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Explicitly Focusing on Personal Values.

If much ethical decision making occurs automatically, then the decision-maker’s personal values and morality becomes a central consideration. Hansen and Goldberg (1999) assert that professionals are influenced by personal (e.g., political or religious) values, what Handelsman, Gottlieb, and Knapp (2005, p. 59) refer to as ethics of origin. In fact, Pope and Bajt (1988) found that 75 percent of a sample of senior psychologists, all of whom were known for ethics expertise, believed that formal codes and statutes should sometimes be violated to ensure client welfare or because of personal values.

It is useful, therefore, to help supervisees to explore their personal values and attitudes. Betan and Stanton (1999), for example, conclude that awareness of how one’s emotions may influence ethical decision making can lead to appropriate management of these emotions. Supervisors and educators can facilitate this exploration in various ways, including the use of an ethics biography (Bashe, Anderson, Handelsman, & Klevansky, 2007).

Mastering the Content of Ethical Codes.

Kahneman (2011) states that, in the interest of efficiency, System 2 thinking tends to migrate to System 1, meaning that situations that initially require deliberate thought eventually, with enough repetition, become so routinized that they are automatic and occur outside of awareness. Anderson (1995) and other cognitive psychologists term this the shift of declarative to procedural knowledge. The same phenomenon occurs with respect to retrieval of ethical knowledge. To accomplish this, supervisees should be exposed to ethics codes consistently enough that they overlearn them, and then the information is retrieved automatically in System 1. To illustrate this, consider the analogy of drilling students in multiplication tables so that eventually the student can retrieve 9 × 9 = 81 without having to think it through.

This is not to suggest a checklist mentality or rote application of ethics codes; however, knowing the codes is a prerequisite for learning to apply them in real-world, professional situations.

Opportunities to Apply Ethical Knowledge.

Many ethical mishaps result from acts of omission, not intentional malice (Bernard, 1981). Such omissions are more likely if professionals have not had an opportunity to experience the ins and outs of a similar situation. The use of simulation and behavioral rehearsal is an excellent way to allow both trainees and supervisors to face difficult situations, try alternative resolutions, and evaluate their outcomes safely. Formal academic settings provide one venue in which students learn to apply ethical knowledge through the use of experiential learning or case analysis (e.g., Plante, 1995; Storm & Haug, 1997).

Much ethical decision making is context based: What may be unethical in one context may not be unethical in another, and so there is a reasoning process to be used. Therefore, it is important that ethical decision-making opportunities are presented in the review of case material that occurs in supervision. Riva, Erickson, and Cornish (2008) surveyed a national sample of group supervisors who were asked about content covered in their groups; 94.5 percent indicated that ethical and legal content was being addresssed. A study of critical incidents reported by supervisors and supervisees found that ethical issues were among those reported, although less frequently than such other issues as relationship and competence issues (Ellis, 1991a).

Modeling Ethical Behavior.

Observing and modeling others is a powerful way to learn, and this extends to the learning of ethical behavior. Supervisors provide that modeling, whether they are conscious of doing it or not (Tarvydas, 1995).

Teaching Explicit Ethical Decision-Making Models.

The default is for people to respond intuitively when they deal with familiar situations, but they shift to rational, deliberate, reflective thinking (i.e., Kahneman’s System 2) when they encounter a novel situation (Anderson, 1995) or one that is somehow puzzling or upsetting. Because many ethical situations have these effects, it is also important that supervisees know of and are prepared to use explicit decision-making models. Some models are specific to a particular issue, such as addressing multiple relationships (Gottlieb, 1993); others focus on more general ethical decision-making processes (Cottone & Claus, 2000; Lipshitz & Strauss, 1997).

The moral principles of autonomy, beneficence, nonmaleficence, justice, and fidelity are of primary importance when evaluating a difficult situation (Beauchamp & Childress, 2001; Bersoff & Koeppl, 1993; Hansen & Goldberg, 1999; Kitchener, 1984). Hansen and Goldberg (1999) outline a seven-category matrix of considerations that could be used to assess ethical and legal dilemmas, both in training and in actual situations. They rightly argue that in a linear model of ethical decision making, one that begins by identifying an ethical dilemma and ends with a decision to act, belies the complexity of most situations with ethical and legal overtones. By considering multiple influencing variables as being interfaced with a linear process, the mental health professional is more likely to arrive at a sound course of action.

The second consideration involves clinical and cultural factors. For example, as stated earlier in our discussion about the duty to warn, the therapist and supervisor must make an assessment of a client’s level of risk in order to make an informed decision about a course of action. What may be ethical in one situation may violate a client’s rights in another. In addition to clinical assessment, cultural assessments must be made. The boundaries of confidentiality can take on different meaning when viewed with cultural sensitivity (Hansen & Goldberg, 1999).

The next four considerations are less fluid and include professional codes of ethics; agency or employer policies; federal, state, and local statutes; and rules and regulations that elaborate statutes, all of which call for a certain amount of vigilance from the professional to stay informed about changes in professional and regulatory pronouncements. At the same time, it must be said that codes, statutes, rules, and regulations are not sufficient for all (or even most) difficult situations.

Finally, because case law calls for interpretation regarding its relevance for a particular ethical or legal dilemma, it could be viewed as more fluid than statutes and codes of ethics. In addition, case law represents the history of our most dramatic struggles as mental health professionals, thus providing a rich context for deliberation (Hansen & Goldberg, 1999).

Once we have carefully attended to the multiple factors already noted, we must eventually return to a process that ends in some form of resolution, including consideration of alternative courses of action (often weighing one aspect of the situation against another), an attempt to predict the consequences of each potential course (both short term and long term and for each of the parties involved), and making a decision about which course of action to take that includes a willingness to take responsibility for the consequences of the selected action (Hadjistavropoulos & Malloy, 2000).

Seeking Consultation.

Finally, supervisees should understand the importance of seeking consultation when they encounter an ethical dilemma. Supervision should reduce the incidence of supervisees’ ethical misbehavior (Pope & Vasquez, 2011). It is interesting, therefore, to speculate whether the effect of lifelong supervision (as in Britain) is an overall reduction in problematic ethical behavior. This intriguing question, however, has yet to be investigated.