Ethical Dilemmas in Training and Doctoral Education: Avoiding Deleterious Effects
Steven Bucky, PhD, ABPP; along with Tamara Anderson, PhD; Candice Clairborne, MA; and Beth Jenks, PhD, have been published in the Winter 2014 issue of The California Psychologist on the topic of Ethical Dilemmas in Training and Doctoral Education: Avoiding Deleterious Effects.
Ethical Dilemmas in Training and Doctoral Education:
Avoiding Deleterious Effects
by Tamara Anderson, PhD; Candice Claiborne, MA; Beth Jenks, PhD; and Steven Bucky, PhD, ABPP
Collaborative article between Division II: Education and Training & California Psychological Association Ethics Committee
Doctoral students in clinical psychology typically look forward to one particular facet of their doctoral training more than others: their clinical training experiences. With much preparation they embark on what will be four to five years of practical training culminating in their post-doctoral year. It is the hope of the student, doctoral program and training site, that their entire course work in theory, research, therapy modalities, ethics, and professional issues will have prepared them well for these experiences. When all three components of this training triad-student, doctoral program, and training site are at their optimal effectiveness, the students no only develops professionally, but also flourishes. While this optimal situation does exist, there are situations where one or all of this triad is less than effective, and even detrimental to their shared goal of “growing” the psychologist in training.
In this article we present two examples of ethical dilemmas trainees have encountered, as well as provide a discussion of the importance of training sites and doctoral programs to work in tandem as they train students.
At a training site, a licensed psychologist (not the trainee’s designated supervisor) delegates responsibilities to a pre-doctoral intern asking the intern to participate in evaluating and working with his client, but adamantly identifies himself to the trainee as a “consultant.” The interactions between the psychologist and intern emulate a supervisor-supervisee relationship but the psychologist has absolved himself of taking responsibility for the intern’s supervisor has made clear her intentions to supervise only those cases she has directly referred. As a result of this situation, without a specified supervisory relationship in place, the intern feels conflicted about fulfilling the request of his superior.
Lastly, when the intern reviewed site policies and procedures, he was unable to locate a process for filing a student grievance.
The American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct (APA, 2010) provide guidelines germane to the dilemma proffered above. Specifically, Principle B, Fidelity and Responsibility, and Principle C, Integrity, calls psychologists to establish relationships of trust, clarify their roles and responsibilities, and decisions that are unwise. Ethical standard 2.05 (2); Delegation of work to others clearly states that psychologists do not delegate work to those who lack the appropriate level of training and supervision. Furthermore, Ethical Standard 3, Human Relations (3.04 and 3.08), outlines expectations for psychologists to avoid harm and refrain from exploiting those with whom they work (APA, 2010). Finally, in Ethical Standard 10.01 (c) clients, as part of the informed consent procedure, are to be informed of the name of the supervisor when the therapist is a trainee.
Like clinical practice, competent supervision arises from a combination of ethics, standards of practice in clinical supervision, and legal requirements. Legal requirements for supervision of interns can be found in the Laws and Regulations Relating to the Practice of Psychology (Board of Psychology, 2012). It stipulates how psychology interns are to present themselves as well as the informed consent process of notifying of their clients of their supervision status, name of their supervisor as well as avenues for contacting their supervisor. Internship programs, in order to be approved for pre-doctoral accrued hours must be either overseen by the American Psychological Association (APA), the Association of Psychology Postdoctoral and Internship Centers (APPIC), or the California Psychology Internship Council (CAPIC), all of which have requirements for student grievances, APA Ethical Standard 7.01 charges psychologists (Training Director and Directors of Clinical Training) to take reasonable steps to ensure that programs are designed to meet the goals for licensure. It is helpful when academic institutions provide their students with an understanding of due process as well as grievance procedures relative to the oversight associations. Likewise, training programs meet to ensure that trainees, at every pre-licensure stage, are aware of due process and grievance procedures and that supervising staff and doctoral program partners are also aware of due process relative to trainees.
At their training site, practicum students and doctoral interns have been instructed by their training supervisor to “modify” standardized administration and scoring procedures to “accurately capture the client’s experience.” Suggested modifications include: (a) changing the instructions to cover a different time period or nature of the problem, (b) interrupting administration in the midst of testing to inform the client that it is extremely rare for him or her to endorse severity on that many items, with the purpose of encouraging the client to change response style in order to insure that a “valid” protocol is obtained, (c) using measures no intended for the problem being evaluated, and (d) interpreting assessment results according to manual guidelines even when standardized administration and scoring have been violated.
When trainees addressed these concerns with the supervisor, they were informed that while their adherence to standardized procedures to maintain the validity of the instrument was “admirable”, as the trainees gained more field experience they would learn that changing the administration and scoring procedures to meet the needs of the client, even when the assessment will be used for a formal evaluation as opposed to a therapeutic technique or explorative intervention, is usual practice, and therefore acceptable.
The supervisor’s behavior presented in the above dilemma obviously constitutes unethical behavior that encompasses those general principles and standards listed in response to dilemma #1, as well as 9.02 Use of Assessments, and 9.06 Interpreting Assessment Results. APA (2010) ethical standards are clear that psychologists base their interpretations on proper administration of instruments and minimize any behavior that could limit the accuracy of their interpretations.
Regarding both dilemmas presented, it is important to acknowledge the power differential that exists between trainees and supervisors or other senior clinicians in an agency. This differential is such that trainees may feel that questioning unethical practices would put them in a precarious position in regards to obtaining desirable opportunities at the site, ratings on their formal evaluation, and future connections and letters of recommendation. And while these reasons do no absolve trainees of engaging discussion around ethical issues, the power differential (Campos, 2009) is areal and strong deterrent to confrontation, both within training sites as well as within doctoral programs. (Ethical Standard 1: Resolving Ethical Conflicts, APA, 2010).
Modeling navigation of professional relationships is key for both doctoral program and training site. One way of accomplishing this is to include trainees in site training committees and faculty meetings. This inclusions and de facto modeling might help empower students to engage in stage appropriate professional assertiveness when faced with ethical dilemmas.