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Integrating New Science of Primitive Brains v. Modern Problems Morality with Ethical Decision- Why we think with emotions and Making heuristics, but not algorithms

Values, Morality, Ethics, and Clinical Practice Please pay attention to Just Ethics

John Gavazzi, PsyD, ABPP Pennsylvania Psychological Association Quick note on the Heuristic Patient April 2019

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Learning Objectives General Outline

1. Explain the difference between ethics and morality • Morality and Moral Development in General 2. Describe two moral emotions in psychotherapy • The New Wave of Moral Psychology 3. Outline the 4 components of the Ethical Acculturation Model • Acculturation Model 4. List two cognitive distortions in ethical decision- making • Principle-based Ethics 5. Apply personal morals and professional ethics to a vignette • Cognitive Biases and ethical dilemmas

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Assumptions in this presentation

• We are all products of biological and cultural evolution Participant Safety • We all have different tolerances, biases, and • Creating a safe environment methods of making moral judgments • Avoid the word “unethical” • We are all learning in this process • Demonstrate courtesy and respect for others • We are all subject to biases, heuristics, and • We are all fallible erroneous thought processes. We do not think in algorithms.

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Morality Personal Moral Development • Typically, individuals think about morality as equivalent to religion or religious beliefs. 1. Religion/Family of Origin • At the most general level, morality is a person’s 2. Education: College and CE ability to determine right from wrong, or

3. Personal Education: Reading and Experience • Good from Bad

4. Honest self-reflection • Please note the dichotomous thinking

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Morality Moral Philosophers

• Common today for people to believe that • Hegel: Believed human ability to self-reflect morality is handed down from God. and imagine helped with developing a strong moral compass.

• Pre-Christian philosophers thought and wrote a • Nietzsche: Believed that ethics and morals great deal about morality, without supernatural were tied up language, which helped us navigate influence. the world. However, language binds us to certain ways of thinking, including accepting our positions in life.

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Morality and Evolution Evolutionary Differences

• A more recent push to understand morality as a component of evolution There are (at least) two ways to conceptualize moral decision-making • Moral judgments are typically affective, rapid, instinctive and unconscious. • Groupishness: • In order for primates to cooperate, form ▫ Better for the collective relationships, and work as groups, reciprocity and ▫ Statistics on DNA empathy are the two essential “pillars of morality”

• Reciprocity and empathy are needed for human • Individualism: morality as well. ▫ Better for individual survival

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Morality Ethics

Personal moral compass-Believe it to be right Rules of Conduct – Profession/society Knowing the difference between right and wrong More external – Community (of peers) Emotional responses to dilemmas and actions Easier means to judge others’ actions Implicit/rapid/automatic/internal/affective Can constrain individual choices or create dilemmas Research shows people judge themselves and others based on moral characteristics – evolutionary and Explicit/cognitive/external/measured social reasons to judge “character”

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Morality, Emotions & Psychology • In the early 2000s, moral psychology changed from the Kohlberg paradigm (more cognitive) and began to research moral emotions. The New Wave of Moral Psychology • Moral reasoning is not just a top-down process, but typically a bottom-up process starting with Social Psychology automatic, emotional, and intuitive experiences. Experimental Philosophy Behavioral Economics • Looking for the role of moral emotions like disgust, fear, elevation, and mirth.

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Moral Foundations Theory Seven Moral Rules Jon Haidt, PhD

• Family Values • Reciprocity • There are specific innate, universally available moral foundations • Loyalty • Respect • These foundations are “intuitive” in that these are automatic, rapid, affective, and non-rational • Bravery • Fairness • These foundations can be used to judge how • Property Rights moral or immoral an action or activity is.

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Intentional, non-conscious processing

• The process that binds us blinds us. More deliberative Slower • Price paid for the automatic process: accuracy Possibly more accurate • A second limitation: rigidity Energy intensive

• The unconscious is swift, less flexible, and not Recent research indicates that empathy is more always accurate. Should I trust my gut or not? emotionally taxing that other emotional responses, such as anger and moral outrage

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Moral Foundations & Intuitions www.yourmorals.org

Care - Harm Fairness – Cheating Loyalty-Betrayal Authority – Subversion Sanctity (Purity) – Degradation [Liberty – Oppression]

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Application of Moral Foundations

Some Disgusting Examples • Ethics – How do these develop?

• Politics – Partisanship Moral Emotion of Disgust

Moral Dumbfounding • Clinical Psychology - Countertransference

• Social Psychology – WEIRD research

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Other Concepts in Moral psychology What does this mean?

• Bad is Stronger than Good • The “self” is essentially moral ▫ Loss Aversion: Avoid loss v. Find Gain ▫ Sunk Cost Fallacy – When to terminate? • Evidence supports we understand the self and ▫ The Knobe Effect others through morality (more so than ▫ Just World Belief (blame the victim) memories) • Priming • Morality has greater influence than memories and behaviors • Moral Licensing

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Morality in Mental Health: Diagnoses Moral Interventions in Psychotherapy • PTSD as moral injury: Transgress deeply held moral beliefs and expectations • Forgiveness • Prayer/Religion/Spirituality

• Components of depressive disorders associated • Grief/Loss/Death • Meditation with guilt, worthlessness, and meaninglessness • Meaningfulness/Purpose • Mindfulness

• OCD as highly correlated with scrupulosity • Values Clarification • Accessing Sacred Writings

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Psychotherapy is inherently a moral enterprise

• Of Good Moral Character • Compassion

• Beneficence: The promise to • Empathy The Acculturation Model do good • Improve quality of life • Fidelity: Loyalty to your patients/family • Respect patient values and One way of remaining a life-long beliefs • Follow your ethics codes, state learner law, federal laws, and court- • Practice positive self-care in Provides another way to discuss ethical based decisions order to remain competent behaviors and decisions

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Acculturation Ethics Acculturation Model

• An outgrowth of positive ethics that integrates A process to change the cultural behavior of an personal ethics and professional obligations. individual through contact with another culture. • Psychology has a system of shared and The process of acculturation occurs when there is distinctive norms, beliefs, and traditions. an adaptation into an organization or society. • This set of beliefs is reflected in our ethics code; especially the overarching ethical principles.

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Acculturation as a Process Ethical Acculturation • Can be a complex process Identification with personal value system • Some parts of a psychologist’s practice and (higher vs. lower) lifestyle may be easily acculturated while others not Identification with value system of psychology (higher vs. lower) • Process that will likely continue throughout the education or career as a psychologist

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Acculturation Model of ethical development Marginalized

Higher on Personal Lower on Personal Matrix: Lower on professional ethics Ethics Ethics Lower on personal ethics Integration Separation Higher on Personal Ethics Risks: *Greatest risk of harm *Lack appreciation for ethics Assimilation Marginalization *Motivated by self-interest Lower on Personal *Less concern for patients Ethics

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Assimilation Separation

Matrix: Higher on professional ethics Matrix: Lower on professional ethics Lower on personal ethics Higher on personal ethics

Risks: Developing an overly legalistic stance Risks: Compassion overrides good professional judgment Rigidly conforming to certain rules while missing broader Fail to recognize the unique issues role of psychologists

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Assimilated and Separated Strategies Assimilated and Separated Strategies

• Assimilated strategies are often “fear based” – • Assimilated strategy attempts to be prevention where motive to avoid harming another or focused incurring punishment for oneself, causes the psychologist to adopt legalistic stances. • Separated strategy attempts to be promotion focused • Separated strategies are often “benefits-based” – where the motive for promoting the well- • But both fail to give adequate attention or being of the patient causes the psychologist to weight to the overarching ethical principles be blind to ways that well-meaning people can that guide or should guide professional cause harm behavior

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Integrated Principle-Based Ethics Matrix: Higher on professional ethics Higher on personal ethics Autonomy Reward: Implement values in context of professional roles Beneficence

Reaching for the ethical Nonmaleficence ceiling Fidelity to Relationship Aspirational ethics Justice

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Respect for Autonomy Principle-Based Ethics and the Acculturation Model • Does not mean promoting autonomy (individuation or separation)

Psychologists using integrated strategies are able • Means respecting the autonomous decision to incorporate overarching ethical principles into making ability of the patient their practices

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Autonomy Beneficence

• It encompasses freedom of thought and action. • The principle of benefiting others and accepting • Individuals are at liberty to behave as they the responsibility to do good underlies the chose. profession.

- Determining goals in therapy - Providing the best treatment possible - Making life decisions (e.g., marriage, divorce) - Competency

- Scheduling appointments and terminating treatment - Referring when needed

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Nonmaleficence Fidelity

The principle is doing no harm. This principle refers to being faithful to commitments. Fidelity includes promise keeping, trustworthiness, and loyalty. - Demonstrating competence - Maintaining appropriate boundaries - Avoiding conflicts of interests that could compromise therapy - Not using an experimental technique as the - Keeping information confidential first line of treatment - Adhering to therapeutic contract (e.g., - Providing benefits, risks, and costs session length, time, phone contacts, etc.)

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Justice

Justice primarily refers to treating people fairly and equally. Ethical and Clinical Decision-

In their work-related activities, psychologists do not making engage in unfair discrimination based on age, gender, We think like defense attorneys gender identity, race, ethnicity, culture, national origin, rather than court justices religion, sexual orientation, disability, socioeconomic status, or any basis proscribed by law. (3.01) Bottom up vs. Top Down

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Important points to remember In certain situations, we need to • Identify the competing ethical principles construct or create a solution • Help to determine which principle has instead of looking up the answer precedence and why in a sacred psychology text • The importance of emotion in ethical decision- making and moral judgments

• Cognitive biases are also important to consider

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Most ethics codes do not include a model of Major Point to this Training ethical decision-making

1. We have to train ourselves to think about larger ethical principles first Other resources may aid with decision-making, but do not highlight how to work through 2. We need to have the ability to slow ourselves dilemmas down prior to making good, ethical decisions

Why?

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Decision-making skills How people make moral, ethical and professional decisions

• Top down approach • Intuitive

• Start with ethical principles • Automatic

• Work from those principles to make good • Emotional decisions about our work • Rapid

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Emotional Components

• Fear • Passion

There is an intuitive, non-rational • Anxiety • Calmness/Centered • Empathy process in ethical decision-making • Disgust • Respect/Sympathy • Disrespect Why do psychologists (still and continue to) have sex • Elevation with their patients? Negative emotions related to Positive emotions related to our ethical and moral decision- good decision-making skills and making ethical knowledge

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Cognitive biases How do you view your world? • The Fundamental Attribution Error

• Actor Observer Bias

• Availability Heuristic

• Trait Negativity Bias

• Confirmation Bias

• Competence Bias

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What can I do?

Independent Actions Help from others • Self Reflection • Consultation Why is any of this important? • Documentation • Supervision Why study ethics and ethical • Transparency decision-making as a part of • Psychotherapy clinical practice? • Continuing Education • Continuing Education • Self-care

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Questions and Answers www.ethicalpsychology.com Complete course evaluations

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