Course excerpt from Ethical Decision Making for Psychologists: A Practical Model

From time to time, psychologists are confronted with ethical dilemmas that are difficult to resolve. How do you know when an ethical issue arises that requires action on your part? What do you think are some of the characteristics of ethical dilemmas as they apply to psychotherapy? It does not take very long to answer these questions.

Recognizing Ethical Dilemmas

Kidder (1995) suggests that ethical dilemmas oftentimes involve right versus wrong choices or “moral temptations.” This certainly applies to a variety of situations including becoming involved in sexual relationships with clients, falsifying data, failing to be up front with clients about policies or procedures pertaining to the psychotherapy process, and using therapeutic techniques without having been trained in the use of those techniques. Most psychologists have either dealt with or thought about situations that make them question what the right thing to do is.

Denise and Andrew were certainly confronted with ethical dilemmas in slightly different ways. You can probably place yourself in their shoes and understand how they must have felt in their respective situations especially being new to the field: confused, surprised, and perhaps overwhelmed. In fact, recognizing ethical dilemmas oftentimes starts with a feeling, specifically, an awareness that you are feeling uncomfortable or uneasy.

Indeed, it is not uncommon for one’s unconscious self to pick up on and react to elements of a situation that one’s conscious self may overlook or fail to react to as quickly. This is not unlike the action of antivirus software, continually monitoring activities that are going on in the background of our computers while we are surfing the net. Although there may be times you are cognizant of the dilemma that aroused these feelings, other times you may realize that something is not right about a situation, but not necessarily be able to put your finger on it until you give it more thought. But it is the realization that “something’s not right” and the associated feeling that is your initial clue that you are dealing with an ethical dilemma.

It is important for you to be tuned in to the feelings that are kindled by ethical dilemmas and to use your feelings as data in the ethical decision-making process. Indeed, Remley and Herlihy (2007) point out that, “Virtue ethicists believe that emotion informs judgment.” They likewise provide the following advice: “Consider what emotions you are experiencing as you contemplate the situation and your possible actions…Your emotions can help guide you in your decision making” (pg. 13).

Think back to when you were a child. Did you parents ever tell you that everyone has a little voice inside that helps us distinguish right from wrong? Some people refer to this as a conscience. The same principle applies to recognizing ethical dilemmas. You might have a gut-level feeling that a situation is somehow problematic and demands action on your part. Although you may not know what you are supposed to do at that moment, you realize that “something’s wrong,” and that feeling does not go away. The emotional uneasiness produced by the dilemma yearns for a response from you to, in essence, put it out of its misery. Knapp and VandeCreek (2006) note that, “…for many psychologists the first indication of a problem comes from their own ‘gut’ reactions or the reactions of a patient. That is, a strain in interpersonal relationships or a feeling of emotional uneasiness is often the first indication of an ethical problem” (pg. 43).

Recognizing ethical dilemmas not only becomes easier with supervision and experience, but if the foundation of your professional identity is the six moral principles, then you will understand intuitively when an issue arises that demands sound reasoning and judgment. There is not one particular moral principle that will help you recognize an ethical dilemma. Psychologists continuously filter experiences through their moral principle net, and when issues get caught in the net they experience a twinge of discomfort that spurs the reasoning and resolution process.

Hare (1991) argues that moral reasoning starts with intuition: “…the intuitive level, with its prima facie duties and principles, is the main locus of everyday moral decisions” (p. 35). Cottone and Tarvydas (2007) likewise note that “The intuitive level of analysis always constitutes the first platform of decision making, even when the situation requires the more detailed level of analysis involved in the critical-evaluative level of consideration” (p. 91). The important point is that intuition is simply a starting point. Psychologists are trained to be self-aware so that they are sensitive to issues that should be addressed with clients. When considered in terms of a scientific process, intuition serves to generate hypotheses that can be confirmed or disconfirmed as psychologists interact with clients throughout the course of the psychotherapy process and discuss ethical concerns with colleagues.

Let’s take into consideration how this might work in the real world. Two psychologists have psychotherapy clients who both suffer from depression. Psychologist A, who is fresh out of graduate school, is concerned that his client is becoming too dependent on him given that the client calls him at home at all hours of the night and will do whatever he tells him to do. Psychologist B, who has been in the field for several years, is also dealing with a depressed client with dependency issues, but has taken a different approach. Psychologist B has placed limits on the number of calls she is willing to receive from the client and has requested that the client not call her at home.

How do the moral principles play a part in the reasoning processes of both psychologists? Psychologist A recognizes that something is wrong, but his moral principle net is “too loose” to catch the problem. Psychologist B understands that allowing the client to call her at home as often as he would like only fosters dependency and is not in the client’s best interests (the moral principle of beneficence or “helpfulness”). Although the client does not like the fact that Psychologist B has placed limits on him, he reluctantly agrees to abide by the rules. Psychologist B felt uncomfortable the first time the client attempted to maneuver into a dependency role and that feeling sparked a response that prevented her from enabling this behavior. But it was only because the discomfort was interpreted in relation to the moral principle of beneficence that Psychologist B understood why it was necessary to set limits.

Learn more:

Ethical Decision Making for Psychologists: A Practical Model is a 3-hour online continuing education (CE) course that provides psychologists with an intuitive method of resolving ethical dilemmas that is grounded in best practices as outlined in the professional literature as well as the APA Code of Ethics. Topics include the differences between ethics and the law, identifying moral principles which underlie the ethical practice of psychotherapy, and how to apply a practical approach to ethical decision-making. The course is written in a conversational style and includes mnemonics to assist in learning the material and drawing upon this knowledge as necessary when ethical dilemmas arise throughout one’s career. Closeout Course #30-41 | 2009 | 32 pages | 24 posttest questions

Professional Development Resources is approved by the American Psychological Association (APA) to sponsor continuing education for psychologists. Professional Development Resources maintains responsibility for this program and its content. Professional Development Resources is also approved by the Florida Board of Psychology and the Office of School Psychology (CE Broker Provider #50-1635).