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Infusing Ethical and Multicultural Competencies into Training: Models and Methods


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Title: Infusing Ethical and Multicultural Competencies into Training: Models and Methods

Infusing Ethical and Multicultural Competencies
into Training Models and Methods
  • Erica H. Wise, Ph.D., Tony Cellucci, Ph.D., ABPP,
    and Robert W. Heffer, Ph.D.
  • Continuing Education Program
  • ADPTC Mid-Year Conference
  • January 18, 2008
  • San Antonio, Texas

Workshop Overview
  • Review underlying philosophical principles and
    ethical guidelines related to supervision in the
    context of an ethical decision making model
  • Describe a developmental competency model that
    promotes the integration and infusion of ethical
    and multicultural competencies into the clinical
    training curriculum
  • Promote the use of active teaching strategies
    for infusing ethical and multicultural
    competencies into clinical training

Being an Ethical Role Model
  • Be familiar with guidelines and standards related
    to supervision and training
  • Incorporate these principles into the day to day
    functioning of your training program
  • Create an atmosphere that fosters discourse about
    ethics and practice

Professional Self-Regulation
  • Risk Management
  • Aspirational

Philosophical TheoryMoral Reasoning
  • Deontological
  • The Moral Imperative
  • Choices and behavior are inherently right or
  • Teleological
  • Utilitarianism or Pragmatism
  • Choices and behavior are judged by outcome

  • Are there ethical challenges inherent in

Supervision as a Triadic System
  • Bernard Goodyear, 2004

The Supervisory Dyad
  • Bernard Goodyear, 2004

How Supervisors Help Foster a Strong Alliance
  • Create shared goals with supervisee
  • Consider the process of evaluation
  • Criteria for evaluation?
  • Formative versus summative?
  • Cultivate a safe, supportive atmosphere
  • Discuss multicultural issues
  • Address negative experiences or interactions
  • Bernard Goodyear, 2004

Empirical Evidence Suggests That With Improved
  • Supervisees will
  • Disclose more in supervision
  • Adhere to treatment better
  • Connect better to their client
  • Bernard Goodyear, 2004

  • What are the major ethical issues related to

Ethical Issues in Supervision
  • Confidentiality
  • Competence and Client Welfare
  • Informed Consent
  • Supervisee Rights
  • The Relationship Between Supervisor and Supervisee

  • Confidentiality

Definition of Terms
  • Privacy
  • Confidentiality
  • Privilege

  • General Rule
  • Mandated Exceptions
  • Permitted Exceptions

General Rule
  • 4.01 Maintaining Confidentiality
  • Psychologists have a primary obligation and take
    reasonable precautions to protect confidential
    information obtained through or stored in any
    medium, recognizing that the extent and limits of
    confidentiality may be regulated by law or
    established by institutional rules or
    professional or scientific relationship.

Limits of Confidentiality
  • 4.02 Discussing the Limits of Confidentiality
  • (a) Psychologists discuss with persons
    (including, to the extent feasible, persons who
    are legally incapable of giving informed consent
    and their legal representatives) and
    organizations with whom they establish a
    scientific or professional relationship (1) the
    relevant limits of confidentiality and (2) the
    foreseeable uses of the information generated
    through their psychological activities. (See also
    Standard 3.10, Informed Consent.)
  • (excerpt)

  • Competence and
  • Client Welfare

2.05 Delegation of Work to Others (excerpt)
  • Psychologists who delegate work
    tosuperviseestake reasonable steps toauthorize
    only those responsibilities that such persons can
    be expected to perform competently on the basis
    of their education, training and experiencewith
    the level of supervision being provided.

  • Informed Consent

10.01 Informed Consent to Therapy
  • Psychologists inform clients/patients as early as
    is feasible in the therapeutic relationship about
    the nature and anticipated course of therapy,
    fees, involvement of third parties, and limits of
    confidentiality and provide sufficient
    opportunity for the client/patient to ask
    questions and receive answers.
  • When the therapist is a trainee and the legal
    responsibility for the treatment provided resides
    with the supervisor, the client/patient, as part
    of the informed consent procedure, is informed
    that the therapist is in training and is being
    supervised and is given the name of the

  • Supervisee Rights

7.02 Descriptions of Education and Training
  • Psychologists responsible for education and
    training programs take reasonable steps to ensure
    that there is a current and accurate description
    of the program content (including participation
    in required course- or program-related
    counseling, psychotherapy, experiential groups,
    consulting projects, or community service),
    training goals and objectives, stipends and
    benefits, and requirements that must be met for
    satisfactory completion of the program. This
    information must be made readily available to all
    interested parties.

7.04 Student Disclosure of Personal Information
  • Psychologists do not require students or
    supervisees to disclose personal information in
    course- or program-related activities, either
    orally or in writing, regarding sexual history,
    history of abuse and neglect, psychological
    treatment, and relationships with parents, peers,
    and spouses or significant others except if

7.04 Student Disclosure of Personal Information
  • The program or training facility has clearly
    identified this requirement in its admissions and
    program materials or
  • The information is necessary to evaluate or
    obtain assistance for students whose personal
    problems could reasonably be judged to be
    preventing them from performing their training-
    or professionally related activities in a
    competent manner or posing a threat to the
    students or others.

7.06 Assessing Student and Supervisee Performance
  • In academic and supervisory relationships,
    psychologists establish a timely and specific
    process for providing feedback to students and
    supervisees. Information regarding the process is
    provided to the student at the beginning of
  • Psychologists evaluate students and supervisees
    on the basis of their actual performance on
    relevant and established program requirements.

  • The Relationship Between Supervisor and

3.05 Multiple Relationships
  • A multiple relationship occurs when a
    psychologist is in a professional role with a
    person and
  • at the same time is in another role with the same
  • at the same time is in a relationship with a
    person closely associated with or related to the
    person with whom the psychologist has the
    professional relationship, or
  • promises to enter into another relationship in
    the future with the person or a person closely
    associated with or related to the person.

3.05 Multiple Relationships(excerpt)
  • A psychologist refrains from entering into a
    multiple relationship if the multiple
    relationship could reasonably be expected to
    impair the psychologists objectivity,
    competence, or effectiveness in performing his or
    her functions as a psychologist, or otherwise
    risks exploitation or harm to the person with
    whom the professional relationship exists.
  • Multiple relationships that would not reasonably
    be expected to cause impairment or risk
    exploitation or harm are not unethical.

3.08 Exploitative Relationships
  • Psychologists do not exploit persons over whom
    they have supervisory, evaluative, or other
    authority such as clients/patients, students,
    supervisees, research participants, and

7.07 Sexual Relationships With Students and
  • Psychologists do not engage in sexual
    relationships with students or supervisees who
    are in their department, agency, or training
    center or over whom psychologists have or are
    likely to have evaluative authority.

Psychologists in Training 90-270.4 Exemptions
  • Example from NC Psychology Practice Act
  • (d) Nothing in this article shall be construed as
    limiting the activities, services, and use of
    title designating training status of a student,
    intern, fellow, or other traineepreparing for
    the practice of psychology under the supervision
    and responsibility of a qualified
    psychologistsprovided that such activities and
    services constitute a part of his or her course
    of study as a matriculated graduate student in

  • How do we Develop Ethical Competencies in our

Strategies for developing ethical competencies
in our trainees
  • Early in training
  • Supervisor initiative to focus on ethics
  • Incorporate ethics in a structured manner into
    supervision process
  • Intervene actively in ethical decision-making
  • Recognize individual differences in critical
    thinking in supervisees

Strategies for developing ethical competencies
in our trainees
  • Later in training
  • Supervisees expected to recognize ethical
    dilemmas and to function more autonomously in
    ethical decision making
  • May still need assistance with complex ethical
  • Inculcate value of life long learning and
    assertiveness related to ethical competency

ADPTC Competency Outline 7 Ethical Competencies
  • During the practicum, the student will build on
    coursework in ethical practice, developing
    individual, practical knowledge of ethical
    practice, including linkage of the APA ethics
    code (APA, 2002) to behavior and decision making
    in actual clinical settings. (excerpt)

ADPTC CO Ethical Competencies
  • More specifically, during practicum training the
    student will work to develop the following
    ethical competencies
  • Knowledge of ethical/professional codes,
    standards and guidelines knowledge of statutes,
    rules, regulations and case law relevant to the
    practice of psychology.
  • Recognize and analyze ethical and legal issues
    across the range of professional activities in
    the practicum setting.
  • Recognize and understand the ethical
    dimensions/features of his/her own attitudes and
    practice in the clinical setting.
  • Seek appropriate information and consultation
    when faced with ethical issues.
  • Practice appropriate professional assertiveness
    related to ethical issues (e.g., by raising
    issues when they become apparent to the student).
    Evidence commitment to ethical practice.

Ethical Decision Making
  • Recognize a situation in which there is an
    ethical dilemma or in which there is potential
    for harm
  • Identify the underlying moral or ethical
    principle or dilemma
  • Consult available sources of guidance
  • Consult a knowledgeable colleague or expert
  • Consider sources of influence (internal/external)
    that might impact your judgment
  • Identify potential options and likely
  • Decide on a course of action
  • Take it one step at a time
  • Adapted from Koocher, G.P. and Keith-Spiegel, P.
  • Ethics in Psychology, 1998

Clinical Applications
  • A 23yo Latina female comes in to the training
    clinic because she is experiencing conflict
    between her desire to continue in her Ph.D.
    program in biochemistry and her wish to be close
    to her extended family in California. They want
    her to come home and they would like her to
    consider marrying a local boy whose family is
    from the same small town in Mexico where there is
    extended family. She is lonely in her graduate
    program, has trouble concentrating on her
    studies and struggles with intense guilt.
  • A 24yo male Asian graduate student from Taiwan
    comes in to the training clinic because he feels
    increasingly unhappy with his major in computer
    science. He tell you that his family expects him
    to be a computer science engineer in fact, they
    would not have funded travel, living and tuition
    expenses for him to study anthropology about
    which he has an intellectual passion.
  • An 19yo male university student comes in to the
    training clinic to be treated for his sexual
    attraction to other men. He tells his therapist
    that these feelings cause intense self-hate.
    He is a fundamentalist Christian and has read on
    the internet about reparative therapies that
    are designed to make me normal. He requests
    this treatment and he is adamant that he has no
    interest in learning to accept the

Program Listserv
  • A clinical graduate student posted a notice on
    the program listserv about the legalization of
    gay marriage in Saskatchewan. Another graduate
    student replied, "What a pity! Where will their
    society be in 50 years? Scary thought..."
  • While there is a policy requiring students to
    refrain from using the listserv to post
    disrespectful, demeaning, value laden and
    offensive material, this incident seems to
    reflect more serious concerns related to
    awareness and sensitivity to diversity.
  • Furthermore, because the department has a
    relatively large number of out LGBT students and
    faculty (as well as allies), failure to address
    this public statement in a similarly public way
    (by privately reprimanding the student) might
    communicate complicity.

Vignette Questions
  • What are the ethical issues involved in
    responding to this incident in a public vs. a
    private manner?
  • Assuming that there is a pattern of this graduate
    student endorsing
  • a strong and pervasive bias against LGBT
    individuals would you restrict this students
    clinical practice?
  • How might it make a difference if the graduate
    student tells you that the bias is rooted in
    religious beliefs?
  • Would you counsel the student out of the program?
  • Would you note the incident to external practicum
    placement supervisors?
  • Would you note the incident or pattern in
    internship letters?

Contact Information
  • Erica Wise, Ph.D.
  • Department of Psychology (CB 3270)
  • UNC Chapel Hill
  • Chapel Hill, NC 27599-3270
  • (919)962-5034

Teaching Ethical Professional Competencies An
Integrated Approach by Tony Cellucci, Ph.D.,
  • ADPTC-CUDCP Mid-Year Meeting
  • San Antonio
  • January 18th , 2008

Brief History of Ethics Education
  • First APA Ethics Code 1952 although through 1970s
    skepticism and/or osmosis
  • 1979-80s CoA mandated majority APA programs
    required course Shift Code to normative
  • 1990s limited research ethics education health
    professions-moral reasoning (DIT)
  • 2000s Professionalism construct arose in medicine
  • 2002 Identification of Professional Ethical
    Competencies (APPIC, ADPTC)
  • More awareness of importance of supervision,
    training environment, and link to Diversity today

Rests Four Components Model
  • I. Components
  • Ethical Sensitivity or Awareness
  • Moral Reasoning (type of reflective thinking
    King Kitchener, 1994)
  • Ethical / Professional Commitment (relevance
    research findings (e.g. Bernard et al, 1987)
  • Implementation
  • II. Model Implications
  • Broader view of ethics as part of
  • development identity
  • Integrated throughout training curriculum
  • and professional life.

Professional Ethics as Culture
  • Integration occurs best when ethics is
  • viewed not only as a set of prohibitions but
  • also as a way to actualize students visions
  • of what it means to be a psychologist
  • (Handelsman,
    Gottlieb, Knapp, 2005)
  • Acculturation Model
  • hi/low maintenance personal ethics
  • hi/low identification psych ethics
  • Questions Raised
  • expectations ethical culture entering?
  • what most counterintuitive activities?
  • what are you having to unlearn?
  • reactions to disparity between principles and

One ModelISU Program Objectives for CoA4B
  • Students will demonstrate knowledge regarding
    ethical principles and the professions code of
    conduct (APA, 2002), as well as practice
    guidelines and the applicability of state laws
    and federal regulations (e.g. HIPAA).
  • They will exhibit awareness and sensitivity to
    clinical and research situations in which ethical
    principles may be a concern, utilizing heuristics
    and models of ethical decision-making to analyze
    and evaluate options. Students will integrate
    their knowledge of ethical principles and
    decision-making with their professional work in
    the clinic and community.

  • Students should gain awareness of how personal
    factors (e.g. personality, values, cultural
    identities) will influence their professional
    work and interpersonal dynamics including how
    their personal life and possible difficulties may
    be relevant to being professional.
  • Both as trainees and professionals, students will
    seek appropriate information and consultation
    when faced with ethical issues.
  • Finally, students will acquire attitudes and
    skills that facilitate raising ethical concerns
    when they become apparent and demonstrate a
    personal and professional commitment to ethical

ISU ModelEthics Distributed
  • Y1 Psyc701 Intro to Clinical Psychology
  • Y2 Psyc512 Ethics course (2sh)
  • Y1-Y3 Integrated Professional Courses along with
  • Y2-Y3 Practicum Clinic Generalization
  • sensitivity/awareness (S)
  • moral reasoning, decision-making (R)
  • implementation, rehearsal (I)
  • Supervisors as Model
  • Y4 Psyc703 Ethics Professional Issues
  • (1sh)

Moodle Course Structure
Psyc512 Ethics
  • Traditional Ethics Course
  • Koocher Keith-Spiegel text
  • Departmental file of articles
  • choice -reaction papers
  • Ethics Autobiography Assignment
  • Knowledge Survey as Study Guide
  • Moodle discussion tool (forums) to
    extend class
  • Incorporate Some Within-Class Activities

Assignment 1 The Ethics Autobiography
  • You are asked to write a short paper (2-3 pages,
    double-spaced) which will be an ethics
    autobiography in which you will explore aspects
    of your background that might make it easier or
    harder to acculturate into psychology as a health
  • What exposure have you had to the field? What is
    your idea of right or wrong professional
    behavior? Where does your conception of right or
    wrong professional behavior come from? What
    aspects of the field are most compatible with who
    you are as a person, and which aspects are least
    compatible? What aspects of this profession
    strike you as not intuitive?
  • You should make use of the ethics as
    acculturation article, but much of the paper will
    be exploring what you bring to the profession.
    Having said this, its important that you know
    that you do NOT need to self-disclose personal
    information that you dont want to disclose (See
    APA Ethics Code, Standard 7.04)

Ethics is all around us
  • Use of Film Clips as Discussion Stimuli (e.g.
    Star Trek, Goodwill Hunting)
  • Bring in News Items (rebirthing, Medicaid fraud)
    Div24 ethics listserv
  • Examine chiropractor advertisements, practitioner
  • Small group work (e.g. vignette responsible test
    use, outline essay question, Knapps shibbolaths)
  • Role-playing Peer Monitoring
  • Mock licensing Board Hearing (Welfel)
  • APA debate/policy regarding BSCT

Sample Knowledge Questions
  • 1. Distinguish between Deontological vs.
    Utilitarian approaches to ethics
  • 2. Explain Judith Barad's argument against
    cultural relativism
  • 3. Characterize the relationship between ethics
    and law
  • 4. Identify the Josephson Institute or Elie
    Weisel Foundation
  • 5. Describe in some detail the structure of the
    2002 ethics code including history, structure,
    and some of the most significant revisions.
  • 6. Why is providing a code of conduct
    insufficient professional ethics training?
  • 7. Briefly discuss five normative ethical
    principles and their role in ethical
    decision-making (i.e., Kitcheners model).

  • 8. Explain the findings and implications of
    survey literature on clinician ethics
  • 9. Discuss Handelsman et al.s (2005) argument
    for learning ethics as an acculturation process.
  • 10. Describe Rests model for studying ethical
  • 11. Provide an overview of how the APA ethics
    committee functions
  • 12. T or F Virtue ethics allows for more
    consideration of cultural diversity. Explain.
  • 13. What constitutes the legal requirements for
  • 14. Describe three different arenas for the
    enforcement of ethical behavior and the
    advantages associated with each.
  • Etc. current version 110 questions

Knowledge Survey Pre-Post
Integrating Ethics into the Training Clinic
  • Include ethics section in clinic manual
  • Make ethics an explicit focus of case
  • Model consultation with colleagues
  • Use ethical diversity vignettes role-playing
    in supervision
  • Model ethical decision-making (heuristics),
    include own values and integration with
    professional self
  • Discuss multiple roles faculty and students, ways
    to minimize risk of harm

Supervision Processes
  • Supervising being supervised
  • Role induction and training contract
  • Maintaining alliance
  • Imparting knowledge technical skills
  • Disclosure of personal information
  • Evaluative concerns

Integration Implicit Ethics
  • Intentional nondisclosure of important
  • Mismanagement of clinic notes, record
  • Operating at an inappropriate level of autonomy
  • Failure to address personal biases
  • Inappropriate methods manage conflict with
  • Failure to engage in necessary professional
    development activities
  • (Worthington, et al., 2002)

Managing Information and Relationships in the
Training Clinic
  • There are complex multiple roles in most academic
    Training Clinics (e.g., advising, research)
  • Common Trainee Difficulties include failure to
    engage in supervision, mismanagement of records,
    difficulties in basic helping skills,
    inappropriate level of autonomy
  • Supervision response must consider developmental
    level violations occur in context academic,
    medical, personal problems
  • Literature Negative Supervisory Events
  • 15, ½ never disclosed to supervisor

In Search of Guidelines
  • Informed consent conversation confidentiality
    evaluation process
  • Recognize/ acknowledge multiple roles clarity
    boundaries more important supervisees experiences
    prof or personal difficulties
  • Avoid exploitative/ negative supervisory behavior
  • Provide educational developmentally appropriate
  • Define/ maintain educational/ clinical standards
  • Teach supervisees their rights responsibilities
  • Invite appropriate confrontation

Psyc703 Ethics Professional Issues
  • Seminar (capstone) for internship class
  • Review of Ethical standards (Fisher Pope
    Vasquez) but more application of principles
  • Complex Case Analyses- Moodle Forum
  • Discussion informed by clinic/community
  • Added class session on Exploring Sterns chapter
    medical professionalism and relating it to
  • Student Selected Advanced Topics- Power points

  • You are a supervisor in a clinical training
    program. Your supervisee (Pat) has seemed quieter
    than usual around the clinic and in a seminar you
    teach. When you casually ask at the end of a
    supervision session if he is feeling alright, he
    confides that his same sex partner has just ended
    a 6 year relationship. As he describes the
    situation in some detail, he begins to sob with
    great intensity, stating that he has really been
    distraught. He is scheduled this afternoon to see
    a relatively new patient who presented for
    depression, and also has an exam for your seminar
    due in two days. He asks you please not to tell
    anyone what he is going through because he would
    feel humiliated and that others (particularly the
    DCT) would think less of him. You are not sure if
    he is okay, but you are running late for a
    university meeting yourself.

  • Bebeau, M. (2002). The Defining Issues Test and
    the Four Component Model Contributions to
    professional education. Journal of Moral
    Education, 31, 271-295.
  • Bernard, J.L., Murphy, M., Little, M. (1987).
    The failure of clinical psychologists to apply
    understood ethical principles. Professional
    Psychology Research Practice, 18, 489-491.
  • Cellucci, T. Heffer, R.W. (2002). The
    psychology training clinic Arena for ethics
    training. The Behavior Therapist, 25, 127-130.
  • De las Fuentes, C. Willmuth, M.E., Yarrow, C.
    (2005). Competency Training in Ethics and
    Practice. Professional Psychology Research and
    Practice, 36, 362-366.
  • Falender, C. Shafranske, E. (2004). Clinical
    supervision A competency-based approach.
    Washington, DC APA.
  • Gottlieb, M., Robinson, K., Younggren, J.
    (2007). Multiple relations in supervision
    Guidance for administrators, supervisors, and
    students. Professional Psychology Research and
    Practice, 38, 241-247.

  • Handelsman, M., Gottlieb, M., Knapp, S. (2005).
    Training ethical psychologists An acculturation
    model. Professional Psychology Research and
    Practice, 36, 59-65.
  • King, P.M. Kitchener, K. (1994). Developing
    reflective judgment. San Francisco Jossey-Bass.
  • Stern, D.T. (2006). Measuring medical
    professionalism. NY Oxford
  • Watson, Z., Herlihy, B.R., Pierce, L.A. (2006).
    Forging the link between multicultural competence
    and ethical counseling practice A historical
    perspective. Counseling and Values, 50, 99-107.
  • Welfel, E. R. (1992). Psychologist as ethics
    educator Successes, failures, and unanswered
    questions. Professional Psychology Research and
    Practice, 23, 182-189.
  • Worthington, R.L., Tan, J.A., Poulin, K.
    (2002). Ethically questionable behaviors among
    supervisees An exploratory investigation. Ethics
    Behavior, 12, 323-351.

Contact Information
  • Tony Cellucci, Ph.D., ABPP
  • ISU Psychology Clinic, Department of Psychology,
    Idaho State University, Pocatello, Idaho 83209
  • 208-282-2129

Training Ethical and Multicultural Issues Through
Practicum Supervision of Child, Adolescent, and
Family Cases by Rob Heffer, Ph.D.
  • ADPTC-CUDCP Mid-Year Meeting
  • San Antonio
  • January 18th , 2008

Child/Adolescent/Family Training
  • Professional psychology training programs and
    training clinics are in a unique position to
    provide a range of practicum experiences for
    their graduate students.
  • Procedures, ethical considerations, and
    multicultural issues may be adapted when serving
    clients who are children or adolescents and their

Child, Adolescent, Family Cases
  • Supervising child, adolescent, and family cases
    evokes unique developmental, systems, and ethical
    issues in which a student must be trained
  • issues of assent and consent for services
  • confidentiality of communications and records
  • consulting with extra-family systems (e.g.,
    schools, medical personnel)
  • abuse reporting laws

Infusing Ethics Multicultural Issues Throughout
  • Inculcate these issues throughout the practicum
    experience and the program curriculum
  • include specific sections of each clinical course
    syllabus on ethics multicultural issues
  • have supervisees/students read present to each
    other sections of the Code the Guidelines

Infusing Ethics Multicultural Issues Throughout
  • Provide written policies/procedures and
    resources/decision trees
  • clinical program handbook/website resources
  • practicum clinic manual

Infusing Ethics Multicultural Issues Throughout
  • Require regularly-scheduled colloquia
  • campus speakers
  • regional/national speakers
  • Use didactic case presentations in supervision
    groups or practicum seminars
  • include outline of format issues to address
    (see handout)
  • press student presenters on specific ethical
    multicultural issues possible in each case

Infusing Ethics Multicultural Issues Throughout
  • Regularly discuss present research that attends
    to research ethics multicultural issues
  • model ethical training practices multicultural
  • attend to IRB process issues

Infusing Ethics Multicultural Issues Throughout
  • Ensure that your program department website
    reflects your program values
  • Bidell, M.P., Ragen, J.K., Broach, C.D.,
    Carillo, E.A. (2007). First impression A
    multicultural content analysis of professional
    psychology program websites. Training Education
    in Professional Psychology, 1, 204-214.
  • Develop a culture for faculty practicum
    supervision based on an active, integrative
    process that assimilates ethical, multicultural,
    therapeutic, and training best practices.

Vignette How Should I Pray?
An advanced graduate student is providing
services to a 12-year-old, Hispanic boy and his
family in your practicum clinic. English and
Spanish are spoken in the home and the boy and
his parents are very comfortable speaking
English. The mom was born in the US and the
father was born in Mexico. Their Catholic faith
is highly valued by the boy and his parents. Some
sessions are with the boy alone and some are with
the boy and his parents. The boy has a range of
ADHD and anxiety-based concerns at home and
school that are being addressed with some
improvement. As you discuss the case in
supervision and view tapes of sessions, you and
the student see signs of OCD (e.g., red dry
hands), which is confirmed, and the treatment
focus is then honed in that direction. What
recently were solely conceptualized as anxious
thoughts begin to be formulated as repeated,
intrusive, obsessive thought patterns. In
session, the boy, who is quite articulate,
describes how he has begun to obsessively pray
for the safety and health of his pets, his
parents, and himself. He wants to solicit help
from God, but is now distressed that his prayer
life has become an OCD symptom. He intensely asks
the student therapist How should I pray?
Vignette Adolescent
  • You are supervising an accomplished senior
    graduate student with whom you have ample
    previous supervisory experiences. She has served
    a 15-year-old female client in the recent past.
    This client was abandoned by her mother two years
    ago and she moved in with her father. She has an
    acceptable relationship with her father, but had
    not spent much time with him previously. Therapy
    included the young woman most of the time, with
    some sessions with her and her father. Adjustment
    and developmental issues, including some risk
    behaviors, were targets in therapy. Attendance
    was somewhat inconsistent. A few months ago,
    phone calls from the therapist to reschedule were
    not returned. Today, the young woman called the
    Clinic and left a message for the therapist. She
    (age 16) is now living with her fiancé, not her
    father and is pregnant (due in 3 months). She
    would like to resume services with the therapist.
  • What are ethical/legal issues involved in this
  • What issues of culture might inform the
    therapists response?
  • What resources could you and the therapist use to
    clarify actions to be taken?
  • Who are you obligated to include in the
    information the young woman has now shared over
    the phone?
  • How can you teach important decision making and
    therapeutic skills to this student and to other
    graduate students?

Contact Information
  • Rob Heffer, Ph.D.
  • TAMU Psychology Clinic, Department of Psychology,
    Texas AM University, College Station, TX
  • 979-845-8017