Parent and Teen Views of Assent in ResearchBrody, J. l., Sherer, D. G., Annett, R. D., & Pearson-bish, m. (2003). Voluntary assent in biomedical research with adolescents: A comparison of parent and adolescent views. Ethics & Behavior, 13 (1), 79-95. Janet Brody and her colleagues at the University of New Mexico studied parent and adolescent views of assent to biomedical research. The research setting was an outpatient hospital clinic with teens who had been diagnosed with asthma and one of their parents. Participants were asked to evaluate one of two vignettes; one vignette had procedures that were thought to be viewed as more aversive for teens. The researchers were studying whether teens and their parents would be less likely to give consent (parent) and assent (teen) to more aversive procedures, and whether they would differ in who they perceived to be responsible for the decision.
Thirty-seven teen-parent sets participated in the study. Teens ranged from 11-17 (M = 13.4 years). Seventy percent of adolescents were male, and 84% of parents were mothers. As the researchers observe, “Informed consent decisions for adolescent research participation are undertaken in the context of a parent- adolescent relationship that may involve differing perceptions of research risk, benefit, and decision making autonomy” (p. 91). What the researchers found was that parents and teens often agreed on the decision whether to participate and on their evaluation of benefit, risk, aversion, and burden. Seventeen percent of the parent-teen sets were such that the parent wanted to enroll his/ her teen in the procedure and the teen did not wish to participate. The ethical issue is a scenario in which the adolescent’s right to decline treatment (dissent) may be challenged. Interestingly, in this scenario, both the parent and the adolescent stated that they had the authority to make the final decision: “Parents reported the expectation that adolescents would acquiesce to their decisions, whereas adolescents indicated they would not have to follow their parents’ wishes” (p. 91). Between the two, parents were more likely to be open to their teens’ opinion, while adolescents stated that they would not have to follow their parents’ preference. This is an important topic for additional research.
Christian counselors can appreciate how complicated these ethical scenarios might become, as both parents and teens respond to their perceptions of risk, as well as hold assumptions about autonomy and self-determination with respect to assent to treatment. Counselor Adherence, Competence & Reprocessing of Abuse Memories Paivio, S. C., Holowaty, k. A. m., & Hall, I. E. (2004). The influence of therapist adherence and competence on client reprocessing of child abuse memories. Psychotherapy, 41 (1), 56-68. This is a study of clinician skill development in emotion-focused therapy for adults who had been sexually abused as children. Sandra Paivio and her colleagues at the University of Windsor studied therapist adherence to principles for intervention, as well as competence with a specific intervention (i.e., imaginal confrontation). Participants were recruited through clinical referrals and newspaper advertisements. Screenings were completed with 110 respondents and interviews were completed with 63 potential participants.
Thirty-seven participants met inclusion criteria for the study and completed posttest data. The majority of participants were female (78%) and average age was 38 years (SD = 11.3). The average length of therapy was 19 weekly one-hour sessions (SD = 4.0). The therapists included six doctoral-level and two master’s-level students in clinical psychology or educational psychology, and the principal investigator. The researchers found that therapist relationship skills and competence with imaginal confrontation improved over the course of therapy. During imaginal confrontation, clinician competence predicted better client processes. Competence involves “helping clients to confront trauma material as well as addressing difficulties with the process” (p. 67). Also, relationship skills contributed to resolution of childhood sexual abuse.
The researchers conclude that “the therapeutic relationship is the foundation of therapy with abuse survivors” (p. 66). Relationship skill is a very important piece to successful therapy, and its importance is noted independent from technical proficiency, which is also important: “…the therapeutic relationship provides both a safe context for exploring painful material and a new interpersonal experience that is directly curative” (p. 66). Christian counselors can recognize the importance of the counseling relationship in providing a safe place to sort out the experience of sexual trauma. Difficulty in Practice Schroder, T. A. & Davis, J. D. (2004). Therapists’ experience of difficulty in practice. Psychotherapy Research 14 (3), 328-345. In this study the researchers began by categorizing different types of therapists’ experiences. The three types were transient (“based on competency deficits”), paradigmatic (“based on therapists’ enduring personal characteristics”), and situational (“based on features of patients or circumstances”).
What Schroder and Davis note is that the various types of difficulties warrant different responses, either in personal reflection or supervision and training. Transient difficulties will require the clinician to increase his or her skill set and knowledge base. This is essentially a question of competence, and there are many ways in which counselors can in- crease their competence in response to clinical difficulties. In contrast to transient difficulties, paradigmatic difficulties require increased self-reflection and awareness. These are opportunities for personal growth. Situational difficulties require neither increased knowledge base nor self-awareness, but acceptance of differences and tolerance. The researchers observe that clinical difficulties do not always fit neatly into one of these three categories, but may reflect a need to consider one or more in making a proper decision. If you function as a supervisor, then your skill as a supervisor “may well be related to the ability to give differential responses to the respective components” of these three types of difficulties (p. 341). Christian counselors can certainly support efforts to clarify the types of difficulties faced in various clinical settings, so that we can identify ways to improve supervision and counselor development. Multiple Relationship Dilemmas Lamb, D. H., Catanzaro, S. J., & moorman, A. S. (2004). A preliminary look at how psychologists identify, evaluate, and proceed when faced with possible multiple relationship dilemmas.
Professional Psychology: Research and Practice, 35 (3), 248-254. Douglas Lamb, Salvatore Catanzaro and Annorah Moorman of Illinois State University examined how clinicians process multiple relationship ethical dilemmas. Two hundred and ninety-eight respondents, mostly Caucasian (95%), completed questionnaires dealing with sexual and nonsexual multiple relationships. The average number of years providing psychological services was approximately 16 years (SD = 8.0). Respondents reported on several relationships identified in prior research (i.e., social interactions and events, religious affiliation relationship, workplace relationship) and identified whether the relationship was with clients, supervisees, or students. Respondents reported discussing social events and collegial relationships most frequently. Least discussed were business/financial relationships. They were more likely to discuss these relationships with supervisees. It was much more common for clinicians to discuss their relationships with those with whom they had a former (rather than current) relationship. The researchers also examined how clinicians identified and avoided potential sexual multiple relationships.
Forty-five percent of respondents indicated that they “thought of initiating a relationship but didn’t act in any way;” 39% indicated that the “other individual initiated a potentially sexual relationship but I was not interested.” Analyses indicated that the former (thought of initiating but did not) was more likely with supervisees and students, while the latter (the other person initiated) was more likely with a client. The rationale for choosing not to pursue a sexual multiple relationship was also considered. “Personal ethics/values/morals” was the most frequently cited rationale for clients, but it was less frequently endorsed for supervisees and students. Another commonly cited rationale was “perpetuity” or the view that “once a client always a client.”
This is a particularly interesting study because much of the research on ethical decision making and multiple relationship violations focus on those who made serious violations. This study, while it has its limitations, is focused on how clinicians identify and make choices to prevent unethical conduct. Christian counselors can support work that helps us become more conscientious about our professional and ethical responsibilities, including those related to multiple relationships. Christian Counseling Today 2004 Vol. 12 No. 4 Ethical Ideologies Hadjistavropoulos, T., malloy, D. C., Sharpe, D., & Fuchs-lacelle, S. (2003). The ethical ideologies of psychologists and physicians: A preliminary comparison. Ethics & Behavior, 13 (1), 97-104. This is a study of the ethical ideologies held by psychologists and physicians. Hadjistavropoulos and his colleagues report on data obtained from 208 psychologists (51% male, mean age 51) and 123 physicians (28% female, mean age = 49).
The researchers report that physicians tend to be more relativistic than psychologists. Physicians’ scores on the Ethics Position Questionnaire classified more of them as situationalists, while psychologists’ scores were more likely to fall into the absolutist category. Along these lines, psychologists tended to be more influenced by their ethics code than by additional factors, such as family views, religious background, or peer attitudes. Both groups were equally idealistic. The researchers did not find any sex differences, though it is widely assumed that men and women approach ethical decision-making differently, nor did they find differences due to professional experience. The authors conclude that the differences related to ethical ideologies are likely due to the “professional cultures” in which psychologists and physicians are “trained and socialized” (p. 98). Online therapy can be helpful to get rid of such problems.
Psychologists tend to be trained in graduate school settings that place “great emphasis…on ethics training, professional standards, and the code of ethics…[making] the code of ethics a more salient tool in ethical decision making than other influences” (p. 103). As the American Association of Christian Counselors has recently developed its own ethics code, it may be interesting to see how Christian counselors are trained to identify the code as a resource when facing ethical decisions. Mark A. Yarhouse, Psy.D., is associate professor of psychology at Regent University, Virginia beach, Virginia. He is coauthor (with Erica S. N. Tan) of the book, Sexual Identity Synthesis: Attributions, Meaning-Making and the Search for Congruence.
