CODE OF PROFESSIONAL ETHICS AND CONDUCT FOR CLINICAL PSYCHOLOGISTS

Rehabilitation Council of India New Delhi - 2008

CODE OF PROFESSIONAL ETHICS AND CONDUCT FOR CLINICAL PSYCHOLOGISTS


Preamble:
The clinical psychologists are committed to work toward enhancing the scientific understanding of normal and abnormal behavior, socio-cultural and religious practices prevailing in the society, and to use such scientific knowledge to improve quality of life of individuals in society and institutions. Clinical psychologists respect and protect all human rights and help individuals in making informed choices and judgments concerning their own life and human behavior in general.

Roles performed and responsibilities shouldered by clinical psychologists include but are not limited to the clinician, diagnostician, assessor, therapist, supervisor, consultant, expert witness in legal matters, researcher, trainer, educator, developer of assessment instruments and administrator. This code of ethics is intended to provide specific standards for professional practice of clinical psychology across a variety of contexts and to inspire and guide clinical psychologists to strive toward the welfare and protection of all individuals with whom they work in different roles. This document has also its goal of education of the public regarding the very highest ethical standards and ideals of the clinical psychology profession.

This code of ethics applies to all those members registered under the professional category of “clinical psychologist” with the Rehabilitation Council of India (RCI) and to students under the training program in RCI recognized centers. Registration in the RCI as clinical psychologist commits members to adhere to the standards of the RCI code of ethics and to the rules and procedures developed to enforce them. Lack of awareness or misunderstanding of an ethical code is not itself a defense to a charge of unethical conduct. The professional activities as outlined in this document shall be distinguished from the private conduct of clinical psychologists, which is not within the purview of the Council. The ethical standards given hereunder are not exhaustive. The fact that a given conduct is not specifically addressed in this document does not mean that it is necessarily either ethical or unethical. The professional judgment on the part of clinical psychologists shall be guiding force in arriving at an ethical co rse of action in all such circumstances to eliminate any injustice or inequality and to attain highest standards of professionalism. In this document “client” means any person or persons or group of persons with whom a clinical psychologist interacts on a professional basis, be it in the capacity of a therapist, counselor, diagnostician, researcher, teacher or in any other professional pursuits across a variety of contexts, such as in person, postal, telephone, internet and other electronic transmissions.

Ethical Standards:
1. Professional Competence
1.1 Clinical Psychologists shall provide services, teach and conduct research in areas only within the boundaries of their competence, based on their education and training or professional experience. Neither they nor professionals employed by them shall practice beyond their areas of competence.
1.2 Clinical Psychologists shall work on the basis of established scientific and professional knowledge of the discipline and the reported evidences.
1.3 Clinical Psychologists shall undertake ongoing efforts to develop and maintain their professional knowledge and skill, and shall keep abreast with scientific innovations relevant to their areas in order to be competent in professional activities.
1.4 Clinical Psychologists shall take up any new areas of professional activity only after obtaining the knowledge, preparatory training and experience as considered necessary for competent functioning in that area, and take steps to protect clients from harm by untrained persons.
1.5 Clinical Psychologists shall become reasonably familiar with the judicial or administrative rules before assuming forensic roles.
1.6 When delegating work to other employees or assistants, Clinical Psychologists shall exercise caution and authorize only those responsibilities that such persons can perform competently on the basis of their education, training or experience, and see such persons perform these services competently.
1.7 When Clinical Psychologists become aware of personal problems that may interfere with discharging of the professional duties competently they shall take appropriate measures including seeking assistance and suspend or terminate their work-related duties.

2. Professional Responsibility
2.1 Clinical Psychologists shall, at all times, consider the client’s welfare and dignity and be responsible towards clients and the profession, and shall take measures to avoid and prevent misuse or abuse of their profession and professional roles.
2.2 Clinical Psychologists shall keep away from practicing if facing charges or convictions for serious criminal offences that could reflect on suitability for continuing in the profession.
2.3 Clinical Psychologists shall encourage colleagues whose health-related or other personal problems may reflect impairment in professional functioning to seek consultation or assistance, and consider other potential sources of intervention when such colleagues appear unable to recognize that a problem exists.
2.4 When working with other professionals Clinical Psychologists shall become reasonably familiar with their training, competence, boundaries and professional roles.
2.5 Clinical psychologists shall terminate professional services to their clients when the clients do not appear to be deriving any benefit or when services are no longer required.
2.6 Clinical psychologists shall refer clients to appropriate alternative sources of assistance and interventions as and when indicated.
2.7 Clinical psychologists shall exercise necessary caution while integrating/adopting new research findings in their professional practice.
2.8 Clinical psychologists shall, while undertaking research, obtain informed consent or assent in writing from the research participants and follow all ethical guidelines and prevailing law governing such research.

3. Professional Integrity
3.1 Clinical Psychologists shall be honest and fair in all of their interactions with clients, and shall uphold integrity in all facets of their professional endeavors.
3.2 Clinical Psychologists shall be accurate in representing their professional affiliations and qualifications, including such matters as knowledge, skill, training, education, and experience, and shall clarify their professional roles for clients and other parties. They shall take reasonable steps to ensure that their qualifications and competency are not misrepresented by him or others, and shall correct any identifiable misrepresentations.
3.3 Clinical Psychologists shall be honest and accurate in conveying professional conclusions, opinions and research findings, and in acknowledging the possible limitations.
3.4 Clinical Psychologists shall ensure that their clients are aware, from the very beginning, about the costs of the services rendered.
3.5 Clinical Psychologists shall refrain from forming such relationships with their clients that may damage professional objectivity or lead to clients’ exploitation or conflicts of interest with the client.
3.6 Clinical Psychologists shall be aware and take necessary steps to avoid the problems that may result from dual or multiple relationships for example, supervising or examining a trainee to whom they are married; teaching and training students with whom they are having an intimate relationship; or providing professional services to family members.

4. Professional Respect for Human Dignity and Rights
4.1 Clinical Psychologists shall value the dignity, autonomy and the rights of their clients irrespective of the age, sex, socio-cultural and religious backgrounds.
4.2 Clinical Psychologists shall respect client’s opinion, autonomy, selfdetermination, sexual orientation, political affiliation, gender, language, nationality, educational standards etc. and render professional services objectively without any discrimination.
4.3 Clinical Psychologists shall take all steps necessary to maintain confidentiality of the clients’ information and obtain consent from clients or from their duly authorized individuals for disclosure of confidential information. They shall strive that the breach of confidentiality is restricted only to those exceptional circumstances where the physical safety of clients is in danger, physical safety of other persons who may be endangered by the client’s behavior and the physical safety of children or vulnerable adults raise a serious concern.
4.4 Clinical Psychologists shall ensure that the clients are aware of the limitations of maintaining confidentiality with specific reference to: supervening legal and ethical obligations; likelihood that consultation with other professional colleagues may occur in order to enhance the effectiveness of professional services etc.
4.5 Clinical Psychologists shall make all efforts to ensure that colleagues, staff, trainees understand and respect the clients and handle information about the clients and their problem confidentially.
4.6 Clinical Psychologists shall obtain informed consent from the clients for research participation after giving ample opportunity to understand the nature, purpose and anticipated consequences and ensuring that the clients are aware of their right from the beginning to withdraw at any time from the research participation.

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Freud’s Dynamic Theory of Personality

Freud’s Dynamic Theory of Personality

1. Freud saw personality and behavior as resulting from a constant interplay between conflicting psychological forces that operate at three different levels of awareness.
A. Conscious : thoughts and feelings you are aware of at this moment.
B. Preconscious : thoughts you can easily bring into awareness.
C. Unconscious: thoughts you are not directly aware of.

2. Often the feelings, wishes and desires contained in the unconscious seep through to the conscious level in disguised or symbolic forms.
A. Dreams
1. manifest content are the dream images we remember
2. latent content is the true, hidden, unconscious meaning of the dream
B. Unintentional revelations
1. Slip-of-the-tongue (Freudian slips)
2. Dirty jokes
3. accidents, mistakes, forgetting, etc.
C. Freud used Free Association to reveal contents of the unconscious.

3. The Structure of Personality
A. Id: the most primitive part of personality
1. Eros: the life instinct: hunger, thirst, physical comfort, sexual motive (libido)
2. Thanatos: the death instinct: aggression, recklessness, and self-destructive actions
3. Pleasure Principle is the drive for immediate satisfaction of instinctual needs.

B. Ego: the organized, rational, and planning part of personality.
1. The Ego is the mediator between the demands of the Id and the restrictions of the real world.
2. The Reality Principle is what postpones instant gratification of the Id until the appropriate time in the real world.
3. If the Ego cannot compromise or satisfy the demands of the Id, it may repress the impulse or remove it from conscious awareness.

C. Superego : The internal voice representing parental and societal values
1. Emerges about age five or six.
2. The guilty conscience of the individual.
3. The superego evaluates behavior as acceptable or unacceptable and then either praises or criticizes.

Issues of feminism and multicultural education for educational technology

Feminism, multiculturalism, and learning styles
Here's an extract from a paper: "Issues of feminism and multicultural education for educational technology" Martin,D.J., Lucek,L.E., & Fuentes,S. (1999) ["Published" on ITFORUM on 8 Nov 1999.]
"We are always on shaky ground when considering cultural differences. It is vital to examine how culture may influence learning and achievement in school, but the danger lies in overgeneralizing its effects" (Nieto, 2000, p. 140). To illustrate the "shaky ground," we discuss one attribute of learning styles, the characteristics of field dependence (more recently, this is referred to as field sensitivity) and field independence. Bennett (1995) indicates that learners with a more field dependent style tend to have a more global view, are more sensitive with "highly developed social skills," and are extrinsically motivated. Field independent learners may be better able to perceive discrete parts, are more individualistic, and are more intrinsically motivated. Shade (1997) summarizes that African-Americans tend to be more field dependent whereas Euro-centric students tend to be more field independent. Bennett (1995) also indicates that "Mexican Americans tend to be relatively field dependent or global in orientation" (p. 168).

Field dependent learners tend to favor a "spectator approach" to learning and field independent learners tend to favor "inquiry" approaches (Bennett, 1995). Is it possible that a particular theory of instruction, such as Reigeluth's Elaboration Theory, is appropriate for designing instruction for some minority groups that have a more field dependent learning style? If some African-Americans tend to be more social and relational in learning styles (field dependent), they may learn more productively with interactive, collaborative situations, but not be as successful with inquiry/Socratic learning situations and with competitive educational methods. Euro-centric students may learn more successfully in inquiry learning situations and individual-based situations, but have more difficulty with collaborative situations.

In her case study of computer use, Chisholm (1996) discusses problems of computer access, but goes beyond that to note learning style differences among a culturally diverse group of young students. Chisholm identified the following cultural themes that emerged in the use of computers:

The students whose cultures value cooperation and interdependence, such as the Mexican-Americans and the African-Americans, could work and share with others. Those whose cultures value independence and self-reliance, such as the white culture, could work alone. Whereas those whose native culture tends to look at the world holistically, such as the Mexican-Americans, could explore and learn through play, those from cultures valuing analytic thinking could learn in a step-by-step deductive fashion (p. 171).

These propositions are not intended to highlight cultural "deficiencies," but to highlight strengths. We are familiar with the literature that indicates the importance of using a variety of learning styles and teaching styles. The argument, however, is that education in the United States has tended to focus on learning styles for the Euro-centric students' competitive, inquiry-driven, and independent work. A vital caution -- where we are standing on shaky ground -- is in the "misapplication of learning style theories" (Nieto, 2000, p. 143). Nieto summarizes studies in which teachers made incorrect assumptions. For example, in one study, Flora Ida Ortiz indicated that teachers assumed Hispanic students would not want to assume leadership roles in the class activities; thus teachers did not provide the Hispanic students with opportunities they provided to non-Hispanic students. Nieto indicates there is particular promise with Howard Gardner's multiple intelligence theory "in challenging current assessment practices that focus almost exclusively on logical-mathematical and linguistic intelligence" (p. 144).

National Seminar on the Adult needs of people with Mental Retardation

National Seminar on the Adult needs of people with Mental Retardation- 08- November 2008

Society for Child Development (SFCD), are a non-profit organization (established in 1992). SFCD aim to create a world of equal opportunities for people with disabilities. SFCD key projects involve providing mentally handicapped children with educational and training facilities that will assist them to acquire basic living and academic skills. In SFCD efforts to explore and address contemporary issues related to disability, SFCD also engage in research activities.

One of SFCD ongoing research projects is directed at addressing the domain of "Sexuality and Disability". It was motivated from the realization that there is a general reluctance on the part of the society to address sexual issues, especially with the mentally disabled. Formal research efforts to explore the specific nature of sexual issues in the mentally disabled have also been very limited. The efforts made have largely been in the domain of biological perspective and rarely in the context of the psychosocial issues.

Realizing that for decades, families of the mentally handicapped and professionals engaged in the area alike, have been mostly silent about the sexuality of the mentally disabled person, our Parent Support Network (a forum for parents established in 2004) has been conducting Focused Group Discussions and workshops aimed not only at exploring the emerging issues and concerns in this area but also aiming to derive ways to cope with and manage the issues.

Similar is the issue of Employment.

SFCD feel that academicians as well as professionals working in this area need to join hands to address these domains. In line with idea, SFCD are organizing a National Seminar on the adult needs of people with Mental Retardation on the 8th of November as an effort to look at the two main adult needs of the Mentally Disabled Sexuality and Employment.

This is the first call for an expression of interest in the Seminar and also submission of any work done in this area by researchers, academicians and professionals. SFCD would appreciate if you could share your experiences in the domain of "Sexuality and Disability" and/or Employment with us so that, together, SFCD can arrive at new understandings and solutions. The goal of SFCD seminar is to derive perspectives that can be of practical use to parents, vocational centers and special schools that are dealing with these people on an everyday basis. Please note that the papers presented at the seminar will only be those that are 'action-oriented' activities or research. The seminar is not planned as an 'academic' exercise.


IMPORTANT DATES:
30th March, 2008: Expression of interest, along with a brief about the nature of work to be presented.
15th May, 2008: Submission of Abstract
30th September: Submission of the final paper

Contact:
Dr Madhumita Puri, Executive Director, Society for Child Development.
Email: madhumita@disabilityindia.org

Lovepreen Kaur, Organizing Secretary, National Seminar on the Adult needs of people with mental retardation

Email: support@disabilityindia.org

Women Who Suffered Child Abuse Spend More On Health Care

Ohio State University issued the following news release about a new study:

Women Who Suffered Child Abuse Spend More On Health Care

Middle-aged women who suffered physical or sexual abuse as children spend up to one-third more than average in health-care costs, according to a long-term study of more than 3,000 women.

Even decades after the abuse ended, these women used health services at significantly higher rates than did non-abused women, the research found.

"What's remarkable is that women with an average age in their late 40s still suffer consequences from abuse that occurred decades ago," said Amy Bonomi, associate professor of human development and family science at Ohio State University, who led the study at Group Health in Seattle.

"No other study has found that before."

Women who had no history of abuse spent an average of $2,413 a year (in 2004 dollars) on health care costs. Women who were sexually abused only paid an average of $382 a year more, those who were physically abused spent $502 more, and women who suffered both types of abuse spent $790 a year in additional health care costs.

The study appears online in advance of the March issue of the Journal of General Internal Medicine.

The study took into account factors such as age and education that also can affect health care use. "We are able to say pretty confidently that it was the abuse itself that is driving higher health care use and costs in these women," she said.

After accounting for women's age and education, women who were sexually abused as children faced health care costs 16 percent higher than non-abused women, while physically abused women's costs were 22 percent higher. For women who suffered both types of abuse, costs rose 36 percent above average.

The research examined data from 3,333 women who belonged to Group Health, a health care system in the Pacific Northwest.

While other studies had linked childhood abuse to higher adult health care costs, this research provides the most comprehensive and accurate evidence to date, Bonomi said.

For one, it includes actual health care data on the women, complete with physician visits and pharmacy use. Other studies have relied on participants to report their health care use.

This study also included a large sample of women, and looked at them over a long period of time an average of 7.5 years per woman. In addition, while many studies have only examined women up to the mid to late 30s, this study included women with an average age of 47.

"This study provides the strongest evidence to date about the impact of abuse well into adulthood," Bonomi said.

Overall, the study found that 34 percent of women reported some type of childhood abuse, which is similar to rates found in other studies.

As would be expected, women who had been abused were more likely than others to be diagnosed with depression. They also reported more physical symptoms and were more likely to have a higher body mass index, a sign of obesity. Abuse was not associated with other chronic conditions such as heart disease, diabetes or asthma.

Women who had suffered both physical and sexual abuse had higher health service use in six areas: mental health, hospital outpatient, emergency department visits, primary care, specialty care, and pharmacy fills.

Those who were only physically abused or only sexually abused had higher use in four of the health service areas.

"It's not surprising that abuse victims had higher use of primary, specialty and mental health care services," said Bonomi. "But it is somewhat surprising that women who were physically abused and those who experienced both types of abuse were also more likely than others to visit the emergency room."

Bonomi said the results reinforce the need for abuse prevention programs that target parents of young children who are at risk of child abuse. Soon-to-be parents should also receive attention. In addition, the findings suggest health care professionals should screen adults for child abuse history, particularly people with high levels of health care
service use.

While this study was funded to look specifically at women, Bonomi said she and her colleagues are currently examining how childhood abuse affects adult health care use and costs in men.

Group Health, the health care system whose members were surveyed for the study, provides health and insurance services to more than 500,000 people in the Pacific Northwest.

Bonomi conducted the study with Melissa Anderson, Paul Fishman, David Carrell, Robert Reid and Robert Thompson of Group Health Center for Health Studies in Seattle; Frederick Rivara of the Harborview Injury Prevention and Research Center and the University of Washington; and Elizabeth Cannon, a graduate student at Ohio State.

The study was funded by the federal Agency for Healthcare Research and Quality.

Disability in Local and Global Worlds

The new issue of *Lancet* includes a review of the book *Disability in Local and Global Worlds* edited by Benedicte Ingstad & Susan Reynolds Whyte (University of California Press, 2007; ISBN 0-520-24616- 4).
The review is by Lenore Manderson.
Here's the review:

How disability is made
On Dec 10, 2007, around 50 people gathered in front of Parliament House in Malaysia, to be shepherded into the observation gallery for the first reading of the Disability Act. The reading was brief but it was momentous --a linchpin towards protecting the rights of many Malaysians, including many of the people in the gallery, to take part fully in society. It is the social dimension of disability that informs Disability in Local and Global Worlds. More than any single ethnographic work, of which there are precious few, this work highlights the need to see disability through a social lens.

In this new collection, the distinctions of ability, inability, and disability are pushed beyond conventional expectations to encompass chronic degenerative disease, old age, genetic conditions, infertility, and customary practices. Ageing is not conventionally regarded as a disability, but it becomes so when infirmity becomes a reason for social exclusion. Similarly, having a chronic condition need not be a disability unless others begin to treat the sufferer with suspicion and their condition a harbinger of evil.

Cultures can create the bodily as well as social conditions of ability and inclusion. As Aud Talle shows in her discussion of female circumcision, women who live in Somalia are regarded as physically defective and so disabled if they have not been circumcised or infibulated, whereas in the UK they become disabled when they are subject to a doctor's gaze. In a different context, Nancy Scheper-Hughes and Mariana Leal Ferreiraa explore how Domba, a Suya tribesman living in Xingu Indigenous Park in central Brazil, is culturally disabled because of his refusal to wear a lip disc. This is why, his father believes, Domba has developed kidney disease. When he returns from Sao Paulo after a kidney transplantation, with another man's kidney and also parts of his soul, Domba is perceived to be further disabled. And so is the group of people connected to him by sex and kinship, who must all now adhere to certain food taboos and who all, because of the transplant, have become "part white".

This extraordinary tale of witches, souls, animal doubles, biomedicine, and Suya cosmology is but one of the compelling stories in this impressive collection. All the contributors challenge assumptions of what is "normal" and what is "disabled" by illustrating the importance of local context and cultural values. In Uganda, for example, Susan Reynolds Whyte describes how men, who because of polio, injury, or other physical problems cannot walk, had used tricycles to trade across the border of Kenya and Uganda, so maintaining their independence. But when tax and import duty collection began in earnest, they lost out to more agile traders who could smuggle along hidden, unsurfaced, and cycle- inaccessible paths. In this way, the men with the tricycles became disabled.

Bodily appearance or function--from birth, accident, disease, or ritual-can enable in one setting but disable in another. Our task, as the contributors to Disability in Local and Global Worlds show, is to remain mindful of such local inflections, institutions, and systems and remember that disability is created, reinforced, or removed through social and cultural action.

Anne Lamott, quoting a friend's 5 Rules For Living:
1. Be born perfect, without imperfection or any significant differences from the majority that might make others uncomfortable.
2. If you have imperfections or are different in any way, get it fixed immediately.
3. If you can't get it fixed, at least act as if it has been fixed.
4. If you can't act as if it has been fixed, then don't show up.
5. If you must show up, at least have the decency to be ashamed.