Essay 1: Self-care and Psychology

 

APA’s Advisory Committee on Colleague Assistance (ACCA): Promoting Prevention, Wellness, and Coping with Challenges

Keeping Psychologists Healthy: Is Self-Care Important?

Self-care is obviously needed but often ignored. Balance drives a healthy self-care regime. Balancing a healthy mind and body enhances our personal and professional lives. Psychologists are not immune to the effects of a busy career and life’s demands. If we follow our own advice, everyone benefits. Maintaining a sense of balance also assists in honoring our professional guild and Principle A of APA’s Code of Ethics.*

Self-care

for the prevention and treatment of professional and personal burnout – regular exercise, sufficient rest and sleep, balanced diet, meditation, mindfulness, prayer/ spirituality, your personal psychotherapy, others?

In the Interest of Self-Care, It Is Important to Remember that Balance

• is especially important given our unique occupational vulnerabilities,
• enables us to be more present and effective with our clients, and
• encourages more rewards in all aspects of our lives.

Listening to What We Offer Our Clients

• Maintain awareness of stressors.
• Use self-assessment and plan coping strategies.
• Maintain participation in consultation, therapy, or treatment when needed.
• Take care of yourself—get an adequate amount of sleep, exercise regularly, maintain a healthy diet, nurture meaningful relationships, and allow for leisure time.
• Give priority to your own mental and physical needs by developing and working toward specific goals.

In addition to the above, one of the most important things we can do is maintain connections with our colleagues. Connecting with colleagues on a regular basis can lessen the isolation often experienced in independent practice. Peer mentoring provides reciprocal support and time to discuss and share vulnerabilities and successes. Many possibilities can be created to increase peer contact.

Suggestions

• Consider a formal consultation group to review ethical dilemmas, for collegial support, and to explore current developments in the field.
• Attend workshops to stay current in professional knowledge and to increase competence in areas of interest.
• Strengthen relationships with colleagues.

Appreciate that not unlike those we serve, we will experience professional and personal issues at all stages of our lives, from graduate school or early career through retirement. It is normal and understandable to have such challenges. We should not let stigma keep us from support. Our field is evolving and colleague support can keep us healthy and adaptive.

Tips for Balance in the Workplace

• Assess and readjust your caseload.
• Set healthy boundaries for yourself and the clients you serve.
• Vary professional activities to prevent isolation and burnout.
• Consider occasional self-assessments to gauge your own level of well-being.

State and local colleague assistance programs (CAPs) can provide support. Visit their websites for valuable resources on self-assessments, self-care, and effective coping strategies. For further information and resources visit the APA website.

_{* “Be aware of the possible affect of [our] physical and mental health on [our] ability to help those with whom [we] work.” APA 2002, page 3.}

By the APA Advisory Committee on Colleague Assistance (ACCA), July 2010

Bibliography

Barnett, J.E., Baker, E.K., Elman, N.S., & Schoener, G.R. (2007). In pursuit of wellness: The self-care imperative. Professional Psychology: Research and practice, 38, 603-612.

Bridgeman, D.L. (2010) Colleague Assistance Toolkit: Tools of Engagement for Psychologists for APA’s Advisory Committee on Colleague Assistance (ACCA), a 21 page resource for developing a colleague assistance program and articles relevant to all psychologists personally & professional from graduate school phase through retirement. APA or California Psychological Association

Bridgeman, D.L. (2009) Balance, Boundaries & Benevolence: The Complexities of Psychologists’ Self-Care, Coping & Wellness, an informal self-assessment. California Psychological Association

Coster, J.S., & Schwebel, M. (1997). Well-functioning in professional psychologists. Professional Psychology: Research and practice, 28, 5-13.

Elman, N.S., Illfelder-Kaye, J., & Robiner, W.N. (2005). Professional development: Training for professionalism as a foundation for competent practice in psychology. Professional Psychology: Research and practice, 36, 367-375.

Kaslow, N.J., Rubin, N.J., Forrest, L., et al. (2007). Recognizing, assessing, and intervening with problems of professional competence. Professional Psychology: Research and practice, 38, 479-492.

Kramen-Kahn, B., & Hansen, N.D. (1998). Rafting the rapids: Occupational hazards, rewards, and coping strategies of psychotherapists. Professional Psychology: Research and practice, 29, 130-134.

Leigh, I.W., Smith, I.L., Bebeau, M.J., et al. (2007). Competence assessment models. Professional Psychology: Research and practice, 38, 463-473.

Skovholt, T. (2001) The Resilient Practitioner: Burnout prevention & self-care strategies for counselors, therapists, teachers, & health care professionals. Allyn & Bacon.

Smith, P. L., & Moss, S.B. (2009). Psychological Impairment: What is it, how can it be prevented, & what can be done to address it? Clinical Psychology: Science & Practice, 16 (1), 1-15.

Stvanovic, P., & Rupert, P.A. (2004). Career-sustaining behaviors: Satisfactions, and stresses of professional psychologists. Psychotherapy: Theory, Research, Practice, Training, 41, 301-309.

Stevanovic, P. & Rupert, P. (2009) Work-Family Spillover & Life Satisfaction Among Professional Psychologists.  Professional Psychology: Research and practice, 40, 1, 62-68.

 

Essay 2: Confidentiality and Psychology

Psychotherapy is most effective when you can be open and honest. If you’ve never seen a psychologist before, you may have some questions about privacy.

Will the things I discuss in therapy be kept private?

Confidentiality is a respected part of psychology’s code of ethics. Psychologists understand that for people to feel comfortable talking about private and revealing information, they need a safe place to talk about anything they’d like, without fear of that information leaving the room. They take your privacy very seriously.

Laws are also in place to protect your privacy. The Health Insurance Portability and Accountability Act (HIPAA) contains a privacy rule that creates national standards to protect individuals’ medical records and personal health information, including information about psychotherapy and mental health.

The HIPAA Privacy Rule is designed to be a minimum level of protection. Some states have even stricter laws in place to protect your personal health information. You can contact your state’s board of psychology to find out its laws and protections.

At your first visit, a psychologist should give you written information explaining privacy policies and how your personal information will be handled. This information will explain that in some cases, there are exceptions to the privacy rule, as described below.

When can a psychologist share my private information without my consent?

In some specific situations, psychologists can share information without the client’s written consent. Common exceptions are:

• Psychologists may disclose private information without consent in order to protect the patient or the public from serious harm — if, for example, a client discusses plans to attempt suicide or harm another person.
• Psychologists are required to report ongoing domestic violence, abuse or neglect of children, the elderly or people with disabilities. (However, if an adult discloses that he or she was abused as a child, the psychologist typically isn’t bound to report that abuse, unless there are other children continuing to be abused.)
• Psychologists may release information if they receive a court order. That might happen if a person’s mental health came into question during legal proceedings.

Will insurance companies see my records?

Psychologists will share certain information about your diagnosis and treatment with the health insurance company or government program (like Medicare or Medicaid) that is paying for your treatment so that the company or program can determine what care is covered. The health insurance company or program is also bound by HIPPA to keep that information confidential. However, if you choose to pay out of pocket for services, and you choose to not ask your insurance provider for reimbursement, your insurance may not be aware that you are seeing a psychologist.

Similarly, your psychologist may ask for your consent to share information, or discuss your care, with your other health care professionals to coordinate your care.

Will my employer know I saw a psychotherapist if I use my company’s insurance?

Employers don’t receive information about the health services an employee receives, even if he or she uses company insurance.

Some companies offer employee assistance programs (EAPs), which offer mental health services to employees. Usually, the company simply provides the service but doesn’t receive information about how each employee uses it. However, if you have any questions about privacy and your organization’s EAP, talk to a human resources representative for more details.

I’m under 18. Will the psychologist tell my parents what we talk about?

Different states have different ages at which young people can seek mental health services without informing parents. In most cases, a parent is involved when a minor receives psychotherapy services.

Psychologists want young people to feel comfortable sharing their feelings, and are careful to respect their privacy. Often, at the first psychotherapy visit, the child, parent and psychologist will sit down together to discuss ground rules for privacy. That way both parents and children know exactly what types of information the psychologist might share with parents, and what he or she will keep private. For example, it is common for parents to agree to be informed only if their minor child is engaged in risky activities.

I’m older than 18, but still use my parents’ insurance. What do I need to know about privacy?

Many college counseling centers don’t require insurance. In those cases, students should be able to receive mental health services without their parents’ knowledge, if they wish.

When a person receives services using medical insurance, the insurance company sends a statement called an Explanation of Benefits (EOB) that explains which services were used and paid for. If you use your parents’ insurance for psychotherapy services, your parents may receive an EOB that outlines the services you used. However, they will not be able to access your records or find out what you discussed during your sessions with a psychologist.

What information can I share about my psychotherapy treatment?

Privacy is your right as a patient or client. If you choose to tell your friends or family that you’re seeing a psychologist, you are free to do so. How much information you decide to share is up to you. Psychologists are ethically bound to protect your privacy regardless of what information you choose to share with others. For example, psychologists typically won’t connect with clients on social media sites, even if the client initiated the request.

Sometimes, psychologists find it helpful to discuss your concerns or behaviors with other people in your life. A psychologist may want to interview your spouse to better understand what’s going on in your home, for example. If a child is having trouble at school, the psychologist may want to interview the child’s teachers. But whether you involve others is completely up to you. Psychologists generally can’t contact anyone else without your written consent.

If you have specific concerns about confidentiality or what information a psychologist is legally required to disclose, discuss it with your psychologist. He or she will be happy to help you understand your rights.

 

Essay 3

Ethics, Diversity, and Multiculturalism in Psychology

Samuel Knapp, Ed.D., ABPP

Director of Professional Affairs

Recent years have seen an emphasis on multiculturalism and diversity issues within psychology* both by addressing the ability of professional psychologists to serve the health care needs of cultural minorities, and by increasing the number of psychologists from ethnically diverse backgrounds. The two strategies may be synergistic. For example, graduate programs with a critical mass of diverse students may find that the minority students will teach (even if informally) the European American students to become more culturally competent.

 

This movement has a foundation in the underlying ethical foundations of our profession. Sometimes psychologists use the word ethics to refer to the minimal standards of conduct that apply to all psychologists and that could be the basis of a disciplinary action by a licensing board or malpractice suit. The enforceable Standards of the APA Ethics Code specifically state that psychologists should not discriminate unfairly (Standard 3.01, Unfair Discrimination) nor harass (Standard 3.03, Harassment) based on age, gender, gender identity, sexual orientation, race, culture, national origin, language, religion, disability, or socioeconomic status. In addition, psychologists should ensure that they are competent when working with diverse populations (Standard 2.01b, Competence); ensure that they use tests Awhose validity and reliability have been established for use with members of the population tested@ (9.02b, Assessments); interpret tests with consideration of linguistic and cultural differences (Standard 9.06); and ensure that consent is obtained when using interpreters (9.03c).

 

 

Ethics also refers to the General or Aspirational Principles that follow the Preamble in the APA Ethics Code. Unlike the enforceable Standards, which can be the basis for a disciplinary complaint against a psychologist, the General Principles are guides for psychologists on how to excel in their professional roles. They can also inform the ethical decision making process. The General Principles state, among other things, that psychologists Aare aware of and respect cultural, individual, and role differences, including those based on age, gender, gender identity, race, ethnicity, culture, national origins, religion, sexual orientation, language, and socioeconomic status.@ (Principle E, Respect for People=s Rights and Dignity).

 

Finally, ethics refers to personal overarching moral perspectives derived from philosophical or religious instruction or study which inform our day-to-day behavior. The enforceable Standards, General (Aspirational) Principles, and personal sense of morality can overlap considerably. For example, a psychologist who has a personal moral perspective, perhaps based on religious instruction, who believes in the universality of human rights and dignity, would easily see that reflected in General Principle E, and operationalized in the directive to avoid unfair discrimination or harassment of individuals based on incidental demographic factors.

 

Few psychologists end up being disciplined specifically for violating enforceable ethical standards related to diversity or multiculturalism. In that sense, diversity and multiculturalism have only a small overlap with ethics. However, many psychologists struggle over how to implement the General (Aspirational) principles and their personal sense of morality when providing professional services to diverse populations. In that sense, diversity and multiculturalism are deeply intertwined with ethics.

The emphasis on a diverse or multicultural perspective appears to rest primarily on two overarching ethical principles. First, diversity or multiculturalism is justified on the basis of justice, in that it helps ensure a more equal access to quality psychological services to persons from traditionally marginalized groups who otherwise would not find them available.

 

Also, diversity and multiculturalism are justified on the basis of beneficence and nonmaleficence in that psychologists with a diverse or multicultural perspective will do better at treating patients and will reduce the likelihood that they will harm patients. Although many authors have argued that a diverse or multicultural perspective will improve outcomes, this relationship was verified by the meta-analysis of Griner and Smith (2006) who found that interventions targeted to specific cultural groups were more effective than generic interventions provided to heterogeneous groups. AOverall, culturally adapted interventions resulted in significant client improvement across a variety of conditions and outcome measures@ (p. 541). In other words, psychologists should be able to upgrade the quality of their services to multicultural patients by accommodating multicultural perspectives into their treatment.

 

Striving for excellence requires more than just good intentions; it requires a conscientious effort at self-reflection and training. For example, consider the experience of one psychologist supervisor who was trying very conscientiously to develop a supervisory relationship based on her deeply held moral values of trust and empowerment. This supervisor was very committed to feminist ideas of equality and power sharing. She told her internship students that they should feel free to challenge her during supervision. For some students this was very empowering and helped them to become more comfortable in sharing their thoughts openly. For another student, the comment created anxiety because it is normative in her Asian culture to show great respect for hierarchy and not to challenge authority directly. Fortunately, the student was able to receive advice on how to approach her supervisor about this issue.

 

Here is another example from my personal experience. About 30 years ago I temporarily worked in an urban mental health clinic after working in very rural mental health centers for several years where I commonly introduced myself to my adult patients by my first name and used their first names as well. However, when I took a job in an urban inner city mental health clinic, in my effort to be egalitarian, I continued to introduce myself to my adult patients, who were mostly African American, by my first name and used their first names as well. However, an African American social worker explained to me that African American males are used to being called by their first names by all Whites, regardless of their age or status. It would be more respectful, she explained, if I called them by their surname and later asked permission to use their first name. Therefore, I became aware of a personal blind spot. I learned that my greeting style, which appeared appropriate and egalitarian in rural Pennsylvania, came across quite differently with inner city African American patients.

 

Or consider this last example: A psychologist sometimes worked with Spanish-surnamed patients and was always careful to ensure that they were comfortable using English (or getting an interpreter if they were not). One patient with a Spanish surname reported that she felt comfortable conducting psychotherapy in English. She related a background of substantial trauma and strife, but did so in a detached manner. However, research shows that the affect associated with a traumatic event can be captured more intensely through the use of the patient’s primary language at the time that the trauma occurred. Relating the trauma in a language that was learned subsequently does not evoke the intensity of feeling or vividness of imagery as it would if the patient had used the original language. A psychologist who was not aware of this fact might miss the emotional significance of certain past events.

 

These are just a sample of the issues that can arise and where a knowledge of cultural or diversity factors can improve relationships and outcomes. Many questions arise, such as how can psychologists evaluate the functioning in a diverse family without unfairly pathologizing culturally normative relationships (e.g., averting eyes in some cultures is not a sign of shyness, but a normative sign of respect)? What teaching technique can help psychologists become more alert to their blind spots (e.g., well meaning people may have implicit prejudices outside of their conscious awareness; Knapp, 2007)? How should psychologists respond when patients make racist, homophobic, or sexist remarks? How, or can, English speakers supervise trainees who treat patients where English is not a primary language? How does diversity inform effective practice? When or how to incorporate folk healing remedies or strategies into therapy? How to accurately evaluate refugees in light of stressful or traumatic experiences that they may have encountered? How to respond when patients’ religious beliefs appear to harm their functioning or adjustment? Continued reflection, dialogue, and training will help conscientious psychologists address these issues, and help them to fulfill their aspirations to be just and helpful health care professionals.

 

References

 

Griner, D., & Smith, T. (2006). Culturally adapted mental health interventions: A meta-analytic review. Psychotherapy: Theory, Research, Practice, 43, 531-548.

 

Knapp, S. (2007, January). Implicit prejudice: The bad news and the good news. Pennsylvania Psychologist, 6-7.

 

Approved as APA Policy by the APA Council of Representatives, August, 2002

These Guidelines, as noted earlier, pertain to the role of psychologists of both racial/ethnic minority and non–minority status in education, training, research, practice, and organizations, as well as to students, research participants, and clients of racial/ethnic heritage minority heritage. In psychological education, training, research, and practice, all transactions occur between members of two or more cultures. As identity constructs and dynamic forces, race and ethnicity can impact psychological practice and interventions at all levels. These tenets articulate respect and inclusiveness for the national heritage of all cultural groups, recognition of cultural contexts as defining forces for individuals’ and groups’ lived experiences, and the role of external forces such as historical, economic, and socio–political events.

This philosophical grounding serves to influence the planning and implementation of culturally and scientifically sound education, research, practice, and organizational change and policy development in the larger society. To have a profession of psychology that is culturally informed in theory and practice calls for psychologists, as primary transmitters of the culture of the profession, to assume the responsibility for contributing to the advancement of cultural knowledge, sensitivity, and understanding. In other words, psychologists are in a position to provide leadership as agents of prosocial change, advocacy, and social justice, thereby promoting societal understanding, affirmation, and appreciation of multiculturalism against the damaging effects of individual, institutional, and societal racism, prejudice, and all forms of oppression based on stereotyping and discrimination.

The Guidelines for Multicultural Education and Training, Research, and Practice in Psychology are founded upon the following principles:

1. Ethical conduct of psychologists is enhanced by knowledge of differences in beliefs and practices that emerge from socialization through racial and ethnic group affiliation and membership and how those beliefs and practices will necessarily affect the education, training, research and practice of psychology (Principles D and F, APA Code of Ethics, 1992; Council of National Associations for the Advancement of Ethnic Minority Issues, 2000).
2. Understanding and recognizing the interface between individuals’ socialization experiences based on ethnic and racial heritage can enhance the quality of education, training, practice, and research in the field of psychology (American Council on Education, 2000; American Council on Education and American Association of University Professors, 2000; Biddle, Bank, & Slavings, 1990).
3. Recognition of the ways in which the intersection of racial and ethnic group membership with other dimensions of identity (e.g., gender, age, sexual orientation, disability, religion/spiritual orientation, educational attainment/experiences, and socioeconomic status) enhances the understanding and treatment of all people (Berberich, 1998; Greene, 2000; Jackson–Triche, Sullivan, Wells, Rogers, Camp, & Mazel, 2000; Wu, 2000).
4. Knowledge of historically derived approaches that have viewed cultural differences as deficits and have not valued certain social identities helps psychologists to understand the under representation of ethnic minorities in the profession, and affirms and values the role of ethnicity and race in developing personal identity (Coll, Akerman, & Cicchetti, 2000; Medved, Morrison, Dearing, Larson, Cline, & Brummans, 2001; Mosely–Howard & Burgan Evans, 2000; Sue, 1999; Witte & Morrison, 1995).
5. Psychologists are uniquely able to promote racial equity and social justice. This is aided by their awareness of their impact on others and the influence of their personal and professional roles in society (Comas–D’az, 2000).
6. Psychologists’ knowledge about the roles of organizations, including employers and professional psychological associations are potential sources of behavioral practices that encourage discourse, education and training, institutional change, and research and policy development, that reflect rather than neglect, cultural differences. Psychologists recognize that organizations can be gatekeepers or agents of the status quo rather than leaders in a changing society with respect to multiculturalism.