APA Student Ethics Writing Prize!
•Roundtrip to APA Convention, with three nights stay
•Student presents winning paper at Convention
•Paper is published in Ethics and Behavior
•$1000
2015 Ethics Educator Award!
•Presented at Convention
•A very nice plaque with your name
•Photograph suitable for framing
www.apa.org/ethics
Competence
The Cornerstone of Ethics:
A View from the APA
Ethics Office
What Does It Mean to be an Ethical
Gatekeeper?
Gatekeeping involves:
1) A passage between
2) Two or more places with the
3) Authority to allow passage, or not, and the
4) Responsibility for that decision.
Gatekeeping involves considering and
balancing multiple ethical responsibilities:
To the public
To the trainee
To the profession
To your program
To the other trainees in the cohort
Would you refer a close friend or family member to this
individual?
Principle A
Beneficence and Nonmaleficence
Psychologists strive to benefit those
with whom they work and take care to
do no harm.
A competent psychologist will have the
capacity to do good and to avoid harm.
Comments that come to the
APA Ethics Office from
trainees
1. My program treated me unethically.
2. My private information was shared with
others in the program.
3. My supervisor makes me feel
uncomfortable.
4. One of the other interns is impaired.
5. What I’m being asked to do violates my
religious beliefs.
What can viewing these five
comments through the lens
of competence tell us about
how to approach ethical
dilemmas in psychology
training?
An Historical Note about the
Law of Competence:
Move from generalized/global
competence
to
competencies
The move from
generalized/global competence
to competencies
Profound implications for
psychology training
Competency Initiatives in
Professional Psychology
Education Directorate
APA Website
www.apa.org/ed/graduate/competency.html
Competence as the cornerstone of ethics
APA Commission on Accreditation
Guidelines and Principles for Accreditation of
Programs in Professional Psychology
Domain B: Program Philosophy, Objectives, and
Curriculum Plan
Revised Competency Benchmarks for Professional
Psychology
•Knowledge of ethical/legal/professional standards and
guidelines
•Awareness and application of ethical decision making
•Ethical conduct across a developmental spectrum
Competence across Five Domains
1. Clinical/training
2. Legal
3. Ethical
4. Institutional policy
5. Risk management
Issue 1:
My program treated me unethically.
APA Ethical Standard 2.01
Boundaries of Competence
(a) Psychologists provide services,
teach and conduct research with
populations and in areas only
within the boundaries of their
competence...
Consider responding to difficult
trainee situations
as a unique competence
Who in your training program has this
competence?
APA Ethics Code
Preamble
The development of a dynamic set of ethical
standards for psychologists' work-related
conduct requires a personal commitment and
lifelong effort to act ethically…and to consult
with others concerning ethical problems.
(emphasis added)
Strong convergence between principles
in law, ethics, and psychology training
A good working relationship with your
program’s attorney should help prevent
situations from becoming adversarial
Orientation of APA General Counsel:
How can we help you achieve your goals?
Attorney as Consultant
Notice and Process
Central to both law and ethics
Combining proactive/prophylactic
and reactive approaches in a
competent, comprehensive
manner
APA Ethical Standard 7.02
Descriptions of Education and Training
Programs
Psychologists responsible for education
and training programs take reasonable
steps to ensure that there is a current and
accurate description of the program
content…
APA Commission on Accreditation
Guidelines and Principles for Accreditation of
Programs in Professional Psychology (2013)
Domain E: Student-Faculty Relations
4. At the time of admission, the program provides the
students with written policies and procedures
regarding program and institution requirements and
expectations regarding students’ performance...
A Practical Guidebook for the Competency
Benchmarks
Orienting trainees to benchmarks and methods of
evaluation. Trainees should be oriented to the
program’s competencies, means of evaluation,
and competency expectations at the start of
their training, and at relevant transitions (e.g.,
before starting practicum)...
APA Ethical Standard 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...
• Make clear to trainees in writing
what is expected
• Make clear to trainees what
policies apply if they fall short of
what is expected of them
• You be clear what policies apply if
trainees fall short of what is
expected of them
The Law of No Surprises
• What is expected of trainees?
• What happens if a trainee falls short of
expectations?
• Whether a particular trainee is meeting
program expectations
• The status of a particular trainee in the
program vis-à-vis a remediation plan
• Be thoroughly familiar with the
process your program has set forth
• Follow your process carefully
• Document that you have followed
your process
• Program faculty speak with one, not
multiple, voices
Critical Role of Assessment
(What psychologists are good at doing!)
McCutcheon, S.R. (2008). Addressing
problems of insufficient competence during
the internship year. Training and Education
in Professional Psychology, 2, 210-214.
Assess at individual and system
levels
Forrest, L., Elman, N., & Miller, D. (2008).
Psychology trainees with competence problems:
From individual to ecological conceptualizations.
Training and Education in Professional
Psychology, 2, 183-192.
Gilfoyle, N. (2008). The legal exosystem: Risk
management in addressing student
competence problems in professional
psychology training. Training and Education
in Professional Psychology, 2, 202-209.
Tie the remediation plan to your assessment
of the problem
A trainee’s remediation plan
follows from
an assessment of the trainee’s deficits
that follows from
the program’s identification of
competencies required for successful
completion
Tie the remediation plan to your assessment
of the problem
A Question:
Which aspect of your trainee’s problem or
challenge will this aspect of your
remediation plan address?
Tie the remediation plan to your
assessment of the problem
Focus on behaviors that need to change
rather than diagnoses
Remediation Plan Template
www.apa.org/ed/graduate/competency.html
Beware of the
Promoveatur ut Amoveatur
Principle
2. My private information was shared
with others in the program.
What is the nature of the
information being shared?
Privacy vs. Confidentiality vs. Privilege
An especially complex relationship in
training programs
APA Ethical Standard 7.04:
Student Disclosure of Personal Information
Psychologists do not require students or supervisees to disclose
personal information in course- or program-related activities,
either orally or in writing, regarding sexual history, history of
abuse and neglect, psychological treatment, and relationships with
parents, peers, and spouses or significant others except if (1) the
program or training facility has clearly identified this requirement
in its admissions and program materials or (2) the information is
necessary to evaluate or obtain assistance for students whose
personal problems could reasonably be judged to be preventing
them from performing their training- or professionally related
activities in a competent manner or posing a threat to the students
or others.
APA Ethical Standard 4.07:
Use of Confidential Information for
Didactic or Other Purposes
Privacy vs. Confidentiality vs. Privilege
What is the rule, guideline, or principle
governing this particular
communication?
3. My supervisor makes me feel
uncomfortable.
Supervisory Competence:
A fairly recent development in
psychology training
A Question:
How “malleable” are the
boundaries in psychology graduate
training programs between
faculty/supervisors and trainees?
A Question of Competence:
When can the malleability of
boundaries be used to the benefit of
trainees?
When does this malleability work to
the detriment of trainees?
Standard 3.05a:
Multiple Relationships
Paragraph 2
A psychologist refrains from entering into a
multiple relationship if the multiple relationship
could reasonably be expected to impair the
psychologist’s objectivity, competence, or
effectiveness in performing his or her functions as
a psychologist, or otherwise risks exploitation or
harm to the person with whom the professional
relationship exists.
44
APA Ethical Standard 3.05:
Multiple Relationships
Multiple multiple relationships exist
within training programs,
rendering an appropriate response
complicated
Conflict of Interest model to
understand multiple
relationships
Self-Other Differentiation
Central to good ethical thinking
Cui bono?
Issue 4
One of the other interns is impaired.
APA Ethical Standard 2.06
Personal Problems and Conflicts
(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.
49
APA Ethical Standard 1.04
Informal Resolution of Ethical Violations
When psychologists believe that there
may have been an ethical violation by
another psychologist, they attempt to
resolve the issue by bringing it to the
attention of that individual...
Responding to Problematic Faculty
Members and Supervisors
“To the extent we become better teachers,
students will become better professionals”
McCutcheon, 2008
Responding/Intervening as a
competence
• Where do psychologists learn this
competence?
• Do psychology training programs
teach this competence?
• Do psychology training programs
model this competence?
Issue 5.
What I’m being asked to do violates my
religious beliefs.
What if a trainee does not wish
to acquire a competence that the
training program believes is
essential to becoming a
psychologist?
Julea Ward
Ward v. Wilbanks (2010)
Ward v. Polite (2012)
Overarching Principles
1. Substance vs. process
2. Deference to educators
Julea Ward
Two options
No-referral policy
The American Counseling Association
Code of Ethics (2005)
A.4.b. Personal Values
Counselors are aware of their own values,
attitudes, beliefs, and behaviors and avoid
imposing values that are inconsistent with
counseling goals. Counselors respect the
diversity of clients, trainees, and research
participants.
The American Counseling Association Code
of Ethics (2005)
C.5. Nondiscrimination
Counselors do not condone or engage in discrimination
based on age, culture, disability, ethnicity, race, religion/
spirituality, gender, gender identity, sexual orientation,
marital status/partnership, language preference,
socioeconomic status, or any basis proscribed by law.
Counselors do not discriminate against clients, students,
employees, supervisees, or research participants in a
manner that has a negative impact on these persons.
The United States Constitution
Amendment I
Congress shall make no law respecting an
establishment of religion, or prohibiting the
free exercise thereof; or abridging the freedom
of speech, or of the press; or the right of the
people peaceably to assemble, and to petition
the Government for a redress of grievances.
How the Courts Analyzed the
Facts
A. The District Court
B. The Appeals Court
The District Court
The program’s policy was “neutral”
and “generally applicable”
The policy did not single out Julea
Ward’s religious beliefs.
e.g., Veterinary school
The District Court
“The dismissal was entirely due to
plaintiff’s refusal to change her
behavior, not her beliefs.”
The Appeals Court
Is the policy being applied in a selective
manner?
The Appeals Court
• School did not have any written no-referral
policy (an “after-the-fact invention”?)
• School and the ACA Ethics Code allow
referrals
• The ACA Ethics Code allows explicitly valuebased referrals
• School had a “yes-referral” policy
The American Counseling Association Code
of Ethics (2005)
A.9.b. Counselor Competence, Choice, and
Referral
Recognizing the personal, moral, and competence
issues related to end-of-life decisions, counselors
may choose to work or not work with terminally ill
clients who wish to explore their end-of-life options.
Counselors provide appropriate referral information
to ensure that clients receive the necessary help.
The Appeals Court
At some point, an exception-ridden
policy takes on the appearance and
reality of a system of individualized
exemptions, the antithesis of a neutral
and generally applicable policy and just
the kind of state action that must run the
gauntlet of strict scrutiny.
The Appeals Court
A reasonable jury could find that the
policy was “Pretextual”
The Formal Review: A “Theological
bout”
Briefly: The take-home points
• A program may establish a policy requiring
students to abide by a professional code of
ethics. How the policy is applied is what caused
the problem in the Ward case.
• Schools may prohibit students from imposing
their values on students.
• Legally relevant question: When do the
exceptions swallow up the rule?
Training and Education in Professional
Psychology
2012, Vol. 6, No. 4, 189-195
Constitutional Claims in the Context of
Mental Health Training: Religion,
Sexual Orientation, and Tensions
Between the First Amendment and
Professional Ethics
“Conscience Clause”
A Misnomer?
What Does It Take to be an Ethical
Gatekeeper?
• Working knowledge of laws and institution’s
policies
• Good clinical skills
• Self-knowledge
• Wisdom
• Courage
• A Close Colleague whom you Trust (if you
don’t have one, begin looking at this meeting).
Thank you, APPIC!
from the APA Ethics Office