Ethics and Self-Care for Psychologists...Ethics and Self-Care for Psychologists Oregon Psychological...

Ethics and Self-Care for Psychologists

Oregon Psychological Association2018 Annual Conference

May 4, 2018General Session (morning)

Erica H. Wise, Ph.D. Department of Psychology and NeuroscinceUNC Chapel Hill

OPA 2018 Annual Conference1

1. Explain how maintaining personal well-being is an ethical responsibility that is directly related to competence in a complex multicultural society, and how care for one’s colleagues can be considered as part of our professional and ethical responsibilities.

2. Identify at least two vulnerabilities to occupational stress common to psychologists and two that are unique to you as an individual psychologist based on a self-assessment exercise.

3. Identify common warning signs of occupational stress for professional psychologists in general and describe two which are most relevant to your professional practice.

4. Develop a plan for implementing two self-care strategies.

Overview

2 OPA 2018 Annual Conference

“. . . Psychologists strive to be aware of the possible effect of their own physical and mental health on their ability to help those with whom they work.”

APA Ethics Code 2010; Principle A


Ethical Principal A

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRw&url=http://www.religareprivatewealth.com/home/careers/understand-our-business.aspx&ei=pLFMVZ6oGYuuyQTcvoCwBw&bvm=bv.92765956,d.aWw&psig=AFQjCNF9Ban5Ihnt2mK77eijkyf0Q-YYvw&ust=1431175932118857


“We teach best what we most need to learn…”

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, based on their education, training, supervised experience, consultation, study, or professional experience. (emphasis added)


Ethical Standardsand Competence

2.03 Maintaining CompetencePsychologists undertake ongoing efforts to develop and maintain their competence



2.06 Personal Problems and Conflicts(a) Psychologists refrain from initiating an activity when they know or should know that there is a substantial likelihood that their personal problems will prevent them from performing their work-related activities in a competent manner.



PresenterPresentation NotesOver focus on individual responsibility. Sometimes we JUST DON’T KNOW and this leaves us vulnerable to harming others…and ourselves.

2.06 Personal Problems and Conflicts(b) When psychologists become aware of personal problems that may interfere with their performing their 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.



PresenterPresentation NotesStrengths and limitations—seems to imply easy to do but these get more and more serious as you go further in 2.06b

Professional consultation and assistance—more gentle adjustments

o The cumulative effect of contact with survivors of violence or disaster or people who are struggling. o What happens to each of us over time as we witness cruelty and loss and hear distressing stories, day after day, and year after year.


Impact of vicarious trauma…

“If you ask a fish to tell you about her environment, the last thing

she’ll mention is water.”


Multicultural Considerations

oBrief and commonplace oDaily verbal, behavioral, or environmental indignities oMay be intentional or unintentionaloCommunicate hostile, derogatory, or negative racial slights and insults toward people of color oPerpetrators are often unaware of their behavior or its impact

~Derald Wing Sue, et al. 2007OPA 2018 Annual Conference11

Racial Microaggressions

o “An implicit bias is a positive or negative mental attitude towards a person, thing, or group that a person holds at an unconscious level. In contrast, an explicit bias is an attitude that somebody is consciously aware of having.

o Research has found that our implicit and explicit biases often diverge. For example, a person may consciously express a neutral or positive opinion about a social group that they unconsciously hold a negative opinion about.”

~http://med.stanford.edu/diversity/FAQ_REDE.html


What is implicit bias?

oCare for self is a private matteroMaintaining competence is an ethical obligation


Is Caring for Ourselves an Ethical Imperative?

o Traditional definition of the term competent: o Being capable or legally qualified to perform a tasko Commonly defined as static attainment of credentials


Redefining Competence

Competent is the present participle of the term competeIn Latin, the term competere is derived from com = with and petere = to seek or to striveCOMPETENT means to seek or strive together!


Redefining Competence

1.04 Informal Resolution of Ethical ViolationsWhen 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, if an informal resolution appears appropriate and the intervention does not violate any confidentiality rights that may be involved.


Ethical Obligations Regarding Colleagues

1.05 Reporting Ethical ViolationsIf an apparent ethical violation has substantially harmed or is likely to substantially harm a person or organization and is not appropriate for informal resolution under Standard 1.04. . . psychologists take further action appropriate to the situation. Such action might include referral to…This standard does not apply when an intervention would violate confidentiality… (excerpt)


Ethical Obligations Regarding Colleagues

oThe majority of psychologists admitted to instances of working when too distressed to be effective despite the fact that most acknowledged that doing so is unethical oMost psychologists were quite confused about whether it was inherently unethical to file an ethics complaint about a colleague or to encourage a colleague to do so.

Pope, Tabachnick, & Keith-Spiegel, 1987


Challenging issues for our profession?

When concerned about colleague substance abuse only 19% acted…Why not?

53% stated they “knew of subtle changes but lacked the tangible evidence of negative impact,” 42% “did not see it detrimental to job performance,” 39% “thought it would do no good,” 30% “thought it was none of my business,” 23% stated that “it was too risky for me,” 19% stated that “the problem was temporary,” 7% reported feeling that it was “too risky for him or her [the impaired colleague]”

Good, Thoreson, & Shaughnessy, 199519 OPA 2018 Annual Conference

PresenterPresentation NotesIt is easy to judge respondents, but how easy would it really be for any of us?

Colleague concerns may be especially challenging…

Limitations in current Ethics Code:Over-focus on individual responsibilityColleague concerns focus on confronting or reporting ethical violationsDifficult to enact and not helpful when the concerns don’t clearly rise to a high levelCultural focus on individualism

Recent calls for a more “communitarian” focus


PresenterPresentation NotesOrganizational norms and culture—don't rock the boat on this slide, re: individual responsibility--could talk about *cultural* focus on individualism v. collectivism--may not be culturally congruent for many psychologists, as well as may root competence in isolated terms

oCare for others can be a delicate and complex matteroMaintaining competence is an ethical obligation for psychology


Is Caring for Our Colleagues an Ethical Imperative?

Standard 2.03, Maintaining Competence:

Psychologists undertake ongoing efforts to develop and maintain their competence. Psychologists maintain regular engagement with colleagues, consultation groups, and professional organizations and routinely solicit feedback from these sources regarding their competence for work in specific roles and with specific populations.Standard 2.06, Personal Problems and Conflicts:

(c) When psychologists become aware that a psychologist colleague is experiencing problems that may lead to interference with professional competence, they offer care and support, and collaborate with that colleague in assessing competence and determining the need to limit, suspend, or terminate their work-related duties.Johnson, Barnett, Elman, et al., 2013


Suggested edits to the Ethics Code (italics)

PresenterPresentation Noteshow much to include or cut--these are some pretty radical ideas--we really will look at these again and talk about them when we get to the vignettes


Why is self and colleague care important?

PresenterPresentation Noteswhen we’re at the edges of our competence, or comfort, or both. Competency of approaching competence problems. Ask: are there any other areas that we’re missing—what else chips away at the ice?

oProfessional isolationoNot enough leisure or non-work activitiesoUnrealistic self-expectations, rigidityoTendency to focus on others’ needs while neglecting our ownoStage of life stressors


Common Vulnerabilities

Surveys of psychologists:o 40% report episodes of emotional exhaustion during the previous

year (Mahoney, 1997).

o Psychosocial isolation and disrupted personal relationships are commonly reported (e.g., Shapiro, 2007)

o Compared to research psychologists, practicing psychologists report higher levels of distress…but also more positive influencefrom their work (Radeke & Mahoney, 2000).OPA 2018 Annual Conference25

Common Patterns

o Loss of pleasure in work

o Depression or anxiety

o Inability to focus or concentrate

o Substance abuse or other compulsive behaviors

o Loss of interest in new learning

o Regularly feeling overwhelmed (e.g., can’t say “no”)26

Warning Signs

OPA 2018 Annual Conference

Skating on Thin Ice!


PresenterPresentation Noteswhen we’re at the edges of our competence, or comfort, or both. Competency of approaching competence problems. Ask: are there any other areas that we’re missing—what else chips away at the ice?

Stress↓

Distress↓

Impairment↓

Improper behaviorOPA 2018 Annual Conference28

Stress-Distress Continuum(APA Advisory Committee on Colleague Assistance)

PresenterPresentation NotesJanet Thomas’s airplane flight metaphor—small corrections vs. large corrections. Much of what happens is getting off course in a small way; there could of course be a large thunderstorm

Self-careAssessment


PresenterPresentation NotesStrong connection between self-care and competence in the helping profession

Understanding wellness is essential to practicing self-care

Stress↓

Distress↓

Impairment↓

Improper behaviorOPA 2018 Annual Conference30

Revisiting the Stress-Distress Continuum(APA Advisory Committee on Colleague Assistance)

PresenterPresentation NotesJanet Thomas’s airplane flight metaphor—small corrections vs. large corrections. Much of what happens is getting off course in a small way; there could of course be a large thunderstorm

Influence of positive psychology…


Flourishing

Competence

Wellness

Self-Care


Flourishing

Competence

Wellness

Self-Care

Re-envisioning the Stress-Distress Continuum

PresenterPresentation NotesHere is a new way that self-care can be envisioned. This idea is highlighted in a paper that I wrote with Matt Harsh and Clare Gibson-which you have a copy. Endpt is flourishing not improper behavior.

Dimensions of Wellness~SAMHSA and others

Spiritual Relational Intellectual

Emotional Vocational Physical


FLOW


“Engaging in an experience that produces ‘flow’ is so gratifying that people are willing to do it for its own sake, rather than for what they will get out of it. The activity is its own reward. Flow is experienced when one’s skills are sufficient for a challenging activity, in the pursuit of a clear goal, with immediate feedback on progress toward the goal. In such an activity, concentration is fully engaged in the moment, self-awareness disappears, and sense of time is distorted.”

~Csikszentmihalyi, 1990

http://www.google.com/imgres?imgurl=http://thecustomizewindows.com/wp-content/uploads/2012/07/Water-Flow-Minimalistic-3D-Wallpaper.jpg&imgrefurl=http://thecustomizewindows.com/2012/07/water-flow-minimalistic-3d-wallpaper/&h=312&w=500&tbnid=Rp0FjOuIMcCYWM:&zoom=1&docid=B7J9QRJ2vEfVwM&ei=U7aQU7_SDafJsASk2ICwCg&tbm=isch&ved=0CA0QMygFMAU4ZA&iact=rc&uact=3&dur=552&page=5&start=104&ndsp=28

Gratitude

o Better physical healtho Optimismo Progress towards goalso Well beingo Help otherso Ask…what am I grateful

for?

Emmons & Crumpler, 2000


PresenterPresentation NotesPeople who express gratitude on a regular basis have better physical health, optimism, progress toward goals, well-being, and help others more (Emmons & Crumpler, 2000). Trying to maximize happiness can lead to unhappiness (Schwartz et al., 2002).

“Wealth is only weakly related to happiness both within and across nations, particularly when income is above the poverty level.”~Diener & Diener, 1996


Wealth and Happiness?

http://www.google.com/imgres?imgurl=http://newgen.nithyananda.org/wp-content/uploads/2012/04/wealthhighachievers_nithyananda-1024x682.jpg&imgrefurl=http://newgen.nithyananda.org/money-career/wealth-is-for-high-achievers/&h=682&w=1024&tbnid=jCCPoaPjVlv3OM:&zoom=1&docid=LXpF-OS5DAeBPM&ei=areQU5vUE8vTsAStkoCYCQ&tbm=isch&ved=0CHIQMygpMCk&iact=rc&uact=3&dur=569&page=2&start=18&ndsp=25

“Mindfulness means paying attention in a particular way: On purpose, in the present moment, and non-judgmentally.” ~Jon Kabat-Zinn


Mindfulness

Leaves on a stream…


Initial randomized control trials suggest:oIncreases in therapist satisfaction (Shapiro, 2007)

oImproved client outcomes (Grepmair, et al., 2007)


Mindfulness training for therapists?

http://yosoyandroid.com/wp-content/uploads/graph-going-up.jpg

The Serenity Prayer


Grant me the serenity to accept the things I cannot change; courage to change the things I can;and wisdom to know the difference.

“Sometimes your joy can be the source of your smile, but sometimes your smile can be the source of your joy.”~Thich Nhat Hahn


Reciprocity

PresenterPresentation NotesIN many ways, the things that make us happy are external--E.g., broad and build-inducing positive emotion helps to broaden our thinking and creativity—so this can be applied to taking care of self-care in that it build resources and coping. Research show that when intentionally inducing positive emotion, increase feelings of closeness, trust, buffer against stress and lead to adaptive ways of thinking and feeling

http://www.google.com/imgres?imgurl=http://1.bp.blogspot.com/_mptnSPsBV0Y/Sf0K0GlFSZI/AAAAAAAADEE/CBQZSwVHlDE/s1600-h/837693_jump_of_joy.jpg&imgrefurl=http://pixshark.com/jumping-for-joy.htm&h=219&w=300&tbnid=3O-zA6NSnb5QAM:&zoom=1&docid=Bx_L9a1_wheigM&ei=d3xKVZerEsruoATahoCgCg&tbm=isch&ved=0CEUQMyg9MD04yAE

Self-Care Principles and Practices


http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&docid=mZ_gxGT6cZ5tPM&tbnid=jyJItV1mJX6-jM:&ved=0CAUQjRw&url=http://www.docstoc.com/docs/77956421/Mindfulness-Based-Stress-Reduction-as-an-Adjunct-to-Psychotherapy&ei=PLSQU5CTOMXisAT0x4G4Dw&bvm=bv.68235269,d.cWc&psig=AFQjCNGw-uaf4xjNISSs57pF8gwVd2OeoQ&ust=1402077033090499

Self-Care Strategies(Norcross & Guy, 2007)


o Value yourselfo Refocus on the rewardso Recognize the hazardso Minding the bodyo Nurturing Relationshipso Healthy escapes and playo Create a flourishing environmento Cultivate spirituality and missiono Foster creativity and growth (diversify)

Therapeutic Lifestyle Changes (TLCs) (Walsh, 2011)


Evidence-based systematic review:o Exerciseo Nutritiono Mindfulnesso Relationshipso Recreation and playo Spiritualityo Be in nature – avoid over-exposure to hyper-reality and

mediao Contribution and serviceo Doing less and other challenging decisions

PresenterPresentation NotesI'm thinking in this last bullet about choosing to leave a dysfunctional organization, taking fewer clients, etc. Sometimes not taking action means colluding with unhealthy organizational dynamics

o Competing pulls or mandateso Potential risk of harm o Emotional intensityo Often no perfect solution


Ethical Dilemmas are Stressful


Stay grounded and follow the curves…


Vignettes

4 Bins (plus one)

48

ClinicalLegal EthicalRisk Management

Behnke, S. (2014). What kind of issue is it? Monitor on Psychology, 45, p. 65

OPA 2018 Annual Conference


1. Distressing Review


2. Early Career Psychologist


3. Overwhelmed at work


4. Disgruntled Colleague

Self-careStrategies


PresenterPresentation NotesStrong connection between self-care and competence in the helping profession

Understanding wellness is essential to practicing self-care


Thank you!

Ethics and Self-Care for PsychologistsOverviewEthical Principal A“We teach best what we most �need to learn…”Ethical Standards�and CompetenceEthical Standards�and CompetenceEthical Standards�and CompetenceEthical Standards�and CompetenceImpact of vicarious trauma…Multicultural ConsiderationsRacial Microaggressions �What is implicit bias?�Is Caring for Ourselves �an Ethical Imperative?Redefining CompetenceRedefining CompetenceEthical Obligations Regarding ColleaguesEthical Obligations Regarding ColleaguesChallenging issues for �our profession?When concerned about colleague substance abuse only 19% acted…��Colleague concerns may be �especially challenging…Is Caring for Our Colleagues �an Ethical Imperative?Suggested edits to the Ethics Code (italics)��Why is self and colleague care important?Common VulnerabilitiesCommon PatternsWarning Signs��Skating on Thin Ice!�Stress-Distress Continuum�(APA Advisory Committee on Colleague Assistance)Self-care�Assessment�Revisiting the Stress-Distress Continuum�(APA Advisory Committee on Colleague Assistance)Influence of positive psychology…Slide Number 32Dimensions of Wellness�~SAMHSA and othersFLOWGratitudeWealth and Happiness?MindfulnessLeaves on a stream…Mindfulness training for therapists?The Serenity PrayerReciprocitySelf-Care Principles and Practices�Self-Care Strategies�(Norcross & Guy, 2007)�Therapeutic Lifestyle Changes (TLCs) �(Walsh, 2011)Ethical Dilemmas are StressfulStay grounded and follow the curves…Vignettes4 Bins (plus one)1. Distressing Review2. Early Career Psychologist3. Overwhelmed at work4. Disgruntled ColleagueSelf-care�Strategies�Thank you!

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