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Psychology (9,569)
PSYC31H3 (100)
Chapter 5


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University of Toronto Scarborough
Zachariah Campbell

PSYC31 Chapter 5: Issues in Clinical Neuropsychological Practice • Field of psychology has developed a code of ethical behaviour called Ethical Principles of Psychologists and Code of Conduct ‐ developed by APA in 2002 that strives to reflect both the aspirations and personal aspects of ethical decisions made by members made by members of the psychology profession • All psychologists who are members/students of APA are bound by ethics law • Ethics Code applies to face‐to‐face interactions and those thru email, phone, etc • Some licensing boards adopt the Association of State and Provincial Psychology Boards (ASPPB) Code of conduct as the basis for their standards for professional behaviour. ASPPB is the association of all of the psychology licensing boards in U.S. and Canada • Licensing board or Board of Psychology is a state organization composed of psychologists and public members who determine whether a psychologist is eligible for a license to practice and who enforce the ethics code; it does not have the force of law but can sanction individuals. Their responsibilities vary by state. They're design to protect the public, not to promote welfare of psychologists. They grant license based on proof do education, training, supervision of clinical hours, and passed examination for professional practice in psychology (and written & oral exams in some states) • Licenses are valid for a set number of years and must be renewed. • Psychologist must demonstrate completion of Continuing Education Credits (CEU) which are designed to ensure that psychologist is up‐to date with current research and theory • Members of the boards are appointed by governor or an official. They are volunteers and get very little compensation. At least one member must be from public. • State psychological associations differ from boards of psychology in scope and focus. They promote science, protect psychologists in employment situations, and give advice to members about ethical issues. These associations have ethical committees which have jurisdiction over members, not licenses. Such committees can issue disciplinary notices, remove an individual from the association. Depending on the situation, they may suggest education in a specific instance or refer issue to the board of psychology • Idea for an ethical code began with Hippocrates and led to Hippocratic Oath which doctors must abide by • An ethical code is not synonymous with law. We should abide by the ethical code if it's a higher standard of conduct. In fact, at times they may conflict with one another. If there's a conflict between them, the psychologist must inform all concerned about his commitment to the code. • Recently term positive ethics was used to promote patient welfare, as opposed avoiding disciplinary actions Ethical Issues in the Practice Neuropsychology • It was most recently revised and adopted 10th ethics code in 2002 by APA Council of Representative • Previous codes were adopted in 1953, 1959,1963,1968,1979,1999,1992 • The code of conduct contains 3 components (Figure 5.1): a) Preamble and General Principles are aspirational goals toward highest ideals of psychology. The Preamble describes the ethics code and it's use b) General Principles to which APA ethics would like its members to adhere: 1) beneficence and non-malfeasance, 2) integrity, 3) fidelity and responsibility, 4) justice, and 5) respect for people's rights and dignity c) All ethical standards that could be sanctionable if violated • Ethical standards are divided in 10 major sections with subsections beneath each heading 1) First standard outlines procedures involved with resolving ethical issues or complaints. According to this standard, you must first talk with the offending person. If it doesn't work or the person fears the psychologist, then talk with the person's supervisor. And lastly, involve the board of psychology, if needed. Sequence for reporting a psychologist himself is similar. Also included are sanctions for improper complaints and stipulations against retaliation for making a complaint. 2) Second standard informs that one must only provide services in areas where they are competent (or trained in). Also, it states that neuropsychologist must make sure that his personal problems don't affect his professional judgement or abilities. Psychologist should not work with clients who have similar issues as the psychologist because he could be unduly affected by own personal issues and be guilty for impaired judgment (Inability to perform the role of a psychologist due to psychological or physical disability; hence one's judgement is not unbiased). Pope and Brown divided competence into 3 areas: knowledge, technical skills, and emotional competence. If the client neglects his own self‐ care, he may disrespect client's feelings, experience mood swings, or make clinical mistakes. It's also important for neuropsychologist to be competent with as many cultures as possible. That can be overwhelming, therefore it's suggested that he follow APA "Guidelines on Multicultural Education,Training, Research, Practice, and Organizational Change for Psychologists" and "Guidelines for Psychotherapy With Lesbian, Gay, and Bisexual Clients" 3) Third standard is a compilation of standards related to human relations, including provisions directing professional to be aware of and not engage in discrimination, sexual harassment, exploitative relationship, or multiple or dual relationships. Dual Relationships are those where psychologist is in a professional role with an individual and at the same time in a different type of relationship with the same individual, ex. Therapist and a teacher. Supposition is that objectivity is lost in a dual relationship. It also addresses 3rd party requests for info and delineates role of psychologist and identification of client and probable user of services provided or info obtained. Procedures through which a psychologist obtains informed consent for assessment, therapy, or rehab, with the assumption that individuals are competent to give consent. Many have legal guardians who will sign the form for the client. Any additional means used may facilitate understanding of treatment on the part of the client and increase motivation and participation. 4) Fourth standard is related to privacy and confidentiality, specifically on limits on confidentiality, ways to maintain confidentiality, and the use of disclosures and consultations. Client must know everything said remains confidential, except in case of threat of suicide, homicide, child abuse with client as victim or perpetrator, and abuse of a vulnerable adult with the client as victims or perpetrator. Parents/legal guardians have access to records of those under age of 18. Clinical neuropsychologists are also mandated reporters (professionals, because of their interaction with the public, who must report any physical or sexual abuse of children or vulnerable adults) and because of this, they must understand the exact law in the state they're practicing in. For vulnerable adults, consent is obtained by legal guardians 5) The term privileged communication is often misunderstood. It means a communication between a client and service provider that may be withheld from a court of law. The neuropsychologist should know the privileged communication law in his area/state. Clinical neuropsychologist are more likely to be involved in forensic issues and will probably be summoned to testify about status of a patient at least once during course of treatment. A new jurisprudence arose in 1991 termed neurolaw ‐ a synthesis of medicine, neuropsychology, rehabilitation, and law which relates to medico legal ramifications of neurological injuries particularly TBI. Fifth standard is advertising and other public statements. It addresses false or deceptive advertising, media presentations, testimonials, and other forms of solicitations. Psychologist are limited in their advertising to their highest degree received, their practice specialities, and the insurance companies for whom they are providers. 6) Sixth standard is record keeping (such as use, storage, and maintenance of client records and test data), protecting records of clients, and fees. At the federal level, Health Insurance Portability and Accountability Act (HIPAA) of 1996 was implemented in 2003 to protect privacy of client's medical and psychological, records, particularly with the advances in biotech and communication technology. It requires various provisions by any provider who uses any electronic medium to send info regarding a patient. It carries force of law. 7) Seventh standard is education and training. It addresses content of educational programs and ensures presentation of materials done in unbiased manner. It involves topics of sexual harassment and exploitation if students by peers, faculty, staff, and clients, and contains clear statements against such behaviour 8) Eighth standard is on research and publication. It discusses conditions for conducting research, consent needed from participants, the care and treatment of both human and animal subjects, and debriefing after completing research with humans, as well as issues related to credit for participation and plagiarism 9) Ninth standard is about assessment. Current tests with appropriate norms must be used. Older forms may only be used for longitudinal studies. Issues of diversity, ethical decision about interpreter, and rights of client to view and understand test results are discussed here. 10) Tenth and final standard discusses all of the variables within therapy: structure, roles of therapist and client, forms of therapy. Sexual intimacies are banned and therapist should not be friends, relatives, or former intimate partners of client - to avoid lack of objectivity. Sanctions for Violation of Ethical Principles • Code of Conduct was developed by APA but sanctions are administered by state boards of psychology, each of which varies in interpretation of the Ethics code. • Sanctions vary by seriousness of the infraction. Minor ones require discussion with the board ex. making an offensive remark unintentionally • Lack of understanding of a code is not a legitimate defense • Education is often the most valuable sanction. After receiving education on a topic, the psychologist explains to the board why his behaviour was unethical • Lack of insight is the deciding factor for determining level of sanctions • Next level of severity is restriction of practice until proven that psychologist has overcome his issue. This includes having personal issues that may interfere with professional judgment. Ex. treating a person with TBI while having a person with TBI in his family. • Most serious is removal of psychologist's license of practice. This is a results of sexual assault or any conviction of felony, whether professional or nonprofessional Availability of Resources • Neuropsych services are often reimbursed
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