ETHICS IN PSYCHOLOGY Session 7 CASE STUDIES

1. ETHICS IN PSYCHOLOGYSession 7CASE STUDIES NİşantaşI UNIVERSITY

2. SESSION 7 • The Stanford Prison Experiment (Zimbardo) • CASE STUDIES

3. The Stanford Prison Experiment • https://www.youtube.com/watch?v=oAX9b7agT9o • It was conducted by Dr. Philip Zimbardo in 1971. • He wanted to learn, how being placed in different social roles affected the way people behave. • 24 healthy white male college students were recruited for the study. • They were randomly separated into 2 groups: Prisoners and Guardians. • Prisoners were given id numbers to dehumanize them. • Guards were given uniforms and told to do whatever they had to do to maintain order.

4. The Stanford Prison Experiment

5. The Stanford Prison Experiment CONT. • Guards became more and more abusive because of the power they were given. • Subjects internalized their assigned roles. • Prisoners became submissive. • Guards became abusive and aggressive. • The study was planned to last for 2 weeks, but it was stopped after 6 days. • You can not conduct this study today. • WHY?

6. The Stanford Prison Experiment CONT. • Zimbardo allowed the guards to subject the prisoners to serious abuse, have caused them real and permanent harm. • No clear cut rules, subjects did not know what will happen in the study. • Wellbeing of the participants was not taken into consideration.

7. CASE STUDIES • Mert, is a new psychologist, who works in a mental health care center/agency that uses the latest technology. Before he begins his first session with each client, he prints out the documents and gives them to the client to read and then sign. • Meryem, a young mother, who discloses that her husband gets angry with their baby daughter when she cries and • shakes the child severely to stop her crying.

8. CASE STUDIES • Mert informs Meryem that he must report her husband’s actions to the authorities as possible child abuse. • Meryemcomplains that she never would have told Mert about her husband’s actions if she had known he would make a report to authorities. • Mert responds that Meryem signed the informed consent form when they began their relationshipand that the form clearly stated the psychologists are obligated to report incidents of suspected child abuse. • Meryem says that she did not read the document. She says she just signed it along with all those other papers. • Meryem says she will not continue her therapy with Mert because she no longer trusts him.

9. CASE STUDIES • What would Mert have done in the beginning of their relationship with Meryem that might have prevented this unfortunate situation? • How can psychologists balance the need to inform new clients of the limits of confidentiality in the relationship and to establish rapport at the same time?

10. CASE STUDIES • Mert might have considered the following actions: • Mert might have spent more time with Meryem in their first session pointing out some of the major exceptions to confidentiality. • At the beginning of the therapy, psychologists should inform their clients about the exceptions to confidentiality. • According to TPA, Ethics Code underlines: • ‘When the client’s condition poses a danger to him/herself and others.’ • ‘In cases of child or adolescent abuse or neglect and in cases of harm to vulnerable adults.’

11. CASE STUDIES • Mert might have asked the intake person, if there is any, in his agency, to go over some of the major details in the documents with Meryem before they begun their first session with her. • In order to discuss confidentiality limits and establish rapport, psychologists may consider taking the following actions: • Focus on establishing rapport in the first session, at the end, go over important details regarding their relationship. • Highlight certain parts of the many papers clients sign, • in bold type or larger type to draw clients’ attention. • Create a written brochure that explains the counseling relationship, including confidentiality limits, so that they read before their first appointment.

12. CASE STUDIES • Melis is a psychologist in private practice with a group that includes 3 other psychologists. One afternoon, at 1pm, she has had a client cancellation and is using the time to work at her computer writing clinical therapy notes for her morning sessions. • Müge, the psychologist next door, pokes her head in the door and asks Melis for a case consultation. Melis and Müge go to Müge’s office and close the door for privacy. • Melis’s 2pm client arrives early, sees that her office door is open and goes in. • The client reads the notes that Melis had left on her computer screen.

13. CASE STUDIES • What actions can psychologists take to ensure that a client’s records are not seen by anyone? • What steps must psychologists take to preserve client privacy when they keep therapy notes on a computer?

14. CASE STUDIES • Psychologists may follow the guidelines below to avoid unfortunate situations like that one: • In your office, be extra careful not to leave records out in the open, so that other clients do not see them. Always put them away, even if you leave your desk for only a few minutes. • Use a secure password for accessing client’s records on your computer. Always close a secure file when you leave the room. • If your computer is networked, be sure your client records are not accessible to others. • Position your computer so that others in your office cannot see what you have on your screen.

15. Case STUDIES • Yağmur, a psychologist in private practice, began working with Burcu, a young woman who came for counseling to deal with her moderate anxiety. Burcu described herself as a perfectionist and sought counseling to learn to stop being so hard on herself. • After several sessions, Burcu felt safe enough in the relationship to reveal to Yağmur that she was so fearful of becoming ‘fat’ that she regularly engaged in self induced vomiting after meals, abused laxatives, and exercised excessively. • Yağmur recognized these behaviors as symptoms of anorexia nervosa or bulimia nervosa, a problem with which she had no experience.

16. Case STUDIES • How should Yağmur approach this situation with Burcu? • If Yağmur decides to take workshops and do independent reading on treatment of individuals who have eating disorders, how will she know when she is competent to provide therapy and counseling services to clients like Burcu? • What if Yağmur is able to find a suitable referral source but Burcu refuses, stating that she had complete faith in Yağmur’s ability to help her?

17. Case STUDIES • Yağmur has an ethical obligation to either refer Burcu to a specialist or to another therapist who is competent to work with clients who suffer from eating disorders, or to ensure that she provides quality counseling services to Burcu by obtaining educational experiences and consultation or supervision from experts. • If Yağmur decides to refer, it might be difficult for her after establishing rapport with Burcu, to tell Burcu she now needs to see a different psychologist. Yağmur will have to be firm in making the referral, and be sensitive to Burcu’s concerns as well.

18. Case STUDIES • If Yağmur decides to take workshops, do reading on eating disorders treatment, get supervision/consultation she will need to determine whether she is competent enough in this new area. • If Yağmur is able to find a referral source but Burcu refuses, Yağmur needs to be firm in refusing to continue seeing Burcu. If Yağmur has trouble being firm in a situation like this, she should get supervision for support in doing has to be done.

19. CASE STUDIES • Aslı, age 22 is getting therapy from Hakan who is a psychologist in private practice. Her goal is to work through issues related to the sexual abuse by her step father that she had endured when she was a child. After 3 months of therapy, Hakan initiates a sexual relationship with Aslı. • He rationalizes his behavior by telling himself that she can benefit from having a healthy sexual relationship. • Aslı feels guilty, confused, and isolated by this betrayal of her trust . She wants to end the sexual relationship but has become so dependent on Hakan that she feels trapped. • She begins to have thoughts of suicide.

20. CASE STUDIES • This case illustrates a severe harm to a client that a sexual dual relationship can cause. • Hakan’s behavior is exploitative. • He is causing harm by revictimizing his client. • Hakan’s behavior is unethical.

21. CASE STUDIES • Leyla is the psychologist of Ela, a 30 year old client. In the session, Ela states that she wishes she could just walk away from her marriage, but she can not do it because it would traumatize the children. • Leyla herself is a child of divorce whose father abandoned the family, further explores Ela’s fears for the children. At one point she says ‘Yes, the statistics show that a lot of children lose relationship with their fathers after a divorce. It would be really for them to if that happened. It could even have effects into their adulthood years.

22. CASE STUDIES • What do you think motivated Leyla to respond the way she did? • Do you see any problem with Leyla’s response?

23. CASE STUDIES • Leyla is interjecting her own feelings about paternal abandonment into the session. Leyla is focusing on her own feelings rather than trying to help Ela clarify her feelings about the issue. • By focusing on the client’s children rather than the client herself, Leyla is discounting the client’s feelings and imposing her own values about the effects of divorce on children onto the client. • This case study illustrates that if psychologists lack self-awareness of their ‘unfinished business’ areas of vulnerability, and defenses, there is a risk that they will be working on their own issues in the counseling relationship, rather than the client’s issues. • Psychologists who are unaware of their own issues are in a poor position to recognize the ways their personal lives are influencing their interactions with clients. This is particularly true when the client’s problems are similar to the unresolved issues of the psychologist.

24. CASE studIes • Bülent is a psychologist who works in an urban community agency. • The agency provides reduced-fee services to some clients who can not pay the standard fee. 3 months ago, Bülent began therapies with Kamile, who is a 29 year old single mother. Kamile works as a maid in a hotel. • She often calls to cancel her appointments, sometimes fails to show up, when she keeps her appointments she arrives late. When Kamile attends sessions, she talk at length about the problems she encounters in daily living but self discloses very little. • Bülent questions whether Kamile has a sincere commitment to relationship.

25. CASE STUDIES • What might be some possible explanations for Kamile’s behavior? • What do you think of Bülent’s questioning the sincerity of Kamile’s commitment to counseling?

26. CASE STUDIES • If Bülent had considered Kamile’s life circumstances to understand his client, he might have given a different explanation of her behavior. • If Bülent had explored with Kamile the context of her daily life, he might have learned that she gets to the counseling agency by bus, transferring 2 times. He would have also discovered that she relies on various family members to babysit for her children when she comes to the sessions. • When the buses do not run on time, or when the family members fail to keep their promise to babysit, Kamile is late for appointments or is unable to come at all. • Kamile may be focusing on her problems in daily living because she expects the psychologist to help her solve those problems rather than disclose her feelings. Bülent seems to be blaming the client for his inability to establish a therapeutic alliance with her.

27. CASE STUDIES • Gül has been coming to see Göknur, her psychologist, for nearly a year. Through therapies, Gül has gained self esteem and confidence and returned to college and complete the last 4 courses she needed in order to graduate. • She asks Göknur to attend the graduation ceremony. She says that Göknur’s attendance would mean a lot to her because she values the therapy process for making it possible for her to achieve her goal. • Göknur agrees to attend the ceremony.

28. CASE STUDIES • The psychologist chooses to engage in a form of dual relationship in order to benefit a client. • Göknur’s choice to attend the graduation ceremony, probably has a low risk of causing harm.

29. CASE STUDIES • Kerem earned his master’s degree in psychology and has been working as a staff psychologist in a hospital since he graduated. In addition to this employment, he opened a part-time private practice. • He recently completed his doctorate in Health Care Administration. He is now focused on his goals of moving into an administrative position within the hospital, as well as building up his private practice in case an administrative job does not occur. • He decides to update his business cards he uses in his private practice and changes the wording. • ‘KeremErken, • PhD., Psychologist.

30. CASE STUDIES • Do you see anything wrong with the wording on Kerem’s card? • Do you believe doctorate in health care administration could be considered a doctorate in psychology or closely related field?

31. CASE STUDIES • His PhD degree is earned in Health Care Administration. İt is not related to the field of psychology. • General health care administration is not a mental health field. • He must be careful not to mislead the public into believing he has a legitimate doctoral degree in mental health field.

32. Reference • Remley, T. P., & Herlihy, B. (2009). Ethical, legal and professional issues in counseling, 3rd Edition. Prentice Hall. • American Psychological Association. (2017). Ethical principles of psychologists and code of conduct. Washington, D.C.: APA. • http://www.apa.org/ethics/code/ethics-code-2017.pdf • https://www.youtube.com/watch?v=oAX9b7agT9o