In a 3-5 page scholarly paper you will evaluate the Hot Topic attached. Address the concepts of the topic and your professional opinion on the issues addressed in “Ethical Issues for the Integration of Religion and Spirituality in Therapy.”

After reading the “Hot Topic” you will use the  Library to find 3-5 scholarly articles regarding ethics and religion/spirituality. You will evaluate the facts of each article and present your professional conclusions, using the text and other references.

Using the Ethics Code, evaluate how the Code works in a religious/spiritual therapy setting. Explain why the APA ethical standards are important in this application. When writing your paper, review all of the standards of the Code that you believe are particularly related to this topic. .

Along with the text, use a minimum of three to five scholarly journal articles.

Your project should include the following:

Title Page

Abstract

Body paper 3-5 pages

References

HOT TOPIC

Ethical Issues for the Integration of Religion and Spirituality in Therapy

The past decade has witnessed increased attention to the importance of understanding and respecting client/patient spirituality and religiosity to psychological assessment and treatment, as well as recognition that religious and spiritual factors remain underexamined in research and practice (APA, 2007d). Advances in addressing the clinical relevance of faith in the lives of clients/patients have raised new ethical dilemmas rooted in theoretical models of personality historically isolated from client/patient faith beliefs, the paucity of research on the clinical benefits or harms of injecting faith concepts into treatment practices, group differences in religious practices and values, and individual differences in the salience of religion to mental health (Shafranske & Sperry, 2005; Tan, 2003).

The Secular–Theistic Therapy Continuum

Integration of religion/spirituality in therapy can be characterized on a secular–theistic continuum. Toward the secular end of the continuum are “religiously sensitive therapies” that blend traditional treatment approaches with sensitivity to the relationship of diverse religious/spiritual beliefs and behaviors to mental health. Midway on the continuum are “religiously accommodative therapies” that do not promote faith beliefs but, when clinically relevant, use religious/spiritual language and interventions consistent with clients’/patients’ faith values to foster mental health. Toward the other end of the continuum are “theistic therapies” that draw on psychologists’ own religious beliefs and use sacred texts and techniques (prayer, forgiveness, and meditation) to promote spiritual health.

The sections that follow highlight ethical challenges that emerge along all points of the secular–theistic therapy continuum.

Competence

All psychologists should have the training and experience necessary to identify when a mental health problem is related to or grounded in religious beliefs ( Standards 2.01 b, Boundaries of Competence, and 2.03, Maintaining Competence; see also Bartoli, 2007; W. B. Johnson, 2004; Plante, 2007; Raiya & Pargament, 2010; Yarhouse & Tan, 2005). Personal faith and religious experience are neither sufficient nor necessary for competence (Gonsiorek, Richards, Pargament, & McMinn, 2009). There is no substitute for familiarity with the foundational empirical and professional mental health knowledge base and treatment techniques. While personal familiarity with a client’s/patient’s religious affiliation can be informative, religious/spiritual therapeutic competencies for mental health treatment include

· understanding how religion presents itself in mental health and psychopathology;

· self-awareness of religious bias that may impair therapeutic effectiveness, including awareness that being a member of a faith tradition is not evidence of expertise in the integration of religion/spirituality into mental health treatment;

· techniques to assess and treat clinically relevant religious/spiritual beliefs and emotional reactions; and

· knowledge of data on mental health effectiveness of religious imagery, prayer, or other religious techniques.

Collaboration With Clergy. Collaborations with clergy can help inform psychologists about the origins of the client’s beliefs, demonstrate respect for the client’s religion, and avoid trespassing into theological domains by increasing the probability that a client’s incorrect religious interpretations will be addressed appropriately within his or her faith community (W. B. Johnson, Redley, & Nielson, 2000; Richards & Bergin, 2005;  Standard 3.09 , Cooperation With Other Professionals). When cooperation with clergy will be clinically helpful to a client/patient, psychologists should

· obtain written permission/authorization from the client/patient to speak with a specific identified member of the clergy,

· share only information needed for both to be of optimal assistance to the client/patient ( Standard 4.04 , Minimizing Intrusions on Privacy),

· discuss with the clergy where roles might overlap (e.g., family counseling, sexual issues), and

· determine ways in which the client/patient can get the best assistance.

Avoiding Secular–Theistic Bias

Psychologists must ensure that their professional and personal biases do not interfere with the provision of appropriate and effective mental health services for persons of diverse religious beliefs (Principle D: Justice and Principle E: Respect for People’s Rights and Dignity;  Standards 2.06 , Personal Problems and Conflicts, and 3.01, Unfair Discrimination).

Disputation or Unquestioned Acceptance of Client/Patient Faith Beliefs. Trivializing or disputing religious values and beliefs can undermine the goals of therapy by threatening those aspects of life that some clients/patients hold sacred, that provide supportive family and community connections, and that form an integral part of their identity (Pargament, Murray-Swank, Magyar, & Ano, 2005;  Standard 3.04 , Avoiding Harm). Similarly, some religious coping styles can be deleterious to client/patient mental health (Sood, Fisher, & Sulmasy, 2006), and uncritical acceptance of theistic beliefs, when they indicate misunderstandings or distortions of religious teachings and values, can undercut treatment goals by reinforcing maladaptive ways of thinking or by ignoring signs of psychopathology. In addition, psychologists should not assume that religious or spiritual beliefs are static and be prepared to help clients/patients identify changes reflecting spiritual maturity positively tied to treatment goals (Knapp, Lemoncelli, & VandeCreek, 2010). To identify if clients’/patients’ religious beliefs are having a deleterious effect on their mental health, psychologists should explore whether their beliefs (a) create or exacerbate clinical distress, (b) provide a way to avoid reality and responsibility, (c) lead to self-destructive behavior, or (d) create false expectations of God (W. B. Johnson et al., 2000). When appropriate, psychologists should consider consulting with clergy to determine if a clients’/patients’ religious beliefs are distortions or misconceptions of religious doctrine.

Imposing Religious Values

Using the therapist’s authority to indoctrinate clients/patients to the psychologists’ religious beliefs violates their value autonomy and exploits their vulnerability to coercion (Principle E: Respect for People’s Rights and Dignity;  Standard 3.08 , Exploitative Relationships). When clients/patients are grappling with decisions in areas in which religious and secular moral perspectives may conflict (e.g., divorce, sexual orientation, abortion, acceptance of transfusions, end-of-life decisions), therapy needs to distinguish between those religious values that have positive or destructive influences on each individual client’s/patient’s mental health—not the religious or secular values of the psychologist. Professional license to practice psychology demands that psychologists provide competent professional services and does not give them license to preach (Plante, 2007). Psychologists should guard against discussing religious doctrine when it is irrelevant to the clients’/patients’ mental health needs (Richards & Bergin, 2005).

Confusing Religious Values With Psychological Diagnoses. The revised Guidelines for Psychological Practice With Lesbian, Gay and Bisexual Clients (APA, 2012d) encourages psychologists to consider the influences of religion and spirituality in the lives of lesbian, gay, and bisexual specifically and transgender and questioning clients in general. The linking of religious values and psychotherapies involving LGBT clients/patients has drawn a considerable amount of public attention. Spiritually sensitive, accommodative, and theistic therapies have a lot to offer LGBT clients/patients (Lease, Horne, & Noffsinger-Frazier, 2005). LGBT persons vary in their religious backgrounds and the extent to which it affects their psychological well-being. Ethical problems arise, however, when psychologists confuse a client’s/patient’s conflicted feelings about their sexual orientation and religious values with psychological diagnoses. Such ethical challenges have raised considerable professional dialogue as they relate to the application of conversion therapies to alter sexual orientation.

All major professional mental health organizations have affirmed that homosexuality is not a mental disorder ( www.apa.org/pi/lgbc/publications/justthefacts.html#2 ). In addition, to date, empirical data dispute the effectiveness of conversion/reparative therapies aimed at changing sexual orientation ( www.Psychology.org.au/Assets/Files/reparative_therapy.pdf ). Psychologists who offer such therapies to LGBT clients/patients risk violating  Standard 2.04 , Bases for Scientific and Professional Judgments. Moreover, when psychologists offer “cures” for homosexuality, they falsely imply that there is established knowledge in the profession that LGBT sexual orientation is a mental disorder. This, in turn, may deprive clients/patients of exploring internalized reactions to a hostile society and risks perpetuating societal prejudices and stereotypes (Cramer, Golom, LoPresto, & Kirkley, 2008; Haldeman, 1994, 2004; Principle A: Beneficence and Nonmaleficence; Principle B: Fidelity and Responsibility; and Principle D: Justice;  Standard 3.04 , Avoiding Harm). In addition, when psychologists base their diagnosis and treatment on religious doctrines that view homosexual behavior as a “sin,” they can be in violation of  Standard 9.01 , Bases for Assessments, and may be practicing outside the boundaries of their profession.

Multiple Relationships

Multiple relationship challenges arise when clergy who have doctoral degrees in psychology provide mental health services to congregants or nonclergy psychologists who treat members of their faith communities ( Standard 3.05 , Multiple Relationships).

Clergy–Psychologists. Clergy–psychologists providing therapy for members of their faith over whom they may have ecclesiastical authority should take steps to ensure they and their clients/patients are both aware of and respect the boundaries between their roles as a psychologist and as a religious leader. Distinguishing role functions becomes particularly important in addressing issues of confidentiality. Psychologists and clergy have different legal and professional obligations when it comes to mandated reporting of abuse and ethically permitted disclosures of information to protect clients/patients and others from harm ( Standard 4.05 , Disclosures).

Therapists at all points along the secular–theistic continuum who share the faith beliefs of clients/patients or work with fellow congregants must take steps to ensure that clients do not misperceive them as having religious or ecclesiastical authority and understand that the psychologists do not act on behalf of the church or its leaders (Gubi, 2001; Richards & Potts, 1995). This may be especially challenging for nonclergy religious psychologists working in faith-based environments (Sanders, Swenson, & Schneller, 2011). Psychologists also need to take steps to ensure that their knowledge of their joint faith community does not interfere with their objectivity and that clients/patients feel safe disclosing and exploring concerns about religion or behaviors that might ostracize them from this community.

Fee-for-Service Quandaries. While psychologists can discuss spiritual issues in therapy, when services are provided as a licensed psychologist eligible for third-party payments, the primary focus must be psychological (Plante, 2007). A focus on religious/spiritual rather than therapeutic goals may risk inappropriately charging third-party payors for nonmental health services not covered by insurance policies (Tan, 2003; see also Principle C: Integrity;  Standard 6.04 , Fees and Financial Arrangements). Clergy and nonclergy psychologists practicing theistic therapies may find it difficult to clearly differentiate in reports to third-party payors those goals and therapeutic techniques that are accepted mental health practices and those that are spiritually based. In most instances clergy–psychologists should encourage their congregants to seek mental health services from other providers in the community and refrain from encouraging their congregants to see them for fee-for-service therapy ( Standard 3.06 , Conflict of Interest). When clergy or nonclergy psychologists provide spiritual counseling free of charge in religious settings, they should clarify they are counseling in their ecclesiastical role and that content will be specific to pastoral issues (Richards & Bergin, 2005).

Informed Consent

The role of religion/spirituality in clients’/patients’ worldview may determine their willingness to participate in therapies along the secular–theistic continuum. Some may find the interjection of religion into therapy discomforting or coercive, while others may find the absence of religion from therapy alienating.

When scientific or professional knowledge indicate that discussion of religion may be essential for effective treatment ( Standards 2.01 b, Boundaries of Competence; 2.04, Bases for Scientific and Professional Judgments), informed consent discussions can help the client/patient and psychologist identify and limit for treatment those religious beliefs and practices that facilitate or interfere with treatment goals (Rosenfeld, 2011; Shumway & Waldo, 2012). In some contexts, it may be ethically appropriate to discuss the risks involved in exploration of the client’s religious beliefs, including loss of current coping mechanisms, stress produced by self-questioning of religious beliefs, and diminished capacity to seek support from one’s religious community (Rosenfeld, 2011). The goal of such discussions is to enhance the therapeutic alliance and treatment context through client–therapist mutual understanding and respect.

When treatments diverge from established psychological practice, clients/patients have a right to consider this information in their consent decisions. Consequently, informed consent for theistic therapies should explain the religious doctrine and values upon which their treatment is based, the religious methods that will be employed (e.g., prayers, reading of scripture, forgiveness), and the relative emphasis on spiritual versus mental health goals. In addition, since theistic therapies are relatively new and currently lack empirical evidence or disciplinary consensus regarding their use (Plante & Sherman, 2001; Richards & Bergin, 2005), psychologists practicing these therapies should consider whether informed consent requirements for “treatments for which generally recognized techniques and procedures have not been established,” described in  Standard 10.01b , apply.

Conclusion

There is a welcome increase in research examining the positive and negative influences of religious beliefs and practices on mental health and the clinical outcomes of treatment approaches along the secular–theistic therapy continuum. Ethical commitment to do what is right for each client/patient and well-informed approaches to treatment will reduce, but not eliminate, ethical challenges that will continue to emerge as scientific and professional knowledge advances. Psychologists conducting psychotherapy with individuals of diverse religious backgrounds and values will need to keep abreast of new knowledge and ethical guidelines that will emerge, continuously monitor the consequences of spirituality and religiously sensitive treatment decisions on client/patient well-being, and have the flexibility and sensitivity to religious contexts, role responsibilities, and client/patient expectations required for effective ethical decision making.

Reference:

Fisher, C. B. (20120904). Decoding the Ethics Code: A Practical Guide for Psychologists, 3rd Edition. [MBS Direct]. Retrieved from https://mbsdirect.vitalsource.com/#/books/978145228587

1. The “frog in the well” analogy illustrates:

Answers
1. a. that frogs start life as tadpoles.
2. b. that frogs are limited in perspective when trapped in a well, but once freed, they can see the whole world.
3. c. frogs change and evolve throughout their lives.
4. d. humans evolved from frogs.
2. The way people grow and change across the life span is referred to as ____.

Answers
1. a. development
2. b. evolution
3. c. change
4. d. growth
3. What is the pattern of a group’s customs, beliefs, art, and technology?

Answers
1. a. clan
2. b. society
3. c. culture
4. d. beliefs
4. ____ is the pattern of a group’s customs, beliefs, art, and technology.

Answers
1. a. Culture
2. b. Ethnicity
3. c Race
4. d Nationality

6. Who did developmental researchers focus on studying because they assumed that the processes of development were universal?

Answers
1. a. Mexicans
2. b. Europeans
3. c. Canadians
4. d. Americans
7. Which study would provide the best picture of worldwide developmental growth patterns?

Answers
1. a. Examining patterns of friendship in each grade level at an elementary school in Tokyo.
2. b. Watching a newborn turn into an adult.
3. c. Comparing children raised in Bangladesh to those raised in the United States.
4. d. Every two years, looking at a set group of subjects across 50 randomly chosen countries from birth to death.
8. What did the text define as the increasing connections between different parts of the world in trade, travel, migration, and communication?

Answers
1. a. globalization
2. b. social networks
3. c. the Internet
4. d. small world syndrome
9. Globalization is ____.

Answers
1. a. the number of births per woman
2. b. the ways people grow and change across the life span
3. c. the total pattern of a group’s customs, beliefs, art, and technology
4. d. the increasing connections between different parts of the world in trade, travel, migration, and communication
10. Which is the BEST example of globalization?

Answers
1. a. Jane immigrated from China to the United States.
2. b. Rita participates in a course online in which she is in daily contact with people all over the world.
3. c. The SARS virus spread from Southeast Asia to North America.
4. d. 19.4% of the world`s population lives in China.
11. According to the text, for most of history the total human population was under ______.

Answers
1. a. 1 million
2. b. 10 million
3. c. 100 million
4. d. 1 billion
12. For most of human history how many children did women typically birth?

Answers
1. a. 1 to 2
2. b. 4 to 8
3. c. 10 to 12
4. d. 13 to 15
13. The human population began to increase noticeably around 10,000 years ago. What has been hypothesized as the reason for the population increase at that time?

Answers
1. a. the discovery of medicine
2. b. the development of agriculture and domestication of animals
3. c. an increase in the size of women’s pelvic openings that assisted in labor
4. d. construction techniques that allowed for stronger homes that were better heated
14. When did the human population reach 500 million people?

Answers
1. a. 400 years ago
2. b. 1,000 years ago
3. c. 4,000 years ago
4. d. 10,000 years ago
15. How long did it take the human population to double from 500 million to 1 billion?

Answers
1. a. 150 years
2. b. 300 years
3. c. 450 years
4. d. 600 years
16. The human population doubled from 1 to 2 billion between 1800 and 1930. What led to this increase in population?

Answers
1. a. government-controlled farming
2. b. globalization and shared resources
3. c. medical advances that eliminated many diseases
4. d. people had more children
17. Which of the following fields had the greatest impact on the Earth’s population explosion in the last 10,000 years?

Answers
1. a. Medical
2. b. Agriculture
3. c. Architecture
4. d. Domesticity
18. The total fertility rate (TFR) is defined as the number of ____.

Answers
1. a. births per woman
2. b. conceptions per woman
3. c. fetuses that were spontaneously aborted
4. d. women on fertility drugs
19. What is the current total fertility rate (TFR) worldwide?

Answers
1. a. 1.4
2. b. 2.8
3. c. 4.2
4. d. 5.6
20. What total fertility rate (TFR) is referred to as replacement rate?

Answers
1. a. 1.4
2. b. 2.1
3. c. 2.8
4. d. 3.2
21. If a country wanted to decrease population, it would want which rate pattern to be in effect?

Answers
1. a. The world total fertility rate (TFR) to be equal to the country`s replacement rate.
2. b. The world total fertility rate (TFR) to be less than the country`s replacement rate.
3. c. The country`s replacement rate must be above 2.1
4. d. The country`s replacement rate must be below 2.1
22. If current trends continue, when will the worldwide total fertility rate (TFR) reach replacement rate?

Answers
1. a. 2020
2. b. 2050
3. c. 2080
4. d. 3010
23. ____ is the number of births per woman.

Answers
1. a. Total fertility rate
2. b. Expressive births
3. c. Implicit calculation of replacement
4. d. The sum of replacement
24. Nearly all of the population growth in the decades to come will take place in ____.

Answers
1. a. developed countries
2. b. developing countries
3. c. emerging countries
4. d. South American countries
25. What will happen to the populations of developed countries during the next few decades and beyond? They will _____.

Answers
1. a. increase more than developing countries
2. b. remain stable in population
3. c. decrease
4. d. increase slowly
26. What term is used in the text to refer to the most affluent countries in the world?

Answers
1. a. affluent countries
2. b. developed countries
3. c. developing countries
4. d. population-rich countries
27. What term is used in the text to refer to countries, which have less wealth, but are experiencing rapid economic growth?

Answers
1. a. impoverished countries
2. b. developed countries
3. c. developing countries
4. d. population-rich countries
28. If a study randomly selected 100 participants from a global pool, where would the majority of participants come from?

Answers
1. a. A developing country
2. b. A developed country
3. c. A declining country
4. d. It could not be determined.
29. What percent of the current world’s population lives in the most affluent countries?

Answers
1. a. 18%
2. b. 34%
3. c. 51%
4. d. 68%
30. ____ refers to the most affluent countries in the world.

Answers
1. a. Developed countries
2. b. Developing countries
3. c. Collective cultures
4. d. Individualistic cultures
31. The United States, Canada, Japan, South Korea, Australia, New Zealand, and nearly all the countries of Europe are examples of ____.

Answers
1. a. developed countries
2. b. developing countries
3. c. collective cultures
4. d. individualistic cultures
32. Developed countries roughly make up ____ of the world’s population, whereas, developing countries make up ____.

Answers
1. a. 18%, 82%
2. b. 27%, 73%
3. c. 37%, 63%
4. d. 47%, 57%
33. Developed countries can be viewed as ____, whereas, developing countries can be seen as ____.

Answers
1. a. wealthy; populated
2. b. populated; wealthy
3. c. collective; individualistic
4. d. individualistic; collective
34. What developed country will have the steepest decline in population between now and 2050?

Answers
1. a. the United States
2. b. Germany
3. c. Japan
4. d. Canada
35. Between now and 2050, what will the increase in population in the United States be nearly entirely due to?

Answers
1. a. immigration
2. b. minority fertility
3. c. majority fertility
4. d. in-vitro fertilization
36. What country allows for more legal immigrations than most other countries and has tens of millions of illegal immigrants as well?

Answers
1. a. the United States
2. b. Canada
3. c. Germany
4. d. Japan
37. What portion of the United States’ population will increase from 16 to 30 percent by 2050?

Answers
1. a. African American
2. b. Anglo American
3. c. Asian American
4. d. Latino American
38. José was born in a country where his parents make less than $2 a day and he is expected to attend grade school but not college. Jose was most likely born in a ____.

Answers
1. a. developed country
2. b. developing country
3. c. collective culture
4. d. individualistic culture
39. What percent of the world’s population lives on a family income of less than $6,000 per year?

Answers
1. a. 20%
2. b. 40%
3. c. 60%
4. d. 80%
40. Although economic growth has been strong for the past decade, what region remains the poorest region in the world?

Answers
1. a. Africa
2. b. South America
3. c. Southeast Asia
4. d. Western Australia
41. What percent of individuals in developed countries attend college or other post-secondary training?

Answers
1. a. 30%
2. b. 50%
3. c. 70%
4. d. 90%
42. What percent of children in developing countries complete primary schooling?

Answers
1. a. 20%
2. b. 40%
3. c. 60%
4. d. 80%
43. Statistically speaking, a child born today will most likely be from ______.

Answers
1. a. a developing country
2. b. a developed country
3. c. an economically wealthy country
4. d. a high social economic status culture
44. Tim’s family has passed down and adhered to traditions that his ancestors practiced hundreds of years ago. His family believes in interdependence, and that he should help support his community and nation. Tim is most likely from a(n) ______________ culture.

Answers
1. a. individualistic
2. b. traditional
3. c. modern
4. d. developed
45. ____ cultures emphasize independence and self-expression, whereas ____ cultures emphasize obedience and group harmony.

Answers
1. a. Individualistic; collective
2. b. Collective; individualistic
3. c. Developed; developing
4. d. Developing; developed
46. What percent of children in developing countries are enrolled in secondary education?

Answers
1. a. 30%
2. b. 50%
3. c. 70%
4. d. 90%
47. Who attends colleges, universities, and other forms of post-secondary education in developing countries?

Answers
1. a. the wealthy elite
2. b. most of the population
3. c. about half of the middle class
4. d. about one fourth of the middle class
48. What term is used to refer to people in the rural areas of developing countries, who tend to adhere more closely to the historical aspects of their culture than people in urban areas do?

Answers
1. a. agrarian cultures
2. b. conventional cultures
3. c. traditional cultures
4. d. rural cultures
49. What general values do developed countries tend to regard highly?

Answers
1. a. collectivistic
2. b. individualistic
3. c. traditional
4. d. modern
50. What general values do developing countries tend to regard highly?

Answers
1. a. collectivistic
2. b. individualistic
3. c. traditional
4. d. modern
51. What percent of the world’s population lives in the United States?

Answers
1. a. 5%
2. b. 10%
3. c. 15%
4. d. 20%
52. Within any given country, which of the following sets most of the norms and standards, and holds most of the positions of political, economic, intellectual, and media power?

Answers
1. a. majority culture
2. b. minority culture
3. c. ethnic populace
4. d. subcultural groups
53. Who sets most of the norms and standards and holds most of the positions of political, economic, intellectual, and media power in most countries?

Answers
1. a. power culture
2. b. controlling culture
3. c. minority culture
4. d. majority culture
54. By position, power and prestige, the President of the United States and his/her family are members of the______.

Answers
1. a. minority culture
2. b. majority culture
3. c. developed culture
4. d. developing culture
55. What term is often used to refer to a person’s social class, which includes educational level, income level, and occupational status?

Answers
1. a. social class status
2. b. socioeconomic status
3. c. tax bracket status
4. d. education status
56. The expectations that cultures have for males and females are different from the time they are born. The degree of the difference depends on _____.

Answers
1. a. culture
2. b. age
3. c. gender
4. d. socioeconomic status
57. ____ includes an individual’s educational level, income level, and occupational status.

Answers
1. a. Nationality
2. b. Ethnicity
3. c. Sociohistorical index
4. d. Socioeconomic status
58. Also referred to as a person’s social class, his or her ____ includes the level of education, their income, and occupational status.

Answers
1. a. socioeconomic status
2. b. ethnicity
3. c. culture
4. d. sociohistorical index
59. In American culture, a physician spends 12 years in college and training, generally has a high income, and possesses a strong occupational status. In terms of socioeconomic status, a physician would most likely be _____.

Answers
1. a. low SES
2. b. middle SES.
3. c. moderate SES.
4. d. high SES.
60. LaWanda has a high school diploma and is currently working as a waitress but is attending school in hopes of becoming a pediatrician. Her current socioeconomic status is likely ____; however, when she becomes an established pediatrician, her socioeconomic status will be ____.

Answers
1. a. low; high
2. b. high; moderate
3. c. high; low
4. d. moderate; low