This post was co-written by Sharon K. Anderson, who writes the "Ethical Therapist" blog.
Some people argue that ethics cannot be taught—you're either ethical or you're not. We beg to differ, especially in the area of professional ethics. We're not saying we can turn a psychopath into an angel, but we can certainly make new professionals aware of the ethical culture they are entering.
For example, in our courses on ethics in psychology it's easy to show how some professional obligations differ from personal ones by asking this: "You are seeing a client. One day they come in for their session and tell you that they've killed somebody. What do you do?" Invariably the first response from a student is, "You turn them into the police." When we tell students that they are prohibited from doing so because of the ethical principle of confidentiality, they begin to understand that (a) this is a strange and wonderful occupation that they've chosen, and (b) confidentiality is a pretty important thing to know about.
Here are five techniques we use in our ethics courses to help students explore the ethics of psychology—and their own ethics. We'll give you one example of each technique; you can take it from there and apply these to ethics in your personal life and your own profession. We make no claim that these are original, and this is certainly not a definitive list.
1: "The Analogous Relationship."
Because professional relationships (especially, we have argued elsewhere, psychotherapy relationships) are different from naturally-occurring relationships in our environment, it's often helpful to do some comparisons. Case: You are seeing a couple in therapy. One member of the couple calls you one night and tells you they're having an affair. Then they say, "Don't tell my spouse." Do you tell the
spouse? The Analogous Relationship questions go something like this: Would you tell if you were not their therapist, but a close friend? A cousin? Their dentist?
Most students have a pretty good handle on how they would act with a friend. At least, they'd have some ideas and concepts to share about what to do. For example, they'd invoke issues like loyalty or kindness. This leads to a great discussion of how, for example, a psychotherapy relationship is similar to, and different from, relationships between friends, teacher-student, physician-patient, ski instructor-circus clown, etc.
2: "Both Sides Toward the Middle."
This technique involves having students agree on ethical behaviors at two extremes of a continuum. For example, it is ethical to break confidentiality (i.e., report to authorities) when a client threatens to kill another person. It is not ethical to break confidentiality when a client threatens to jaywalk. Virtually all students can see that; extreme situations are easy. But then we push students to think more deeply by shifting the facts toward the gray areas. When does the promise to not breach confidentiality change to breaching confidentiality? For example: What if the client threatens to defame a person by writing a scathing blog post? What if they threaten to embezzle a small amount of money from a bank? What if it's a large amount of money? What if it's a large amount of money from your bank? You get the idea.
3: "Testing the Limits."
This is similar to the last one except we don't have the two extremes. We simply change the facts of the case until the decision is different. For example, in our couple case above, you could start with having the person who told you about having an affair be your best friend. Then, what if the person about whom you know a secret is your best friend? What if that person is a business partner—or competitor? What if you're friends with the person outside the couple with whom one member of the couple is having the affair (the affair-ee?). We can then come back to the therapy situation and see if the decision would change based on such factors as whether the couple has not paid their bills, whether one spouse has a history of abuse, whether one or both members of the couple are from a different culture, etc. This technique is designed to tease out and articulate the influences and the reasoning behind students' decisions.
4: "Writing a Policy."
This sounds really boring, but actually it can be great fun and pretty effective. We start with, "What is your policy concerning ...?" A great example is accepting gifts, which is a fascinating issue in psychotherapy. Many new students try to avoid the complexity involved. Some students, taking friendship as their "analogous relationship" will say, "I think it's fine! It shows that they are happy with therapy." That's our chance to explain (again) that gifts may have multiple meanings, and some may actually get in the way of therapy. For example, gifts might carry romantic or sexual connotations: a dozen long-stem roses is not just an expression of gratitude! Other students will say, "My policy will be never to accept gifts. That way I avoid all the problems." It doesn't take much testing the limits to show that this position is untenable: What if a client gives you a Christmas card or 10-cents-off coupon at Dunkin' Donuts on their last day of treatment? It might be pretty offensive to refuse such a token. We try to help students think more carefully about "all-or-none" policies and build exceptions and gray areas into their thinking.
5: "Role Reversal."
This one is helpful any time, but especially when developing policies. It is based on the Golden Rule and Kantian notions, and says: "Would you want to live under the rules you just created? What if you were the client, student, research participant, etc.?" A variant of this technique, and related to the Analogous Relationship approach, explores parallel relationships at different points on a hierarchy. For example: "If you, as a teacher, think it's OK to gossip about students, would you consider it OK for administrators (deans, etc.) to gossip about you?"
Have you used or experienced other meaningful approaches?
Mitch Handelsman is a professor of psychology at the University of Colorado Denver and the co-author (with Sharon Anderson) of Ethics for Psychotherapists and Counselors: A Proactive Approach (Wiley-Blackwell, 2010).