Impact of Client Suicide on Psychologists in Australia

Objective

This research aimed to assess the frequency and impact of client suicides on psychologists in Australia.

Method

Participants were 178 psychologists who completed an online self‐report questionnaire concerning the frequency of occurrence and impact of client suicide.

Result

Fifty six (31.5%) participants reported one or more client suicides. Psychologists with more years of experience reported more client suicides. Participants who had experienced a client suicide reported a range of emotional, cognitive and behavioural reactions as well as professional impacts. Ratings of responsibility, preventability and predictability of a client suicide were associated with emotional and/or professional impacts. Beneficial coping responses included talking to supervisors and colleagues, recognising the psychologist is not responsible and having increased acceptance of a client suicide.

Conclusions

The findings have important implications for training, workplace practices and research.     

Expectations and preferences regarding confidentiality in the psychologist-client relationship

Two hundred and fifty-six members of the Australian public were surveyed regarding situations in which a psychologist might breach confidentiality and third parties to whom information might be disclosed. There was strong agreement between respondents' expectations about the way in which psychologists would act, and their preferences regarding how psychologists should act. While respondents supported confidentiality within the psychotherapeutic relationship, they clearly distinguished situations in which, and third parties to whom, disclosure could appropriately occur. Disclosure was expected and preferred when a client revealed a murder (planned or confessed), suicide plans, child abuse, or treason, and where the recipients of the information were colleagues of the psychologist or parents of a client younger than 13 years. Compared to nonparents, parents more strongly supported disclosure regarding illegal drug use and child abuse, and believed that parents should have access to a child's records. In general, respondents' view of the way in which psychologists should treat confidentiality issues were consistent with the guidelines prescribed by the Australian Psychological Society in the Code of Professional Conduct (1986).     

The ethical confrontation of the unethical forensic colleague

In the course of clinical and forensic work, psychologists sometimes discover serious weaknesses in knowledge, performance, or ethics in other psychologists' work. The ethical code of the American Psychological Association mandates confronting such a psychologist prior to making a professional complaint. This mandatory confrontation typically is omitted because of a sense of awkwardness or a fear of insulting the other psychologist. Education and training in psychology does not cover this sensitive and important area. In this article, sample templates of letters are provided to meet that ethical requirement and to begin to resolve problem behaviors by colleagues.     

Demographic, criminal, and psychiatric factors related to inmate suicide

A review of 19 studies suggests that it may be feasible to identify prisoners with suicide risk on the basis of demographic, psychiatric, and criminal characteristics. The present study aimed to identify combinations of characteristics that are capable of identifying potential suicide victims. Characteristics of 95 suicide victims in the Dutch prison system were compared with those of a random sample of 247 inmates in ten jails. Combinations of indicators for suicide risk were also tested for their capability of identifying 209 suicides in U.S. jails and 279 prison suicides in England and Wales. A combination of six characteristics (age 40+, homelessness, history of psychiatric care, history of drug abuse, one prior incarceration, violent offence) was capable of correctly classifying 82% of the Dutch suicide victims (82% specificity). Less powerful combinations correctly classified 53% of the U.S. suicides and 47% of the U.K. suicides. It is concluded that a set of demographic and criminal characteristics and indicators of psychiatric problems is useful for the identification of suicide risk in jails and prisons.     

Sanctions for ethics violations: does licensure of socioeconomic status matter?

Although sexual relationships between therapists and their clients are unethical, such beahviors still occur. This study investigated whether psychologists with applied versus nonapplied training differed in the severity of sanctions advocated for psychologists charged with sexual ethical violations toward high- or low-socioeconomic status victims. Licensed and Nonlicensed psychologists (N=48) viewed a 15-min videotape simulating the adjudication process about an alleged sexual involvement between client and psychologist, then prescribed either: Dismissal of Charges, Educative Advisory, Educative Warning, Reprimand, Censure, Stipulated Resignation, Permitted Resignation, or Expulsion. The alleged victim was described as a college professor of home economics or a hairdresser. Licensed psychologists chose more severe sanctions ("Stipulated or Permitted Resignation") than did Nonlicensed psychologists ("Censure"). Socioeconomic status made no significant difference in sanctions. Apparently, applied therapy training results in more severe judgements toward those who violate American Psychological Association ethical guidelines than other types of psychology training.     

The politics of scientific social reform, 1936–1960: Goodwin Watson and the Society for the Psychological Study of Social Issues

This paper explores the development and subsequent transformation of a “radical” professional model in American psychology. Its focal point is Goodwin Watson and the Society for the Psychological Study of Social Issues (SPSSI), an organization Watson helped found in 1936. During the Depression, he and many of his SPSSI colleagues called upon psychologists to abandon value neutrality and political disinterestedness in favor of an explicit set of social democratic goals and left-wing political alliances. Government service and political persecution during World War II led Watson to conclude that his Depression-era calls for sweeping change in psychology had neglected a number of significant political dimensions. Of particular importance was the problematic interface between psychological expertise and policy formation. In response to this concern, Watson encouraged the development of the now familiar model of the psychologist as a disinterested purveyor of value-neutral expertise. © 1997 John Wiley & Sons, Inc.     

Prison suicides in Austria, 1975-1997

Suicide prevention in custody is hampered by the lack of funds and professional staff. In order to evaluate the prison suicide phenomenon, a study was conducted evaluating all suicides that occurred in Austrian prisons between 1975 and 1997 (n = 220). In addition to evaluating the number of male versus female suicides, the preferred suicide methods were studied, as well as suicide risk of different circumstances of custody. Suicide rates of distinguishable, important subgroups of prisoners were calculated. The suicide rate for prisoners on remand was 236.0 per 100,000, and for offenders classified as mentally ill it was 205.4 per 100,000. That is about 8 times higher than the suicide rate in Austria's general population (1975-1997: 24.6 per 100,000). The suicide rate for sentenced offenders was 81.3 per 100,000, about twice the suicide rate in Austria's general male population. We recommend that psychologists or psychiatrists concentrate on the suicide prevention of high-risk offenders after screening the newly admitted offenders for their propensity to suicide.     

The science of ethics: Deception, the resilient self, and the APA code of ethics, 1966-1973

This paper has two aims. The first is to shed light on a remarkable archival source, namely survey responses from thousands of American psychologists during the 1960s in which they described their contemporary research practices and discussed whether the practices were "ethical." The second aim is to examine the process through which the American Psychological Association (APA) used these survey responses to create principles on how psychologists should treat human subjects. The paper focuses on debates over whether "deception" research was acceptable. It documents how members of the committee that wrote the principles refereed what was, in fact, a disagreement between two contemporary research orientations. The paper argues that the ethics committee ultimately built the model of "the resilient self" into the APA's 1973 ethics code. At the broadest level, the paper explores how prevailing understandings of human nature are written into seemingly universal and timeless codes of ethics.     

Promoting Clinical Knowledge,Skills, and Empathy via a Creative Self-Suicide Assignment

Abstract

Suicide is a leading cause of American deaths. Given suicide's overall frequency and negative effects, specialized suicide training is warranted. This article describes a creative self-suicide assignment designed to enhance doctoral students? suicide assessment and intervention knowledge and clinical skills, and promote greater counselor empathy for clients presenting with suicidal ideation. Doctoral students who participated in the assignment reported increased suicide assessment and intervention knowledge and skills, and enhanced empathy toward clients presenting with suicide-related issues. Student summarizations related to their assignment experiences are included.     

Financial and Ethical Considerations for Professionals in Psychology

The profession of psychology is one of many entities affected by the current economic recession. The question of what to do when clients cannot pay agreed-upon charges will need to be answered. Ethical issues related to setting the fee for psychotherapy, insurance coverage, abandonment, pro bono psychotherapy, and lack of resources are addressed in light of the 2002 American Psychological Association's Ethical Principles of Psychologists and Code of Conduct and other relevant literature. The impact of the Mental Health Parity Act on the financial complexities that professionals in psychology now face is also discussed. Several recommendations are made for psychologists, calling them to be proactive in their communities, to be advocates for their clients, and to critically evaluate their financial practices.     

When Expertise and Ethics Diverge: Lay and Professional Evaluation of Psychotherapists in Israel

This study investigated school psychology doctoral students' beliefs concerning their preparation for, and concern about, dealing with 12 ethical issues based on year in graduate school and whether they had taken an ethics course. Two hundred thirty-three doctoral students from 18 of the 44 American Psychological Association accredited programs in school psychology listed in the December 1996 issue of the American Psychologist completed ethical issues surveys. Results showed that students who had taken an ethics course and those with more years of graduate education said they felt more prepared to deal with ethical issues than students who had not taken an ethics course and who had fewer years of graduate education. Participants believed they were least prepared to deal with ethical issues involving child custody cases, possible ethical violations by colleagues, and potentially violent clients. Participants' concern about dealing with ethical issues was negatively related to their number of internship hours.     

Medical Center Politics and Decisions: A Discussion

Presented as part of a symposium at the 1996 American Psychological Association Convention in Toronto, Canada, this paper reflects an historical overview of the political issues faced by psychologists in academic medical centers. Ivan Mensh, Ph.D., senior psychologist and founding member of the Association of Medical School Psychologists, suggests that those psychologists involved in medical education should learn who the decision makers are and how decisions are made at academic medical centers in order better to assure the continued viability of psychology in those settings.     

Advertised Australian counselling psychologists: A descriptive survey of their practice details and self perceived competence in six counselling psychology practice areas

This survey research in a field setting aimed to describe psychologists who advertised themselves in the Australian Yellow Pages as counsellors, thus providing a snapshot of advertised counselling psychologists in Australia. Data was collected using a multiple mailing survey method and resulted in a 62.2% return rate. The psychologists’ (a) demographic characteristics, (b) training and development, (c) provision of services, (d) professional involvement, and (e) their self perceived competence in working with (i) depression, (ii) anxiety, (iii) substance use, (iv) clients from non English speaking backgrounds and Indigenous and Torres Strait Islander individuals, (v) clients who are same sex attracted (gay, lesbian, and bisexual individuals), and (vi) clients using electronic mail and instant messaging were assessed. Advertised Australian counselling psychologists tend to be female, mature and Caucasian. The majority of the psychologists surveyed live in urban areas. Master and Bachelor level degrees were most often reported, a minority held doctoral degrees. The average psychologist charged $96.32 per hour, less than the Australian Psychological Society (APS) recommended fee for an hour of service. Eclectic and cognitive behaviour therapy were indicated most often as the theoretical orientations guiding psychological work. Psychologists belonged almost exclusively to the Australian Psychological Society as a professional association. Surprisingly, 2.9% of psychologists indicate not following an ethical code in their work and 3.9% failed to ensure that their work was covered by professional indemnity insurance. Advertised psychologists are thus described and suggestions are given for the further development of the profession. Regarding their self perceived competence, Australian advertised psychologists present as having self perceived strengths and areas of weakness regarding their counselling competence. This indicates that they are aware of their varying ability to work with various issues and populations. The self perceived competence of Australian psychologists in six specific counselling practice areas and suggestions for future training and development are provided.     

Studying suicide with psychological autopsy: social and cultural feasibilities of the methodology in China

As China opens its door to the world, suicide research is making rapid progress using methods and instruments developed in the West. This is a feasibility study of the psychological autopsy methodology applied in China, with its emphasis on the social and cultural environments. With samples of 66 completed suicides and 66 community normal living controls, the authors found that it is feasible to interview at least two informants for each suicide case and each control, between 2 and 6 months after the suicide. With the Chinese-cultivated contacting method of recruiting cases, the refusal rate is nearly zero. The Western-developed methodology per se proved to be valid in the Chinese culture. Ethical considerations in the context of Chinese culture are as important as in the West. Psychological autopsy technique is shown to be an equally applicable method for the study of completed suicides in Chinese culture as it is in the West. Future epidemiological research on Chinese suicide should use the psychological autopsy method to collect data from larger samples in order to increase our understanding of the risk factors for Chinese suicides.     

Politics, operant conditioning, Galileo, and the American Psychological Association's response to Rind et al. (1998)

The controversy surrounding B. Rind, P. Tromovitch, and R. Bauserman (1998) provides valuable lessons into scientific independence, politics, and organizational decision making. In an unprecedented action, the U.S. Congress officially condemned findings of Rind et al. Meanwhile, the American Psychological Association took similarly unprecedented measures in an effort to assuage its Congressional critics. This article, written from the perspective of a psychologist serving in Congress, discusses the various political and organizational dynamics that developed during the controversy. Understanding and learning from this incident can help psychologists and their professional associations better prepare for and respond to potential controversies arising from research or other publications.     

The ethics of interrogation and the American Psychological Association: A critique of policy and process

The Psychological Ethics and National Security (PENS) task force was assembled by the American Psychological Association (APA) to guide policy on the role of psychologists in interrogations at foreign detention centers for the purpose of U.S. national security. The task force met briefly in 2005, and its report was quickly accepted by the APA Board of Directors and deemed consistent with the APA Ethics Code by the APA Ethics Committee. This rapid acceptance was unusual for a number of reasons but primarily because of the APA's long-standing tradition of taking great care in developing ethical policies that protected anyone who might be impacted by the work of psychologists. Many psychological and non-governmental organizations (NGOs), as well as reputable journalists, believed the risk of harm associated with psychologist participation in interrogations at these detention centers was not adequately addressed by the report. The present critique analyzes the assumptions of the PENS report and its interpretations of the APA Ethics Code. We demonstrate that it presents only one (and not particularly representative) side of a complex set of ethical issues. We conclude with a discussion of more appropriate psychological contributions to national security and world peace that better respect and preserve human rights.     

The Big Ten Student Suicide Study: A 10-Year Study of Suicides on Midwestern University Campuses

The Big Ten Student Suicide Study was undertaken from 1980–1990 to determine the suicide rates on Big Ten University campuses. The study design attempted to address many of the statistical and epidemiological flaws identified in previous studies of campus student suicides. The 10-year study collected demographic and correlational data on 261 suicides of registered students at 12 midwestern campuses. The largest number of suicides for both males and females were in the 20–24-year-old age group (46%), and amongst graduate students (32%). The overall student suicide rate of 7.5/100,000 is one half of the computed national suicide rate (15.0/100,000) for a matched sample by age, gender, and race. Despite the overall lower suicide rate, the analyses revealed that students 25 and over have a significantly higher risk than younger students. Although women have rates roughly half those of men throughout their undergraduate years, graduate women have rates not significantly different from their male counterparts (graduate women 9.1/100,000 and graduate men 11.6/100,000).     

A thematic comparison of suicide notes drawn from Northern Ireland and the United States

Suicide is a global concern hence cross-cultural research ought to be central to national suicide prevention strategies. This study sought to investigate suicide notes drawn from Northern Ireland and the United States as these countries have broadly similar suicide rates but markedly different cultures. A theoretical-conceptual analysis of sixty suicide notes drawn from these countries, matched for age and sex, was undertaken based on a thematic model of suicide developed by Leenaars (1996) across countries. The results suggested that there were more psychological commonalities than differences. Two differences emerged which suggested that aspects of the interpersonal components may be more salient in Northern Irish rather than American suicides. It is argued that more wide-ranging cross-cultural studies are required to enhance our ability to identify and predict those most at risk from suicide.     

Treatment of Deaf Clients: Ethical Considerations for Professionals in Psychology

Providing therapy to deaf clients raises important ethical considerations for psychologists related to competence; multiple relationships and boundary issues; confidentiality; assessment, diagnosis, and evaluation; and communication and using interpreters. In evaluating and addressing these, psychologists must consider the American Psychological Association’s Ethics Code and other relevant issues (e.g., Americans with Disabilities Act) necessary to provide ethical treatment. The current article provides background, ethical considerations, principles and standards relevant to the treatment of deaf clients, and recommendations to support psychologists, training programs, and the field. Psychologists have the responsibility to guarantee that the benefits of mental health treatment are fairly and justly provided to this traditionally underserved population.     

A thematic comparison of suicide notes drawn from Northern Ireland and the United States

Suicide is a global concern hence cross-cultural research ought to be central to national suicide prevention strategies. This study sought to investigate suicide notes drawn from Northern Ireland and the United States as these countries have broadly similar suicide rates but markedly different cultures. A theoretical-conceptual analysis of sixty suicide notes drawn from these countries, matched for age and sex, was undertaken based on a thematic model of suicide developed by Leenaars (1996) across countries. The results suggested that there were more psychological commonalities than differences. Two differences emerged which suggested that aspects of the interpersonal components may be more salient in Northern Irish rather than American suicides. It is argued that more wide-ranging cross-cultural studies are required to enhance our ability to identify and predict those most at risk from suicide.