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02/25/2004: "Translating Knowledge Into Action"
How can we help more psychologists act ethically?
We've seen how most psychologists are aware of the Ethics Code and the law. We've also seen how even the Masters of Ethics - the luminaries in the field who've written the definitive texts on the Code or even the Code itself - have had trouble adhering to it, at least in some situations. I have no doubt that you all, as bright, enthusiastic, and well-intentioned doctoral students, knew 80-90% of the factual of the information in this course before you stepped foot in the class.
So how do we get from here to there?
Because we know that knowledge and education are not really the problem, I think we first have to re-evaluate how we select our doctoral students. Most programs choose their students through reviewing an application, letters of recommendation, and a personal interview. In terms of job selection, we know that applications and interviews have the lowest validity coefficients in predicting job success. How much can you really learn about a person from
1. perusing an application created by that person
2. letters written on that person's behalf by people selected by the applicant, who probably don't want to rock the boat, and who may fear being sued for documenting anything negative
3. spending an hour with that person?
Some of you may be familiar with the drama that my wife and I have been going through trying to adopt a child . The state and the adoption agency has a vested interest in protecting the welfare of a vulnerable individual - in this case, the child - so we had to go through multiple procedures just to get approval to adopt. We had to:
1. complete an application and 15 page questionnaire about our marriage, attitudes about adoption, and parenting skills
2. meet with a social worker for a personal interview
3. attend multiple educational classes
4. have a home visit to ensure our house is safe and that our application responses are true
5. undergo a physical examination by our family doctor
6. pass a criminal background check
7. get a child abuse clearance
8. get fingerprinted and get clearance from the FBI
9. probably more that I'm forgetting
All of this, just to protect the interests of one person, albeit a vulnerable one due to his or her age. Our clients are vulnerable, emotionally, and most of us have many of them. Don't they deserve the same respect and due diligence to their interests?
Perhaps we should add a background check and psychological testing to the admissions procedures for graduate school in clinical psychology. If our tests are good enough to use with our clients, they should be good enough as a tool to help police ourselves. Clearly, a negative finding shouldn't necessarily exclude someone from becoming a clinical psychologist, but maybe that person needs more intensive scutiny, additional coursework, or prescribed psychotherapy in addition to the normal classwork and practica. There is something to be said for choosing people of good moral character (though not perfect people) for a noble profession that works with a vulnerable segment of the public.
Second, we need better role models for graduate students. When I was in gradute school, I was appalled at some of the behavior that I observed by some professors, and this was on a regular basis. Part of teaching should be leading by example. If we do a better job of selecting graduate students, as outlined above, perhaps this problem will take care of itself - eventually. But if we believe in vicarious learning and the power of modeling (Bandura's stuff), we need to hold professors to the same standards as students.
Finally, I think we need to have mandated peer-supervision as a requirement to maintain one's license. As it stands now, to practice in Pennsylvania you need to:
1. get permission to take the licensing exam by graduating from an acceptable school and do your post-doctoral hours
2. pass the national and state exams
3. get 30 hours of continuing education credit every two years, including 3 hours in ethics
4. pay the fee
That's it. The three hours of ethics is a step in the right direction, certainly. But I think we need to look out for each other, and more importantly, realize we need to be looked out for. Isolation and hubris are two dangerous ingredients in the recipe for a serious ethical violation. Mandatory monthly or bi-monthly peer supervision would ensure that we all take the time to discuss difficult situations with our peers, demonstrating that we took "reasonable" steps and were trying to maintain the general standard of care for our profession. It also allows us to spot problems in our peers - either their blindspots or problems they are having which they may be unaware of - that are impacting their work. And with the Internet, even a clinician who is geographically isolated from other professionals can become part of a peer-support network through online technologies.
If you've taken my Group Psychotherapy course, you may remember reading that Yalom has a monthly peer-supervision meeting with his colleagues. If it's good enough for him, shouldn't it be good enough for us?
Those are a few of my ideas about this problem. I am sure there are plenty of other excellent suggestions that would help alleviate this problem with being unduly burdensome on the clinician.
