Episode 24: The Nudge in Ethics, Psychotherapy, and Public Policy

Suicide is the 10th leading cause of death in the United States and the most frequent crisis encountered by mental health professionals. This podcast reviews basic information about the assessment, management, and treatment of patients at risk to die from suicide. It fulfills Act 74 requirements for Pennsylvania licensed psychologists, social workers, marriage and family therapists, and professional counselors. Program Learning Objectives: At the end of this program the participants will learn basic information that will help them to Assess patients who are at risk to die from a suicide attempt; Manage the risks of suicide; and Treat patients who are at risk to die from a suicide attempt. Resources Bongar, B., & Sullivan, G. (2013). The suicidal patient: Clinical and legal standards of care. (3rd ed.). Washington, DC: American Psychological Association. Bryan, C. J. (2015). Cognitive behavior strategies for preventing suicidal attempts. NY: Routledge. Jamison, K. R. (2000). Night Falls Fast: Understanding suicide. New York: Random House. Jobes, D. (2016). Managing suicide risk (2nd Ed.). NY: Guilford. Joiner, T. (2005). The myths of suicide. Cambridge, MA: Harvard University Press. McKeon, R. (2009). Suicidal behavior. Cambridge, MA: Hogrefe & Huber. Disclaimer As an educational program, this podcast/video does not purport to provide clinical or legal advice on any particular patient. Listeners or viewers with concerns about the assessment, management, or treatment of any patient are urged to seek clinical or legal advice. Also, individual psychotherapists need to use their clinical judgment with their patients and incorporate procedures or techniques not covered in this podcast/video, or modify or omit certain recommendations herein because of the unique needs of their patients. This one-hour video/podcast provides a basic introduction to the assessment, management, and treatment of patients at risk to die from a suicide attempt. This podcast/video may be a useful refresher course for experienced clinicians. However, listeners/viewers should not assume that the completion of this course will, in and of itself, make them qualified to assess or treat individuals who are at risk to die from suicide. For those who do not have formal training in suicide, this podcast/video should be seen as providing an introduction or exposure to the professional literature on this topic. Proficiency in dealing with suicidal patients, like proficiency in other areas of professional practice, is best achieved through an organized sequence of study including mastery of a basic foundation of knowledge and attitudes, and supervision. It is impossible to give a fixed number of hours of continuing education and supervision that professionals need to have before they can be considered proficient in assessing, managing, and treating suicidal patients. Much depends on their existing knowledge base and overall level of clinical skill. It would be indicated to look at competency standards from noted authorities, such as those developed by the American Association of Suicidology ( http://www.sprc.org/training-events/amsr), by David Rudd and his associates (Rudd et al., 2008), or Cramer et al. (2014).   Click here for the slides associated with this podcast. Click here to link for CE credits.

Nudge theory has gained popularity in behavioral science, mainly in the field of behavioral economics.  The theory broadly indicates that indirect suggestions or contextual changes can influence choices or compliance with healthy behaviors or decisions.  Nudge theory contrasts its approach with direct suggestions, instructions, and education.  In psychotherapy, we nudge patients frequently.  Sometimes we do it consciously, other times unconsciously.  Because of this potentially powerful influence over our clients, we must remain vigilant about our nudges in the form of soft paternalism or projecting our values onto our patients.  Psychologists must be mindful of the power imbalance in the psychotherapy relationship and our duty to respect client autonomy.    John’s guest is Dr. Jennifer Blumenthal-Barby, Associate Professor of Medicine and Medical Ethics, Center for Medical Ethics and Health Policy, Baylor College of Medicine, located in Texas.   At the end of the podcast, the participants will be able to: Describe what “Nudge Theory” is; Explain how Nudge Theory applies to ethics in the psychotherapy relationship; Name two ways that psychologists can use nudge theory to promote healthy behaviors.   References Blumenthal-Barby J.S., Burroughs H. (2012). Seeking better health care outcomes: the ethics of using the "nudge". American Journal of Bioethics. Volume 12(2): 1-10.   Blumenthal-Barby, J.S. McCullough, L.B., Kreiger, H. and Coverdale, J.C. (2013). Methods of Influencing the Decisions of Psychiatric Patients. Harvard Review of Psychiatry, Volume 21 (5), 275-279.   DeAngelis, T. Coaxing Better Behavior. (2014). The Monitor on Psychology. Volume 45(11): 62.   Barkan, R. Ayal, S. and Ariely, D. (2010). Ethical dissonance, justifications, and moral behavior. Current Opinion in Psychology, Volume 6, December 2015, 157-161.   Sunstein, C. R. Fifty Shades of Manipulation. (2015). Journal of Behavioral Marketing.   Sunstein, C. R. The Ethics of Nudging. (2014). Social Science Research Network.  

Podcasts 21, 22, and 23 will provide supervisors and supervisees with an understanding of the skills and ethical issues surrounding supervision, including the Pennsylvania State Board of Psychology’s Regulations dealing with postdoctoral supervision. The workshop will review the basic requirements for ethical supervision, common pitfalls, and give supervisors an understanding of the requirements that must be met for obtaining post-doctoral supervision.   In this episode, John's guest is Don McAleer, Psy.D., ABPP, a psychologist and post-doctoral supervisor, and Samuel J. Knapp, Ed.D., ABPP, psychologist and Professional Affairs Officer at the Pennsylvania Psychological Association.   At the end of the podcast series the participants will be able to:   1.  Describe essential factors involved in ethically sound and effective supervision; 2.  List or identify the State Board of Psychology requirements for post-doctoral supervision. 3.  Explain ways to improve supervisee's level of competence, self-reflection, and professionalism; & 4.  Identify strategies to comply with the Pennsylvania State Board of Psychology regulations on supervision of post-doctoral trainees.   The associated SlideShare presentation can be found here.   Competency Assessment Form   Sample Supervision Agreement   Sample Post-Doc Performance Problem Sheet   Click here to earn 3 APA-approved continuing education credits

Podcasts 21, 22, and 23 will provide supervisors and supervisees with an understanding of the skills and ethical issues surrounding supervision, including the Pennsylvania State Board of Psychology’s Regulations dealing with postdoctoral supervision. The workshop will review the basic requirements for ethical supervision, common pitfalls, and give supervisors an understanding of the requirements that must be met for obtaining post-doctoral supervision.   In this episode, John's guest is John Jay Mills, Ph.D., ABPP, a psychologist and professor at Indiana University of Pennsylvania, and Samuel J. Knapp, Ed.D., ABPP, psychologist and Professional Affairs Officer at the Pennsylvania Psychological Association.   At the end of the podcast series the participants will be able to:   1.  Describe essential factors involved in ethically sound and effective supervision; 2.  List or identify the State Board of Psychology requirements for post-doctoral supervision. 3.  Explain ways to improve supervisee's level of competence, self-reflection, and professionalism; & 4.  Identify strategies to comply with the Pennsylvania State Board of Psychology regulations on supervision of post-doctoral trainees.   The associated SlideShare presentation can be found here.   PA § 41.33. Supervisor requirements   PA § 41.32. Experience qualifications to become a psychologist   Verification of Post-doctoral Experience from the Pennsylvania State Board of Psychology

Podcasts 21, 22, and 23 will provide supervisors and supervisees with an understanding of the skills and ethical issues surrounding supervision, including the Pennsylvania State Board of Psychology’s Regulations dealing with postdoctoral supervision. The workshop will review the basic requirements for ethical supervision, common pitfalls, and give supervisors an understanding of the requirements that must be met for obtaining post-doctoral supervision.     In this episode, John's guest is John Jay Mills, Ph.D., ABPP, a psychologist and professor at Indiana University of Pennsylvania.   At the end of the podcast series the participants will be able to: 1.  Describe essential factors involved in ethically sound and effective supervision; and, 2.  List or identify the State Board of Psychology requirements for post-doctoral supervision. 3.  Explain ways to improve supervisee's level of competence, self-reflection, and professionalism; and, 4.  Identify strategies to comply with the Pennsylvania State Board of Psychology regulations on supervision of post-doctoral trainees.    The associated SlideShare presentation can be found here.

In this continuing education program, John and Sam Knapp discuss the critical elements of the new Child Protective Service law.  Act 31 of 2014 requires all mandated reporters who hold licenses to receive at least two hours of approved continuing education in the signs of child abuse and the reporting requirements for child abuse in Pennsylvania. In Episode 20, Drs. Gavazzi and Knapp review sexual abuse as sex crimes, abuse of newborn children, who mandated reporters are, and why supervises and employees of licensed professionals need to know the mandated reporter requirements.  Sam gives John a pop quiz to help listeners with the Child Protective Services law.  Psychology students, interns, and other mental health workers are subject to the new Child Protective Services Law.  Finally, they review the requirements of reporting, how to report, and mandated reporter rights and protections.   Click here to find the PowerPoint presentation associated with this podcast.     Click here to take the required testing and course evaluation for appropriate credit.   This podcast is designed for mental health professionals and has been approved by the Department of Human Services and the Pennsylvania Department of State to meet the Act 31 requirements.    Additionally, these credits will also count towards the 30 hours required for licensing renewal for psychologists. 

In this continuing education program, John and Sam Knapp discuss the critical elements of the new Child Protective Service law.  Act 31 of 2014 requires all mandated reporters who hold licenses to receive at least two hours of approved continuing education in the signs of child abuse and the reporting requirements for child abuse in Pennsylvania.   Episode 19 is the first hour of that training.  In hour one, Drs. Gavazzi and Knapp discuss the definitions of a child and perpetrator as these pertain to the new mandated reporting law.  John and Sam highlight the legal definitions of physical abuse, emotional abuse, and begin to discuss the definition of sexual abuse in the new Pennsylvania law.   Click here to find the PowerPoint presentation associated with this podcast.     Please go to Part 2.  Once you listen to parts 1 and 2, a link will be provided for Continuing Education credit.   This podcast is not yet approved by the PA Department of Human Services or the PA Department of State.   My estimate is that it will be approved in early March 2015

If you have missed AM radio, then you will appreciate this episode.  John experiments with conference call software with his guests to discuss ethics and safety from a psychologist's point of view.  I apologize about the squeaks (Shannon's phone), scratches and other recording imperfections.   John's guests include Dr. Don McAleer, psychologist, gun owner, firearms instructor, firearm collector; Massad Ayoob, an international firearms and self-defense instructor, expert in lethal force encounters and shooting cases, and author; and, Dr. Shannon Clark, psychologist, FBI agent, active shooter and response instructor, and lifelong martial artist.   We discuss the ethics of nonmaleficence (do no harm) versus personal safety.  It is no secret that psychologists are vulnerable to threat, assault, and stalking of patients and family members of patients.  The overarching goal is to start a discussion for psychologists and mental health professionals about potential dangers for mental health professionals and some options to help keep them safe.   At the end of this podcast, the listener will be able to:   1. Outline your personal values related to safety in your professional life. 2. List the options to enhance personal safety in your office. 3. Describe several responsible steps to take if you decide to carry a firearm or house one in your office.       Reading Material   Ken Pope: Therapists' Resources for Threats, Stalking, or Assaults by Patients   Robert B. Young: When a Psychiatrist Shoots to Kill    Dave Grossman: On Killing: The Psychological Cost of Learning to Kill in War and Society   Massad Ayoob: In the Gravest Extreme: The Role of the Firearm in Personal Protection   Massad Ayoob: Deadly Force: Understanding Your Right to Self Defense     Massad Ayoob Information   Massad's Training Institute   Shannon Clark's email address   Click here

Are you a psychologist working independently?  If so, do you have a professional will?  If not, you need to listen to this podcast.  John welcomes Drs. Mary O’Leary Wiley and Cathy Spayd to outline the important points in constructing a professional will.  A professional will is part of your ethical obligation to your patients should you die suddenly or become incapacitated.  The podcast will address the pragmatics of constructing a professional will and why it is important for all psychologists to have a professional will.   At the end of the workshop the participants will be able to:   1. Explain the importance of a professional will. 2. Locate documents on the Internet to help create a professional will. 3. Create your professional will.   Click here to earn one APA-approved CE credit   Resources   Mary O'Leary Wiley, PhD ABPP web site   Catherine Spayd, PhD   Closing a Professional Practice: Clinical, Ethical and Practical Considerations for Psychologists Throughout the Lifespan PowerPoint presentation by Drs. Wiley and Spayd   APA Sample of a Professional Will   Ragusea, S. (2002). A professional living will for psychologists and other mental health professionals.  In L. VandeCreek & T. Jackson (Eds.), Innovations in clinical practice:  A source book (Vol. 20, pp. 301 – 305). Sarasota, FL: Professional Resource Press.   Spayd, C.S. and Wiley, M.O. (2009). Closing a Professional Practice:  Clinical and Practical Considerations.  Pennsylvania Psychologist, 69 (11), 15-17.   Dashlane.com - A secure site to store passwords

John welcomes Dr. Marlene Maheu back for Part 2 of Ethics and Telepsychology.  The podcast starts out with a vignette on practicing psychology over state lines using telepsychology.  John and Marlene review important aspects of informed consent, privacy and security laws, documentation, and interstate practice.  Marlene gives a variety of tips, including the need to utilize a risk management tool for telepsychology practice, additional components of informed consent, and the need to document more information.   At the end of the podcast, the listener will be able to:   1. Explain two important interjurisdictional issues with telepsychology. 2. Described three important components of informed consent with telepsychology. 3. List one relevant security law and one relevant security law related to the practice of telepsychology.   Click here to earn one APA-approved CE credit   Resources for Episode 16   TeleMental Health Institute, Inc.   American Psychological Association Guidelines on Telepsychology   HIPAA Security Standards: Technical Safeguards   HIPAA Risk Assessment Tool: HHS & HealthIT.gov   Gros, D. F., Yoder, M., Tuerk, P. W., Lozano, B. E., & Acierno, R. (2011). Exposure therapy for PTSD delivered to veterans via telehealth: Predictors of treatment completion and outcome and comparison to treatment delivered in person. Behavior Therapy, 42, 276-283. doi: 10.1016/j.beth.2010.07.005   Harris, E., & Younggren, J. N. (2011). Risk management in the digital world.  Professional Psychology: Research and Practice, 42, 412-418. doi: 10.1037/a0025139   Bibliography from TeleMental Health Institute, Inc.   Marlene Maheu SlideShare