Psychological Resources

Tuesday, August 19, 2008

Ethics and Malpractice

Ethics and Malpractice

Index to Full-text Articles, Sample Agreement, Books and Abstracts
Ethics for Psychologists: 7 Fundamentals [excerpt from Ethics in Psychotherapy & Counseling, 3rd Edition]
This article discusses the 7 essential basics of ethics in psychology.
Steps in Ethical Decision-Making [excerpt from Ethics in Psychotherapy & Counseling, 3rd Edition]

This article provides some steps helpful in thinking through how to respond to an ethical dilemma, taking action, and assuming personal responsibility for our response. These steps may help us to identify important aspects of a situation, consider positive and negative consequences of the ways in which we might respond, and discover better approaches.
21 Cognitive Strategies To Justify Any Unethical Behavior [excerpt from What Therapists Don't Talk About and Why: Understanding Taboos That Hurt Us and Our Clients]
This brief article discusses 21 common fallacies and rationalizations we tend to use to justify unethical behavior and quiet a noisy conscience.
Developing & Practicing Ethics [The Portable Mentor: Expert Guide to a Successful Career in Psychology]
This chapter discusses important steps in developing and practicing professional ethics, as well as the ways in which we rationalize unethical behavior. It includes national actuarial data on ethical problems encountered by psychologists, the 9 most frequent causes of licensing board disciplinary actions involving psychologists over a 14 year period, and the 16 most frequent causes of malpractice suits against psychologists over a 15 year period.

Informed Consent: Sample Forms, Standards, Guildelines, & References
A selection of sample forms for obtaining and documenting informed consent in psychotherapy & counseling; excerpts addressing informed consent from a large array of ethics codes and practice guidelines adopted by professional organizations; and excerpts from books, articles, and chapters discussing informed consent.

Ethics of Practice: The Beliefs and Behaviors of Psychologists as Therapists [American Psychologist]
This national survey of the degree to which clinical and counseling psychologists engage in each of 83 behaviors and the degree to which they considered each behavior to be ethical included such items as: treating homosexuality per se as pathological; accepting a client's decision to commit suicide; discussing clients (without names) with friends; engaging in sexual fantasies about a client; going into business with a client; breaking confidentiality if a client is suicidal; charging a client no fee; making a custody evaluation without seeing both parents; hugging a client; signing for hours a supervisee has not earned; filing an ethics complaint against a colleague; performing forensic work for a contingency fee; altering a diagnosis to meet insurance criteria; breaking confidentiality to report child abuse; inviting clients to a party or social event; accepting goods as payment; seeing a minor client without parental consent; telling a client "I'm sexually attracted to you"; terminating therapy if a client cannot pay; asking favors from clients; using a law suit to collect fees; lending money to a client; becoming sexually involved with a former client; and engaging in sex with clinical supervisees

Ethics of Teaching: Beliefs and Behaviors of Psychologists as Educators [American Psychologist]
This national survey of the degree to which psychology professors engage in each of 63 behaviors and the degree to which they considered each of these to be ethical included behaviors in such categories as course content, evaluation of students, educational environment, disrespectful behavior, research and publication issues, financial and material transactions, social relationships with students, and sexual relationships with students and other faculty.

Ethical Dilemmas Encountered by Members of the American Psychological Association [American Psychologist]
This survey of the general APA membership, based on the unique critical incident study that lead to APA's original code of ethics, examined 705 incidents (falling into 23 categories) that APA members described as ethically challenging or troubling.

Ethical and Malpractice Issues in Hospital Practice [American Psychologist]
This review of ethical and malpractice issues arising in hospital practice includes: (a) preparation and authorization to carry out clinical responsibilities, (b) personnel procedures, (c) financial and political forces influencing hospital policies, (d) billing procedures, (e) clinical procedures for responding to patients' needs, (f) confidentiality, (g) discrimination, (h) internship and training issues, (i) sexual abuse of patients, and (j) staff conflicts influencing patient care.

When Laws and Values Conflict: A Dilemma for Psychologists [American Psychologist]
This national study asked psychologists whether they believed "that formal legal and ethical standards should ever be violated on the basis of patient welfare or other deeper values" and "In the most serious, significant, or agonizing instance, if any, what law or formal ethical principle have you broken intentionally in light of a client's welfare or other deeper value?"

Disability, Accessibility, & Ethics in Psychology: 3 Barriers [Ethics & Behavior]
This article discusses the physical barriers, internet barriers, and cognitive & affective barriers in psychology training and practice that block accessibility for people with disabilities.

Identifying and Implementing Ethical Standards for Primary Prevention [Journal of Prevention & Intervention in the Community]
This article examines the prerequisites (e.g., group identity, recognition of need, and active participation) and necessary steps for establishing formal ethical accountability in the area of primary prevention, with emphasis on 5 ancient principles (avoiding harm, competence, avoiding exploitation, respect, and confidentiality) as well as two more historically recent principles (informed consent; social equity and justice).

On Violating Ethical Standards: 20 Easy Steps [Ethics in Psychotherapy & Counseling]
This article presents 20 of the most common fallacies and rationalizations we tend to use to justify unethical behavior and quiet a noisy conscience.

When The Therapist Doesn't Know What To Do: Some Steps That May Help [American Psychological Association]
Based on the views (a) that there are no clear, one-size-fits-all answers to therapeutic dilemmas, complexities, and challenge; (b) that various theoretical orientations provide different, sometimes opposing ways of approaching question, and (c) that each therapist, each client, and each situation is unique, whatever qualities they may share with other therapists, clients, and situations, these 10 steps may be helpful when therapists reach an impasse or just aren't sure what to do.

Malpractice & Licensing Pitfalls for Therapists: A Defense Attorney's List [Innovations in Clinical Practice] A question asked of attorneys who defend psychotherapists in civil suits and before licensing boards is what are the most common areas where therapists leave themselves vulnerable to attack. In this article, a defense attorney identifies some of the more common pitfalls that psychotherapists may encounter in hope that they can be avoided in the future.

HIPAA & Forensic Practice [American Psychology Law Society News] Does the Health Insurance Portability and Accountability Act (HIPAA) apply to forensic practice? In particular, do forensic practitioners incur the obligations of "covered entities," as defined in the Privacy Rules (§160.103), a subset of HIPAA? Do our files and the information we compile constitute Protected Health Information (PHI)? If so, what steps must we take to be compliant? Do HIPAA obligations attach to some areas of forensic practice, but not others? Even if forensic practice does not fall under HIPAA regulation, must we still attend to some issues raised by HIPAA?

AIDS and HIV Infection Update: New Research, Ethical Responsibilities, Evolving Legal Frameworks, and Published Resources [Innovations in Clinical Practice]
This chapter discusses research, ethical responsibilities, and legal considerations for practitioners; denial, delay, and distortion; test reliability, risk factors, and risk groups; general principles of counseling those people who have AIDs or who are or might be HIV-positive; suicide, the dilemma of the right to die, and foregoing life-sustaining interventions; neuropsychological aspects of AIDS and HIV infections; is there a legal duty to protect or warn third parties; and education and prevention.

The Ethics of Research Involving Memories of Trauma [General Hospital Psychiatry]
This invited editorial emphasizes the importance of ethical considerations in research on traumatic memories.

Security of Clinical Records on Computers
This brief article notes threats to the privacy of records on computers and the steps that therapists and counselors can take to make their computerized records secure.

Children, Ethics, & the Law
The complete contents of this book are presented here. Chapters include "Introduction & Basic Concepts"; "Psychotherapy With Children"; "Ethical Issues in the Psychological Assessment of Children"; "Confidentiality & Clinical Competence in Serving Children & Families"; "Research with Children: Planning & Recruiting Participants"; " Research with Children: Risk Potential & Management"; "Kids & the Courts"; Glossary of Major Case Law Decisions Cited"; & "References."

Psychologists' Use of E-mail with Clients: Some Ethical Considerations
This article by Kenneth Drude, Ph.D. & Michael Lichstein, Ph.D. examines email guidelines in such areas as policies & procedures, turn-around time for responding, message content, when not to use email, emergencies or crises, confidentiality & privacy, security, informed consent, fees, documentation & record-keeping, licensing jurisdiction, and competency.
Sample Agreement

Sample Agreement Between Expert Witness & Attorney by Kenneth S. Pope, Ph.D., ABPP, James N. Butcher, Ph.D., & Joyce Seelen, J.D.
Books

Ethics in Psychotherapy and Counseling: A Practical Guide, (Third Edition, 2007), by Kenneth S. Pope, Ph.D., ABPP & Melba J. T. Vasquez, Ph.D., ABPP Publisher: Jossey-Bass.
"This is absolutely the best text on professional ethics around... This is a refreshingly open and inviting text that has become a classic in the field." --Derald Wing Sue, Ph.D., Professor of Psychology, Teachers College, Columbia University
"I love this book! And so will therapists, supervisors and trainees. In fact, it really should be required reading for every mental professional and aspiring professional.... And it is a fun read to boot!"--Stephen J. Ceci, Ph.D., H.L. Carr Professor of Psychology, Cornell University

What Therapists Don't Talk About and Why: Taboos That Hurt Us and Our Clients by Kenneth S. Pope, Ph.D., ABPP, Janet L. Sonne, Ph.D., and Beverly Greene, PhD., ABPP Publisher: American Psychological Association
"This book is a must read for any psychotherapist. It explores the real world and often secret problems encountered in clinical practice in a creative, personal and very useful fashion. In this world of increasing professional accountability and liability, clinicians can be assured that their practices will be much better off for having implemented the common sense suggestions made by the authors."Jeffrey N. Younggren, Ph.D., ABPPRisk Management ConsultantAmerican Psychological Association Insurance Trust

How To Survive and Thrive as a Therapist: Information, Ideas, & Resources for Psychologists by Kenneth S. Pope, Ph.D., ABPP & Melba J. T. Vasquez, Ph.D., ABPP
Publisher: American Psychological Association
"This comprehensive practical guidebook is a must for all new and seasoned clinicians. From attorneys to ethics, from billing to possible errors in logic--it is all here. A remarkable compendium. Kudos to Pope and Vasquez!" Donald Meichenbaum, PhD, University of Waterloo, Ontario, Canada

Law and Mental Health Professionals: California by Brandt Caudill & Kenneth S. Pope, Publisher: American Psychological Association
This book reviews legislation, case law, and regulations relevant to mental health practice in California.

Abstracts
The Ethics of Counseling: A National Survey of Certified Counselors [Journal of Counseling & Development]
This national survey of counselors certified by the National Board for Certified Counselors asked participants to report their beliefs about whether each of 88 behaviors was ethical and the degree to which they were confident of their judgment about the behavior.
A Community Psychology of Ethics [American Journal of Community Psychology]
The topics in this discussion of ethical responsibilities in community psychology include: (1) difficulties in adapting ethical codes to the values, concerns, and language of community psychology; (2) the elusive nature of community psychology; (3) unforeseen effects of interventions; (4) the necessity of assuming responsibility for the consequences of interventions; (5) the clarification of assumptions and values underlying any formal code of ethics; and (6) the creative nature of ethical decision making.
Fee assessment and outpatient psychotherapy [Journal of Consulting & Clinical Psychology]
This multivariate study of 3 predictor variables (fee, diagnosis, and socioeconomic status) found only diagnosis to be significantly related to the outcome, number of appointments, and attendance of individual outpatient psychotherapy

Lie-Detector Tests Be Used To Monitor Convicted Sex Offenders

The British Psychological Society issued the following announcement about articles in the September, 2008, issue of the journal *Legal and Criminological Psychology*:

Should Lie-Detector Tests Be Used To Monitor Convicted Sex Offenders?

Article Date: 09 Aug 2008 - 4:00 PDT

In the September edition of Legal and Criminological Psychology, Forensic Psychiatrist Professor Don Grubin and Professor Gershon Ben- Shakhar argue the cases for and against the use of polygraph testing of convicted sex offenders.

Polygraph, or lie detector tests, monitor physiological responses such as heart rate. Individual's physiological responses to questions are measured and the polygraph records the body's responses that reflect psychological stress and arousal. In the case of convicted sex offenders, offender's responses to questions such as their use of pornography or whether they have been on the lookout for victims are measured, with the aim of monitoring behaviour and adherence to relapse prevention plans.

Polygraph testing is widely used with convicted sex offenders in the United States to assist in their treatment and supervision, and in 2007 legislation was passed in England enabling a national trial of mandatory testing in the probation service.

In the journal Legal & Criminological Psychology, Professor Don Grubin from Newcastle University and the Northumberland, Tyne and Wear NHS Trust puts forward the case for post-conviction sex offender testing (PCSOT).

He claims: "The focus of PCSOT is facilitating disclosure to assist in the treatment and supervision of sex offenders. PCOST has been found to be effective at getting a complete sexual history, checking compliance with treatment and supervision and gaining information about an
individual's offending."

However Professor Gershon Ben-Shakhar (Hebrew University of Jerusalem) believes: "Polygraph examinations have no value as a scientific method for detecting deception and uncovering information the examinee does not wish to disclose." Arguing that "autonomic measures are by no means measures of deception".

Furthermore, he claims that as the measurement of these physiological responses lacks standardization, the results cannot be quantified objectively so 'pass' and 'fail' are subjective judgements vulnerable to several biases.

The full cases for and against the use of polygraph testing of sex offenders can be found in Legal and Criminological Psychology, Volume 13 Part 2 September 2008.

Ken Pope

"It's a bit embarrassing to have been concerned with the human problem all one's life and find at the end that one has no more to offer by way of advice than 'Try to be a little kinder.'"
--Aldous Huxley (1894-1963)

NACO Revised Sex Education Manual

NACO releases revised sex education manual
August 10, 2008,

It has taken two years for the National Aids Control Organization or NACO to bring out a revised sex education manual after major flaws were reported in the earlier one. But despite the long delayed revisions huge shortcomings still remain.

Sakshi Sharma a student of Delhi's Veer Savarkar Sarvodaya Kanya Vidyalaya has just turned fourteen and like many of her classmates has questions about sex.

She thinks the internet may help her with sex education chapters that the government wants to introduce in schools by the end of this year.

"Since the diagrams have been deleted, we may have to depend upon external sources for information. But there, nobody will be able to tell us what is right or wrong," said Sakshi.

Detailed diagrams and flip charts were all part of the original manual developed for sex education by the National Aids Control Organization. But states like Madhya Pradesh and Maharashtra objected and a watered-down version has been prepared over two years. It's now posted on the net at nacoonline.org for feedback from parents, students and teachers.

But those who have been involved in revising the sex education manual say that it's best to introduce the subject slowly.

"Earlier, the content was explicit and needed revision. This revised version is culturally acceptable," said Jitendra Nagpal, member, sub-committeee, NACO.

But the reviews to the online draft are harsh.

"Students need to be told about basic sexual acts like sexual intercourse and masturbation," said Veena Batra, principal, Veer Savarkar Sarvodaya Kanya Vidyalaya.

While the NACO manual is being drafted Delhi's government schools are making do with a sex education manual prepared by local experts. Diagrams describing the anatomy of man and woman are missing from this book as well. So for now teenagers say they rely upon each other for information which is a dangerous trend for a city where sexual awareness is setting in earlier.

"It has been seen that children get exposed to sex and sexuality through internet and other sources from the age of 12, 13 onwards. The exposure is more in public schools but the government school children too are equally exposed to this. So, it is necessary that they are provided with basic and right information on this," said Dr Rajesh Sagar, psychiatrist, AIIMS.

Correct information is critical at a time when Delhi reported 15,970 HIV/AIDS cases last year. Of them 27.9 per cent or nearly 4,500 victims are between 15 and 29 years. More alarmingly, 1000 out of the 2000 new HIV/AIDS victims each year belong to this age group

http://www.ndtv.com/convergence/ndtv/story.aspx?id=NEWEN20080060831&ch=8/10/2008%208:59:00%20AM

Nursing Homes, Hospices, and End-of-Life Resources

Resources for Nursing Homes, Hospices, & End-of-Life Issues
Ken Pope

The following resources are intended to help individuals, families, and friends in their search for information, services, and facilities.
The material below includes searchable online databases, 24-hour helplines, books, and articles. They are meant to be of help to those who may need nursing homes, home health care, paliative care, hospices, assisted living, continuing care, geriatric care managers, living wills, advanced directives, hospital visitation authorization for unmarried partners, web connections with other family caregivers, and so on.
There are 5 groups of resources below: (a) online resources, (b) books, (c) hospice articles & chapters, (d) nursing home articles & chapters, and (e) end-of-life articles & chapters.
One of the other pages of this web site that provides relevant resources provides links for searching for free or low-cost medications and for searching for health insurance.
One of my other web sites focuses on disability & accessibily resources for psychology training & practice.
I hope you find these resources helpful.

Online Resources
AARP Guide To Medicare Coverage for Getting Care in a Hospital, Nursing Home, at Home and with Hospice: "Medicare Part A helps pay for inpatient care in hospitals and skilled nursing facilities. It also helps cover hospice care and some home health care. You must meet certain conditions to get these benefits. Medicare does not pay all of these costs. You, or separate insurance, must pay some of these costs, too."
Alzheimer's Association: Resources include 24-hour helpline, senior housing finder, carefinder, & library services.
Assisted Living INFO: "online guide for selecting an assisted living facility, retirement community, or other personal care facility anywhere in the United States. Our site is designed to assist you throughout the selection process. We offer tools to help you evaluate a senior's needs, facility selection tips, and our highly-acclaimed, map-based search engine to find a facility near family and friends."
Buddhist Hospice Directory: Listing, descriptions, & links to Buddhist organizations offering hospice and palliative care services.
Canadian Hospice Palliative Care Association: Information and services including an "on-line directory...designed to provide you with information on the availability of hospice palliative care services across Canada. Here you will find a listing of programs and services, their contact information, the population they serve, and where they provide care."
Cancer Care: "CancerCare is a national nonprofit organization that provides free, professional support services to anyone affected by cancer: people with cancer, caregivers, children, loved ones, and the bereaved. CancerCare programs – including counseling, education, financial assistance and practical help – are provided by trained oncology social workers and are completely free of charge."
Caregiver: information for family & professional caregivers; includes online listings for each state's Support Groups, Non-Profit Resources, Financial Aid. & Rural Caregiver Resources.
CaringBridge: "Free, personalized web sites that support and connect loved ones during critical illness.... A CaringBridge website helps keep loved ones informed during difficult times. In return, family and friends give patient and caregiver support through guestbook messages. Every free, personalized CaringBridge website includes: patient care journal to update family and friends; guestbook for messages of love; photo gallery; & free online support for using the service."
Caring Connections: online resources include "a state-specific living will or healthcare power of attorney"
Children's Hospice International: Directory: searchable online "worldwide database of programs caring for children with life-threatening conditions and their families"
Compassion and Choices: resources include forms for living will and advance directive (for each state) and hospital visitation authorization form for unmarried partners.
Consumer Reports: "The Deficient Dozen: Homes Noted for Poor Care on All Five of Our Lists": "The following nursing facilities have appeared on all four of our Nursing Home Watch Lists published between 2000 and 2005 as well as on the list of homes to avoid in the current Consumer Reports Nursing Home Quality Monitor."
Consumer Reports: "Form 2567: How to read this very important document": "When scouting nursing homes for a family member or another person, one of the best things you can do is get and read each home's Form 2567. It's the state inspection report for the facility, frequently called the state survey, and by law it must be 'readily accessible' to residents and visitors... Regular surveys are conducted every 12 to 15 months by state inspectors on behalf of the federal Centers for Medicare & Medicaid Services."
Consumer Reports: Nursing homes: Business as usual": "Two decades after the passage of a federal law to clean up the nation’s nursing homes, bad care persists and good homes are still hard to find. Two decades after the passage of a federal law to clean up the nation’s nursing homes, bad care persists and good homes are still hard to find."
A Dying Person's Guide to Dying by Roger Bone, M.D.: "By thinking ahead about what could happen - and about how you will deal with problems if they do happen, you can create a better life and a better quality of life for yourself and for the people who love and care about you. What I have to say is for the person who, like myself, is dying. We, too, need to plan - to think ahead in order to fashion, out of the time remaining, the best of what is possible. As I am dying from cancer..."
Family Caregiver Alliance: "information on care strategies, stress relief, community resources, family issues and hands-on care. Be sure to also visit our Fact Sheet section for a comprehensive collection of family-friendly publications filled with practical information. For more personal assistance, click on 'Ask FCA'. And don’t miss our online Discussion Groups, to keep you connected, 24 hours a day, with other caregivers."
Gilbert Guide: Allows online searching for facilities & services including: (a) assisted living, (b) homecare, (c) continuing care (CCRC), (d) nursing homes, (e) home health care, (f) geriatric care managers, (g) adult day services, and (h) hospices.
Homecare Directory: online searchable database for home care, hospice care, & geriatric care managers. "the most comprehensive site on the web for finding Home Care, Home Health Care and Hospice Care providers throughout the United States and Canada. We have simplified your search for Homecare, and Hospice Care providers by only listing the most qualified providers within North America. All Home Health Care providers on TheHomeCareDirectory.com are fully licensed, bonded, and insured."
Hospice Directory: online searchable database of hospices in Canada and the United States.
International Association for Hospice & Palliative Care: Directory: provides online searching of worldwide directory of hospices & sources of palliative care.
Mayo Clinic: Anticipating end-of-life needs of people with Alzheimer's disease: "The challenges of Alzheimer's disease multiply as the end of life approaches. Here are some ways to prepare for the tough choices ahead."
National Cancer Institute: End-of-Life Care: questions and answers - "The following information can help answer some of the questions that many patients, their family members, and caregivers have about the end of life."
National Hospice & Palliative Care Organization: Find a Provider: Allows online searches by city, name, specialization, etc.
National Institute for Jewish Hospice: "A 24 hour toll-free number counsels families, patients and care-givers, and provides locations of hospices, hospitals, health professionals and clergy of all faiths."
Nursing Home Directory: "free online guide for finding nursing homes and assisted living facilities nationwide."
Nursing Home INFO: Allows online searching for nursing homes by city, county, state, name, management, or special needs.
Palliative Care Directory of Hospitals: searchable online database "to help you or a loved one locate a hospital in your area that provides a palliative care program. The directory is based upon palliative care programs listed in the 2007 American Hospital Association (AHA) Annual Survey."
Palliative Dementia Care Resources: "We are dedicated to providing access to appropriate online resources for family and professional caregivers. In order to be responsive to the needs of caregivers in managing life's changes, preparing for life's end, and coping with grief and loss, our content is focused on those topics that are often most pressing."
Perinatal hospice/palliative care programs and support: online listing and links to hospitals with perinatal hospice/palliative care programs. "As prenatal testing becomes increasingly routine, more parents are learning devastating news before their babies are born. In too many places, the ability to diagnose has raced ahead of the ability to care for these families and their babies. But in a beautiful and practical response, some pioneering hospitals and hospices are starting perinatal hospice or perinatal palliative care programs for families who wish to continue their pregnancies with babies who likely will die before or shortly after birth. A perinatal hospice approach walks with these families on their journey through pregnancy, birth and death, honoring the baby as well as the baby's family. Even in areas without a formal program, parents can create a loving experience for themselves and their baby, and health professionals and family and friends can offer support in the spirit of hospice (see our resources pages)."
U.S. Department of Health & Human Services: Centers for Medicare & Medicaid Services: comprehensive government web site for medicare & medicaid coverage.
U.S. Department of Health & Human Services: Eldercare Locator: "links those who need assistance with state and local area agencies on aging and community-based organizations that serve older adults and their caregivers."
U.S. Health & Human Services Nursing Home Comparison Site: "The primary purpose of this tool is to provide detailed information about the past performance of every Medicare and Medicaid certified nursing home in the country." The site allows you to search by geography (i.e. all homes within a state or county), proximity (within a certain distance of a town or zip code), or name.
Veterans Aid & Attendance Pension Benefit: Guide to using veterans' pension benefit for home care, assisted living, nursing home, etc.
Veterans Coalition Senior Veterans Initiative: provides support to veterans and their families in regard to understanding and applying for disability, long-term care, assisted living, skilled nursing, and homebound care.

Books
Ahead of Your Time: A Complete Guide for End-of-Life Planning. Dick Coffin & Sue Coffin. Ahead Of Your Time Publishers, 2007.
American Medical Association Guide to Home Caregiving. American Medical Association. AMA, 2001.
Baby Boomer's Guide to Nursing Home Care. Eric M. Carlson & Katharine Bau Hsiao. Taylor, 2006.
Caregiving: Hospice-Proven Techniques for Healing Body and Soul. Douglas C. Smith. Wiley, 1997.
Caring for Your Parents by Hugh Delehanty and Elinor Ginzler. AARP, Sterling Publishing Co., Inc., New York, 2005.
Christian Caregiving: A Way of Life. Kenneth C. Haugk. Augsburg Publishing House. 1984.
The Comfort of Home: A Complete Guide for Caregivers. Maria M. Meyer & Paula Derr. CareTrust Publications, 2007.
Complete Eldercare Planner, 2nd Edition. Joy Loverde. Three Rivers Press, 2000.
Communicating at the end of life: Finding magic in the mundane. E. Foster. Lawrence Erlbaum Associates Publishers, 2007.
Dying at home: a family guide for caregiving. A. Sankar. Johns Hopkins University Press, 1999.
Emotional Survival Guide for Caregivers: Looking After Yourself and Your Family While Helping an Aging Parent. Barry Jacobs. Guilford Press, 2006.
End-of-Life Advisor: Personal, Legal, and Medical Considerations for a Peaceful, Dignified Death. Susan Dolan & Audrey R. Vizzard. Kaplan Publishing, 2008.
End-of-Life Handbook: A Compassionate Guide to Connecting with and Caring for a Dying Loved One. David B. Feldman, Stephen Andrew Lasher Jr., & Ira Byock. New Harbinger, 2008.
Everything You Need to Know About Nursing Homes: The Family's Comprehensive Guide to Either Working with the Institution or Finding Care Alternatives. Charlotte Digregorio. Civetta Press, 2005.
Family Hospice Care: Pre-Planning and Care Guide. Harry van Bommel. Media Futures Institute, 2006.
A Final Farewell: Your Personal Guide to End of Life Issues. Nancy Lawson. Legacy, 2002.
Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying. Maggie Callanan & Patricia Kelley. Bantom, 1997.
Guide to Caregiving in the Final Months of Life. Betsy Murphy & Linda Roberts. T. M. Brown Publishers, 2007.
Hospice Care for Children (2nd ed.). A. Armstrong-Dailey & S. Zarbock. Oxford University Press, 2001.
Hospice Care at Home: A Guide to Caring for Your Dying Loved One at Home. Starr Calo-oy & Bob Calo-oy. Orchard Publications, 2006.
The Hospice Choice: In Pursuit of a Peaceful Death. by Marcia Lattanzi-Licht, Galen W. Miller, & John J. Mahoney. Fireside, 1998.
Hospice Handbook: A Complete Guide. Larry Beresford & Elisabeth Kubler-Ross. Little, Brown, 1993.
Hospice and Palliative Care: Concepts and Practice, Second Edition. Denice C. Sheehan. Jones and Bartlett, Publishers, 2003.
How to Find Great Senior Housing: A Roadmap for Elders and Those Who Love Them, 2nd Edition. Phyllis Staff. The Best Is Yet.Net Press, 2004.
Infection Control In Home Care and Hospice, 2nd Edition. Emily Rhinehart & Mary McGoldrick Friedman. Jones & Bartlett, 2005.
Insider's Guide to Better Nursing Home Care: 75 Tips You Should Know. Donna M. Reed. Promethius, 2008.
Journey through the Dying Process: Caring for a Loved one at the End of Life. Fairview Health Services. Fairview Press, 2003.
Let Me Decide: What You Need to Know Now about End-Of-Life Care. William Molloy. Penguin Books Canada, 2005.
Living Well in a Nursing Home: Everything You & Your Folks Need to Know. Lynn Dickinson, Xenia Vosen, & Severine Biedermann. Hunter House, 2005.
Needs of the Dying: A Guide for Bringing Hope, Comfort, and Love to Life's Final Chapter. David Kessler. Harper, 2007.
Notes from the Waiting Room: Managing a Loved One's End-of-Life-Hospitalization (includes Choosing End-of-Life Care Without Hospitalization). Bart Windrum. Axiom Action, 2008.
Nursing Homes: The Family's Journey. Peter S. Silin. Johns Hopkins University Press, 2001.
On Death and Dying: What the Dying Have to Teach their Doctors, Nurses, Clergy, and their Own Families. Elisabeth Kubler-Ross. Scribner, 1969.
Peaceful Dying: The Step-by-step Guide To Preserving Your Dignity, Your Choice, And Your Inner Peace At The End Of Life. Daniel R. Tobin, With & Karen Lindsey. Da Capo Press, 1968.
Peaceful Journey: A Hospice Chaplain's Guide to End-of-Life. Matthew P. Binkewicz. Paramount Market Publishing, 2005.
Raising Moms. Rhonda H. Kelley. New Hope Publishers, 2006.
The Senior's Guide to End-of-Life Issues: Advance Directives, Wills, Funerals & Cremations. Rebecca Sharp Colmer & Todd M. Thomas. Eklektika Press, 2006.
Staying in Charge: Practical Plans for the End of Your Life. Karen Orloff Kaplan & Christopher Lukas. Wiley, 2004.
Transitions in Dying and Bereavement: A Psychosocial Guide for Hospice and Palliative Care. Moira Cairns, Marney Thompson, Wendy Wainwright, & Victoria Hospice Society. Health Professions Press, 2003. When Someone You Love Needs Nursing Home Care: The Complete Guide. Robert F. Bornstein, Mary A., Ph.D. Languirand, & Robert Bornstein. Newmarket Press, 2001.

Hospice Articles & Chapters
Abdel-Karim, I. A., Sammel, R. B., & Prange, M. A. (2007). Causes of death at autopsy in an inpatient hospice program. Journal of Palliative Medicine, 10(4), 894-898.
Ackson, A., Hodson, M., Brady, D., & Pahl, N. (2007). Spreading the word...Hospice Information systems. Omega: Journal of Death and Dying, 56(1), 47-62.
Adamle, K. N., & Ludwick, R. (2005). Humor in hospice care: Who, where, and how much? American Journal of Hospice & Palliative Medicine, 22(4), 287-290.
Adunsky, A., Aminoff, B. Z., Arad, M., & Bercovitch, M. (2008). Mini-Suffering State Examination: Suffering and survival of end-of-life cancer patients in a hospice setting. American Journal of Hospice & Palliative Medicine, 24(6), 493-498.
Andruccioli, J., Montesi, A., Raffaeli, W., Monterubbianesi, M. C., Turci, P., Pittureri, C., et al. (2007). Illness awareness of patients in hospice: Psychological evaluation and perception of family members and medical staff. Journal of Palliative Medicine, 10(3), 741-748.
Arber, A. (2007). "Pain talk" in hospice and palliative care team meetings: An ethnography. International Journal of Nursing Studies, 44(6), 916-926.
Ardelt, M., & Koenig, C. S. (2006). The Role of Religion for Hospice Patients and Relatively Healthy Older Adults. Research on Aging, 28(2), 184-215.
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Ethics Codes and Practice Guidelines for Assessment, Therapy, Counseling, and Forensic Practice

Ethics Codes and Practice Guidelines for Assessment, Therapy, Counseling, and Forensic Practice

This page presents links to therapy, counseling, forensic, and related ethics (and practice) codes developed by professional organizations (e.g., of psychologists, psychiatrists, social workers, marriage and family counselors). Codes are listed only if they appear online.

Links to related resources are listed at the end.

"Awareness of the ethics codes is crucial to competence in the area of ethics, but the formal standards are not a substitute for an active, deliberative, and creative approach to fulfilling our ethical responsibilities. They prompt, guide, and inform our ethical consideration; they do not preclude or serve as a substitute for it. There is no way that the codes and principles can be effectively followed or applied in a rote, thoughtless manner. Each new client, whatever his or her similarities to previous clients, is a unique individual. Each situation also is unique and is likely to change significantly over time. The explicit codes and principles may designate many possible approaches as clearly unethical. They may identify with greater or lesser degrees of clarity the types of ethical concerns that are likely to be especially significant, but they cannot tell us how these concerns will manifest themselves in a particular clinical situation. They may set forth essential tasks that we must fulfill, but they cannot tell us how we can accomplish these tasks with a unique client facing unique problems. . . . There is no legitimate way to avoid these struggles."--Ethics in Psychotherapy & Counseling, 3rd Edition

Science: new research on borderline personality disorder; trust; brain activation

The new issue of the American Association for the Advancement of Science* (Vol. 321. no. 5890, Aug 8) includes an article on borderline personality disorder: "PSYCHOLOGY: Trust Me on This" by Andreas Meyer-Lindenberg.

Here are some excerpts:

[begin excerpts]

Unstable interpersonal relationships, reduced impulse control, and difficulty regulating emotions characterize borderline personality disorder, a severe mental illness that accounts for up to 20% of psychiatric inpatients and exerts a tremendous toll on those afflicted, their social network, and the health-care system (1).

Close relationships of patients are often tumultuous, spiraling out of control through highly emotional and unpredictable behavior that can leave others baffled, angry, and frightened. On page 806 in this issue, King-Casas et al. (2) use an economic exchange game and neuroimaging to provide a glimpse into the neural mechanisms underlying the breakdown of cooperation in individuals with borderline personality disorder. The study also establishes a game theory paradigm that holds promise for investigating social interactions, particularly psychiatrically relevant disturbances of social behavior.

In the multiround economic trust game, money is exchanged between an investor, who decides how much money to commit, and a trustee, who decides how much of the investment (which is tripled during the transfer) to repay the investor. If both cooperate, both benefit from the exchange, much more so than if the investor keeps most of the money. However, this requires a degree of trust between the players, which is built up through repeated fair offers. An investor who does not trust will not invest much money. This is exactly what happened at the end of games with trustees who suffered from borderline personality disorder, indicating that they were less likely to establish or maintain a cooperative relationship. By contrast, healthy trustees were successful at doing so (thus, investment remained high at the end of the game). The better outcome was accomplished through a coaxing strategy, in which wary investors transferring small amounts of money were encouraged by generous returns, which signaled trustworthiness. Healthy players used this strategy twice as often as borderline personality disorder subjects. Why?

To find out, King-Casas et al. used neuroimaging to study brain activation of trustees confronted with a small investment (a signal of the investor's lack of trust). Individuals with borderline personality disorder and healthy players differed in the activity of one brain area-- the anterior insula (see the figure). In healthy trustees, small investments corresponded to large activations and large investments corresponded to small activations. By contrast, in players with borderline personality disorder, the anterior insula did not distinguish between offer sizes. As expected from previous work (3), the same brain area was also reactive to the amount trustees were about to repay the investor, but this was now found in both patients and healthy controls. In healthy controls, the anterior insula was activated in response both to distrustful offers from investors and stingy repayments they were about to make, whereas in trustees with the personality disorder, differential neural activity was observed only when they were repaying.

Thus, their impairment selectively affected representation of the other player in the pair.

The anterior insula is traditionally associated with sensing the physiological state of the body, but strongly reacts to adverse or uncomfortable occurrences in social interactions, such as unfairness (4), risky choices, frustration, or impending loss of social status (5). This brain region also responds to the intentions and emotional state of thers (6, 7), and imbues them with feeling (8). Because rewarding aspects of social interactions have been mapped to the ventral striatum in the brain (9), the present results suggest that activation of the anterior insula in a social context represents a negative/aversive evaluation of perceived or planned action, perhaps associated with a feeling of discomfort. If true, this implies that individuals with borderline personality disorder may have difficulty cooperating because they lack the "gut feeling" (corresponding to the anterior insula signal) that the relationship is in jeopardy and/or expect such behavior from the outset. The correspondence of these brain findings to current psychotherapeutic practice is remarkable. The most effective treatment of borderline personality disorder (1), dialectical behavior therapy, is based on the assumption that patients lack skills in interpersonal self- regulation, and attempts to build these abilities.

The use of a game theoretic approach to investigate personality disorders may be useful for studying other mental illnesses where social dysfunction is a prominent source of disability and distress, such as schizophrenia or autism. Game theory originated as an instrument of neuroeconomic analyses that assume perfect rationality of the players, and at first it came as a surprise that economic choices were in fact strongly impacted by emotional and reward-related brain processes. As King-Casas et al. show, it has now evolved into a tool for investigating psychopathological impairment of social interactions. Such advances are needed for patients, therapists, and researchers to grapple with social dysfunction, which is among the most impairing and least treatable components of severe illnesses such as schizophrenia.

[end excerpts]

The author note states that reprint requests may be sent to the author at Central Institute of Mental Health, J5, University of Heidelberg, 68159 Mannheim, Germany. E-mail: <a.meyerlindenberg@ zi-mannheim. de>.

"Believe nothing merely because you have been told it.... Do not believe what your teacher tells you merely out of respect for the teacher. But whatsoever, after due examination and analysis, you find to be kind, conducive to the good, the benefit, the welfare of all beings--that doctrine believe and cling to, and take it as your guide." Buddha (about 623-543 BC)

Logical Fallacies in Psychology: 20 Types

Logical Fallacies in Psychology: 20 Types
Kenneth S. Pope, Ph.D., ABPP

Here are 20 logical fallacies. We've all probably fallen for them -- and perhaps used them -- from time to time.

Articles in other sections of this web site examine logical fallacies in more detail (e.g., the affirming the consequent fallacy discussed in the "Science As Careful Questioning" American Psychologist article; the ad hominem fallacy discussed in the "Pseudoscience, Cross-examination, & Scientific Evidence" Psychology, Public Policy, & Law article). I thought it might be helpful to draw these fallacies together on one page. This list is not, of course, comprehensive. I've tried to choose those fallacies that seem to thrive and are unlikely to appear on the "endangered species" list in the psychological literature and in psychological discussions.

The fallacies are ad hominem or ad feminam, affirming the consequent, appeal to ignorance (ad ignorantium), argument to logic (argumentum ad logicam), begging the question (petitio principii), composition fallacy, deny ing the antecedent, disjunctive fallacy, division fallacy, false analogy, false dilemma, golden mean fallacy, mistaking deductive validity for truth, naturalistic fallacy, nominal fallacy, post hoc ergo propter hoc (after this, therefore because of this), red herring, slippery slope, straw person, and you too (tu quoque).

The name of each fallacy is followed by a brief description and an example from the field of psychology.

For those interested, other articles in this section include 21 ethical fallacies and 7 fallacies & pitfalls in psychological assessment.

Ad Hominem or Ad Feminam
The argumentum ad hominem or ad feminam attempts to discredit an argument or position by drawing attention to characteristics of the person who is making the argument or who holds the position.

Example: "The research and reasoning that supposedly supports (or that supposedly discredits) this intervention are a joke. The researchers are people who are not methodologically sophisticated and there have been rumors--I have no idea whether they're true or not--that they faked some of the data. The advocates (or opponents) of this intervention are the worst kind of sloppy thinkers. They are fanatical adherents who already have their minds made up; they've become true believers in their cause. They make arguments only a stupid person would accept, and mistakes in reasoning that would make an undergrad psych major blush. These are not the kind of people who deserve to be taken seriously."

Affirming the Consequent
This fallacy takes the form of:
If x, then y.
y.
therefore: x.

Example: "People who are psychotic act in a bizarre manner. This person acts in a bizarre manner. Therefore: This person is psychotic."

Alternate example: "If this client is competent to stand trial, she will certainly know the answers to at least 80% of the questions on this standardized test. She knows the answers to 87% of the test questions. Therefore she is competent to stand trial."

Appeal To Ignorance (Ad Ignorantium)
The appeal to ignorance fallacy takes the form of:
There is no (or insufficient) evidence establishing that x is false.
Therefore: x is true.

Example: "In the 6 years that I have been practicing my new and improved brand of cognitive-humanistic-dynamic-behavioral-deconstructive-metaregressive-deontological psychotherapy (now with biofeedback!), which I developed, there has not been one published study showing that it fails to work or that it has ever harmed a patient. It is clearly one of the safest and most effective interventions ever devised."

Argument to Logic (Argumentum ad Logicam)
The argument to logic fallacy takes the form of assuming that a proposition must be false because an argument offered in support of that proposition was fallacious.

Example: "This new test seemed so promising, but the 3 studies that supported its validity turned out to have critical methodological flaws, so the test is probably not valid."

Begging the Question (Petitio Principii)
This fallacy, one of the fallacies of circularity, takes the form of arguments or other statements that simply assume or re-state their own truth rather than providing relevant evidence and logical arguments.

Examples: Sometimes this fallacy literally takes the form of a question, such as, "Has your psychology department stopped teaching that ineffective approach to therapy yet?" (The question assumes--and a "yes" or "no" response to the question affirms--that the approach is ineffective.) Or: "Why must you always take positions that are so unscientific?" (The question assumes that all of the person's positions are unscientific.) Sometimes this fallacy takes the form of a statement such as "No one can deny that [my theoretical orientation] is the only valid theoretical orientation" or "It must be acknowledged that [whatever psychological test battery I use] is the only legitimate test battery." Sometimes it takes the form of a logical argument, such as, "My new method of conducting meta-analyses is the most valid there is because it is the only one capable of such validity, the only one that has ever approached such validity, and the only one that is so completely valid."

Composition Fallacy
This fallacy takes the form of assuming that a group possesses the characteristics of its individual members.

Example: "Several years ago, a group of 10 psychologists started a psychology training program. Each of those psychologists is efficient, effective, and highly-regarded. Their training program must be efficient, effective, and highly-regarded."

Denying the Antecedent
This fallacy takes the form of:
If x, then y.
Not x.
therefore: not y.

Example: "If this test were based on fraudulent norms, then it would be invalid. But the norms are not fraudulent. Therefore, this test is valid."

Disjunctive Fallacy
This fallacy takes the form of:
Either x or y.
x.
Therefore: not y.

Example: "These test results are clearly wrong, and it must be either because the client was malingering or because I bungled the test administration. Taking another look at the test manual, I see now that I bungled the test administration. Therefore the client was not malingering."

Division Fallacy
The division fallacy or decomposition fallacy takes the form of assuming that the members of a group posses the characteristics of the group.

Example: "This clinic sure makes a lot of money. Each of the psychologists who work there must earn a large income."

False Analogy
The false or faulty analogy fallacy takes the form of argument by analogy in which the comparison is misleading in at least one important aspect.

Example: "There were wonderful psychologists who passed away several decades ago. If they could be effective in what they did without reading any of the studies or other articles that have been published in the last several decades, there's no need for me to read any of those works in order to be effective."

False Dilemma
Also known as the "either/or" fallacy or the fallacy of false choices, this fallacy takes the form of only acknowledging 2 (one of which is usually extreme) options from a continuum or other array of possibilities.

Example: "Either we accept the findings of this study demonstrating that this new intervention is the best to be used for this disorder, or we must no longer call ourselves scientists, psychologists, or reasonable people."

Golden Mean Fallacy
The fallacy of the Golden Mean (or fallacy of compromise, or fallacy of moderation) takes the form of assuming that the most valid conclusion is that which accepts the best compromise between two competing positions.

Example: "In our psychology department, half of the faculty believe that a behavioral approach is the only valid approach; the other half believe that the only valid approach is psychodynamic. Obviously the most valid approach must be one that incorporates both behavioral and psychodynamic elements."

Mistaking Deductive Validity for Truth
This fallacy takes the form of assuming that because an argument is a logical syllogism, therefore the conclusion must be true. It ignores the possibility that the premises of the argument may be false.

Example: "I just read a book that proves that that book's author can do much better than any psychological test at finding out if someone is malingering. The book's author reviews the literature showing that no psychological test is perfect at identifying malingering. All have at least some false positives and false negatives. But the author has a new method of identifying malingerers. All he does is listen to the sound of their voice as they say a sentence or two. And he included in the book a chart showing that by using this method he has never been wrong in hundreds of cases. That proves his method is better than using psychological tests."

Naturalistic Fallacy
The naturalistic fallacy takes the form of logically deducing values (e.g., what is good, best, right, ethical, or moral) based only on statements of fact.

Example: "There is no intervention for victims of domestic violence that has more empirical support from controlled studies than this one. It is clear that this is the right way to address this problem and we should all be providing this therapy whenever victims of domestic violence come to us for help."

Nominal Fallacy
The nominal fallacy is the mistake of assuming that because we have given a name to something, therefore we have explained it.

Example:

Therapist A: "I just don't care about my patient anymore. I don't pay attention to what they say. I show up late for sessions. I don't care if they show up. I ask them if they'd rather we just use the session playing a game of tennis or sharing a cup of coffee. I don't keep records."

Therapist B: "You have a classic case of burn-out!"

Therapist A: "But why am I doing all these things?"

Therapist B: "Because you're burned out."

Post Hoc, Ergo Propter Hoc (After this, therefore on account of this)
The post hoc, ergo propter hoc fallacy takes the form of confusing correlation with causation and concluding that because Y follows X, then Y must be a result of X.

Example: "My new sport psychology intervention works! I chose the player with the lowest batting average based on the last game from each of the teams in our amateur baseball league. Then I gave each of them my 5-minute intervention. And almost all of them improved their batting average in the next game!" (Note: this example may also involve the statistical phenomenon of regression to the mean.)

Red Herring
This fallacy takes the form of introducing or focusing on irrelevant information to distract from the valid evidence and reasoning. It takes its name from the strategy of dragging a herring or other fish across the path to distract hounds and other tracking dogs and to throw them off the scent of whatever they were searching for.

Example: "Some of you have objected to the new test batteries that were purchased for our program, alleging that they have no demonstrable validity, were not adequately normed for the kind of clients we see, and are unusable for clients who are physically disabled. What you have conveniently failed to mention, however, is that they cost less than a third of the price for the other tests we had been using, are much easier to learn, and can be administered and scored in less than half the time of the tests we used to use."

Slippery Slope (also known as "The Continuum Falacy," and "Camel's Nose Falacy"
The slippery slope fallacy is a form of the Non Causa Pro Causa (mistaking a non-cause as a cause) and the non sequitur (it does not follow), which claims (without proof) that A inevitably must cause B, and B can have no other outcome than C, and C is sufficient cause for D, and D must lead to E, and E must produce F, and so on, and because the last link in the supposedly causal chain is undesirable, therefore the first step is undesirable.

Examples: "If the government allows psychologists to prescribe medications there will be no basis to block them from obtaining competence and legal authority to conduct other traditionally medical procedures such as diagnosing minor skin irritations, treating a sprained ankle, setting a broken bone, and performing neurosurgery." Or: "Never reduce a fee for any patient for any reason or else you'll find yourself constantly reducing fees for everyone, everyone will take advantage of you, your patients will lose respect for you and for therapy, and you'll loose money and go bankrupt."

Straw Person
The straw person, or straw man, or straw woman fallacy takes the form mischaracterizing someone else's position in a way that makes it weaker, false, or ridiculous.

Example: "Those who believe in behavior modification obviously want to try to control everyone by subjecting them to rewards and punishments."

You Too! (tu quoque)
This fallacy takes the form of distracting attention from error or weakness by claiming that an opposing argument, person, or position has the same error or weakness.

Example: "I have been accused of using an ad hominem approach in trying to defend my research. But those who attack me and my research are also using ad hominem. And they started it!"