· Observe nurses in a care delivery setting. Identify a recurring conflict with the potential to negatively impact patient care

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To Prepare:

· Read Finkelman (2016), Chapter 13: Improving Teamwork: Collaboration, Coordination, and Conflict Resolution, section on Negotiation and Conflict Resolution, pp. 324-333 (see attached chapter 13 in word document).

· Observe nurses in a care delivery setting. Identify a recurring conflict with the potential to negatively impact patient care. Decide if delegation was an issue in the conflict. This should be from your practice setting or prelicensure experiences.

· Provide details of what happened, including who was involved, what was said, where it occurred, and what was the outcome that led you to decide the conflict was unresolved.

· Identify the type of conflict. Explain your rationale for selecting this type.

· Outline the four stages of conflict, as described in our text, and how they relate to your example.

· Propose strategies to resolve the conflict. Search scholarly sources in the library and the Internet for evidence on what may be effective.

· Discuss if delegation was an issue in the conflict. Be specific.

· Describe how you would collaborate with a nurse leader to reach consensus on the best strategy to employ to deal with the conflict.

· Describe the rationale for selecting the best strategy.

· Provide a summary or conclusion about this experience or assignment and how you may deal with conflict more effectively in the future.

· Type your paper using Microsoft Word 2010 or later.

Write a 5-7-page paper (not including the title or References pages) using APA format and at least four scholarly references no older than 5 years that includes the following level one headings:

1) Start your paper with an introduction ending with a purpose statement (e.g. “the purpose of this paper is…”)

2) Describe an unresolved (recurring) conflict that you experienced or observed. Identify the type of conflict.

3) Provide details of what happened, including who was involved, what was said, where it occurred, and what was the outcome that led you to decide the conflict was unresolved.

4) Outline the four stages of conflict, as described in Finkelman, and how the stages relate to your example. Decide if delegation was an issue in the conflict. Be specific.

5) Describe the strategies for conflict resolution and how you would collaborate with a nurse leader to resolve the conflict. Cites the course textbook and three scholarly sources.

6) Provide a conclusion or summary about this experience and how you may deal with conflict more effectively in the future.

 

The post · Observe nurses in a care delivery setting. Identify a recurring conflict with the potential to negatively impact patient care appeared first on Infinite Essays.

How does the sociological imagination help to examine private acts such as suicide within a larger societal context

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SOCS185N-11504 Discussions Week 1 Discussion: Social Caus…!

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This is a graded discussion: 25 points possible

due Sep 9 at 1:59am

Week 1 Discussion: Social Causes of Suicide

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# Reply

Required Resources Read/review the following resources for this activity:

Lesson Minimum of 1 outside scholarly source

Initial Post Instructions Sociologist C. Wright Mills preferred to call the sociological perspective the sociological imagination, and he saw it transforming personal troubles into public issues. Let us begin our discussion this week by considering suicide, which is thoroughly explored in Chapter 1 of the textbook.

For the initial post, address the following:

How does the sociological imagination help to examine private acts such as suicide within a larger societal context? What are some examples of social forces influencing youth suicide trends in the United States, suicide trends in India, and suicide trends in the U.S. military? Use the sociological imagination to explain your observations, and how the sociological imagination helps us consider the causes and possible solutions to suicide.

Follow-Up Post Instructions Respond to at least two peers or one peer and the instructor. Further the dialogue by providing more information and clarification and/or include perspectives from outside scholarly sources shared in the discussion forum by classmates and/or the instructor.

Writing Requirements

Minimum of 3 posts (1 initial & 2 follow-up) APA format for in-text citations and list of references Include citations from at least the assigned textbook/lesson reading and one additional outside scholarly source to support your response.

Grading This activity will be graded using the Discussion Grading Rubric. Please review the following link:

Link (webpage): Discussion Guidelines

Course Outcomes (CO): 1, 2

Due Date for Initial Post: By 11:59 p.m. MT on Wednesday Due Date for Follow-Up Posts: By 11:59 p.m. MT on Sunday

Reference

Kendall, D. (2018). Sociology in our times: The essentials (11 ed). Boston: Cengage Learning.

 

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Sheila Farr (Instructor) Aug 25, 2019

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Hello Students,

As you begin to analyze “the sociological imagination, I encourage you to ask yourself the following question: “How can you analyze other situations, not just suicide as you will do in this question using what you have learned about the sociological imagination.” It may be helpful if you have this question in the back of your mind as you are addressing the various parts of this discussion question. I think this discussion will be a lively one!

This discussion covers the following outcomes: (CO #1 ) (PO #1 & #3) as outlined in your syllabus.

http://www.popularsocialscience.com/2013/04/29/t he-sociological-imagination-thinking-outside-the- box/

Best,

Sheila Farr

Sameera Farhood Thursday

# Reply $

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Suicide is more than a private act amongst oneself. The sociological imagination helps us place seemingly personal troubles, such as loosing one’s job or feeling like committing suicide, into a larger social context, where we can distinguish whether and how personal troubles may be related to public issues (Kendall, 2018). It helps us take personal troubles, that are happening worldwide, and make them into public issues. For example, in New Delhi, India, a new economic boom has increased suicide rates in the 15-29 age category, especially high among those living in the wealthier areas. Many people would read about an economic boom and automatically think about how the civilians living in that area must be living a “good” life, when in reality, it is causing a major public issue behind the scenes. The result? Intensified job anxiety, higher expectations, and more pressure for individual achievement (Kendall, 2018). The sociological imagination is the reason today that we are able to take personal troubles, such as suicide, and link them to many different public issues, figuring out what the cause is. It has helped us focus more on the social problems causing individuals to act out rather than blaming individuals for creating their own problems, making them act in such ways. Many sociologists have also used the sociological imagination in a way to explore the relationship between suicide and today’s society, creating theoretical perspectives. One perspective that was applied to suicide is the Symbolic Interactionist Perspective which focuses on studying at a microlevel, analyzing people’s face-face interactions and the roles they play in society. From this point of view, a suicide attempt may be a way of garnering attention-a call for help- rather than ending ones life (Kendall 2018). Social forces influencing youth suicide trends starts with what one see’s, hears about or is exposed to. About a third of respondents reported hearing about cutting from an outside source, such as books, magazines, TV, or friends. In some instances, it was picked up from friends who were engaged in the practice. These findings suggest that some self-injurers do in fact learn the practice from others ( Taylor & Ibañez 2015). In today’s society I have observed many different things when referring to suicide. I believe that there are still problems with people blaming an individual instead of trying to solve the issue, whether it is personal or public; I have also seen many areas, globally, attempt to reach out and help suicidal people, making them feel like they have another option, another reason to continue living. Overall, the sociological imagination has helped us look deeper into the causes of suicide, analyzing the individual at a micro and macro-level, which has helped us realize the private issue is more of a public issue in todays society.

 

 

Taylor, J., & Ibañez, L. (2015). Sociological approaches to self-injury. Sociology Compass, 9(12), 1005-1014. doi:10.1111/soc4.12327

Kendall, D. (2018). Sociology in our times: The essentials (11 ed). Boston: Cengage Learningth

Amber Britt Yesterday

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Hello, Sameera! I loved your interpretation of C. Wright Mills sociological perspective. I also agree that a problem often seen is blaming. I’d personally have to say blaming is another form of and/or can lead to shaming which is a big concern for me. An approach I’ve recently learned about that can help minimize such acts are social support as introduced in the functional perspective of sociological imagination! Like any plan, it could be disrupted, leading to a disorderly system, so I encourage anyone dealing with their own “private affairs or distresses” to continue to seek help and guidance and to be reminded that their problem is not being faced by only them but others too (global interdepence—a relationship in which the lives of all people are closely intertwined and any one nation’s problems are part of a larger global problem).

Eric Devich Yesterday

# Reply $ (1 like)

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Sameera, I agree that personal troubles refer to the problems affecting the individuals, that the affecting individual, including other members of the society, typically will blame on the individuals own personal and moral failings. As you have said, blaming is a form of rejection that society uses to reject a person who made mistakes or failed at something. Instead society should do everything to still accept that person and help pick them back up. Just like Amber said in her reply, there are many things in society that will help an individual. Social Support definitely is a big one. Social issues are the main reasons why individuals commit suicide. When society makes you feel like you belong, you get a since of being wanted. This in turn gives that individual a since of purpose. Appraisal support is another key concept that should be followed. Having another person to get reasonable advice from to help in a certain situation is very beneficial. I agree that the Social Imagination helps us to get a bigger picture of what may cause suicide and being able to look at the smaller details, which help us to realize that an individual issue is more of a public issue.

Amber Britt Yesterday

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One would think their struggles are supposedly lived alone and told they are brought on because of their own personal actions and decisions. C. Wright Mills proposes those thoughts to be disprovable through a systematic study called sociological imagination. It is simply not ‘you vs. the world’, but you AND the world. This perspective gives one the ability to differentiate experiences of oneself and societal molding and to see private affairs like financial instability or unemployment are caused by social causes like environmental concerns or even poverty. Social Imagination is constructed of research methods (e.g. surveys, questionnaires and interviews) and theoretical perspectives such as the functionalist perspective and symbolic interactions which views society on a microlevel.

Global interdependence—a relationship in which the lives of all people are closely intertwined and any one nation’s problems are part of a larger global problem (Kendall, 2018)

is introduced when grasping an understanding of the relations of both personal distresses and public affairs. Mills points out that your problem is faced by others but even so your simple daily activities like jeopardizing study time to scroll on a social media platform and like pictures. (Examples of Sociological Imagination, n.d.) Sociological imagination, encourages one to think outside of their norm, to remove themselves and think beyond in certain approaches, global for example. Society removes individualistic decision making. One might think that their subconscious decision to take a certain route over the other or choice to purchase a specific brand instead of the other is commonsense, almost like an un-doubtly right decision that’s been shaped by past experiences. C. Wright Mills deems “commonsense” not commonsense at all but rather myths. (Kendall, 2018 p.6) For example, memes created by users on the internet and shared by thousands a day can be said to be agreeable or felt need to be. They encourage groupthink and could produce harmful outcomes like suicide. Memes or rather social media ultimately, are big social forces influencing suicide trends in the United States. Social media includes any coverage that can be seen, heard or experienced like tv shows (copycat suicides), the news, and peer pressure from (cyber)bullies or friends who’ve attempted themselves. Social media in the U.S. even effects our food and drinking consumption which becomes social rituals that places more importance on the symbolic value of a cup of coffee or tea than the food itself. A cup of tea could be more than for a health benefit but rather social interaction or coffee for its drug effects on the brain rather taste. (Crossman, 2019)

Is the saying, “money can’t buy happiness” true? The economic boom in Dehli, India proves it to be. The suicide rates in India are highest amongst the rich, in ages ranging from 15 to 29, as well the well educated. (NDTV.com, 2012;Lancet 2012; Kendall, 2018 p.7) It is understandable that with wealth and proper education more opportunities are introduced, however, so are job performance anxieties, mental and health issues (e.g. sleep disorders, depression, heart issues) and weakened relationships with people because of moving. When people move because of an increase of income, they lose social support which is expressed to be very important in the functionalist perspective of sociological imagination. The functionalist perspective, when disrupted leave people to question their lives and their ability to live it. One study that examined the functions of social support in reducing or preventing suicidal ideation in Air Force personnel during U.S. combat operations in Iraq and Afghanistan found that all forms of social support were not equally important in protecting individuals against suicidal thoughts or actions. Esteem support played a big factor in the severity of the Air Force personnel’s thoughts of suicide. (Kendall, 2018 p.15)

Sociological imagination helps identify the causes (and indirect preventions) and solutions by placing flaw in public issues rather than a person’s life’s decisions. Shame is a factor I’ve observed that results in suicide and many seemingly private acts like it. Others shame people into losing their interests and rob them of the fact they are human. This shame tactic is often seen with teen pregnancies, addiction, homelessness, incarceration and even simply music taste. Resources for help and guidance in certain communities are limited or not utilized as a result of self-shame or fear of being ridiculed.

Overall, the sociological approach has allowed for us the opportunity to look more in depth to an act deemed private. It allows us to take the action of an individual that would other wise be classified as personal and relate it to and identify society’s role in that action. We are able to then use theories and perspectives to help further understand an individual and find solutions to help.

 

 

 

 

Kendall, D (2018) Sociology in our times: The essentials (11 ed). Boston: Cengage Learning

 

Examples of Sociological Imagination. (n.d.). In YourDictionary. Retrieved from https://examples.yourdictionary.com/examples-of- sociological-imagination.html

 

Crossman, Ashley. (2019, March 26). Definition of the Sociological Imagination and Overview of the Book. Retrieved from https://www.thoughtco.com/sociological-imagination- 3026756)

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Sheila Farr (Instructor) Yesterday

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Hello Students,

Thinking specifically about the connection between personal troubles and public issues, do you think there are any social problems in which this connection is hard to make? For example, can you look at poverty in general from this perspective?

Best,

Sheila Farr

Sameera Farhood Yesterday

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Poverty from a sociological stand point can be interpreted in many different ways. Two main ways are; someone living in poverty brought it upon themselves or someone is living in poverty due to the society they live in and social forces around them. Generally speaking I truly think linking poverty (a personal trouble) to public issues is a hard connection to make.

Think of it this way, you can attempt to link poverty to unemployment issues globally but; not everyone who is unemployed is poor and not everyone who is poor is unemployed. Poverty is one of those things that is not fully understood yet due to the many different people/social classes dealing with the issue.

I do believe that there are some social forces and public issues that can be linked to poverty, especially those who are dealing with it while employed. For example, you have a single mother who is living in poverty while working a full time job but she’s only being paid minimum wage and she has to provide for herself and her child. With that example, we could definitely link minimum wage being too low (a public issue) to poverty (a personal trouble).

Although looking at poverty from a sociology stand point can be difficult, there are some ways you can look at it from the perspective of linking a personal trouble to a public issue.

Eric Devich Yesterday

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The Sociological Imagination helps to examine private acts such as suicide in a larger societal content as explained by the Sociologist C. Wright Mills. He helped individuals see the relationship between personal experiences and the larger social world. Suicide is more of an individual act of oneself that may be the result of personal troubles or social issues. Personal troubles are private problems that affect individuals and the networks of people with whom they regularly associate (Kendall, 2018, p. 6). Today, there are many trends in different countries all around the world that influence the current rise of youth suicide. One example, in New Delhi, India, suicide rates are highest in the 15-29 age category and are especially high among those living in the wealthier and more educated regions of the nation (NDTV.com, 2012;Lancet 2012; Kendall, 2018, p. 7). One might believe that in the world today, areas of great wealth would have lower risk of suicide. When in reality, they have the highest risk. Intensified job anxiety, higher expectations, and more pressure for individual achievement (Kendall 2018, p. 6). People would normally think the poor and uneducated would have the greater risk of suicide.

Some trends that are increasing youth suicide in the United States are income, gender disparities, age group differences and risk factors. In the United States, females are more likely to commit suicide than males. Some risk factors may include not having access to healthcare, to help prevent the chance of an individual committing suicide. Trends that lead to suicide in the U.S. Military may include unequal social support or companionship. Tangible support, which an individual has someone who is willing to help them with money or assistance. Appraisal support, which requires having someone to listen and hear problems and provide useful information on how to solve them. Esteem support deals with having people show concern for an individuals well-being and have confidence in that individual to overcome any obstacle. Esteem support was found to be one of the most important factors in whether the Air Force personal had experienced severe suicidal ideation (Kendall 2018, p. 15).

Today, the sociological imagination allows us to bridge the connection between why an individuals problems and thoughts of suicide occur in relation to problems in society. Social issues are the main reason why individuals commit suicide. Being able to distinguish between personal troubles and greater social issues is the true heart of of thinking sociologically (Wiley 2015). I have observed many ways that suicide has been expressed to the public. Whether it has been on television or on social media. It does not help that almost everyone in the world has easy access to both of these and in return is exposed to the ways that some individuals live their daily lives. Seeing this puts an added pressure on individuals who may not live an extravagant lifestyle. Individuals posting on social media such as, Facebook and Instagram, expressing a new job and are advancing up the ladder of success. Individuals today are triggered by this because they may not possess the same skills and advantages that some individuals may have. Many times individuals feel that their failure to get hired is a personal problem due to a poor interview or lack of experience (Wiley 2015). Another problem in society today are structures. Structures are “common and persistent roles and relationships that shape human interaction (Wiley 2015). Relationships could be husband and wife, boyfriend and girlfriend, employee and employer. Problems between structures can lead to suicide. Whether it may be an argument between a husband and a wife or the loss of a job to an employer. Both of these are reasons in a society that lead to suicide. Individual choices of a person reflect how they see themselves. Society looks at individuals who are different from the rest and considers them to be outcasts. Individuals involved in teen pregnancy, drugs, or even who smoke are open targets for society to single out and look at differently. Social media has a big influence on depicting this and how these individuals are shown. Television shows picturing women who became pregnant at a young age and now have trouble supporting there children because they’re trying to go to school and work at the same time. All of this shows what can happen after making poor choices. Society today looks down on individuals who make the poor choices. As a result, that individual becomes ignored and feels like they are not accepted anymore in society.

Overall, C. Wright Mill’s Social Imagination has helped us to paint a bigger picture and really understand how society has an influence on the lives of its people. If we don’t make a change, suicide as a resort to end individual problems will continue to rise. It is clear that being aware of structures and institutions can drastically alter the way we view the world. They act as tools within the greater sociological imagination to help us think critically about why individuals may make choices (Wiley 2015). Being able to analyze the smallest problems with the biggest problems of an individual, will help to understand how an individual issue can become more public in society.

 

 

Kendall, D. (2018). Sociology in our times: The essentials (11 ed). Boston: Cengage Learning

Wiley, Jeanette. “Sociological Imagination: A Critical Way to the World (Community, Environment, and Development: An Undergraduate Research Journal).” Community, Environment, and Development: An Undergraduate Research Journal (Penn State University), 6 May 2015, https://aese.psu.edu/students/research/ced- urj/news/2015/sociological-imagination-a-critical- way-to-the-world.

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Mental health processes and disorders originate from mechanisms within the brain.

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TO DO A REPLY COMMENT TO EACH POST. TWO REFERENCE PER COMMENT.
Post 1

Mental health processes and disorders originate from mechanisms within the brain. There has been the question within the psychiatric field as to whether plastic changes in the brain that can occur with the use of  pharmacological interventions for mental health disorders could also occur with the use of psychotherapy. Psychotherapy is extremely beneficial in treating several mental health issues (Laureate Education, 2016).There is compounding evidence that psychotherapy does have a biological basis and can have a positive impact in brain recovery from the stress response. According to Wheeler (2014), psychotherapy mediates the reintegration and connection of neural networks that have become maladaptively linked due to adverse life events facilitating healing of the brain. Psychotherapy has been found to be an effective treatment method for a variety of mental health disorders such as anxiety, major depression, and post-traumatic stress disorder. According to Fournier (2014), activity in regions associated with negative emotion, emotion regulation, fear, and reward are associated with respones to psychotherapy, and psychotherapy appears to alter the functioning of these regions.

While proven to be an effective treatment modality for mental health disorders, there are factors such as culture, religion, and socioeconomic background that can affect the client and their perspective on the use of psychotherapy. Psychotherapy within itself can bring conflicting emotions for the client and the clinician must be aware of how religion, culture, and socioeconomics can alter how the client perceives psychotherapy and its efficacy in their treatment. According to Wheeler (2014), the powerful influence of culture permeates all dimensions of out life in a way that is often unconscious. For example, if a client comes from a culture where emotions are not to be discusssed or if one discusses there past traumas or fears then the client could be resistant to the role of psychotherapy in their treatment plan. The clinician must be aware of the importance of culture in medical or psychological treatments. Religion also plays an instrumental role in how psychotherapy will be perceived by a client. Many clients may come from a religious background where one only speaks of negative emotions with someone from their clergy or a religious figure. According to Kim, Chen & Brachfeld (2018), religion and spirituality are important issues to consider and address in psychotherapy. Communication could become stagnant if the clinician is not aware of the role religion plays in the psychotherapy framework. Socioeconomic background can also be a variable in one‘s perspective of the value of psychotherapy. Certain traumatic events that a person can suffer throughout their lifetime can be directly correlated to socioeconomic standing. For example, poverty can be associated with depression, anxiety, substance abuse, and mood disorders. Patients from this type of background can experience barriers in both seeking and receiving mental health services. According to Bernal et al. (2017), vulnerable populations such as those low in social status face additional barriers to mental health treatment and experience unique barriers to receiving optimal care.

References

Bernal, D.R., Herbst, R.B., Lewis, B.L., & Feibelman, J. (2017). Ethical care for vulnerable populations receiving psychotropic treatment. Ethics & Behavior, 27(7), 582-598. doi:10.1080/10508422.2016.1224187

Fournier, J.C., & Price, R.B. (2014). Psychotherapy and neuroimaging. Psychotherapy: New Evidence and New Approaches, 12(3), 290-298. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4207360

Kim, E.E., Chen, E.C., & Brachfeld, C. (2018). Patients’ experience of spirituality and change in individual psychotherapy at a Christian counseling clinic: A grounded theory analysis. Spirituality in Clinical Practice, doi:10.1037/scp0000176

Laureate Education (Producer). (2016). Introduction to psychotherapy with individuals [Video file]. Baltimore, MD: Author.

Wheeler, K. (Eds.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.

POST 2

Psychotherapy is just as controversial as mental health as a whole is. Some believe it is helpful, others believe it is a waste of time. One question still remains unanswered for many, can talking about feelings help change behavior and therefore sure whatever condition a person is suffering from? I believe psychotherapy has a biological basis. Lyrakos, Spinaris, and Spyropoulos (2017) clearly stated as results of a research that “the use of psychotherapy plays a significant role in achieving optimal health outcomes of psychiatric patients” (p. s753). Pairing psychopharmacology with psychotherapy can make a positive impact towards recovery compared to treatment with just psychopharmacology.

Many different reasons can influence the belief that psychotherapy might or might not work. For example, Adams et al. (2017) concluded in an article that “findings suggest that patients’ attachment characteristics play a role in their views and choices regarding treatments” (p. 194). Other factors that can impact the belief that therapy is a waste of time are culture, religion, and socioeconomic status. A person’s upbringing can be one to avoid talking about feelings with a stranger, or even with a loved one. Religion can also play a role in not receiving this type of treatment as faith in a spiritual belief might be the perceived as the cure to an ailment. Economical status and education level can also negatively impact the decision to avoid this type of treatment as the importance of it might not be completely comprehended or there are no means to afford the treatment. In another study that correlates the importance of psychotherapy, data showed “that children/adolescents with not only behavioral and emotional disorders, but also affective (mood) disorders had a higher chance for nondrug psychiatric/psychotherapeutic treatment compared to children with other psychiatric disorders” (Abbas et al., 2017, p. 442).

References

Lyrakos, G., Spinaris, V., & Spyropoulos, I. (2017). The introduction of psychotherapy in

psychiatric outpatients as part of the treatment in the last four years in a Greek

hospital. European Neuropsychopharmacology, 27(4).

Adams, G. C., McWilliams, L. A., Wrath, A. J., Adams, S., & Souza, D. D. (2017).

Relationships between patients’ attachment characteristics and views and use of

psychiatric treatment. Psychiatry Research, 256:194-201.

Abbas, S., Ihle, P., Adler, J., Engel, S., Günster, C., Holtmann, M., & …Schubert, I. (2017).

Predictors of non-drug psychiatric/psychotherapeutic treatment in children and

adolescents with mental or behavioral disorders. European Child & Adolescent

            Psychiatry, 26(4).

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In the first 60 years after the founding of the American Psychological Association (APA) in 1892, no formal code of ethics existed (Pope & Vetter

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18 ETHICS IN PSYCHOTHERAPY

NORMAN ABELES AND GERALD P. KOOCHER

In the first 60 years after the founding of the American Psychological Association (APA) in 1892, no formal code of ethics existed (Pope & Vetter, 1992). Not until 1938 did APA establish a Committee on Scientific and Pro- fessional Ethics and begin dealing with ethical complaints on an informal basis (Golann, 1969). In 1948, development of a formal ethical code began under the leadership of Nicholas Hobbs (1948). The first provisional Ethical Standards of Psychologists ultimately won adoption by the APA Council of Representatives in 1952 for a 3-year trial period (APA, 1953).

The standards originated using a critical incident methodology (Flanagan, 1954). APA encouraged its members to critique the 1953 publication and provide additional incidents leading to a vote of the membership principle by principle, with formal adoption by the Council to follow in 1955. The APA has revised its code a number of times in ensuing years, but not until the 2002 revision did it again use a critical incident survey. In the 5 years leading to adoption of that revision, APA invited both critiques and case examples that did not seem well addressed in prior versions. During that revision APA members and the public could submit comments and cases via the APA web- site for electronic review by the Ethics Code Revision Task Force. The APA

http://dx.doi.org/10.1037/12353-048 History of Psychotherapy: Continuity and Change (2nd Ed.), edited by J. C. Norcross, G. R. VandenBos, and D. K. Freedheim Copyright © 2011 American Psychological Association. All rights reserved.

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approach proved more relevant to actual practice than codes developed by other professional associations by virtue of the early reliance on actual incidents, and the resulting document became a model for the ethical codes of other health professions.

As the practice of psychotherapy bloomed, and as more psychologists and other professions entered the field, attention to the unique ethics of psychotherapy broadened. Other professional groups added their own per- spectives, and the major professions of psychotherapists have all evolved distinct ethical codes. These include the American Association for Marriage and Family Counseling (2001), American Counseling Association (2005), American Psychiatric Association (2006), and National Association of Social Workers (1999). Many more specialized psychotherapy ethical codes exist, and one can easily locate these via Web searches (Pope, 2008).

An important survey of ethical dilemmas encountered by APA members (Pope &Vetter, 1992) yielded categories of ethically troubling incidents closely tied to psychotherapy. The prominent categories involved confidentiality; blurred, multiple, and/or conflicted relationships; and payment for services. Reports of the APA Ethics Committee describing the nature and incidence of ethical complaints, published annually in American Psychologist, suggest that these three categories remain the most salient bases for complaints in psychotherapy practice. In the pages that follow, we trace the evolution of these three concerns over the past 6 decades and then consider controversial professional and public issues related to psychotherapy.

CONFIDENTIALITY

American history provides many examples of how breaches in confi- dentiality of mental health information have hurt both clients and society. Thomas Eagleton, a senator from Missouri, was dropped as George McGovern’s vice presidential running mate in 1968 following public disclosure that he had previously undergone hospitalization for the treatment of depression. Dr. Lewis J. Fielding, better known as “Daniel Ellsberg’s psychiatrist,” certainly did not suspect that the break-in at his office by federal agents on September 3, 1971, might ultimately contribute to the only resignation of an American president (Morganthau, Lindsay, Michael, & Givens, 1982; G. R. Stone, 2004). Disclosures of confidential information received by therapists also played prominently in the press during the well-publicized murder trials of the Menendez brothers (Scott, 2005) and O. J. Simpson (Hunt, 1999).

No discussion of confidentiality in the mental health arena can occur without reference to the Tarasoff case (Tarasoff v. Board of Regents of the

724 ABELES AND KOOCHER

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University of California, 1976) and the family of so-called progeny cases that followed in its wake (see Quattrocchi & Schopp, 2005; A. A. Stone, 1976; VandeCreek & Knapp, 2001), as these contributed to significant changes in how psychotherapists deal with confidentiality. The case began in fall 1969, when a student at the University of California’s Berkeley campus killed Ms. Tarasoff, a young woman who had spurned his affections. The perpetrator had sought psychotherapy at the university’s student health facility and gave his psychologist cause to seek civil commitment by notifying police about fears that his client posed a danger to Ms. Tarasoff. The police concluded that the patient did not pose a danger and secured a promise that he would stay away from Ms. Tarasoff. After his release by the police, the man understandably never returned for further psychotherapy, and 2 months later killed Tarasoff. California courts determined that the psychologist had a duty to protect Ms. Tarasoff and awarded damages. With respect to risk to public safety, little hard data exist to demonstrate that warnings effectively prevent harm, although reasonable indirect evidence does suggest that treatment can pre- vent violence (Douglas & Kropp, 2002; Otto, 2000). Obviously, ethical prin- ciples preclude direct empirical validation of management strategies that may or may not prevent people at a high risk from doing harm to others (Koocher & Keith-Spiegel, 2008).

In addition, many states had already begun passing legislation mandat- ing that certain professionals, including psychologists, report knowledge of physical or emotional abuse of vulnerable persons (e.g., children, older people, people with disabilities). APA subsequently amended its Ethics Code to reflect authorized breaches to prevent imminent harm to self or others, or as mandated by law.

In 1996, Congress enacted Public Law 104-191, better known as the Health Insurance Portability and Accountability Act or HIPAA. Regulations and implementation took several years, but many focus on protecting the privacy of personal health information (PHI). HIPAA specifies that health care providers, including psychotherapists, must give clients specific notices about the confidentiality of records and standards for authorizing the release of PHI. It is interesting to note that the APA Ethics Code already addressed most of the key principles mandated under HIPAA, albeit with less specificity (e.g., the need to alert clients about limits of confidentiality at the outset of the professional relationship, releasing information to third parties only with a client’s consent). As a result of these cases and statutes, psychotherapists in the United States must ethically give all clients information on the limits of confidentiality at the outset of a professional relationship and must breach confidentiality in certain circumstances to protect the client or other vulner- able parties.

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MULTIPLE RELATIONSHIPS

The APA (2002) “Ethical Principles of Psychologists and Code of Conduct” defines multiple role relationships as occurring when a psychologist stands in a professional role with a person and also (a) holds another role with the same person, (b) has a relationship with someone closely associated with or related to the person with whom the psychologist has the professional relationship, or (c) makes promises to enter into another relationship in the future with the person or a person closely associated with or related to the person. One often cannot avoid such role overlap, and the APA Ethics Code recognizes this by noting that not all multiple role relationships with clients are necessarily unethical so long as no risk of harm can be reasonably expected. The code admonishes psychologists to refrain from entering a multiple role relationship when their objectivity, competence, or effectiveness in performing their professional functions could be impaired or if a risk of exploitation exists.

Some mental health professionals decry the concept of professional boundaries, asserting that they promote the conduct of psychotherapy as a mechanical technique rather than relating to clients as unique human beings. Such critics call attention to boundaries’ rigid, cold, and aloof “cookbook therapy,” harmful to the natural process of psychotherapy (Koocher & Keith- Spiegel, 2008). Lazarus (1994) put it bluntly: “Practitioners who hide behind rigid boundaries, whose sense of ethics is uncompromising, will, in my opinion, fail to really help many of the clients who are unfortunate enough to consult them” (p. 260).

The evolution of strong concern about boundaries appeared most intensely in the mid-20th century. As described in Chapter 13a, Jean-Marc Itard thought nothing of taking “the wild boy of Aveyron” into his home for treatment in 1799. In 1914, Sigmund Freud sent his daughter, Anna, on a trip to England in the care of one of his patients, Leo Kann. Freud later conducted the psycho- analysis of Anna from 1918 to 1922. Anna in turn analyzed Erik Erikson and allowed him to travel with the family on vacations so that he could continue his treatment. One of the most sensational accounts of multiple role conflicts concerns Henry A. Murray (related by his authorized biographer Forrest Robinson [1992]). In spring 1925 Murray visited Carl Jung in Zurich and told Jung of his infatuation with Christiana Morgan, the wife of a friend, with whom Murray would later create the Thematic Apperception Test. Murray’s story triggered a self-disclosure by Jung of his intimate relationship with his patient Antonia “Toni” Wolff, conducted with the full approval of his wife, Emma Jung. At Murray’s urging, Jung agreed to see Christina in October 1925 and encour- aged her to become Murray’s professional and sexual muse, while both were married to other people.

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In the latter part of the 20th century, complaints by patients alleging harmful sexual intimacies with psychotherapists became significant ethical and professional problems. Increasingly, the field became aware of how social and business relationships can compromise the quality of professional ser- vices and integrity (Koocher & Keith-Spiegel, 2008). These factors led to the founding of the interdisciplinary Neuroethics Society, which held its first meeting in November 2008. The society’s president, Steven Hyman, a psychiatrist turned neurobiologist and provost of Harvard University, spoke on “Neuroethics of Pediatric Bipolar Disorder.” He discussed the controversy of assigning the diagnosis of bipolar disorder to hundreds of thousands of American children who never before had signs of major mood disorder, and simultaneously treating these children with powerful drugs in off-label usage (i.e., treatment with drugs neither tested nor approved by the Food and Drug Administration for use in children). Other speakers noted the extremely rare incidence of the same diagnosis outside of the United States.

As new medications abound, adult diagnoses such as bipolar disorder and attendant off-label drug treatments have found their way to children as young as 2 or 3 years old. Such medications pose significant unevaluated risks for children at young ages. How has this ethically risky practice evolved? Recent congressional investigations by Senator Chuck Grassley (R-Iowa) have revealed enormous conflicts of interests involving several of the strongest proponents of such medical applications. Two Boston Globe reporters broke the story of a world-renowned Harvard Medical School professor and child psychiatrist at the Massachusetts General Hospital whose work fueled “an explosion in the use of powerful antipsychotic medicines in children,” earning him at least $1.6 million in consulting fees from pharmaceutical companies between 2000 and 2007. The psychiatrist and two of his colleagues allegedly never reported much of their income from the drug companies, estimated at a combined $4.2 million over 7 years, to university officials (Harris & Carey, 2008). The psychiatrists earned much of the money giving continuing medical education lectures teaching other physicians about prescribing such drugs to children.

Couple these circumstances with long-sought mental health parity legis- lation (i.e., granting fiscal parity to coverage of mental conditions with that afforded physical conditions), and one sees interesting contradictions. The same professionals who support a biopsychosocial model of emotional problems willingly adopted enough focus on “illness” to seek insurance reimbursement parity (i.e., more money to pay providers). Many psychiatrists, who have increasingly eschewed psychotherapy training over psychopharmacology practice (Gabbard, 2005), have flocked to incorporate the new off-label uses into their practices. Just as others have argued against viewing psychological problems as mental illnesses (Szasz, 1960), we now see economic forces aligning

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to promote remedicalization of such difficulties and even create new ones to fit existing or newly created drug protocols (Harris & Carey, 2008). Many years will pass before one can assess whether these shifting roles, trends, and motivations benefit patients or practitioners more.

PAYMENT PROBLEMS

Payment for psychotherapy services has played a significant role in the evolution of service delivery. In particular, the advent of health insurance and coverage for mental conditions influences who practices psychotherapy and how. During the early years of the psychoanalytic movement, few people sought or could afford individual therapy, and professional regulation as we know it today did not exist. So-called lay analysts abounded. From the perspective of psychology, the post–World War II era saw a boom in the training of psychologists and struggles with psychiatry over which profession owned psychotherapy. The key became insurance reimbursement, as psychologists sought licensing recognition, demanded “freedom of choice” laws, and created organizations such as the National Register of Health Service Providers in Psychology to help secure insurance coverage for their services. The 1990s brought managed care and growing ranks of licensed mental health providers who needed to account to third parties (i.e., the client and therapist being the first and second parties) for their therapeutic decisions and treatment plans.

Today, newly licensed mental health professionals worry about their ability to secure a listing on overcrowded rolls of approved health insurance providers. And practice patterns have changed dramatically. Most younger psychiatrists have reduced or completely ceased practicing psychotherapy in favor of pharmacotherapy (Gabbard, 2005), and licensed psychotherapists at the master’s degree level abound. This has led to many efforts by psycho- therapists to differentiate themselves with brand-name psychotherapies, discussed below, and has led to a host of ethical problems related to third- party payments. Some of these concern co-insurance (i.e., copayments and deductibles), billing for missed appointments, and other potential contract violations (Koocher & Keith-Spiegel, 2008). The key to ethical conduct in financial matters involves carefully informing clients of fees and other costs in advance and securing their agreement to these prior to billing. In addition, when psychologists sign a contract with a third-party payer, they must honor provisions of that contract by such acts as collecting specified copayments and not billing clients for amounts in excess of contractual agreements.

The modern reality involves ethical dealings with clients, government, and insurers who have a powerful say in what services they will pay for and what data they will demand to process such payments. In every case, obeying

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